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Surgical Reconstruction of Severe Forefoot Derangement in a Patient with Traumatically Acquired Contralateral Limb-length Discrepancy

A Case Report

Alexander Bonner Doctor’s Hospital, Coral Gables, Florida. Dr. Patel is now with the Department of Podiatry, St. Vincent’s Medical Center, Jacksonville, Florida. Dr. Chi is now with the Department of Podiatry, Palmetto General Hospital, Hialeah, Florida. Dr. Bhikha is now with the Department of Podiatry, Inova Fairfax Hospital, Falls Church, Virginia.

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Carlton C. Cranford Department of Podiatry, Ochsner Medical Center, New Orleans, Louisiana.

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Rakesh Patel Doctor’s Hospital, Coral Gables, Florida. Dr. Patel is now with the Department of Podiatry, St. Vincent’s Medical Center, Jacksonville, Florida. Dr. Chi is now with the Department of Podiatry, Palmetto General Hospital, Hialeah, Florida. Dr. Bhikha is now with the Department of Podiatry, Inova Fairfax Hospital, Falls Church, Virginia.

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Andy Chi Doctor’s Hospital, Coral Gables, Florida. Dr. Patel is now with the Department of Podiatry, St. Vincent’s Medical Center, Jacksonville, Florida. Dr. Chi is now with the Department of Podiatry, Palmetto General Hospital, Hialeah, Florida. Dr. Bhikha is now with the Department of Podiatry, Inova Fairfax Hospital, Falls Church, Virginia.

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Shamir Bhikha Doctor’s Hospital, Coral Gables, Florida. Dr. Patel is now with the Department of Podiatry, St. Vincent’s Medical Center, Jacksonville, Florida. Dr. Chi is now with the Department of Podiatry, Palmetto General Hospital, Hialeah, Florida. Dr. Bhikha is now with the Department of Podiatry, Inova Fairfax Hospital, Falls Church, Virginia.

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Limb-length discrepancy is a very common condition. A severe debilitating forefoot deformity resulting from a post-traumatic limb length discrepancy is quite rare. This case study discusses the surgical reconstruction of a forefoot deformity of a 64-year-old male following a post-traumatic limb-length discrepancy from a motor vehicle accident that caused compensatory biomechanical changes in the unaffected lower extremity. These changes resulted in a severe hallux abducto valgus deformity with subluxated metatarsophalangeal joints of the second and third digits, leaving the patient with a severe symptomatic forefoot deformity that closely mimics the radiographic appearance of a rheumatoid forefoot. The forefoot deformity was corrected using the Mckeever and Hoffman procedures with Kirschner-wire fixation. Seven months following the corrective procedures, the patient was able to obtain an asymptomatic plantigrade foot and can now wear regular footwear. (J Am Podiatr Med Assoc 102(4): 324–329, 2012)

Corresponding author: Carlton C. Cranford, DPM, MPH, Department of Podiatry, Ochsner Medical Center, 1514 Jefferson Hwy, New Orleans, LA 70121. (E-mail: cranfo1079@aol.com)