What are some conservative treatment options for Tailor’s bunion?
- debridement of lesions
- padding
- shoegear modifications
- NSAIDs
- physical therapy
- injections
- orthoses
what are some surgical treatment options for Tailor’s bunion?
- exostectomy
- arthroplasty
- osteotomies
what is an arthroplasty and when is it used?
last resort removal of the 5th met head. indicated in elderly patients or those who are sedentary since it is joint destructive and may cause retraction of the toe
what are some of the osteotomies done at the capital (head) of the metatarsal?
- Hohmann
- reverse wilson
- chevron
- mercado
describe the hohmann procedure.
(capital osteotomy) - transverse osteotomy of metatarsal neck
what are some drawbacks to hohmann procedure?
fixation is difficult bc it is a transverse osteotomy
what are some complications associated with hohmann procedure?
undercorrection, delayed or non-union, transfer lesions
describe the reverse wilson procedure.
(capital osteotomy) - an oblique osteotomy is made distal lateral to proximal medial.
describe the chevron osteotomy.
(capital osteotomy)- a V shaped cut made on the 5th met
*aka “mini-austin”
describe the mercado procedure.
(capital osteotomy)- distal closing wedge in subcapital bone with apex proximal-lateral
describe the fixation ability and technical ability for mercado procedure.
- increased technical difficulty to perform
- but fixation is easier
what complications are associated with mercado procedure?
hinge fx
fixation failure/retrieval
what is the name for the procedure that is done at the 5th metatarsal shaft?
Yancey
describe the yancey procedure.
(shaft osteotomy)- closing wedge at metatarsal shaft
what is the disadvtg of Yancey procedure?
NWB bc osteotomy is made in the shaft (which is not good healing bone)
what complications are associated with Yancey procedure?
fx
delayed healing
non-union
what is the procedure done at the base of the metatarsal?
Gerbert
describe the Gerbert procedure.
(basilar osteotomy)- closing wedge procedure done at the base of the met
which surgical procedures have post-op instructions that must be NWB?
Yancey (shaft osteotomy) and Gerbert (basilar osteotomy)
*all the capital osteotomies can be WB
If you have an increased lateral deviation angle (>8), which procedure would you elect do it?
capital procedures
if you have an increased IM angle btwn 4th and 5th mets, which procedure would you choose to do?
basilar procedure (Gerbert)
