What's New in Foot and Ankle Surgery
Gregory P. Guyton, MD; Mark S. Mizel, MD

The purpose of this review is to update the reader on current topics of interest in the foot and ankle community. It provides a brief overview of the material presented at the recent meetings of the American Orthopaedic Foot and Ankle Society (AOFAS) and the American Academy of Orthopaedic Surgeons (AAOS). Selected articles published in Foot and Ankle International and other journals since the last update are discussed as well. Some of the studies discussed last year have now passed the peer-review process and are emphasized again. Progress across the field continues to be stepwise and evolutionary; it is not surprising that the primary topics of interest have changed little over the last year.

Forefoot Disorders

The distal chevron osteotomy, the proximal metatarsal osteotomy, and the Lapidus procedure are appropriately regarded as mainstays in the treatment of adult hallux valgus. Much debate continues over the precise indications for each of the three procedures.

Glasoe and colleagues introduced doubt into one critical decision-making step by examining the reliability of manual testing for first metatarsocuneiform instability 1. They compared subjective clinical findings, as reported by a group of trained examiners, with measurements obtained with use of a previously validated mechanical apparatus in a series of fifteen subjects. The correlation between the instrumented measurements and the clinical assessment was poor (r = 0.21), calling into question the utility of the clinical assessment of first metatarsocuneiform instability when one is deciding whether or not to perform a proximal metatarsal osteotomy or a Lapidus procedure.

To address another recurring question related to hallux valgus surgery, Thordarson and Krewer examined whether true osseous hypertrophy occurs at the medial eminence when a bunion develops 2. They found no significant difference between a group of patients with hallux valgus and an age-matched control group without the disease with …


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