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This seems like the thread to post this. This is popping up on Facebook.
The 2nd and 3rd TMTJ were NOT needed for the purposes of correction. Am I wrong? (I know, I know - the whole thing wasn't needed - do it with cheaper screws, plates, don't dorsiflex it etc). I literally put those pictures up side by side on top of each other and clicked back and forth between them. The only thing changing is the 1st ray and the hallux. The 2nd and 3rd didn't lateralize to any significant degree....
I think the one you posted is the only one of the three they advertised that is a decent repair.
The
other two Treazze posted had even less met adductus, and the postop pics for mid and left pts risked hallux varus over time for sure (as well as nonunion, neuritis, pain, edema, recur HAV, and everything else these always risk). They are insane for trying to post those as nice repairs. Maybe they have taken those down? Dunno.
None of their 3 had anywhere near the adductus level of central rays compared to this thread
orig post one I did (early
post-ops middle first page). With that one, there's absolutely no possible way to get a decent IM correction without lesser ray work or no way to avoid rebound hallux varus/valgus with MPJ release and not fusion (imo). These are good convos... to take a break from a 16th pod school soon opening and tuition debts being 550k avg and DPM board pass rate and incomes mysteriously still not high.
For the one you posted (first and only good result of the 3 Trease advertises), it's
debatable if they needed the 2nd and 3rd fusions since there was not a ton of adductus. I agree with above ideas. You def could have slammed the 1-2 IM to basically zero, effective IM stays at 10-15, but foot fits much better in the shoe. That would avoid a
lot of midfoot pain, work, hardware devasc, potential neuritis, etc... so that's usually what I do unless met adductus is truly massive. The edema potential is just huge on these cases.
I think less is better in most cases, but it probably depends on midfoot ROM and pains pre-op. For mine, she was NWB a month, WB in boot for a month, and then she could have gone to wide tennis shoes (as most of my first ray fusions do).... but she stayed in velcro post-op shoe and comp stocking the whole 3rd and half the 4th month due to edema (and that's even with 2+ 3 met osteotomies and not fusions). She is about 6mo post now and into wide tennis shoes without callus but also not using any insoles (accommodative advised), and she might do the other foot and any HWR on this one foot year. On to WB XRs since I'd posted on pg 1... this is the 5mo view.
...Either way, definitely not easy cases. There are no perfect results in terms of foot function or shoe fit or pain or edema. I would say first (not 2nd or 3rd) Trease case worked out ok as long as it all fuses and no hallux varus/valgus recur. There will almost certainly be HWR with 4 plates, but you can say same of mine at either MPJ or MCJ (fewer plates but thicker). The main difference is the cost... probably $10k+ for more thin titanium weaker plates for vs probably under 2-3k for Synthes stronger steel.
Fwiw, if you catch massive adductus/bunion in kids, you can sometimes do a lateral closing cuboid and medial opening cunieform wedge in elementary age and then a Lapidus later in high school age.
