Bibliographic record
Abstract
The Journal of Bone and Joint Surgery. British volumeVol. 89-B, No. 2 CorrespondenceFree AccessAuthor’s replyS. G. HOFSTAETTER, H. J. TRNKAS. G. HOFSTAETTERClinical Research FellowSearch for more papers by this author, H. J. TRNKAConsultant Orthopaedic SurgeonSearch for more papers by this authorPublished Online:1 Feb 2007https://doi.org/10.1302/0301-620X.89B2.19169AboutSectionsPDF/EPUB ToolsDownload CitationsTrack CitationsPermissionsAdd to Favourites ShareShare onFacebookTwitterLinked InRedditEmail Sir,We were interested to read the comments from Messrs Ramisetty and Greiss. Clinical results of the Weil osteotomy with short-term and long-term results prove its value. A significant reduction in pain, disappearance of plantar callosities, increase of patient’s satisfaction rate and walking ability are all reported.1–4In their letter they stated that in the Weil osteotomy, the insertion of the plantar plates to the proximal phalanx is not dealt with. The plate part of the joint capsule has a substantial attachment to the proximal phalanx and the plantar fascia but, except for the collateral ligaments, it is without substantial fibrous attachment to the metatarsal head.5,6 We are convinced, as described by Hicks6 and Scheck,7 that rupture or elongation of the plantar plate in senile feet occurs where the plantar aponeurosis fuses with the plantar plate. With the Stainsby procedure (modified Keller’s procedure)8,9 you sacrifice the remaining intact attachment of the plate to the proximal phalanx and the metatarsophalangeal joint (MTPJ) when excising the proximal 3/4 of the proximal phalanx. Moreover, the insertions of the interossei and the lumbricals at the base of the proximal phalanx hold the proximal phalanx in its neutral position.10,11 With the Stainsby procedure, the insertion of the muscles is removed and there is no way to obtain flexion in the MTPJ. In theory, the latter is possible with the Weil osteotomy and the joint remains intact.They also state that with their method it is possible to release and replace the plantar plate. However, through the shortening effect of the Weil osteotomy, the plate becomes looser and releasing and replacing the plate under the metatarsal head is possible, although we doubt the long lasting effect of this manoeuvre. Scarring of the plate occurs. Nevertheless, the reversed windlass mechanism of the weakened plantar aponeurosis will not be strong enough to prevent a postoperative extension contracture, floating or stiff toes.1–4 Myerson and Jung12 showed in their study with second toe instability in 64 feet that the MTPJ, even after a flexor to extensor transfer, remains unstable. To date, the longest Stainsby procedure follow-up study9 had a follow-up period of three years and four months in 69 feet. The indication in this study was severe claw toes in rheumatoid feet and cannot be compared with our results as rheumatoid feet were excluded from our study. Unfortunately there are no clinical studies of the Stainsby procedure related to patient numbers/demographics, nor statistical evaluation.8,9,13The goal of the Weil osteotomy is firstly to decompress the MTPJ and secondly to alter load transmission through the forefoot by shifting the plantar fragment proximal to the area of the lesion where thicker and more compliant soft tissue is still present.14 However, instability of the MTPJ of the lesser toes by the rupture of the plantar plate is, and continues to be, a challenging problem.12 A randomised, controlled trial, to compare the Weil osteotomy with the Stainsby procedure would be of value. References 1 Barouk LS. Weil’s metatarsal osteotomy in the treatment of metatarsalgia. Orthopade 1996;25:338–44. Crossref, Medline, ISI, Google Scholar2 Hart R, Janecek M, Bucek P. The Weil osteotomy in metatarsalgia. Z Orthop Ihre Grenzgeb 2003;141:590–4. Crossref, Medline, ISI, Google Scholar3 Hofstaetter SG, Hofstaetter JG, Petroutsas JA, et al. The Weil osteotomy: a seven-year follow-up. J Bone Joint Surg [Br] 2005;87-B:1507–11. Link, Google Scholar4 Muhlbauer M, Trnka HJ, Zembsch A, Ritschl P. Short-term outcome of Weil osteotomy in treatment of metatarsalgia. Z Orthop Ihre Grenzgeb 1999;137:452–6. Medline, ISI, Google Scholar5 Deland JT, Lee KT, Sobel M, DiCarlo EF. Anatomy of the plantar plate and its attachments in the lesser metatarsal phalangeal joint. Foot Ankle Int 1995;16:480–6. Crossref, Medline, ISI, Google Scholar6 Hicks JH. The mechanics of the foot. II: the plantar aponeurosis and the arch. J Anat 1954;88:25–30. Medline, ISI, Google Scholar7 Scheck M. Etiology of acquired hammertoe deformity. Clin Orthop 1977;123:63–9. Google Scholar8 Stainsby GD. Pathological anatomy and dynamic effect of the displaced plantar plate and the importance of the integrity of the plantar plate-deep transverse metatarsal ligament tie-bar. Ann R Coll Surg Engl 1997;79:58–68. Medline, ISI, Google Scholar9 Briggs PJ, Stainsby GD. Metatarsal head preservation in forefoot arthroplasty and the correction of severe claw toe deformity. Foot Ankle Surg 2001;7:93–101. Crossref, Google Scholar10 Gray H. Anatomy of the humam body. Philadelphia: Lea & Febiger, 1918. Google Scholar11 Trnka HJ, Nyska M, Parks BG, Myerson MS. Dorsiflexion contracture after the Weil osteotomy: results of cadaver study and three dimensional analysis. Foot Ankle Int 2001;22:47–50. Crossref, Medline, ISI, Google Scholar12 Myerson MS, Jung HG. The role of toe flexor-to-extensor transfer in correcting metatar-sophalangeal joint instability of the second toe. Foot Ankle Int 2005;26:675–9. Crossref, Medline, ISI, Google Scholar13 Hossain S, Dhukaram V, Sampath J, Barrie JL. Stainsby procedure for non-rheumatoid claw toes. Foot Ankle Surg 2003;9:113–18. Crossref, Google Scholar14 Weijers RE, Walenkamp GH, van Mameren H, Kessels AG. The relationship of the position of the metatarsal heads and peak plantar pressure. Foot Ankle Int 2003;24:349–53. Crossref, Medline, ISI, Google ScholarFiguresReferencesRelatedDetails Vol. 89-B, No. 2 Metrics History Published online 1 February 2007 Published in print 1 February 2007 InformationCopyright © 2007, The British Editorial Society of Bone and Joint Surgery: All rights reservedPDF download
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.043 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.002 | 0.002 |
| Scholarly communication | 0.003 | 0.004 |
| Open science | 0.002 | 0.003 |
| Research integrity | 0.023 | 0.022 |
| Insufficient payload (model declined to judge) | 0.048 | 0.029 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".