Holiday, Allan D.

Implant removal and synovectomy were used to treat the failure of 14 first metatarsophalangeal joint implant arthroplasties. Revision surgery was performed at an average of 3.1 years after arthroplasty. Follow-up (average 4.9 years) was possible in 10 patients, and clinical results were excellent in seven patients, good in one patient, fair in one patient, and poor in one patient. No significant changes in alignment occurred, although a trend toward toe extension was noted. Dynamic force plate studies in these patients demonstrated less pressure under the first metatarsal head and greater loading under the lateral forefoot. The great toe had less contact time during gait in the involved feet than in the control feet.

Nineteen distal chevron metatarsal osteotomy operations were performed in 13 patients with painful bunionette. The average duration of follow-up was 7.1 years. Mean forefoot score improved from 35.8 points to 73.9 points out of a possible 75 points. Intermetatarsal 4–5 angle, metatarsophalangeal 5 angle, and forefoot width improved significantly. Overall results were considered good in 17 feet and fair in 2; there were no failures. Complications were transfer metatarsalgia (1 foot) and wound infection (1 foot). Distal chevron fifth metatarsal osteotomy is effective treatment for symptomatic bunionette.

The extraosseous and intraosseous vascular anatomy to the fifth metatarsal as visualized in a group of below-the- knee amputation specimens has been described. The extrinsic circulation to the area is provided by the dorsal metatarsal artery, the plantar metatarsal arteries, and the fibular plantar marginal artery. These three source arteries supply branches to the metatarsal and adjacent joints. The intraosseous vascularity consists of a periosteal plexus, a nutrient artery, and a system of metaphyseal and capital vessels.