Lateral Wind Swept Toes Deformity

Generalities

In most cases, this deformity is combined with hallux valgus deformity as well as hammertoe. The wind-swept toes will remain even after correction of hallux valgus. Furthermore, the wind-swept toes are mostly combined with excessive length of the lesser metatarsals.

To assess the necessity of performing lesser rays specific surgery, we perform a check test, (passive hallux valgus correction) which in main cases shows that the wind-swept devia tion remains in spite of the great toe correction.

Surgical Treatment

MTP Release on the Lesser Rays Combined with Toe Surgery and Hallux Valgus Correction

We have performed tendon lengthening, MTP lateral release, PIP fusion or resection arthro-plasty. Except in very emerging or mild deformity, we were disappointed by the results: Ordinarily the valgus of the toe remains almost the same, or, in a case where we performed PIP resection arthroplasty, valgus occurs in the PIP joint.

Fig. 34a. Lateral wind-swept toes deformity - Generalities.

1. The valgus of the great toe increases the wind-swept toe deformity.

2. Check test: Active toes ground contact while the valgus of the great toe is maintained: If there is still a windswept deformity of the lesser toes, the soft tissue procedure should not be sufficient to the deformity correction.

3. The wind-swept deformity should be increased by the foot valgus and the lateral rotation of the forefoot -

but does not directly result from them.

Fig. 34a. Lateral wind-swept toes deformity - Generalities.

1. The valgus of the great toe increases the wind-swept toe deformity.

2. Check test: Active toes ground contact while the valgus of the great toe is maintained: If there is still a windswept deformity of the lesser toes, the soft tissue procedure should not be sufficient to the deformity correction.

3. The wind-swept deformity should be increased by the foot valgus and the lateral rotation of the forefoot -

but does not directly result from them.

Valgus Deformity Foot

Fig. 34b1. Lateral wind-swept toe correction - Only soft tissue procedure should be insufficient.

1. Soft tissue procedure: Additionally to extensor or flexor tendons lengthening, MTP lateral release.

2. Same foot before and after scarf osteotomy and soft tissue procedure. X-ray: In spite of good correction of the hallux valgus deformity, the wind-swept appearance of the toes remains.

3. Same foot: Clinical insufficiency of the correction.

4. Another case of undercorrection with soft tissue procedure. We note the medial deviation in the PIP joint.

5. Same remark in this case, in spite of MTP axial K-wiring and PIP resection arthroplasty.

Fig. 34b1. Lateral wind-swept toe correction - Only soft tissue procedure should be insufficient.

1. Soft tissue procedure: Additionally to extensor or flexor tendons lengthening, MTP lateral release.

2. Same foot before and after scarf osteotomy and soft tissue procedure. X-ray: In spite of good correction of the hallux valgus deformity, the wind-swept appearance of the toes remains.

3. Same foot: Clinical insufficiency of the correction.

4. Another case of undercorrection with soft tissue procedure. We note the medial deviation in the PIP joint.

5. Same remark in this case, in spite of MTP axial K-wiring and PIP resection arthroplasty.

Fig. 34b2. Weil osteotomy for lateral wind-swept toe deformity correction.

1. Principle. Lesser metatarsals: Above all, shortening, combined with a slight lateral shift of the metatarsal heads. 1st ray: Correction of hallux valgus deformity and harmonization of the metatarsal parabola (M1 = M2).

2. Operative view of the head displacement resulting from the Weil osteotomy.

3. Percutaneous section of the extensor tendons.

4. Green procedure for extensors tendons lengthening.

5. Assessment of remaining lateral deviation of the toes.

6. MTP lateral release for final correction of the lateral deviation.

7. Toe K-wiring as required, excluding the MTP joint.

8. Final check of the correction, with the Load Simulation Test.

Wiring Toes

Fig. 34b2. Weil osteotomy for lateral wind-swept toe deformity correction.

1. Principle. Lesser metatarsals: Above all, shortening, combined with a slight lateral shift of the metatarsal heads. 1st ray: Correction of hallux valgus deformity and harmonization of the metatarsal parabola (M1 = M2).

2. Operative view of the head displacement resulting from the Weil osteotomy.

3. Percutaneous section of the extensor tendons.

4. Green procedure for extensors tendons lengthening.

5. Assessment of remaining lateral deviation of the toes.

6. MTP lateral release for final correction of the lateral deviation.

7. Toe K-wiring as required, excluding the MTP joint.

8. Final check of the correction, with the Load Simulation Test.

Weil Lesser Metatarsal Osteotomy

The Weil osteotomy has two effects.

1) First the longitudinal MTP decompression provided by the proximal translation of the metatarsal head.

2) The lateral shift of the head, which works like the medial shift for medial toe deviation (overlapping second toe or medial wind-swept toes, J. B. Johnson).

Although the Weil osteotomy provides the correction once performed, this correction is not complete and needs K-wiring of the toe, lengthening of the extensor tendons and MTP lateral release. With this additional procedure, the Weil osteotomy provided good and reliable results in the wind-swept toes deformity correction.

Compared with soft tissue and toe surgery, the performance of the Weil osteotomy shows a clear advantage.

However, we observed that the proximal sli ding of the metatarsal head has to be generous to ensure complete and long-lasting correction. This metatarsal shortening is more effective than the lateral shift of the head in providing such good results.

Furthermore, in order to harmonize the meta-tarsal parabola, the lesser metatarsals shortening leads in some cases to shorten the first metatarsal. This is easy with the scarf osteotomy, which also provides the hallux valgus correction.

Hallux Valgus Scarf

Fig. 34c1. Weil osteotomy versus soft tissue surgery in lateral wind-swept toe deformity.

1. Clinical and radiological preoperative aspects. On the left foot, more advanced deformity: We decide to make Weil osteotomy only on this foot.

2. Clinical and radiological results: Same patient, on the left foot, better correction with Weil and scarf osteotomies, in spite of preoperative more advanced deformity on this side.

Fig. 34c1. Weil osteotomy versus soft tissue surgery in lateral wind-swept toe deformity.

1. Clinical and radiological preoperative aspects. On the left foot, more advanced deformity: We decide to make Weil osteotomy only on this foot.

2. Clinical and radiological results: Same patient, on the left foot, better correction with Weil and scarf osteotomies, in spite of preoperative more advanced deformity on this side.

Hallux Valgus Osteotomy

Fig. 34c2. Weil osteotomy for lateral wind-swept toe deformity - The reliable solution.

1, 2. Radiological and clinical results of wind-swept toe deformity correction by Weil osteotomy. The required shortening of the lesser metatarsals leads to also shorten the first metatarsal by scarf osteotomy. 3, 4, 5. In case where the wind-swept deformity does not affect the fifth metatarsal, the required shortening of the metatarsal head leads to also shorten the fifth metatarsal. Same case: Complete correction of the deformity.

Fig. 34c2. Weil osteotomy for lateral wind-swept toe deformity - The reliable solution.

1, 2. Radiological and clinical results of wind-swept toe deformity correction by Weil osteotomy. The required shortening of the lesser metatarsals leads to also shorten the first metatarsal by scarf osteotomy. 3, 4, 5. In case where the wind-swept deformity does not affect the fifth metatarsal, the required shortening of the metatarsal head leads to also shorten the fifth metatarsal. Same case: Complete correction of the deformity.

How To Reduce Acne Scarring

How To Reduce Acne Scarring

Acne is a name that is famous in its own right, but for all of the wrong reasons. Most teenagers know, and dread, the very word, as it so prevalently wrecks havoc on their faces throughout their adolescent years.

Get My Free Ebook


Post a comment