SLR - August 2011 - Stacie D. Anderson
Reference: Masquijo JJ, et al. Symptomatic Bunionette Deformity in Adolescents: Surgical Treatment with Metatarsal Sliding Osteotomy. J Pediatr Orthop. 2010; 30:904-909.
Scientific Literature Review
Reviewed by: Stacie D. Anderson, DPM
Residency Program: OCPM/Richmond Heights; Cleveland, OH
Podiatric Relevance:
This article has obvious relevance to the podiatric profession as a relatively basic forefoot pathology and surgical intervention. It is somewhat unique in that pediatric patients with symptomatic 5th ray pathologies are evaluated.
Methods:
Eleven patients (thirteen feet) were evaluated between 2003 and 2008. The mean patient age was 14.8 years, and patients were followed for an average of 32 months following surgery. All patients were female and had failed a three month trial of conservative treatment.
Surgical technique involved an oblique shaft osteotomy of the 5th metatarsal and resection of the lateral prominence. The osteotomy was fixated utilizing either a 2.0 mm screw or two 0.062 k-wires. The patients were placed NWB in a BK cast for three weeks, and then placed in a WB cast until a radiographic union was seen at the osteotomy site.
Results:
Patients were evaluated through radiographs and according to the AOFAS scale. The mean post-operative AOFAS score was 91 points. Seven patients (eight feet) had excellent outcomes, and four patients (five feet) had good outcomes. The average 4-5 IM angle decreased from 12.29 degrees to 6.18 degrees, demonstrating a statistically significant decrease (p-value = 0.0001). Only one patient developed a superficial infection surrounding the k-wire site.
Conclusions:
Surgical correction of any deformity is not a common practice in the adolescent population, unless the deformity is severe. However, the sliding osteotomy for the bunionette deformity was shown to be a safe and effective procedure for patients under the age of eighteen. Conservative treatment should always be utilized before surgical treatment is discussed. The study did have a limited number of patients and had a minimum amount of conservative treatment (only three months). It seems to be an effective treatment for adolescents with painful bunionette deformity, as none of the patients reported a recurrence of pain or prominence to the fifth metatarsal.