BACKGROUND: The purpose of this study was to report outcomes of congenital hallux varus deformity after surgical treatment. METHODS: We evaluated ten feet of eight patients with a congenital hallux varus deformity, including four feet combined with a longitudinal epiphyseal bracket (LEB). There were seven male patients and one female patient with a mean age of 33 months (range, 7 to 103 months) at the time of surgery. Two patients were bilaterally involved. The mean duration of follow-up was 5.9 years (range, 2.3 to 13.8 years). Clinical outcomes were assessed according to the criteria of Phelps and Grogan. Surgical procedures included the Farmer procedure, the McElvenny procedure or an osteotomy at the first metatarsal or proximal phalanx. RESULTS: The clinical results were excellent in two feet, good in six and poor in two feet. The LEB was associated with hallux varus in four feet and were treated by osteotomy alone or in conjunction with soft tissue procedure. CONCLUSIONS: Congenital hallux varus was successfully corrected by surgery with overall favorable outcome. Preoperatively, a LEB should be considered as a possible cause of the deformity in order to prevent recurrent or residual varus after surgery.
Child ; Child, Preschool ; Female ; Foot Deformities, Congenital/radiography/*surgery ; Hallux Varus/radiography/*surgery ; Humans ; Infant ; Male ; Osteotomy

BACKGROUND: Free fat graft has been used for the treatment of congenital hand differences. However, there have been a few reports about the outcome of that treatment. In this study, the outcome of free fat grafts for congenital hand and foot differences was investigated. METHODS: Fourteen bones with longitudinal epiphyseal bracket, 3 wrists with Madelung deformity, and 5 cases of osseous syndactyly were treated with free fat graft with osteotomy, physiolysis, or separation of osseous syndactyly. Of the fourteen bones with longitudinal epiphyseal bracket, 9 were treated with open wedge osteotomy with free fat graft and 5 with physiolysis and free fat graft. The Madelung deformity was treated with physiolysis with free fat graft. For osseous syndactyly, syndactyly release with free fat graft was performed five times on four hands. RESULTS: In the fourteen cases with longitudinal epiphyseal bracket, lateral deviation improved in all except two cases after surgery. The average lateral deviation angle changed from 32.5 degrees before surgery to 15.2 degrees after surgery. The average improvement of the lateral deviation angle was 12.2 degrees in the osteotomy group and 20.6 degrees in the physiolysis group. The mean ratio of improvement of the lateral deviation angle to the lateral deviation angle before surgery was 39.4% in the osteotomy group and 51.2% in the physiolysis group. The Madelung deformity improved after surgery in two cases but there was no improvement in one case. For these conditions, the results were not good enough when surgery was done after age 13 or at age four for severely hypoplastic brachymesophalangy. Of the 5 cases of osseous syndactyly, reunion of the separated bones occurred in one case. The grafted free fat should be deep enough to cover the osteotomy site of the bones to prevent reunion of the separated bones. CONCLUSIONS: Physiolysis and free fat graft performed during the growth period can correct the deviation due to longitudinal epiphyseal bracket and Madelung deformity. Free fat graft is also useful to prevent reunion of the bones after separation of osseous syndcatyly, if the grafted fat is securely filled into the space between the separated bones.
Adipose Tissue/*transplantation ; Adolescent ; Child ; Child, Preschool ; Female ; Fingers/*abnormalities/surgery ; Foot Deformities, Congenital/surgery ; Hallux Varus/surgery ; Hand Deformities, Congenital/*surgery ; Humans ; Male ; Osteotomy ; Statistics, Nonparametric ; Syndactyly/*surgery ; Treatment Outcome

BACKGROUND: Free fat graft has been used for the treatment of congenital hand differences. However, there have been a few reports about the outcome of that treatment. In this study, the outcome of free fat grafts for congenital hand and foot differences was investigated. METHODS: Fourteen bones with longitudinal epiphyseal bracket, 3 wrists with Madelung deformity, and 5 cases of osseous syndactyly were treated with free fat graft with osteotomy, physiolysis, or separation of osseous syndactyly. Of the fourteen bones with longitudinal epiphyseal bracket, 9 were treated with open wedge osteotomy with free fat graft and 5 with physiolysis and free fat graft. The Madelung deformity was treated with physiolysis with free fat graft. For osseous syndactyly, syndactyly release with free fat graft was performed five times on four hands. RESULTS: In the fourteen cases with longitudinal epiphyseal bracket, lateral deviation improved in all except two cases after surgery. The average lateral deviation angle changed from 32.5 degrees before surgery to 15.2 degrees after surgery. The average improvement of the lateral deviation angle was 12.2 degrees in the osteotomy group and 20.6 degrees in the physiolysis group. The mean ratio of improvement of the lateral deviation angle to the lateral deviation angle before surgery was 39.4% in the osteotomy group and 51.2% in the physiolysis group. The Madelung deformity improved after surgery in two cases but there was no improvement in one case. For these conditions, the results were not good enough when surgery was done after age 13 or at age four for severely hypoplastic brachymesophalangy. Of the 5 cases of osseous syndactyly, reunion of the separated bones occurred in one case. The grafted free fat should be deep enough to cover the osteotomy site of the bones to prevent reunion of the separated bones. CONCLUSIONS: Physiolysis and free fat graft performed during the growth period can correct the deviation due to longitudinal epiphyseal bracket and Madelung deformity. Free fat graft is also useful to prevent reunion of the bones after separation of osseous syndcatyly, if the grafted fat is securely filled into the space between the separated bones.
Adipose Tissue/*transplantation ; Adolescent ; Child ; Child, Preschool ; Female ; Fingers/*abnormalities/surgery ; Foot Deformities, Congenital/surgery ; Hallux Varus/surgery ; Hand Deformities, Congenital/*surgery ; Humans ; Male ; Osteotomy ; Statistics, Nonparametric ; Syndactyly/*surgery ; Treatment Outcome

OBJECTIVETo analyze the clinical characteristics of 73 cases of macrodactyly.

METHODSReview the incidence, distribution, characteristic, X-rays, pathogenesis and treatment of involved digits on the base of the clinical documents of 73 macrodactyly which were treated from 1965 to 2006. Twenty-eight cases had been followed-up.

RESULTSUnilateral involved 71 cases, bilateral involved 2 cases. In upper deformities, the most involved digit was the index finger, followed by thumb and middle finger enlargement. In lower deformities, the second toes were affected more. There were 12 cases of static macrodactyly, which were all presented at or soon after birth. Sixty-one cases were progressive macrodactyly: 39 cases presented at birth; 17 cases occurred at about 2 years old; 5 cases were found after age 2. Thirty-seven cases of progressive type presented digital deviation; 3 cases associated with syndactyly; 16 cases complicated with thenar eminence hypertrophy; 8 cases of multiple-digit involved combined with palm and forearm hyperplasia.

CONCLUSIONSMacrodactyly in hand has a preference for the median nerve territory, mainly involving index, thumb and middle finger. Pedal macrodactyly prefers medial plantar nerve territory, the second toe is the most commonly affected. The progressive macrodactyly is more common than static. It may present at birth and combine with syndactyly, digital deviation, thenar eminence hypertrophy, palm and forearm hyperplasia.

Adolescent ; Adult ; Aged ; Child ; Child, Preschool ; Female ; Fingers ; abnormalities ; Follow-Up Studies ; Foot Deformities, Congenital ; surgery ; Hand Deformities, Congenital ; surgery ; Humans ; Infant ; Male ; Middle Aged ; Retrospective Studies ; Toes ; abnormalities ; Treatment Outcome

OBJECTIVETo summarize the clinical characteristic and outcome of digital gigantism of the foot.

METHODSRetrospectively analyze the clinical documents of cases of digital gigantism of the foot. Twelve 12 cases with 13 feet in this study included 8 male and 4 female with an average 4.6-years-old. All the deformities were found at birth. Multiple toes involved were more than single toe, and tibial toe involved more than fibular. Forefoot was enlarged. All the phalanges involved and partial metatarsal bones were enlarged. Marked increase in subcutaneous fat was found in all cases in the operation which infiltrated interossei and articular capsules. The appearance of the nerves and its branches in the foot were normal and fat infiltrating was not discovered. The operation types included debulking, epiphyseal arrest, amputation, nerve stripping and anastomosis.

RESULTSSeven cases were followed up with mean periods 25.6 months. Functional evaluation according to a criterion formulated by author revealed a result of 2 excellent, 2 good and 3 fair.

CONCLUSIONSDigital gigantism of the foot is an uncommon congenital deformity of the foot characterized by overgrowth of both the soft-tissue and the osseous elements of the enlarged toe and forefoot. Surgical treatment is the unique method, and the goal is to reduce the size of the foot to allow fitting regular shoes and walking readily. There are several types of operations which to be chosen. The indication, the timing of operative intervention and the selection of operation type should be paid more attention.

Adolescent ; Adult ; Child ; Child, Preschool ; Female ; Follow-Up Studies ; Foot Deformities, Congenital ; surgery ; Forefoot, Human ; surgery ; Humans ; Infant ; Male ; Retrospective Studies ; Toes ; abnormalities ; Treatment Outcome

OBJECTIVETo explore the therapeutic effectiveness of vacuum sealing drainage (VSD) technique and mesh grafting in treating defects of skin and soft tissues in foot.

METHODSA retrospective analysis was done on 17 cases (11 male and 6 female) suffering from defects of skin and soft tissues in foot, which were treated by vacuum sealing drainage and mesh grafting. The age of patients was from 18 to 67 years with an average of 43 years. The wound surface was filled with polyvinyl alcohol gelatin sponge after debridement and continuous negative pressure drainage was taken for 24 h. After 7 days, granulation tissue growing mesh grafting was performed and to observe the skin colour, survival rate and feet function.

RESULTSAll the infection of wounds was controlled with VSD for 1 to 3 times. Skin survival rate of 14 cases more than 98%, 2 cases more than 95%; skin edge of 1 case had little necrosis, but foot function obtained rehabilitation after dress-changing.

CONCLUSIONVacuum sealing drainage (VSD) technique and mesh grafting is effective methods for the treatment of defects of skin and soft tissues in foot and is worthy generalization and application.

Adolescent ; Adult ; Aged ; Drainage ; Female ; Foot Deformities, Congenital ; physiopathology ; surgery ; Humans ; Male ; Middle Aged ; Reconstructive Surgical Procedures ; Retrospective Studies ; Skin Abnormalities ; physiopathology ; surgery ; Soft Tissue Injuries ; physiopathology ; surgery ; Treatment Outcome ; Vacuum ; Young Adult