Some patients following operation for Hallux Valgus deformity develop Transfer Metatarsalgia. Many believe that a long oblique osteotomy of the second metatarsal as part of surgical correction of Hallux Valgus deformity reduces the risk of developing transfer metatarsalgia.

Metatarsal Break Angle (MBA) is the angle subtended by one line from the centre of the head of First Metatarsal to the centre of the head of the Second Metatarsal and another from the centre of the head of the Second Metatarsal to the centre of the head of Fifth Metatarsal. The MBA changes following osteotomy of the Second metatarsal.

Is the Metatarsal Break Angle(MBA) altered in patients who undergo long oblique osteotomy of the second metatarsal?. Literature does not mention anything to this effect. We prospectively studied the course of this angle in patients who underwent osteotomy of the second metatarsal at the same time as they had surgical correction of their painful Hallux Valgus deformity.

Twenty-four consecutive patients (thirty-one feet), nineteen Female and five Male, in the age range of eighteen to seventy-one years successfully fulfilled the inclusion criteria. The inclusion criteria being - Hallux Valgus deformity with a dorsally subluxed second Meta-tarsaophalangeal joint(MTPJ) and presence of tenderness/hyperkeratotic plantar patch at the second MTPJ.

The postoperative range of increase in the angle was two to sixteen degrees in all except one patient (decreased by one degree). Median change was eight degree increase. This study concludes that the MBA is altered in patients who undergo long oblique osteotomy of the second metatarsal. This type of osteotomy done so as to provide the head of the second metatarsal a fresh plantar fat pad to rest upon does help to remove the tenderness over the second MTPJ.

To the best of our knowledge this change in MBA has not been mentioned in the medical literature and we believe that our study highlights this important geometrical change in the architecture of post-operative forefoot.

Introduction and Aims: To assess the efficacy of fibular osteotomy on the rate of arthrodesis at the tibiofibular syndesmosis in patients with Total Ankle Replacement (TAR).

Method: A prospective trial of fibular osteotomy was performed in 16 consecutive TAR (13F/3M), mean age 67 (41–82). All operations were performed by the same surgeon, as described by the inventor of the procedure, Dr. Frank Alvine, MD. After completion of the syndesmotic fusion, the fibula was exposed proximal to the proximal syndesmotic screw. An oblique osteotomy of the fibula was performed. Importantly, the angle of the cut was made such that the proximal fibula was trapped by the distal cut surface. The osteotomy was directed from medial distal to lateral proximal. All cases were followed until radiographic and clinical signs of healing were seen.

Results: Union occurred in all cases, with a mean time to fusion of seven weeks, with six patients achieving union within five weeks. No patient developed pain at the osteotomy site. All osteotomies showed signs of radiographic healing and none of these were symptomatic. There were no neuromas related to this procedure, and no patient experienced sensory changes along the nerve distribution. One patient developed symptomatic prominence of the screw on the medial malleolus and was asypmtomatic after implant removal.

Conclusion: The addition of a fibular osteotomy resulted in a 100% rate of syndesmosis fusion. We postulate that the osteotomy is successful because it removes the micromotion at the syndesmosis, which occurs with loading of the intact fibula. As the fibula only functions as a lateral strut in patients with an Agility total ankle, we felt that the osteotomy would cause minimal if any concerns. Our findings corroborate our hypothesis in that all the fusions were successful and none of the patients experienced secondary problems related to the osteotomy. We would recommend this technique as an adjunct to standard ankle replacement using the Agility system.

Aim We asked the following questions:

Are there reliable clinical signs that herald an impending disorganisation of the Lisfranc’s joint in a diabetic foot?

Does the Charcot changes begin at the Lisfranc’s joint?

Method Forty-five consecutive patients (63% male, 37% female) with a mean age of 59.9 years (range 38–80) were prospectively studied. All had either Type I/II diabetes (75% had Type II diabetes). Diagnosis of Char-cot foot was made using a standardised clinical protocol. Patients with a definite history of trauma/open injuries were excluded. All had a standard follow up programme. The mean follow up was 20 months (range 7–46).

Results In 75% of cases radiographs showed malalignment of the Lisfranc joint, 25% had navicular and 6% had fracture of the medial cuneiform. Thirteen per cent had fractures of the metatarsal and another 13% had fracture of the calcaneum. In all patients, Charcot changes were heralded buy a silent, red swollen foot and in few patients these features did exist in spite of no clear-cut radiological findings. As the Charcot changes progressed, more fractures were seen and in 80% of the patients we saw rapid disorganisation of the intertarsal joints of the midfoot. In 80% the earliest radiological change was seen at the Lisfranc’s region.

Conclusion and significance of this study The pattern of changes in the Charcot foot varies with the type of diabetes. Conventional radiography is reliable if there is a high degree of suspicion. Charcot changes often appear first at Lisfranc’s joint and usually there are no clear-cut signs in order to make a clinical diagnosis.