The distal chevron metatarsal osteotomy has become a mainstay in the treatment of mild to moderate hallux valgus [usually with intermetatarsal (IM) angles <= 15 degrees]. Patients with wider IM angles >= 15 degrees have required more proximal osteotomies or shaft osteotomies to allow for greater degrees of correction of metatarsus primus varus. The use of the distal chevron osteotomy for IM angles > 15 degrees has been limited by the required degree of translation of the capital fragment rendering fixation more difficult and the stability of the osteotomy tenuous. The use of an intramedullary plate (ISO Plate, Tornier/OrthoHelix) fixed to both the capital fragment and the metatarsal shaft provides a means to allow up to 50% translation of the capital fragment, permitting early weight-bearing and reliable maintenance of correction. Improvement in sesamoid position and the ability to correct the distal metatarsal articular angle are the unique features of this technique. This article aims to describe a novel surgical technique using an intramedullary plate for fixation of the distal first metatarsal chevron osteotomy.

Platelet-rich plasma (PRP) has generated a significant amount of interest from both the medical community and the mainstream media because of its potential to aid in the healing process. Concentration of growth factors has been shown in animal models to enhance the rate and quality of healing, particularly for tendinopathy. Despite the increase in the use of PRP over the past 10 years, there is much to be learned with respect to where, when, why, and how it can best be used. The technique of procuring PRP and its delivery for the treatment of proximal plantar fascia is presented.

Calcaneal osteotomy remains the single most powerful means of correcting varus or valgus deformities of the hindfoot. The degree of correction is proportional to the ability of the osteotomy to close or open in the frontal plane when one uses a Dwyer technique that leaves the far cortex intact. Sliding osteotomies allow for a greater degree of axial correction while permit some additional varus or valgus realignment. Triple-step cut osteotomy affords the greatest degree of correction for both varus and valgus hindfoot conditions. Malerba developed the Z osteotomy for varus hindfoot anomalies, and Weil developed a calcaneal scarf technique for valgus anomalies, combining a medial displacement of the calcaneal tuberosity and lateral column lengthening via one extensile approach. Both techniques have proven to be effective, with rapid healing through broad cancellous surface contact. Fixation options are many, and in the case of the calcaneal scarf technique, one has the ability to correct deformities in the axial, transverse, and coronal planes with the use of wedge-shaped grafts of the tricortical bone or composite materials.

Summary: Primary as well as revision arthrodesis procedures of the ankle are associated with a high rate of complications including nonunion, malunion, infection, wound healing problems, damage to nerves and blood vessels, and gait disturbance secondary to malposition, all of which have prompted the development of various techniques to avoid or minimize said complications. In addition to those dilemmas are other complex scenarios such as failed total ankle arthroplasty and paralytic or neuropathic deformities which can render a plethora of problems for the treating physician to deal with, including maintenance of length and alignment, and problems with prior incisions or soft tissue damage with a potential for delays in wound healing or complications with bony union

This revised and updated volume offers readers a selection of up-to-date information, designed to be of use to orthopaedic surgeons and physicians who must treat various foot and ankle problems in patients ranging in age from infancy to old age. Among the wide range of topics covered are: sports injuries, tumors, skin and nail disorders, the insensate foot, hallux valgus deformities in adolescents and adults, pedorthic devices, ankle arthroscopy, fractures and soft tissue injuries, neuromuscular diseases, and nerve problems. Chapters which have been added to this edition deal with amputation and with the cavus foot.