A Two-Stage Foot Repair in a 55-Year-Old Man with Poliomyelitis

Area of Science:

• Orthopedic Surgery
• Reconstructive Surgery

Background:

• Poliomyelitis can lead to significant foot deformities, such as a plantarflexed foot, causing chronic pain and ulceration.
• A plantarflexed foot deformity, particularly affecting the sub-first metatarsophalangeal joint, presents a complex challenge in surgical management.

Observation:

• A 55-year-old male patient with a history of poliomyelitis presented with a long-standing plantarflexed foot and a painful sub-first metatarsophalangeal joint ulcer.
• The ulceration was characterized by chronic pain and difficulty in healing due to the abnormal foot biomechanics.

Findings:

• A two-stage surgical intervention was performed, addressing both soft-tissue and osseous components of the deformity.
• The first stage included hydrosurgery debridement, skin plasty for ulcer closure, and Achilles tendon lengthening. The second stage involved a dorsiflexory wedge osteotomy of the first metatarsal.
• Post-operatively, the ulcer remained closed, and the patient experienced complete pain resolution with improved foot alignment.

Implications:

• This combined surgical strategy effectively corrects severe plantarflexed foot deformities and resolves associated ulcerations.
• The findings suggest that a staged approach, addressing soft tissues and bone, can achieve successful long-term outcomes in complex foot deformities post-poliomyelitis.
• This case highlights the potential for reconstructive surgery to significantly improve quality of life for patients with debilitating orthopedic conditions.