Operative repair of tendo Achilles ruptures is associated with a lower re-rupture rate. A medial approach is made and the tendon ends debrided. The tendon is repaired with two non-absorbable core sutures and an absorbable perimeter suture, with care to avoid any lengthening of the musculotendinous unit. The tendon sheath is repaired, with a deep fascial releasing incision to allow apposition of the edges if necessary. In the case of insertional avulsions, the avulsed bony fragment is excised and the tendon repaired to bone with a 3.5 mm corkscrew anchor and non-absorbable suture.

A frontslab is applied with the ankle in gravitational equinus and worn for eight weeks with protected weight bearing. Sutures are removed at 10 to 14 days and active range of motion commenced. At eight weeks, weight bearing as tolerated is allowed with a heel raise and physiotherapy for calf strenghthening is commenced. Recovery of full strength will take one year.

Background: First Metatarsophalangeal joint (MTP) arthrodesis is commonly performed for hallux valgus with an arthritic joint, however previous studies have recommended that this should be combined with another procedure to correct the hallux valgus when the intermetatarsal angle is enlarged. We propose that an arthrodesis of the first MTP joint with a soft tissue release produces a significant correction of the intermetatarsal angle in such a group of patients avoiding the need for a concomitant procedure to change the intermetatatarsal angle.

Patients and Methods: The charts and radiographs of 20 patients who had an arthrodesis of the first MTP joint were retrospectively reviewed. All 20 patients were female with a mean age of 54.2 years (range 42–78 years). The intermetatarsal (IMT) angles were measured by two individuals independently. These were measured on a weight-bearing pre-operative film and a weight-bearing 6-week post-operative film. Fusions were performed using either the Hallu-S® plate or two crossed screws. A Student “t” test was performed on the change of the IMT angle and also on the inter-observer variations for the same.

Results: The mean pre-operative IMT angle was 16.85° (range 12–30°). The mean post-operative IMT angle was 10.6° (range 6–20°). The mean change in the IMT angle was 6.25° (range 2–12°). This change of the IMT angle was statistically significant – p< 0.0001 – Student “t” test. There was no significance in the inter-observer difference (p> 0.5) note in 6 radiographs with a mean of 1.3° (range 1–2°).

Conclusion: This is the first study to show that performing an arthrodesis of the first MTP joint with soft tissue release in patients with hallux valgus and degenerate first MTP joint will significantly correct the IM angle. Therefore, this alleviates the need for performing another procedure on these patients.

Aim Pressure on inpatient beds can lead to high cancellation rates for inpatient elective orthopaedic surgery. The use of day surgery facilities is one way to overcome this problem. We set out to assess patient satisfaction after Scarf osteotomy, as a day case procedure, to help determine whether this is a valid routine practice.

Method Twenty-six consecutive patients (25 female and 1 male) undergoing Scarf metatarsal osteotomy, lateral release, medial capsulorraphy, and Akin osteotomy were prospectively followed up. Three patients had bilateral procedures resulting in 29 operations being performed. All had their surgery under midfoot block with intravenous sedation administered by an anaesthetist. All patients were discharged on the day of surgery with oral analgesia and contact details of the on-call orthopaedic registrar. A telephone interview and questionnaire were performed on day 3 and day 7 post-operatively.

Results Post-operative pain: seven patients (24%) had no pain, 15 (51%) mild pain, five (17%) moderate pain and two (6%) had episodes of severe pain. Twenty-eight patients (96%) were satisfied with their level of postoperative analgesia. Twenty-eight patients (96%) would have the surgery as a day case again. One patient would not due to post-operative nausea and vomiting.

Post-operative problems experienced by patients: 17 patients (58%) had no problems, six (20%) felt that their pain was a problem, five (17%) experienced bleeding/bruising and one (3%) felt faint.

Survey of medical services contacted by patients: 26 (89%) contacted no-one, one (3%) day surgery unit staff, two (3%) their GP and one (3%) the hospital.

Significance Scarf osteotomy can be successfully performed under midfoot block with a high degree of patient satisfaction. This has the potential to reduce cancellations due to inpatient bed shortage.

Aim When first metatarsophalangeal (MTP) joint fusion is performed in the presence of a high first intermeta-tarsal angle (IMA), an important question to arise is whether the first metatarsal varus will correct with MTP fusion alone or whether an additional basal osteotomy is necessary. We compared the pre-operative IMAs to the post-operative angles to answer this question.

Method Twenty patients had a first MTP fusion for severe hallux valgus deformity performed by the senior author over a 2-year period. All were female. Mean age was 54.2 years (range 42–78). Seven patients had rheumatoid arthritis. Their IMAs were retrospectively measured on weight bearing X-rays taken pre-operatively and 6 weeks post-operatively. They were recalled for an additional measurement at a mean of 13.72 months (range 6–30).

Results Pre-operatively the mean hallux valgus angle was 46.55 degrees and the mean IMA was 16.65 degrees (range 12–26). The mean 6 week post-operative IMA was 10.35 degrees (range 6–15) with a mean improvement of 6.3 degrees (range 0–12). The mean IMA at final follow-up was 8.67 degrees (range 5–12). The mean final improvement was 8.22 degrees (range 4–14). In eight patients with a pre-operative IMA of 15 degrees or less the mean improvement was 6.13 degrees. In 10 patients with an pre-operative IMA of 16 degrees or more, the mean improvement was 9.9 degrees.

Significance First MTP joint fusion in hallux valgus deformity permanently reduces the IMA. As the pre-operative IMA increases from moderate to severe, there is a significant increase in post-operative correction. An additional basal osteotomy is not indicated.