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85 y/o post cva,MI, and pvd patient with with no ehl activity , severe fhl contracture.
would fhl tenotomy be appropriate or would medial column collapse occur due to loss of fhl strut?
85 y/o post cva,MI, and pvd patient with with no ehl activity , severe fhl contracture.
would fhl tenotomy be appropriate or would medial column collapse occur due to loss of fhl strut?
Hi "bunion":
First, let's consider the patients age. At 85 and post stroke, I would assume you may not want to put the patient through the prolonged post-op routine that would be required for a successful IP fusion. Also, at 85, and post CVA, I'm sure there is some concomitant osteoporosis which would contraindicate a fusion.
Is the contraction reducible?
It would be somewhat unusual to have an isolated FHL contraction with paresis of the EHL. If this is the case the MTPJ would not be dorsally contracted. Is this the clinical picture you see?
If you do have an isolated, reducible FHL contraction then a simple "z" lengthening would help. You would need to assess the FHB as well. A tenotomy at the level of the IPJ would straighten the toe (again, if it's reducible and no other soft tissue or bony contractions exist)
You may also want to isolate exactly where the pain is and why it is painful. Pressure, irritation. unopposed spasm, joint pain, etc.... and go on from there.
Hope this helps
DrSArbes
patient is not a candidate for hipj fusion. . Patient has long 2nd ray so would also like to avoid keller arthroplasty.Deformity is reduced when plantarflexory force is applied to proximal hallux ceating some slack in fhl . Patient complaint is pain
with history of tissue break down distal aspect hallux. Skin lesion is healed which is good idicator of healing potential for low impact surgery .Tube foam /recovery poron provides some relief. Thinking that tenotomy would have the least amount of vascular insult. Follow up with orthotic to provide medial support.? thanks
Well, it's difficult to advise. It still sounds to me as though it's a contracted EHL and not the flexor, but again, I have not seen the patient. If his pain is limited to the distal hallux from irritation, it is reducible and you're set on surgery, and tenotomy or lengthening seems like the logical procedure choice.
Good luck
DrSArbes
hallux malleus
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