USING CALCULATIONS IN THE RECONSTRUCTIVE SURGERY OF STATIC FOREFOOT DEFORMITY (case report)

Introduction. Studying the matters of surgically treating various forefoot static deformities and their poor outcomes revealed the shortcomings of correction methods using metatarsal osteotomies, one of which is the lack of preoperative calculations of the necessary reconstruction. The aim is to demonstrate how to use calculations necessary for the forefoot reconstruction, exemplified by treating a female patient with a combination of the first- and second-toe deformities. Materials and Methods. A clinical case is presented demonstrating the successful application of a new surgical technique to correct the second hammer toe combined with hallux valgus, including the exact calculations of the required values of shortening the metatarsal bone and of laterally displacing its head towards the toe deviation. Results and Discussion. In a 63-year-old female patient, based on clinical and X-ray examinations, a mobile hammer toe deformity was determined, accompanied by a lateral toe deviation in the metatarsophalangeal joint and metatarsalgia under the head of the second metatarsal bone, and a deformity of the first toe, i.e., hallux valgus. Surgery was recommended and performed. To correct the first toe deformation, the proprietary technology was successfully used. Correction of the second toe deformation included preoperative calculations of the values required for shortening the second metatarsal bone and displacing its head, marking two parallel lines at a distance of the shortening calculated, and performing osteotomies of the second metatarsal at different angles with the removal of a free bone fragment, comparison of distal and proximal fragments, lateral displacement of the metatarsal head, and screw fixation. Using accurate preliminary calculations that allow reducing the metatarsal bone length by the required value and laterally shifting its head towards the toe deflection in the metatarsophalangeal joint ensures the correction of the second hammer toe and the release of the toe flexion position in the proximal interphalangeal joint, the toe extensor position and external deviation in the metatarsophalangeal joint, and the amelioration of metatarsalgia. Conclusions. Using a new surgical technique for the treatment of the second hammer toe, including calculations and the performance of two osteotomies along the marked lines, allows achieving a good result and a normal ratio of metatarsal lengths, optimally redistributing the loads on the metatarsal heads, eliminating forefoot pain and metatarsalgia manifestations, and preventing from the development of transitional metatarsalgia and deformation recurrence.