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Abstract
Purpose
The purpose of this study is to evaluate the clinical and radiographic results of symptomatic bunionette treated with a diaphyseal oblique osteotomy.
Materials and Methods
We retrospectively reviewed 12 feet of nine patients diagnosed as symptomatic bunionette and treated with diaphyseal oblique osteotomy. All patients were female and the average age at the time of surgery was 48 years. We checked the foot standing anteroposterior, oblique, and lateral images pre- and post-operatively. We measured the fourth intermetatarsal angle and fifth metatarsophalangeal angle and evaluated the clinical results using the American Orthopaedic Foot and Ankle Society (AOFAS) lesser metatarsophalangeal-interphalangeal (MTP-IP) scale preoperatively and six months postoperatively.
Results
Of the nine patients, hallux valgus was combined with symptomatic bunionette in seven feet of five patients. In all of our cases, the average AOFAS lesser MTP-IP scale showed improvement after surgery. Painful callosity around the fifth metatarsophalangeal joint disappeared after surgery in all of our cases. The fourth intermetatarsal angle improved from 12.7o to 3.1o and the fifth metatarsophalangeal angle improved from 16.6o to 2.3o.
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Figure 1.
Surgical techniques of diaphyseal oblique osteotomy. (A) We performed a diaphyseal oblique osteotomy on the 5th metatarsal. The direction of the osteotomy was from the dorsal side of the proximal metatarsal to the plantar side of the distal metatarsal. (B) We corrected the location of the distal fragment under the C-arm fluoroscopy and inserted three 1.1 mm Kirschner wires (K-wires). (C) We removed one K-wire and inserted a 2.3 mm mini screw at the same position one by one. (D) Three mini screws were used for the fixation of the diaphyseal oblique osteotomy of the 5th metatarsal.
Figure 2.
A 52-year-old woman with painful plantar callosity under the 5th metatarsal head on the right side. (A) Initial both foot standing antero-posterior images show increased 4th intermetatarsal angle (13.6o) and the 5th metatarsophalangeal angle (17.6o) on the right side. (B) The bunionette deformity was corrected with diaphyseal oblique osteotomy and fixed with three screws. (C) Bony union was achieved and the correction of the bunionette deformity was well maintained 6 months postoperatively.
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