Acta Ortopédica Mexicana

López GE, Parra TP, Burgos PR, Vázquez EJ
Clinical course of the quintus varus supraductus osteotomy in postoperative patients subjected to the LP-INR surgical approach
Acta Ortop Mex 2010; 24 (4)

Language: Español
References: 25
Page: 235-241
PDF: 0. Kb.

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Objective: to evaluate the clinical course of patients subjected to the osteotomy designed at the National Rehabilitation Institute (LP-INR) with a memory staple to treat the congenital quintus varus supraductus deformity, from December 2002 to August 2009. Moreover, to show that the LP-INR osteotomy decreases weight bearing under the 5th metatarsal head, descends the phalanx, spares the metatarsophalangeal joint, and prevents relapses and pain. Material and methods: the study was conducted from December 2002 to August 2009 and included 51 patients with quintus varus supraductus deformity and 78 feet; 33 patients were males (64.7%) and 18 were females (35.2%), the Maryland clinical scale was applied at postoperative month six. The AOFAS scale was applied in the preoperative and postoperative periods to assess pain, gait and alignment. Results: the Maryland scale showed excellent results in 42 patients (84.3%), good results in 3 patients (5.8%), fair in 3 patients (5.8%) with a score of 75 to 50, and poor in 3 patients (5.8%). The AOFAS scale score for the forefoot was 55 + 8 preoperatively and 90 + 5 postoperatively. The Student t test was statistically significant in the preoperative and postoperative periods ‹ 0.05. Discussion: the LP-INR osteotomy for the treatment of the congenital quintus varus supraductus deformity provides appropriate alignment of the 5th toe with decreased load on the 5th metatarsal head and avoids broad resections that result in both cosmetic and functional alterations.

Key words: osteotomy, toe, foot, technique, pain, course.


  1. Maceira E: Análisis cinemática y cinético de la marcha humana. Revista del pie y tobillo Tomo XVII, N.º 1, octubre 2003: 29-37

  2. Maceira E: Aproximación al estudio del paciente con metatarsalgia. Revista del Pie y Tobillo Tomo XVII, N.º 2, diciembre 2003: 14-29

  3. Black GB: Butler arthroplasty for correction of the adducted fifth toe: a retrospective study of 36 operations between 1968 and1982. J Pediatr Orthop 1985; 5(4): 439-41.

  4. De Doncker E, Kowalski C: Le pied normal et pathologique. Acta Orthop Belg 1970; 36: 337.

  5. Viladot A: Patología del antepié. 3.ª edición. Barcelona: Toray 1981.

  6. McDaniel L, Tafuri SA: Congenital digital deformities. Clin Podiatr Med Surg 1996; 13(2): 327-42.

  7. Boc SF, Martone JD:Varus toes: a review and case report. J Foot Ankle Surg 1995; 34(2): 220-2.

  8. De Palma L, Zanoli G: Zanoli´s procedure for overlapping fifth toe retrospective study of 18 cases followed for 4-17 years. Acta Orthop Scand 1998; 69 (5): 505-7.

  9. Thordarson PP: Congenital fifth toe correction junction with soft tissue release and cutaneous Z-plasty. Foot Ankle Int 2001; 22(6): 511-2.

  10. Cockin J: Butler’s operation for an overriding fifth toe. J Bone Joint Surg (Br) 1968; 50: 78-81.

  11. Derhy Y, Binder JP, Mitrofanoff M, Haddad R, Pavy B: Quintus varus supraductus congenital: technique chirurgicale. Annales de chirurgie plastique esthétique 2004; 49: 373-7.

  12. Dyal CM, Davis WH: Thomson clinical evaluation of the Ruiz Mora procedure: long-term follow-up. Foot Ankle Int 1997; 18(2): 94-7

  13. Enciclopedia Medico-Chirurgicale. Podologia. Tomo II. 2003: 227, 080-A-34: 10-11.

  14. Janecki CJ: Results of phalangectomy of the fifth toe for hammertoe. The Ruiz Mora procedure. JBJS 1976; 58(7): 1005-7.

  15. Kelikian H: Hallux valgus allied deformities of the forefoot and metatarsalgia. 1a edición. Filadelfia: WB Saunders Company 1965: 169-75.

  16. Núñez-Samper M, Llanos Alcazar F: Biomecánica, medicina y cirugía del pie.1ª. Edición. Barcelona: Masson 2000: 247-9.

  17. Paton RW: V-Y plasty for correction of varus fifth toe. J Pediatr Orthop 1990; 10(2): 248-9.

  18. Rao GS, James JH: Artificial sindactilization for congenital crossed toes. Br J Plast Surg 1987; 40(5): 502-4.

  19. Zwierzchowski TJ: Evaluation of surgical treatment for congenital over-riding fifth toe. Chir Narzadow Ruchu Ortop Pol 1994; 59(1): 51-3.

  20. Tawil HJ, Pilliard D, Taussig G: Quintus varus supraductus. Results of the surgical treatment by cutaneous graft, internal capsulotomy and external transfer of the extensor of the 5th toe. Rev Chir Orthop Reparatrice Appar Mat 1992; 78(2): 107-11.

  21. Träger D: Operative treatment of digitus quintus varus et superductus (V-Y correction). Z Orthop Ihre Grenzgeb 1984; 122(6): 838-40.

  22. De Boeck H: Butler’s operation for congenital overriding of the fifth toe. Retrospective 1-7-year study of 23 cases. Acta Orthop Scand 1993; 64(3): 343-4.

  23. Schuh A, Werber S, Zeiler G, Schraml A: Experiences with the Butler procedure for overlapping fifth toe. Zentralbl Chir 2005; 130(2): 153-6.

  24. Viladot A: Quince lecciones sobre patología del antepié. 2da edición. Barcelona Masson 2000: 153-7.

  25. López-Gavito E, Parra-Téllez P, Vázquez-Escamilla J: Tratamiento quirúrgico del quinto dedo supraducto del pie. Técnica Original. Revista de Pie y Tobillo 2006: 125-30.