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is there anyone out there that can tell me why hohmann osteotomy is not a good procedure for a bunionectomy following a tibial sesamoidectomy in a cavus foot type? also what procedure if any that you would recomend.And why it is not used by that many doctors anymore? thank you any info would be great. www.legtat43@aol.com
This osteotomy as I understand it (I have never seen it performed in Australia over the last 10 years by Podiatric surgeons) is performed at the surgical neck of the first metatarsal, with a medial wedge of bone removed. I guess it is simular in concept to a Reverdin (which I have seen) but which is in the metatarsal head to reduce deviated joint cartilage associated with HAV. The osteotomy appears to me to be inherently unstable in design (a single straight cut through bone) compared to other procedures such as the Austin or chevron osteotomy (V osteotomy through bone), which make more sense in terms of stability. Also the Hohmann osteotomy is performed extra articularly, and it is often nessessary to inspect the metatsral head and address the lateral contracture, and hence release and balance of soft tissue structures in and immediately around the first MPJ. The literature cites that this procedure is also associated with a higher incidence of reoccurance of the HAV than other procedures and this may be becuase the soft tissue contrcture has not been balanced as well as the osteotomy. In short the chevron osteotomy makes more sense to me than does the Hohmann. Please correct me if I have misunderstood the Hohmann osteotomy as I have not seen it performed.
Is a Hohmann osteotomy is that a good procedure to do for a buionectomy followed by a Tibial Sesamoidectomy?
The Hohmann osteotomy is a first metatarsal neck procedure that is very infrequently used these days here in the States. I did a few in my surgical residency 22 years ago but haven't done any since. I don't know why a bunionectomy would be followed by a tibial sesamoidectomy?? However, a tibial sesamoidectomy may cause a bunionectomy procedure to be required some time after the tibial sesamoidectomy is performed. Your question really doesn't make any sense.
Enjoying sunny Melbourne!
__________________
Sincerely,
Kevin
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Kevin A. Kirby, DPM
Adjunct Associate Professor
Department of Applied Biomechanics
California School of Podiatric Medicine at Samuel Merritt College
A modified Hohmann method for hallux valgus and telescoping osteotomy for lesser toe deformities in patients with rheumatoid arthritis. Clin Rheumatol. 2006 Mar 18;
Quote:
To preserve the function of metatarsophalangeal joints and to ensure forefoot stability in patients with rheumatoid arthritis (RA), we performed a modified Hohmann method for hallux valgus (HV) and telescoping osteotomy of lesser toe deformities instead of fusion of HV or resection of all metatarsal heads. From October 1995 through March 2001, 47 RA patients (90 feet) with severe HV and forefoot deformities were examined. The indication for the procedure in all the patients was disabling foot pain secondary to intractable plantar callosities below the lesser metatarsal heads, painful HV deformities, and the severe deviation of the sesamoid complex diagnosed by the basis of X-ray images. The HV and intermetatarsal (M1M2 and M1M5) angles and sesamoid complex were measured on the preoperative and postoperative roentgenograms. According to the results of a questionnaire survey, the patients were divided into three groups using the visual analogue scale; group 1: satisfied, group 2: fair and or no pain, group 3: dissatisfied. HV and M1M2 angles significantly improved compared between pre- and postoperative or preoperative and the follow-up periods. Out of the 47 patients, 78.9% were satisfied with the results of the operation and 8.9% were dissatisfied. Of these patients, 12.2% reported fair results. There were several complications, such as painful callosity, which was recurrent in seven feet, and delayed wound healing was observed in two out of 90 feet. A modified Hohmann method and abductor hallucis correction are effective in relieving pain and ensuring the bony union of the great toe in spite of severe osteoporosis.
Question on Hohmann osteotomy
please answer?????????
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