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Distale plantarisierende Osteotomie des Os metatarsale I zur Behandlung des Hallux limitus bei Metatarsus primus elevatus

Distal osteotomy of the first metatarsal bone with plantarization for the treatment of hallux limitus due to metatarsus primus elevatus

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Zusammenfassung

Operationsziel

Gelenkerhaltender Eingriff zur Plantarisierung des 1. Strahls und Verbesserung des Bewegungsumfangs des Großzehengrundgelenkes.

Indikationen

Geringe bis moderate degenerative Veränderungen des Großzehengrundgelenkes mit Schmerzen und dorsalem Schuhkonflikt bei Elevationsstellung des 1. Strahls und Versagen der konservativen Therapie.

Kontraindikationen

Fortgeschrittene degenerative Veränderungen des Großzehengrundgelenkes mit ausgeprägter Bewegungseinschränkung präoperativ. Allgemeine Kontraindikationen gegen eine operative Versorgung/Anästhesie.

Operationstechnik

Dorsomedialer Zugang zum Großzehengrundgelenk, milde Cheilotomie MTP-1-Gelenk und Arthrolyse, V‑förmige Osteotomie des Metatarsale 1 von dorsal mit Plantarisierung des Köpfchens, Schraubenfixation von proximal dorsal nach distal plantar.

Weiterbehandlung

Vollbelastung im Verbandsschuh für 6 Wochen.

Ergebnisse

Alle Patienten zeigten eine Verbesserung der präoperativ auf 35 Grad eingeschränkten Beweglichkeit auf 50 Grad Dorsalextension nach 6 Monaten. In 80 % der Fälle kam es zu einer deutlichen Verbesserung des Bewegungsschmerzes (VAS 6–7 auf VAS 2–3).

Abstract

Objective

Joint-preserving procedure with plantarization of the 1st metatarsal and improvement of range of motion.

Indications

Mild and moderate arthrosis of the 1st metatarsophalangeal joint with pain and shoe discomfort due to elevation of 1st ray and failed conservative treatment.

Contraindications

Severe degenerative conditions 1st metatarsophalangeal joint with significant loss of range of motion preoperatively. General contraindications for surgical treatment/anesthesia.

Surgical technique

Dorsomedial approach to 1st metatarsophalangeal joint, mild cheilectomy and arthrolysis, v‑shaped osteotomy of metatarsal 1 from dorsal with plantarization of the metatarsal head, screw fixation from proximal dorsal to distal plantar.

Postoperative management

Full weightbearing in rocker bottom shoe for 6 weeks.

Results

Improvement of range of motion from 35° dorsal extension to 50° in all cases after 6 months. Reduction of painful movement from VAS 6–7 to VAS 2–3 in 80% of patients.

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Author information

Authors and Affiliations

  1. Zentrum für Fuß- und Sprunggelenkchirurgie, Schön Klinik München Harlaching, Harlachinger Str. 51, 81547, München, Deutschland

    Carla Weber

  2. orthoprofis Hannover, Hannover, Deutschland

    Hazibullah Waizy

Authors
  1. Carla Weber
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  2. Hazibullah Waizy
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Corresponding author

Correspondence to Carla Weber.

Ethics declarations

Interessenkonflikt

C. Weber und H. Waizy geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Redaktion

Stefan Rammelt, Dresden

Zeichnungen

Rüdiger Himmelhan, Mannheim

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Weber, C., Waizy, H. Distale plantarisierende Osteotomie des Os metatarsale I zur Behandlung des Hallux limitus bei Metatarsus primus elevatus. Oper Orthop Traumatol 33, 487–494 (2021). https://doi.org/10.1007/s00064-021-00744-5

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  • DOI: https://doi.org/10.1007/s00064-021-00744-5

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