by Manjunath Koti, and Nicola Maffulli

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Fig. 1. (A) Schematic drawing of the standard method

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by Manjunath Koti, and Nicola Maffulli Bunionette by Manjunath Koti, and Nicola Maffulli J Bone Joint Surg Am Volume 83(7):1076-1082 July 1, 2001 ©2001 by The Journal of Bone and Joint Surgery, Inc.

Fig. 1 a: The fourth-fifth intermetatarsal angle as measured with one method. Fig. 1 a: The fourth-fifth intermetatarsal angle as measured with one method. The angle is formed between a line along the medial and proximal portions of the shaft of the fifth metatarsal and a line drawn along the axis of the fourth metatarsal. This angle is more accurate than the one labeled b. b: The fourth-fifth intermetatarsal angle as measured with another method. The angle is formed between the long axes of the fifth and fourth metatarsals. Manjunath Koti, and Nicola Maffulli J Bone Joint Surg Am 2001;83:1076-1082 ©2001 by The Journal of Bone and Joint Surgery, Inc.

Fig. 2 Measurement of the lateral deviation angle. Fig. 2 Measurement of the lateral deviation angle. On dorsoplantar radiographs, a line is drawn bisecting the midpoint of the articular surface of the head and neck of the fifth metatarsal. Another line is drawn adjacent and parallel to the medial surface of the proximal metatarsal, intersecting the first line and forming the lateral deviation angle (c). Manjunath Koti, and Nicola Maffulli J Bone Joint Surg Am 2001;83:1076-1082 ©2001 by The Journal of Bone and Joint Surgery, Inc.

Fig. 3 The fifth metatarsophalangeal angle indicates the magnitude of medial deviation of the fifth toe in relation to the axis of the fifth metatarsal shaft. Fig. 3 The fifth metatarsophalangeal angle indicates the magnitude of medial deviation of the fifth toe in relation to the axis of the fifth metatarsal shaft. Manjunath Koti, and Nicola Maffulli J Bone Joint Surg Am 2001;83:1076-1082 ©2001 by The Journal of Bone and Joint Surgery, Inc.

Fig. 4 Type-1 bunionette (enlargement of the lateral surface of the fifth metatarsal). Manjunath Koti, and Nicola Maffulli J Bone Joint Surg Am 2001;83:1076-1082 ©2001 by The Journal of Bone and Joint Surgery, Inc.

Fig. 5 Type-2 bunionette (lateral bowing of the distal aspect of the fifth metatarsal without hypertrophy of the metatarsal head). Fig. 5 Type-2 bunionette (lateral bowing of the distal aspect of the fifth metatarsal without hypertrophy of the metatarsal head). Manjunath Koti, and Nicola Maffulli J Bone Joint Surg Am 2001;83:1076-1082 ©2001 by The Journal of Bone and Joint Surgery, Inc.

Fig. 6 Type-3 bunionette (an increase in the fourth-fifth intermetatarsal angle). Manjunath Koti, and Nicola Maffulli J Bone Joint Surg Am 2001;83:1076-1082 ©2001 by The Journal of Bone and Joint Surgery, Inc.

a: Technique for sliding oblique metaphyseal osteotomy. a: Technique for sliding oblique metaphyseal osteotomy. The oblique osteotomy is started at the fifth metatarsal neck and is angled 40° to 45° in a proximal direction. b: The head is receded proximally and medially, and the distal 7 mm of the proximal fragment is removed if the proximal recession is impaled by the spike. Manjunath Koti, and Nicola Maffulli J Bone Joint Surg Am 2001;83:1076-1082 ©2001 by The Journal of Bone and Joint Surgery, Inc.

A Kirschner wire is used to maintain stability. Manjunath Koti, and Nicola Maffulli J Bone Joint Surg Am 2001;83:1076-1082 ©2001 by The Journal of Bone and Joint Surgery, Inc.