title: Transfer of the second to the first metatarsal ray in a case of lawn mower injury: a case report.
abstract: The medial longitudinal arch of the foot plays a major role for a physiologic transfer of the load from the heel to the forefoot during walking and running. Traumatic amputation that involve either the great toe or the whole first metatarsal bone can lead to collapse of the medial longitudinal arch, overload of the metatarsal heads, and painful callus formation. If replant of the amputated part is not possible or has failed, it is advisable to reconstruct the medial longitudinal arch in order to re-establish a functional transfer of the load in the foot. We present a case of a young lady who suffered from traumatic amputation at the distal third of the first metatarsal. Replantation failed due to the severity of the initial injury. Despite a good coverage of the defect with a lateral arm flap, the patient developed a painful plantar callus underneath the amputated stump. The adjacent second metatarsal ray was then raised as a pedicled flap including bone and soft tissues and transferred to the first ray in order to reconstruct a physiologic medial longitudinal arch. The patient had excellent functional results with no recurrence of the callus.
authors.affiliation: Christine M. Kleinert Institute, Louisville, KY 40202, USA.
authors.forename: Paolo
authors.initials: P
authors.lastname: Sassu
authors.forename: Tsu Min
authors.initials: TM
authors.lastname: Tsai
mesh_terms: D000673:Amputation, Traumatic / Q000601:surgery*; D002675:Child, Preschool; D005260:Female; D005531:Foot Deformities, Acquired / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D006214:Hallux / Q000293:injuries*; D006801:Humans; D008682:Metatarsal Bones / Q000637:transplantation*; D008866:Microsurgery; D013524:Surgical Flaps; D016474:Weight-Bearing