Six first metatarsal shaft osteotomies - Mechanical and immobilization comparisons

Because malunion (usually with dorsal elevation of the first metatarsal) ha s been reported after the treatment of severe hallux. valgus deformities by proximal osteotomies, the current study was designed to compare the sagitt al stability of six different metatarsal shaft osteotomies: the proximal cr escentic, proximal chevron, Mau, Scarf, Ludloff and biplanar closing wedge osteotomies. A plate was used in the biplanar closing wedge osteotomy; all others used screws for fixation. Ten fresh-frozen, human anatomic lower ext remity specimens were used for each osteotomy, Failure loads were measured as units of force (newtons) and converted to pressure (kilopascals), Then t he F-Scan system, which uses a thin insole to measure plantar pressure, was used to evaluate the pressure under the first-metatarsal of seven voluntee rs using four types of shoes. According to the results, in patients with no rmal bone stock who are compliant, any of the four shoe types tested may be used after a Ludloff, Scarf, biplanar wedge (plantar screw fixation), or M au osteotomy, but the wedge-based shoe should be used after a proximal cres centic or chevron osteotomy or for patients with severe osteopenic bone.