PMC7403941_01
Time course of radiographs of the right foot. At 61 years old, X-ray shows that the hallux valgus angle (HVA) is 29 , the interphalangeal angle between the first and second metatarsals (M1M2A) is 9 , and the interphalangeal angle between the first and fifth metatarsals (M1M5A) is 30  (a; anteroposterior view) (b; oblique view). Just before surgery at 76 years old, HVA is 50 , M1M2A is 15 , and M1M5A is 35 , respectively (c; anteroposterior view) (d; oblique view). Mitchell's osteotomy for hallux and shortening oblique osteotomies for lesser toes were performed. Postoperative radiographs show that HVA is 19 , M1M2A is 7 , and M1M5A is 23 , respectively (e; anteroposterior view) (f; oblique view). Recent follow-up radiographs at 6 months after the surgery show that temporal Kirschner wires for lesser toes are removed and that each osteotomy site healed (g; anteroposterior view) (h; oblique view).
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fig1
At the age of 61 years, there was no observable dislocation of the MTP joints, with relevant radiographic measures of forefoot alignment as follows: hallux valgus angle (HVA), 29 ; angle between metatarsals 1 and 2 (M1M2A), 9 ; and angle between metatarsals 1 and 5 (M1M5A), 30  (Figures 1(a) and 1(b)). At the age of 76 years, these angles had progressed as follows: HVA, 50 ; M1M2A, 15 ; and M1M5A, 35  (Figures 1(c) and 1(d)). Rather, we decided to proceed with surgical correction of forefoot alignment, including correction of hallux valgus, using Mitchell's osteotomy, and correction of the overlap between the 4th and 5th digits using a shortening oblique osteotomy of metatarsals 2 through 5 (Figures 1(e) and 1(f)). Radiograph of right foot demonstrated healing at all the osteotomy site, and overlapping between the 4th and 5th toes was no longer detected at 6 months after the surgery (Figures 1(g) and 1(h)).
Preoperative macroscopic findings of the dorsum of the right foot (a), with an observable ulcer on the dorsomedial aspect of the 5th digit (b).
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fig2
A valgus deformity of the forefoot, including the 2nd and 4th digits, was observed, with a varus deformity of the 5th digit (Figure 2(a)). Persistent redness and swelling of the 5th digit were diagnosed as a subcutaneous infection (Figure 2(b)), and intravenous (IV) piperacillin/tazobactam treatment at a dose of 4.5 g every 8 h was initiated.
Postoperative macroscopic findings of the right foot, showing complete resolution of the ulcer.
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fig3
On postoperative day 30, redness and discharge from the wound were no longer observable (Figure 3).