S. Jay Kumar

Macrodactyly of the foot.

Background: The purpose of this study was to focus on the problems associated with macrodactyly of the foot and to formulate guidelines for optimum treatment. Methods: Seventeen feet (fifteen patients) with macrodactyly formed the basis of this retrospective review. The feet were classified into one of two groups, depending on whether the macrodactyly involved only the lesser toes (group A) or involved the great toe with or without involvement of the lesser toes (group B). Toe amputation or ray resection was usually done to reduce the length and width of the foot in group A, whereas the length of the first ray was reduced by epiphysiodesis or amputation of the phalanx in four of the five feet in group B. In both groups, soft-tissue debulking was an integral part of the treatment. The severity of the macrodactyly and the effect of treatment were documented radiographically by measurement of the so-called metatarsal spread angle. At the latest follow-up evaluation, each foot was graded with regard to pain and shoe wear. Results: Toe amputation was performed in six of the twelve feet in group A and toe shortening was performed in two, but only three of those procedures had a good result. Ray resection was performed in five feet (as an initial or secondary procedure) in Group A, and all had a good result. The mean reduction of the metatarsal spread angle was 10.0° following resection of a single ray in Group A. In Group B, four of the five feet were rated as having only a fair result because shortening alone did not effectively reduce the size of the great toe. The macrodactyly of the great toe was not treated in the fifth foot, which also had a fair result. Conclusions: Toe amputation, which is cosmetically unappealing, is not effective for treating macrodactyly of the lesser toes and does not address the enlargement of the forefoot. Ray resection results in the best cosmetic and functional outcomes in feet with involvement of the lesser toes. When the great toe is involved, the result is often only fair, and repeated soft-tissue debulking may be necessary.

Vertebral Body Shape as a Predictor of Spinal Deformity in Osteogenesis Imperfecta

We analyzed forty-four patients who had osteogenesis imperfecta, in order to determine the prevalence of spinal deformities. At the time of the most recent follow-up, scoliosis was present in thirty patients (68 per cent) and kyphosis, in eighteen (41 per cent). According to the classification system of Falvo et al., scoliosis progressed rapidly with growth in twelve of fifteen patients who had the congenita type of osteogenesis imperfecta and in four of thirteen who had the tarda-I type. Curves that progressed before puberty did not always continue to progress after cessation of growth. Lateral roentgenograms made at the initial examination revealed four types of vertebral body deformities: biconcave, flattened, wedged, and unclassifiable vertebrae. Biconcave vertebrae were seen characteristically in patients who had the congenita type of osteogenesis imperfecta. The presence of six biconcave vertebrae or more before puberty indicated that severe scoliosis (more than 50 degrees) was likely to develop. Biconcave vertebrae did not appear to affect the severity of kyphosis. The other types of vertebral deformities were not useful for predicting progression of spinal deformity.

CONGENITAL CLUBFOOT. FUNDAMENTALS OF TREATMENT. Ignacio V. Ponseti. New York, Oxford University Press, 1996.

This fascinating little book emphasizes the importance of a more temperate operative approach to the treatment of congenital clubfoot in children and stresses the importance of manipulation, stretching, and the use of casts. In the preface, the author states: “Our treatment, supported by limited operative interventions and based on a clear understanding of the functional anatomy of the foot, has yielded optimum results in …

125.00, 140 pp.

This book is divided into seven sections. The first section, the introduction, includes two chapters that are written in English and five that are written in Spanish. The second section, on calcaneovalgus deformity of the foot, includes one chapter in English and two …