X-ref For other Roundups in this issue that cross-reference with Foot & Ankle see: Children’s Orthopaedics Roundup 2, 7; Trauma Roundup 8.
Improving safety in the medial calcaneal osteotomy
The medial displacement calcaneal osteotomy is a workhorse for a range of hindfoot pathologies, including tibialis posterior insufficiency. The osteotomy is effected usually from the lateral side and as such, the medial neurovascular structures cannot be identified and protected. There isn’t a universally-agreed ‘safe zone’ for effecting the osteotomy and surgeons potentially risk iatrogenic injury. A cadaveric study of 40 feet reported by researchers in Baltimore (USA) aims to improve on safety by identifying a radiographic ‘safe zone’ to perform the osteotomy.1 In the first part of their study they dissected the medial neurovascular structures, marked with radiopaque wire and took a true lateral radiograph providing visualisation of these structures. The landmark of a line from the origin of the plantar fascia to the apex of the calcaneal tuberosity was used. Whilst the investigators established that a ‘safe zone’ as such does not really exist, with iatrogenic nerve injuries seen after osteotomy even within their ‘safe zone’, they were able to describe the best position for minimising risk to the neural structures. This information is useful as an intraoperative guideline to minimise neural complications. They established that an osteotomy placed 11 mm anterior to their ‘landmark’ line was in all likelihood the safest position to minimise neurological injury. However, they do make the valid point that iatrogenic nerve injury with this procedure may be more common than we think.
Operative treatment of Freiberg disease X-ref
Freiberg disease (idiopathic osteonecrosis of the head of the second metatarsal) is a relatively common condition which for the most part is treated conservatively. There are however some severe or refractory cases in which operative intervention can be considered. Like many conditions in which just a small …