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We have some difficulties about surgery tactic with patient who asked for help. .
Female, 62 y.o.
Complaints:
Forefoot deformity of the left foot
painful callus on the ventral surface of the distal phalanges of the 2nd toe which cause gait disturbances and difficulties with shoes.
Medical Hystory: From patient's words.....
She had a surgery for Hallux valgus and forefoot deformity
It was done 3 years ago at one of the local hospitals.
An inflamatory complication broke out (with osteomyelitis). After several revision surgery with bone necrectomy the wound healed. She can't provide us with any X-ray or documents from that period.
Status localis:
Abscense of the Mt1 and big toe on the left foot
Deformity (medial deviation) of the residual part of forefoot
Lateral deviation of 2nd, 3rd toes can be manually (partially) corected.
Hammertoe deformity of 2-3-4-5 toes at PIPj is fixed
There are calluses (non painfull) under the heads Mt2 and Mt3
Neurovascular status is normal.
There is a postoperative scar on the dorsal surface of the IV intermetatarsal space, and it seems to me that extensor tendon of IV th toe was cutted off during previous surgery. It doesn't work and It's absent (by palpation)
Another foot is normal, without any deformities (just a mild non-painful H. valgus)
What would be the best plan for her forefoot deformity?
We will appreciate any advice
_____________________________________________________
Yershov Dmitriy
Ukraine, Sytenko Institute of Spine and Joint Pathology
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