RESPONSES / COMMENTS (CLINICAL) ACTIVE - PART 2

10/31/2008     

RE: 4th Ray Resection or Transmet? (Jeffrey Kass, DPM)
From: Multiple Respondents

I would do the TMA as a primary procedure. However, Dr. Kass's patient already has a BKA; so as an alternative option, in addition to a TAL and a 4th met. head resection, I would also resect the 2nd and 3rd met. heads in an attempt to equalize the length pattern and hopefully prevent further tissue breakdown.

S. Jeffrey Siegel, DPM, Philadelphia, PA, Heeldoc1@aol,com

A trans met with Achilles tendon lengthening would probably be your best bet. The patient will function well in a shoe with filler. I would maintain the metatarsal parabola and bias my cuts from dorsal distal to plantar proximal as to minimize the potential for further ulceration.

Gerald Mauriello Jr., DPM, MA, Toms River NJ, mauriellodpm@gmail.com

Based upon Hx and clinical status, a proximal TMA, with well-contoured parabola and appropriate reduction of any distal osseous "spikes" would be my goal. The base of the 5th presumably has the peroneal insertion and medial soft tissue insertions are also assumed to be non-disrupted. TAL, immediate post-op bracing, rehabilitation and surveillance for contractures with Botox, and consideration for release residual deformity have been very positive for many of our patients in similar scenarios.

Alan Cantor, DPM, East Meadow, NY, ajcdpm@aol.com