Introduction: Arthrodesis of 1st MTPJ is performed using various fixation techniques including lag screws, dorsal plate and screws, K-wiring. We evaluated the strength of fixation using two staples placed at right angles.

Methods: Ten pairs of cadaveric feet were dissected to harvest the hallux MTPJ. Planar cut of articular surfaces using a micro-saggital saw. The bony ends were then approximated with an intervening blade and fixed using 2 staples placed at right angles. The specimen was supported on either ends and subjected to 3 point loading using a materials testing machine (Instron). The load at which the joint opened up sufficiently to let the blade fall was recorded. The load at which the construct failed was then recorded

Results: The joint opened up at an average of 41 Newtons. The load to failure was 130 Newtons. The corresponding average values in kilograms were 4.19 kilograms for the opening of the joint and 12.61 kilograms for the failure of the construct. On full weight bearing using the heel weight bearing shoes that we normally use post-operatively, the forces going through the forefoot were 0 newtons/kilograms, calculated using a TEK SCAN (measures the foot pressure on walking)

Conclusion: It is safe to walk patients using a heel weight bearing shoe (Benefoot post op wedge shoe) following 1st MTPJ fusion using staples (uniclip-NewDeal). This is a major advantage compared to other methods of fixation that require plaster cast immobilisation thus reducing inconvenience, plaster expenses and possible complications like DVT.

Introduction: Arthrodesis of 1st metatarsophalangeal joint is a reliable procedure for the treatment of symptomatic arthritis. Various techniques are in use to facilitate arthrodesis. We evaluated our results using a new and simple construct of two staples applied perpendicular to one another.

Material and Methods: Prospective observational study. A total of 29 patients (26 females, 3 males), Mean age 59yrs. 34 Hallux MTP joint fusions, 5 of them bilateral. Pre-operative diagnosis was Osteoarthritis in 27 and Rheumatoid arthritis in 2.

Technique: Medial incision, planar cuts using saw. Staples placed dorsoventrally and mediolaterally.

Patients: were mobilised in heel weight bearing post op shoe for 4–6 weeks. All patients had regular clinical and radiological assessment. Mean followup was 24 months.

Results: Pre-op mean AOFAS score was 31 (Modified AOFAS score, total value 90 Portion of MTP joint motion was not included). Post-op mean AOFAS (modified) score was 81. 26 patients were very satisfied with the outcome of surgery, 2 were satisfied with reservation and one patient was not satisfied. 28 out of 29 patients would recommend this procedure to others. Ability to wear shoes improved in 26, same in 2 and worse in one patient. There were two mal-unions, one superficial wound infection treated with antibiotics and 6 patients had prominent staples requiring removal. There was no radiological non-union

Conclusion: Our technique of 1st MTP joint arthrodesis using 2 staples applied perpendicular to each other provides a reliable and stable construct that does not require use of plaster post-operatively. This has resulted in painfree post-op period without any need for plaster thus saving time and avoiding complications of plaster i.e stiffness and DVT. We strongly recommend the use of this type of fixation.

Introduction Surgical treatment of metatarsalgia remains controversial, with many different techniques described. Recently the Weil osteotomy is gaining in popularity because of its relatively simple technique and excellent union rates, however, it is well known that the procedure does lead to stiffness in the metatarsophalangeal (MTP) joint with a reduction in plantarflexion. The aim of this study was to evaluate the outcome of the Weil osteotomy from a radiological and patient-based perspective.

Method This was a retrospective review of 42 patients (110 Weil osteotomies), with mean follow up of 24.8 months (range 6–48). Clinical examination and X-ray assessment were performed at follow-up, along with completion of patient questionnaires, American Orthopaedic Foot and Ankle Society (AOFAS) Score and Lesser Metatarsal Scores (LMTS). Additional parameters including arc of motion of each metatarsal, metatarsal shortening, non-union, redislocation and requirement for further surgery were also recorded.

Results Results showed that the average arc of motion for the second metatarsal was 61.1 degrees, the third metatarsal 59.6 degrees, and the fourth metatarsal 69.8 degrees. In all cases there was a significant reduction in plantarflexion at the MTP joint, with the average combined plantar flexion of less than 5 degrees. The average shortening was 7.2 mm, and there were no cases of redislocation or non-union. Analysis of the scoring systems showed that with AOFAS there were 88% excellent/ good results and with LMTS there were 83% excellent/ good results. No patients had residual metatarsalgia and plantar callosities disappeared in almost all patients, with 91% of patients reporting excellent/good satisfaction.

Conclusion Formal scoring systems and patient satisfaction scores showed that dorsiflexion contractures post-operatively were not of concern to the patients. The study suggests that the Weil osteotomy remains a safe, reliable and predictable operation with excellent results, and may be of value in the treatment of resistant metatarsalgia.

We present the results of the first two years of experience with the Weil osteotomy at The Royal Oldham Hospital and endeavour to define its role in the management of intractable plantar keratosis (IPK) and complication rate.

All patients undergoing Weil osteotomy in 2000 & 2001 were included in this prospective study. A total of 21 consecutive patients, having 61 lesser metatarsal osteotomies were reviewed (95% female). The mean age was 62 years (range 12 to 86). The mean follow-up period was 17 months (range seven to 28 months). Fourteen patients (66%) had no previous foot surgery. In 11 patients (53%) only Weil osteotomy was performed; in the other 10 patients (47%) the procedure was combined with surgery to the first ray for the correction of hallux valgus deformity.

There were no major complications. Superficial wound infections in four (19%) patients were treated successfully with antibiotics. No screws needed to be removed and no non-union / avascular necrosis were seen. Only one patient was left with residual pain and stiffness on ambulation but the rest (95%) were able to walk comfortably in either normal shoe wear or trainers.

We found that the patients consistently reported pain relief although some stiffness of the toes may remain. The majority of patients were satisfied with the outcome in terms of symptoms and function when evaluated by using the American Orthopaedic Foot and Ankle Society scoring system. Excellent results (90–100 points) were achieved in 10 patients (47%), good (80–89 points) in six patients (28%), fair (70–79 points) in four (20%) and poor (less than 70 points) in only one patient (5%). We conclude that although there is a considerable learning curve that must be overcome the Weil osteotomy can be a reliable procedure that effectively reduce the load under the lesser metatarsal heads.

Knee arthroscopy is probably the most common procedure performed in orthopaedic practice. A number of patients who undergo this procedure do not have any abnormality detected. Is negative arthroscopy really such an unnecessary procedure?

We evaluated the outcome of patients in whom knee arthroscopy proved to be normal. Hospital records of patients who had had knee arthroscopy were retrospectively studied and all patients with a normal knee arthroscopy were selected.

Fifty-three patients (55 knees) with a normal arthroscopy were included into the study. Patients were then interviewed either by telephone or questionnaire to ascertain current symptoms, job changes and patient perception of the procedure.

The mean follow up was 43 months. Fifty percent of the patients had had a history of injury, and the preoperative diagnosis was thought to be a meniscal lesion or ACL rupture in 38% of patients. Sixty eight percent of the patients felt they were better and there were no complications. The incidence of all symptoms was significantly reduced after arthroscopy.

A significant number of patients felt that they were better after the knee arthroscopy. The reason for this is no entirely clear. It may well be due to a placebo effect, the fact that patients now know that there is no abnormality and learn to live with the symptoms or there may be an additional benefit of the procedure itself.