374 Forefoot Reconstruction
Seventh Principle Keep the toes long
The seventh principle is to take care of the toes.
Keep the Toes Long(Fig. 45g1)
– i.e. without joint resection or fusion. This is possible thanks to the longitudinal decompres- sion provided by the metatarsal shortening. It is it useful but it also preserves the cosmetic appearance of the forefoot, which has to be emphasized.
Obtain a Square Type Foot(Fig. 45g2)
– Egyptian type foot: We know that many people have a preference for Egyptian type foot and it is true that it is as well as more elegant sign of a certain strength of the foot; at last, perhaps a sexual signification… But we also know that we cannot leave the Egyptian foot in a case of first MTP arthritic changes and gene- rally to secure the hallux valgus correction. So we can leave a slight Egyptian foot in a young person or when there is no arthritic changes.
– Greek type foot: This is not a good type!
First because we observe that it is not well tole- rated, providing also hallux valgus deformity and second toes problems, secondly because
Fig. 45g1. Principle VII – The toes. a) Keep the lesser toes long.
1, 2, 3. The correction of this deformity is obtained only by the shortening of the metatarsals: The toes are corrected by soft tissue procedure and toe K-wiring. The toes remain long and more effective in the ground contact strength. The foot cosmetic aspect is preserved notably by keeping the toes long.
4, 5. Other example of the toe length preservation.
Eight Principles of Forefoot Reconstruction
Fig. 45g2. Principle VII – The toes. b) To obtain a square type foot.
1. An Egyptian type foot remaining may result in recurrence of deformity or in longitudinal overpressure notably in the MTP joint. However a slight excess of the grant toe length is well tolerated.
2. A Greek type foot is not well tolerated if a second hammertoe deformity previously exists.
3. So we have to obtain a square type foot which is the best tolerated by footwear (above all by ladies footwear).
hallux valgus is more difficult to treat, thirdly because the second toe excessive length is often accompanied by the corresponding metatarsal excess of length.
– Square type foot: The security is to reach a square type foot, which is not only an elegant foot, but also very well tolerated regarding the footwear.
This introduces the eighth and last principle.
Obtain a foot which fits to elegant shoes
The eighth principle is to obtain a foot which fits to elegant shoes (Fig. 45h1-2-3-4-5).
First, a few words about my experience as a
“shoemaker”. Since 1981, I have studied feminine shoes with designers and also technicians and last manufacturers. From 1985 to 1995 I was additio- nally a shoemaker. I made myself the lasts, trying to combine comfort and elegance. Twice a year, I launched a collection “Spring/Summer” and
“Autumn/Winter”. It was a very exciting period in which I learned a lot of things about shoes, com- fort, fashion… and the foot. I wrote some papers on this subject . Unfortunately a medical sur- geon is not a businessman and this period fini- shed in 1995. However, the same year, I met L. Piclet and Ph. Alberola, who created a society for medical and comfort shoes (Romans Industrie) which actually make the Type I heel support shoe, the Type II and at last some models of Type III which are good-looking.