In another thread about MIS for metatarsalgia, there is a discussion about the 'Leventen formula'. Who and what is the Leventen formula.
Ref blog: https://podiatry.com/etalk/index.php?topicid=20291#-1
To provide for a better, more reliable outcome, following metatarsal osteotomy for metatarsalgia, and to reduce the incidence of later additional surgery Leventen devised a surgical approach to pre-emptively also address the adjacent metatarsals. This is based on the primary location.
Leventen's approach, which some now refer to as the 'Leventen Formula' is named after Edward O. Leventen, MD. Dr. Leventen is an orthopedic surgeon (see picture) who, in 1990, published a paper in the journal of Foot & Ankle, entitled 'Distal Metatarsal Osteotomy for Intractable plantar keratoses'.
In this article, Leventen reports on the outcome of 21 feet, with an average follow up of 31 months. Outcome measures include a subjective assessment of pain & function. This is a non-validated outcome measure tool. (Not unusual for the year of publication). A clinical examination was performed for callus, stiffness, sensory changes, metatarsalgia. Harris mat impression was obtained and x-ray's performed.
After the surgery 15 feet were rated good to excellent. 6 feet rated poor to fair.
In this paper he advocates a particular strategy to know which of the metatarsal need to be addressed surgically, to both resolve the IPK and to limit also the risk of a possible transfer lesion to an adjacent metatarsal.
Although Dr. Leventen does not describe MIS surgery, in his paper, this strategic approach is advocated by some MIS surgeons.
Dr. Leventen performs conventional open surgery. Unlike the MIS surgeon, who perform a through-and-through osteotomy, Dr. Leventen's technique uses a partial osteotomy (closing wedge-type configuration with manual osteoclasis w/out fixation) to elevate the metatarsal head, modelled after the orthopedic surgeon, Wolf (1973).
Wolf would confine his attention to the affected metatarsal only. Leventen observed that many patients would subsequently require additional surgery to manage the problem of new pain and transfer lesions.
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