OKOJ, Volume 5, No. 11

Several unique deformities can occur in the fifth toe, including overlapping, underlapping, and cock-up malpositions. Conservative treatment involves wearing shoes with higher and wider toe box areas. Toe caps and sleeves can also be used to relieve symptoms. Surgical treatment is determined by the severity of the deformity. For mild deformities, soft-tissue procedures such as VY-plasty and tendon transfers (Lapidus procedure, Zanoli procedure) may be recommended. For severe deformities, bone procedures (PIP joint arthroplasty, Ruiz-Mora procedure, partial phalangectomy) and soft-tissue procedures can be added to tendon transfers.

Rheumatoid arthritis (RA) is a systemic, autoimmune-mediated disease that affects 1% to 2% of the population. The disease is characterized by an inflammatory synovitis that can erode and ultimately destroy joint surfaces. People of all ages may be affected by RA, but the disease usually begins in middle age, and women are affected more often than men. The etiology of RA is unknown, although researchers believe that some people have genes that make them susceptible to the disease. Of the upper extremity joints, the wrist is the most commonly affected by RA. Disease-modifying antirheumatic drugs, such as methotrexate, and gold therapy are used in the early stages of the disease. Selective surgical intervention by synovectomy can be used bring the inflammation under control and prevent joint damage until medical treatment is efficacious. End-stage arthritis requires total wrist arthroplasty or complete or partial fusion of the wrist joints.

Proximal tibial osteotomy is effective for managing a variety of knee conditions, including unicompartmental arthritis with varus or valgus malalignment, instability, and chondral protection. With unicompartmental degeneration in the knee, an altered limb alignment redistributes more load to the diseased compartment, which may accelerate the degenerative process and cause severe pain. Thus, the goal of proximal tibial osteotomy is to unload the diseased articular surfaces by correcting the angular deformity at the knee. The decision to perform a proximal tibial osteotomy versus arthroplasty depends on the patient's age, activity level, and distribution of disease. The ideal candidate for this procedure is physiologically young and active with high functional demand. This article describes the surgical technique for a valgus-producing proximal tibial osteotomy to unload the medial compartment of the varus-malaligned knee.