title: Z-bunionectomy: retrospective long-term study.
abstract: Long-term patient satisfaction and objective clinical and radiographic examinations of patients who had undergone the Z-bunionectomy at the University of Chicago Medical Center were evaluated. Fifty-six surgeries were performed on 31 patients, with a follow-up range of 5 to 9 years. The University of Maryland 100-Point Painful Foot Center Scoring System was modified to be more specific to bunion surgery, and we used this modification to measure patient satisfaction. Patient satisfaction was rated good to excellent by 90% of the patients. Radiographic findings included: intermetatarsal angle-mean, 7.1 degrees; hallux abductus angle-mean, 8.96 degrees; tibial sesamoid position-mean, 2.8. The mean protrusion was -1.64 mm. Radiographic findings consistent with osteonecrosis were noted of one patient, one foot, although the patient was clinically asymptomatic. The objective findings were as follows: dorsiflexion, mean, 60 degrees; plantarflexion, mean, 14 degrees. No patients had pain or crepitus, nor were they tract-bound in their first metatarsophalangeal joint range of motion. In addition, stance dorsiflexion had a mean of 21 degrees, and the purchase power was 88% good to excellent on plantar paper pull-out testing. First ray motion qualitatively demonstrated 1 1/2 to 2 times dorsiflexion to plantarflexion. There were no subsecond metatarsal head keratoses. Generalized ligamentous laxity was not seen. For the resting calcaneal stance position the mean was 3.5 degrees everted, with 24% of the patients maximally pronated in this position. We were unable to correlate any structural and functional postoperative features with patient satisfaction.
authors.affiliation: Department of Surgery, University of Chicago Medical Center, Illinois, USA.
authors.forename: N S
authors.initials: NS
authors.lastname: Schoen
authors.forename: K
authors.initials: K
authors.lastname: Zygmunt
authors.forename: C
authors.initials: C
authors.lastname: Gudas
mesh_terms: D005260:Female; D005500:Follow-Up Studies; D006215:Hallux Valgus / Q000601:surgery*; D006801:Humans; D008297:Male; D010027:Osteotomy / Q000379:methods; D010147:Pain Measurement; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D011379:Prognosis; D016059:Range of Motion, Articular; D012189:Retrospective Studies