Prenatal diagnosis of congenital hallux varus deformity associated with pericentric inversion of chromosome 9.

PubMed

Gürel, Sebahat Atar

2015-04-01

Congenital hallux varus is a rare deformity of the great toe characterized by adduction of the hallux and medial displacement of the first metatarsophalangeal joint. Prenatal diagnosis of congenital hallux varus is presented herein. A 32-year-old woman was referred to our unit due to significant deviation of the fetal right great toe at 22(+2) weeks of pregnancy. Ultrasound examination revealed a thick and short great toe, which was significantly angulated medially on the right side. Amniocentesis was performed and the result was reported as inv(9) (p11;q12). After delivery, the clinical examination confirmed the prenatal diagnosis. To our knowledge, this is the first reported prenatal diagnosis of an isolated congenital hallux varus. Congenital hallux varus can be diagnosed easily in the prenatal period by 2-D and 4-D ultrasonography. Prenatal karyotyping should be taken into consideration, especially in the presence of associated anomalies, such as polydactyly and clubfoot. © 2014 The Author. Journal of Obstetrics and Gynaecology Research © 2014 Japan Society of Obstetrics and Gynecology.

[Distal soft-tissue procedure in hallux valgus deformity].

PubMed

Arbab, D; Wingenfeld, C; Frank, D; Bouillon, B; König, D P

2016-04-01

Distal, lateral soft tissue release to restore mediolateral balance of the first metatarsophalangeal (MTP) joint in hallux valgus deformity. Incision of the adductor hallucis tendon from the fibular sesamoid, the lateral capsule, the lateral collateral ligament, and the lateral metatarsosesamoid ligament. Hallux valgus deformities or recurrent hallux valgus deformities with an incongruent MTP joint. General medical contraindications to surgical interventions. Painful stiffness of the MTP joint, osteonecrosis, congruent joint. Relative contraindications: connective tissue diseases (Marfan syndrome, Ehler-Danlos syndrome). Longitudinal, dorsal incision in the first intermetatarsal web space between the first and second MTP joint. Blunt dissection and identification of the adductor hallucis tendon. Release of the adductor tendon from the fibular sesamoid. Incision of the lateral capsule, the lateral collateral ligament, and the lateral metatarsosesamoid ligament. Postoperative management depends on bony correction. In joint-preserving procedures, dressing for 3 weeks in corrected position. Subsequently hallux valgus orthosis at night and a toe spreader for a further 3 months. Passive mobilization of the first MTP joint. Postoperative weight-bearing according to the osteotomy. A total of 31 patients with isolated hallux valgus deformity underwent surgery with a Chevron and Akin osteotomy and a distal medial and lateral soft tissue balancing. The mean preoperative intermetatarsal (IMA) angle was 12.3° (range 11-15°); the hallux valgus (HV) angle was 28.2° (25-36°). The mean follow-up was 16.4 months (range 12-22 months). The mean postoperative IMA correction ranged between 2 and 7° (mean 5.2°); the mean HV correction was 15.5° (range 9-21°). In all, 29 patients (93%) were satisfied or very satisfied with the postoperative outcome, while 2 patients (7%) were not satisfied due to one delayed wound healing and one recurrent hallux valgus deformity. There were no infections, clinical and radiological signs of avascular necrosis of the metatarsal head, overcorrection with hallux varus deformity, or significant stiffness of the first MTP joint.

Traumatic hallux varus repair utilizing a soft-tissue anchor: a case report.

PubMed

Labovitz, J M; Kaczander, B I

2000-01-01

Hallux varus is usually iatrogenic in nature; however, congenital and acquired etiologies have been described in the literature. The authors present a case of traumatic hallux varus secondary to rupture of the adductor tendon. Surgical correction was performed using a soft tissue anchor for maintenance of the soft tissues utilized for repair.

Effect of medial arch support foot orthosis on plantar pressure distribution in females with mild-to-moderate hallux valgus after one month of follow-up.

PubMed

Farzadi, Maede; Safaeepour, Zahra; Mousavi, Mohammad E; Saeedi, Hassan

2015-04-01

Higher plantar pressures at the medial forefoot are reported in hallux valgus. Foot orthoses with medial arch support are considered as an intervention in this pathology. However, little is known about the effect of foot orthoses on plantar pressure distribution in hallux valgus. To investigate the effect of a foot orthosis with medial arch support on pressure distribution in females with mild-to-moderate hallux valgus. Quasi-experimental. Sixteen female volunteers with mild-to-moderate hallux valgus participated in this study and used a medial arch support foot orthosis for 4 weeks. Plantar pressure for each participant was assessed using the Pedar-X(®) in-shoe system in four conditions including shoe-only and foot orthosis before and after the intervention. The use of the foot orthosis for 1 month led to a decrease in peak pressure and maximum force under the hallux, first metatarsal, and metatarsals 3-5 (p < 0.05). In the medial midfoot region, peak pressure, maximum force, and contact area were significantly higher with the foot orthosis than shoe-only before and after the intervention (p = 0.00). A foot orthosis with medial arch support could reduce pressure beneath the hallux and the first metatarsal head by transferring the load to the other regions. It would appear that this type of foot orthosis can be an effective method of intervention in this pathology. Findings of this study will improve the clinical knowledge about the effect of the medial arch support foot orthosis used on plantar pressure distribution in hallux valgus pathology. © The International Society for Prosthetics and Orthotics 2014.

Comparison of outcomes between proximal and distal chevron osteotomy, both with supplementary lateral soft-tissue release, for severe hallux valgus deformity: A prospective randomised controlled trial.

PubMed

Park, H-W; Lee, K-B; Chung, J-Y; Kim, M-S

2013-04-01

Severe hallux valgus deformity is conventionally treated with proximal metatarsal osteotomy. Distal metatarsal osteotomy with an associated soft-tissue procedure can also be used in moderate to severe deformity. We compared the clinical and radiological outcomes of proximal and distal chevron osteotomy in severe hallux valgus deformity with a soft-tissue release in both. A total of 110 consecutive female patients (110 feet) were included in a prospective randomised controlled study. A total of 56 patients underwent a proximal procedure and 54 a distal operation. The mean follow-up was 39 months (24 to 54) in the proximal group and 38 months (24 to 52) in the distal group. At follow-up the hallux valgus angle, intermetatarsal angle, distal metatarsal articular angle, tibial sesamoid position, American Orthopaedic Foot and Ankle Society (AOFAS) hallux metatarsophalangeal-interphalangeal score, patient satisfaction level, and complications were similar in each group. Both methods showed significant post-operative improvement and high levels of patient satisfaction. Our results suggest that the distal chevron osteotomy with an associated distal soft-tissue procedure provides a satisfactory method for correcting severe hallux valgus deformity.

[A cadaveric study of a new capsulorrhaphy for the surgical treatment of hallux valgus].

PubMed

Orozco-Villaseñor, S L; Monzó-Planella, M; Martín-Oliva, X; Vázquez-Escamilla, J; Mayagoitia-Vázquez, J J; Frías-Chimal, J E

2017-01-01

There are many surgical options for the treatment of hallux valgus in combination with capsular repairs for the correction of hallux valgus. This report corresponds to a descriptive study where a new capsulorrhaphy technique in hallux valgus is proposed. Six dissections were performed on cadavers with hallux valgus deformity using the following surgical technique: medial approach on the first toe longitudinally, dissecting by planes and locating the metatarsophalangeal joint capsule; it was incised longitudinally. The capsule was separated and an exostectomy of the first metatarsal head was done, the edges were regularized and a release of the abductor hallucis was performed. Later, the capsular remnant was resected and repaired. Six cadaveric feet with hallux valgus were studied, five with mild deformity, one with moderate deformity, one foot with the 2nd finger on supraductus. Many capsular repairs have been reported in the literature, including «L», triangular, «V-Y», rectangular, with satisfactory results, along with osteotomy of the first metatarsal. In this report, a new capsular repair was described. Applying this new capsular repair, we reduced the metatarsophalangeal and intermetatarsal angles and achieved a capsular closure with suitable tension; the metatarsophalangeal joint mobility was preserved.

[Arthrodesis of the First Metatarsophalangeal Joint by Locking Plate].

PubMed

Kunovský, R; Pink, T; Jarošík, J

2017-01-01

PURPOSE OF THE STUDY The authors in their paper evaluate a group of patients who underwent arthrodesis of the first metatarsophalangeal joint using a locking plate. MATERIAL AND METHODS In the period 2010-2015, we performed surgery in 51 patients (56 forefeet), of which in 5 cases bilaterally and in 46 cases unilaterally, in 38 women and 13 men. The mean age was 57.8 years, the mean follow-up was 3.1 years. The indications for surgery were hallux rigidus in 23 patients, hallux valgus in 15 patients, hallux varus in 3 patients, and hallux erectus in 2 patients. In 4 patients the surgery was performed for valgus deformity associated with rheumatoid arthritis, 9 patients were indicated for a failure of the prior surgical intervention. In all 56 forefeet, the anatomic, low-profile titanium plate Variable Angle LCP 1st MTP Fusion Plate 2.4/2.7 was used. RESULTS According to Gainor s score the surgical outcomes were assessed as excellent in 46 patients who underwent surgery (90%), good in 4 patients (8%), fair in 1 patient (2%), and poor in 0 patient (0%). In 53 forefeet, the control radiographs showed solid bone union. In 2 patients and 3 forefeet, non-union of the arthrodesis occurred. In 2 forefeet, revision arthrodesis was performed, after which solid bone union followed. Malpositioned union was reported in 5 forefeet, of which in 4 cases into valgosity and in 1 case into dorsiflexion. DISCUSSION Numerous fixation materials can be used for arthrodesis of the first metatarsophalangeal joint. The use of the least stable Kirschner wires (cerclage) is being abandoned and substituted with a more stable fixation by screws, memory staples and locking plates. The achievement of excellent results requires proper positioning of the arthrodesis. Impingement syndrome between the big toe and the second toe can result in painful callosities formation, too large dorsiflexion can lead to a hallux hammertoe, with reduced big toe support function, to metatarsalgia. CONCLUSIONS The arthrodesis is indicated in patients with Grade III and IV hallux rigidus, with severe hallux valgus, hallux varus, and in patients in whom the previous surgeries failed. We tend to prefer stable arthrodesis. Fixation by anatomic LCP plate facilitates early rehabilitation, loading and early return to work and sports activities. Key words: arthrodesis, metatarsophalangeal joint, hallux rigidus, hallux valgus.

Equivalent correction in scarf and chevron osteotomy in moderate and severe hallux valgus: a randomized controlled trial.

PubMed

Deenik, Axel; van Mameren, Henk; de Visser, Enrico; de Waal Malefijt, Maarten; Draijer, Frits; de Bie, Rob

2008-12-01

Chevron osteotomy is a widely accepted osteotomy for correction of hallux valgus.(18) Algorithms were developed to overcome the limitations of distal osteotomies. Scarf osteotomy has become popular as a versatile procedure that should be able to correct most cases of acquired hallux valgus. The purpose of this study was to evaluate whether patients with moderate or severe hallux valgus have better correction with a scarf osteotomy as compared to chevron osteotomy. After informed consent, 136 feet in 115 patients were randomized to 66 scarf and 70 chevron osteotomies. Deformities of patients were classified as mild, moderate and severe according to IMA, and both groups were compared with independent t-tests. The results were measured using radiographic HVA, IMA and DMAA measurements. There were no statistical differences in HVA, IMA and DMAA between scarf and chevron osteotomy in mild to moderate hallux valgus. In severe hallux valgus, chevron osteotomy corrected HVA better than scarf osteotomy, although this group consisted of twelve patients only. Five patients in the chevron group and seven in the scarf group developed recurrent subluxation of the metatarsophalangeal joint. In patients with moderate and severe hallux valgus, the results of chevron osteotomy were at least as effective as a scarf osteotomy. Recurrent subluxation of the first metatatarsophalangeal joint was the main cause for insufficient correction. We favor the chevron osteotomy because it is less invasive, without sacrificing correction of HVA and IMA.

Improved ankle push-off power following cheilectomy for hallux rigidus: a prospective gait analysis study.

PubMed

Smith, Sheryl M; Coleman, Scott C; Bacon, Stacy A; Polo, Fabian E; Brodsky, James W

2012-06-01

There is limited objective scientific information on the functional effects of cheilectomy. The purpose of this study was to test the hypothesis that cheilectomy for hallux rigidus improves gait by increasing ankle push-off power. Seventeen patients with symptomatic Stage 1 or Stage 2 hallux rigidus were studied. Pre- and postoperative first metatarsophalangeal (MTP) range of motion and AOFAS hallux scores were recorded. A gait analysis was performed within 4 weeks prior to surgery and repeated at a minimum of 1 year after surgery. Gait analysis was done using a three-dimensional motion capture system and a force platform embedded in a 10-m walkway. Gait velocity sagittal plane ankle range of motion and peak sagittal plane ankle push-off power were analyzed. Following cheilectomy, significant increases were noted for first MTP range of motion and AOFAS hallux score. First MTP motion improved an average of 16.7 degrees, from means of 33.9 degrees preoperatively to 50.6 degrees postoperatively (p<0.001). AOFAS hallux score increased from 62 to 81 (p<0.007). As demonstrated through gait anaylsis, a significant increase in postoperative peak sagittal plane ankle push-off power from 1.71±0.92 W/kg to 2.05±0.75 W/kg (p<0.04). In addition to clinically increased range of motion and improved AOFAS Hallux score, first MTP joint cheilectomy produced objective improvement in gait, as measured by increased peak sagittal-plane ankle push-off power.

Medial capsular interpositional arthroplasty for severe hallux rigidus.

PubMed

Hahn, Michael Patrick; Gerhardt, Nels; Thordarson, David B

2009-06-01

Multiple surgical options have been described for severe hallux rigidus. One option is capsular interpositional arthroplasty. We report our initial results with a technique using the thicker medial capsule as our interpositional material instead of the dorsal capsule and extensor hallucis brevis (EHB). Twenty-two patients with grade IV hallux rigidus underwent minimal proximal phalanx resection (modified Keller) with preservation of the flexor hallucis brevis (FHB) insertion and medial capsular interpositional arthroplasty. Postoperative AOFAS hallux MTP-IP scores (mean 77.8), and SF-36 scores (mean 68.7 on physical function, 79.5 role limitations) demonstrated clinical improvement compared to historical controls. Alignment and stability were well maintained (mean preoperative HV angle of 11.8 degrees, mean postoperative HV angle of 13.0 degrees). Dorsiflexion/plantarflexion arc of motion showed sustained improvement (mean 38.4 degrees preoperative, mean 62.3 degrees postoperative). These results are comparable to other forms of interpositional arthroplasty and arthrodesis for end stage arthritis of the hallux MTPJ.

Short-Term Radiographic Outcome After Distal Chevron Osteotomy for Hallux Valgus Using Intramedullary Plates With an Amended Algorithm for the Surgical Management of Hallux Valgus.

PubMed

Matsumoto, Takumi; Gross, Christopher E; Parekh, Selene G

2018-03-01

Distal Chevron osteotomy is a well-established surgical procedure for mild to moderate hallux valgus deformity. Many methods have been described for fixation of osteotomy site; secure fixation, enabling large displacement of the metatarsal head, is one of the essentials of this procedure. The purpose of the present study was to evaluate the short-term radiographic outcome of a distal Chevron osteotomy using an intramedullary plate for the correction of hallux valgus deformity. The present study evaluated 37 patients (40 feet) who underwent distal Chevron osteotomy using an intramedullary plate by periodic radiographs obtained preoperatively and at 4 weeks, 8 weeks, 3 months, and 6 months postoperatively. Correction of the hallux valgus angle averaged 17.8°, intermetatarsal angle 7.4°, distal metatarsal articular angle 2.7°, and sesamoid position 1.4 stages at 3 months postoperatively. The average lateral shift of the capital fragment was 6.5 mm. All patients achieved bone union, and there were no cases of dislocation, displacement, or avascular necrosis of the metatarsal head fragment. In conclusion, a distal Chevron osteotomy using an intramedullary plate was a favorable method for the correction of mild to moderate hallux valgus deformity. Level IV: Case series.

Prophylactic stretching does not reduce cramp susceptibility.

PubMed

Miller, Kevin C; Harsen, James D; Long, Blaine C

2018-03-01

Some clinicians advocate stretching to prevent muscle cramps. It is unknown whether static or proprioceptive neuromuscular facilitation (PNF) stretching increases cramp threshold frequency (TF c ), a quantitative measure of cramp susceptibility. Fifteen individuals completed this randomized, counterbalanced, cross-over study. We measured passive hallux range of motion (ROM) and then performed 3 minutes of either static stretching, PNF stretching (hold-relax-with agonist contraction), or no stretching. ROM was reassessed and TF c was measured. PNF stretching increased hallux extension (pre-PNF 81 ± 11°, post-PNF 90 ± 10°; P < 0.05) but not hallux flexion (pre-PNF 40 ± 7°, post-PNF 40 ± 7°; P > 0.05). Static stretching increased hallux extension (pre-static 80 ± 11°, post-static 88 ± 9°; P < 0.05) but not hallux flexion (pre-static 38 ± 9°, post-static 39 ± 8°; P > 0.05). No ROM changes occurred with no stretching (P > 0.05). TF c was unaffected by stretching (no stretching 18 ± 7 Hz, PNF 16 ± 4 Hz, static 16 ± 5 Hz; P = 0.37). Static and PNF stretching increased hallux extension, but neither increased TF c . Acute stretching may not prevent muscle cramping. Muscle Nerve 57: 473-477, 2018. © 2017 Wiley Periodicals, Inc.

A comparison of proximal and distal Chevron osteotomy, both with lateral soft-tissue release, for moderate to severe hallux valgus in patients undergoing simultaneous bilateral correction: a prospective randomised controlled trial.

PubMed

Lee, K B; Cho, N Y; Park, H W; Seon, J K; Lee, S H

2015-02-01

Moderate to severe hallux valgus is conventionally treated by proximal metatarsal osteotomy. Several recent studies have shown that the indications for distal metatarsal osteotomy with a distal soft-tissue procedure could be extended to include moderate to severe hallux valgus. The purpose of this prospective randomised controlled trial was to compare the outcome of proximal and distal Chevron osteotomy in patients undergoing simultaneous bilateral correction of moderate to severe hallux valgus. The original study cohort consisted of 50 female patients (100 feet). Of these, four (8 feet) were excluded for lack of adequate follow-up, leaving 46 female patients (92 feet) in the study. The mean age of the patients was 53.8 years (30.1 to 62.1) and the mean duration of follow-up 40.2 months (24.1 to 80.5). After randomisation, patients underwent a proximal Chevron osteotomy on one foot and a distal Chevron osteotomy on the other. At follow-up, the American Orthopedic Foot and Ankle Society (AOFAS) hallux metatarsophalangeal interphalangeal (MTP-IP) score, patient satisfaction, post-operative complications, hallux valgus angle, first-second intermetatarsal angle, and tibial sesamoid position were similar in each group. Both procedures gave similar good clinical and radiological outcomes. This study suggests that distal Chevron osteotomy with a distal soft-tissue procedure is as effective and reliable a means of correcting moderate to severe hallux valgus as proximal Chevron osteotomy with a distal soft-tissue procedure. ©2015 The British Editorial Society of Bone & Joint Surgery.

Proximal reverse chevron metatarsal osteotomy, lateral soft tissue release, and akin osteotomy through a single medial incision for hallux valgus.

PubMed

Jung, Hong-Geun; Kim, Tae-Hoon; Park, Jong-Tae; Shin, Min-Ho; Lee, Sang-Hun

2014-04-01

Scarring on the dorsal first web space after lateral soft tissue release can be a major contributor to patient dissatisfaction following hallux valgus surgery. We hypothesized that performing distal soft tissue procedure (DSTP), proximal reverse chevron metatarsal osteotomy (PCMO), and Akin osteotomy through a single medial incision would provide better clinical and radiographic results with improved patient satisfaction compared with bunion corrections performed through 2 incisions. The study included 117 feet (of 98 patients) with moderate to severe hallux valgus. Clinically, the preoperative and final follow-up visual analog scale (VAS) pain scores, the preoperative and final follow-up American Orthopaedic Foot & Ankle Society (AOFAS) hallux metatarsophalangeal (MTP)-interphalangeal (IP) scores, first MTP joint range of motion (ROM), and patient satisfaction after the surgery were evaluated. Radiographically, the hallux valgus angle (HVA), intermetatarsal angle (IMA), hallux valgus interphalangeal angle (HIA), medial sesamoid position (MSP), and first to fifth metatarsal width (1-5MTW) were analyzed before and after surgery. The mean AOFAS hallux score improved from 56.3 preoperatively to 90.6 at the final follow-up, and the mean VAS pain score decreased from 6.8 preoperatively to 1.5 at the final follow-up (P < .001). Ninety-five percent of the patients were satisfied with the surgery. Radiographically, the mean HVA decreased from 36.1 degrees (range, 16.0 to 44.0 degrees) preoperatively to 5.4 degrees (range, -12.4 to 29.7 degrees) at the final follow-up (P < .001), and the mean IMA decreased from 19.0 degrees (range, 9.0 to 28.0 degrees) preoperatively to 4.5 degrees (range, -5.0 to 14.2 degrees) at the final follow-up (P < .001). The mean 1-5MTW also decreased by 16% (16 mm) from 97.3 mm (range, 85.0 to 110.0 mm) preoperatively to 81.3 mm (range, 70.0 to 95.0 mm) at the final follow-up (P < .001). We achieved very favorable clinical and radiographic outcomes with minimal complications in patients with moderate to severe hallux valgus, by treating hallux valgus using DSTP, PCMO, and Akin osteotomy through a single medial incision. The single medial incision scar improved the cosmetic results by avoiding the formation of a disfiguring dorsal first web space scar. Level IV, retrospective case series.

Evaluating the Quality, Accuracy, and Readability of Online Resources Pertaining to Hallux Valgus.

PubMed

Tartaglione, Jason P; Rosenbaum, Andrew J; Abousayed, Mostafa; Hushmendy, Shazaan F; DiPreta, John A

2016-02-01

The Internet is one of the most widely utilized resources for health-related information. Evaluation of the medical literature suggests that the quality and accuracy of these resources are poor and written at inappropriately high reading levels. The purpose of our study was to evaluate the quality, accuracy, and readability of online resources pertaining to hallux valgus. Two search terms ("hallux valgus" and "bunion") were entered into Google, Yahoo, and Bing. With the use of scoring criteria specific to hallux valgus, the quality and accuracy of online information related to hallux valgus was evaluated by 3 reviewers. The Flesch-Kincaid score was used to determine readability. Statistical analysis was performed with t tests and significance was determined by P values <.05. Sixty-two unique websites were evaluated. Quality was significantly higher with use of the search term "bunion" as compared to "hallux valgus" (P = .045). Quality and accuracy were significantly higher in resources authored by physicians as compared to nonphysicians (quality, P = .04; accuracy, P < .001) and websites without commercial bias (quality, P = .038; accuracy, P = .011). However, the reading level was significantly more advanced for websites authored by physicians (P = .035). Websites written above an eighth-grade reading level were significantly more accurate than those written at or below an eighth-grade reading level (P = .032). The overall quality of online information related to hallux valgus is poor and written at inappropriate reading levels. Furthermore, the search term used, authorship, and presence of commercial bias influence the value of these materials. It is important for orthopaedic surgeons to become familiar with patient education materials, so that appropriate recommendations can be made regarding valuable resources. Level IV. © 2015 The Author(s).

Long-term Follow-up of a Randomized Controlled Trial Comparing Scarf to Chevron Osteotomy in Hallux Valgus Correction.

PubMed

Jeuken, Ralph M; Schotanus, Martijn G M; Kort, Nanne P; Deenik, Axel; Jong, Bob; Hendrickx, Roel P M

2016-07-01

Hallux valgus is one of the most common foot deformities. This long-term follow-up study compared the results of 2 widely used operative treatments for hallux valgus: the scarf and chevron osteotomy. Conventional weight bearing anteroposterior (AP) radiographs of the foot were made for evaluating the intermetatarsal angle and hallux valgus angle. For clinical evaluation, the American Orthopaedic Foot & Ankle Society (AOFAS) rating system for the hallux metatarsophalangeal-interphalangeal scale was used together with physical examination of the foot. These data were compared with the results from the original study. The Short Form 36 questionnaire, the Manchester-Oxford Foot Questionnaire (MOXFQ), and a general questionnaire including a visual analog scale (VAS) pain score were used for subjective evaluation. The primary outcome measures were the radiologic recurrence of hallux valgus and reoperation rate of the same toe. Secondary outcome measures were the results from the radiographs and subjective and clinical evaluation. The response rate was 76% at the follow-up of 14 years; in the chevron group, 37 feet were included compared with 36 feet in the scarf group. Twenty-eight feet in the chevron group and 27 in the scarf group developed recurrence of hallux valgus (P = .483). One patient in the scarf group had a reoperation of the same toe compared with none in the chevron group (P = .314). Current VAS pain scores and results from the SF-36, MOXFQ, and AOFAS did not significantly differ between groups. Both techniques showed similar results after 2 years of follow-up. At 14 years of follow-up, neither technique was superior in preventing recurrence. Level II, randomized controlled trial. © The Author(s) 2016.

A geometric analysis of hallux valgus: correlation with clinical assessment of severity

PubMed Central

Piqué-Vidal, Carlos; Vila, Joan

2009-01-01

Background Application of plane geometry to the study of bunion deformity may represent an interesting and novel approach in the research field of hallux valgus. For the purpose of contributing to development of a different perspective in the assessment of hallux valgus, this study was conducted with three objectives: a) to determine the position on the intersection point of the perpendicular bisectors of the longitudinal axes of the first metatarsal and proximal phalanx (IP), b) to correlate the location of this point with hallux valgus deformity according to angular measurements and according to visual assessment of the severity carried out by three independent observers, and c) to assess whether this IP correlated with the radius of the first metatarsophalangeal arc circumference. Methods Measurements evaluated were intermetatarsal angle (IMA), hallux valgus angle (HVA), and proximal phalangeal articular angle (PPAA). The Autocad® program computed the location of the IP inside or outside of the foot. Three independent observers rated the severity of hallux valgus in photographs using a 100-mm visual analogue scale (VAS). Results Measurements of all angles except PPAA showed significantly lower values when the IP was located out of the foot more distantly and vice versa, significantly higher values for severe deformities in which the IP was found inside the foot (p < 0.001). The IP correlated significantly with VAS scores and with the length of the radius of the circle that included the first metatarsophalangeal arc circumference (p < 0.001) Conclusion The IP is a useful indicator of hallux valgus deformity because correlated significantly with IMA and HVA measurements, VAS scores obtained by visual inspection of the degree of deformity, and location of the center of the first metatarsophalangeal arc circumference. PMID:19442286

[Treatment of Hallux Valgus: Current Diagnostic Testing and Surgical Treatment Performed by German Foot and Ankle Surgeons].

PubMed

Arbab, Dariusch; Schneider, Lisa-Maria; Schnurr, Christoph; Bouillon, Bertil; Eysel, Peer; König, Dietmar Pierre

2018-04-01

Hallux valgus is one of the most prevalent foot deformities, and surgical treatment of Hallux valgus is one of the most common procedures in foot and ankle surgery. Diagnostic and treatment standards show large variation despite medical guidelines and national foot and ankle societies. The aim of this nationwide survey is a description of the current status of diagnostics and therapy of Hallux valgus in Germany. A nationwide online questionnaire survey was sent to two German foot and ankle societies. The participants were asked to answer a questionnaire of 53 questions with four subgroups (general, diagnostics, operation, preoperative management). Surgical treatment for three clinical cases demonstrating a mild, moderate and severe Hallux valgus deformity was inquired. 427 foot and ankle surgeons answered the questionnaire. 388 participants were certified foot and ankle surgeons from one or both foot and ankle societies. Medical history (78%), preoperative radiographs (100%) and preoperative radiographic management (78%) are of high or very high importance for surgical decision pathway. Outcome scores are used by less than 20% regularly. Open surgery is still the gold standard, whereas minimally invasive surgery is performed by only 7%. Our survey showed that diagnostic standards are met regularly. There is a wide variation in the type of procedures used to treat Hallux valgus deformity. TMT I arthrodesis is preferred in severe Hallux valgus, but also used to treat moderate and mild deformities. Minimally invasive surgery is still used by a minority of surgeons. It remains to be seen, to what extent minimally invasive surgery will be performed in the future. Georg Thieme Verlag KG Stuttgart · New York.

Rolled Tendon Allograft Interposition Arthroplasty for Salvage Surgery of the Hallux Metatarsophalangeal Joint.

PubMed

Thomas, Danielle; Thordarson, David

2018-04-01

Hallux rigidus is a common osteoarthritic disease of the first metatarsophalangeal joint (MTPJ). Few salvage treatment options exist that preserve motion for patients who have failed an initial procedure and who are not amenable to fusion, typically patients who are active or who would like to wear high heels. Allograft tendon interpositional arthroplasty is an unconventional salvage treatment option that may preserve motion and prevent bone loss. A retrospective chart review is reported of 19 patients who failed previous procedures and refused fusion who underwent allograft tendon interpositional arthroplasty of the hallux MTPJ by a single surgeon between 2012 and 2015. Outcomes included the American Orthopaedic Foot & Ankle Society (AOFAS) hallux metatarsophalangeal-interphalangeal scale assessment as well as measurement of apparent joint space on anterior to posterior and lateral views. The cumulative average AOFAS score for all patients was 68.5 preoperatively and 74.1 postoperatively. The average AOFAS pain subscore was 24.7 preoperatively and 26.8 postoperatively (SD = 7.7 and 13.8, respectively). Radiographically, patients had an increase in apparent joint space from pre- to postoperatively, most notable on the lateral view (0.6 to 4.7 mm; SD = 0.7 and 3.2 mm). Five patients required a second operative procedure, for an overall 26% reoperation rate. One patient underwent hallux MTPJ fusion after the interpositional arthroplasty. An additional 4 patients (21%) had symptoms requiring a steroid injection, and another 3 patients (16%) were recommended to undergo a revision procedure based on their symptoms. Rolled allograft tendon interposition arthroplasty performed poorly as a salvage strategy for failed previous hallux MTPJ surgery for hallux rigidus because of a high rate of complication and minimal benefits. The senior author has abandoned the technique. Level IV, retrospective case series.

Comparison of Clinical Outcomes of Scarf and Chevron Osteotomies and the McBride Procedure in the Treatment of Hallux Valgus Deformity

PubMed Central

Fakoor, Mohammad; Sarafan, Naser; Mohammadhoseini, Payam; Khorami, Mohsen; Arti, Hamidreza; Mosavi, SeyedShahnam; Aghaeeaghdam, Amir

2014-01-01

Background: Hallux valgus deformity is a common chronic problem with a reported prevalence of 28.4% and its chief complaint is pain. Thus far, different surgical procedures with their proposed indications have been introduced. This study compared three current procedures, namely the chevron and scarf osteotomies and the McBride procedure. Methods: This retrospective cohort was conducted at the Ahvaz University of Medical Sciences on 44 patients with moderate hallux valgus deformity from 2010 and 2013. All of the patients underwent one of the three procedures (chevron, scarf or McBride). Preoperative and follow up radiographies were evaluated in terms of hallux valgus and intermetatarsal angle correction. The Foot and Ankle Disability Index was filled out to assess the functional outcome and the Visual Analogue Scale was used to evaluate pain. Also, satisfaction, aesthetics and the rate of recurrence was evaluated. Results: Hallux valgus angle and intermetatarsal angle correction were significantly higher in scarf, but not in chevron and McBride. However, from amongst the three procedures, there was no significant difference in terms of the Foot and Ankle Disability Index score, aesthetics, satisfaction level, pain score and recurrence rate. Conclusions: Considering that scarf osteotomy had better results in this study, we think that scarf osteotomy can be considered as a first choice for the treatment of moderate hallux valgus deformity. PMID:25207310

Distal chevron osteotomy with distal soft tissue procedure for moderate to severe hallux valgus deformity.

PubMed

Bai, Long Bin; Lee, Keun Bae; Seo, Chang Young; Song, Eun Kyoo; Yoon, Taek Rim

2010-08-01

Distal chevron osteotomy has been widely employed to treat mild to moderate hallux valgus deformity. The purpose of the present study was to evaluate the outcomes of distal chevron osteotomy with a distal soft tissue procedure for the correction of moderate to severe hallux valgus. We reviewed 76 patients (86 feet) that underwent distal chevron osteotomy with a distal soft tissue procedure for symptomatic moderate to severe hallux valgus deformity. At a mean followup of 31 months, all patients were evaluated using subjective, objective and radiographic measurements. Ninety-four percent of the patients were very satisfied or satisfied. Average AOFAS score improved from 54.7 points preoperatively to 92.9 at final followup. Average hallux valgus angle changed from 36.2 degrees preoperatively to 12.4 degrees at final followup, and average first-second intermetatarsal angle changed from 17.1 to 7.3 degrees. Average tibial sesamoid position changed from 2.4 preoperatively to 1.2 at final followup. Dorsal angulation of the head was observed in two feet, and plantaflexion of the head in four feet. There were no cases of avascular necrosis of the metatarsal head. Our results indicate that distal chevron osteotomy with a distal soft tissue procedure provides an effective and reliable means of correcting moderate to severe hallux valgus deformity, and that it does so with high levels of patient satisfaction and low incidence of complications.

Comparison of Clinical Outcomes of Scarf and Chevron Osteotomies and the McBride Procedure in the Treatment of Hallux Valgus Deformity.

PubMed

Fakoor, Mohammad; Sarafan, Naser; Mohammadhoseini, Payam; Khorami, Mohsen; Arti, Hamidreza; Mosavi, SeyedShahnam; Aghaeeaghdam, Amir

2014-03-01

Hallux valgus deformity is a common chronic problem with a reported prevalence of 28.4% and its chief complaint is pain. Thus far, different surgical procedures with their proposed indications have been introduced. This study compared three current procedures, namely the chevron and scarf osteotomies and the McBride procedure. This retrospective cohort was conducted at the Ahvaz University of Medical Sciences on 44 patients with moderate hallux valgus deformity from 2010 and 2013. All of the patients underwent one of the three procedures (chevron, scarf or McBride). Preoperative and follow up radiographies were evaluated in terms of hallux valgus and intermetatarsal angle correction. The Foot and Ankle Disability Index was filled out to assess the functional outcome and the Visual Analogue Scale was used to evaluate pain. Also, satisfaction, aesthetics and the rate of recurrence was evaluated. Hallux valgus angle and intermetatarsal angle correction were significantly higher in scarf, but not in chevron and McBride. However, from amongst the three procedures, there was no significant difference in terms of the Foot and Ankle Disability Index score, aesthetics, satisfaction level, pain score and recurrence rate. Considering that scarf osteotomy had better results in this study, we think that scarf osteotomy can be considered as a first choice for the treatment of moderate hallux valgus deformity.

Hallux valgus in a historical French population: paleopathological study of 605 first metatarsal bones.

PubMed

Mafart, Bertrand

2007-03-01

To estimate the prevalence of hallux valgus in a historical population in France, to identify associated skeletal abnormalities, and to look for an influence of footwear changes through time. We studied the 605 first metatarsals found in the necropolis of the Notre-Dame-du-Bourg cathedral in Digne in the Alpes-de-Hautes-Provence region of southern France. The necropolis contains remains from the 5th to the 17th century. Hallux valgus was identified only in individuals older than 30years at death, and its prevalence increased significantly with age. Exostosis at the medial and dorsal aspects of the head of the first metatarsal were common in advanced forms. The prevalence was comparable in males and females in the Middle Ages but was significantly higher in males in the 16th and 17th centuries, whereas in contemporary populations females are selectively affected. The increase in the prevalence of hallux valgus over time suggests an influence of changes in footwear. The heeled shoes and boots made of stiff leather that men wore in premodern times probably promoted the development of hallux valgus. However, the prevalence of hallux valgus in women in western industrialized countries today is even higher than that in our historical population of older premodern individuals, suggesting an extremely deleterious effect of contemporary female footwear.

Intra- and Interobserver Reliability of Three Classification Systems for Hallux Rigidus.

PubMed

Dillard, Sarita; Schilero, Christina; Chiang, Sharon; Pham, Peter

2018-04-18

There are over ten classification systems currently used in the staging of hallux rigidus. This results in confusion and inconsistency with radiographic interpretation and treatment. The reliability of hallux rigidus classification systems has not yet been tested. The purpose of this study was to evaluate intra- and interobserver reliability using three commonly used classifications for hallux rigidus. Twenty-one plain radiograph sets were presented to ten ACFAS board-certified foot and ankle surgeons. Each physician classified each radiograph based on clinical experience and knowledge according to the Regnauld, Roukis, and Hattrup and Johnson classification systems. The two-way mixed single-measure consistency intraclass correlation was used to calculate intra- and interrater reliability. The intrarater reliability of individual sets for the Roukis and Hattrup and Johnson classification systems was "fair to good" (Roukis, 0.62±0.19; Hattrup and Johnson, 0.62±0.28), whereas the intrarater reliability of individual sets for the Regnauld system bordered between "fair to good" and "poor" (0.43±0.24). The interrater reliability of the mean classification was "excellent" for all three classification systems. Conclusions Reliable and reproducible classification systems are essential for treatment and prognostic implications in hallux rigidus. In our study, Roukis classification system had the best intrarater reliability. Although there are various classification systems for hallux rigidus, our results indicate that all three of these classification systems show reliability and reproducibility.

Evaluation of Hallux Valgus Correction With Versus Without Akin Proximal Phalanx Osteotomy.

PubMed

Shibuya, Naohiro; Thorud, Jakob C; Martin, Lanster R; Plemmons, Britton S; Jupiter, Daniel C

2016-01-01

Although the efficacy of Akin proximal phalanx closing wedge osteotomy as a sole procedure for correction of hallux valgus deformity is questionable, when used in combination with other osseous corrective procedures, the procedure has been believed to be efficacious. However, a limited number of comparative studies have confirmed the value of this additional procedure. We identified patients who had undergone osseous hallux valgus correction with first metatarsal osteotomy or first tarsometatarsal joint arthrodesis with (n = 73) and without (n = 81) Akin osteotomy and evaluated their radiographic measurements at 3 points (preoperatively, within 3 months after surgery, and ≥6 months after surgery). We found that those people who had undergone the Akin procedure tended to have a larger hallux abduction angle and a more laterally deviated tibial sesamoid position preoperatively. Although the radiographic correction of the deformity was promising immediately after corrective surgery with the Akin osteotomy, maintenance of the correction was questionable in our cohort. The value of additional Akin osteotomy for correction of hallux valgus deformity is uncertain. Published by Elsevier Inc.

New modified technique of osteotomy for hallux valgus.

PubMed

Oh, I S; Kim, M K; Lee, S H

2004-12-01

To improve the technique of osteotomy for hallux valgus (bunion). 38 cases of a new modified osteotomy procedure for hallux valgus were performed for 22 patients (21 women and one man). During a 3-year (range, 2-5 years) follow-up, the patients underwent physical examination; and their American Orthopedic Foot and Ankle Society hallux-metatarso-phalangeal-interphalangeal scale scores and standard foot radiographic measurements were recorded. 20 of the 22 patients (38 cases) had no pain, achieved good cosmesis, and were completely satisfied with the results of the operation. The remaining 2 patients had occasional mild discomfort. The mean hallux-metatarso-phalangeal-interphalangeal scale score was 93 points (range, 78-100 points). The mean preoperative and postoperative metatarsophalangeal angles were 34 degrees and 11 degrees, respectively. The mean postoperative reduction of the intermetatarsal angle and metatarsophalangeal angle were 6 degrees and 23 degrees, respectively. The new technique of osteotomy achieved even greater stability and accurate correction of the deformity in our 38 cases. Furthermore, it was more effective than conventional 'chevron' osteotomy in terms of correction of the deformity. Therefore, it should be used more widely.

Modified Chevron osteotomy for hallux valgus deformity in female athletes. A 2-year follow-up study.

PubMed

Giotis, Dimitrios; Paschos, Nikolaos K; Zampeli, Franceska; Giannoulis, Dionisios; Gantsos, Apostolos; Mantellos, George

2016-09-01

Hallux valgus is an increasingly common deformity in young female athletes that constricts their daily athletic activities and influences foot cosmesis. The aim of this study was to evaluate the outcome of modified Chevron osteotomy for hallux valgus deformity in this specific population. Forty-two cases of modified Chevron osteotomies were carried out in 33 patients with mild to moderate hallux valgus deformity. Each participant was evaluated for AOFAS score, pain, range of motion, cosmetic and radiological outcome. Mean AOFAS score improved to 96.3 (p<0.001) while the mean range of motion of the metatarsophalangeal joint was maintained (p=0.138). The cosmetic result was excellent/good in 40 cases (95%). Mean metatarsophalangeal and intermetatarsal angles were decreased from 29.8° and 14.2° preoperatively to 12.2° and 8.1° postoperatively (p<0.001 and p<0.036), respectively. Modified Chevron osteotomy could offer substantial correction of hallux valgus deformity in young female athletes, with excellent clinical outcome. Copyright © 2015 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.

Longitudinal bracketed epiphysis of proximal phalanx of the great toe with congenital hallux varus managed simultaneously with monorail external fixator: a case report.

PubMed

Verma, Vineet; Batra, Amit; Singla, Rohit; Gogna, Paritosh; Magu, Narender; Gupta, Rakesh

2014-02-01

Longitudinal bracketed epiphysis (delta phalanx) is a rare congenital anomaly that affects phalanges in the hand more commonly than toes. We present a rare case of congenital hallux varus with longitudinal bracketed epiphysis of proximal phalanx with bifid distal phalanx of the great toe, which was managed with monorail type of external fixator. To the best of our knowledge, this is the first report of its successful implementation in simultaneous treatment of longitudinal bracketed epiphysis of the proximal phalanx of the great toe and hallux varus. Apart from adding to the literature a case of rare subtype of delta phalanx with hallux varus, the present study highlights the role of a reliable alternative in its management.

Stabilization of chevron bunionectomy with a capsuloperiosteal flap.

PubMed

Guclu, Berk; Kaya, Alper; Akan, Burak; Koken, Murat; Kemal Us, Ali

2011-04-01

Distal chevron osteotomy (DCO) for mild to moderate hallux valgus deformity is inherently more stable than the other forms of distal metatarsal osteotomy, but complications such as loss of correction, infection, joint stiffness, delayed union, malunion and nonunion can occur. In this study, we evaluated the use of a capsuloperiosteal flap for stabilization of DCO in the treatment of hallux valgus. A retrospective study was conducted on 59 patients (88 feet) that underwent distal Chevron osteotomy stabilized only with a capsuloperiosteal flap for mild and moderate hallux valgus deformity with a mean followup of 11.3 years. Clinical evaluation was calculated using the hallux score of the American Orthopaedic Foot and Ankle Society (AOFAS). The score improved from a preoperative mean of 52 to a mean of 91.5 points at last followup. Average hallux valgus angle changed from 30.3 degrees preoperatively to 14.2 degrees postoperatively at the last followup. Intermetatarsal angle 1-2 changed from 13.6 degrees preoperatively to 10.2 degrees postoperatively. The correction proved to be consistent with only an average of 3.4-degree correction loss and 4.9-degree loss in the range of motion. Eighty-six feet (97.7%) were pain free. Discomfort with shoewear was absent in 84 feet (95.5%) postoperatively and 24 of 25 (96%) patients were satisfied cosmetically. Capsuloperiosteal flap stabilization of distal chevron osteotomy for mild-moderate hallux valgus yielded excellent clinical results at long-term followup.

Preoperative radiological factors correlated to long-term recurrence of hallux valgus following distal chevron osteotomy.

PubMed

Pentikainen, Ilkka; Ojala, Risto; Ohtonen, Pasi; Piippo, Jouni; Leppilahti, Juhana

2014-12-01

The purpose of this article was to analyze the long-term radiologic results after distal chevron osteotomy for hallux valgus treatment and to determine the preoperative radiographic factors correlating with radiological recurrence of the deformity. The study included 100 consecutive patients who received distal chevron osteotomy for hallux valgus. The osteotomy included fixation with an absorbable pin in 50 cases, and no fixation in the other 50. For 6 weeks postoperatively, half of each group used a soft cast and half had a traditional elastic bandage. Weight-bearing radiographs were evaluated at 6 weeks, 6 months, 1 year, and a mean of 7.9 (range, 5.8-9.4) years postoperatively. At the final follow-up, radiological recurrence of hallux valgus deformity (HVA > 15 degrees) was observed in 56 feet (73%). Eleven feet (14%) had mild recurrence (HVA < 20 degrees), 44 (57%) moderate (20 degrees ≥ HVA < 40 degrees), and 1 (1%) severe (HVA ≥ 40 degrees). All recurrences were painless, and thus no revision surgery was required. Long-term hallux valgus recurrence was significantly affected by preoperative congruence, DMAA, sesamoid position, HVA, and I/II IMA. Radiological recurrence of hallux valgus deformity of 15 degrees or more was very common at long-term follow-up after distal chevron osteotomy. Preoperative congruence, DMAA, sesamoid position (LaPorta), HVA, and I/II IMA significantly affected recurrence. Level III, comparative case series. © The Author(s) 2014.

Comparative study of scarf and extended chevron osteotomies for correction of hallux valgus.

PubMed

Vopat, Bryan G; Lareau, Craig R; Johnson, Julie; Reinert, Steven E; DiGiovanni, Christopher W

2013-12-01

Scarf and chevron osteotomies are two described treatments for the correction of hallux valgus deformity, but they have traditionally been employed for different levels of severity. We hypothesized that there would be no statistically significant difference between the results of these two treatments. This study is a retrospective review of 70 consecutive patients treated operatively for moderate and severe hallux valgus malalignment. The two groups based on their operative treatment: scarf osteotomy (Group A) and extended chevron osteotomy (Group B). Preoperative and postoperative hallux valgus angle (HVA), intermetatarsal angle and distal metatarsal articular angle (DMAA) were measured at final follow-up. Charts were also assessed to determine the postoperative rate of satisfaction, stiffness, and pain. There were no statistically significant differences between Groups A and B with regard to the HVA preoperatively and postoperatively. The DMAA was statistically significantly higher for Group B both preoperatively (p=0.0403) and postoperatively (p<0.0001). The differences in HVA correction and IMA correction were not statistically significant. There were no statistically significant differences with regard to post-operative stiffness, pain, and satisfaction. The scarf and extended chevron osteotomies are capable of adequately reducing the HVA and IMA in patients with moderate to severe hallux valgus. These two techniques yielded similar patient outcomes in terms of stiffness, pain and satisfaction. Based on these results, we recommend both the scarf and extended chevron osteotomy as acceptable forms of correction for moderate to severe hallux valgus.

Hallux rigidus: How do I approach it?

PubMed Central

Lam, Aaron; Chan, Jimmy J; Surace, Michele F; Vulcano, Ettore

2017-01-01

Hallux rigidus is a degenerative disease of the first metatarsalphalangeal (MTP) joint and affects 2.5% of people over age 50. Dorsal osteophytes and narrowed joint space leads to debilitating pain and limited range of motion. Altered gait mechanics often ensued as 119% of the body force transmit through the 1st MTP joint during gait cycle. Precise etiology remains under debate with trauma being often cited in the literature. Hallux valgus interphalangeus, female gender, inflammatory and metabolic conditions have all been identified as associative factors. Clinical symptoms, physical exam and radiographic evidence are important in assessing and grading the disease. Non-operative managements including nonsteroidal antiinflammatory drugs, intra-articular injections, shoe modification, activity modification and physical therapy, should always be attempted for all hallux rigidus patients. The goal of surgery is to relieve pain, maintain stability of the first MTP joint, and improve function and quality of life. Operative treatments can be divided into joint-sparing vs joint-sacrificing. Cheilectomy and moberg osteotomy are examples of joint-sparing techniques that have demonstrated great success in early stages of hallux rigidus. Arthrodesis is a joint-sacrificing procedure that has been the gold standard for advanced hallux rigidus. Other newer procedures such as implant arthroplasty, interpositional arthroplasty and arthroscopy, have demonstrated promising early patient outcomes. However, future studies are still needed to validate its long-term efficacy and safety. The choice of procedure should be based on the condition of the joint, patient’s goal and expectations, and surgeon’s experience with the technique. PMID:28567339

Plantar pressures determinants in mild Hallux Valgus.

PubMed

Martínez-Nova, Alfonso; Sánchez-Rodríguez, Raquel; Pérez-Soriano, Pedro; Llana-Belloch, Salvador; Leal-Muro, Alejo; Pedrera-Zamorano, Juan Diego

2010-07-01

While podobarometric techniques have been applied to the study of pressures in Hallux Valgus (HV), little is known about its clinical and radiological determinants. So, the aim of the present study was to determine the plantar pressure pattern in participants with mild HV, comparing to a control group, and their clinical and anthropometric determinants. Biofoot/IBV(®) in-shoe system was used to evaluate 79 participants with mild HV. Computerized measurements of the 1st intermetatarsal angle (IMA) and the hallux abductus angle (HAA) were made on antero-posterior radiographs. The clinical outcome was assessed using the AOFAS score. The dependent baropodometric variables and the independent clinical and anthropometric variables were subjected to a multiple regression analysis. In both groups, the highest average pressure was in the 2nd metatarsal head (MTH). The mean pressure under the Hallux was significantly higher in HV group (controls, 146.5±92.5kPa; HV, 328.5±113.2kPa; p<0.001). An 18.6% of average pressure under the 1st MTH was accounted for pain, first ray alignment and total AOFAS score. Variations of the HAA explained 26.8% of the mean Hallux pressure. Women with mild HV present with pathologically increased pressure under the Hallux, which is caused by the altered alignment of the first ray. Pain and clinical result were associated with the pressure under the 1st MTH and the remaining variables were only moderate predictors of dynamic plantar pressures. Copyright © 2010 Elsevier B.V. All rights reserved.

Venous thrombosis after hallux valgus surgery.

PubMed

Radl, Roman; Kastner, Norbert; Aigner, Christian; Portugaller, Horst; Schreyer, Herbert; Windhager, Reinhard

2003-07-01

Although surgery for the treatment of hallux valgus is frequently performed, the exact rate of deep vein thrombosis following this procedure is unknown. We performed a single-center, prospective, phlebographically controlled study to quantify the rate of venous thrombosis following operative correction of hallux valgus. Consecutive patients undergoing chevron bunionectomy for correction of hallux valgus deformity were enrolled in the study. Patients with clinical or hematological risk factors for venous thrombosis were excluded. One hundred patients with a mean age of 48.9 years were operated on and did not receive medical prophylaxis against thrombosis. All patients were assessed with phlebography at a mean of twenty-nine days postoperatively. Venous thrombosis was found in four patients (4%). The mean age of these patients (and standard deviation) was 61.7 +/- 6.1 years compared with a mean age of 48.4 +/- 13.9 years for the patients in whom thrombosis did not develop (p = 0.034). Patients are at a low risk for venous thrombosis following surgical treatment of hallux valgus. The need for prophylaxis against thrombosis should be calculated individually for each patient according to his or her known level of risk. Routine medical prophylaxis against thrombosis might be justified for patients over the age of sixty years.

[Distal osteotomy for the treatment of hallux valgus (Chevron osteotomy)].

PubMed

Stukenborg-Colsman, C; Claaßen, L; Ettinger, S; Yao, D; Lerch, M; Plaaß, C

2017-05-01

Distal osteotomies, like the Chevron osteotomy, is indicated for mild to moderate hallux valgus deformities. Splayfoot, painful pseudoexostosis, and transfer metatasalgia are observed in the clinical examination. Radiographic examination should be done with weight bearing in two planes. Preoperatively the intermetatarsal (IM), hallux valgus, and distal metatarsal articular (DMAA) angles should be measured. The operative technique is based on soft tissue and bony correction. Modifications of the osteotomy allow a shortening, lengthening, or neutral correction of the first metatarsal. With a modified Chevron osteotomy, an increased DMAA can be also corrected.

The Gibson and Piggott osteotomy for adult hallux valgus.

PubMed

Rangrez, Arshad Bashir; Dar, Tahir Ahmed; Badoo, Abdul Rashid; Wani, Sharief Ahmed; Dhar, Shabir Ahmed; Mumtaz, Imran; Ahmed, Muzzaffar

2012-01-01

The Gibson and Piggott procedure for hallux valgus is based on sound surgical principles addressing the basic pathologies of this disorder. However, this procedure has not been studied extensively in the literature in comparison to the Mitchell and Chevron osteotomies. We report a prospective study conducted on 50 adult feet with hallux valgus. The Gibson and Piggot osteotomy was done on all the feet. We obtained 76% excellent and 18% good results with this procedure. The results bear out the fact that this procedure is a useful procedure for the management of this disorder.

Clinical outcome after Chevron-Akin double osteotomy versus isolated Chevron procedure: a prospective matched group analysis.

PubMed

Lechler, Philipp; Feldmann, Christine; Köck, Franz Xaver; Schaumburger, Jens; Grifka, Joachim; Handel, Martin

2012-01-01

Hallux valgus is a frequent condition of the forefoot, resulting in cosmetic deformity and pain. Chevron osteotomy (CO) is widely employed for the treatment of hallux valgus. Chevron-Akin double osteotomy (CAO) was previously described and superiority over an isolated Chevron procedure was assumed. The objective of this study was to compare the short-to-middle term outcomes of CO and CAO. This study included 72 patients with established diagnosis of mild-to-moderate hallux valgus, treated by either isolated CO or CAO. The CO group included 46 patients (mean 51.5 years) with a mean hallux valgus angle of 27°, while the CAO group included 26 subjects (mean 53.1 years) and a mean hallux valgus angle of 32° preoperatively. All patients were reviewed by physical examination, and standardized questionnaire, and pre- and postoperative standing X-rays were performed. Matched group analysis was carried out to analyze statistical differences of both techniques. The patients were assessed and group matched at a mean of 1.37 years for the CO group and 1.04 years for the CAO group, postoperatively. Mean improvement of HVA (hallux valgus angle) was 10.6° in the CO group and the CAO group improved by 17.5°. DMAA (distal metatarsal articular angle) improved in the CO group by 5.4° and in the CAO by 13.7°. Mean AOFAS score improved by 27.9 (CO) and 21.5 (CAO). Patient satisfaction was high in both groups, with a tendency towards higher values within the CAO group. These findings indicate that Chevron-Akin double osteotomy is a save and practicable procedure for the treatment of mild-to-moderate hallux valgus. Superiority of combined Chevron-Akin procedure over an isolated Chevron osteotomy might be limited to distinct clinical settings, but should not be generally assumed.

Preliminary Results and Learning Curve of the Minimally Invasive Chevron Akin Operation for Hallux Valgus.

PubMed

Jowett, Charlie R J; Bedi, Harvinder S

Minimally invasive surgery is increasing in popularity. It is relevant in hallux valgus surgery owing to the potential for reduced disruption of the soft tissues and improved wound healing. We present our results and assess the learning curve of the minimally invasive Chevron Akin operation for hallux valgus. A total of 120 consecutive feet underwent minimally invasive Chevron Akin for symptomatic hallux valgus, of which 14 were excluded. They were followed up for a mean of 25 (range 18 to 38) months. The patients were clinically assessed using the American Orthopaedic Foot and Ankle Society score. Complications and patient satisfaction were recorded. The radiographs were analyzed and measurements recorded for hallux valgus and intermetatarsal angle correction. The mean age of the patients undergoing surgery was 55 (range 25 to 81) years. Of the 78 patients, 76 (97.4%) were female and 2 (2.6%) were male; 28 (35.9%) cases were bilateral. The mean American Orthopaedic Foot and Ankle Society score improved from 56 (range 23 to 76) preoperatively to 87 (range 50 to 100) postoperatively (p < .001). The mean hallux valgus and intermetatarsal angles preoperatively were 29.7° (range 12° to 46°) and 14.0° (range 8° to 20°). The corresponding postoperative angles were 10.3° (range 0° to 25°) and 7.6° (range 3° to 15°; p < .001). The patients were satisfied with the results of surgery in 87% of cases (92 of 106). The incidence of reoperation was 14% (15 of 106). These are the only reported results for this technique. They display a steep associated learning curve. However, the results are promising, and the learning curve is comparable to that for open hallux valgus surgery. Copyright © 2017 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

Outcomes in chevron osteotomy for Hallux Valgus in a large cohort.

PubMed

van Groningen, Bart; van der Steen, M C Marieke; Reijman, Max; Bos, Janneke; Hendriks, Johannes G E

2016-12-01

Clinical and radiological related outcomes have been reported for Chevron osteotomy as correction for mild to moderate hallux valgus, but only for relatively small patient series. Moreover, evaluation of the patient's point of view has mostly been conducted by means of more physician-based outcome measures. The goal of this study was to evaluate the effect of the Chevron osteotomy for hallux valgus on patients' daily lives using the Foot and Ankle Outcome Score (FAOS) as a validated and a hallux valgus specific patient reported outcome measure (PROM). Secondary outcome measures were radiological correction, complication rate, and re-operations. All 438 Chevron procedures (336 patients), at two surgical hospital sites in the period between January 2010 and October 2014, were retrospectively evaluated with a follow-up of at least 6 months. Patients were invited to fill in a cross-sectional online FAOS. For the FAOS, a total response of 60% was achieved. The FAOS ranged between 71 and 88 with a follow-up of on average 36 months. Patients with an undercorrection of their hallux valgus (11.6% of the procedures) scored significantly lower on three subscales of the FAOS (range between 61 and 77 versus 72-84). Patients who had a reoperation (12.6% of the procedures) also scored significantly lower on four subscales: 58-100 versus 73-89. Postoperative radiological measurements improved significantly with a mean difference of 6.1 (5.9; 6.4) degrees for the intermetatarsal angle and 13.7 (13.0; 14.5) degrees for the hallux valgus angle. In this large study cohort, Chevron osteotomy for hallux valgus offers good PROM scores on FAOS. These scores were significantly lower in patients with radiological undercorrection or with a reoperation. Results of the FAOS appear to modulate with physician based outcomes and therapeutic incidents. Improvement of outcome may therefore well be possible by increased attention on these surgical details. Copyright © 2016 Elsevier Ltd. All rights reserved.

Is Double Metatarsal Osteotomy Superior to Proximal Chevron Osteotomy in Treatment of Hallux Valgus With Increased Distal Metatarsal Articular Angle?

PubMed

Park, Chul Hyun; Lee, Woo-Chun

We compared the results of proximal chevron osteotomy and double metatarsal osteotomy for hallux valgus with an increased distal metatarsal articular angle (DMAA). From October 2008 to December 2012, first metatarsal osteotomies were performed in 64 patients (69 feet) with symptomatic hallux valgus associated with an increased DMAA. Proximal chevron with Akin osteotomy and lateral soft tissue release was performed in 46 feet (PCO group); double metatarsal osteotomy and Akin osteotomy without lateral soft tissue release was performed in 23 feet (DMO group). Clinical assessments were performed using the American Orthopaedic Foot and Ankle Society (AOFAS) scale and visual analog scale (VAS). The hallux valgus angles, intermetatarsal angles, sesamoid positions, metatarsus adductus angles, and DMAAs were compared at different postoperative times. Postoperative shortening of first the metatarsal and complications were compared. The mean AOFAS scale and VAS scores showed significant improvement in both groups after surgery; however, no significant difference was observed between the 2 groups. The immediate postoperative hallux valgus angle and sesamoid position were significantly larger in DMO group; however, no intergroup difference was observed at the last follow-up visit, with the hallux valgus angle gradually increasing in the PCO group. The postoperative DMAA was significantly smaller in the DMO group. The mean shortening of the first metatarsal after surgery was significantly larger in the DMO group than in the PCO group. Transfer metatarsalgia developed in 1 foot (2.2%) in the PCO group and 2 feet (8.7%) in the DMO group. Partial avascular necrosis of the metatarsal head with advanced arthritis of the first metatarsophalangeal joint developed in 1 foot (4.3%) in the DMO group. In conclusion, no differences in the clinical and radiographic results were observed between the 2 groups for hallux valgus deformity with an increased DMAA. Copyright © 2017 The American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

Distal chevron osteotomy with lateral soft tissue release for moderate to severe hallux valgus decided using intraoperative varus stress radiographs.

PubMed

Kim, Hyong-Nyun; Park, Yoo-Jung; Kim, Gab-Lae; Park, Yong-Wook

2013-01-01

The purpose of the present study was to investigate the outcomes of distal chevron osteotomy with lateral soft tissue release for moderate to severe hallux valgus. The patients were selected using criteria that included the degree of lateral soft tissue contracture and metatarsocuneiform joint flexibility. The contracture and flexibility were determined from intraoperative varus stress radiographs. From April 2007 to May 2009, 56 feet in 51 consecutive patients with moderate to severe hallux valgus had undergone distal chevron osteotomy with lateral soft tissue release. This was done when the lateral soft tissue contracture was not so severe that passive correction of the hallux valgus deformity was not possible and when the metatarsocuneiform joint was flexible enough to permit additional correction of the first intermetatarsal angle after lateral soft tissue release. The mean patient age was 45.2 (range 23 to 54) years, and the duration of follow-up was 27.5 (range 24 to 46) months. The mean hallux abductus angle decreased from 33.5° ± 3.1° to 11.6° ± 3.3°, and the first intermetatarsal angle decreased from 16.4° ± 2.7° to 9.7° ± 2.1°. The mean American Orthopaedic Foot and Ankle Society hallux-interphalangeal scores increased from 66.6° ± 10.7° to 92.6° ± 9.4° points, and 46 of the 51 patients (90%) were either very satisfied or satisfied with the outcome. No recurrence of deformity or osteonecrosis of the metatarsal head occurred. When lateral soft tissue contracture is not severe and when the metatarsocuneiform joint is flexible enough, distal chevron osteotomy with lateral soft tissue release can be a useful and effective choice for moderate to severe hallux valgus deformity. Copyright © 2013 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

Plantar fasciitis and its relationship with hallux limitus.

PubMed

Aranda, Yolanda; Munuera, Pedro V

2014-05-01

We sought to determine whether patients with plantar fasciitis have limited dorsiflexion in the first metatarsophalangeal joint and which type of foot, pronated or supinated, is most frequently associated with plantar fasciitis. The 100 study participants (34 men and 66 women) were divided into two groups: patients with plantar fasciitis and controls. The Foot Posture Index and dorsiflexion of the first metatarsophalangeal joint were compared between the two groups, and a correlation analysis was conducted to study their relationship. In the plantar fasciitis group there was a slight limitation of dorsiflexion of the hallux that was not present in the control group (P < .001). Hallux dorsiflexion and the Foot Posture Index were inversely correlated (Spearman correlation coefficient, -0.441; P < .01). Participants with plantar fasciitis presented less hallux dorsiflexion than those in the control group, and their most common foot type was the pronated foot.

Plate fixation for proximal chevron osteotomy has greater risk for hallux valgus recurrence than Kirschner wire fixation.

PubMed

Park, Chul-Hyun; Ahn, Ji-Yong; Kim, Yu-Mi; Lee, Woo-Chun

2013-06-01

The purpose of this study was to compare the results of hallux valgus surgery between feet fixed with Kirschner wires and those fixed with a plate and screws. Between December 2008 and November 2009, 53 patients (62 feet) were treated with proximal chevron osteotomy and distal soft tissue procedure for symptomatic moderate to severe hallux valgus deformity. Thirty-four patients (41 feet) were stabilised with Kirschner wires (K-wire group) and 19 patients (21 feet) were stabilised with a locking plate (plate group). Clinical results were assessed using American Orthopaedic Foot and Ankle Society (AOFAS) score. Radiographic parameters were compared between these groups. Recurrence rate at the last follow-up was compared between the K-wire and plate groups. Mean AOFAS score was lower in the plate group, however, the difference between the groups was not statistically significant in AOFAS score at the last follow-up. Hallux valgus angle and intermetatarsal angle were significantly larger in the plate group at the last follow-up. Mean 1-2 metatarsal (MT) distance on immediately postoperative radiographs was significant larger in the plate group. Four (9.8 %) of the 41 feet in the K-wire group and 7 (33.3 %) of the 21 feet in the plate group showed hallux valgus recurrence at the last follow-up. The plate group had a significantly higher risk of recurrence than the K-wire group. Fixation of proximal chevron osteotomy using a plate and screws has a greater risk of hallux valgus recurrence than fixation using Kirschner wires.

Effect of various hallux valgus reconstruction on sesamoid location: a radiographic study.

PubMed

Huang, Eddie H; Charlton, Timothy P; Ajayi, Samuel; Thordarson, David B

2013-01-01

The correction of sesamoid subluxation is an important component of hallux valgus reconstruction with some surgeons feeling that the sesamoids can be pulled back under the first metatarsal head when imbricating the medial capsule during surgery. The purpose of this study was to radiographically assess the effect of an osteotomy on sesamoid location relative to the second metatarsal. This is a retrospective radiographic study review of 165 patients with hallux valgus treated with reconstructive osteotomies. Patients were included if they underwent a scarf or basilar osteotomy for hallux valgus but were excluded if they had inflammatory arthropathy or lesser metatarsal osteotomy. A modified McBride soft tissue procedure was performed in conjunction with the basilar and scarf osteotomies. Each patient's preoperative and postoperative radiographs were evaluated for hallux valgus angle, intermetatarsal 1-2 angle, tibial sesamoid classification, and lateral sesamoid location relative to the second metatarsal. The greatest correction of both hallux valgus and intermetatrsal 1-2 angle was achieved in basilar osteotomies (20.6 degrees and 9.7 degrees, respectively), then scarf osteotomies (14.4 degrees and 8.7 degrees, respectively). Basilar and scarf osteotomies both corrected medial sesamoid subluxation relative to the first metatarsal head an average of 2-3 classification stages. All osteotomies had minimal lateral sesamoid location change relative to the second metatarsal. The majority of sesamoid correction correlated with the intermetatarsal 1-2 correction. The concept that medial capsular plication pulls the sesamoids beneath the first metatarsal (ie, changes the location of the sesamoids relative to the second metatarsal) was not supported by our results. Level III, retrospective case series.

No midterm benefit from low intensity pulsed ultrasound after chevron osteotomy for hallux valgus.

PubMed

Zacherl, Max; Gruber, Gerald; Radl, Roman; Rehak, Peter H; Windhager, Reinhard

2009-08-01

Chevron osteotomy is a widely accepted method for correction of symptomatic hallux valgus deformity. Full weight bearing in regular shoes is not recommended before 6 weeks after surgery. Low intensity pulsed ultrasound is known to stimulate bone formation leading to more stable callus and faster bony fusion. We performed a randomized, placebo-controlled, double-blinded study on 44 participants (52 feet) who underwent chevron osteotomy to evaluate the influence of daily transcutaneous low intensity pulsed ultrasound (LIPUS) treatment at the site of osteotomy. Follow-up at 6 weeks and 1 year included plain dorsoplantar radiographs, hallux-metatarsophalangeal-interphalangeal scale and a questionnaire on patient satisfaction. There was no statistical difference in any pre- or postoperative clinical features, patient satisfaction or radiographic measurements (hallux valgus angle, intermetatarsal angle, sesamoid index and metatarsal index) except for the first distal metatarsal articular angle (DMAA). The DMAA showed statistically significant (p = 0.046) relapse in the placebo group upon comparison of intraoperative radiographs after correction and fixation (5.2 degrees) and at the 6-week follow-up (10.6 degrees). Despite potential impact of LIPUS on bone formation, we found no evidence of an influence on outcome 6 weeks and 1 year after chevron osteotomy for correction of hallux valgus deformity.

Z-osteotomy in hallux valgus: clinical and radiological outcome after Scarf osteotomy

PubMed Central

Jäger, Marcus; Schmidt, Michael; Wild, Alexander; Bittersohl, Bernd; Courtois, Susanne; Schmidt, Troy G.; Rüdiger, Krauspe

2009-01-01

Correction osteotomies of the first metatarsal are common surgical approaches in treating hallux valgus deformities whereas the Scarf osteotomy has gained popularity. The purpose of this study was to analyze short- and mid-term results in hallux valgus patients who underwent a Scarf osteotomy. The subjective and radiological outcome of 131 Scarf osteotomies (106 hallux valgus patients, mean age: 57.5 years, range: 22–90 years) were retrospectively analyzed. Mean follow-up was 22.4 months (range: 6 months–5 years). Surgical indications were: intermetatarsal angle (IMA) of 12–23°; increased proximal articular angle (PAA>8°), and range of motion of the metatarsophalangeal joint in flexion and extension >40°. Exclusion criteria were severe osteoporosis and/or osteoarthritis. The mean subjective range of motion (ROM) of the great toe post-surgery was 0.8±1.73 points (0: full ROM, 10: total stiffness). The mean subjective cosmetic result was 2.7±2.7 points (0: excellent, 10: poor). The overall post-operative patient satisfaction with the result was high (2.1±2.5 points (0: excellent, 10: poor). The mean hallux valgus angle improvement was 16.6° (pre-operative mean value: 37.5°) which was statistically significant (p<0.01). The IMA improved by an average of 5.96° from a pre-operative mean value of 15.4° (p<0.01). Neither osteonecrosis of the distal fragment nor perioperative fractures were noted during the follow-up. In keeping with our follow-up results, the Scarf osteotomy approach shows potential in the therapy of hallux valgus. PMID:21808668

Resection Arthroplasty for Resistant Ulcers Underlying the Hallux in Insensate Diabetics.

PubMed

Tamir, Eran; Tamir, Jeremy; Beer, Yiftah; Kosashvili, Yona; Finestone, Aharon S

2015-08-01

Foot ulcers carry considerable morbidity in patients with peripheral neuropathy and frequently lead to foot amputation. The purpose of this study was to present our experience treating recalcitrant ulcers underlying the hallux interphalangeal joint in patients with diabetes mellitus (DM)-related neuropathy with a first metatarsophalangeal (MTPJ1) resection arthroplasty. We retrospectively reviewed the computerized medical files of patients with diabetic neuropathy treated with a MTPJ1 resection arthroplasty. We performed 28 arthroplasties on 20 patients with a mean age of 59 years. The patients had a diagnosis of DM for a mean of 10.7 years. Of the ulcers, 26 were grade 1A ulcers, and 2 were grade 2A ulcers (University of Texas score); the ulcer's mean age was 5.4 months. The mean dorsiflexion of the hallux before surgery was 46 degrees. The primary ulcer recovered in a mean of 3.1 weeks. Major complications (wound dehiscence and infection) occurred in 6 of 28 operations. Patients returned to normal activity 4 weeks after all procedures except in the 6 patients with dehiscence. In a subgroup of patients with follow-up longer than a year, the ulcer recurred after 4 of 18 arthroplasties (22%) between 3 and 12 months due to postoperative hallux rigidus. In the remaining 14 of 18 arthroplasties (78%), there was no recurrence during a mean follow-up of 26 months. MTPJ1 resection arthroplasty may be considered in a patient with resistant plantar hallux ulcerations, even in the absence of hallux rigidus. As with all operations on neuropathic feet in patients with DM, the surgeon and the patient should be aware that there is a significant likelihood of complications, but most are treatable. Level IV, case series. © The Author(s) 2015.

Use of the iPhone for radiographic evaluation of hallux valgus.

PubMed

Ege, Tolga; Kose, Ozkan; Koca, Kenan; Demiralp, Bahtiyar; Basbozkurt, Mustafa

2013-02-01

The purpose of this study was to compare the measurements made using a smartphone accelerometer and computerized measurements as a reference in a series of 32 hallux valgus patients. Two observers used an iPhone to measure the hallux valgus angle (HVA), intermetatarsal angle (IMA), and distal metatarsal articular angle (of anteroposterior foot radiographs in 32 patients with symptomatic hallux valgus on a computer screen. Digital angular measurements on the computer were set as the reference standard for analysis and comparison. The difference between computerized measurements and all iPhone measurements, and the difference between the first and second iPhone measurements for each observer were calculated. Inter- and intraobserver reliability of the smartphone measurement method was also tested. The variability of all measurements was similar for the iPhone and the computer-assisted techniques. The concordance between iPhone and computer-assisted angular measurements was excellent for the HVA, IMA, and DMAA. The maximum mean difference between the two techniques was 1.25 ± 1.02° for HVA, 0.92 ± 0.92° for IMA, and 1.10 ± 0.82° for DMAA. The interobserver reliability was excellent for HVA, IMA, and DMAA. The maximum mean difference between observers was 1.31 ± 0.89° for HVA, 0.90 ± 0.92° for IMA, and 0.78 ± 0.87° for DMAA. The intraobserver reliability was excellent for HVA, IMA, and DMAA. We conclude that the Hallux Angles software for the iPhone can be used for measurement of hallux valgus angles in clinical practice and even for research purposes. It is an accurate and reproducible method.

Comparison of the Modified McBride Procedure and the Distal Chevron Osteotomy for Mild to Moderate Hallux Valgus.

PubMed

Choi, Gi Won; Kim, Hak Jun; Kim, Taik Seon; Chun, Sung Kwang; Kim, Tae Wan; Lee, Yong In; Kim, Kyoung Ho

2016-01-01

Distal metatarsal osteotomy and the modified McBride procedure have each been used for the treatment of mild to moderate hallux valgus. However, few studies have compared the results of these 2 procedures for mild to moderate hallux valgus. The purpose of the present study was to compare the results of distal chevron osteotomy and the modified McBride procedure for treatment of mild to moderate hallux valgus according to the severity of the deformity. We analyzed the data from 45 patients (49.5%; 48 feet [49.0%]), who had undergone an isolated modified McBride procedure (McBride group), and 46 patients (50.5%; 50 feet [51.0%]), who had a distal chevron osteotomy (chevron group). We subdivided each group into those with mild and moderate deformity and compared the clinical and radiologic outcomes between the groups in relation to the severity of the deformity. The improvements in the American Orthopaedic Foot and Ankle Society scale score and the visual analog scale for pain were significantly better for the chevron group for both mild and moderate deformity. The chevron group experienced significantly greater correction in the hallux valgus angle and intermetatarsal angle for both mild and moderate deformity. The chevron group experienced a significantly greater decrease in the grade of sesamoid displacement for patients with moderate deformity. The McBride group had a greater risk of recurrence than did the chevron group for moderate deformity (odds ratio 14.00, 95% confidence interval 3.91 to 50.06, p < .001). The results of the present study have demonstrated the superiority of the distal chevron osteotomy over the modified McBride procedure for mild to moderate deformity. For patients with moderate deformity, the McBride group had a greater risk of hallux valgus recurrence than did the distal chevron group. Therefore, we recommend distal chevron osteotomy rather than a modified McBride procedure for the treatment of mild and moderate hallux valgus. Copyright © 2016 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

Hallux valgus correction using transarticular lateral release with distal chevron osteotomy.

PubMed

Choi, Young Rak; Lee, Ho Seong; Jeong, Jae Jung; Kim, Sang Woo; Jeon, In-Ho; Lee, Dong Ho; Lee, Woo Chun

2012-10-01

Transarticular lateral release through a medial incision can avoid a dorsal incision. This study investigated outcomes following hallux valgus correction using transarticular lateral release, distal chevron metatarsal osteotomy and Akin phalangeal osteotomy through one medial incision. Between June 2004 and May 2009, a single surgeon performed a transarticular lateral release, distal chevron metatarsal osteotomy and Akin phalangeal osteotomy through one medial incision for hallux valgus on a total of 103 feet of 68 patients. The average patient age at the time of surgery was 51 years, and the average followup was 27 months. The average preoperative and final followup results were: 1) hallux valgus angle improvement from 29 degrees to 5 degrees, 2) intermetatarsal angle from 13 degrees to 5 degrees and 3) medial sesamoid bone position from 3 to 1 (p < 0.05 for each variable). The average AOFAS scores were improved from 49 to 92, and the VAS pain scores were improved from 7 to 1 (p < 0.05 for both variables). No patient had a serious complication such as infection, avascular necrosis, nonunion, transfer-metatarsalgia, or first metatarsophalangeal joint arthritis. Hallux valgus correction using transarticular lateral release, distal chevron metatarsal osteotomy and Akin phalangeal osteotomy through one medial incision was found to be effective and safe. The advantages include that the procedure is simple, early ambulation is possible, and there is no dorsal scarring.

Hallux valgus (bunions)

PubMed Central

2014-01-01

Introduction Hallux valgus (bunions) are prominent and often inflamed metatarsal heads and overlying bursae. They are associated with valgus deviation of the great toe which moves towards the second toe. Hallux valgus is found in at least 2% of children aged 9 to 10 years, and almost half of adults, with greater prevalence in women. Methods and outcomes We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of conservative treatments for hallux valgus (bunions)? What are the effects of osteotomy for hallux valgus (bunions)? We searched: Medline, Embase, The Cochrane Library, and other important databases up to October 2013 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). Results We found 15 studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. Conclusions In this systematic review, we present information relating to the effectiveness and safety of the following interventions: chevron osteotomy plus adductor tenotomy; distal metatarsal osteotomy; minimally invasive surgery (percutaneous distal metatarsal osteotomy, SERI [Simple, Effective, Rapid, Inexpensive] distal metatarsal osteotomy); phalangeal (Akin) osteotomy plus distal chevron osteotomy; proximal osteotomy; night splints; and orthoses (including antipronatory orthoses in children).

Hallux Valgus Deformity and Treatment: A Three-Dimensional Approach: Modified Technique for Lapidus Procedure.

PubMed

Santrock, Robert D; Smith, Bret

2018-06-01

In a hallux valgus deformity, the problem is deviation of the hallux at the metatarsophalangeal joint and of the first metatarsal at the tarsometatarsal joint. Although anterior-posterior radiograph findings have been prioritized, deviation in the other planes can substantially change visible cues. The modified technique for Lapidus procedure procedure, uses all 3 planes to evaluate and correct the deformity, making radiographic measurements less useful. Using a triplane framework and focusing on the apex of the deformity, all bunions become the same modified technique for Lapidus procedure can be performed regardless of the degree of deformity, always includes triplane correction, and deformity size becomes irrelevant. Copyright © 2018 Elsevier Inc. All rights reserved.

Extended plantar limb (modified) chevron osteotomy versus scarf osteotomy for hallux valgus correction: A randomised controlled trial.

PubMed

Mahadevan, Devendra; Lines, Stephen; Hepple, Stephen; Winson, Ian; Harries, William

2016-06-01

The purpose of this RCT was to compare the extended plantar limb (modified) chevron osteotomy with the scarf osteotomy in correcting hallux valgus deformity and improving functional scores and patient satisfaction. Patients were randomly assigned and kept blind to surgical allocation. Cases requiring additional procedures including the Akin osteotomy were excluded. Outcomes were measured at 1 year following surgery. 84 patients (109 feet) were analysed (60 modified chevron; 49 Scarf). The mean age was 50.7 years (75F: 9M). Post-operative intermetatarsal angle (IMA) was significantly lower in the modified chevron group (5.8° versus 6.9°, p=0.045). Hallux valgus angle and distal metatarsal articular angle were similar. The magnitude of IMA correction with the modified chevron was also significantly greater (9.1° versus 7.1°, p=0.007). Both osteotomies produced comparable MOxFQ scores and satisfaction ratings. The modified chevron was superior to the scarf osteotomy in correcting IMA in hallux valgus deformity. Copyright © 2015 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.

Tetradactyl Footprints of an Unknown Affinity Theropod Dinosaur from the Upper Jurassic of Morocco

PubMed Central

Nouri, Jaouad; Díaz-Martínez, Ignacio; Pérez-Lorente, Félix

2011-01-01

Background New tetradactyl theropod footprints from Upper Jurassic (Oxfordian-Kimmeridgian) have been found in the Iouaridène syncline (Morocco). The tracksites are at several layers in the intermediate lacustrine unit of Iouaridène Formation. The footprints were named informally in previous works “Eutynichnium atlasipodus”. We consider as nomen nudum. Methodology/Principal Findings Boutakioutichnium atlasicus ichnogen. et ichnosp. nov. is mainly characterized by the hallux impression. It is long, strong, directed medially or forward, with two digital pads and with the proximal part of the first pad in lateral position. More than 100 footprints in 15 trackways have been studied with these features. The footprints are large, 38–48 cm in length, and 26–31 cm in width. Conclusions/Significance Boutakioutichnium mainly differs from other ichnotaxa with hallux impression in lacking metatarsal marks and in not being a very deep footprint. The distinct morphology of the hallux of the Boutakioutichnium trackmaker –i.e. size and hallux position- are unique in the dinosaur autopodial record to date. PMID:22180775

Operative Treatment of Traumatic Hallux Valgus in Elite Athletes.

PubMed

Covell, D Jeff; Lareau, Craig R; Anderson, Robert B

2017-06-01

Traumatic hallux valgus is an increasingly common injury in the athletic population and represents a unique variant of turf toe. Failure to appropriately recognize and treat these injuries can lead to continued pain, decreased performance, progressive deformities, and ultimately degeneration of the hallux metatarsophalangeal joint. Limited literature currently exists to assist in the diagnosis, management, and operative treatment. Nineteen patients were reviewed in this series, including 12 National Football League, 6 college, and 1 high school player who was a college prospect. The average age for all patients at the time of surgery was 24.4 years (range, 19-33 years). Return to play and complications were evaluated. Overall, good operative results were obtained, with 74% of patients returning to their preinjury level of play at an average recovery time of 3.4 months. Traumatic hallux valgus is an increasingly common injury in the athletic population and represents a unique variant of turf toe. The impact of this injury cannot be overstated, as one-quarter of players were unable to return to play. Level IV, case series.

Hallux Valgus Correction Comparing Percutaneous Chevron/Akin (PECA) and Open Scarf/Akin Osteotomies.

PubMed

Lee, Moses; Walsh, James; Smith, Margaret M; Ling, Jeff; Wines, Andrew; Lam, Peter

2017-08-01

Minimally invasive surgery is being used increasingly, including for hallux valgus surgery. Despite the growing interest in minimally invasive procedures, there have been few publications on percutaneous chevron/akin (PECA) procedures, and no studies have been published comparing PECA to open scarf/akin osteotomies (SA). This was a prospective, randomized study of 50 patients undergoing operative correction of hallux valgus using one of 2 techniques (PECA vs open SA). Data were collected preoperatively and on 1 day, 2 weeks, 6 weeks, and 6 months postoperatively. Outcome measures include the American Orthopaedic Foot & Ankle Society Hallux-Metatarsophalangeal-Interphalangeal (AOFAS-HMI) Score, visual analog pain score, hallux valgus angle (HVA), and 1-2 intermetatarsal angle (IMA). Twenty-five patients underwent PECA procedures and 25 patients received SA procedures. Both groups showed significantly improved AOFAS-HMI scores after surgery (PECA group: 61.8 to 88.9, SA group: 57.3 to 84.1, P = .560) with comparable final scores. HVA and IMA also presented similar outcomes at final follow-up ( P = .520 and P = .270, respectively). However, the PECA group showed significantly lower pain level (VAS) in the early postoperative phase (postoperative day 1 to postoperative week 6, P < .001 and P = .004, respectively). No serious complications were observed in either group. Both groups showed comparable good to excellent clinical and radiologic outcomes at final follow-up. However, the PECA group had significantly less pain in the first 6 weeks following surgery. Level of Evidence Level II, prospective comparative study.

Bunion correction using proximal chevron osteotomy: a single-incision technique.

PubMed

Sammarco, G J; Russo-Alesi, F G

1998-07-01

Proximal chevron first metatarsal osteotomy with lateral capsulotomy, adductor tenotomy, and binding of the first and second metatarsals was reviewed in 88 consecutive cases. Seventy-two cases in 55 patients are reported, with an average clinical follow-up of 41 months. The hallux valgus angle improved an average of 15 degrees , from 32.0 degrees preoperatively to an average of 17.0 degrees postoperatively. The intermetatarsal I-II angle improved an average of 5.5 degrees, from 15.3 degrees preoperatively to 9.0 degrees postoperatively. The lateral plantar first metatarsal angle did not change. First metatarsal length was decreased by 2.0 mm. Union occurred at an average of 2 months. Sesamoid position improved 49%, from a preoperative average subluxation of 80% to a postoperative average subluxation of 29%. Subjective foot score profiles improved from a preoperative average of 70.1/100 to a postoperative average of 94.4/100 with respect to pain, deformity, motion, disability, and cosmesis. There were 10 patients with complications, including three patients with delayed unions, two with second metatarsal stress fractures, one with hallux varus, two with hallux limitus, one with progressive arthritis, one with cellulitis, and one with hallux elevatus. Eighty-four percent of the patients stated that they would undergo the procedure again without reservation, 9% would proceed with reservation, and 7% would not proceed with surgery again if offered. This technique provides reliable successful long-term results for the treatment of moderate and severe symptomatic bunion, hallux valgus, and metatarsus primus varus.

[The retrocapital osteotomy ("chevron") for correction of splayfoot with hallux valgus].

PubMed

Gabel, Michael

2008-12-01

Surgical treatment of hallux valgus deformity with a distal osteotomy of the first metatarsal to address an increased intermetatarsal angle (IMA) I-II. This procedure is combined with a soft-tissue procedure at the first metatarsophalangeal joint: realignment of the first ray, lateral displacement of the first metatarsal head above the sesamoids, rebalancing of the soft tissues at the metatarsophalangeal joint. Pain and soft-tissue inflammation at the bunion, impaired function of the metatarsophalangeal joint, and lateral deviation of the hallux. IMA I-II 10 degrees. Symptomatic osteoarthritis of the first metatarsophalangeal joint, assessed clinically or radiographically. Acute inflammation of the forefoot, osteoporosis of the first metatarsal. Vascular disturbance. Cosmetic indication only. Relative: hypermobility of the first ray, valgus malalignment of the hindfoot, previous retrocapital osteotomy. Lateral soft-tissue release. Resection of the medial pseudoexostosis. V-shaped osteotomy of the distal metatarsal I. Exostosectomy. Lateral displacement of the first metatarsal head. Screw fixation. Realignment of the metatarsophalangeal joint by tightening of the medial soft tissues. Postoperative shoe with full weight bearing. Active exercises of the foot and hallux. Physiotherapy. Prophylaxis of deep vein thrombosis depending on the degree of mobility. Radiographic control after 6 weeks. Bandage or orthosis to maintain toe alignment. IMA I-II was reduced from 13.6 degrees preoperatively to 6.6 degrees postoperatively. HVA decreased from 29.8 degrees to 8.2 degrees postoperatively.

[Clinical effect modified Chevron osteotomy combined with lateral tissue loosening in treating mild-moderate hallux valgus through internal signal approach].

PubMed

Chen, Xue-Qiang; Wu, Qun-Feng; Dong, Wei-Qin; Yu, Li-Xin; Li, Xiong-Feng

2018-03-25

To explore clinical effect of modified Chevron osteotomy combined with lateral tissue loosening for the treatment of mild-moderate hallux valgus through internal signal approach. From July 2015 to June 2016, 26 patients with mild-moderate hallux valgus treated with modified Chevron osteotomy combined with lateral tissue loosening through internal signal approach, including 2 males and 24 females aged from 45 to 65 years old with an average of(54.6±4.8) years old;the courses of diseases ranged from 1 to 5 months with an average of (7.5±3.3) months. Hallux valgus angle(HVA), inter metatarsal angle(IMA) were measured at 12 months after operation, and AOFAS score was applied to evaluate clinical effect before and after operation. All incisions were healed at stage I. No incision occurred infection, metatarsal necrosis and recurrence of hallux valgus deformity. Two patients occurred skin numbness caused by musculocutaneous nerve injury. Twenty-six patients were followed up from 6 to 12 months with an average of(9.12±2.06) months. HVA, IMA were(30.01±3.71)°, (14.00±1.50)° before operation and(9.41±4.16)°, (7.00±0.60)° after operation, which had significant difference. There was statistical significance in AOFAS score before operation 54.77±9.59 and after operation 92.73±5.47, and 19 cases obtained excellent results and 7 moderate. Modified Chevron osteotomy combined with full thread headless pressure screw fixation and lateral tissue loosening for the treatment of mild-moderate hallux valgus has advantages of excellent exposure, simple operation, stable fixation, rapid recovery. Akin osteotomy with internal capsulorrhaphy were used with lateral loosening and could recover soft tissue balance between lateral and internal, and could receive satisfied clinical effects. Copyright© 2018 by the China Journal of Orthopaedics and Traumatology Press.

Effect of First Tarsometatarsal Joint Derotational Arthrodesis on First Ray Dynamic Stability Compared to Distal Chevron Osteotomy.

PubMed

Klemola, Tero; Leppilahti, Juhana; Laine, Vesa; Pentikäinen, Ilkka; Ojala, Risto; Ohtonen, Pasi; Savola, Olli

2017-08-01

Hallux valgus alters gait, compromising first ray stability and function of the windlass mechanism at the late stance. Hallux valgus correction should restore the stability of the first metatarsal. Comparative studies reporting the impact of different hallux valgus correction methods on gait are rare. We report the results of a case-control study between distal chevron osteotomy and first tarsometatarsal joint derotational arthrodesis (FTJDA). Two previously studied hallux valgus cohorts were matched: distal chevron osteotomy and FTJDA. Seventy-seven feet that underwent distal chevron osteotomy (chevron group) and 76 feet that underwent FTJDA (FTJDA group) were available for follow-up, with a mean of 7.9 years (range, 5.8-9.4 years) and 5.1 years (range, 3.0-8.3 years), respectively. Matching criteria were the hallux valgus angle (HVA) and a follow-up time difference of a maximum 24 months. Two matches were made: according to the preoperative HVA and the HVA at late follow-up. Matching provided 30 and 31 pairs, respectively. Relative impulses (%) of the first toe (T1) and metatarsal heads 1 to 5 (MTH1-5), weightbearing radiographs, and American Orthopaedic Foot & Ankle Society (AOFAS) (hallux metatarsophalangeal-interphalangeal [MTP-IP]) scores were studied. The relative impulse of MTH1 was higher in the FTJDA group, whereas a central dynamic loading pattern was seen in the chevron group. This result remained when relative impulses were analyzed according to the postoperative HVA. The mean difference in the HVA at follow-up was 6.2 degrees (95% confidence interval, 3.0-9.5; P = .001) in favor of the FTJDA group. The dynamic loading capacity of MTH1 was higher in the FTJDA group in comparison to the chevron group. The follow-up HVA remained better in the FTJDA group. Level III, case-control study.

[A special soft tissue procedure for treatment of hallux valgus].

PubMed

Waizy, H; Stukenborg-Colsman, C; Abbara-Czardybon, M; Emmerich, J; Windhagen, H; Frank, D

2011-02-01

Maintaining the corrected position of the first metatasophalangeal axis. Reducing postoperative stiffness by forgoing a medial capsular shift. Hallux valgus deformities or recurrent hallux valgus deformities. Existing osteoarthritis, joint stiffness, large bone defects, osteonecrosis. General medical contraindications to surgical interventions and anesthesiological procedures. Operation under regional anesthesia (foot block) or general anesthesia. Tourniquet. Longitudinal skin incision medial over the pseudexostosis of the first metatarsal bone. Preparing the tendon of the Musculus abductor hallucis. Detaching the tendon from the capsule. Incision of the joint capsule with protection of the extensor hallucis longus tendon and the dorsal neurovascular bundle in an L-wise manner. Osteotomy of the first metatarsal bone. Lax sutures of the capsule in correct position and reattachment of the Musculus abductor hallucis tendon shifted toward distal and dorsal, regarding the rotation of the hallux. Postoperative elevation of the operated foot. Analgesia with nonsteroidal antiinflammatory drugs. Postoperative weight-bearing according to the osteotomy. Passive mobilization of the metatarsophalangeal joint. Dressing for 4 weeks postoperatively in the corrected position. Radiologic control after 6 weeks. Hallux valgus orthosis at night and a toe spreader for a further 6 weeks. A total of 30 isolated hallux valgus deformities with a mean preoperative intermetatarsal (IMA) angle of 12.9° (range 11-15°) were operated with a chevron osteotomy. The mean follow-up was 14.4 (range 8-17) months. The mean dorsiflexion at the last follow-up was 44° (range 20-60°). Only 2 patients had a dorsiflexion <40°. The mean reduction of the IM angle was 5.6° (range 3-7°). One patient required wound revision. There was no infection or avascular necrosis of the metatarsal head observed in the patients. At follow-up, 20 (67%) patients were completely satisfied, 9 (30%) satisfied, and 1 (3%) was not satisfied.

Bosch osteotomy and scarf osteotomy for hallux valgus correction.

PubMed

Maffulli, Nicola; Longo, Umile Giuseppe; Oliva, Francesco; Denaro, Vincenzo; Coppola, Cristiano

2009-10-01

Minimally invasive distal metatarsal osteotomies are becoming broadly accepted for correction of hallux valgus. We compared the duration of surgery, the length of hospital stay, the American Orthopaedic Foot and Ankle Society (AOFAS) score, and the Foot and Ankle Outcome Score (FAOS) in 36 patients who underwent a minimal incision subcapital osteotomy of the first metatarsal with 36 matched patients who had hallux valgus corrected by a scarf technique. The minimum follow-up was 2.1 years (mean, 2.5 years; range, 2.1-3.2 years). Patients having the osteotomy had similar AOFAS and FAOS scores with less operating time and earlier discharge. Less operative time may benefit the patients, and earlier discharge has financial implications for the hospital.

Correlation of Postoperative Position of the Sesamoids After Chevron Osteotomy With Outcome.

PubMed

Shi, Glenn G; Henning, Peter; Marks, Richard M

2016-03-01

Postoperative incomplete reduction of the sesamoids has been identified as a potential risk factor for hallux valgus recurrence after proximal osteotomy. However, it is not known whether the postoperative sesamoid position is a risk factor in hallux valgus correction via distal chevron osteotomy with or without dorsal webspace release (DWSR). In this retrospective study, 169 patients who underwent distal chevron osteotomy with or without DWSR were reviewed. Preoperative and postoperative (6 weeks, 6 months, 12 months) weightbearing radiographs were evaluated. Functional hallux valgus angle (HVA), intermetatarsal angle (IMA), and the position of the tibial sesamoid were graded using the center of head method. Seventy-six radiographs were available for review at the 12-month follow-up. Of these, 41 patients underwent DWSR procedure and 35 did not. In both groups, correction of all 3 parameters (HVA, IMA, tibial sesamoid position) were significant at the 12-month follow-up. Comparison of the postoperative results of the 2 groups showed no statistically significant differences. Four feet demonstrated displaced sesamoid position at the 12-month follow-up, with radiographic evidence of recurrence in just one. No significant relationship was found between postoperative sesamoid position and hallux valgus recurrence that occurred in 4 feet. Combining DWSR with a distal chevron osteotomy did not delay healing or increase risk of avascular necrosis, but it did not significantly improve angular measurements or sesamoid position. The concept that postoperative sesamoid position can be used to predict hallux valgus recurrence was not supported by our results when looking at distal chevron correction. Level III, retrospective comparative study. © The Author(s) 2015.

Perioperative analgesia with a buprenorphine transdermal patch for hallux valgus surgery: a prospective, randomized, controlled study

PubMed Central

Xu, Can; Li, Mingqing; Wang, Chenggong; Li, Hui; Liu, Hua

2018-01-01

Purpose Hallux valgus surgery often results in significant postoperative pain. Adequate control of pain is essential for patient satisfaction and improves the outcome of the procedure. This study aimed to investigate the perioperative analgesic effect of a buprenorphine transdermal patch in patients who underwent hallux valgus surgery. Patients and methods A total of 90 patients were randomly divided into the following three groups based on the perioperative analgesic method: flurbiprofen axetil intravenous injection (Group F), oral celecoxib (Group C), and buprenorphine transdermal delivery system (BTDS) (Group BTDS). The pain status, degree of satisfaction, adverse effects, and administration of tramadol hydrochloride for uncontrolled pain were recorded on the night before surgery, postoperative day 1, postoperative day 2, and postoperative day 3. Results The BTDS could effectively control perioperative pain for patients undergoing hallux valgus surgery. The analgesic effect of the BTDS was better than that of oral celecoxib. In addition, statistically significant differences were not observed in the visual analog scale (VAS) scores, adverse effects, and rescue analgesia between the patients who received the BTDS and the patients who received the flurbiprofen axetil intravenous injection. However, the degree of patient satisfaction of the BTDS group was significantly higher (P<0.05) than that of the other two groups. Conclusion The BTDS (a preemptive analgesia regimen) could exert an analgesic effect during the perioperative period for patients who had received hallux valgus surgery, and this effect is beneficial for sustaining postoperative physiological and psychological states and promoting functional rehabilitation. PMID:29731664

Youngswick-Austin versus distal oblique osteotomy for the treatment of Hallux Rigidus.

PubMed

Viladot, Antonio; Sodano, Luca; Marcellini, Lorenzo; Zamperetti, Marco; Hernandez, Elsa Sanchez; Perice, Ramon Viladot

2017-08-01

Hallux Rigidus is the most common degenerative joint pathology of the foot. Several procedures are described for the management of this deformity. In this prospective study we compared Youngswick-Austin and distal oblique osteotomy in the treatment of grade II Hallux Rigidus, in terms of clinical outcomes, efficacy and complications. Forty-six patients (50 feet) with moderate Hallux Rigidus (Regnauld grade II) were recruited and operated between March 2009 and December 2012. Surgical technique was Youngswick-Austin osteotomy (Group A) or distal oblique osteotomy (Group B). Mean follow-up was 42.7 ±12.2 (range, 24-70) months. Both groups achieved significant improvement of AOFAS score and first metatarsophalangeal joint range of motion (p value <.05). The mean AOFAS score improved from a preoperative score of 44.1 ±11.8 to 89.2 ± 9.4 (24 months) in Group A and from 40.9 ±11.3 to 89.5 ±7.2 (24 months) in Group B. At 24 months, the average improvement of first metatarsophalangeal joint range of motion was 20.9° in Group A and 22.4° in Group B. The postoperative AOFAS score and joint range of motion were comparable in both groups. For this specific patient population Youngswick-Austin and distal oblique osteotomies provides subjective patient improvement and increases the first metatarsophalangeal joint range of motion. The results of grade II Hallux Rigidus treatment were comparable when using a Youngswick-Austin or distal oblique osteotomy. Level II, prospective comparative study. Copyright © 2017 Elsevier Ltd. All rights reserved.

Turf Toe

PubMed Central

McCormick, Jeremy J.; Anderson, Robert B.

2010-01-01

Context: Despite an increasing awareness of turf toe injury, confusion still exists regarding the anatomy, mechanism, diagnosis, and treatment of this hyperextension injury to the hallux metatarsophalangeal (MTP) joint. Evidence Acquisition: This article reviews the anatomy, diagnosis, and treatment algorithm for turf toe injury by reviewing relevant studies and presenting information useful to clinicians, therapists, and athletic trainers. A literature search was performed by a review of PubMed and OVID articles published from 1976 to July 2010. Results: Grade I injury is a sprain or attenuation of the plantar capsular ligamentous complex of the hallux MTP joint; athletes are typically able to return to play as tolerated. Grade II injury is a partial rupture of the plantar soft tissue structures of the hallux MTP joint, typically requiring about 2 weeks to recover. Grade III injury is a complete rupture of the plantar structures of the hallux MTP joint, requiring at least 10 to 16 weeks to recover. Some complete ruptures require surgical repair. Conclusion: With accurate diagnosis, athletes can have an appropriate treatment plan, and their expectations can be tempered to the degree of injury. Careful management may allow successful return to play at a preinjury level of participation. PMID:23015979

Radiographic angles in hallux valgus: differences between measurements made manually and with a computerized program.

PubMed

Piqué-Vidal, Carlos; Maled-García, Ignaci; Arabi-Moreno, Juanjo; Vila, Joan

2006-03-01

The objective of this study was to compare angular measurements in the evaluation of hallux valgus deformities using a goniometer and a computerized program to assess degree of concordance between the two methods and determine the reliability of manual measurements. Angles measured included the hallux valgus angle (HVA), the intermetatarsal angle (IMA), the distal metatarsal articular angle (DMAA), and the proximal phalangeal articular angle (PPAA), also called the hallux valgus interphalangeus angle or interphalangeal angle. Measurements were made on preoperative weightbearing radiographs in 176 patients with symptomatic hallux valgus. Manual measurements were made with a goniometer by an orthopaedic surgeon. An independent experienced technician used digitized images to perform angular measurements with the Autocad software program (Autodesk Inc., San Rafael, CA). HVA values obtained with the two techniques were similar. However, significantly higher mean values were obtained with the Autocad for the IMA and PPAA measurements, and higher mean values were obtained for the DMAA measurement with the manual technique. Whereas differences were more or less randomly distributed for the HVA, in the remaining patients, measurements were clearly related to the measurement technique, i.e., for the DMAA, the manual technique had a tendency to show higher values, and for the IMA and PPAA the manual technique showed lower values than the computer. Correlations between both techniques for the different angular measurements were as follows: HVA, -0.179 (p = 0.018); DMMA, -0.294 (p < 0.001); PPAA, -0.876 (p < 0.001); and IMA, -0.661 (p < 0.001). The intraclass correlation coefficient (ICC) showed that the concordance between manual and Autocad angular measurements was excellent for the HVA (ICC = 0.89) and DMAA (ICC = 0.80) and very poor for the PPAA (ICC = 0.11) and IMA (ICC = 0.42). Angular measurements made on weightbearing radiographs with the Autocad in patients with hallux valgus deformities were more reliable than those made with a goniometer. Although for large angles, such as HVA and DMAA, results obtained with both measurement techniques were similar. Manual measurements, however, may underestimate the true values of the smaller IMA and PPAA angles.

Rehabilitation after hallux valgus surgery: importance of physical therapy to restore weight bearing of the first ray during the stance phase.

PubMed

Schuh, Reinhard; Hofstaetter, Stefan G; Adams, Samuel B; Pichler, Florian; Kristen, Karl-Heinz; Trnka, Hans-Joerg

2009-09-01

Operative treatment of people with hallux valgus can yield favorable clinical and radiographic results. However, plantar pressure analysis has demonstrated that physiologic gait patterns are not restored after hallux valgus surgery. The purpose of this study was to illustrate the changes of plantar pressure distribution during the stance phase of gait in patients who underwent hallux valgus surgery and received a multimodal rehabilitation program. This was a prospective descriptive study. Thirty patients who underwent Austin (n=20) and scarf (n=10) osteotomy for correction of mild to moderate hallux valgus deformity were included in this study. Four weeks postoperatively they received a multimodal rehabilitation program once per week for 4 to 6 weeks. Plantar pressure analysis was performed preoperatively and 4 weeks, 8 weeks, and 6 months postoperatively. In addition, range of motion of the first metatarsophalangeal joint was measured, and the American Orthopaedic Foot and Ankle Society (AOFAS) forefoot questionnaire was administered preoperatively and at 6 months after surgery. The mean AOFAS score significantly increased from 60.7 points (SD=11.9) preoperatively to 94.5 points (SD=4.5) 6 months after surgery. First metatarsophalangeal joint range of motion increased at 6 months postoperatively, with a significant increase in isolated dorsiflexion. In the first metatarsal head region, maximum force increased from 117.8 N to 126.4 N and the force-time integral increased from 37.9 N.s to 55.6 N.s between the preoperative and 6-month assessments. In the great toe region, maximum force increased from 66.1 N to 87.2 N and the force-time integral increased from 18.7 N.s to 24.2 N.s between the preoperative and 6-month assessments. A limitation of the study was the absence of a control group due to the descriptive nature of the study. The results suggest that postoperative physical therapy and gait training may lead to improved function and weight bearing of the first ray after hallux valgus surgery.

Increased Incidence and Severity of Postoperative Radiographic Hallux Valgus Interphalangeus With Surgical Correction of Hallux Valgus.

PubMed

Dixon, Alexis E; Lee, Lydia C; Charlton, Timothy P; Thordarson, David B

2015-08-01

A previous study has shown an increased radiographic prevalence and severity of hallux valgus interphalangeus (HVIP) after surgical correction of hallux valgus (HV) due to correction of pronation deformity. The purpose of this study was to evaluate the change in pre- and postoperative HVIP deformity with correction of HV with multiple radiographic parameters. A retrospective chart review identified all bunion surgeries performed at a single center from July 1, 2009, to September 30, 2012. Exclusion criteria included prior bony surgery to the first ray, inadequate films, nonadult bunion, Akin osteotomy, or surgical treatment other than bunion correction. Pre- and postoperative films were reviewed for 2 HV angular measurements and 5 HVIP measurements, which were compared. The angles measured were hallux valgus angle (HVA), first intermetatarsal angle (IMA), hallux interphalangeus angle (HIA), distal metatarsal articular angle (DMAA), proximal phalangeal articular angle (PPAA), proximal to distal phalangeal articular angle (PDPAA), and total distal deformity (TDD). Prevalence of HVIP was analyzed in pre- and postoperative radiographs. A 1-sided Student t test was used to compare continuous data, and a chi-square test was used to compare categorical data. Ninety-two feet in 82 patients were eligible. The average preoperative HV improved with surgery. Preoperative HVA improved from 27 to 11 degrees (P < .001). Preoperative IMA improved from 13.6 to 6.1 degrees (P < .001). HVIP worsened after surgery. Preoperative HIA increased from 7.2 to 13.2 degrees (P < .001). DMAA worsened from 7.3 to 9.2 degrees (P = .001). PPAA worsened from 3.2 to 6.2 degrees. PDPAA worsened from 6.7 to 8.2 degrees (P < .001). The TDD increased from 14.6 to 17.9 degrees (P < .001). The prevalence of HVIP pre- and postoperatively as defined by HIA increased from 26% to 79% (P < .001) and by PPAA from 12% to 46% (P < .001). Initial assessment of preoperative radiographs underestimated HVIP. Postoperative correction of the deformity revealed HVIP that was not obvious preoperatively. Level III, retrospective comparative series. © The Author(s) 2015.

Chevron osteotomy with lateral release and adductor tenotomy for hallux valgus.

PubMed

Potenza, Vito; Caterini, Roberto; Farsetti, Pasquale; Forconi, Fabrizio; Savarese, Eugenio; Nicoletti, Simone; Ippolito, Ernesto

2009-06-01

Distal chevron osteotomy is a procedure widely performed for the surgical treatment of painful hallux valgus. The risks and benefits of a lateral capsular release and adductor tenotomy combined with chevron osteotomy are still debated. The aim of our study was to report the clinical and radiographic outcomes of this combined procedure in mild and moderate incongruent bunion deformities, with a hallux valgus angle (HVA) up to 40 degrees and an intermetatarsal angle (IMA) up to 20 degrees. Forty-two patients (52 feet) who consecutively underwent chevron osteotomy combined with lateral release and adductor tenotomy were reviewed 24-36 months after surgery. The mean age of the patients was 53.5 (range, 43 to 64) years. All the deformities were mild to moderate, with a mean preoperative value of 28 degrees in the HVA (range, 16 degrees to 40 degrees) and of 13 degrees in the IMA (range, 9 degrees to 20 degrees). At followup, the AOFAS hallux score improved from an average of 46 to an average of 88. The HVA and IMA had an average postoperative decrease respectively of 12 degrees and 6 degrees; lateral sesamoid displacement decreased by a mean of 15%. In no case did we observe infection or nonunion of the osteotomy. In one case, painless avascular necrosis of the first metatarsal head developed. Our short-term results show that distal chevron osteotomy combined with lateral release and adductor tenotomy is a feasible surgical option to address mild to moderate hallux valgus deformity, even with an IM angle between 15 and 20 degrees. Clinical and radiographic outcomes are generally good and patient satisfaction is generally high.

Clinical and Radiological Outcomes Comparing Percutaneous Chevron-Akin Osteotomies vs Open Scarf-Akin Osteotomies for Hallux Valgus.

PubMed

Lai, Mun Chun; Rikhraj, Inderjeet Singh; Woo, Yew Lok; Yeo, William; Ng, Yung Chuan Sean; Koo, Kevin

2018-03-01

Minimally invasive surgeries have gained popularity due to less soft tissue trauma and better wound healing. To date, limited studies have compared the outcomes of percutaneous and open osteotomies. This study aims to investigate the clinical and radiological outcomes of percutaneous chevron-Akin osteotomies vs open scarf-Akin osteotomies at 24-month follow-up. We reviewed a prospectively collected database in a tertiary hospital hallux valgus registry. Twenty-nine feet that underwent a percutaneous technique were matched to 58 feet that underwent open scarf and Akin osteotomies. Clinical outcome measures assessed included visual analog scale (VAS) scores, American Orthopaedic Foot & Ankle Society Hallux Metatarsophalangeal-Interphalangeal score (AOFAS Hallux MTP-IP), and Short Form 36 (SF-36) Health Survey. Radiological outcomes included hallux valgus angle (HVA) and intermetatarsal angle (IMA). All patients were prospectively followed up at 6 and 24 months. Both groups showed comparable clinical and radiological outcomes at the 24-month follow-up. However, the percutaneous group demonstrated less pain in the perioperative period ( P < .001). There were significant differences in the change in HVA between the groups but comparable radiological outcomes in IMA at the 24-month follow-up. The percutaneous group demonstrated shorter length of operation ( P < .001). There were no complications in the percutaneous group but 3 wound complications in the open group. We conclude that clinical and radiological outcomes of third-generation percutaneous chevron-Akin osteotomies were comparable with open scarf and Akin osteotomies at 24 months but with significantly less perioperative pain, shorter length of operation, and less risk of wound complications. Level III, retrospective comparative series.

Proximal metatarsal osteotomy for hallux valgus: an audit of radiologic outcome after single screw fixation and full postoperative weightbearing

PubMed Central

2013-01-01

Background Proximal metatarsal osteotomy combined with a distal soft-tissue procedure is a common treatment for moderate to severe hallux valgus. Secure stabilisation of the metatarsal osteotomy is necessary to avoid complications such as delayed union, nonunion or malunion as well as loss of correction. The aim of this study was to report our results using a single screw for stabilisation of the osteotomy. Methods We retrospectively reviewed 151 patients with severe hallux valgus who were treated by the above mentioned way with full postoperative weightbearing in a stiff soled shoe. Mean age of patients at time of surgery was 54 years, 19 patients were male and 132 female. Assessment of clinical and radiographic results was performed after 2 days and 6 weeks. Results were also correlated to the experience of the performing surgeon. Results Mean preoperative HVA (hallux valgus angle) was 36.4 degrees, and then 3.5 degrees 2 days and 13.4 degrees 6 weeks after the procedure (p < 0.001). Mean preoperative IMA (intermetarsal angle) was 16.8 degrees, and then 6.4 degrees after 2 days and 9.8 degrees after 6 weeks (p < 0.001). Mean preoperative first metatarsal length of 56.4 mm decreased to 53.6 mm after 6 weeks. Possible non-union of the osteotomy was observed in 4 patients (2.6%) after 6 weeks. Performing residents (n = 40) operated in 65 minutes and attending surgeons (n = 111) in 45 minutes, with no significant differences in radiographic measurements between both groups. Conclusions Single screw stabilisation of proximal chevron osteotomy is a reliable method for treating severe hallux valgus deformities with satisfactory results. PMID:23725485

Role of intraoperative varus stress test for lateral soft tissue release during chevron bunion procedure.

PubMed

Kim, Hyong-Nyun; Suh, Dong-Hyun; Hwang, Pil-Sung; Yu, Sun-O; Park, Yong-Wook

2011-04-01

The purpose of this study was to evaluate the clinical results of distal chevron osteotomy performed in conjunction with selective lateral soft tissue release. The criterion for doing a lateral soft tissue release was assessed by determining the ease and completeness of passive hallux valgus correction at the time of surgery. Between August 2005 and November 2007, 48 feet in 43 patients classified as having mild to moderate hallux valgus were retrospectively studied. Distal chevron osteotomy without lateral soft tissue release was performed in 26 cases (Group 1) when passive correction of the hallux valgus deformity was possible. Distal chevron osteotomy with lateral soft tissue release was performed in 22 cases (Group 2) when passive correction was not possible. Average followup was 23 (range, 12 to 28) months. Clinical results were assessed using radiographic parameters [hallux valgus angle (HVA), first and second intermetatarsal angle (1,2 IMA)], AOFAS scale and patient's subjective satisfaction. For Group 1: the average correction of HVA was 12.8 degrees, the average correction of IMA was 4.7 degrees, and the AOFAS score improved an average of 29.2 points at the last followup. Thirteen patients were very satisfied and ten patients were satisfied with the results. No patient was dissatisfied. For Group 2: the average correction of HVA was 19.1 degrees, the average correction of IMA was 7 degrees and AOFAS score improved at an average of 31.8 points at the last followup. Twelve patients were very satisfied, seven patients were satisfied and one patient, who had stiffness of the first metatarsophalangeal joint, was dissatisfied with the result. Distal chevron osteotomy with selective lateral soft tissue release based on the ability to passively correct the hallux valgus deformity lead to safe and stable correction.

Impact of Podiatry Resident Experience Level in Hallux Valgus Surgery on Postoperative Outcomes

PubMed Central

Fleischer, Adam E.; Yorath, Martin C.; Joseph, Robert; Baron, Adam; Nordquist, Thomas; Moore, Braden; Robinson, Richmond; Reilly, Charles

2018-01-01

Background Despite modern advancements in transosseous fixation and operative technique, hallux valgus (i.e., bunion) surgery is still associated with a higher than usual amount of patient dissatisfaction, and is generally recognized as a complex and nuanced procedure requiring precise osseous and capsulotendon balancing. It stands to reason then that familiarity and skill level of trainee surgeons might impact surgical outcomes in this surgery. The aim of this study was to determine whether podiatry resident experience level influences mid-term outcomes in hallux valgus surgery. Methods Consecutive adults who underwent isolated hallux valgus surgery via distal metatarsal osteotomy at a single US metropolitan teaching hospital from January 2004 to January 2009 were contacted and asked to complete a validated outcome measure of foot health (Manchester-Oxford Foot Questionnaire) regarding their operated foot. Resident experience level was quantified using the surgical logs for the primary resident of record at the time of each case. Associations were assessed using simple, multiple and logistic regression analyses. Results A total of 102 adult patients (n=102 feet) agreed to participate with a mean age of 46.8 (SD 13.1 years, range 18-71) and average length of follow-up 6.2 years (SD 1.4, range 3.6-8.6). Level of trainee experience was not associated with postoperative outcomes in either the univariate (odds ratio 0.99 [95% CI 0.98-1.01], p = 0.827) or multivariate analyses (odds ratio 1.00 [95% CI 0.97-1.02], p = 0.907). Conclusions We conclude that podiatry resident level of experience in hallux valgus surgery does not contribute appreciably to postoperative clinical outcomes. PMID:24726058

Correlation between static radiographic measurements and intersegmental angular measurements during gait using a multisegment foot model.

PubMed

Lee, Dong Yeon; Seo, Sang Gyo; Kim, Eo Jin; Kim, Sung Ju; Lee, Kyoung Min; Farber, Daniel C; Chung, Chin Youb; Choi, In Ho

2015-01-01

Radiographic examination is a widely used evaluation method in the orthopedic clinic. However, conventional radiography alone does not reflect the dynamic changes between foot and ankle segments during gait. Multiple 3-dimensional multisegment foot models (3D MFMs) have been introduced to evaluate intersegmental motion of the foot. In this study, we evaluated the correlation between static radiographic indices and intersegmental foot motion indices. One hundred twenty-five females were tested. Static radiographs of full-leg and anteroposterior (AP) and lateral foot views were performed. For hindfoot evaluation, we measured the AP tibiotalar angle (TiTA), talar tilt (TT), calcaneal pitch, lateral tibiocalcaneal angle, and lateral talcocalcaneal angle. For the midfoot segment, naviculocuboid overlap and talonavicular coverage angle were calculated. AP and lateral talo-first metatarsal angles and metatarsal stacking angle (MSA) were measured to assess the forefoot. Hallux valgus angle (HVA) and hallux interphalangeal angle were measured. In gait analysis by 3D MFM, intersegmental angle (ISA) measurements of each segment (hallux, forefoot, hindfoot, arch) were recorded. ISAs at midstance phase were most highly correlated with radiography. Significant correlations were observed between ISA measurements using MFM and static radiographic measurements in the same segment. In the hindfoot, coronal plane ISA was correlated with AP TiTA (P < .001) and TT (P = .018). In the hallux, HVA was strongly correlated with transverse ISA of the hallux (P < .001). The segmental foot motion indices at midstance phase during gait measured by 3D MFM gait analysis were correlated with the conventional radiographic indices. The observed correlation between MFM measurements at midstance phase during gait and static radiographic measurements supports the fundamental basis for the use of MFM in analysis of dynamic motion of foot segment during gait. © The Author(s) 2014.

Comparison of arthrodesis, resurfacing hemiarthroplasty, and total joint replacement in the treatment of advanced hallux rigidus.

PubMed

Erdil, Mehmet; Elmadağ, Nuh Mehmet; Polat, Gökhan; Tunçer, Nejat; Bilsel, Kerem; Uçan, Vahdet; Erkoçak, Omer Faruk; Sen, Cengiz

2013-01-01

The purpose of the present study was to compare the functional results of arthrodesis, resurfacing hemiarthroplasty, and total joint replacement in hallux rigidus. The data from patients treated from 2006 to 2010 for advanced stage hallux rigidus were retrospectively reviewed. A total of 38 patients who had at least 2 years (range 24 to 66 months, mean 31.1) of follow-up were included in the present study. Of the 38 patients, 12 were included in the total joint replacement group (group A), 14 in the resurfacing hemiarthroplasty group (group B), and 12 in the arthrodesis group (group C). At the last follow-up visit, the functional outcomes were evaluated using the American Orthopaedic Foot and Ankle Society-Hallux Metatarsophalangeal Interphalangeal (AOFAS-HMI) scale, visual analog scale (VAS), and metatarsophalangeal range of motion. Significant improvements were seen in the AOFAS-HMI score, with a decrease in the VAS score in all 3 groups. According to the AOFAS-HMI score, no significant difference was found between groups A and B. However, in group C, the AOFAS-HMI scores were significantly lower than in the other groups owing to the lack of motion. According to the final VAS scores, no significant difference was found between groups A and B; however, the VAS score had decreased significantly more in group C than in the other groups. No major complications occurred in any of the 3 groups. After 2 years of follow-up, all the groups had good functional outcomes. Although arthrodesis is still the most reliable procedure, implant arthroplasty is also a good alternative for advanced stage hallux rigidus. Copyright © 2013 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

Inter and intra-observer reliability in assessment of the position of the lateral sesamoid in determining the severity of hallux valgus.

PubMed

Panchani, Sunil; Reading, Jonathan; Mehta, Jaysheel

2016-06-01

The position of the lateral sesamoid on standard dorso-plantar weight bearing radiographs, with respect to the lateral cortex of the first metatarsal, has been shown to correlate well with the degree of the hallux valgus angle. This study aimed to assess the inter- and intra-observer error of this new classification system. Five orthopaedic consultants and five trainee orthopaedic surgeons were recruited to assess and document the degree of displacement of the lateral sesamoid on 144 weight-bearing dorso-plantar radiographs on two separate occasions. The severity of hallux valgus was defined as normal (0%), mild (≤50%), moderate (51-≤99%) or severe (≥100%) depending on the percentage displacement of the lateral sesamoid body from the lateral cortical border of the first metatarsal. Consultant intra-observer variability showed good agreement between repeated assessment of the radiographs (mean Kappa=0.75). Intra-observer variability for trainee orthopaedic surgeons also showed good agreement with a mean Kappa=0.73. Intraclass correlations for consultants and trainee surgeons was also high. The new classification system of assessing the severity of hallux valgus shows high inter- and intra-observer variability with good agreement and reproducibility between surgeons of consultant and trainee grades. Copyright © 2015 Elsevier Ltd. All rights reserved.

Tensile Properties of the Deep Transverse Metatarsal Ligament in Hallux Valgus: A CONSORT-Compliant Article.

PubMed

Abdalbary, Sahar Ahmed; Elshaarawy, Ehab A A; Khalid, Bahaa E A

2016-02-01

The deep transverse metatarsal ligament (DTML) connects the neighboring2 metatarsal heads and is one of the stabilizers connecting the lateral sesamoid and second metatarsal head. In this study, we aimed to determine the tensile properties of the DTML in normal specimens and to compare these results with hallux valgus specimens. We hypothesized that the tensile properties of the DTML would be different between the 2 groups of specimens.The DTML in the first interspace was dissected from 12 fresh frozen human cadaveric specimens. Six cadavers had bilateral hallux valgus and the other 6 cadavers had normal feet. The initial length (L0) and cross-sectional area (A0) of the DTML were measured using a digital caliper, and tensile tests with load failure were performed using a material testing machine.There were significant between-groups differences in the initial length (L0) P = 0.009 and cross-sectional area (A0) of the DTML P = 0.007. There were also significant between-groups differences for maximum force (N) P = 0.004, maximum distance (mm) P = 0.005, maximum stress (N/mm) P = 0.003, and maximum strain (%) P = 0.006.The DTML is an anatomical structure for which the tensile properties differ in hallux valgus.

Radiographic angles in hallux valgus: Comparison between protractor and iPhone measurements.

PubMed

Meng, Hong-Zheng; Zhang, Wei-Lin; Li, Xiu-Cheng; Yang, Mao-Wei

2015-08-01

Radiographic angles are used to assess the severity of hallux valgus deformity, make preoperative plans, evaluate outcomes after surgery, and compare results between different methods. Traditionally, hallux valgus angle (HVA) has been measured by using a protractor and a marker pen with hardcopy radiographs. The main objective of this study is to compare HVA measurements performed using a smartphone and a traditional protractor. The secondary objective was to compare the time taken between those two methods. Six observers measured major HVA on 20 radiographs of hallux valgus deformity with both a standard protractor and an Apple iPhone. Four of the observers repeated the measurements at least a week after the original measurements. The mean absolute difference between pairs of protractor and smartphone measurements was 3.2°. The 95% confidence intervals for intra-observer variability were ±3.1° for the smartphone measurement and ±3.2° for the protractor method. The 95% confidence intervals for inter-observer variability were ±9.1° for the smartphone measurement and ±9.6° for the protractor measurement. We conclude that the smartphone is equivalent to the protractor for the accuracy of HVA measurement. But, the time taken in smartphone measurement was also reduced. © 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

First metatarsal length change after basilar closing wedge osteotomy for hallux valgus.

PubMed

Day, Thomas; Charlton, Timothy P; Thordarson, David B

2011-05-01

Hallux valgus deformities with large intermetatarsal angles require a more proximal metatarsal procedure to adequately correct the deformity. Due to the relative ease of a closing wedge osteotomy, this technique was adopted but with concern over first metatarsal shortening. In this study, we primarily evaluated angular correction and first metatarsal shortening. We evaluated 70 feet in 57 patients (average age, 54 years) with 52 female and five male. The average followup was 14 (range, 6 to 45) months. The charts were reviewed for the presence of metatarsalgia. Digital radiographic measurements were made for pre- and postoperative hallux valgus and intermetatarsal angles, dorsiflexion angle of the first metatarsal, and absolute and relative shortening of the first metatarsal. The average hallux valgus angle improved from 31 to 11 degrees (p < 0.0001) and intermetatarsal angle from 13.2 to 4.4 angles (p < 0.0001). The absolute shortening of the first metatarsal was 2.2 mm and relative shortening was 0.6 mm. There was 1.3 degrees of dorsiflexion on average. Excellent correction of the deformity with minimal dorsiflexion or new complaints of metatarsalgia was found with this technique. The new method of assessing the relative shortening found to be less than the absolute shortening, which we feel more accurately reflects the functional length of the first metatarsal.

Karl Ludloff (1864-1945): An Inventive Orthopedic Surgeon, His Work and His Surgical Technique for the Correction of Hallux Valgus.

PubMed

Markatos, Konstantinos; Karaoglanis, Georgios; Damaskos, Christos; Garmpis, Nikolaos; Tsourouflis, Gerasimos; Laios, Konstantinos; Tsoucalas, Gregory

2018-05-01

The purpose of this article is to summarize the work and pioneering achievements in the field of orthopedic surgery of the German orthopedic surgeon Karl Ludloff. Ludloff had an impact in the diagnostics, physical examination, orthopedic imaging, and orthopedic surgical technique of his era. He was a pioneer in the surgical treatment of dysplastic hip, anterior cruciate ligament reconstruction, and hallux valgus. His surgical technique for the correction of hallux valgus, initially stabilized with plaster of Paris, remained unpopular among other orthopedic surgeons for decades. In the 1990s, the advent and use of improved orthopedic materials for fixation attracted the interest of numerous orthopedic surgeons in the Ludloff osteotomy for its ability to correct the deformity in all 3 dimensions, its anatomic outcomes, and its low recurrence rate and patient satisfaction.

History of surgical treatments for hallux valgus.

PubMed

Galois, Laurent

2018-05-31

In the nineteenth century, the prevalent understanding of the hallux valgus was that it was purely an enlargement of the soft tissue, first metatarsal head, or both, most commonly caused by ill-fitting footwear. Thus, treatment had varying results, with controversy over whether to remove the overlying bursa alone or in combination with an exostectomy of the medial head. Since 1871, when the surgical technique was first described, many surgical treatments for the correction of hallux valgus have been proposed. A number of these techniques have come into fashion, and others have fallen into oblivion. Progress in biomechanical knowledge, and improvements in materials and supports have allowed new techniques to be developed over the years. We have developed techniques that sacrifice the metatarsophalangeal joint (arthrodesis, arthroplasties), as well as conservative procedures, and one can distinguish those which only involve the soft tissues from those that are linked with a first ray osteotomy.

[Short-Term Results of Surgical Treatment of Patients with Hallux Rigidus].

PubMed

Dygrýnová, M; Uvízl, M; Gallo, J

2017-01-01

PURPOSE OF THE STUDY Hallux rigidus is common and degenerative arthritis of the first metatarsophalangeal joint. The aim of this study was to assess the results of cheilectomy and total joint replacement (TJR) in patients with hallux rigidus. Minimum duration of followup was 18 months. MATERIAL AND METHODS The study included fifty-nine patients who underwent surgery at our Department due to hallux rigidus between January 2013 and December 2014. Thirty-seven patients underwent cheilectomy and twenty-two patients had total joint arthroplasty using METIS®. The outcomes were assessed by comparing preoperative and postoperative ranges of motion, VAS (Visual Analogue Scale), AOFAS-HMI (American Orthopaedic Foot and Ankle Society Hallux Metatarsophalangeal Interphalangeal) and patients' satisfaction with operative treatment. Preoperative and postoperative outcomes were compared for the individual types of surgery using the repeated measures ANOVA. The level of statistical significance was set at p < 0.01. RESULTS The mean age was 47.9 ± 7.0 years in patients who underwent cheilectomy and 62.5 ± 5.5 years in patients after TJR METIS®. There was a significant decrease (p < 0.001) in the VAS pain score and a significant improvement in dorsiflexion, range of movements, AOFAS-HMI scores in both the treatment groups. In both the groups more than 75% of patients reported good or excellent subjective results. DISCUSSION Our results are in agreement with findings of other studies assessing the results of cheilectomy and TJR surgery in patients with hallux rigidus. Direct comparison of the VAS pain score, AOFAS-HMI and ranges of motion across studies is difficult because of variability in the evaluation systems. Cheilectomy is mostly recommended for young active patients with mild osteoarthritis. Moreover, it is also possible to use minimally invasive surgery with early and reliable outcomes. At our Department, we perform cheilectomy also in younger patients with moderate osteoarthritis in order to extend the period of clinically acceptable results and thereby to postpone the TJR indication. TJR (similarly to arthrodesis of the first metatarsophalangeal joint) is a procedure performed in elderly patients with low physical activity and more advanced deformities. CONCLUSIONS Both the reported methods offer reliable and valuable short-term clinical outcomes with relatively low complication rate. Cheilectomy is undoubtedly more appropriate for younger patients with mild or moderate arthritic changes. Although it does not appear to alter the natural progression of the disease process, it provides satisfactory pain relief, motion improvement and overall patient gait comfort for patients in a short-term period. TJR seems to be a better solution for less active older patients to whom it provides a loadable, painless, and moving joint. Key words: hallux rigidus, first metatarsophalangeal joint, cheilectomy, arthroplasty, Metis®, surgical treatment.

Vibrotactile perception thresholds at the sole of the foot: effects of contact force and probe indentation.

PubMed

Gu, Cheng; Griffin, Michael J

2012-05-01

When using vibrotactile thresholds to investigate neuropathy in the fingers, the indentation of a vibrating probe, and the force applied to a static surround around a vibrating probe, affect thresholds. This study was designed to investigate the effects on vibrotactile perception thresholds at the sole of the foot of probe indentation (i.e. height of a vibrating probe relative to a static surround) and the force applied to the static surround. Thresholds at 20 Hz (expected to be mediated by the NP I channel) and at 160 Hz (expected to be mediated by the Pacinian channel) were obtained at the hallux (i.e. greater toe) and the ball of the foot on 14 healthy subjects. In one condition, the height of the vibrating probe was varied to 0, 1, 2, 3, and 4 mm above a static surround with 4-N force applied to the surround. In a second condition, the force applied to the surround was varied to 1, 2, 3, 4, 5, and 6 N while using a probe height of 1mm. Thresholds at 20 Hz decreased with increasing probe height from 0 to 1 mm but showed no significant variation between 2, 3, and 4mm at either the hallux or the ball of the foot. Thresholds at 160 Hz decreased with increasing probe height from 0 to 4 mm at both the hallux and the ball of the foot. Thresholds at 20 Hz obtained with 1-N surround force were higher than thresholds obtained with 2 N, but there was no significant difference with surround forces from 2 to 6 N at either the hallux or the ball of the foot. Thresholds at 160 Hz were unaffected by variations in surround force at the ball of the foot but tended to decrease with increasing force at the hallux. It is concluded that a vibrating probe flush with a static surround, and a surround force in the range 2-4 N, are appropriate when measuring vibrotactile thresholds at the hallux and the ball of the foot with a 6-mm diameter contactor and a 2-mm gap to the static surround. Copyright © 2011 IPEM. Published by Elsevier Ltd. All rights reserved.

[Dynamic plantar pressure distribution after percutaneous hallux valgus correction using the Reverdin-Isham osteotomy].

PubMed

Rodríguez-Reyes, Gerardo; López-Gavito, Eduardo; Pérez-Sanpablo, Alberto Isaac; Galván Duque-Gastélum, Carlos; Alvarez-Camacho, Michelín; Mendoza-Cruz, Felipe; Parra-Téllez, Patricia; Vázquez-Escamilla, Jesús; Quiñones-Urióstegui, Ivett

2014-07-01

Percutaneous surgical techniques are suitable for the correction of the hallux valgus deformity. Satisfactory aesthetic and functional results obtained with the Reverdin- Isham osteotomy have been reported. The aim of this study was to describe dynamic plantar pressure redistribution after the correction of the deformity using this technique. A sample of 20 feet with mild or moderate hallux valgus was conformed and surgically treated using the Reverdin-Isham osteotomy. Clinical, radiological, surface and pressure assessments were performed pre and postoperatively. Postoperative mean (± SD) values of the American Orthopaedic Foot and Ankle Society (AOFAS) score, metatarsophalangeal, first intermetatarsal and proximal articular sect angles were 95.7 (3.3), 15.5° (5.4), 9.5° (1.5) y 5.3° (3.0), respectively. A significant decrease was observed in surface values of both lateral (P = 0.003) and medial (P = 0.001) masks of the forefoot. Mean pressure values of the lateral forefoot region denoted a significant increase (P < 0.001) while the medial forefoot region showed no change (P = 0.137). There is evidence that this particular surgical technique promotes a new plantar pressure pattern in the foot that might significantly favour the increase of the pressure observed under the lesser metatarsal heads and might not induce meaningful changes in the mean pressure registered under the first metatarsal head and hallux.

Ninety-Degree Chevron Osteotomy for Correction of Hallux Valgus Deformity: Clinical Data and Finite Element Analysis

PubMed Central

Matzaroglou, Charalambos; Bougas, Panagiotis; Panagiotopoulos, Elias; Saridis, Alkis; Karanikolas, Menelaos; Kouzoudis, Dimitris

2010-01-01

Hallux valgus is a very common foot disorder, with its prevalence estimated at 33% in adult shoe-wearing populations. Conservative management is the initial treatment of choice for this condition, but surgery is sometimes needed. The 600 angle Chevron osteotomy is an accepted method for correction of mild to moderate hallux valgus in adults less than 60 years old. A modified 900 angle Chevron osteotomy has also been described; this modified technique can confer some advantages compared to the 600 angle method, and reported results are good. In the current work we present clinical data from a cohort of fifty-one female patients who had surgery for sixty-two hallux valgus deformities. In addition, in order to get a better physical insight and study the mechanical stresses along the two osteotomies, Finite Element Analysis (FEA) was also conducted. FEA indicated enhanced mechanical bonding with the modified 900 Chevron osteotomy, because the compressive stresses that keep the two bone parts together are stronger, and the shearing stresses that tend to slide the two bone parts apart are weaker, compared to the typical 600 technique. Follow-up data on our patient cohort show good or excellent long-term clinical results with the modified 900 angle technique. These results are consistent with the FEA-based hypothesis that a 900 Chevron osteotomy confers certain mechanical advantages compared to the typical 600 procedure. PMID:20648223

Relationship between foot posture measurements and force platform parameters during two balance tasks in older and younger subjects

PubMed Central

Carvalho, Carlos E.; da Silva, Rubens A.; Gil, André W.; Oliveira, Márcio R.; Nascimento, Juliana A.; Pires-Oliveira, Deise A. A.

2015-01-01

[Purpose] The aim of this study was to compare age-related differences in balance and anthropometric posture measurements of the foot and to determine any relationship between them. [Subjects and Methods] Sixty-eight older and 42 younger adults participated in this study. Foot posture was tested for four domains: 1) hallux flexion and extension range of motion using a goniometer, 2) navicular height and 3) length of the foot using a pachymeter, and 4) footprint (width of forefoot, arch index and hallux valgus). Balance was tested under two conditions on a force platform: bipodal in 60-s trials and unipodal in 30-s trials. The sway area of the center of pressure and velocity in the anteroposterior and mediolateral directions were computed. [Results] Older individuals showed significantly poorer balance compared with younger adults under in the unipodal condition (center of pressure area 9.97 vs. 7.72 cm2). Older people presented a significantly lower hallux mobility and higher values for width of the forefoot and transverse arch index than younger adults. The correlations between all foot posture and center of pressure parameters varied across groups, from weak to moderate (r −0.01 to −0.46). Low hallux mobility was significantly related to higher center of pressure values in older people. [Conclusion] These results have clinical implications for balance and foot posture assessments. PMID:25931713

Relationship between foot posture measurements and force platform parameters during two balance tasks in older and younger subjects.

PubMed

Carvalho, Carlos E; da Silva, Rubens A; Gil, André W; Oliveira, Márcio R; Nascimento, Juliana A; Pires-Oliveira, Deise A A

2015-03-01

[Purpose] The aim of this study was to compare age-related differences in balance and anthropometric posture measurements of the foot and to determine any relationship between them. [Subjects and Methods] Sixty-eight older and 42 younger adults participated in this study. Foot posture was tested for four domains: 1) hallux flexion and extension range of motion using a goniometer, 2) navicular height and 3) length of the foot using a pachymeter, and 4) footprint (width of forefoot, arch index and hallux valgus). Balance was tested under two conditions on a force platform: bipodal in 60-s trials and unipodal in 30-s trials. The sway area of the center of pressure and velocity in the anteroposterior and mediolateral directions were computed. [Results] Older individuals showed significantly poorer balance compared with younger adults under in the unipodal condition (center of pressure area 9.97 vs. 7.72 cm(2)). Older people presented a significantly lower hallux mobility and higher values for width of the forefoot and transverse arch index than younger adults. The correlations between all foot posture and center of pressure parameters varied across groups, from weak to moderate (r -0.01 to -0.46). Low hallux mobility was significantly related to higher center of pressure values in older people. [Conclusion] These results have clinical implications for balance and foot posture assessments.

Minimally Invasive and Open Distal Chevron Osteotomy for Mild to Moderate Hallux Valgus.

PubMed

Brogan, Kit; Lindisfarne, Edward; Akehurst, Harold; Farook, Usama; Shrier, Will; Palmer, Simon

2016-11-01

Minimally invasive surgical (MIS) techniques are increasingly being used in foot and ankle surgery but it is important that they are adopted only once they have been shown to be equivalent or superior to open techniques. We believe that the main advantages of MIS are found in the early postoperative period, but in order to adopt it as a technique longer-term studies are required. The aim of this study was to compare the 2-year outcomes of a third-generation MIS distal chevron osteotomy with a comparable traditional open distal chevron osteotomy for mild-moderate hallux valgus. Our null hypothesis was that the 2 techniques would yield equivalent clinical and radiographic results at 2 years. This was a retrospective cohort study. Eighty-one consecutive feet (49 MIS and 32 open distal chevron osteotomies) were followed up for a minimum 24 months (range 24-58). All patients were clinically assessed using the Manchester-Oxford Foot Questionnaire. Radiographic measures included hallux valgus angle, the intermetatarsal angle, hallux interphalangeal angle, metatarsal phalangeal joint angle, distal metatarsal articular angle, tibial sesamoid position, shape of the first metatarsal head, and plantar offset. Statistical analysis was done using Student t test or Wilcoxon rank-sum test for continuous data and Pearson chi-square test for categorical data. Clinical and radiologic postoperative scores in all domains were substantially improved in both groups (P < .001), but there was no statistically significant difference in improvement of any domain between open and MIS groups (P > .05). There were no significant differences in complications between the 2 groups ( > .5). The midterm results of this third-generation technique show that it was a safe procedure with good clinical outcomes and comparable to traditional open techniques for symptomatic mild-moderate hallux valgus. Level III, retrospective comparative study. © The Author(s) 2016.

Footwear modification following hallux valgus surgery: The all-or-none phenomenon.

PubMed

Robinson, Cal; Bhosale, Abhijit; Pillai, Anand

2016-06-26

To define footwear outcomes following hallux valgus surgery, focusing on patient return to comfortable and heeled footwear and patterns of post-operative footwear selection. Surgical intervention is indicated for symptomatic cases of hallux valgus unresponsive to conservative methods, with favourable reported outcomes. The return to various types of footwear post-operatively is reflective of the degree of correction achieved, and corresponds to patient satisfaction. Patients are expected to return to comfortable footwear post-operatively without significant residual symptoms. Many female patients will additionally attempt to return to high-heeled, narrow toe box shoes. However, minimal evidence exists to guide their expectations. Sixty-five female hallux valgus patients that had undergone primary surgery between 2011 and 2013 were retrospectively identified using our hospital surgical database. Patients were reviewed using a footwear-specific outcome questionnaire at a mean 18.5 mo follow-up. Eighty-six percent of patients were able to return to comfortable footwear post-operatively with minimal discomfort. Of those intending to resume wearing heeled footwear, 62% were able to do so, with 77% of these patients wearing these as or more frequently than pre-operatively. No significant difference was observed between pre- and post-operative heel size. Mean time to return to heeled footwear was 21.4 wk post-operation. Cosmetic outcomes were very high and did not adversely impact footwear selection. We report high rates of return to both comfortable and heeled shoes in female patients following primary hallux valgus surgery. We observed an "all-or-none phenomenon" where patients rejected a return to heeled footwear unless able to tolerate them at the same frequency and heel size as pre-operatively. A minority of patients were unable to return to comfortable footwear post-operatively, which had adverse ramifications on their quality-of-life. We recommend that the importance of managing patient expectations through appropriate pre-operative counselling be emphasized in forefoot surgery.

Footwear modification following hallux valgus surgery: The all-or-none phenomenon

PubMed Central

Robinson, Cal; Bhosale, Abhijit; Pillai, Anand

2016-01-01

AIM: To define footwear outcomes following hallux valgus surgery, focusing on patient return to comfortable and heeled footwear and patterns of post-operative footwear selection. METHODS: Surgical intervention is indicated for symptomatic cases of hallux valgus unresponsive to conservative methods, with favourable reported outcomes. The return to various types of footwear post-operatively is reflective of the degree of correction achieved, and corresponds to patient satisfaction. Patients are expected to return to comfortable footwear post-operatively without significant residual symptoms. Many female patients will additionally attempt to return to high-heeled, narrow toe box shoes. However, minimal evidence exists to guide their expectations. Sixty-five female hallux valgus patients that had undergone primary surgery between 2011 and 2013 were retrospectively identified using our hospital surgical database. Patients were reviewed using a footwear-specific outcome questionnaire at a mean 18.5 mo follow-up. RESULTS: Eighty-six percent of patients were able to return to comfortable footwear post-operatively with minimal discomfort. Of those intending to resume wearing heeled footwear, 62% were able to do so, with 77% of these patients wearing these as or more frequently than pre-operatively. No significant difference was observed between pre- and post-operative heel size. Mean time to return to heeled footwear was 21.4 wk post-operation. Cosmetic outcomes were very high and did not adversely impact footwear selection. CONCLUSION: We report high rates of return to both comfortable and heeled shoes in female patients following primary hallux valgus surgery. We observed an “all-or-none phenomenon” where patients rejected a return to heeled footwear unless able to tolerate them at the same frequency and heel size as pre-operatively. A minority of patients were unable to return to comfortable footwear post-operatively, which had adverse ramifications on their quality-of-life. We recommend that the importance of managing patient expectations through appropriate pre-operative counselling be emphasized in forefoot surgery. PMID:27376022

The results of Scarf osteotomy combined with distal soft tissue procedure are mostly satisfactory in surgical management of moderate to severe hallux valgus.

PubMed

Şaylı, Uğur; Akman, Budak; Tanrıöver, Altuğ; Kaspar, Çiğdem; Güven, Melih; Özler, Turhan

2017-05-29

Intrinsically stable diaphyseal osteotomy gained popularity in recent years for symptomatic hallux valgus deformities. In this study, Scarf osteotomy results, in surgical management of moderate to severe hallux valgus, are presented. Study group consisted of 40 feet of 32 (28 females, four males) patients surgically managed by Scarf osteotomy between September 2009 and 2011, with a mean age of 52,98 (range, 31-75) years at the time of surgery. Patient satisfaction and VAS were used for subjective evaluation while for objective measures AOFAS score, first metatarsophalangeal joint ROM and radiological measurements (intermetatarsal, hallux valgus and distal metatarsal articular angles) were evaluated. Mean follow-up period was 38 (range, 24-60) months. Sixteen feet (40%) were reported as very satisfied, 19 (47,5%) as satisfied and the remaining five (12,5%) as unsatisfied resulting with a total of 35 (87,5%) satisfaction. The mean preoperative VAS and AOFAS forefoot scores improved from 8,13±0,791 to 2,68±1,228 (p=0,0001) and from 58,25±6,15 to 78,25±8,13 (p=0,0001) on the final follow-up, respectively. The postoperative change of first metatarsophalangeal joint ROM was not statistically significant (p=0,281). On the radiological evaluation; intermetatarsal and hallux valgus angles improved from a mean value of 14,77±1,76 to 8,13±1,52° (p=0,0001) and from 35,28±5,86 to 20,10±5,55° (p=0,0001), respectively. Distal metatarsal articular angle did not show any statistically significant change (p=0,195). Scarf osteotomy combined with distal soft tissue procedure is a technically demanding procedure. The osteotomy is intrinsically stable and the correction power is high and the results are mostly satisfactory. Copyright © 2017. Published by Elsevier Ltd.

Revision with suture-tape augmentation after failed collateral ligament reconstruction for chronic interphalangeal instability of the hallux.

PubMed

Cho, Byung-Ki; Park, Ji-Kang; Choi, Seung-Myung; SooHoo, Nelson F

2017-12-01

Chronic varus instability or recurrent subluxation following isolated interphalangeal dislocation of the hallux is a rare injury. No consensus has been reached regarding the best joint-salvage procedure for patients with the failed collateral ligament reconstruction using tendon graft. We report a case who achieved satisfactory clinical outcome through a modified surgical procedure (revision collateral ligament reconstruction augmented with suture-tape). Copyright © 2017 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.

Hallux amputation after a freshwater stingray injury in the Brazilian Amazon.

PubMed

Monteiro, Wuelton Marcelo; Oliveira, Sâmella Silva de; Sachett, Jacqueline de Almeida Gonçalves; Silva, Iran Mendonça da; Ferreira, Luiz Carlos de Lima; Lacerda, Marcus Vinícius Guimarães

2016-01-01

Freshwater stingray injuries are a common problem in the Brazilian Amazon, affecting mostly riverine and indigenous populations. These injuries cause severe local and regional pain, swelling and erythema, as well as complications, such as local necrosis and bacterial infection. Herein, we report a case of bacterial infection and hallux necrosis, after a freshwater stingray injury in the Brazilian Amazon, which eventually required amputation. Different antimicrobial regimens were administered at different stages of the disease; however, avoiding amputation through effective treatment was not achieved.

Comparison of distal chevron osteotomy with and without lateral soft tissue release for the treatment of hallux valgus.

PubMed

Lee, Ho-Jin; Chung, Jin-Wha; Chu, In-Tak; Kim, Yoon-Chung

2010-04-01

A lateral soft tissue release is often performed with distal chevron osteotomy for the correction of hallux valgus deformities. However, many complications of lateral soft tissue release have been reported. To define the necessity of lateral soft tissue release, the authors compared the clinical and radiographic results of distal chevron osteotomy with and without it. 86 consecutive patients (152 feet) were enrolled in this prospective study. In Group A, 45 patients (74 feet) underwent a chevron osteotomy with lateral soft tissue release. In Group B, 41 patients (78 feet) underwent a chevron osteotomy without it. Mean followup was 1.7 years and 2.1 years, respectively. The hallux valgus angle (HVA) and intermetatarsal angle (IMA), and AOFAS score were measured preoperatively, and 1-year followup postoperatively and complications were evaluated. The change in HVA, IMA and AOFAS score were insignificant (p > 0.05) between Group A and Group B, however, the range of motion of the first metatarsophalangeal joint was significantly less in Group A (p < 0.05). Complications of digital neuritis and cosmetically dissatisfied scarring of the dorsal web space were seen only in Group A. No cases had avascular necrosis of the metatarsal head, malunion or nonunion. Lateral soft tissue release may not be needed for mild or moderate hallux valgus deformities which may prevent decreased range of motion of the first metatarsophalangeal joint, neuritis of dorsal or plantar lateral digital nerve and cosmetic dissatisfaction of a dorsal scar.

Scarf versus chevron osteotomy in hallux valgus: a randomized controlled trial in 96 patients.

PubMed

Deenik, A R; Pilot, P; Brandt, S E; van Mameren, H; Geesink, R G T; Draijer, W F

2007-05-01

The degree of correction of hallux valgus deformity using a distal chevron osteotomy is reported as limited. The scarf osteotomy is reported to correct large intermetatarsal angles (IMA). The purpose of this study was to evaluate if one technique gave greater correction of the IMA and hallux valgus angle (HVA) than the other. After informed consent, 96 feet in 83 patients were randomized into two treatment groups (49 scarf and 47 chevron osteotomies). The results were evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) Hallux Valgus Scale and radiographic HVA and IMA measurements. At 27 (range 23-31) months followup both groups improved. The AOFAS score in the chevron group improved from 48 to 89 points and in the scarf group from 47 to 91 points. In the chevron group the HVA corrected from 30 to 17 degrees, and in the scarf group the HVA corrected from 29 to 18 degrees. In both groups, the IMA was corrected from 13 to 10 degrees. The differences were not statistically significant. Three patients in the chevron group developed a partial metatarsal head necrosis. In the scarf group, four patients developed grade 1 complex regional pain syndrome compared to one patient in the chevron group. No differences of statistical significance could be measured between the two groups with respect to the AOFAS score, HVA, and IMA. Although both groups showed good to excellent results, we favor the chevron osteotomy because the procedure is technically less demanding.

Effects of the lapidus arthrodesis and chevron bunionectomy on plantar forefoot pressures.

PubMed

King, Christy M; Hamilton, Graham A; Ford, Lawrence A

2014-01-01

Hallux valgus with or without first ray insufficiency has been strongly implicated as a contributing factor in lesser metatarsal overload. The principle goals of a bunionectomy are to relieve the pain, correct the deformity, and restore first metatarsophalangeal joint congruity. Until now, little evidence has been available to assess the effects of bunionectomy procedures on forefoot pressure. The primary aim of the present prospective study was to evaluate the preoperative and postoperative plantar pressures after 2 specific bunionectomies: the chevron bunionectomy and Lapidus arthrodesis. A total of 68 subjects, 34 in each group, were included for radiographic and pedographic evaluation. Both procedures demonstrated radiographic improvements in the mean intermetatarsal and hallux abductus angles. The mean hallux plantar pressure decreased significantly in both procedure groups (p < .001). However, Lapidus group exhibited an increase in the mean fifth metatarsal head plantar pressure (p = .008) and pressure under the fifth metatarsal as a percentage of the total forefoot pressure (p = .01). Furthermore, the pressure under the second metatarsal as a percentage of the total forefoot pressure decreased significantly (p = .01). This study suggests that the Lapidus arthrodesis and chevron bunionectomy both provide correction for hallux valgus deformity, but when comparing forefoot load sharing pressures, the Lapidus arthrodesis appeared to have greater influence on the load sharing distribution of forefoot pressure than did the bunionectomy employing the chevron osteotomy. Copyright © 2014 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

Ninety-degree chevron osteotomy for correction of hallux valgus deformity: clinical data and finite element analysis.

PubMed

Matzaroglou, Charalambos; Bougas, Panagiotis; Panagiotopoulos, Elias; Saridis, Alkis; Karanikolas, Menelaos; Kouzoudis, Dimitris

2010-04-22

Hallux valgus is a very common foot disorder, with its prevalence estimated at 33% in adult shoe-wearing populations. Conservative management is the initial treatment of choice for this condition, but surgery is sometimes needed. The 60(0) angle Chevron osteotomy is an accepted method for correction of mild to moderate hallux valgus in adults less than 60 years old. A modified 90(0) angle Chevron osteotomy has also been described; this modified technique can confer some advantages compared to the 60(0) angle method, and reported results are good. In the current work we present clinical data from a cohort of fifty-one female patients who had surgery for sixty-two hallux valgus deformities. In addition, in order to get a better physical insight and study the mechanical stresses along the two osteotomies, Finite Element Analysis (FEA) was also conducted. FEA indicated enhanced mechanical bonding with the modified 90(0) Chevron osteotomy, because the compressive stresses that keep the two bone parts together are stronger, and the shearing stresses that tend to slide the two bone parts apart are weaker, compared to the typical 60(0) technique. Follow-up data on our patient cohort show good or excellent long-term clinical results with the modified 90(0) angle technique. These results are consistent with the FEA-based hypothesis that a 90(0) Chevron osteotomy confers certain mechanical advantages compared to the typical 60(0) procedure.

The role of foot morphology on foot function in diabetic subjects with or without neuropathy.

PubMed

Guiotto, Annamaria; Sawacha, Zimi; Guarneri, Gabriella; Cristoferi, Giuseppe; Avogaro, Angelo; Cobelli, Claudio

2013-04-01

The aim of this study was to investigate the role of foot morphology, related with respect to diabetes and peripheral neuropathy in altering foot kinematics and plantar pressure during gait. Healthy and diabetic subjects with or without neuropathy with different foot types were analyzed. Three dimensional multisegment foot kinematics and plantar pressures were assessed on 120 feet: 40 feet (24 cavus, 20 with valgus heel and 11 with hallux valgus) in the control group, 80 feet in the diabetic (25 cavus 13 with valgus heel and 13 with hallux valgus) and the neuropathic groups (28 cavus, 24 with valgus heel and 18 with hallux valgus). Subjects were classified according to their foot morphology allowing further comparisons among the subgroups with the same foot morphology. When comparing neuropathic subjects with cavus foot, valgus heel with controls with the same foot morphology, important differences were noticed: increased dorsiflexion and peak plantar pressure on the forefoot (P<0.05), decreased contact surface on the hindfoot (P<0.03). While results indicated the important role of foot morphology in altering both kinematics and plantar pressure in diabetic subjects, diabetes appeared to further contribute in altering foot biomechanics. Surprisingly, all the diabetic subjects with normal foot arch or with valgus hallux were no more likely to display significant differences in biomechanics parameters than controls. This data could be considered a valuable support for future research on diabetic foot function, and in planning preventive interventions. Copyright © 2012 Elsevier B.V. All rights reserved.

Greater Growth of Proximal Metatarsals in Bird Embryos and the Evolution of Hallux Position in the Grasping Foot.

PubMed

Botelho, João Francisco; Smith-Paredes, Daniel; Soto-Acuña, Sergio; Núñez-León, Daniel; Palma, Verónica; Vargas, Alexander O

2017-01-01

In early theropod dinosaurs-the ancestors of birds-the hallux (digit 1) had an elevated position within the foot and had lost the proximal portion of its metatarsal. It no longer articulated with the ankle, but was attached at about mid-length of metatarsal 2 (mt2). In adult birds, the hallux is articulated closer to the distal end of mt2 at ground level with the other digits. However, on chick embryonic day 7, its position is as in early theropods at half-length of mt2. The adult distal location is acquired during embryonic days 8-10. To assess how the adult phenotype is acquired, we produced fate maps of the metatarsals of day 6 chicken embryos injecting the lipophilic tracer DiI. The fates of these marks indicate a larger expansion of the metatarsals at their proximal end, which creates the illusory effect that d1 moves distally. This larger proximal expansion occurs concomitantly with growth and early differentiation of cartilage. Histological analysis of metatarsals shows that the domains of flattened and prehypertrophic chondrocytes are larger toward the proximal end. The results suggest that the distal position of the hallux in the avian foot evolved as a consequence of an embryological period of expansion of the metatarsus toward the proximal end. It also brings attention to the developmental mechanisms leading to differential growth between epiphyses and their evolutionary consequences. © 2016 Wiley Periodicals, Inc.

Comparison of distal soft-tissue procedures combined with a distal chevron osteotomy for moderate to severe hallux valgus: first web-space versus transarticular approach.

PubMed

Park, Yu-Bok; Lee, Keun-Bae; Kim, Sung-Kyu; Seon, Jong-Keun; Lee, Jun-Young

2013-11-06

There are two surgical approaches for distal soft-tissue procedures for the correction of hallux valgus-the dorsal first web-space approach, and the medial transarticular approach. The purpose of this study was to compare the outcomes achieved after use of either of these approaches combined with a distal chevron osteotomy in patients with moderate to severe hallux valgus. One hundred and twenty-two female patients (122 feet) who underwent a distal chevron osteotomy as part of a distal soft-tissue procedure for the treatment of symptomatic unilateral moderate to severe hallux valgus constituted the study cohort. The 122 feet were randomly divided into two groups: namely, a dorsal first web-space approach (group D; sixty feet) and a medial transarticular approach (group M; sixty-two feet). The clinical and radiographic results of the two groups were compared at a mean follow-up time of thirty-eight months. The American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot scale hallux metatarsophalangeal-interphalangeal scores improved from a mean and standard deviation of 55.5 ± 12.8 points preoperatively to 93.5 ± 6.3 points at the final follow-up in group D and from 54.9 ± 12.6 points preoperatively to 93.6 ± 6.2 points at the final follow-up in group M. The mean hallux valgus angle in groups D and M was reduced from 32.2° ± 6.3° and 33.1° ± 8.4° preoperatively to 10.5° ± 5.5° and 9.9° ± 5.5°, respectively, at the time of final follow-up. The mean first intermetatarsal angle in groups D and M was reduced from 15.0° ± 2.8° and 15.3° ± 2.7° preoperatively to 6.5° ± 2.2° and 6.3° ± 2.4°, respectively, at the final follow-up. The clinical and radiographic outcomes were not significantly different between the two groups. The final clinical and radiographic outcomes between the two approaches for distal soft-tissue procedures were comparable and equally successful. Accordingly, the results of this study suggest that the medial transarticular approach is an effective and reliable means of lateral soft-tissue release compared with the dorsal first web-space approach. Therapeutic level II. See Instructions for Authors for a complete description of levels of evidence.

Daughter and her mildly affected father with Keipert syndrome.

PubMed

Dumic, Miroslav; Kokic, Durda Dovzak; Matic, Toni; Potocki, Kristina

2006-11-15

A 10-year-old girl with characteristic features of Keipert syndrome (broad terminal phalanges, especially of the thumb and hallux, sensorineural deafness, unusual facial features, large head circumference, maxillary hypoplasia, hoarse voice) and her mildly affected father (broad terminal phalanges, especially of the thumb and hallux, large head circumference, maxillary hypoplasia, and hoarse voice) are presented. The girl is the first reported female with this rare syndrome to date, and the fact that she probably inherited the disease from her father suggests an autosomal dominant pattern of inheritance. (c) 2006 Wiley-Liss, Inc.

Subungual melanoma of the great toe in a Hispanic male with Down syndrome: a case report and review of the literature.

PubMed

Kwok-Oleksy, Christina; Berenji, Manijeh; Argerakis, Nicholas G; Trepal, Michael; Wallack, Marc K

2012-01-01

Solid mass tumors are not as common as leukemia in individuals with Down syndrome. In this report, we describe the rare case of an adult Hispanic male with Down syndrome who developed advanced subungual melanoma in the hallux. We also describe the course of treatment, which involved hallux amputation along with metastatic work-up and sentinel lymph node biopsy with eventual resection. Copyright © 2012 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

Outcome of Joint-Preserving Arthroplasty for Rheumatoid Forefoot Deformities.

PubMed

Fukushi, Jun-ichi; Nakashima, Yasuharu; Okazaki, Ken; Yamada, Hisakata; Mawatari, Taro; Ohishi, Masanobu; Oyamada, Akiko; Akasaki, Yukio; Iwamoto, Yukihide

2016-03-01

Along with the recent advances in the pharmacological management of rheumatoid arthritis, there is a trend toward the use of joint-preserving surgery in the treatment of rheumatoid forefoot deformities. However, the clinical outcomes of joint-preserving surgery for rheumatoid forefoot deformities have not been assessed in comparison to resection arthroplasty. We retrospectively evaluated 23 feet in 17 patients with rheumatoid forefoot deformities who underwent surgery between January 2010 and December 2013. The patients included 1 male (1 foot) and 16 females (22 feet), with a mean age of 62 years. The mean length of follow-up was 28 months. The patients were treated by 3 surgeons. One surgeon performed joint-preserving procedures (JP group) to the feet in which (1) no pain with motion existed, and (2) the range of motion in the first metatarsophalangeal (MTP) joint was greater than 30 degrees (n = 10); otherwise, resection arthroplasty with arthrodesis of the first MTP joint was performed (n = 3). The other surgeons performed resection arthroplasty in all cases (n = 10) (RA group, n = 13 in total). The clinical outcomes of the patients were evaluated using the Japanese Society for Surgery of the Foot (JSSF) hallux and lesser toe scales. There were no significant differences in the preoperative total JSSF scores for either the hallux (54.5 and 61.4 points) or the lesser toe (45.2 and 57.4 points) between the RA and JP groups, respectively. Postoperatively, the total JSSF scores for both the hallux (79.4 and 88.2 points) and lesser toes (73.6 and 87.7 points) showed significant improvement in both the RA and JP groups, respectively; however, the JP group showed a greater postoperative improvement. The scores relating to the function category on the hallux scale and the alignment category on the lesser toe scale were significantly higher in the JP group. With regard to the function of the hallux and the alignment of the lesser toes, the joint-preserving procedures for rheumatoid forefoot deformities resulted in better clinical outcomes than resection arthroplasty. Level III, comparative case series. © The Author(s) 2015.

Foot Morphological Difference between Habitually Shod and Unshod Runners.

PubMed

Shu, Yang; Mei, Qichang; Fernandez, Justin; Li, Zhiyong; Feng, Neng; Gu, Yaodong

2015-01-01

Foot morphology and function has received increasing attention from both biomechanics researchers and footwear manufacturers. In this study, 168 habitually unshod runners (90 males whose age, weight & height were 23±2.4 years, 66±7.1 kg & 1.68±0.13 m and 78 females whose age, weight & height were 22±1.8 years, 55±4.7 kg & 1.6±0.11 m) (Indians) and 196 shod runners (130 males whose age, weight & height were 24±2.6 years, 66±8.2 kg & 1.72±0.18 m and 66 females whose age, weight & height were 23±1.5 years, 54±5.6 kg & 1.62±0.15 m) (Chinese) participated in a foot scanning test using the easy-foot-scan (a three-dimensional foot scanning system) to obtain 3D foot surface data and 2D footprint imaging. Foot length, foot width, hallux angle and minimal distance from hallux to second toe were calculated to analyze foot morphological differences. This study found that significant differences exist between groups (shod Chinese and unshod Indians) for foot length (female p = 0.001), width (female p = 0.001), hallux angle (male and female p = 0.001) and the minimal distance (male and female p = 0.001) from hallux to second toe. This study suggests that significant differences in morphology between different ethnicities could be considered for future investigation of locomotion biomechanics characteristics between ethnicities and inform last shape and design so as to reduce injury risks and poor performance from mal-fit shoes.

Biodegradable magnesium-based screw clinically equivalent to titanium screw in hallux valgus surgery: short term results of the first prospective, randomized, controlled clinical pilot study

PubMed Central

2013-01-01

Purpose Nondegradable steel-and titanium-based implants are commonly used in orthopedic surgery. Although they provide maximal stability, they are also associated with interference on imaging modalities, may induce stress shielding, and additional explantation procedures may be necessary. Alternatively, degradable polymer implants are mechanically weaker and induce foreign body reactions. Degradable magnesium-based stents are currently being investigated in clinical trials for use in cardiovascular medicine. The magnesium alloy MgYREZr demonstrates good biocompatibility and osteoconductive properties. The aim of this prospective, randomized, clinical pilot trial was to determine if magnesium-based MgYREZr screws are equivalent to standard titanium screws for fixation during chevron osteotomy in patients with a mild hallux valgus. Methods Patients (n=26) were randomly assigned to undergo osteosynthesis using either titanium or degradable magnesium-based implants of the same design. The 6 month follow-up period included clinical, laboratory, and radiographic assessments. Results No significant differences were found in terms of the American Orthopaedic Foot and Ankle Society (AOFAS) score for hallux, visual analog scale for pain assessment, or range of motion (ROM) of the first metatarsophalangeal joint (MTPJ). No foreign body reactions, osteolysis, or systemic inflammatory reactions were detected. The groups were not significantly different in terms of radiographic or laboratory results. Conclusion The radiographic and clinical results of this prospective controlled study demonstrate that degradable magnesium-based screws are equivalent to titanium screws for the treatment of mild hallux valgus deformities. PMID:23819489

Foot Morphological Difference between Habitually Shod and Unshod Runners

PubMed Central

Shu, Yang; Mei, Qichang; Fernandez, Justin; Li, Zhiyong; Feng, Neng; Gu, Yaodong

2015-01-01

Foot morphology and function has received increasing attention from both biomechanics researchers and footwear manufacturers. In this study, 168 habitually unshod runners (90 males whose age, weight & height were 23±2.4years, 66±7.1kg & 1.68±0.13m and 78 females whose age, weight & height were 22±1.8years, 55±4.7kg & 1.6±0.11m) (Indians) and 196 shod runners (130 males whose age, weight & height were 24±2.6years, 66±8.2kg & 1.72±0.18m and 66 females whose age, weight & height were 23±1.5years, 54±5.6kg & 1.62±0.15m)(Chinese) participated in a foot scanning test using the easy-foot-scan (a three-dimensional foot scanning system) to obtain 3D foot surface data and 2D footprint imaging. Foot length, foot width, hallux angle and minimal distance from hallux to second toe were calculated to analyze foot morphological differences. This study found that significant differences exist between groups (shod Chinese and unshod Indians) for foot length (female p = 0.001), width (female p = 0.001), hallux angle (male and female p = 0.001) and the minimal distance (male and female p = 0.001) from hallux to second toe. This study suggests that significant differences in morphology between different ethnicities could be considered for future investigation of locomotion biomechanics characteristics between ethnicities and inform last shape and design so as to reduce injury risks and poor performance from mal-fit shoes. PMID:26148059

A Prospective Study of Distal Metatarsal Chevron Osteotomies with K-Wire Fixations to Treat Hallux Valgus Deformities.

PubMed

Baig, M N; Baig, Usman; Tariq, Ali; Din, Robert

2017-09-20

Introduction Hallux valgus is one of the most common forefoot deformities worldwide. Females are affected more often than males. The three most common clinical symptoms are the painful bunion, transfer metatarsalgia, and hammer or claw toes. Methods This case series consisted of 20 patients who had chevron osteotomy from January 2015 to January 2016. The clinical assessment was measured by The American Orthopedic Foot and Ankle Score (AOFAS), and radiologic assessment was determined by preoperative and postoperative hallux valgus angle (HVA) and intermetatarsal angle (IMA). Results The patients' mean age was 56 years. Out of 20 patients, 19 were female, and one was male. The mean AOFAS improved from 51 preoperatively to 82 postoperatively. The HVA improved from 26° preoperatively to 14°. There were five complications including four Kirschner (K)-wire complications. Conclusion Distal chevron osteotomy is a reliable and time-tested procedure. The K-wire fixation has a relatively high complication rate. We planned to use other methods of fixation and then compared them with K-wires fixation results for future studies.

A Prospective Study of Distal Metatarsal Chevron Osteotomies with K-Wire Fixations to Treat Hallux Valgus Deformities

PubMed Central

Baig, Usman; Tariq, Ali; Din, Robert

2017-01-01

Introduction Hallux valgus is one of the most common forefoot deformities worldwide. Females are affected more often than males. The three most common clinical symptoms are the painful bunion, transfer metatarsalgia, and hammer or claw toes. Methods This case series consisted of 20 patients who had chevron osteotomy from January 2015 to January 2016. The clinical assessment was measured by The American Orthopedic Foot and Ankle Score (AOFAS), and radiologic assessment was determined by preoperative and postoperative hallux valgus angle (HVA) and intermetatarsal angle (IMA). Results The patients’ mean age was 56 years. Out of 20 patients, 19 were female, and one was male. The mean AOFAS improved from 51 preoperatively to 82 postoperatively. The HVA improved from 26° preoperatively to 14°. There were five complications including four Kirschner (K)-wire complications. Conclusion Distal chevron osteotomy is a reliable and time-tested procedure. The K-wire fixation has a relatively high complication rate. We planned to use other methods of fixation and then compared them with K-wires fixation results for future studies. PMID:29167752

The morphological basis of hallucal orientation in extant birds.

PubMed

Middleton, K M

2001-10-01

The perching foot of living birds is commonly characterized by a reversed or opposable digit I (hallux). Primitively, the hallux of nonavian theropod dinosaurs was unreversed and lay parallel to digits II-IV. Among basal birds, a unique digital innovation evolved in which the hallux opposes digits II-IV. This digital configuration is critical for grasping and perching. I studied skeletons of modern birds with a range of hallucal designs, from unreversed (anteromedially directed) to fully reversed (posteriorly directed). Two primary correlates of hallucal orientation were revealed. First, the fossa into which metatarsal I articulates is oriented slightly more posteriorly on the tarsometatarsus, rotating the digit as a unit. Second, metatarsal I exhibits a distinctive torsion of its distal shaft relative to its proximal articulation with the tarsometatarsus, reorienting the distal condyles and phalanges of digit I. Herein, I present a method that facilitates the re-evaluation of hallucal orientation in fossil avians based on morphology alone. This method also avoids potential misinterpretations of hallucal orientation in fossil birds that could result from preserved appearance alone. Copyright 2001 Wiley-Liss, Inc.

The influence of personality traits on the subjective outcome of operative hallux valgus correction.

PubMed

Radl, Roman; Leithner, Andreas; Zacherl, Maximilian; Lackner, Ursula; Egger, Josef; Windhager, Reinhard

2004-10-01

We studied prospectively the influence of personality traits on the subjective outcome of a chevron osteotomy in 42 patients with hallux valgus. The mean age of patients was 48.3 (20-70) years. Personality traits were evaluated by the means of the Freiburg Personality Inventory (FPI-R). Three months postoperatively 37 patients were satisfied, and five patients not satisfied with the operative procedure. The preoperative AOFAS Score improved from an average of 48.7 (30-65) points to 87.9 (50-100) points. A comparison of satisfied and dissatisfied patients revealed statistically significant differences in the personality traits aggressiveness (p=0.003), extraversion (p=0.001) and health worries (p=0.04). The postoperative hallux valgus angle was 12.2+/-7.8 degrees and 13.4+/-8.3 degrees (p=0.74) among satisfied and not satisfied patients, respectively, and the intermetatarsal angle (I-II) was 7.4+/-2.5 degrees and 7.6+/-4 degrees (p=0.89), respectively. The results suggest that the patient's subjective result after the operative correction may be influenced by some individual, personality profiles.

Foot loading characteristics during three fencing-specific movements.

PubMed

Trautmann, Caroline; Martinelli, Nicolo; Rosenbaum, Dieter

2011-12-01

Plantar pressure characteristics during fencing movements may provide more specific information about the influence of foot loading on overload injury patterns. Twenty-nine experienced fencers participated in the study. Three fencing-specific movements (lunge, advance, retreat) and normal running were performed with three different shoe models: Ballestra (Nike, USA), Adistar Fencing Lo (Adidas, Germany), and the fencers' own shoes. The Pedar system (Novel, Munich, Germany) was used to collect plantar pressures at 50 Hz. Peak pressures, force-time integrals and contact times for five foot regions were compared between four athletic tasks in the lunge leg and supporting leg. Plantar pressure analysis revealed characteristic pressure distribution patterns for the fencing movements. For the lunge leg, during the lunge and advance movements the heel is predominantly loaded; during retreat, it is the hallux. For the supporting leg, during the lunge and advance movements the forefoot is predominantly loaded; during retreat, it is the hallux. Fencing-specific movements load the plantar surface in a distinct way compared with running. An effective cushioning in the heel and hallux region would help to minimize foot loading during fencing-specific movements.

Correction of moderate to severe hallux valgus with combined proximal opening wedge and distal chevron osteotomies: a reliable technique.

PubMed

Jeyaseelan, L; Chandrashekar, S; Mulligan, A; Bosman, H A; Watson, A J S

2016-09-01

The mainstay of surgical correction of hallux valgus is first metatarsal osteotomy, either proximally or distally. We present a technique of combining a distal chevron osteotomy with a proximal opening wedge osteotomy, for the correction of moderate to severe hallux valgus. We reviewed 45 patients (49 feet) who had undergone double osteotomy. Outcome was assessed using the American Orthopaedic Foot and Ankle Society (AOFAS) and the Short Form (SF) -36 Health Survey scores. Radiological measurements were undertaken to assess the correction. The mean age of the patients was 60.8 years (44.2 to 75.3). The mean follow-up was 35.4 months (24 to 51). The mean AOFAS score improved from 54.7 to 92.3 (p < 0.001) and the mean SF-36 score from 59 to 86 (p < 0.001). The mean hallux valgus and intermetatarsal angles were improved from 41.6(o) to 12.8(o) (p < 0.001) and from 22.1(o) to 7.1(o), respectively (p < 0.001). The mean distal metatarsal articular angle improved from 23(o) to 9.7(o). The mean sesamoid position, as described by Hardy and Clapham, improved from 6.8 to 3.5. The mean length of the first metatarsal was unchanged. The overall rate of complications was 4.1% (two patients). These results suggest that a double osteotomy of the first metatarsal is a reliable, safe technique which, when compared with other metatarsal osteotomies, provides strong angular correction and excellent outcomes with a low rate of complications. Cite this article: Bone Joint J 2016;98-B:1202-7. ©2016 The British Editorial Society of Bone & Joint Surgery.

Treatment of moderate hallux valgus by percutaneous, extra-articular reverse-L Chevron (PERC) osteotomy.

PubMed

Lucas y Hernandez, J; Golanó, P; Roshan-Zamir, S; Darcel, V; Chauveaux, D; Laffenêtre, O

2016-03-01

The aim of this study was to report a single surgeon series of consecutive patients with moderate hallux valgus managed with a percutaneous extra-articular reverse-L chevron (PERC) osteotomy. A total of 38 patients underwent 45 procedures. There were 35 women and three men. The mean age of the patients was 48 years (17 to 69). An additional percutaneous Akin osteotomy was performed in 37 feet and percutaneous lateral capsular release was performed in 22 feet. Clinical and radiological assessments included the type of forefoot, range of movement, the American Orthopedic Foot and Ankle (AOFAS) score, a subjective rating and radiological parameters. The mean follow-up was 59.1 months (45.9 to 75.2). No patients were lost to follow-up. The mean AOFAS score increased from 62.5 (30 to 80) pre-operatively to 97.1 (75 to 100) post-operatively. A total of 37 patients (97%) were satisfied. At the last follow up there was a statistically significant decrease in the hallux valgus angle, the intermetatarsal angle and the proximal articular set angle. The range of movement of the first metatarsophalangeal joint improved significantly.. There was more improvement in the range of movement in patients who had fixation of the osteotomy of the proximal phalanx. Preliminary results of this percutaneous approach are promising. This technique is reliable and reproducible. Its main asset is that it maintains an excellent range of movement. The PERC osteotomy procedure is an effective approach for surgical management of moderate hallux valgus which combines the benefits of percutaneous surgery with the versatility of the chevron osteotomy whilst maintaining excellent first MTPJ range of motion. ©2016 The British Editorial Society of Bone & Joint Surgery.

Management of pain on hallux valgus with percutaneous intra-articular Pulse-Dose Radiofrequency.

PubMed

Masala, Salvatore; Fiori, Roberto; Calabria, Eros; Raguso, Mario; de Vivo, Dominique; Cuzzolino, Alessandro; Simonetti, Giovanni

2017-01-01

The purpose of our study was to investigate the role of intra-articular pulse-dose radiofrequency in management of painful hallux valgus refractory to conservative therapies. Between November 2010 and April 2012, 51 patients (15 male, 36 female) with a median age of 71.4 years were included in our clinical trial. Under fluoroscopic guidance we introduced a 22 gauge 10 cm length cannula by a percutaneous access in the first metatarsophalangeal joint and its tip was placed intra-articularly. After removing the spindle, a radiofrequency needle with a 5 mm active tip was introduced. The following parameters were used: 1200 pulses at high voltage (45 V) with 20 msec duration followed by 480 msec silent phases. A great reduction in pain intensity was documented at 1 week, 1 month and 3 months after procedures. Pain intensity increased between 5 and 8 months after treatments, so we performed a second procedure in all patients between 7 months and 9 months since the first treatment. Also in this case we obtained a great reduction of pain intensity in the first 3 months after the procedure. Pain intensity returned at preprocedural values after 9 months after second procedure. No complications were observed. Our experience shows pulse-dose radiofrequency is a safe, repeatable and effective technique for managing patients with symptomatic hallux valgus in the short and medium term. Pulse-dose radiofrequency may improve pain control and quality of life in patients with hallux valgus refractory to conservative therapies. © 2014 Asia Pacific League of Associations for Rheumatology and Wiley Publishing Asia Pty Ltd.

Outcomes After Interpositional Arthroplasty of the First Metatarsophalangeal Joint.

PubMed

Aynardi, Michael C; Atwater, Lara; Dein, Eric J; Zahoor, Talal; Schon, Lew C; Miller, Stuart D

2017-05-01

For patients with hallux rigidus seeking a motion-sparing procedure, interposition arthroplasty is an alternative to fusion. The purpose of this study was to report patient outcomes after interpositional arthroplasty for hallux rigidus. All patients undergoing interpositional arthroplasty at our institution from 2001 to 2014 were identified and a retrospective chart review was performed. Follow-up was conducted through a telephone survey to obtain survivorship, satisfaction, and functional scores. Survivorship of the interpositional arthroplasty procedure was defined as no subsequent surgery on the hallux after the index procedure. Patients were excluded for incomplete records. Complications were recorded. From 2001 to 2014, 183 patients were identified. Of these, 14 were excluded for incomplete data, leaving 169 patients. Of these, 133 had an average follow-up of 62.2 months (range, 24.3 months to 151.2 months). The overall failure rate was 3.8% (5/133). Patient-reported outcome was rated as excellent in 65.4% (87/133) or good in 24.1% (32/133) of patients and fair or poor in 10.5% (14/133) of patients. Of 133 patients, 101 (76%) were able to return to fashionable or regular footwear. The infection rate was 1.5% (2/133). Patient-reported cock-up deformity of the first metatarsophalangeal joint (MTPJ) occurred in 4.5% (6/133) of patients. In addition, 17.3% (23/133) of patients reported metatarsalgia of the second or third MTPJ at the time of final follow-up, and there was no significant difference between interposition types ( P = .441). Interpositional arthroplasty for hallux rigidus was found to have excellent or good results in most patients at a mean follow-up of 62.2 months. Level IV, retrospective case series.

Reliability of doming and toe flexion testing to quantify foot muscle strength.

PubMed

Ridge, Sarah Trager; Myrer, J William; Olsen, Mark T; Jurgensmeier, Kevin; Johnson, A Wayne

2017-01-01

Quantifying the strength of the intrinsic foot muscles has been a challenge for clinicians and researchers. The reliable measurement of this strength is important in order to assess weakness, which may contribute to a variety of functional issues in the foot and lower leg, including plantar fasciitis and hallux valgus. This study reports 3 novel methods for measuring foot strength - doming (previously unmeasured), hallux flexion, and flexion of the lesser toes. Twenty-one healthy volunteers performed the strength tests during two testing sessions which occurred one to five days apart. Each participant performed each series of strength tests (doming, hallux flexion, and lesser toe flexion) four times during the first testing session (twice with each of two raters) and two times during the second testing session (once with each rater). Intra-class correlation coefficients were calculated to test for reliability for the following comparisons: between raters during the same testing session on the same day (inter-rater, intra-day, intra-session), between raters on different days (inter-rater, inter-day, inter-session), between days for the same rater (intra-rater, inter-day, inter-session), and between sessions on the same day by the same rater (intra-rater, intra-day, inter-session). ICCs showed good to excellent reliability for all tests between days, raters, and sessions. Average doming strength was 99.96 ± 47.04 N. Average hallux flexion strength was 65.66 ± 24.5 N. Average lateral toe flexion was 50.96 ± 22.54 N. These simple tests using relatively low cost equipment can be used for research or clinical purposes. If repeated testing will be conducted on the same participant, it is suggested that the same researcher or clinician perform the testing each time for optimal reliability.

[Preemptive local anesthetic infiltration in hallux valgus one-day surgery].

PubMed

Gądek, Artur; Liszka, Henryk

2015-01-01

The surgical treatment of hallux valgus deformity is connected with significant postoperative pain. Spinal and general anesthesia as well as peripheral blocks are successfully used in foot surgery. The purpose of this study was to evaluate the influence of local anesthetic infiltration before hallux valgus one-day surgery on postoperative pain and the need for analgesics. 134 patients underwent chevron or miniinvasive Mitchell-Kramer osteotomy of the first distal metatarsal. After general anesthesia each patient randomly received an infiltration of 7ml of local anesthetic (4 ml of 0.25% bupivacaine and 3 ml of 2% lidocaine) or the same amount of normal saline 15 minutes before the skin incision. Both the patient and the surgeon were blinded. The patient was discharged after approximately 2 hours of observation. 2, 4, 8, 12, 16, 24 and 72 hours after the release of the tourniquet the level of pain was assessed by the visual analogue scale (VAS). Rescue analgesia, side effects and the use of painkillers were noted. Preemptive local anesthetic infiltration significantly decreased pain during the first 24 hours after the surgery. None of the patients from the injected group and 38 from the placebo group received 100 mg of ketoprofen intravenously for rescue analgesia in the first 2 hours after the release of the tourniquet. During the first 24 hours we noted significantly decreased use of 1000 mg of paracetamol and 100 mg mg of ketoprofen orally in the injected group. No systemic adverse effects were noted. One patient from placebo group had allergic rush after use of 100 mg ketoprofen. Preemptive local anesthetic infiltration in one-day hallux valgus surgery significantly decreases postoperative pain. It is safe, efficient and allows fast discharge.

Comparison of the proximal chevron and Ludloff osteotomies for the correction of hallux valgus.

PubMed

Choi, Woo Jin; Yoon, Han Kook; Yoon, Hang Seob; Kim, Bom Soo; Lee, Jin Woo

2009-12-01

Although several studies have described good results of proximal chevron and Ludloff osteotomies, there have been no studies comparing the results of these two techniques at a single institution. We consecutively evaluated 46 patients who underwent proximal chevron osteotomies and 52 patients who underwent Ludloff osteotomies. Patients were evaluated by preoperative and postoperative weight bearing radiographs and the American Orthopaedic Foot and Ankle Society (AOFAS) hallux MP score. Both groups had similarly high AOFAS scores and good correction by radiographic parameters. No statistically significant differences were found with respect to correction of hallux valgus angle (HVA) and intermetatarsal angle (IMA) between the two groups. Significant shortening of the first metatarsal was found after Ludloff osteotomy (p < 0.05). At 6 weeks after surgery, the pain subscore was significantly lower in the proximal chevron group than in the Ludloff group (p < 0.05). The proximal chevron and Ludloff osteotomies yielded equivalent clinical and radiological results. The Ludloff osteotomy with lag screw fixation is more stable and does not require postoperative hardware removal, although it is technically demanding and has a tendency toward greater shortening of the first metatarsal.

[The minimally invasive Chevron and Akin osteotomy (MICA)].

PubMed

Altenberger, Sebastian; Kriegelstein, Stefanie; Gottschalk, Oliver; Dreyer, Florian; Mehlhorn, Alexander; Röser, Anke; Walther, Markus

2018-04-18

Percutaneous correction of a hallux valgus deformity with or without transfer metatarsalgia. Hallux valgus deformity up to 20° intermetatarsal angle, without instability of the first tarsometatarsal joint. Symptomatic arthritis of the first metatarsophalangeal joint, as well as instability of the first tarsometatarsal joint. Percutaneous performed osteotomy of the distal metatarsal 1 in combination with a medial closing wedge osteotomy of the proximal phalanx of the first toe. The use of a postoperative shoe with a rigid sole allows adapted weight bearing in the first 6 weeks. Active and passive mobilization can start immediately after surgery. The method is very effective to treat even severe deformities with or without metatarsalgia. The amount of correction is similar to open procedures. We recommend cadaver training to become familiar with this technique. Thus, complications such as nerve, vessel or tendon injuries can be avoided. The intraoperative radiation exposure remains significantly elevated even for experienced surgeons. In addition to the aesthetic benefits, there is less soft tissue traumatization compared to conventional open procedures. There is no need of bloodlessness. The minimally invasive Chevron and Akin osteotomy is a safe and powerful technique for the treatment of hallux valgus deformity.

Foot Disorders, Foot Posture, and Foot Function: The Framingham Foot Study

PubMed Central

Hagedorn, Thomas J.; Dufour, Alyssa B.; Riskowski, Jody L.; Hillstrom, Howard J.; Menz, Hylton B.; Casey, Virginia A.; Hannan, Marian T.

2013-01-01

Introduction Foot disorders are common among older adults and may lead to outcomes such as falls and functional limitation. However, the associations of foot posture and foot function to specific foot disorders at the population level remain poorly understood. The purpose of this study was to assess the relation between specific foot disorders, foot posture, and foot function. Methods Participants were from the population-based Framingham Foot Study. Quintiles of the modified arch index and center of pressure excursion index from plantar pressure scans were used to create foot posture and function subgroups. Adjusted odds ratios of having each specific disorder were calculated for foot posture and function subgroups relative to a referent 3 quintiles. Results Pes planus foot posture was associated with increased odds of hammer toes and overlapping toes. Cavus foot posture was not associated with the foot disorders evaluated. Odds of having hallux valgus and overlapping toes were significantly increased in those with pronated foot function, while odds of hallux valgus and hallux rigidus were significantly decreased in those with supinated function. Conclusions Foot posture and foot function were associated with the presence of specific foot disorders. PMID:24040231

[Clinical and radiographic evaluation of a new percutaneous technique for moderate to severe hallux valgus deformity].

PubMed

Vélez-de Lachica, J C; Valdez-Jiménez, L A; Inzunza-Sánchez, J M

2017-01-01

Hallux valgus is considered the most common musculoskeletal deformity, with a prevalence of 88%. There are more than 130 surgical techniques for its treatment; currently, percutaneous ones are popular; however, they do not take into account the metatarsal-phalangeal correction angle. The aim of this study is to propose a modified technique for the correction of the percutaneous metatarsal-phalangeal and inter-metatarsal angles and to evaluate its clinical and radiological results. An experimental, prospective and longitudinal study in 10 patients with moderate to severe hallux valgus according to the classification of Coughlin and Mann were collected; the results were evaluated with the AOFAS scale at 15, 30, 60 and 90 days. The McBride technique and the technique of percutaneous anchor with the proposed amendment were performed. The AOFAS scale was applied as described, finding a progressive increase of the rating; the average correction of the inter-metatarsal angle was 8.8 degrees and of the metatarsal-phalangeal, 9.12. The modified technique of percutaneous anchor showed clear clinical and radiographic improvements in the short term. Our modified technique is proposed for future projects, including a large sample with long-term follow-up.

Single absorbable polydioxanone pin fixation for distal chevron bunion osteotomies.

PubMed

Deorio, J K; Ware, A W

2001-10-01

The distal chevron osteotomy is a well-established technique for correction of symptomatic mild to moderate metatarsus primus varus with hallux valgus deformity. Fixation of the osteotomy ranges from none to bone pegs, Kirschner wires, screws, or absorbable pins. We evaluated one surgeon's (J.K.D.) results of distal chevron osteotomy fixation with a single, nonpredrilled, 1.3-mm poly-p-dioxanone pin and analyzed any differences in patients with unilateral or bilateral symptomatic metatarsus primus varus with hallux valgus deformities. All osteotomies healed without evidence of infection, osteolysis, nonunion, or necrosis. Equal correction was achieved in unilateral and bilateral procedures. The technique is quick and easy, and adequate fixation is achieved.

Early results using a biodegradable magnesium screw for modified chevron osteotomies.

PubMed

Plaass, Christian; Ettinger, Sarah; Sonnow, Lena; Koenneker, Soeren; Noll, Yvonne; Weizbauer, Andreas; Reifenrath, Janin; Claassen, Leif; Daniilidis, Kiriakos; Stukenborg-Colsman, Christina; Windhagen, Henning

2016-12-01

This is the first larger study analyzing the use of magnesium-based screws for fixation of modified Chevron osteotomies in hallux valgus surgery. Forty-four patients (45 feet) were included in this prospective study. A modified Chevron osteotomy was performed on every patient and a magnesium screw used for fixation. The mean clinical follow up was 21.4 weeks. The mean age of the patients was 45.5 years. Forty patients could be provided with the implant, in four patients the surgeon decided to change to a standard metallic implant. The AOFAS, FAAM and pain NRS-scale improved markedly. The hallux valgus angle, intermetatarsal angle and sesamoid position improved significantly. Seven patients showed dorsal subluxation, rotation or medial shifting of the metatarsal heads within the first 3 months. One of these patients was revised, in all others the findings were considered clinically not significant or the patients refused revision. This study shows the feasibility of using magnesium screws in hallux valgus-surgery. Surgeons starting with the use of these implants should be aware of the proper handling of these implants and should know about corrosion effects during healing and its radiographic appearance. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:2207-2214, 2016. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

A comparison of proximal and distal chevron osteotomy for the correction of moderate hallux valgus deformity.

PubMed

Park, C-H; Jang, J-H; Lee, S-H; Lee, W-C

2013-05-01

The purpose of this study was to compare the results of proximal and distal chevron osteotomy in patients with moderate hallux valgus. We retrospectively reviewed 34 proximal chevron osteotomies without lateral release (PCO group) and 33 distal chevron osteotomies (DCO group) performed sequentially by a single surgeon. There were no differences between the groups with regard to age, length of follow-up, demographic or radiological parameters. The clinical results were assessed using the American Orthopaedic Foot and Ankle Society (AOFAS) scoring system and the radiological results were compared between the groups. At a mean follow-up of 14.6 months (14 to 32) there were no significant differences in the mean AOFAS scores between the DCO and PCO groups (93.9 (82 to 100) and 91.8 (77 to 100), respectively; p = 0.176). The mean hallux valgus angle, intermetatarsal angle and sesamoid position were the same in both groups. The metatarsal declination angle decreased significantly in the PCO group (p = 0.005) and the mean shortening of the first metatarsal was significantly greater in the DCO group (p < 0.001). We conclude that the clinical and radiological outcome after a DCO is comparable with that after a PCO; longer follow-up would be needed to assess the risk of avascular necrosis.

Intra-rater reliability of hallux flexor strength measures using the Nintendo Wii Balance Board.

PubMed

Quek, June; Treleaven, Julia; Brauer, Sandra G; O'Leary, Shaun; Clark, Ross A

2015-01-01

The purpose of this study was to investigate the intra-rater reliability of a new method in combination with the Nintendo Wii Balance Board (NWBB) to measure the strength of hallux flexor muscle. Thirty healthy individuals (age: 34.9 ± 12.9 years, height: 170.4 ± 10.5 cm, weight: 69.3 ± 15.3 kg, female = 15) participated. Repeated testing was completed within 7 days. Participants performed strength testing in sitting using a wooden platform in combination with the NWBB. This new method was set up to selectively recruit an intrinsic muscle of the foot, specifically the flexor hallucis brevis muscle. Statistical analysis was performed using intra-class coefficients and ordinary least product analysis. To estimate measurement error, standard error of measurement (SEM), minimal detectable change (MDC) and percentage error were calculated. Results indicate excellent intra-rater reliability (ICC = 0.982, CI = 0.96-0.99) with an absence of systematic bias. SEM, MDC and percentage error value were 0.5, 1.4 and 12 % respectively. This study demonstrates that a new method in combination with the NWBB application is reliable to measure hallux flexor strength and has potential to be used for future research and clinical application.

Characteristics of Selected Anthropometric Foot Indicators in Physically Active Students.

PubMed

Bac, Aneta; Bogacz, Gabriela; Ogrodzka-Ciechanowicz, Katarzyna; Kulis, Aleksandra; Szaporów, Tomasz; Woźniacka, Renata; Radlińska, Natalia

2018-05-01

The aim of this study was to determine the type of medial longitudinal arch (MLA) in students of Krakow universities, investigate the relationship between physical activity and the shaping of the feet, and examine the relationship between hallux valgus angle and the type of footwear chosen most often. The study group consisted of 120 students, of which 56 respondents were students of the University School of Physical Education in Krakow, whereas the remaining 64 respondents were students of the Pedagogical University of Krakow. To evaluate the MLA, a podoscope was used, which allowed us to determine the length and width of the foot, and calculation of the Clarke angle, heel angle γ, and the angle of hallux valgus. All students were also subjected to a measurement of body weight and height. There was a statistically significant relationship between physical activity and the Clarke angle in the group of women studying at the University School of Physical Education. There was no correlation between the hallux valgus angle and the type of footwear chosen most often in the research groups. The most frequently diagnosed type of longitudinal and transverse arch foot in the research group was normal MLA. There was no relationship between physical activity and transverse arch foot in any of the research groups.

A comparison of Chevron and Lindgren-Turan osteotomy techniques in hallux valgus surgery: a prospective randomized controlled study.

PubMed

Uygur, Esat; Özkan, Namık Kemal; Akan, Kaya; Çift, Hakan

2016-01-01

The aim of this prospective randomized controlled single-blind study was to compare the results of Chevron and Lindgren-Turan osteotomy techniques for treatment of moderate hallux valgus. A total of 66 female patients (34 in Chevron group, 32 Lindgren-Turan group) were recruited in this study and followed up for an average of 26.08 months. Operative procedures were performed by 2 surgeons, and patients were evaluated by an another researcher who was blinded to the surgical technique. The groups were compared for their radiological and clinical results. Both techniques was clinically and radiologically effective (p<0.01). However, no significant differences were found between the 2 groups regarding American Orthopaedic Foot and Ankle Society's clinical rating system, Painful Foot Evaluation scale of Maryland University scores, or radiologic evaluation (p>0.05). Compared to the Chevron group, the Lindgren-Turan group was found to have shorter surgical duration (p<0.05) and significantly more shortening at the first metatarsal (p<0.05). In moderate hallux valgus deformity, both the Chevron and Lindgren-Turan osteotomy techniques are clinically and radiologically safe, effective, and reliable alternatives. No superiority was detected in either technique. Although shortening at the first metatarsal in the Lindgren-Turan group was radiologically significant, the results were clinically tolerable.

Being overweight has limited effect on SCARF osteotomy outcome for hallux valgus correction.

PubMed

Milczarek, Marcin A; Milczarek, Julia J; Tomasik, Bartłomiej; Łaganowski, Przemysław; Nowak, Krzysztof; Domżalski, Marcin

2017-04-01

The purpose of this study was to investigate the association between body mass index (BMI) and the results of SCARF osteotomy of the first metatarsal for hallux valgus (HV) correction, as the literature on this is scant. This prospective study was carried out between 2011 and 2015. One hundred and thirty-three patients diagnosed with moderate to severe HV underwent a SCARF corrective osteotomy. We divided the patients into two groups according to their BMI: normal and overweight. Postoperative follow-up was two years. All patients were examined twice by two medical doctors simultaneously: pre-operatively and post-operatively at two years' follow-up. Data collected included biometrical records, X-rays [HV angle (HVA), intermetatarsal angle (IMA), American Orthopaedic Foot and Ankle Society Hallux Metatarsophalangeal Index (AOFAS-HMI) and visual analogue scale (VAS) for pain and satisfaction]. There was a significant difference between patient age (p = 0.001), age at onset (p < 0.001) and AOFAS-HMI (p = 0.035) at follow-up. Other parameters were similar in both groups. Regardless of BMI, the radiological outcome was comparable. Despite a significant difference in AOFAS-HMI results, pain and satisfaction level were similar. The authors agreed that high BMI has protective role in the prevalence of HV.

High-heeled shoes and musculoskeletal injuries: a narrative systematic review

PubMed Central

Barnish, Maxwell S; Barnish, Jean

2016-01-01

Objectives To conduct the first systematic review from an epidemiological perspective regarding the association between high-heeled shoe wear and hallux valgus, musculoskeletal pain, osteoarthritis (OA) and both first-party and second-party injury in human participants without prior musculoskeletal conditions. Setting A systematic review of international peer-reviewed scientific literature across seven major languages. Data sources Searches were conducted on seven major bibliographic databases in July 2015 to initially identify all scholarly articles on high-heeled shoes. Supplementary manual searches were conducted. Titles, abstracts and full-text articles were sequentially screened to identify all articles assessing epidemiological evidence regarding the association between high-heeled shoe wear and hallux valgus, musculoskeletal pain, OA and both first-party and second-party injury in human participants without prior musculoskeletal conditions. Standardised data extraction and quality assessment (Threats to Validity tool) were conducted. Primary and secondary outcome measures Musculoskeletal pain or OA as assessed by clinical diagnosis or clinical assessment tool. First-party or second-party injury. Results 644 unique records were identified, 56 full-text articles were screened and 18 studies included in the review. Four studies assessed the relationship with hallux valgus and three found a significant association. Two studies assessed the association with OA and neither found a significant association. Five studies assessed the association with musculoskeletal pain and three found a significant association. Eight studies assessed first-party injury and seven found evidence of a significant injury toll associated with high-heeled shoes. One study provided data on second-party injury and the injury toll was low. Conclusions High-heeled shoes were shown to be associated with hallux valgus, musculoskeletal pain and first-party injury. No conclusive evidence regarding OA and second-party injury was found. Societal and clinical relevance of these findings is discussed. Concern is expressed about the expectation to wear high-heeled shoes in some work and social situations and access by children. PMID:26769789

The dowel technique for first metatarso-phalangeal joint arthrodesis in revision surgery with bone loss.

PubMed

Malagelada, Francesc; Welck, Matthew J; Clark, Callum

2017-02-27

The operative management of failed first metatarso-phalangeal joint (MTPJ) surgery is often complicated by bone loss and shortening of the hallux. Restoration of first ray length and alignment often cannot be achieved with in situ fusion and reconstruction techniques with bone graft are therefore required. We present a novel technique of longitudinal (proximo-distal) bone dowel arthrodesis for first MTPJ arthrodesis with bone loss. Between August 2007 and February 2015, eight patients have been treated by the senior author with this technique. The mean age at surgery was 60.5 years (range 45-80) with seven females and one male. Index surgery was MTPJ arthrodesis (three patients), Keller excision arthroplasty (two patients), MTPJ hemiarthroplasty (two patients) and silastic arthroplasty (one patient). Clinical and radiological fusion was assessed and other radiological measurements included hallux valgus angle (HVA) and length of the hallux (LOH). All patients achieved fusion at a mean of 9.3 weeks (range 6-12) from surgery and only one patient required removal of metalwork. There were no major complications. The HVA improved in all cases from 21.4±2.8 pre-operatively to 11.6±3.5 post-operatively (p>0.05). The LOH also increased in all cases from 82.1±8.3mm to 86.7±8.2mm (p>0.05). The subgroup of patients who were revised from an arthroplasty, where maintenance of length rather than increase in length was desirable (hemiarthroplasty, silastic) had significantly lower increase in LOH than those revised from a non-arthroplasty index surgery (arthrodesis, Keller) (p=0.029). The dowel technique is successful for first MTPJ arthrodesis revision surgery with optimal union rates and satisfactory radiographic and clinical outcomes. It is an effective and versatile option for managing bone loss and deformity of the hallux. Copyright © 2017 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.

Surgical Treatment of Moderate Hallux Valgus: A Comparison of Distal Chevron Metatarsal Osteotomy With and Without Lateral Soft-Tissue Release.

PubMed

Grle, Maki; Vrgoc, Goran; Bohacek, Ivan; Hohnjec, Vladimir; Martinac, Marko; Brkic, Iva; Stefan, Lovro; Jotanovic, Zdravko

2017-12-01

The purpose of the study was to determine whether lateral soft-tissue release (LSTR) has a beneficial or detrimental effect on the outcome of distal Chevron first metatarsal osteotomy (DCMO) in the treatment of moderate hallux valgus (HV). We compared the effect of different surgical treatments in 2 groups of patients: group I (23 patients, 25 feet, average age of 55 [from 43 to 77] years) was subjected to DCMO only, whereas group II (18 patients, 23 feet, average age of 59 [from 52 to 70] years]) was subjected to DCMO with LSTR. The American Orthopaedic Foot and Ankle Society's Hallux Metatarsophalangeal-Interphalangeal scale survey was conducted postoperatively, followed by the brief survey on postoperative patient satisfaction. The patient follow-up period was from 18 to 24 months after surgical treatment, on average. After surgical intervention, both groups of patients presented with an improved HV angle, but there was no significant difference between the groups. However, group II showed significant improvements in medial sesamoid bone position and patient satisfaction scores as compared with group I. Our midterm follow-up of surgical treatments for moderate HV deformity suggests that both procedures provide good postoperative results. However, according to our results, DCMO with LSTR provides better results than procedures without LSTR. Therapeutic, Level III: Retrospective comparative study.

Foot ulcer risk and location in relation to prospective clinical assessment of foot shape and mobility among persons with diabetes.

PubMed

Cowley, Matthew S; Boyko, Edward J; Shofer, Jane B; Ahroni, Jessie H; Ledoux, William R

2008-11-01

We assessed baseline clinical foot shape for 2939 feet of diabetic subjects who were monitored prospectively for foot ulceration. Assessments included hammer/claw toes, hallux valgus, hallux limitus, prominent metatarsal heads, bony prominences, Charcot deformity, plantar callus, foot type, muscle atrophy, ankle and hallux mobility, and neuropathy. Risk factors were linked to ulcer occurrence and location via a Cox proportional hazards model. Hammer/claw toes (hazard ratio [HR] (95% confidence interval [CI])=1.43 (1.06, 1.94) p=0.02), marked hammer/claw toes (HR=1.77 (1.18, 2.66) p=0.006), bony prominences (HR=1.38 (1.02, 1.88), p=0.04), and foot type (Charcot or drop foot vs. neutrally aligned) (HR=2.34 (1.33, 4.10), p=0.003) were significant risk factors for ulceration adjusting for age, body mass index, insulin medication, ulcer history and amputation history. With adjustment for neuropathy only hammer/claw toes (HR=1.40 (1.03, 1.90), p=0.03) and foot type (HR=1.76 (1.04, 3.04), p=0.05) were significantly related to ulceration. However, there was no relationship between ulcer location and foot deformity. Certain foot deformities were predictive of ulceration, although there was no relationship between clinical foot deformity and ulcer location.

WITHDRAWN: Interventions for treating hallux valgus (abductovalgus) and bunions.

PubMed

Ferrari, Jill; Higgins, Julian Pt; Prior, Trevor D

2009-04-15

Hallux valgus is classified as an abnormal deviation of the great toe (hallux) towards the midline of the foot. To identify and evaluate the evidence from randomised trials of interventions used to correct hallux valgus. We searched the Cochrane Bone, Joint and Muscle Trauama Group trials register (2003/1), the Cochrane Central Register of Controlled Trials (The Cochrane Library issue 1, 2003), MEDLINE (January 1966 to March 2003) and EMBASE (1980 to January 2003). No language restrictions were applied. Hand searching of specific foot journals was also undertaken.Date of the most recent search: 31st March 2003. Randomised or quasi-randomised trials of both conservative and surgical treatments of hallux valgus. Excluded were studies comparing areas of surgery not specific to the control of the deformity such as use of anaesthetics or tourniquet placement. Methodological quality of trials which met the inclusion criteria was independently assessed by two reviewers. Data extraction was undertaken by two reviewers. The trials were grouped according to the interventions being compared, but the dissimilarity in the comparisons prevented pooling of results. The methodological quality of the 21 included trials was generally poor and trial sizes were small.Three trials involving 332 participants evaluated conservative treatments versus no treatment. There was no evidence of a difference in outcomes between treatment and no treatment.One good quality trial involving 140 participants compared surgery to conservative treatment. Evidence was shown of an improvement in all outcomes in patients receiving chevron osteotomy compared with those receiving orthoses. The same trial also compared surgery to no treatment in 140 participants. Evidence was shown of an improvement in all outcomes in patients receiving chevron osteotomy compared with those receiving no treatment.Two trials involving 133 people with hallux valgus compared Keller's arthroplasty with other surgical techniques. In general, there was no advantage or disadvantage using Keller's over the other techniques. When the distal osteotomy was compared to Keller's arthroplasty, the osteotomy showed evidence of improving the intermetatarsal angle and preserving joint range of motion. The arthroplasty was found to have less of an impact on walking ability compared to the arthrodesis.Six trials involving 309 participants compared chevron (and chevron-type) osteotomy with other techniques. The chevron osteotomy offered no advantages in these trials. For some outcomes, other techniques gave better results. Two of these trials (94 participants) compared a type of proximal osteotomy to a proximal chevron osteotomy and found no evidence of a difference in outcomes between techniques.Three trials involving 157 participants compared outcomes between original operations and surgeon's adaptations. There was no advantage found for any of the adaptations.Three trials involving 71 people with hallux valgus compared new methods of fixation to traditional methods. There was no evidence that the new methods of fixation were detrimental to the outcome of the patients.Four trials involving 162 participants evaluated methods of post-operative rehabilitation. The use of continuous passive motion appeared to give an improved range of motion and earlier recovery following surgery. Early weightbearing or the use of a crepe bandage were not found to be detrimental to final outcome. Only a few studies had considered conservative treatments. The evidence from these suggested that orthoses and night splints did not appear to be any more beneficial in improving outcomes than no treatment. Surgery (chevron osteotomy) was shown to be beneficial compared to orthoses or no treatment, but when compared to other osteotomies, no technique was shown to be superior to any other. Only one trial had compared an osteotomy to an arthroplasty. There was limited evidence to suggest that the osteotomy gave the better outcomes. It was notable that the numbers of participants in some trials remaining dissatisfied at follow-up were consistently high (25 to 33%), even when the hallux valgus angle and pain had improved. A few of the more recent trials used assessment scores that combine several aspects of the patients outcomes. These scoring systems are useful to the clinician when comparing techniques but are of dubious relevance to the patient if they do not address their main concern and such scoring systems are frequently unvalidated. Only one study simply asked the patient if they were better than before the treatment. Final outcomes were most frequently measured at one year, with a few trials maintaining follow-up for 3 years. Such time-scales are minimal given that the patients will be on their feet for at least another 20-30 years after treatment. Future research should include patient-focused outcomes, standardised assessment criteria and longer surveillance periods, more usefully in the region of 5-10 years.

Interventions for treating hallux valgus (abductovalgus) and bunions.

PubMed

Ferrari, J; Higgins, J P T; Prior, T D

2004-01-01

Hallux valgus is classified as an abnormal deviation of the great toe (hallux) towards the midline of the foot. To identify and evaluate the evidence from randomised trials of interventions used to correct hallux valgus. We searched the Cochrane Musculoskeletal Injuries Group trials register (2003/1), the Cochrane Central Register of Controlled Trials (The Cochrane Library issue 1, 2003), MEDLINE (January 1966 to March 2003) and EMBASE (1980 to January 2003). No language restrictions were applied. Hand searching of specific foot journals was also undertaken. Date of the most recent search: 31st March 2003. Randomised or quasi-randomised trials of both conservative and surgical treatments of hallux valgus. Excluded were studies comparing areas of surgery not specific to the control of the deformity such as use of anaesthetics or tourniquet placement. Methodological quality of trials which met the inclusion criteria was independently assessed by two reviewers. Data extraction was undertaken by two reviewers. The trials were grouped according to the interventions being compared, but the dissimilarity in the comparisons prevented pooling of results. The methodological quality of the 21 included trials was generally poor and trial sizes were small. Three trials involving 332 participants evaluated conservative treatments versus no treatment. There was no evidence of a difference in outcomes between treatment and no treatment. One good quality trial involving 140 participants compared surgery to conservative treatment. Evidence was shown of an improvement in all outcomes in patients receiving chevron osteotomy compared with those receiving orthoses. The same trial also compared surgery to no treatment in 140 participants. Evidence was shown of an improvement in all outcomes in patients receiving chevron osteotomy compared with those receiving no treatment. Two trials involving 133 people with hallux valgus compared Keller's arthroplasty with other surgical techniques. In general, there was no advantage or disadvantage using Keller's over the other techniques. When the distal osteotomy was compared to Keller's arthroplasty, the osteotomy showed evidence of improving the intermetatarsal angle and preserving joint range of motion. The arthroplasty was found to have less of an impact on walking ability compared to the arthrodesis. Six trials involving 309 participants compared chevron (and chevron-type) osteotomy with other techniques. The chevron osteotomy offered no advantages in these trials. For some outcomes, other techniques gave better results. Two of these trials (94 participants) compared a type of proximal osteotomy to a proximal chevron osteotomy and found no evidence of a difference in outcomes between techniques. Three trials involving 157 participants compared outcomes between original operations and surgeon's adaptations. There was no advantage found for any of the adaptations. Three trials involving 71 people with hallux valgus compared new methods of fixation to traditional methods. There was no evidence that the new methods of fixation were detrimental to the outcome of the patients. Four trials involving 162 participants evaluated methods of post-operative rehabilitation. The use of continuous passive motion appeared to give an improved range of motion and earlier recovery following surgery. Early weightbearing or the use of a crepe bandage were not found to be detrimental to final outcome. Only a few studies had considered conservative treatments. The evidence from these suggested that orthoses and night splints did not appear to be any more beneficial in improving outcomes than no treatment. Surgery (chevron osteotomy) was shown to be beneficial compared to orthoses or no treatment, but when compared to other osteotomies, no technique was shown to be superior to any other. Only one trial had compared an osteotomy to an arthroplasty. There was limited evidence to suggest that the osteotomy gat the osteotomy gave the better outcomes. It was notable that the numbers of participants in some trials remaining dissatisfied at follow-up were consistently high (25 to 33%), even when the hallux valgus angle and pain had improved. A few of the more recent trials used assessment scores that combine several aspects of the patients outcomes. These scoring systems are useful to the clinician when comparing techniques but are of dubious relevance to the patient if they do not address their main concern and such scoring systems are frequently unvalidated. Only one study simply asked the patient if they were better than before the treatment. Final outcomes were most frequently measured at one year, with a few trials maintaining follow-up for 3 years. Such time-scales are minimal given that the patients will be on their feet for at least another 20-30 years after treatment. Future research should include patient-focused outcomes, standardised assessment criteria and longer surveillance periods, more usefully in the region of 5-10 years.

Hallux Rigidus

MedlinePlus

... in the big toe during use (walking, standing, bending, etc.) Pain and stiffness aggravated by cold, damp ... ps.position.alert.message}} Getting your location, one moment... Please enter a 5-digit zip code. Please ...

Use of 3D Printed Bone Plate in Novel Technique to Surgically Correct Hallux Valgus Deformities

PubMed Central

Smith, Kathryn E.; Dupont, Kenneth M.; Safranski, David L.; Blair, Jeremy; Buratti, Dawn; Zeetser, Vladimir; Callahan, Ryan; Lin, Jason; Gall, Ken

2016-01-01

Three-dimensional (3-D) printing offers many potential advantages in designing and manufacturing plating systems for foot and ankle procedures that involve small, geometrically complex bony anatomy. Here, we describe the design and clinical use of a Ti-6Al-4V ELI bone plate (FastForward™ Bone Tether Plate, MedShape, Inc., Atlanta, GA) manufactured through 3-D printing processes. The plate protects the second metatarsal when tethering suture tape between the first and second metatarsals and is a part of a new procedure that corrects hallux valgus (bunion) deformities without relying on doing an osteotomy or fusion procedure. The surgical technique and two clinical cases describing the use of this procedure with the 3-D printed bone plate are presented within. PMID:28337049

Foot length measurements of newborns of high and low risk pregnancies.

PubMed

Salge, Ana Karina Marques; Rocha, Érika Lopes; Gaíva, Maria Aparecida Munhoz; Castral, Thaíla Correa; Guimarães, Janaína Valadares; Xavier, Raphaela Maioni

2017-03-09

Comparing foot length measurements of newborns in high and low risk pregnancies at a public hospital in Goiânia, GO, Brazil. A cross-sectional study carried out between April, 2013 and May, 2015, with a sample consisting of 180 newborns; 106 infants of women from high-risk pregnancies and 74 of women from low-risk pregnancies. Data were descriptively analyzed. Foot length measurement was performed using a stiff transparent plastic ruler, graduated in millimeters. The length of both feet was measured from the tip of the hallux (big toe) to the end of the heel. A statistically significant relationship was found between the foot length and newborn's weight, between the cephalic and thoracic perimeters in the high-risk group and between the cephalic perimeter in the control group. There is a need for creating cut-off points to identify newborns with intrauterine growth disorders using foot length. Comparar as medidas do comprimento hálux-calcâneo de recém-nascidos em gestações de alto e baixo risco em um hospital público de Goiânia, GO. Estudo transversal, realizado no período de abril de 2013 a maio de 2015, cuja amostra constituiu-se de 180 recém-nascidos, 106 filhos de mulheres com gestação de alto risco e 74 de mulheres com gestação de baixo risco. Os dados foram analisados descritivamente. A medida do comprimento hálux-calcâneo foi realizada utilizando-se de régua plástica transparente rígida, graduada em milímetros. Foram medidos ambos os pés, aferindo-se o comprimento da ponta do hálux até a extremidade do calcâneo. Foi encontrada relação estatisticamente significante entre o comprimento hálux-calcâneo e o peso do recém-nascido, entre os perímetros cefálico e torácico no grupo de alto risco e entre o perímetro cefálico no grupo controle. Existe necessidade da criação de pontos de corte para identificar recém-nascidos com desvios de crescimento intrauterino utilizando-se do comprimento hálux-calcâneo. Comparar las mediciones de la longitud hallux-calcáneo de los recién nacidos en embarazos de alto y bajo riesgo en un hospital público de Goiânia, GO.MÉTODOSEstudio transversal realizado de abril 2013 a mayo 2015, cuya muestra estuvo constituida por 180 recién nacidos, 106 de mujeres con embarazos de alto riesgo y 74 de mujeres con embarazos de bajo riesgo. Los datos se analizaron de manera descriptiva. La medida de la longitud hallux-calcáneo se realizó mediante regla de plástico rígido transparente, graduada en milímetros. Se midieron en ambos pies, las longitudes de la punta del hallux hasta el final del calcáneo. Se encontró una relación estadísticamente significativa entre la longitud hallux-calcáneo y el peso del recién nacido, entre las circunferencias cefálica y torácica en el grupo de alto riesgo y entre la circunferencia cefálica en el grupo control. Existe la necesidad de crear puntos de corte para identificar los recién nacidos con desviaciones de crecimiento intrauterino utilizando la longitud desde el hallux hasta el calcáneo.

Proximal Intermetatarsal Divergence in Distal Chevron Osteotomy for Hallux Valgus: An Overlooked Finding.

PubMed

Akpinar, Evren; Buyuk, Abdul Fettah; Cetinkaya, Engin; Gursu, Sarper; Ucpunar, Hanifi; Albayrak, Akif

2016-01-01

The goal of distal chevron osteotomy for hallux valgus is to restore proper first-toe joint alignment by performing lateral translation of the distal first metatarsal fragment (the metatarsal head). We hypothesized that in some patients this procedure might also result in involuntary medial translation of the proximal first metatarsal fragment, which we called proximal intermetatarsal divergence. The aim of the present study was to compare the pre- and postoperative radiographs of patients with hallux valgus to determine whether we could identify proximal intermetatarsal divergence. We retrospectively compared the pre- and postoperative radiographs of 29 feet in 28 patients treated with distal chevron osteotomy. Two different methods were used to measure the intermetatarsal angles: the anatomic intermetatarsal angle (aIMA) and the mechanical intermetatarsal angle (mIMA). The maximum intermetatarsal distance (MID) was also measured. We defined proximal intermetatarsal divergence as a postoperative increase in the aIMA or MID, coupled with a decrease in the mIMA. For data analysis, we divided the patients into low-angle (mild deformity) and high-angle (severe deformity) groups, according to their preoperative mIMA. The mean ± standard deviation patient age was 41 ± 14 years. In the low-angle group, the mean mIMA decreased (from 10.91° to 7.00°), the mean aIMA increased (from 11.80° to 13.55°), and the mean MID increased (from 17.97 mm to 20.60 mm; p = .001, for all). In the high-angle group, the mean mIMA decreased (from 14.30° to 6.90°; p = .001), the mean aIMA decreased (from 14.77° to 13.54°; p = .06), and the mean MID decreased (from 20.74 mm to 20.37 mm; p = .64). The results of our study suggest that proximal intermetatarsal divergence might occur after distal chevron osteotomy for hallux valgus, primarily in patients with a low preoperative mIMA. Copyright © 2016 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

Bunions (Hallux Abducto Valgus)

MedlinePlus

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A pictorial review of reconstructive foot and ankle surgery: hallux abductovalgus

PubMed Central

Meyr, Andrew J; Singh, Salil; Chen, Oliver; Ali, Sayed

2015-01-01

This pictorial review focuses on basic procedures performed within the field of podiatric surgery, specifically for the hallux abductovalgus or “bunion” deformity. Our goal is to define objective radiographic parameters that surgeons utilize to initially define deformity, lead to procedure selection and judge post-operative outcomes. We hope that radiologists will employ this information to improve their assessment of post-operative radiographs following reconstructive foot surgeries. First, relevant radiographic measurements are defined and their role in procedure selection explained. Second, the specific surgical procedures of the distal metatarsal, metatarsal shaft, metatarsal base, and phalangeal osteotomies are described in detail. Additional explanations of arthrodesis of the first metatarsal-phalangeal and metatarsal-cuneiform joints are also provided. Finally, specific plain film radiographic findings that judge post-operative outcomes for each procedure are detailed. PMID:26622935

[Melorheostosis of the foot: a case report of a rare entity].

PubMed

Craiovan, B; Zeiler, G; Delling, G; Schuh, A

2006-12-01

Melorheostosis is a rare bony dysplasia and often recognised just sporadically by chance. We present a case of a 15 year old girl who presented a melorheostosis of the left foot. After birth there was recognized a shortening and deformity of the 2nd toe on the left foot. Furthermore she had an interphalangeal hallux valgus that displaced the 2nd toe increasingly. Thus in the last years there were more and more difficulties to wear normal shoes. Conservative therapy was not successful. We performed a lengthening extending osteotomy of the 2nd toe (a modified Weil osteotomy) and an Akin osteotomy of the interphalangeal hallux valgus. Since the surgical procedure the patient is out of any complaints. We demonstrate the radiologic and histologic findings and discuss the relevant literature and possible etiology.

Hallux valgus, ankle osteoarthrosis and adult acquired flatfoot deformity: a review of three common foot and ankle pathologies and their treatments

PubMed Central

Crevoisier, Xavier; Assal, Mathieu; Stanekova, Katarina

2016-01-01

The pathogenesis of hallux valgus deformity is multifactorial. Conservative treatment can alleviate pain but is unable to correct the deformity. Surgical treatment must be adapted to the type and severity of the deformity. Success of surgical treatment ranges from 80% to 95%, and complication rates range from 10% to 30%. Ankle osteoarthrosis most commonly occurs as a consequence of trauma. Ankle arthrodesis and total ankle replacement are the most common surgical treatments of end stage ankle osteoarthrosis. Both types of surgery result in similar clinical improvement at midterm; however, gait analysis has demonstrated the superiority of total ankle replacement over arthrodesis. More recently, conservative surgery (extraarticular alignment osteotomies) around the ankle has gained popularity in treating early- to mid-stage ankle osteoarthrosis. Adult acquired flatfoot deformity is a consequence of posterior tibial tendon dysfunction in 80% of cases. Classification is based upon the function of the tibialis posterior tendon, the reducibility of the deformity, and the condition of the ankle joint. Conservative treatment includes orthotics and eccentric muscle training. Functional surgery is indicated for treatment in the early stages. In case of fixed deformity, corrective and stabilising surgery is performed. Cite this article: Crevoisier X, Assal M, Stanekova K. Hallux valgus, ankle osteoarthrosis and adult acquired flatfoot deformity: a review of three common foot and ankle pathologies and their treatments. EFORT Open Rev 2016;1:58–64. DOI: 10.1302/2058-5241.1.000015. PMID:28461929

Ultrasonically assisted anchoring of biodegradable implants for chevron osteotomies - clinical evaluation of a novel fixation method.

PubMed

Olms, Kai; Randt, Thorsten; Reimers, Nils; Zander, Nils; Schulz, Arndt P

2014-01-01

Reconstructive osteotomies for the treatment of Hallux valgus are among the most prevalent procedures in foot and ankle surgery. The combination of biodegradable materials with an innovative method for fixation by application of ultrasonic energy facilitates a new bonding method for fractures or osteotomies. As clinical experience is still limited, the aim of this study was to assess the safety and performance of the SonicPin system for fixation of Austin/Chevron osteotomies. Chevron osteotomy was performed on 30 patients for the treatment of Hallux valgus. The used SonicPins were made from polylactide and are selectively melted into the cancellous bone structure during insertion by ultrasonic energy. Patients were followed for one year, which included X-ray and MRI examinations as well as evaluation of life quality by EQ-5D (EuroQol). The MRI after three months showed adequate bone healing in all cases and no signs of foreign body reactions, which was again confirmed by MRI 12 months postoperatively. The bony healing after 12 months was uneventful without any signs of foreign body reactions. In summary, based on the low complication rate and the significant improvement in health related quality of life (EQ-5D) reported in this study, fixation of an Austin/Chevron osteotomy with a SonicPin for treatment of Hallux valgus can be considered to be safe and efficient over the short term. Therapeutic Level III.

Change in First Metatarsal Length After Proximal and Distal Chevron Osteotomies for Hallux Valgus Deformity.

PubMed

Lee, Jun Young; Lee, Yeon Soo; Song, Kyoung Chul; Choi, Kwi Youn

2015-01-01

The present study assessed the changes in the length of the first metatarsal bone after performing proximal chevron metatarsal osteotomy (PCMO) or distal Chevron metatarsal osteotomy (DCMO) for patients with hallux valgus deformity. A total of 60 patients with moderate-to-severe hallux valgus deformity from July 2009 to July 2011 were randomly divided into the PCMO and DCMO groups, with 30 patients in each group. The distal soft tissue procedure was performed in the same method for both groups. Measurements were performed preoperatively, postoperatively, and at the last follow-up visit at 6.1 ± 0.8 months. The postoperative length change with respect to the preoperative length was 0.7 ± 2.5 mm and -0.7 ± 5.1 mm for the PCMO and DCMO groups, respectively, with a slight lengthening of the first metatarsal bone in the PCMO group and a shortening in the DCMO group (p < .01). The follow-up length change with respect to the preoperative length was -2.1 ± 3.0 mm and -4.4 ± 2.2 mm for the PCMO and DCMO groups, respectively, demonstrating a clear shortening of the first metatarsal length at the last follow-up point in the DCMO group (p < .01).When DCMO and the distal soft tissue procedure were performed, significant shortening was found at 6 months of follow-up. Copyright © 2015 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

Role of Fixation and Postoperative Regimens in the Long-Term Outcomes of Distal Chevron Osteotomy: A Randomized Controlled Two-by-Two Factorial Trial of 100 Patients.

PubMed

Pentikäinen, Ilkka; Piippo, Jouni; Ohtonen, Pasi; Junila, Juhani; Leppilahti, Juhana

2015-01-01

The necessity of chevron osteotomy fixation is controversial and evidence for the effectiveness of postoperative regimens is limited. In a prospective, randomized study, we compared the long-term results of 2 operative techniques (osteotomy fixation versus no fixation) and 2 postoperative regimens (a soft cast versus an elastic bandage) in 100 patients who underwent surgery for hallux valgus. Clinical evaluations with the American Orthopaedic Foot and Ankle Society (AOFAS) scale scoring were performed at baseline and 6 weeks, 6 months, 1 year, and a mean of 7.9 years postoperatively. The mean AOFAS function score were better in the group treated without osteotomy fixation and with an elastic bandage at 6 weeks postoperatively, but the differences then disappeared. The total AOFAS scores improved significantly in all 4 subgroups during the first 12 months; however, in the long term, some deterioration occurred. In the AOFAS scores, the average function, alignment, and total points were significantly worse when the preoperative hallux valgus angles exceeded 30°. The incidence of complication was low (1%); there was 1 superficial wound infection. The AOFAS score did not differ statistically among the groups in our population. An elastic bandage for postoperative treatment is recommended. The risk of recurrence is greater and functional result worse if the preoperative hallux valgus angle exceeds 30°. Copyright © 2015 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

Ultrasonically Assisted Anchoring of Biodegradable Implants for Chevron Osteotomies – Clinical Evaluation of a Novel Fixation Method

PubMed Central

Olms, Kai; Randt, Thorsten; Reimers, Nils; Zander, Nils; Schulz, Arndt P.

2014-01-01

Reconstructive osteotomies for the treatment of Hallux valgus are among the most prevalent procedures in foot and ankle surgery. The combination of biodegradable materials with an innovative method for fixation by application of ultrasonic energy facilitates a new bonding method for fractures or osteotomies. As clinical experience is still limited, the aim of this study was to assess the safety and performance of the SonicPin system for fixation of Austin/Chevron osteotomies. Chevron osteotomy was performed on 30 patients for the treatment of Hallux valgus. The used SonicPins were made from polylactide and are selectively melted into the cancellous bone structure during insertion by ultrasonic energy. Patients were followed for one year, which included X-ray and MRI examinations as well as evaluation of life quality by EQ-5D (EuroQol). The MRI after three months showed adequate bone healing in all cases and no signs of foreign body reactions, which was again confirmed by MRI 12 months postoperatively. The bony healing after 12 months was uneventful without any signs of foreign body reactions. In summary, based on the low complication rate and the significant improvement in health related quality of life (EQ-5D) reported in this study, fixation of an Austin/Chevron osteotomy with a SonicPin for treatment of Hallux valgus can be considered to be safe and efficient over the short term. Level of Clinical Evidence: Therapeutic Level III. PMID:24851140

Diabetic foot ulcer incidence in relation to plantar pressure magnitude and measurement location.

PubMed

Ledoux, William R; Shofer, Jane B; Cowley, Matthew S; Ahroni, Jessie H; Cohen, Victoria; Boyko, Edward J

2013-01-01

We prospectively examined the relationship between site-specific peak plantar pressure (PPP) and ulcer risk. Researchers have previously reported associations between diabetic foot ulcer and elevated plantar foot pressure, but the effect of location-specific pressures has not been studied. Diabetic subjects (n=591) were enrolled from a single VA hospital. Five measurements of in-shoe plantar pressure were collected using F-Scan. Pressures were measured at 8 areas: heel, lateral midfoot, medial midfoot, first metatarsal, second through fourth metatarsal, fifth metatarsal, hallux, and other toes. The relationship between incident plantar foot ulcer and PPP or pressure-time integral (PTI) was assessed using Cox regression. During follow-up (2.4years), 47 subjects developed plantar ulcers (10 heel, 12 metatarsal, 19 hallux, 6 other). Overall mean PPP was higher for ulcer subjects (219 vs. 194kPa), but the relationship differed by site (the metatarsals with ulcers had higher pressure, while the opposite was true for the hallux and heel). A statistical analysis was not performed on the means, but hazard ratios from a Cox survival analysis were nonsignificant for PPP across all sites and when adjusted for location. However, when the metatarsals were considered separately, higher baseline PPP was significantly associated with greater ulcer risk; at other sites, this relationship was nonsignificant. Hazard ratios for all PTI data were nonsignificant. Location must be considered when assessing the relationship between PPP and plantar ulceration. © 2013.

Diabetic foot ulcer incidence in relation to plantar pressure magnitude and measurement location☆,☆☆,★

PubMed Central

Ledoux, William R.; Shofer, Jane B.; Cowley, Matthew S.; Ahroni, Jessie H.; Cohen, Victoria; Boyko, Edward J.

2014-01-01

Aims We prospectively examined the relationship between site-specific peak plantar pressure (PPP) and ulcer risk. Researchers have previously reported associations between diabetic foot ulcer and elevated plantar foot pressure, but the effect of location-specific pressures has not been studied. Methods Diabetic subjects (n = 591) were enrolled from a single VA hospital. Five measurements of in-shoe plantar pressure were collected using F-Scan. Pressures were measured at 8 areas: heel, lateral midfoot, medial midfoot, first metatarsal, second through fourth metatarsal, fifth metatarsal, hallux, and other toes. The relationship between incident plantar foot ulcer and PPP or pressure–time integral (PTI) was assessed using Cox regression. Results During follow-up (2.4 years), 47 subjects developed plantar ulcers (10 heel, 12 metatarsal, 19 hallux, 6 other). Overall mean PPP was higher for ulcer subjects (219 vs. 194 kPa), but the relationship differed by site (the metatarsals with ulcers had higher pressure, while the opposite was true for the hallux and heel). A statistical analysis was not performed on the means, but hazard ratios from a Cox survival analysis were nonsignificant for PPP across all sites and when adjusted for location. However, when the metatarsals were considered separately, higher baseline PPP was significantly associated with greater ulcer risk; at other sites, this relationship was nonsignificant. Hazard ratios for all PTI data were nonsignificant. Conclusions Location must be considered when assessing the relationship between PPP and plantar ulceration. PMID:24012295

Is it too early to move to full electronic PROM data collection?: A randomized controlled trial comparing PROM's after hallux valgus captured by e-mail, traditional mail and telephone.

PubMed

Palmen, Leonieke N; Schrier, Joost C M; Scholten, Ruben; Jansen, Justus H W; Koëter, Sander

2016-03-01

Patient reported outcome measures (PROM's) after hallux valgus surgery are used to rate the effectiveness as perceived by the patient. The interpretability of these PROM's is highly dependent on participation rate. Data capture method may be an important factor contributing to the response rate. We investigated the effect on response rate of traditional paper mail, telephone and e-mail PROM's after hallux valgus surgery. All consecutive patients operated between January and September 2013, were identified. Included patients were randomized by envelope in three groups: traditional pen and paper mail, e-mail and telephone. They were asked to fill in a FFI and EQ-5D. Two weeks later non-responders were sent a reminder. Of the 73 included patients, 25 were approached by mail, 24 by e-mail and 24 patients by telephone. The response rate on traditional mail was highest (88%), while response on e-mail was lowest (33%). Response rate on telephone was also high (79%). Response rate on traditional mail and telephone was significantly higher (p<0.001) than response on e-mail. Though electronic data collection has enormous potential, this study shows that e-mail yields unacceptable low response rates. It is too early to replace traditional pen-and-paper PROM's by electronic questionnaires. Copyright © 2015 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.

The risk of avascular necrosis following chevron osteotomy: a prospective study using bone scintigraphy.

PubMed

Shariff, Raheel; Attar, Fahad; Osarumwene, Donald; Siddique, Rehan; Attar, Gulam Dastagir

2009-04-01

Controversy exists with regard to the effects of chevron osteotomy on blood supply and subsequent development of avascular necrosis (AVN) of the first metatarsal head. The aim of this study was to assess the incidence of avascular necrosis in our centre following chevron osteotomy for hallux valgus, using bone scintigraphy. Thirty nine patients who had a chevron osteotomy for treatment of hallux valgus were prospectively studied. Mean follow-up was 14 months. Bone scintigraphy was used to assess metatarsal head perfusion at an average 8.5 weeks post operatively. Three patients (7.7%) showed abnormal bone scan around the metatarsal head. Further evaluation of these patients did not show any sign of AVN. We conclude there appears to be a risk of circulatory disturbance to the metatarsal head following chevron osteotomy of the first metarsal (7.7% in this study); however this does not translate into clinically significant AVN.

Lengthening of the shortened first metatarsal after Wilson's osteotomy for hallux valgus.

PubMed

Singh, D; Dudkiewicz, I

2009-12-01

Metatarsalgia is a recognised complication following iatrogenic shortening of the first metatarsal in the management of hallux valgus. The traditional surgical treatment is by shortening osteotomies of the lesser metatarsals. We describe the results of lengthening of iatrogenic first brachymetatarsia in 16 females. A Scarf-type osteotomy was used in the first four cases and a step-cut of equal thicknesses along the axis of the first metatarsal was performed in the others. The mean follow-up was 21 months (19 to 26). Relief of metatarsalgia was obtained in the six patients in whom 10 mm of lengthening had been achieved, compared to only 50% relief in those where less than 8 mm of lengthening had been gained. One-stage step-cut lengthening osteotomy of the first metatarsal may be preferable to shortening osteotomies of the lesser metatarsals in the treatment of metatarsalgia following surgical shortening of the first metatarsal.

Cannabis arteritis: ever more important to consider.

PubMed

Santos, Rui Pedro; Resende, Cristina Isabel Pinho; Vieira, Ana Paula; Brito, Celeste

2017-03-13

Cannabis arteritis (CA) is a major and underdiagnosed cause of peripheral arterial disease in young patients. A 34-year-old man, daily smoker of 20 cigarettes and two cannabis cigarettes for 14 years, presented with a necrotic plaque of left hallux for 3 weeks. The Doppler ultrasound and angiography were compatible with severe Buerger's disease. Submitted to a revascularisation procedure and hypocoagulation with rivaroxaban. He had ceased smoking but maintained consumption of cannabis. Owing to the persistence of distal necrosis, amputation of the hallux was performed with good evolution. CA is a subtype of Buerger's disease. It is poorly known but increasingly prevalent and manifests in cannabis users regardless of tobacco use. The drug is considered at least a cofactor of the arteriopathy. The most effective treatment is cessation of consumption. Being cannabis one of the most consumed drugs, its mandatory to ask about its use in all young patients with arteriopathy. 2017 BMJ Publishing Group Ltd.

Structural and functional predictors of regional peak pressures under the foot during walking.

PubMed

Morag, E; Cavanagh, P R

1999-04-01

The objective of this study was to identify structural and functional factors which are predictors of peak pressure underneath the human foot during walking. Peak plantar pressure during walking and eight data sets of structural and functional measures were collected on 55 asymptomatic subjects between 20 and 70 yr. A best subset regression approach was used to establish models which predicted peak regional pressure under the foot. Potential predictor variables were chosen from physical characteristics, anthropometric data, passive range of motion (PROM), measurements from standardized weight bearing foot radiographs, mechanical properties of the plantar soft tissue, stride parameters, foot motion in 3D, and EMG during walking. Peak pressure values under the rearfoot, midfoot, MTH1, and hallux were measured. Heel pressure was a function of linear kinematics, longitudinal arch structure, thickness of plantar soft tissue, and age. Midfoot pressure prediction was dominated by arch structure, while MTH1 pressure was a function of radiographic measurements, talo-crural joint motion, and gastrocnemius activity. Hallux pressure was a function of structural measures and MTP1 joint motion. Foot structure and function predicted only approximately 50% of the variance in peak pressure, although the relative contributions in different anatomical regions varied dramatically. Structure was dominant in predicting peak pressure under the midfoot and MTH1, while both structure and function were important at the heel and hallux. The predictive models developed in this study give insight into potential etiological factors associated with elevated plantar pressure. They also provide direction for future studies designed to reduce elevated pressure in "at-risk" patients.

Arthrodesis of the first metatarsophalangeal joint using a dorsal titanium contoured plate.

PubMed

Flavin, Robert; Stephens, Michael M

2004-11-01

Arthrodesis of the first metatarsophalangeal joint (MTPJ) is used to treat a variety of foot pathologies. Numerous methods of internal fixation and bone end preparation have been reported. In an effort to bring together the best features of the various internal fixation devices, a low-profile contoured titanium plate (LPCT) using a compression screw was designed to be used with a ball-and-socket bone end preparation. A prospective study was carried out to determine the efficacy of this technique. First MTPJ arthrodesis using an LPCT was done in 12 patients (10 women and two men) either as an isolated procedure (seven patients) or in conjunction with other forefoot procedures (five patients). The changes in the level of pain and activities of daily living were evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) hallux score and the Short-Form 36 (SF-36) score. Time to bone union also was assessed. Mean followup was 18 months (+/-6 months). Statistically significant increases in the AOFAS hallux score and the SF-36 score were noted (p = .002 and .001, respectively). All radiographs showed bone union at 6 weeks and an appropriate degree of hallux dorsiflexion in relation to the first metatarsal (20 to 25 degrees). The combination of the LPCT plate and a ball-and-socket bone-end preparation has both operative and biomechanical advantages over other fixation techniques. This combination ensures that the anatomical length of the first ray is only minimally shortened and the angle of plantarflexion of the first metatarsal is maintained, resulting in preservation of medial column stability and a better functional result.

Postoperative pain and preemptive local anesthetic infiltration in hallux valgus surgery.

PubMed

Gądek, Artur; Liszka, Henryk; Wordliczek, Jerzy

2015-03-01

Several techniques of anesthesia are used in foot surgery. Preemptive analgesia helps to prevent the development of hypersensitivity in the perioperative period. The aim of our study was to assess the role of preemptive local anesthetic infiltration and postoperative pain after hallux valgus surgery. We evaluated 118 patients who underwent modified chevron and mini-invasive Mitchell-Kramer bunionectomy of the first distal metatarsal. After spinal anesthesia each patient randomly received an infiltration of local anesthetic or the same amount of normal saline 10 minutes before the skin incision. We measured the intensity of pain 4, 8, 12, 16, 24, and 72 hours after the release of the tourniquet using a visual analogue scale (VAS). Rescue analgesia and all other side effects were noted. Preemptive analgesia resulted in less pain during the first 24 hours after surgery. The decrease of VAS score was significantly lower in the study group during all the short postoperative periods measured. The rescue analgesia was administered in 11.9% of patients in the injected group and 42.4% in the placebo group (P < .05). In the injected group we did not observe significant difference in VAS score between patients post-chevron and miniinvasive Mitchell-Kramer osteotomy of the first distal metatarsal. No systemic adverse effects were noted. One persistent injury of dorsomedial cutaneous nerve was observed. Preemptive local anesthetic infiltration was an efficient and safe method to reduce postoperative pain after hallux valgus surgery. The analgesic effect was satisfactory in both traditional and minimally invasive techniques. © The Author(s) 2014.

A Comparison of Two Designs of Postoperative Shoe on Function, Satisfaction, and Back Pain After Hallux Valgus Surgery.

PubMed

Patel, Shelain; Garg, Parag; Fazal, M Ali; Shahid, Muhammad S; Park, Derek H; Ray, Pinak S

2018-06-01

The reverse camber shoe is commonly used after hallux valgus corrective surgery to offload the forefoot but is associated with back pain and poor compliance. Recent designs of postoperative shoes may obviate the need for a reverse camber. The purpose of this study was to compare the effects of a reverse camber shoe and a noncambered shoe with transitional rigidity after hallux valgus correction. A cohort of 80 feet was prospectively studied undergoing surgery at a single NHS trust. The first 40 feet received the reverse cambered Jura Medical Off-loader Heel shoe and the subsequent 40 feet received the noncambered DonJoy Podalux shoe. No demographic differences existed between the groups and data were collected at 2 weeks, 6 weeks, and 6 months. The Manchester-Oxford Foot Questionnaire (MOXFQ), a 5-question survey and dichotomous question about back pain was used to assess clinical outcome and radiographs were reviewed by 2 orthopaedic surgeons to monitor for loss of correction. Both groups experienced comparable improvements in MOXFQ and shoe satisfaction from 2 weeks compared with 6 weeks. Six patients experienced back pain in the reverse cambered shoe group and none in the noncambered shoe group. Five patients stopped using the reverse cambered shoe during the first 6 weeks after surgery and none stopped using their prescribed noncambered shoe. No loss of corrections were observed in either group. Both shoe designs gave equal foot specific functional and radiological outcomes, but the noncambered shoe with transitional rigidity was associated with less back pain and better compliance. Level II: Prospective comparative study.

Foot deformities, function in the lower extremities, and plantar pressure in patients with diabetes at high risk to develop foot ulcers.

PubMed

Tang, Ulla Hellstrand; Zügner, Roland; Lisovskaja, Vera; Karlsson, Jon; Hagberg, Kerstin; Tranberg, Roy

2015-01-01

Foot deformities, neuropathy, and dysfunction in the lower extremities are known risk factors that increase plantar peak pressure (PP) and, as a result, the risk of developing foot ulcers in patients with diabetes. However, knowledge about the prevalence of these factors is still limited. The aim of the present study was to describe the prevalence of risk factors observed in patients with diabetes without foot ulcers and to explore possible connections between the risk factors and high plantar pressure. Patients diagnosed with type 1 (n=27) or type 2 (n=47) diabetes (mean age 60.0±15.0 years) were included in this cross-sectional study. Assessments included the registration of foot deformities; test of gross function at the hip, knee, and ankle joints; a stratification of the risk of developing foot ulcers according to the Swedish National Diabetes Register; a walking test; and self-reported questionnaires including the SF-36 health survey. In-shoe PP was measured in seven regions of interests on the sole of the foot using F-Scan(®). An exploratory analysis of the association of risk factors with PP was performed. Neuropathy was present in 28 (38%), and 39 (53%) had callosities in the heel region. Low forefoot arch was present in 57 (77%). Gait-related parameters, such as the ability to walk on the forefoot or heel, were normal in all patients. Eighty percent had normal function at the hip and ankle joints. Gait velocity was 1.2±0.2 m/s. All patients were stratified to risk group 3. Hallux valgus and hallux rigidus were associated with an increase in the PP in the medial forefoot. A higher body mass index (BMI) was found to increase the PP at metatarsal heads 4 and 5. Pes planus was associated with a decrease in PP at metatarsal head 1. Neuropathy did not have a high association with PP. This study identified several potential risk factors for the onset of diabetic foot ulcers (DFU). Hallux valgus and hallux rigidus appeared to increase the PP under the medial forefoot and a high BMI appeared to increase the PP under the lateral forefoot. There is a need to construct a simple, valid, and reliable assessment routine to detect potential risk factors for the onset of DFU.

The association of foot structure and footwear fit with disability in children and adolescents with Down syndrome.

PubMed

Lim, Polly Qx; Shields, Nora; Nikolopoulos, Nikolaos; Barrett, Joanna T; Evans, Angela M; Taylor, Nicholas F; Munteanu, Shannon E

2015-01-01

Foot deformity, flat feet, and the use of ill-fitting footwear are common in children and adolescents with Down syndrome (DS). The aim of this study was to determine whether these observations are associated with foot-specific disability in this group. A cross-sectional study design. Foot structure (foot posture determined using the Arch Index, presence of hallux valgus and lesser toe deformities) and footwear fit (determined by length and width percentage differences between the participant's foot and footwear) were assessed in 50 participants with DS (22 females, 28 males) aged five to 18 with a mean (SD) age of 10.6 (3.9) years. Foot-specific disability was determined using the parent-reported Oxford Ankle Foot Questionnaire for Children (OxAFQ-C). Associations between foot structure and footwear fit with the four domains (Physical, School and play, Emotional and Footwear) of the OxAFQ-C were determined using multivariate regression modelling. The mean (SD) Arch Index was 0.29 (0.08), and the prevalence of flat feet, hallux valgus and lesser toe deformities was 76%, 10% and 12% respectively. Few participants wore footwear that was too short (10%), but the use of footwear that was too narrow was common (58%). The presence of hallux valgus was significantly associated with increased disability for the OxAFQ-C School and play domain scores. The use of narrow-fitting footwear was significantly associated with increased levels of disability for the OxAFQ-C Physical, School and play, and Emotional domains. However, these variables only explained between 10% to 14% of the variance in the OxAFQ-C domain scores. There were no significant associations between foot structure and footwear fit with the OxAFQ-C Footwear domain scores. Flatter feet and lesser toe deformities are not associated with foot-specific disability in children and adolescents with DS. Hallux valgus is associated with foot-specific disability during school and play activities. Ill-fitting footwear (too narrow) is common and is associated with foot-specific disability. Further research is required to identify if the relationship between narrow-fitting footwear and foot-specific disability is causal, and to identify other factors associated with foot-specific disability in children and adolescents with DS.

Impact of podiatry resident experience level in hallux valgus surgery on postoperative outcomes.

PubMed

Fleischer, Adam E; Yorath, Martin C; Joseph, Robert M; Baron, Adam; Nordquist, Thomas; Moore, Braden J; Robinson, Richmond C O; Reilly, Charles H

2014-06-15

Despite modern advancements in transosseous fixation and operative technique, hallux valgus (i.e., bunion) surgery is still associated with a higher than usual amount of patient dissatisfaction and is generally recognized as a complex and nuanced procedure requiring precise osseous and capsulotendon balancing. It stands to reason then that familiarity and skill level of trainee surgeons might impact surgical outcomes in this surgery. The aim of this study was to determine whether podiatry resident experience level influences midterm outcomes in hallux valgus surgery (HVS). Consecutive adults who underwent isolated HVS via distal metatarsal osteotomy at a single US metropolitan teaching hospital from January 2004 to January 2009 were contacted and asked to complete a validated outcome measure of foot health (Manchester-Oxford Foot Questionnaire) regarding their operated foot. Resident experience level was quantified using the surgical logs for the primary resident of record at the time of each case. Associations were assessed using linear and logistic regression analyses. A total of 102 adult patients (n = 102 feet) agreed to participate with a mean age of 46.8 years (standard deviation 13.1, range 18-71) and average length of follow-up 6.2 y (standard deviation 1.4, range 3.6-8.6). Level of trainee experience was not associated with postoperative outcomes in either the univariate (odds ratio 0.99 [95% confidence interval, 0.98-1.01], P = 0.827) or multivariate analyses (odds ratio 1.00 [95% confidence interval, 0.97-1.02], P = 0.907). We conclude that podiatry resident level of experience in HVS does not contribute appreciably to postoperative clinical outcomes. Copyright © 2014 Elsevier Inc. All rights reserved.

Descriptive quantitative analysis of hallux abductovalgus transverse plane radiographic parameters.

PubMed

Meyr, Andrew J; Myers, Adam; Pontious, Jane

2014-01-01

Although the transverse plane radiographic parameters of the first intermetatarsal angle (IMA), hallux abductus angle (HAA), and the metatarsal-sesamoid position (MSP) form the basis of preoperative procedure selection and postoperative surgical evaluation of the hallux abductovalgus deformity, the so-called normal values of these measurements have not been well established. The objectives of the present study were to (1) evaluate the descriptive statistics of the first IMA, HAA, and MSP from a large patient population and (2) to determine an objective basis for defining "normal" versus "abnormal" measurements. Anteroposterior foot radiographs from 373 consecutive patients without a history of previous foot and ankle surgery and/or trauma were evaluated for the measurements of the first IMA, HAA, and MSP. The results revealed a mean measurement of 9.93°, 17.59°, and position 3.63 for the first IMA, HAA, and MSP, respectively. An advanced descriptive analysis demonstrated data characteristics of both parametric and nonparametric distributions. Furthermore, clear differentiations in deformity progression were appreciated when the variables were graphically depicted against each other. This could represent a quantitative basis for defining "normal" versus "abnormal" values. From the results of the present study, we have concluded that these radiographic parameters can be more conservatively reported and analyzed using nonparametric descriptive and comparative statistics within medical studies and that the combination of a first IMA, HAA, and MSP at or greater than approximately 10°, 18°, and position 4, respectively, appears to be an objective "tipping point" in terms of deformity progression and might represent an upper limit of acceptable in terms of surgical deformity correction. Copyright © 2014 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

Shear and pressure under the first ray in neuropathic diabetic patients: Implications for support of the longitudinal arch.

PubMed

Davis, Brian; Crow, Mariam; Berki, Visar; Ciltea, Daniela

2017-02-08

To assess dynamic arch support in diabetic patients at risk for Charcot neuroarthopathy whose arch index has not yet shown overt signs of foot collapse. Two indirect measures of toe flexor activation (ratios: peak hallux pressure to peak metatarsal pressure - Ph/Pm; peak posterior hallux shear to peak posterior metatarsal shear - Sh/Sm) were obtained with a custom built system for measuring shear and pressure on the plantar surface of the foot during gait. In addition, the tendency of the longitudinal arch to flatten was measured by quantifying the difference in shear between the 1st metatarsal head and the heel (S flatten ) during the first half of the stance phase. Four stance phases from the same foot for 29 participants (16 control and 13 neuropathic diabetic) were assessed. The peak load ratio under the hallux (Ph/Pm) was significantly higher in the control group (2.10±1.08 versus 1.13±0.74, p=0.033). Similarly, Sh/Sm was significantly higher in the control group (1.87±0.88 versus 0.88±0.45, p=0.004). The difference in anterior shear under the first metatarsal head and posterior shear under the lateral heel (S flatten ) was significantly higher in the diabetic group (p<0.01). Together these findings demonstrate reduced plantar flexor activity in the musculature responsible for maintaining the longitudinal arch. With no significant difference in arch index between the two groups, but significant differences in Ph/Pm, Sh/Sm and S flatten the collective results suggest there are changes in muscle activity that precede arch collapse. Copyright © 2017 Elsevier Ltd. All rights reserved.

Point-Connecting Measurements of the Hallux Valgus Deformity: A New Measurement and Its Clinical Application

PubMed Central

Seo, Jeong-Ho; Boedijono, Dimas

2016-01-01

Purpose The aim of this study was to investigate new point-connecting measurements for the hallux valgus angle (HVA) and the first intermetatarsal angle (IMA), which can reflect the degree of subluxation of the first metatarsophalangeal joint (MTPJ). Also, this study attempted to compare the validity of midline measurements and the new point-connecting measurements for the determination of HVA and IMA values. Materials and Methods Sixty feet of hallux valgus patients who underwent surgery between 2007 and 2011 were classified in terms of the severity of HVA, congruency of the first MTPJ, and type of chevron metatarsal osteotomy. On weight-bearing dorsal-plantar radiographs, HVA and IMA values were measured and compared preoperatively and postoperatively using both the conventional and new methods. Results Compared with midline measurements, point-connecting measurements showed higher inter- and intra-observer reliability for preoperative HVA/IMA and similar or higher inter- and intra-observer reliability for postoperative HVA/IMA. Patients who underwent distal chevron metatarsal osteotomy (DCMO) had higher intraclass correlation coefficient for inter- and intra-observer reliability for pre- and post-operative HVA and IMA measured by the point-connecting method compared with the midline method. All differences in the preoperative HVAs and IMAs determined by both the midline method and point-connecting methods were significant between the deviated group and subluxated groups (p=0.001). Conclusion The point-connecting method for measuring HVA and IMA in the subluxated first MTPJ may better reflect the severity of a HV deformity with higher reliability than the midline method, and is more useful in patients with DCMO than in patients with proximal chevron metatarsal osteotomy. PMID:26996576

Inter-segmental motions of the foot: differences between younger and older healthy adult females.

PubMed

Lee, Dong Yeon; Seo, Sang Gyo; Kim, Eo Jin; Lee, Doo Jae; Bae, Kee Jeong; Lee, Kyoung Min; Choi, In Ho

2017-01-01

Although accumulative evidence exists that support the applicability of multi-segmental foot models (MFMs) in evaluating foot motion in various pathologic conditions, little is known of the effect of aging on inter-segmental foot motion. The objective of this study was to evaluate differences in inter-segmental motion of the foot between older and younger adult healthy females during gait using a MFM with 15-marker set. One hundred symptom-free females, who had no radiographic evidence of osteoarthritis, were evaluated using MFM with 15-marker set. They were divided into young ( n  = 50, 20-35 years old) and old ( n  = 50, 60-69 years old) groups. Coefficients of multiple correlations were evaluated to assess the similarity of kinematic curve. Inter-segmental angles (hindfoot, forefoot, and hallux) were calculated at each gait phase. To evaluate the effect of gait speed on intersegmental foot motion, subgroup analysis was performed according to the similar speed of walking. Kinematic curves showed good or excellent similarity in most parameters. Range of motion in the sagittal ( p  < 0.001) and transverse ( p  = 0.001) plane of the hallux, and sagittal ( p  = 0.023) plane of the forefoot was lower in older females. The dorsiflexion ( p  = 0.001) of the hallux at terminal stance and pre-swing phases was significantly lower in older females. When we compared young and older females with similar speed, these differences remained. Although the overall kinematic pattern was similar between young and older females, reduced range of inter-segmental motion was observed in the older group. Our results suggest that age-related changes need to be considered in studies evaluating inter-segmental motion of the foot.

Effects of Corrective Taping on Balance and Gait in Patients With Hallux Valgus.

PubMed

Gur, Gozde; Ozkal, Ozden; Dilek, Burcu; Aksoy, Songul; Bek, Nilgun; Yakut, Yavuz

2017-05-01

Taping is an effective temporary therapy for improving hallux valgus (HV) in adults. Although HV has been demonstrated to impair postural balance, there is a lack of information about how corrective taping affects balance and gait patterns in adults with HV deformity. Eighteen middle-aged female patients (average age, 53.5 years) with HV were included. Corrective tape was applied to correct HV angulation. A series of balance and gait stability tests were performed before applying tape and 1 hour after the tape was applied with a Balance Master computerized posturography device. The study involved the following tests: modified clinical test of sensory interaction and balance (mCTSIB), unilateral stance (US), limit of stability (LoS), step up/over (SUO), and walk across (WA) tests. No significant difference was found between the no-tape and taped condition in the static balance mCTSIB and US tests ( P > .05). The taping intervention resulted in significant improvement in the dynamic balance measures for the LoS test's backward reaction time and left maximum excursion ( P < .05), a significantly higher impact index bilaterally in the SUO assessment ( P < .05), and an increase in step width mean and variability in the WA test ( P < .05). Taping for correcting HV angulation had negative acute effects on dynamic balance in the SUO and WA tests and positive effects in the LoS test. Corrective taping, although a form of conservative treatment for hallux valgus, has been insufficiently studied in terms of effects on balance. Our results show that taping, as an acute effect, may impair balance in middle-aged adults when walking or ascending and descending stairs.

Demographic and clinical factors associated with radiographic severity of first metatarsophalangeal joint osteoarthritis: cross-sectional findings from the Clinical Assessment Study of the Foot.

PubMed

Menz, H B; Roddy, E; Marshall, M; Thomas, M J; Rathod, T; Myers, H; Thomas, E; Peat, G M

2015-01-01

To explore demographic and clinical factors associated with radiographic severity of first metatarsophalangeal joint osteoarthritis (OA) (First MTPJ OA). Adults aged ≥50 years registered with four general practices were mailed a Health Survey. Responders reporting foot pain within the last 12 months were invited to undergo a clinical assessment and weight-bearing dorso-plantar and lateral radiographs of both feet. Radiographic first MTPJ OA in the most severely affected foot was graded into four categories using a validated atlas. Differences in selected demographic and clinical factors were explored across the four radiographic severity subgroups using analysis of variance (ANOVA) and ordinal regression. Clinical and radiographic data were available from 517 participants, categorised as having no (n = 105), mild (n = 228), moderate (n = 122) or severe (n = 62) first MTPJ OA. Increased radiographic severity was associated with older age and lower educational attainment. After adjusting for age, increased radiographic first MTPJ OA severity was significantly associated with an increased prevalence of dorsal hallux and first MTPJ pain, hallux valgus, first interphalangeal joint (IPJ) hyperextension, keratotic lesions on the dorsal aspect of the hallux and first MTPJ, decreased first MTPJ dorsiflexion, ankle/subtalar joint eversion and ankle joint dorsiflexion range of motion, and a trend towards a more pronated foot posture. This cross-sectional study has identified several dose-response associations between radiographic severity of first MTPJ OA and a range of demographic and clinical factors. These findings highlight the progressive nature of first MTPJ OA and provide insights into the spectrum of presentation of the condition in clinical practice. Crown Copyright © 2014. Published by Elsevier Ltd. All rights reserved.

Plantar pressure asymmetry and risk of stress injuries in the foot of young soccer players.

PubMed

Azevedo, Renato R; da Rocha, Emmanuel S; Franco, Pedro S; Carpes, Felipe P

2017-03-01

Asymmetries in the magnitude of plantar pressure are considered a risk factor for stress fracture of the fifth metatarsal in soccer athletes. To investigate the presence of plantar pressure asymmetries among young soccer athletes. Observational. Laboratory. Thirty young adolescents divided into a soccer player group (n = 15) or a matched control group (n = 15). Mean plantar pressure was determined for seven different regions of the foot. Data were compared between the preferred and non-preferred foot, and between the groups, during barefoot standing on a pressure mat system. Higher pressure was found in the hallux, 5th metatarsal and medial rearfoot of the non-preferred foot in the young soccer players. These asymmetries were not observed in the control group. Magnitudes of plantar pressure did not differ between the groups. Young soccer players present asymmetries in plantar pressure in the hallux, 5th metatarsal and medial rearfoot, with higher pressure observed in the non-preferred foot. Copyright © 2016 Elsevier Ltd. All rights reserved.

Foot deformities, function in the lower extremities, and plantar pressure in patients with diabetes at high risk to develop foot ulcers

PubMed Central

Tang, Ulla Hellstrand; Zügner, Roland; Lisovskaja, Vera; Karlsson, Jon; Hagberg, Kerstin; Tranberg, Roy

2015-01-01

Objective Foot deformities, neuropathy, and dysfunction in the lower extremities are known risk factors that increase plantar peak pressure (PP) and, as a result, the risk of developing foot ulcers in patients with diabetes. However, knowledge about the prevalence of these factors is still limited. The aim of the present study was to describe the prevalence of risk factors observed in patients with diabetes without foot ulcers and to explore possible connections between the risk factors and high plantar pressure. Patients and methods Patients diagnosed with type 1 (n=27) or type 2 (n=47) diabetes (mean age 60.0±15.0 years) were included in this cross-sectional study. Assessments included the registration of foot deformities; test of gross function at the hip, knee, and ankle joints; a stratification of the risk of developing foot ulcers according to the Swedish National Diabetes Register; a walking test; and self-reported questionnaires including the SF-36 health survey. In-shoe PP was measured in seven regions of interests on the sole of the foot using F-Scan®. An exploratory analysis of the association of risk factors with PP was performed. Results Neuropathy was present in 28 (38%), and 39 (53%) had callosities in the heel region. Low forefoot arch was present in 57 (77%). Gait-related parameters, such as the ability to walk on the forefoot or heel, were normal in all patients. Eighty percent had normal function at the hip and ankle joints. Gait velocity was 1.2±0.2 m/s. All patients were stratified to risk group 3. Hallux valgus and hallux rigidus were associated with an increase in the PP in the medial forefoot. A higher body mass index (BMI) was found to increase the PP at metatarsal heads 4 and 5. Pes planus was associated with a decrease in PP at metatarsal head 1. Neuropathy did not have a high association with PP. Conclusions This study identified several potential risk factors for the onset of diabetic foot ulcers (DFU). Hallux valgus and hallux rigidus appeared to increase the PP under the medial forefoot and a high BMI appeared to increase the PP under the lateral forefoot. There is a need to construct a simple, valid, and reliable assessment routine to detect potential risk factors for the onset of DFU. PMID:26087865

First metatarsophalangeal joint replacement with modular three-component press-fit implant. Preliminary report.

PubMed

Kolodziej, L; Bohatyrewicz, A; Zietek, P

2013-01-01

The aim of this retrospective study was to assess functional and radiographic results of the first metatarsophalangeal joint replacement with use of unconstrained, modular, three components, porous titanium and hydroxyapatite coated, press-fit METIS® prosthesis. According to author's knowledge, results of that type of prosthesis have never been published before. 25 prosthesis were implanted in 24 patients between February 2009 and May 2011. American Orthopaedic Foot and Ankle Society Hallux Metatarsophalangeal Interphalangeal scoring system (AOFAS-HMI) was used to assess functional results. Patients were also asked if they would undergo procedure again or recommend it to other people. Weight bearing radiographs ware made at final follow up and analyzed for presence of osteolysis and radiolucencies. In 8 patients total joint replacement was introduced as a salvage after failure of previous surgery like Keller resection arthroplasty, failed arthrodesis, avascular necrosis and postoperative arthritis. In 11 patients the reason for prosthetic replacement were hallux rigidus, in 4 cases rheumatoid arthritis and gout in one patient. In two patients additional procedures like Akin phalangeal osteotomy and in one case fifth metatarsal osteotomy, was performed. There were 20 females and 4 males in presented group. The mean age at the operation was 56 years. The average follow up period was 18 months (from 12 to 36 months). The median postoperative value of AOFAS-HMI scores was 88 points (from 75 to 95 points). First metatarsophalangeal joint motion (dorsiflexion plus plantarflexion) was classified according to AOFAS-HMI ranges as: moderately restricted (between 30 to 70 degrees) in 19 patients 80% (20 prosthesis) and severely restricted (less then 30 degrees) in 5 patients (20%). 15 (64%) patients were completely satisfied, 5 (20%) reported moderate satisfaction and (16%) 4 were totally disappointed and would not undergo this procedure again. A limited hallux dorsiflexion was the main dissatisfaction reason. Partial radiolucent line was seen in one patient (4%). Authors noticed two serious complications. In one patient, with rheumatoid arthritis, deep infection occurred 12 months after prosthesis implantation. In second case phalangeal implant was revised due to misalignment. METIS® metatarsophalangeal joint replacement allows alleviate of pain relating to hallux rigidus and partial restoration of joint movement, even in patients after failures of primary metatarsophalangeal joint surgery. AOFAS-HMI results are better than previously reported in the literature in assessment of the first metatarsophalangeal joint replacement. Radiographic results imply satisfactory bone ingrowth into the cementless implants.

Chevron versus Mitchell osteotomy in hallux valgus surgery: a comparative study.

PubMed

Lambers Heerspink, F O; Verburg, H; Reininga, I H F; van Raaij, T M

2015-01-01

Good clinical results have been reported for chevron and Mitchell osteotomies in mild hallux valgus (HV). The primary aim of the present study was to compare first metatarsal shortening after chevron and Mitchell osteotomies in HV. The secondary outcome measures were the degree of valgus correction, metatarsalgia, and patient satisfaction. A total of 84 patients were included in the present study and were treated from 2005 to 2007; 42 patients were in each group. The outcome measurements-first metatarsal length, HV angle, 1-2 intermetatarsal angle, satisfaction, and metatarsalgia-were taken preoperatively and at follow-up. The Mitchell osteotomy resulted in a significantly larger decrease in the first metatarsal length. No significant difference in transfer metatarsalgia was found. Approximately 30% of patients were mildly or not satisfied after HV surgery. Mitchell osteotomy leads to a larger decrease in the first metatarsal length. Patients with metatarsalgia performed poorly, and no significant differences in metatarsalgia were found. Preventing postoperative metatarsalgia is important for a successful outcome after HV surgery. Copyright © 2015 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

Discrete normal plantar stress variations with running speed.

PubMed

Gross, T S; Bunch, R P

1989-01-01

The distribution of force beneath the plantar foot surface during shod distance running, a kinetic descriptor of locomotion not previously reported, was recorded for ten rearfoot striking runners. Normal discrete stresses were assessed while the subjects ran on a treadmill at 2.98, 3.58, and 4.47 ms-1, with eight piezoceramic transducers secured inside the left shoe. Between 2.98 and 4.47 ms-1, mean peak stress increased significantly beneath the calcaneus (303.9-426.6 kPa), second metatarsal head (633.5-730.5 kPa), and hallux (575.1-712.4 kPa). Calcaneal stresses were notable for their rapid loading rate, averaging 10.1 kPa (ms)-1 at 3.58 ms-1. Highest stresses were measured beneath the second and third metatarsal heads and hallux. Peak first metatarsal head stress was less than peak second and third metatarsal head stresses in each of the 30 combinations of subjects and running speeds. However, lower stresses do not necessarily imply lower forces, as the force bearing surface area of each metatarsal head must be considered.

Wound healing complications in patients with and without systemic diseases following hallux valgus surgery.

PubMed

Kromuszczyńska, Justyna; Kołodziej, Łukasz; Jurewicz, Alina

2018-01-01

There are many defined risk factors for wound healing. Comorbidities and their treatment are identified to be one of them. The aim of this study is to verify whether there are significant differences in wound healing between patients with and without systemic diseases, who underwent hallux valgus correction with Scarf osteotomy. A total of 155 consecutive patients were included into this prospective study. All of the patients underwent Scarf osteotomy for hallux valgus correction. In 60,6% of patients comorbidities were present, most often hypertension (57 patients, 36,8%), hypothyroidism (19 patients 12,3%) and diabetes (7 patients, 4,5%) occurred. Most of the patients were women (96,1%). During the study complication rate was noted. Patients underwent follow-up: 1,2, 3, 6 and 12 weeks and 6 months after the surgery. Preoperatively and during the last visit treatment results were assessed with AOFAS HMI scale. Scar assessment was performed by independent observer with VAS followed by patient scar assessment with VSS. In 30 patients complications were noted (19,4%). Surgical site infection was found in 6 patients (3,9%). In 13 patients (8,4%) partial wound dehiscence occurred, in 5 of them (3,2%) additional skin closure (Steri-Strips) was applied. Treatment results assessed with AOFAS HMI scale were good and very good in both healthy and comorbidity group, and the results improved significantly after surgical procedure. Scar assessment with VAS was on the average 1,5 pts. Average result in VSS was 2 pts. Results in both scales were rated as very good. No statistically significant differences were found in both healthy and comorbidity group in scar assessment. Based on the results of the study authors believe there are no significant differences between patients with and without comorbidities in aspects like: complication rate, surgery result and scar assessment as long as foot surgery is concerned.

Observed changes in radiographic measurements of the first ray after frontal plane rotation of the first metatarsal in a cadaveric foot model.

PubMed

Dayton, Paul; Feilmeier, Mindi; Hirschi, Jordan; Kauwe, Merrell; Kauwe, John S K

2014-01-01

We observed the changes in the angular measurements commonly used in the evaluation of the first metatarsal and first metatarsophalangeal joint in cadaveric specimens before and after frontal plane rotation of the first metatarsal. Measurements of the first and second intermetatarsal angle (IMA), hallux abductus angle, proximal articular set angle, and tibial sesamoid position (TSP) were taken after varying degrees of varus and valgus rotation of the first metatarsal. Standard dorsoplantar radiographs were taken at 0°, 10°, 20°, and 30° of valgus rotation of the first metatarsal and repeated at 10°, 20°, and 30° varus rotation of the first metatarsal. The data were analyzed using a mixed linear model to compare the change in each angle measurement over the range of valgus and varus rotation. The change in the TSP was significant in both valgus and varus rotations (p = .0004 and p = .028, respectively), an increase in valgus rotation causing an increase in the TSP and an increase in varus rotation causing a decrease in TSP. The change in the IMA was significant compared with valgus rotation (p = .028), showing that as the valgus rotation increased, the IMA also increased. However, compared with the varus rotation, the correlation was not significant (p = .18). The proximal articular set angle and hallux abductus angle measurements, compared with metatarsal rotation, showed positive trends but were not statistically significant. From our results and a review of the published data, we have hypothesized that frontal plane rotation of the first metatarsal is an integral component of hallux abducto valgus pathologic features, specifically in relation to the TSP and IMA. Copyright © 2014 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

[Modified chevron osteotomy with lateral release and screw fixation for treatment of severe hallux deformity].

PubMed

Hofstaetter, S G; Schuh, R; Trieb, K; Trnka, H J

2012-12-01

This prospective study examined the clinical and radiological results of the Chevron osteotomy with screw fixation and distal soft tissue release up to an intermetatarsal angle of 19°. Furthermore, the results are presented for patients over the age of 70 years, and whether or not there is a higher complication rate. 86 feet of patients between 23 and 81 years were included in the study. Apart from the overall group, a group with an intermetatarsal angle of 16° to 19° and a group of patients over 70 years old were eavaluated. They were evaluated preoperatively and at follow-up after an average of 3.3 years according to the American Orthopaedic Foot and Ankle Society score. The AOFAS score showed a significant improvement from 55 points preoperatively to 90 points at follow-up. The preoperative hallux valgus angle decreased significantly from 32° to 5° and the preoperative intermetatarsal angle decreased from 14° to 6°. Patient satisfaction in the overall group was rated in 92 % as excellent or good. Also, the patient group with 16° to 19° angles and the patients over 70 years showed a significant improvement of clinical and radiological parameters. The complication rate was very low in all groups. The results show that the Chevron osteotomy is a very good surgical technique with few complications for the correction of splay foot with hallux valgus deformity. We showed that by using the modified technique with a long plantar arm, an excessive soft tissue release and screw fixation, the indication can be extended up to an intermetatarsal angle of 19° when using screw fixation. Furthermore the patients over 70 years of age showed a significant improvement of clinical and radiological parameters without serious complications such as avascular necrosis or dislocation of the metatarsal head. Georg Thieme Verlag KG Stuttgart · New York.

The effect of ankle position on the exam for first ray mobility.

PubMed

Grebing, Brett R; Coughlin, Michael J

2004-07-01

The clinical assessment of first ray motion in the sagittal plane, as originally described by Morton, is difficult to quantify. Different reports have shown inconsistent values and variability between the manual exam and examination using an external measuring device. The authors hypothesize that when performing a manual examination for evidence of increased first ray motion, the magnitude of first ray mobility varies as the position of ankle dorsiflexion/plantarflexion varies. Using an external caliper (a modified Klaue device), the authors quantified first ray motion in reference to variable ankle positions in a group of normal patients, a group of patients with untreated moderate and severe hallux valgus, a group who had undergone a successful metatarsophalangeal joint arthrodesis for hallux valgus, and a small group who had previously undergone a plantar fasciectomy. A total of 119 feet (109 patients) were measured. In addition to first ray motion, radiographic data were compared between groups. With the ankle in the neutral dorsiflexion position, the mean first ray motion was 4.9 mm for the control group, 7.0 mm for the hallux valgus group, 4.4 mm for the metatarsophalangeal fusion group, and 7.7 mm for the plantar fasciectomy group. There was a significant decrease (p < .05) in first ray motion when the ankle was moved to the dorsiflexed position for all four groups. There was a significant increase in first ray motion when the ankle was moved to the plantarflexed position (p < .01) for all groups except the plantar fasciectomy group. No significant difference in first ray motion was observed for the plantar fasciectomy group between the neutral and plantarflexed ankle positions (p < .05). The exam for first ray mobility is influenced by the position of the ankle and may explain the discrepancy between the manual exam and measurement with an external device. Recommendations for the manual exam of first ray mobility are given.

Analysis of foot kinematics wearing high heels using the Oxford foot model.

PubMed

Wang, Meizi; Gu, Yaodong; Baker, Julien Steven

2018-04-29

Wearing high heels is thought to lead to various foot disorders and injuries such as metatarsal pain, Achilles tendon tension, plantar fasciitis and Haglund malformation. However, there is little available information explaining the specific mechanisms and reasons why wearing high heels causes foot deformity. Therefore, the purpose of this study was to investigate the foot kinematics of high heel wearers and compare any differences with barefoot individuals using the Oxford Foot Model (OFM). Fifteen healthy women aged 20-25 years were measured while walking barefoot and when wearing high heels. The peak value of angular motion for the hallux with respect to the forefoot, the forefoot with respect to the hind foot, and the hind foot with respect to the tibia were all analyzed. Compared to the barefoot, participants wearing high heels demonstrated larger hallux dorsiflexion (22.55∘± 1.62∘ VS 26.6∘± 2.33∘ for the barefoot; P= 0.001), and less hallux plantarflexion during the initial stance phase (-4.86∘± 2.32∘ VS -8.68∘± 1.13∘; P< 0.001). There were also greater forefoot adduction (16.15∘± 1.37∘ VS 13.18∘± 0.79∘; P< 0.001), but no significant differences were found in forefoot abduction between the two conditions. The hind foot demonstrated a larger dorsiflexion in the horizontal plane (16.59∘± 1.69∘ VS 12.08∘± 0.9∘; P< 0.001), greater internal rotation (16.72∘± 0.48∘ VS 7.97∘± 0.55∘; P< 0.001), and decreased peak hind foot extension rotation (-5.49∘± 0.69∘ VS -10.73∘± 0.42∘; P= 0.001). These findings complement existing kinematic evidence that wearing high heels can lead to foot deformities and injuries.

An explorative investigation of functional differences in plantar center of pressure of four foot types using sample entropy method.

PubMed

Mei, Zhanyong; Ivanov, Kamen; Zhao, Guoru; Li, Huihui; Wang, Lei

2017-04-01

In the study of biomechanics of different foot types, temporal or spatial parameters derived from plantar pressure are often used. However, there is no comparative study of complexity and regularity of the center of pressure (CoP) during the stance phase among pes valgus, pes cavus, hallux valgus and normal foot. We aim to analyze whether CoP sample entropy characteristics differ among these four foot types. In our experiment participated 40 subjects with normal feet, 40 with pes cavus, 19 with pes valgus and 36 with hallux valgus. A Footscan ® system was used to collect CoP data. We used sample entropy to quantify several parameters of the investigated four foot types. These are the displacement in medial-lateral (M/L) and anterior-posterior (A/P) directions, as well as the vertical ground reaction force of CoP during the stance phase. To fully examine the potential of the sample entropy method for quantification of CoP components, we provide results for two cases: calculating the sample entropy of normalized CoP components, as well as calculating it using the raw data of CoP components. We also explored what are the optimal values of parameters m (the matching length) and r (the tolerance range) when calculating the sample entropy of CoP data obtained during the stance phases. According to statistical results, some factors significantly influenced the sample entropy of CoP components. The sample entropies of non-normalized A/P values for the left foot, as well as for the right foot, were different between the normal foot and pes valgus, and between the normal foot and hallux valgus. The sample entropy of normalized M/L displacement of the right foot was different between the normal foot and pes cavus. The measured variable for A/P and M/L displacements could serve for the study of foot function.

Metatarsal head resurfacing arthroplasty in the treatment of hallux rigidus: is it reliable treatment option?

PubMed

Circi, E; Tuzuner, T; Sukur, E; Baris, A; Kanay, E

2016-08-01

This study looks at the failure and complications arising secondary to resurfacing and hemi-arthroplasty done at the metatarsal head in patients with hallux rigidus. Our report includes a review of the relevant literature to verify the validity of our techniques. We performed metatarsal head resurfacing with hemi-arthroplasty using the HemiCap(®), on 12 patients with hallux rigidus between the dates of March 2010 and October 2013. The mean follow-up period was 22.3 months (range 12-54). All patients were clinically and radiologically evaluated according to the American Orthopedics Foot and Ankle Society (AOFAS) functional scale and the Coughlin and Shurnas classification. The recorded mean AOFAS score showed an increase from the preoperative score of 49.2 ± 13.1 to a postoperative follow-up score of 80.8 ± 13.1 (p < 0.001). Pain scores also showed an improvement from 16.5 ± 7.1 points preoperatively to 32.5 ± 6.9 points during the postoperative follow-up (p < 0.001). The mean function score improved from 17.7 ± 7.6 points preoperatively to 33.2 ± 7.6 points during the final postoperative follow-up (p < 0.001). Furthermore, the mean range of motion improved from 16.3 ± 4.8° preoperatively to 45.4 ± 13.2° postoperatively (p < 0.001). Three patients (25 %) reported pain at rest. Surgical revision was done on these patients who have significant pain that limited their range of motion. Favorable outcomes were achieved by performing minimal bone resection which also helps maintain metatarso-phalangeal joint function through metatarsal head resurfacing arthroplasty. We expect the failure rates to decrease with the advancements of surgical techniques. Selecting the appropriate patient populous in the application of the technique is crucial in attaining successful clinical results.

Differences in neutral foot positions when measured barefoot compared to in shoes with varying stiffnesses.

PubMed

Shultz, R; Birmingham, T B; Jenkyn, T R

2011-12-01

This study examined the absolute differences in neutral positions of the joints of the foot with different footwear. This addresses the question of whether separate static trials should be collected for each footwear condition to establish neutral positions. A multi-segment kinematic foot model and optical motion analysis system measured four inter-segmental joints of the foot: (1) hindfoot-to-midfoot in the frontal plane, (2) forefoot-to-midfoot in the frontal plane, (3) hallux-to-forefoot in the sagittal plane, and (4) the height-to-length ratio of the medial longitudinal arch. Barefoot was compared to three shoe condition using Nike Free trainers of varying longitudinal torsional stiffness in ten male volunteers. There was high variability both within subjects and shoe conditions. Shoes in general tended to raise the medial longitudinal arch and dorsiflex the hallux compared to barefoot condition. For the hallux, a minimum important difference of 5° or more was found between shoe conditions and the barefoot condition for majority of the subjects in all three shoe conditions (90% for control, 60% for least stiff, 50% for most stiff). This was less for the frontal plane inter-segmental joints of the foot where 50% of the subjects experience a change above 5° for at least one of the conditions. The choice of using condition-specific neutral trials versus a single common neutral trials should be considered carefully. A single common trial allows for differences in absolute joint angles to be compared between footwear conditions. This can be important clinically to determine whether a joint is approaching its end-of-range and therefore at risk of injury. Several condition-specific neutral trials allows for subtleties in kinematic waveforms to be better compared between conditions, since absolute shifts in joint angles due to changing neutral position are removed and the waveforms are better aligned. Copyright © 2011. Published by Elsevier Ltd.

[Application of three-dimensional printing technology to design individual angle section on Chevron of hallux valgus osteotomy].

PubMed

Zhang, Yu-Hang; Bi, Da-Wei; Chen, Yi-Min; Zu, Gang; Ma, Hai-Tao

2018-03-25

To explore clinical application of three-dimensional printing technology to design individual angle section on Chevron of hallux valgus osteotomy. From May 2013 to May 2016, 47 patients(66 feet) with mild to moderate hallux valgus treated by Chevron osteotomy according to different preoperative design were divided into computer osteotomy group(group A) and traditional osteotomy group(group B). In group A, there were 25 patients (33 feet), including 4 males(5 feet) and 21 females(28 feet) with an average age of (47.88±6.08) years old, average weight IMA was (13.58±1.15) degree, AOFAS score was 59.00±5.86, and treated individual 3D printing technology to design operation scheme. While in group B, there were 22 patients (33 feet), including 3 males (3 feet) and 19 females (28 feet) with an average age of (48.16±6.16) years old, average weight IMA was(13.51±1.14) degree, AOFAS score was 60.67±5.85, and treated with osteotomy according to surgical experience. Operation time, blood loss, hospital stays, VAS score at 1 week after operation, wound healing and improvement of postoperative weight-bearing intermetatarsal angle(IMA) were compared between two groups, AOFAS score system was used to evaluate ankle function after surgery. There was no significant difference in following-up between group A 12.41±2.32 and group B 11.73±2.76. There was 1 patient in group B were excluded. Others perform good wounds healing on the first stage after operation. There were no significant differences in operation time, blood loss, hospital stays and VAS score at 1 week after operation( P <0.05); IMA in group A was (5.21±0.88)°, (6.42±0.85)° in group B, and had significant differences between two groups ( t =5.68, P <0.05). There was obvious meaning in AOFAS score between group A 88.15±5.19 and group B 82.90±5.01( t =4.14, P <0.05). Fourteen feet in group A obtained excellent results and 19 feet good, while 5 feet in group B obtained excellent results and 27 feet good. Compared with traditional osteotomy group, three-dimensional printing technology to design individual angle section on Chevron of hallux valgus osteotomy could better correct IMA, improve postoperative foot function, and it is a kind of individualized and digital method to design operation. Copyright© 2018 by the China Journal of Orthopaedics and Traumatology Press.

L'ostéotomie de scarf dans le traitement de l'hallux valgus: à propos de 19 cas

PubMed Central

Boussakri, Hassan; Bachiri, Mohammed; Elidrissi, Mohammed; Shimi, Mohammed; Elibrahimi, Abdelhalim; Elmrini, Abdelmajid

2014-01-01

L'ostéotomie de Scarf constitue une technique chirurgicale bien décrite, grâce à ses résultats excellents, elle est considérée comme un traitement de choix de l'hallux valgus. Le but de ce travail est de décrire le profil épidémiologique et radio-clinique des hallux valgus, ainsi qu’évaluer les résultats radiologiques et fonctionnels des patients traités par la technique classique d'ostéotomie de Scarf. Nous avons mené une étude rétrospective, concernant 22 ostéotomies de Scarf chez 19 patients, opérés d'hallux valgus entre mai 2009 et janvier 2013. Le recul moyen était de 22,5 mois (3-42 mois). L'âge moyen des patients au moment de l'intervention était de 49 ans, avec des extrêmes de 19 et 75 ans. Tous les patients ont bénéficié d'une évaluation clinique et radiologique préopératoire et postopératoire ainsi qu'une analyse statistique. Au dernier recul, selon des critères subjectifs, nos résultats étaient très satisfaisants dans 42%, satisfaisants dans 52% et déçus dans 6%, et en fonction du score de l'AOFAS, les résultats étaient nettement améliorée avec un AOFAS préopératoire de 57% à 84% en postopératoire. Concernant les résultats radiologiques, la déformation métatarsophalangienne (angle M1P1) a été corrigée (43,63 °-12,8°) avec une p très significative (p <0,001). D'autre part une amélioration de l'Angle moyen M1M2, passer de 18,18° préopératoire à 12,95° au dernier recul, avec une correction significative (p <0,001). Le valgus épiphysaire de premier métatarsien (AADM) a été statistiquement amélioré (p <0,001), passer de 24,45° à 7,91°. Concernant les complications nous avons noté un cas de sepsis précoce superficiel géré par une antibiothérapie adaptée, deux cas de névrome et un cas d'ostéonécrose. Par contre on n'a pas noté aucune fracture per opératoire du premier métatarsien. Nous concluons que l'ostéotomie de Scarf est une technique reproductible fiable, en pleine évolution. PMID:25848452

Children with ADHD Show No Deficits in Plantar Foot Sensitivity and Static Balance Compared to Healthy Controls

ERIC Educational Resources Information Center

Schlee, Gunther; Neubert, Tom; Worenz, Andreas; Milani, Thomas L.

2012-01-01

The goal of this study was to investigate plantar foot sensitivity and balance control of ADHD (n = 21) impaired children compared to age-matched healthy controls (n = 25). Thresholds were measured at 200 Hz at three anatomical locations of the plantar foot area of both feet (hallux, first metatarsal head (METI) and heel). Body balance was…

Proximal opening wedge osteotomy with wedge-plate fixation compared with proximal chevron osteotomy for the treatment of hallux valgus: a prospective, randomized study.

PubMed

Glazebrook, Mark; Copithorne, Peter; Boyd, Gordon; Daniels, Timothy; Lalonde, Karl-André; Francis, Patricia; Hickey, Michael

2014-10-01

Hallux valgus with an increased intermetatarsal angle is usually treated with a proximal metatarsal osteotomy. The proximal chevron osteotomy is commonly used but is technically difficult. This study compares the proximal opening wedge osteotomy of the first metatarsal with the proximal chevron osteotomy for the treatment of hallux valgus with an increased intermetatarsal angle. This prospective, randomized multicenter (three-center) study was based on the clinical outcome scores of the Short Form-36, the American Orthopaedic Foot & Ankle Society forefoot questionnaire, and the visual analog scale for pain, activity, and patient satisfaction. Subjects were assessed prior to surgery and at three, six, and twelve months postoperatively. Surgeon preference was evaluated based on questionnaires and the operative times required for each procedure. No significant differences were found for any of the patients' clinical outcome measurements between the two procedures. The proximal opening wedge osteotomy was found to lengthen, and the proximal chevron osteotomy was found to shorten, the first metatarsal. The intermetatarsal angles improved (decreased) significantly, from 14.8° ± 3.2° to 9.1° ± 2.9 (mean and standard deviation) after a proximal opening wedge osteotomy and from 14.6° ± 3.9° to 11.3° ± 4.0° after a proximal chevron osteotomy (p < 0.05 for both). Operative time required for performing a proximal opening wedge osteotomy is similar to that required for performing a proximal chevron osteotomy (mean and standard deviation, 67.1 ± 16.5 minutes compared with 69.9 ± 18.6 minutes; p = 0.510). Opening wedge and proximal chevron osteotomies have comparable radiographic outcomes and comparable clinical outcomes for pain, satisfaction, and function. The proximal opening wedge osteotomy lengthens, and the proximal chevron osteotomy shortens, the first metatarsal. The proximal opening wedge osteotomy was subjectively less technically demanding and was preferred by the orthopaedic surgeons in this study. Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence. Copyright © 2014 by The Journal of Bone and Joint Surgery, Incorporated.

Three-dimensional quantitative analysis of healthy foot shape: a proof of concept study.

PubMed

Stanković, Kristina; Booth, Brian G; Danckaers, Femke; Burg, Fien; Vermaelen, Philippe; Duerinck, Saartje; Sijbers, Jan; Huysmans, Toon

2018-01-01

Foot morphology has received increasing attention from both biomechanics researches and footwear manufacturers. Usually, the morphology of the foot is quantified by 2D footprints. However, footprint quantification ignores the foot's vertical dimension and hence, does not allow accurate quantification of complex 3D foot shape. The shape variation of healthy 3D feet in a population of 31 adult women and 31 adult men who live in Belgium was studied using geometric morphometric methods. The effect of different factors such as sex, age, shoe size, frequency of sport activity, Body Mass Index (BMI), foot asymmetry, and foot loading on foot shape was investigated. Correlation between these factors and foot shape was examined using multivariate linear regression. The complex nature of a foot's 3D shape leads to high variability in healthy populations. After normalizing for scale, the major axes of variation in foot morphology are (in order of decreasing variance): arch height, combined ball width and inter-toe distance, global foot width, hallux bone orientation (valgus-varus), foot type (e.g. Egyptian, Greek), and midfoot width. These first six modes of variation capture 92.59% of the total shape variation. Higher BMI results in increased ankle width, Achilles tendon width, heel width and a thicker forefoot along the dorsoplantar axis. Age was found to be associated with heel width, Achilles tendon width, toe height and hallux orientation. A bigger shoe size was found to be associated with a narrow Achilles tendon, a hallux varus, a narrow heel, heel expansion along the posterior direction, and a lower arch compared to smaller shoe size. Sex was found to be associated with differences in ankle width, Achilles tendon width, and heel width. Frequency of sport activity was associated with Achilles tendon width and toe height. A detailed analysis of the 3D foot shape, allowed by geometric morphometrics, provides insights in foot variations in three dimensions that can not be obtained from 2D footprints. These insights could be applied in various scientific disciplines, including orthotics and shoe design.

Effect of thong style flip-flops on children's barefoot walking and jogging kinematics.

PubMed

Chard, Angus; Greene, Andrew; Hunt, Adrienne; Vanwanseele, Benedicte; Smith, Richard

2013-03-05

Thong style flip-flops are a popular form of footwear for children. Health professionals relate the wearing of thongs to foot pathology and deformity despite the lack of quantitative evidence to support or refute the benefits or disadvantages of children wearing thongs. The purpose of this study was to compare the effect of thong footwear on children's barefoot three dimensional foot kinematics during walking and jogging. Thirteen healthy children (age 10.3 ± 1.6 SD years) were recruited from the metropolitan area of Sydney Australia following a national press release. Kinematic data were recorded at 200 Hz using a 14 camera motion analysis system (Cortex, Motion Analysis Corporation, Santa Rosa, USA) and simultaneous ground reaction force were measured using a force platform (Model 9281B, Kistler, Winterthur, Switzerland). A three-segment foot model was used to describe three dimensional ankle, midfoot and one dimensional hallux kinematics during the stance sub-phases of contact, midstance and propulsion. Thongs resulted in increased ankle dorsiflexion during contact (by 10.9°, p; = 0.005 walk and by 8.1°, p; = 0.005 jog); increased midfoot plantarflexion during midstance (by 5.0°, p; = 0.037 jog) and propulsion (by 6.7°, p; = 0.044 walk and by 5.4°, p;= 0.020 jog); increased midfoot inversion during contact (by 3.8°, p;= 0.042 jog) and reduced hallux dorsiflexion during walking 10% prior to heel strike (by 6.5°, p; = 0.005) at heel strike (by 4.9°, p; = 0.031) and 10% post toe-off (by 10.7°, p; = 0.001). Ankle dorsiflexion during the contact phase of walking and jogging, combined with reduced hallux dorsiflexion during walking, suggests a mechanism to retain the thong during weight acceptance. Greater midfoot plantarflexion throughout midstance while walking and throughout midstance and propulsion while jogging may indicate a gripping action to sustain the thong during stance. While these compensations exist, the overall findings suggest that foot motion whilst wearing thongs may be more replicable of barefoot motion than originally thought.

Effect of thong style flip-flops on children’s barefoot walking and jogging kinematics

PubMed Central

2013-01-01

Background Thong style flip-flops are a popular form of footwear for children. Health professionals relate the wearing of thongs to foot pathology and deformity despite the lack of quantitative evidence to support or refute the benefits or disadvantages of children wearing thongs. The purpose of this study was to compare the effect of thong footwear on children’s barefoot three dimensional foot kinematics during walking and jogging. Methods Thirteen healthy children (age 10.3 ± 1.6 SD years) were recruited from the metropolitan area of Sydney Australia following a national press release. Kinematic data were recorded at 200 Hz using a 14 camera motion analysis system (Cortex, Motion Analysis Corporation, Santa Rosa, USA) and simultaneous ground reaction force were measured using a force platform (Model 9281B, Kistler, Winterthur, Switzerland). A three-segment foot model was used to describe three dimensional ankle, midfoot and one dimensional hallux kinematics during the stance sub-phases of contact, midstance and propulsion. Results Thongs resulted in increased ankle dorsiflexion during contact (by 10.9°, p; = 0.005 walk and by 8.1°, p; = 0.005 jog); increased midfoot plantarflexion during midstance (by 5.0°, p; = 0.037 jog) and propulsion (by 6.7°, p; = 0.044 walk and by 5.4°, p;= 0.020 jog); increased midfoot inversion during contact (by 3.8°, p;= 0.042 jog) and reduced hallux dorsiflexion during walking 10% prior to heel strike (by 6.5°, p; = 0.005) at heel strike (by 4.9°, p; = 0.031) and 10% post toe-off (by 10.7°, p; = 0.001). Conclusions Ankle dorsiflexion during the contact phase of walking and jogging, combined with reduced hallux dorsiflexion during walking, suggests a mechanism to retain the thong during weight acceptance. Greater midfoot plantarflexion throughout midstance while walking and throughout midstance and propulsion while jogging may indicate a gripping action to sustain the thong during stance. While these compensations exist, the overall findings suggest that foot motion whilst wearing thongs may be more replicable of barefoot motion than originally thought. PMID:23497571

Chevron closing base wedge bunionectomy.

PubMed

Bruyn, J M

1993-01-01

The Chevron-base wedge Association for Osteosynthesis fixated bunionectomy provides a stable, aggressive correction of the severe hallux abducto valgus deformity. It is intended for the bunion requiring a double osteotomy in order to adequately reduce both intermetatarsal and proximal articular facet angle with minimal shortening and elevation. This article presents the rationale for the procedure, technique, and a 4-year follow-up of six patients with eight Chevron-base wedge bunionectomies.

Development of a finite element model of female foot for high-heeled shoe design.

PubMed

Yu, Jia; Cheung, Jason Tak-Man; Fan, Yubo; Zhang, Yan; Leung, Aaron Kam-Lun; Zhang, Ming

2008-01-01

Wearing high-heeled shoes may produce deleterious effects on the musculoskeletal system while elevation of the shoe heel with arch insole insert is used as a treatment strategy for plantar fasciitis. Due to limitations of the experimental approaches, direct measurements of internal stress/strain of the foot are impossible or invasive. This study aims at developing a finite element model for evaluating the biomechanical effects of high-heeled support on the ankle-foot complex. A 3D anatomically detailed FE model of the female foot and ankle together with a high-heeled support was developed and used to investigate the plantar contact pressure and internal loading responses of the bony and soft tissue structures of the foot with varying heel heights during simulated balanced standing. In the balanced standing position with high-heeled support, a pronounced increase in von Mises stress at the first metatarsophalangeal (MTP) joint was predicted. The strain on plantar fascia decreased compared to the flat horizontal support and valgus deformity of the hallux was not significant. The increased stress in forefoot especially at the first MTP segment during prolonged high-heeled standing may contribute to progressive hallux valgus (HV) deformity. However, the reduced tensile strain in the plantar fascia with heel elevation may help relieve plantar fasciitis related pain and inflammation.

Moje first metatarsophalangeal replacement--a case series with functional outcomes using the AOFAS-HMI score.

PubMed

Brewster, Mark; McArthur, John; Mauffrey, Cyril; Lewis, Andrew Charles; Hull, Peter; Ramos, James

2010-01-01

We report the functional results of a case series of Moje first metatarsophalangeal total joint replacements carried out between February 2001 and November 2006. All patients who underwent Moje arthroplasty under the care of a single surgeon were included; outcome scores and complications were recorded annually. A total of 32 joints in 29 consecutive patients were followed for a mean duration of 34 (range 6 to 74) months, and the mean patient age at the time of operation was 56 (range 38 to 79) years. Hallux rigidus was the primary diagnosis in 28 (87.5%) of the cases. The mean American Orthopaedic Foot & Ankle Society Hallux-Metatarsophalangeal-Interphalangeal score at final follow-up was 74/100 (range 9 to 100), with 13 (40.63%) joints rated good to excellent. Two (6.25%) joints were revised to arthrodesis at a mean of 52 (range 41 to 63) months following the arthroplasty procedure, and the overall prevalence of postoperative complications was 6 (18.75%). Based on these results, we concluded that first MTPJ total joint replacement with the Moje device remains promising, but still has room for improvement before the results match those obtained with larger joint (knee, hip) arthroplasty. Copyright 2010 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

Plantar Pressure Anomalies After Open Reduction With Internal Fixation of High-Grade Calcaneal Fractures.

PubMed

Hetsroni, Iftach; Ben-Sira, David; Nyska, Meir; Ayalon, Moshe

2014-07-01

Plantar pressure abnormalities after open reduction with internal fixation (ORIF) of intra-articular calcaneal fractures have been observed previously, but high-grade fractures were not selectively investigated and follow-up times were shorter than 2 years. The purpose of this study was to characterize plantar pressure anomalies in patients with exclusively high-grade calcaneal fractures after ORIF with a minimum 2 years of follow-up, and to test the association between plantar pressure distribution and the clinical outcome. The orthopaedic registry was reviewed to identify patients with isolated high-grade calcaneal fractures (Sanders types III-IV) who were operated on and had a minimum 2 years of follow-up. Sixteen patients were evaluated. Mean age was 47 years and follow-up was between 2 and 6 years. The Pedar-Mobile system was used to measure 3 loading and 3 temporal variables and compare these between the operated and the uninjured limbs. Mean American Orthopaedic Foot and Ankle Society (AOFAS) score was 76 ± 7 at latest follow-up. Bohler's angle was 5 ± 8 degrees before surgery and 25 ± 7 degrees at latest follow-up. Stance was shorter in operated limbs (P = .001). Timing of the peak of pressure was delayed in operated limbs under the hallux and the second toe (P ≤ .03). Peak pressure, force time integral, and pressure time integral were increased under the lateral midfoot (P ≤ .03) and decreased under the second metatarsal (P ≤ .03). Force time integral was decreased under the first metatarsal (P = .02) and under the hallux and the lateral toes (P ≤ .05). Increased loading under the lateral midfoot and decreased loading under the lateral toes were correlated with poorer clinical outcome (r = -.53, P < .05, and r = .63, P < .01, respectively). Side-to-side plantar pressure mismatch persisted at more than 2 years after ORIF of high-grade calcaneal fractures performed via lateral approach, despite improvement of Bohler's angle. This was characterized by shortened stance phase, delayed timing of peak of pressure under the hallux and second toe, lateral load shift at the midfoot, and decreased toe pressures in operated limbs. Since loading abnormalities were correlated with the clinical outcome, modifications in treatment strategy that can improve foot loading may be desirable in these cases. Level III, case control. © The Author(s) 2014.

Interphalangeal joint involvement of the big toe in gout: a rare presentation.

PubMed

Dobson, Michael; Alwahab, Yasir; Fazal, Muhammad A

2012-01-01

Atypical presentation of gout can cause diagnostic dilemmas. We report a case of gout that presented with an expansile lytic lesion involving the interphalangeal joint of the hallux, lack of a history of gout, and an associated solitary lung nodule. Magnetic resonance imaging showed an expansile destructive bony lesion with soft-tissue involvement suggestive of a possible bony metastasis. A needle biopsy was performed, and histopathologic features were diagnostic of chronic tophaceous gout.

A clinically applicable six-segmented foot model.

PubMed

De Mits, Sophie; Segers, Veerle; Woodburn, Jim; Elewaut, Dirk; De Clercq, Dirk; Roosen, Philip

2012-04-01

We describe a multi-segmented foot model comprising lower leg, rearfoot, midfoot, lateral forefoot, medial forefoot, and hallux for routine use in a clinical setting. The Ghent Foot Model describes the kinematic patterns of functional units of the foot, especially the midfoot, to investigate patient populations where midfoot deformation or dysfunction is an important feature, for example, rheumatoid arthritis patients. Data were obtained from surface markers by a 6 camera motion capture system at 500 Hz. Ten healthy subjects walked barefoot along a 12 m walkway at self-selected speed. Joint angles (rearfoot to shank, midfoot to rearfoot, lateral and medial forefoot to midfoot, and hallux to medial forefoot) in the sagittal, frontal, and transverse plane are reported according to anatomically based reference frames. These angles were calculated and reported during the foot rollover phases in stance, detected by synchronized plantar pressure measurements. Repeated measurements of each subject revealed low intra-subject variability, varying between 0.7° and 2.3° for the minimum values, between 0.5° and 2.1° for the maximum values, and between 0.8° and 5.8° for the ROM. The described movement patterns were repeatable and consistent with biomechanical and clinical knowledge. As such, the Ghent Foot model permits intersegment, in vivo motion measurement of the foot, which is crucial for both clinical and research applications. Copyright © 2011 Orthopaedic Research Society.

Foot shape in arboreal birds: two morphological patterns for the same pincer-like tool.

PubMed

Abourachid, Anick; Fabre, Anne-Claire; Cornette, Raphaël; Höfling, Elizabeth

2017-07-01

The feet are the only contact between the body and the substrate in limbed animals and as such they provide a crucial interface between the animal and its environment. This is especially true for bipedal and arboreal species living in a complex three-dimensional environment that likely induces strong selection on foot morphology. In birds, foot morphology is highly variable, with different orientations of the toes, making it a good model for the study of the role of functional, developmental, and phylogenetic constraints in the evolution of phenotypic diversity. Our data on the proportions of the phalanges analyzed in a phylogenetic context show that two different morphological patterns exist that depend mainly on habitat and toe orientation. In the anisodactyl foot, the hallux is the only backward-oriented toe and is enlarged in climbing species and reduced in terrestrial ones. Moreover, a proximo-distal gradient in phalanx size is observed depending on the degree of terrestriality. In the two other cases (heterodactyl and zygodactyl) that have two toes that point backward, the hallux is rather small in contrast to the other backward-pointing toe, which is enlarged. The first pattern is convergent and common among tetrapods and follows rules of skeletal development. The second pattern is unique for the clade and under muscle-morphogenetic control. In all cases, the functional result is the same tool, a pincer-like foot. © 2017 Anatomical Society.

A morphological database for 606 colombian bird species.

PubMed

Montoya, Paola; Gonzalez, Mailyn A; Tenorio, Elkin A; López-Ordóñez, Juan Pablo; Pinto Gómez, Alejandro; Cueva, Diego; Acevedo Rincón, Aldemar A; Angarita Yanes, Camilo; Arango Martínez, Héctor Manuel; Armesto, Orlando; Betancur, Jefry S; Caguazango Castro, Angela; Calderon Leyton, Jhon Jairo; Calpa-Anaguano, Edna Viviana; Cárdenas-Posada, Ghislaine; Castaño Díaz, Michael; Chaparro-Herrera, Sergio; Diago-Muñoz, Nicolás; Franco Espinosa, Laura; Gómez Bernal, Luis Germán; Gonzalez-Zapata, Fanny L; Gutiérrez Zamora, Eduardo Aquiles; Gutiérrez-Zuluaga, Ana M; Lizcano Jiménez, Robinson Stivel; Lopera-Salazar, Andrea; Martínez Alvarado, Dariel; Maya Girón, Ana María; Medina, Wilderson; Montealegre-Talero, Carolina; Parra, Juan L; Pérez-Peña, Sebastián; Ramírez Ramírez, Francis; Reyes, Julián; Rivera-Gutiérrez, Héctor Fabio; Rosero Mora, Yuri; Trujillo-Torres, Carlos M; Vidal-Maldonado, Cristian Camilo; Salgado-Negret, Beatriz

2018-04-27

Colombia is the country with the highest bird diversity in the world. Despite active research in ornithology, compelling morphological information of most bird species is still sparse. However, morphological information is the baseline to understand how species respond to environmental variation and how ecosystems respond to species loss. As part of a national initiative, the Instituto Alexander von Humboldt in collaboration with twelve Colombian institutions and seven biological collections, measured up to 15 morphological traits of 9892 individuals corresponding to 606 species: 3492 from individuals captured in field and 6400 from museum specimens. Species measured are mainly distributed in high Andean forest, páramo, and wetland ecosystems. Overall, seven ornithological collections in Colombia and 18 páramo complexes throughout Colombia were visited from 2013 to 2015. The morphological traits involved measurements from bill (total and exposed culmen, bill width and depth), wing (length, area, wingspan and the distance between longest primary and longest secondary), tail (length and shape), tarsus (length), hallux (length and claw hallux) and weight. The number of measured specimens per species was variable, ranging from 1 to 321 individuals with a median of 4 individuals per species. Overall, this database gathered morphological information for more than 30% of Colombian bird diversity. No copyright, proprietary, or cost restrictions apply; the data should be cited appropriately when used. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

Traumeel S® for pain relief following hallux valgus surgery: a randomized controlled trial

PubMed Central

2010-01-01

Background In spite of recent advances in post-operative pain relief, pain following orthopedic surgery remains an ongoing challenge for clinicians. We examined whether a well known and frequently prescribed homeopathic preparation could mitigate post-operative pain. Method We performed a randomized, double blind, placebo-controlled trial to evaluate the efficacy of the homeopathic preparation Traumeel S® in minimizing post-operative pain and analgesic consumption following surgical correction of hallux valgus. Eighty consecutive patients were randomized to receive either Traumeel tablets or an indistinguishable placebo, and took primary and rescue oral analgesics as needed. Maximum numerical pain scores at rest and consumption of oral analgesics were recorded on day of surgery and for 13 days following surgery. Results Traumeel was not found superior to placebo in minimizing pain or analgesic consumption over the 14 days of the trial, however a transient reduction in the daily maximum post-operative pain score favoring the Traumeel arm was observed on the day of surgery, a finding supported by a treatment-time interaction test (p = 0.04). Conclusions Traumeel was not superior to placebo in minimizing pain or analgesic consumption over the 14 days of the trial. A transient reduction in the daily maximum post-operative pain score on the day of surgery is of questionable clinical importance. Trial Registration This study was registered at ClinicalTrials.gov. # NCT00279513 PMID:20380750

[Case report: comprehensive treatment of forefoot with double brachymetatarsia in one surgical stage].

PubMed

Caldiño-Lozada, I; Gallegos-de la Torre, O; Esperón-Hernández, R

2017-01-01

Brachymetatarsia (shortening of the metatarsal) directly affects the transversal arch of the foot causing severe deformities, such as hallux valgus, divergent toes, overlapping toes, metatarsalgia, all of these alter the biomechanics of the foot and gait. Treatment consists of two main techniques, one-stage lengthening with bone graft or elongation through callotaxis with external fixator; there are variants of both techniques used to minimize the disadvantages of each. The objective of treatment must be to return the structural harmony to the forefoot, improving the biomechanics, resulting in a satisfactory outcome for the patients. This article presents a surgical treatment for feet with closed physis to obtain the appropriate metatarsal formula and to reestablish aesthetics and function. This case was treated by means of one-stage lengthening with bone graft to the affected metatarsal; shortening of the adjacent metatarsals; hallux valgus alignment through the necessary osteotomies and the treatment of deformities of the lesser toes as needed. This surgical technique has as one of its advantages the correction of the entire forefoot at one time, without the need of an external fixator and its required postoperative care. Its main disadvantages are its dependence on structural bone graft and the need of postoperative dressing until healing of the bone has taken place. Satisfactory clinical and radiographical outcomes were obtained in treated patient.

Ecological divergence and medial cuneiform morphology in gorillas.

PubMed

Tocheri, Matthew W; Solhan, Christyna R; Orr, Caley M; Femiani, John; Frohlich, Bruno; Groves, Colin P; Harcourt-Smith, William E; Richmond, Brian G; Shoelson, Brett; Jungers, William L

2011-02-01

Gorillas are more closely related to each other than to any other extant primate and are all terrestrial knuckle-walkers, but taxa differ along a gradient of dietary strategies and the frequency of arboreality in their behavioral repertoire. In this study, we test the hypothesis that medial cuneiform morphology falls on a morphocline in gorillas that tracks function related to hallucial abduction ability and relative frequency of arboreality. This morphocline predicts that western gorillas, being the most arboreal, should display a medial cuneiform anatomy that reflects the greatest hallucial abduction ability, followed by grauer gorillas, and then by mountain gorillas. Using a three-dimensional methodology to measure angles between articular surfaces, relative articular and nonarticular areas, and the curvatures of the hallucial articular surface, the functional predictions are partially confirmed in separating western gorillas from both eastern gorillas. Western gorillas are characterized by a more medially oriented, proportionately larger, and more mediolaterally curved hallucial facet than are eastern gorillas. These characteristics follow the predictions for a more prehensile hallux in western gorillas relative to a more stable, plantigrade hallux in eastern gorillas. The characteristics that distinguish eastern gorilla taxa from one another appear unrelated to hallucial abduction ability or frequency of arboreality. In total, this reexamination of medial cuneiform morphology suggests differentiation between eastern and western gorillas due to a longstanding ecological divergence and more recent and possibly non-adaptive differences between eastern taxa. Published by Elsevier Ltd.

Minimal Clinically Important Differences for American Orthopaedic Foot & Ankle Society Score in Hallux Valgus Surgery.

PubMed

Chan, Hiok Yang; Chen, Jerry Yongqiang; Zainul-Abidin, Suraya; Ying, Hao; Koo, Kevin; Rikhraj, Inderjeet Singh

2017-05-01

The American Orthopaedic Foot & Ankle Society (AOFAS) score is one of the most common and adapted outcome scales in hallux valgus surgery. However, AOFAS is predominantly physician based and not patient based. Although it may be straightforward to derive statistical significance, it may not equate to the true subjective benefit of the patient's experience. There is a paucity of literature defining MCID for AOFAS in hallux valgus surgery although it could have a great impact on the accuracy of analyzing surgical outcomes. Hence, the primary aim of this study was to define the Minimal Clinically Important Difference (MCID) for the AOFAS score in these patients, and the secondary aim was to correlate patients' demographics to the MCID. We conducted a retrospective cross-sectional study. A total of 446 patients were reviewed preoperatively and followed up for 2 years. An anchor question was asked 2 years postoperation: "How would you rate the overall results of your treatment for your foot and ankle condition?" (excellent, very good, good, fair, poor, terrible). The MCID was derived using 4 methods, 3 from an anchor-based approach and 1 from a distribution-based approach. Anchor-based approaches were (1) mean difference in 2-year AOFAS scores of patients who answered "good" versus "fair" based on the anchor question; (2) mean change of AOFAS score preoperatively and at 2-year follow-up in patients who answered good; (3) receiver operating characteristic (ROC) curves method, where the area under the curve (AUC) represented the likelihood that the scoring system would accurately discriminate these 2 groups of patients. The distribution-based approach used to calculate MCID was the effect size method. There were 405 (90.8%) females and 41 (9.2%) males. Mean age was 51.2 (standard deviation [SD] = 13) years, mean preoperative BMI was 24.2 (SD = 4.1). Mean preoperative AOFAS score was 55.6 (SD = 16.8), with significant improvement to 85.7 (SD = 14.4) in 2 years ( P value < .001). There were no statistical differences between demographics or preoperative AOFAS scores of patients with good versus fair satisfaction levels. At 2 years, patients who had good satisfaction had higher AOFAS scores than fair satisfaction (83.9 vs 78.1, P < .001) and higher mean change (30.2 vs 22.3, P = .015). Mean change in AOFAS score in patients with good satisfaction was 30.2 (SD = 19.8). Mean difference in good versus fair satisfaction was 7.9. Using ROC analysis, the cut-off point is 29.0, with an area under the curve (AUC) of 0.62. Effect size method derived an MCID of 8.4 with a moderate effect size of 0.5. Multiple linear regression demonstrated increasing age (β = -0.129, CI = -0.245, -0.013, P = .030) and higher preoperative AOFAS score (β = -0.874, CI = -0.644, -0.081, P < .001) to significantly decrease the amount of change in the AOFAS score. The MCID of AOFAS score in hallux valgus surgery was 7.9 to 30.2. The MCID can ensure clinical improvement from a patient's perspective and also aid in interpreting results from clinical trials and other studies. Level III, retrospective comparative series.

Axial loading screw fixation for chevron type osteotomies of the distal first metatarsal: a retrospective outcomes analysis.

PubMed

Murphy, Ryan M; Fallat, Lawrence M; Kish, John P

2014-01-01

The distal chevron osteotomy is a widely accepted technique for the treatment of hallux abductovalgus deformity. Although the osteotomy is considered to be stable, displacements of the capital fragment has been described. We propose a new method for fixation of the osteotomy involving the axial loading screw (ALS) used in addition to single screw fixation. We believe this method will provide a more mechanically stable construct. We reviewed the charts of 46 patients in whom 52 feet underwent a distal chevron osteotomy that was fixated with either 1 screw or 2 screws that included the ALS. We hypothesized that the ALS group would have fewer displacements and would heal more quickly than the single screw fixation group. We found that the group with ALS fixation had healed at a mean of 6.5 weeks and that the group with single screw fixation had healed at 9.53 weeks (p = .001). Also, 8 cases occurred of displacement of the capital fragment in the single screw, control group compared with 2 cases of displacement in the ALS group. However, this finding was not statistically significant. The addition of the ALS to single screw fixation allowed the patients to heal approximately 3 weeks earlier than single screw fixation alone. The ALS is a fixation option for the surgeon to consider when osseous correction of hallux abducto valgus is performed. Copyright © 2014 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

The Efficacy of a Silicone Sheet in Postoperative Scar Management.

PubMed

Kim, Jin Sam; Hong, Joon Pio; Choi, Jong Woo; Seo, Dong Kyo; Lee, Eun Sook; Lee, Ho Seong

2016-09-01

Silicone gel sheeting has been introduced to prevent scarring, but objective evidence for its usefulness in scar healing is limited. Therefore, the authors' objective was to examine the effectiveness of silicone gel sheeting by randomly applying it to only unilateral scars from a bilateral hallux valgus surgery with symmetrical closure. In a prospective randomized, blinded, intraindividual comparison study, the silicone gel sheeting was applied to 1 foot of a hallux valgus incision scar (an experiment group) for 12 weeks upon removal of the stitches, whereas the symmetrical scar from the other foot was left untreated (a control group). The scars were evaluated at 4 and 12 weeks after the silicon sheet application. The Vancouver Scar Scale was used to measure the vascularity, pigmentation, pliability, height, and length of the scars. Adverse effects were also evaluated, and they included pain, itchiness, rash, erythema, and skin softening. At weeks 4 and 12, the experiment group scored significantly better on the Vancouver Scar Scale in all items, except length (P < .05 for all except the length of scar), compared with the control group. In all items, adverse effects of the experiment group were significantly lower than those of the control group at week 12, suggesting that direct attachment of the silicone sheet does not cause adverse effects (P < .05). To the authors' knowledge, this is one of the first models to minimize bias related to scar evaluation by using symmetrical scars. The early silicone sheet application did show a significant improvement in prevention of postoperative scarring.

How to report and monitor the performance of waiting list management.

PubMed

Torkki, Markus; Linna, Miika; Seitsalo, Seppo; Paavolainen, Pekka

2002-01-01

Potential problems concerning waiting list management are often monitored using mean waiting times based on empirical samples. However, the appropriateness of mean waiting time as an indicator of access can be questioned if a waiting list is not managed well, e.g., if the queue discipline is violated. This study was performed to find out about the queue discipline in waiting lists for elective surgery to reveal potential discrepancies in waiting list management. There were 1,774 waiting list patients for hallux valgus or varicose vein surgery or sterilization. The waiting time distributions of patients receiving surgery and of patients still waiting for an operation are presented in column charts. The charts are compared with two model charts. One model chart presents a high queue discipline (first in-first out) and another a poor queue discipline (random) queue. There were significant differences in waiting list management across hospitals and patient categories. Examples of a poor queue discipline were found in queues for hallux valgus and varicose vein operations. A routine waiting list reporting should be used to guarantee the quality of waiting list management and to pinpoint potential problems in access. It is important to monitor not only the number of patients in the waiting list but also the queue discipline and the balance between demand and supply of surgical services. The purpose for this type of reporting is to ensure that the priority setting made at health policy level also works in practise.

Hallux valgus surgery may produce early improvements in balance control: results of a cross-sectional pilot study.

PubMed

Sadra, Saba; Fleischer, Adam; Klein, Erin; Grewal, Gurtej S; Knight, Jessica; Weil, Lowell Scott; Weil, Lowell; Najafi, Bijan

2013-01-01

Hallux valgus (HV) is associated with poorer performance during gait and balance tasks and is an independent risk factor for falls in older adults. We sought to assess whether corrective HV surgery improves gait and balance. Using a cross-sectional study design, gait and static balance data were obtained from 40 adults: 19 patients with HV only (preoperative group), 10 patients who recently underwent successful HV surgery (postoperative group), and 11 control participants. Assessments were made in the clinic using body-worn sensors. Patients in the preoperative group generally demonstrated poorer static balance control compared with the other two groups. Despite similar age and body mass index, postoperative patients exhibited 29% and 63% less center of mass sway than preoperative patients during double-and single-support balance assessments, respectively (analysis of variance P =.17 and P =.14, respectively [both eyes open condition]). Overall, gait performance was similar among the groups, except for speed during gait initiation, where lower speeds were encountered in the postoperative group compared with the preoperative group (Scheffe P = .049). This study provides supportive evidence regarding the benefits of corrective lower-extremity surgery on certain aspects of balance control. Patients seem to demonstrate early improvements in static balance after corrective HV surgery, whereas gait improvements may require a longer recovery time. Further research using a longitudinal study design and a larger sample size capable of assessing the long-term effects of HV surgical correction on balance and gait is probably warranted.

[Fingers, toes and thumbs, correct digital nomenclature based on early Hebrew texts].

PubMed

Leibner, Efraim D; London, Eli; Elishoov, Ofer

2005-08-01

There is some dissonance as to the correct Hebrew terms for the digits of the extremities. Terms in common use include 'Etzba, 'Bohen' and 'Agudal'. While most agree that 'Etzba' in the singular represents the index finger, there is debate about the plural (Etzba'ot), whether it represents 'fingers' (upper extremity only) or 'digits' (upper and lower). The meaning of 'Bohen' is disputed as well, with proponents existing for it to represent: 'Toe', 'Big Toe' or 'Big Digit'. 'Agudal' is in the same predicament, with uses as 'Thumb' or 'Big Digit'. We undertook a computerized search of the Bible for these words and their derivatives in order to establish their correct use. The term 'Etzba' and its derivatives appeared numerous times in the scriptures both in singular and in plural. 'Bohen' appeared somewhat less, however, all appearances were in conjunction, viz" 'Bohen' of the hand" or " 'Bohen' of the foot". 'Agudal' was not found in our computerized search. According to the early Hebrew texts 'Etzba' in singular usually represents the index finger. However, the plural form 'Etzba'ot', corresponds to the term 'digits' and may be used both for fingers and toes. 'Bohen' is a term representing the large digit of all extremities, i.e. both 'Thumb' and 'Hallux'. Likewise, the term 'Agudal', while not appearing in the scriptures, appears in later contexts in early Hebrew texts, and also represents both the thumb and the hallux.

The Effectiveness of Calf Muscle Electrostimulation on Vascular Perfusion and Walking Capacity in Patients Living With Type 2 Diabetes Mellitus and Peripheral Artery Disease.

PubMed

Ellul, Christian; Formosa, Cynthia; Gatt, Alfred; Hamadani, Auon Abbas; Armstrong, David G

2017-06-01

The aim of the study was to explore calf muscle electrostimulation on arterial inflow and walking capacity in claudicants with peripheral artery disease and diabetes mellitus. A prospective, 1-group, pretest-posttest study design was used on 40 high-risk participants (n = 40) who exhibited bilateral limb ischemia (ankle brachial pressure index [ABPI] <0.90), diabetes mellitus, and calf muscle claudication. A program of calf muscle electrical stimulation with varying frequency (1-250 Hz) was prescribed for 1 hour per day for 12 weeks. Spectral waveforms analysis, ABPI, absolute claudication distance (ACD), and thermographic temperature patterns across 4 specified regions of interest (hallux, medial forefoot, lateral forefoot, heel) at rest and after exercise, were recorded at baseline and following intervention to evaluate for therapeutic outcomes. A significant improvement in ACD and ABPI was registered following the intervention ( P = .000 and P = .001, respectively). Resting foot temperatures increased significantly ( P = .000) while the postexercise temperature drops were halved across all regions at follow-up, with hallux ( P = .005) and lateral forefoot ( P = .038) reaching statistical significance. Spectral Doppler waveforms were comparable ( P = .304) between both serial assessments. Electrical stimulation of varying frequency for 1 hour per day for 12 consecutive weeks registered statistically significant improvement in outcome measures that assess arterial inflow and walking capacity in claudicants with diabetes mellitus. These results favor the use of electrostimulation as a therapeutic measure in this high-risk population.

Geometric morphometric footprint analysis of young women

PubMed Central

2013-01-01

Background Most published attempts to quantify footprint shape are based on a small number of measurements. We applied geometric morphometric methods to study shape variation of the complete footprint outline in a sample of 83 adult women. Methods The outline of the footprint, including the toes, was represented by a comprehensive set of 85 landmarks and semilandmarks. Shape coordinates were computed by Generalized Procrustes Analysis. Results The first four principal components represented the major axes of variation in foot morphology: low-arched versus high-arched feet, long and narrow versus short and wide feet, the relative length of the hallux, and the relative length of the forefoot. These shape features varied across the measured individuals without any distinct clusters or discrete types of footprint shape. A high body mass index (BMI) was associated with wide and flat feet, and a high frequency of wearing high-heeled shoes was associated with a larger forefoot area of the footprint and a relatively long hallux. Larger feet had an increased length-to-width ratio of the footprint, a lower-arched foot, and longer toes relative to the remaining foot. Footprint shape differed on average between left and right feet, and the variability of footprint asymmetry increased with BMI. Conclusions Foot shape is affected by lifestyle factors even in a sample of young women (median age 23 years). Geometric morphometrics proved to be a powerful tool for the detailed analysis of footprint shape that is applicable in various scientific disciplines, including forensics, orthopedics, and footwear design. PMID:23886074

[Lesser toe deformities. Definition, pathogenesis, and options for surgical correction].

PubMed

Arnold, H

2005-08-01

Whereas in the past resection arthroplasty was - in analogy to hallux valgus surgery - the preferred therapy to correct lesser toe deformities, the point of view has undergone a change. Much interest is directed toward functional aspects that require reconstructive management. Whenever possible the integrity of joint play should be saved. Above all the metatarsophalangeal joint of the lesser toes is worth being preserved to prevent a severe disturbance of the biomechanics of the foot. Tendon transfers and subtle corrective osteotomies such as the Weil procedure allow restricting resection procedures to contraction deformities.

Biomechanical Comparison of Fixation With a Single Screw Versus Two Kirschner Wires in Distal Chevron Osteotomies of the First Metatarsal: A Cadaver Study.

PubMed

Trost, Matthias; Bredow, Jan; Boese, Christoph Kolja; Loweg, Lennard; Schulte, Tobias Ludger; Scaal, Martin; Eysel, Peer; Oppermann, Johannes

Distal chevron osteotomy is a common procedure for surgical correction of hallux valgus. Osteosynthesis with 1 screw or 2 Kirschner wires has been commonly used. We compared the stability of the 2 techniques in distal chevron osteotomy. Sixteen first metatarsals from fresh-frozen human cadaver feet (9 different cadaveric specimens) were used. A standardized distal chevron osteotomy was performed. One first metatarsal from each pair was assigned to group 1 (3.5-mm cortical screw; n = 8) and one to group 2 (two 1.6-mm Kirschner wires; n = 8). Using a materials testing machine, the head of the first metatarsals was loaded in 2 different configurations (cantilever and physiologic) in succession. In the cantilever configuration, the relative stiffness of the osteosynthesis compared with intact bone was 59% ± 27% in group 1 and 68% ± 18% in group 2 (p = .50). In the physiologic configuration, it was 38% ± 25% in group 1 and 35% ± 7% in group 2 (p = .75). The failure strength in the cantilever configuration was 187 ± 105 N in group 1 and 259 ± 71 N in group 2 (p = .21). No statistically significant differences were found in stability between the 2 techniques. The use of 1 screw or 2 Kirschner wires had no significant differences in their biomechanical loading capacity for osteosynthesis in distal chevron osteotomies for treatment of hallux valgus. Copyright © 2017 The American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

Dynamic foot function and morphology in elite rugby league athletes of different ethnicity.

PubMed

Gurney, Jason K; Kersting, Uwe G; Rosenbaum, Dieter

2009-05-01

It has long been assumed that foot function and morphology differ between ethnicities. However, quantitative research proving or disproving this relationship is sparse. As a starting point, the objective of this study was to investigate the plantar loading characteristics and foot geometry of athletes from three ethnicities, being Caucasian, Maori and Pacific Islanders. Four plantar pressure parameters were compared in 28 male elite rugby league players using an EMED-AT plantar pressure distribution platform [Novel GmbH, Munich, Germany] and the five-step method. Foot geometry measures were also taken, including arch index, coefficient of spreading, hallux angle and sub-arch angle. Five trials were collected per foot at a self-selected speed. It was found that Caucasian and Maori subjects had a relatively wider forefoot than the Pacific Island subjects; however the Pacific Islanders' foot was found to be wider than both these ethnicities in absolute terms. While Caucasian subjects loaded the toes to a much greater extent than the Maori and Pacific Island subjects, the latter demonstrated a greater loading of the mid and forefoot regions. Pacific Island subjects revealed a significantly more pronounced hallux valgus angle as compared to the Caucasian and Maori subjects. The results of this study may be relevant for/should be taken into consideration in footwear design issues, where allowances need to be made during the design process for anatomical differences between ethnicities. However these observations cannot be generalised to whole ethnic populations, and further research is required on non-athletes to build on the current research findings.

A comparative biomechanical analysis of habitually unshod and shod runners based on a foot morphological difference.

PubMed

Mei, Qichang; Fernandez, Justin; Fu, Weijie; Feng, Neng; Gu, Yaodong

2015-08-01

Running is one of the most accessible physical activities and running with and without footwear has attracted extensive attention in the past several years. In this study 18 habitually male unshod runners and 20 habitually male shod runners (all with dominant right feet) participated in a running test. A Vicon motion analysis system was used to capture the kinematics of each participant's lower limb. The in-shoe plantar pressure measurement system was employed to measure the pressure and force exerted on the pressure sensors of the insole. The function of a separate hallux in unshod runners is analyzed through the comparison of plantar pressure parameters. Owing to the different strike patterns in shod and unshod runners, peak dorsiflexion and plantarflexion angle were significantly different. Habitually shod runners exhibited a decreased foot strike angle (FSA) under unshod conditions; and the vertical average loading rate (VALR) of shod runners under unshod conditions was larger than that under shod conditions. This suggests that the foot strike pattern is more important than the shod or unshod running style and runners need to acquire the technique. It can be concluded that for habitually unshod runners the separate hallux takes part of the foot loading and reduces loading to the forefoot under shod conditions. The remaining toes of rearfoot strike (RFS) runners function similarly under unshod conditions. These morphological features of shod and unshod runners should be considered in footwear design to improve sport performance and reduce injury. Copyright © 2015 Elsevier B.V. All rights reserved.

Ultrasound evaluation of intrinsic plantar muscles and fascia in hallux valgus

PubMed Central

Lobo, César Calvo; Marín, Alejandro Garrido; Sanz, David Rodríguez; López, Daniel López; López, Patricia Palomo; Morales, Carlos Romero; Corbalán, Irene Sanz

2016-01-01

Abstract A cross-sectional area (CSA) and thickness reduction of the abductor hallucis (AbH) is shown in subjects with hallux valgus (HV). To date, other soft-tissue structures have not been researched in relation with HV. The aim of this study was to compare the CSA and thickness of the intrinsic plantar muscles and fascia (PF) between feet with and without HV. Therefore, a cross-sectional and case-control study was performed using B-mode with an iU22 Philips ultrasound system and a 5 to 17-MHz transducer. The CSA and thickness were measured for the AbH, flexor digitorum brevis (FDB) and flexor hallucis brevis (FHB), and also the thickness for the anterior, middle, and posterior PF portions. A convenience sample of 40 feet, 20 with HV and 20 without HV, was recruited from a clinical and research center. A multivariate regression analysis using linear regression was performed to evaluate the ultrasound imaging measurements (α = 0.05). Consequently, statistically significant differences were observed between the groups (P < 0.05) for the AbH and FHB thickness, and CSA reduction, and also the plantar fascia thickness increase in favor of the HV group. On the contrary, the FDB thickness and CSA did not show statistically significant differences (P ≥ 0.05). In conclusion, the CSA and thickness of the AbH and FHB intrinsic plantar muscles are reduced, whereas the thickness of the anterior, middle, and posterior PF portions are increased, in subjects with HV compared with those without HV. PMID:27828846

Ultrasound evaluation of intrinsic plantar muscles and fascia in hallux valgus: A case-control study.

PubMed

Lobo, César Calvo; Marín, Alejandro Garrido; Sanz, David Rodríguez; López, Daniel López; López, Patricia Palomo; Morales, Carlos Romero; Corbalán, Irene Sanz

2016-11-01

A cross-sectional area (CSA) and thickness reduction of the abductor hallucis (AbH) is shown in subjects with hallux valgus (HV). To date, other soft-tissue structures have not been researched in relation with HV. The aim of this study was to compare the CSA and thickness of the intrinsic plantar muscles and fascia (PF) between feet with and without HV. Therefore, a cross-sectional and case-control study was performed using B-mode with an iU22 Philips ultrasound system and a 5 to 17-MHz transducer. The CSA and thickness were measured for the AbH, flexor digitorum brevis (FDB) and flexor hallucis brevis (FHB), and also the thickness for the anterior, middle, and posterior PF portions. A convenience sample of 40 feet, 20 with HV and 20 without HV, was recruited from a clinical and research center. A multivariate regression analysis using linear regression was performed to evaluate the ultrasound imaging measurements (α = 0.05). Consequently, statistically significant differences were observed between the groups (P < 0.05) for the AbH and FHB thickness, and CSA reduction, and also the plantar fascia thickness increase in favor of the HV group. On the contrary, the FDB thickness and CSA did not show statistically significant differences (P ≥ 0.05). In conclusion, the CSA and thickness of the AbH and FHB intrinsic plantar muscles are reduced, whereas the thickness of the anterior, middle, and posterior PF portions are increased, in subjects with HV compared with those without HV.

Integrating health economics into the product development cycle: a case study of absorbable pins for treating hallux valgus.

PubMed

Vallejo-Torres, Laura; Steuten, Lotte; Parkinson, Bonny; Girling, Alan J; Buxton, Martin J

2011-01-01

The probability of reimbursement is a key factor in determining whether to proceed with or abandon a product during its development. The purpose of this article is to illustrate how the methods of iterative Bayesian economic evaluation proposed in the literature can be incorporated into the development process of new medical devices, adapting them to face the relative scarcity of data and time that characterizes the process. A 3-stage economic evaluation was applied: an early phase in which simple methods allow for a quick prioritization of competing products; a mid-stage in which developers synthesize the data into a decision model, identify the parameters for which more information is most valuable, and explore uncertainty; and a late stage, in which all relevant information is synthesized. A retrospective analysis was conducted of the case study of absorbable pins, compared with metallic fixation, in osteotomy to treat hallux valgus. The results from the early analysis suggest absorbable pins to be cost-effective under the beliefs and assumptions applied. The outputs from the models at the mid-stage analyses show the device to be cost-effective with a high probability. Late-stage analysis synthesizes evidence from a randomized controlled trial and informative priors, which are based on previous evidence. It also suggests that absorbable pins are the most cost-effective strategy, although the uncertainty in the model output increased considerably. This example illustrates how the method proposed allows decisions in the product development cycle to be based on the best knowledge that is available at each stage.

Imaging of digital neuromas.

PubMed

Baron, R L; Galinski, A W; Vlahos, M

1997-08-01

In this case presentation, an incision was made on the nonweightbearing surface of the hallux directly over the mass in question, just long enough to allow for the isolation of the entire mass. This permitted easier identification of the mass and enabled dissection of the abnormal tissue and excision of only the tumor with a minimum of tissue trauma. Healing was uneventful and expedient largely because of the reduced tissue handling. Prior to the advent of magnetic resonance imaging, this type of preoperative detailed surgical mapping would not have been possible. Continuing improvements in magnetic resonance imaging hold great and increasing promise.

Biomechanical Comparison Study of Three Fixation Methods for Proximal Chevron Osteotomy of the First Metatarsal in Hallux Valgus.

PubMed

Kim, Jin Su; Cho, Hun Ki; Young, Ki Won; Kim, Ji Soo; Lee, Kyung Tai

2017-12-01

Fixation of proximal chevron metatarsal osteotomy has been accomplished using K-wires traditionally and with a locking plate recently. However, both methods have many disadvantages. Hence, we developed an intramedullary fixation technique using headless cannulated screws and conducted a biomechanical study to evaluate the superiority of the technique to K-wire and locking plate fixations. Proximal chevron metatarsal osteotomy was performed on 30 synthetic metatarsal models using three fixation techniques. Specimens in group I were fixated with K-wires (1.6 mm × 2) and in group II with headless cannulated screws (3.0 mm × 2) distally through the intramedullary canal. Specimens in group III were fixated with a locking X-shaped plate (1.3-mm thick) and screws (2.5 mm × 4). Eight metatarsal specimens were selected from each group for walking fatigue test. Bending stiffness and dorsal angulation were measured by 1,000 repetitions of a cantilever bending protocol in a plantar to dorsal direction. The remaining two samples from each group were subjected to 5 mm per minute axial loading to assess the maximal loading tolerance. All samples in group I failed walking fatigue test while group II and group III tolerated the walking fatigue test. Group II showed greater resistance to bending force and smaller dorsal angulation than group III ( p = 0.001). On the axial loading test, group I and group II demonstrated superior maximum tolerance to group III (54.8 N vs. 47.2 N vs. 28.3 N). Authors have demonstrated proximal chevron metatarsal osteotomy with intramedullary screw fixation provides superior biomechanical stability to locking plate and K-wire fixations. The new technique using intramedullary screw fixation can offer robust fixation and may lead to better outcomes in surgical treatment of hallux valgus.

Prospective randomized study of chevron osteotomy versus Mitchell's osteotomy in hallux valgus.

PubMed

Buciuto, Robert

2014-12-01

We conducted a prospective randomized trial to compare the most popular osteotomy types of operative treatment of hallux valgus (HV) used in Norway, Mitchell's osteotomy (MO) and chevron osteotomy (CO). One hundred twenty adult female patients were prospectively randomized to treatment with either MO or CO. All operative procedures were performed with ankle block and with tourniquet applied. None of the patients received any antibiotic or antithrombotic prophylaxis. The follow-up period was 3 years. Clinical results were rated according to the American Orthopaedic Foot and Ankle Society (AOFAS) Clinical Rating System (CRS). HV in the MO group was reduced from 30 (range, 20 to 44) to 15 (range, 8 to 24) degrees and IM angle from 11 (range, 6 to 14) to 7 (range, 4 to 11) degrees. HV in the CO group was reduced from 31 (range, 22 to 42) to 16 (range, 6 to 24) degrees and IM angle from 14 (range, 8 to 20) to 6 (range, 2 to 10) degrees. Transfer metatarsalgia occurred in 36 (60%) patients and hammertoe in 6 (10%) patients in the MO group. In the CO group, metatarsalgia occurred in 5 patients. The median loss of postoperative HV correction was 4 (range, 2 to 10) degrees in mild deformity and 6 (6 to 10) degrees in moderate deformity. Patients treated with CO had significantly better results for AOFAS CRS, number of postoperative complications, patient satisfaction, and length of sick leave for the employed patients. Based on our results, we consider that in female patients CO should be regarded as the first-line procedure for treatment of mild and moderate HV. Level I, prospective randomized study. © The Author(s) 2014.

The phylogeny of the red panda (Ailurus fulgens): evidence from the hindlimb

PubMed Central

Fisher, Rebecca E; Adrian, Brent; Elrod, Clay; Hicks, Michelle

2008-01-01

The red panda (Ailurus fulgens) is an endangered carnivore living in the temperate forests of the Himalayas and southern China. The phylogeny of the red panda has been the subject of much debate. Morphological and molecular studies have supported a wide range of possible relationships, including close ties to procyonids, ursids, mustelids, and mephitids. This study provides additional morphological data, including muscle maps, for Ailurus. The hindlimbs of four cadavers from the National Zoological Park were dissected. Red pandas retain a number of muscles lost in other carnivore groups, including muscles and tendons related to their robust and weight-bearing hallux. Three features, including a single-bellied m. sartorius, a proximal insertion for m. abductor digiti V, and an absent m. articularis coxae, are found in all terrestrial arctoids, including Ailurus. In addition, red pandas are similar to ursids and canids in lacking a caudal belly of m. semitendinosus, while they resemble procyonids and mustelids in the degree of fusion observed between mm. gluteus medius and piriformis. Furthermore, Ailurus and procyonids are characterized by numerous subdivisions within the adductor compartment, while red pandas and raccoons share a variable m. semimembranosus, composed of one, two, or three bellies. Lastly, a deep plantar muscle inserting onto the metatarsophalangeal joint of the hallux is described for Ailurus. This muscle has not been previously described and is given the name m. flexor hallucis profundus. Additional dissections of the forelimb and axial musculature of red pandas may shed further light on the phylogeny of this species. In addition, the muscle maps presented here offer a valuable resource for interpreting the functional anatomy of fossil ailurids. PMID:19014366

Kinetics and Kinematics after the Bridle Procedure for Treatment of Traumatic Foot Drop

PubMed Central

Hastings, Mary K.; Sinacore, David R.; Woodburn, James; Paxton, E. Scott; Klein, Sandra E.; McCormick, Jeremy J.; Bohnert, Kathryn L.; Beckert, Krista S.; Stein, Michelle L.; Strube, Michael J; Johnson, Jeffrey E.

2014-01-01

Background The Bridle procedure restores active ankle dorsiflexion through a tri-tendon anastamosis of the tibialis posterior, transferred to the dorsum of the foot, with the peroneus longus and tibialis anterior tendon. Inter-segmental foot motion after the Bridle procedure has not been measured. The purpose of this study is to report kinetic and kinematic variables during walking and heel rise in patients after the Bridle procedure. Methods 18 Bridle and 10 control participants were studied. Walking and heel rise kinetic and kinematic variables were collected and compared using an ANOVA. Findings During walking the Bridle group, compared with controls, had reduced ankle power at push off [2.3 (SD 0.7) W/kg, 3.4 (SD 0.6) W/kg, respectively, P<.01], less hallux extension during swing [−13 (SD 7)°, 15 (SD6)°, respectively, P<.01] and slightly less ankle dorsiflexion during swing [6 (SD4)°, 9 (SD 2)°, respectively, P=.03]. During heel rise the Bridle group had 4 (SD 6)° of forefoot on hindfoot dorsiflexion compared to 8 (SD 3)° of plantarflexion in the controls (P<.01). Interpretation This study provides evidence that the Bridle procedure restores the majority of dorsiflexion motion during swing. However, plantarflexor function during push off and hallux extension during swing were reduced during walking in the Bridle group. Abnormal mid-tarsal joint motion, forefoot on hindfoot dorsiflexion instead of plantarflexion, was identified in the Bridle group during the more challenging heel rise task. Intervention after the Bridle procedure must maximize ankle plantarflexor function and midfoot motion should be examined during challenging tasks. PMID:23684087

Are Pressure Time Integral and Cumulative Plantar Stress Related to First Metatarsophalangeal Joint Pain? Results From a Community-Based Study.

PubMed

Rao, Smita; Douglas Gross, K; Niu, Jingbo; Nevitt, Michael C; Lewis, Cora E; Torner, James C; Hietpas, Jean; Felson, David; Hillstrom, Howard J

2016-09-01

To examine the relationship between plantar stress over a step, cumulative plantar stress over a day, and first metatarsophalangeal (MTP) joint pain among older adults. Plantar stress and first MTP pain were assessed within the Multicenter Osteoarthritis Study. All included participants were asked if they had pain, aching, or stiffness at the first MTP joint on most days for the past 30 days. Pressure time integral (PTI) was quantified as participants walked on a pedobarograph, and mean steps per day were obtained using an accelerometer. Cumulative plantar stress was calculated as the product of regional PTI and mean steps per day. Quintiles of hallucal and second metatarsal PTI and cumulative plantar stress were generated. The relationship between predictors and the odds ratio of first MTP pain was assessed using a logistic regression model. Feet in the quintile with the lowest hallux PTI had 2.14 times increased odds of first MTP pain (95% confidence interval [95% CI] 1.42-3.25, P < 0.01). Feet in the quintile with the lowest second metatarsal PTI had 1.50 times increased odds of first MTP pain (95% CI 1.01-2.23, P = 0.042). Cumulative plantar stress was unassociated with first MTP pain. Lower PTI was modestly associated with increased prevalence of frequent first MTP pain at both the hallux and second metatarsal. Lower plantar loading may indicate the presence of an antalgic gait strategy and may reflect an attempt at pain avoidance. The lack of association with cumulative plantar stress may suggest that patients do not limit their walking as a pain-avoidance mechanism. © 2016, American College of Rheumatology.

Prevalence estimation and familial tendency of common forefoot deformities in Turkey: A survey of 2662 adults.

PubMed

Şaylı, Uğur; Altunok, Elif Çiğdem; Güven, Melih; Akman, Budak; Biros, Jnev; Şaylı, Ayşe

2018-02-19

This survey was designed to evaluate the prevalence estimations of HV, bunionette, hammertoe as well as their relations to shoe wearing and also familial tendency, in Turkey. Two thousand six hundred sixty two volunteers (1615 females and 1047 males) with a mean age of 34.15 ± 14.23 (range; 18 to 96) years were asked to answer the predetermined questionnaire between January and June, 2016. Hallux valgus, hammertoe and bunionette images were provided as references and every adult participant without any known forefoot problems or past forefoot surgery history was asked to rate his/her foot and to respond the questions about family history and shoe wearing habits. Responses were statistically analyzed. The prevalence estimations of hallux valgus, bunionette and hammertoe were calculated as 54.3%, 13.8% and 8.9% and positive family history rates were 53.2%, 61.2% and 56.1%, respectively. All three deformities were more common in females than in males (p < 0.001). Nonetheless the older age group reported significantly higher prevalence rates for only HV (p < 0.001). Likewise, among the three deformities, females reported a higher rate of positive family history only in HV compared to men (p < 0.001). Constricting shoe wear was found to affect HV incidence in women (p < 0.001) and bunionette incidence in both sexes (p < 0.01). This study concludes that forefoot deformities are common with high familial tendency. Hence it is worthwhile to work on molecular genetics and this may enable the anticipation of forthcoming deformities in order to take early action in prevention, in nearly the half of the population. Copyright © 2018 Turkish Association of Orthopaedics and Traumatology. Production and hosting by Elsevier B.V. All rights reserved.

A multi-segment foot model based on anatomically registered technical coordinate systems: method repeatability in pediatric feet.

PubMed

Saraswat, Prabhav; MacWilliams, Bruce A; Davis, Roy B

2012-04-01

Several multi-segment foot models to measure the motion of intrinsic joints of the foot have been reported. Use of these models in clinical decision making is limited due to lack of rigorous validation including inter-clinician, and inter-lab variability measures. A model with thoroughly quantified variability may significantly improve the confidence in the results of such foot models. This study proposes a new clinical foot model with the underlying strategy of using separate anatomic and technical marker configurations and coordinate systems. Anatomical landmark and coordinate system identification is determined during a static subject calibration. Technical markers are located at optimal sites for dynamic motion tracking. The model is comprised of the tibia and three foot segments (hindfoot, forefoot and hallux) and inter-segmental joint angles are computed in three planes. Data collection was carried out on pediatric subjects at two sites (Site 1: n=10 subjects by two clinicians and Site 2: five subjects by one clinician). A plaster mold method was used to quantify static intra-clinician and inter-clinician marker placement variability by allowing direct comparisons of marker data between sessions for each subject. Intra-clinician and inter-clinician joint angle variability were less than 4°. For dynamic walking kinematics, intra-clinician, inter-clinician and inter-laboratory variability were less than 6° for the ankle and forefoot, but slightly higher for the hallux. Inter-trial variability accounted for 2-4° of the total dynamic variability. Results indicate the proposed foot model reduces the effects of marker placement variability on computed foot kinematics during walking compared to similar measures in previous models. Copyright © 2011 Elsevier B.V. All rights reserved.

Contoured in-shoe foot orthoses increase mid-foot plantar contact area when compared with a flat insert during cycling.

PubMed

Bousie, Jaquelin A; Blanch, Peter; McPoil, Thomas G; Vicenzino, Bill

2013-01-01

To determine the effect of contouring of an in-shoe foot orthosis on plantar contact area and surface pressure, as well as perceived comfort and support at the foot-orthosis interface during stationary cycling. A randomised, repeated measures control study. Twelve cyclists performed steady-state seated cycling at a cadence of 90 rpm using a contoured orthosis and a flat insert of similar hardness. Contact area (CA) and plantar mean pressure (PP) were measured using the PEDAR® system, determined for seven discrete plantar regions and represented as the percentage of the total CA and PP respectively (CA% and PP%). Perceived comfort and support were rated using a visual analogue scale (VAS). The contoured orthosis produced a significantly greater CA% at the medial midfoot (p=0.001) and lateral midfoot (p=0.009) with a standardised mean difference (SMD) of 1.3 and 0.9 respectively. The contoured orthosis also produced a significantly greater PP% at the hallux (p=0.003) compared to the flat insert with a SMD of 1.1. There was a small non-significant effect (SMD<0.4) for the perceived comfort measures between conditions, but perceived support was significantly greater at the arch (p=0.000) and heel (p=0.013) with the contoured orthoses (SMD of 1.5 and 0.9, respectively). Contoured orthoses influenced the plantar surface of the foot by increasing contact area as well as a perception of greater support at the midfoot while increasing relative pressure through the hallux when compared to a flat insert during stationary cycling. No difference in perceived comfort was noted. Crown Copyright © 2012. Published by Elsevier Ltd. All rights reserved.

Forefoot plantar pressure reduction of off-the-shelf rocker bottom provisional footwear.

PubMed

Kavros, Steven J; Van Straaten, Meegan G; Coleman Wood, Krista A; Kaufman, Kenton R

2011-08-01

Increased plantar pressures have been shown to be a risk factor in ulceration of the neuropathic foot. Prescriptive footwear is a common medical treatment, yet evidence regarding the efficacy of these prescriptions is underdeveloped. The purpose of this study is to determine the off-loading properties of four provisional shoes; a rocker sole compared to a flat sole shoe with and without the addition of a 1.25 cm plastizote insert. Fifteen subjects with peripheral neuropathy and a normal longitudinal arch were recruited to compare four types of provisional (post-operative) footwear. Plantar surface foot pressures were measured while wearing a rocker sole shoe or a flat stiff sole shoe. Both shoes were worn with and without a 1.25 cm plastizote insert. Peak plantar pressures were recorded for the hallux, metatarsal heads (1-5), midfoot, and heel. The rocker sole shoe with plastizote had the best off-loading properties. While wearing this footwear, mean peak plantar pressure was 2.8 kg/cm(2) (range: 1.7 to 4.5 kg/cm(2), 50% mean reduction from flat sole shoe without plastizote) and 1.9 kg/cm(2) (range: 0.7 to 3.6 kg/cm(2), 35% mean reduction) at the five metatarsal heads and hallux, respectively. For patients with a normal longitudinal arch and forefeet, either at risk of developing an ulcer or are healing a forefoot ulcer, a provisional shoe with a rocker sole and plastizote insole provides plantar pressure reduction of the forefoot. However, when results were analyzed for the subjects individually the amount of off-loading varied. Copyright © 2011 Elsevier Ltd. All rights reserved.

Kinematic adaptations of the hindfoot, forefoot, and hallux during cross-slope walking.

PubMed

Damavandi, Mohsen; Dixon, Philippe C; Pearsall, David J

2010-07-01

Despite cross-slope surfaces being a regular feature of our environment, little is known about segmental adaptations required to maintain both balance and forward locomotion. The purpose of this study was to determine kinematic adaptations of the foot segments in relation to transverse (cross-sloped) walking surfaces. Ten young adult males walked barefoot along an inclinable walkway (level, 0° and cross-slope, 10°). Kinematic adaptations of hindfoot with respect to tibia (HF/TB), forefoot with respect to hindfoot (FF/HF), and hallux with respect to forefoot (HX/FF) in level walking (LW), inclined walking up-slope (IWU), i.e., the foot at the higher elevation, and inclined walking down-slope (IWD), i.e., the foot at the lower elevation, were measured. Multivariate analysis of variance (MANOVA) for repeated measures was used to analyze the data. In the sagittal plane, the relative FF/HF and HX/FF plantar/dorsiflexion angles differed across conditions (p=0.024 and p=0.026, respectively). More importantly, numerous frontal plane alterations occurred. For the HF/TB angle, inversion of IWU and eversion of IWD was seen at heel-strike (p<0.001). This pattern reversed with IWU showing eversion and IWD inversion in early stance (p=0.024). For the FF/HF angle, significant differences were observed in mid-stance with IWD revealing inversion while IWU was everted (p<0.004). At toe-off, the pattern switched to eversion of IWD and inversion of IWU (p=0.032). The information obtained from this study enhances our understanding of the kinematics of the human foot in stance during level and cross-slope walking. Copyright © 2010 Elsevier B.V. All rights reserved.

Are Pressure Time Integral and Cumulative Plantar Stress Related to First Metatarsophalangeal Joint Pain? Results From a Community-Based Study

PubMed Central

RAO, SMITA; GROSS, K. DOUGLAS; NIU, JINGBO; NEVITT, MICHAEL C.; LEWIS, CORA E.; TORNER, JAMES C.; HIETPAS, JEAN; FELSON, DAVID; HILLSTROM, HOWARD J.

2017-01-01

Objective To examine the relationship between plantar stress over a step, cumulative plantar stress over a day, and first metatarsophalangeal (MTP) joint pain among older adults. Methods Plantar stress and first MTP pain were assessed within the Multicenter Osteoarthritis Study. All included participants were asked if they had pain, aching, or stiffness at the first MTP joint on most days for the past 30 days. Pressure time integral (PTI) was quantified as participants walked on a pedobarograph, and mean steps per day were obtained using an accelerometer. Cumulative plantar stress was calculated as the product of regional PTI and mean steps per day. Quintiles of hallucal and second metatarsal PTI and cumulative plantar stress were generated. The relationship between predictors and the odds ratio of first MTP pain was assessed using a logistic regression model. Results Feet in the quintile with the lowest hallux PTI had 2.14 times increased odds of first MTP pain (95% confidence interval [95% CI] 1.42–3.25, P < 0.01). Feet in the quintile with the lowest second metatarsal PTI had 1.50 times increased odds of first MTP pain (95% CI 1.01–2.23, P = 0.042). Cumulative plantar stress was unassociated with first MTP pain. Conclusion Lower PTI was modestly associated with increased prevalence of frequent first MTP pain at both the hallux and second metatarsal. Lower plantar loading may indicate the presence of an antalgic gait strategy and may reflect an attempt at pain avoidance. The lack of association with cumulative plantar stress may suggest that patients do not limit their walking as a pain-avoidance mechanism. PMID:26713755

Hallux Valgus, By Nature or Nurture? A Twin Study.

PubMed

Munteanu, Shannon E; Menz, Hylton B; Wark, John D; Christie, Jemma J; Scurrah, Katrina J; Bui, Minh; Erbas, Bircan; Hopper, John L; Wluka, Anita E

2017-09-01

To evaluate the contributions of shared but unmeasured genetic and environmental factors to hallux valgus (HV). Between 2011 and 2012, 74 monozygotic (MZ) and 56 dizygotic (DZ) female twin pairs self-reported HV and putative risk factors, including footwear use across their lifespan. Estimates of casewise concordance (P C ), correlation (ρ), and odds ratios (ORs) were calculated, adjusting for age and other risk factors, and compared between MZ and DZ pairs using logistic regression, generalized estimating equations, and a maximum likelihood-based method, respectively. A total of 70 participants (27%) reported HV, with 12 MZ and 7 DZ pairs being concordant. After adjusting for age, twins were correlated (ρ = 0.27 [95% confidence interval (95% CI) 0.08, 0.46]) and concordant (P C  = 0.45 [95% CI 0.29, 0.61]; mean age 58 years), with no difference between MZ and DZ pairs (P = 0.7). HV was associated with regularly wearing footwear with a constrictive toe-box during the fourth decade (adjusted OR 2.73 [95% CI 1.12, 6.67]). This risk factor was correlated in MZ (ρ = 0.38 [95% CI 0.15, 0.60]) but not DZ (ρ = -0.20 [95% CI -0.43, 0.03]) pairs. These correlations were significantly different (P = 0.002). Twins are correlated for HV, but we found no evidence that correlation was due to shared genetic factors. We identified an environmental risk factor, footwear with a constrictive toe-box, that is not shared to the same extent by MZ and DZ pairs, contrary to the assumption of the classic twin model. Footwear, and possibly genetic factors and unknown shared environmental factors, could contribute to developing HV. © 2016, American College of Rheumatology.

Effects of turf and cleat footwear on plantar load distributions in adolescent American football players during resisted pushing.

PubMed

Taylor, Jeffrey B; Nguyen, Anh-Dung; Griffin, Janet R; Ford, Kevin R

2018-06-01

Metatarsal and midfoot injuries are common in American football. Footwear design may influence injury rates by altering plantar foot loading patterns in these regions. The purpose of this study was to determine the effect of cleat design on in-shoe plantar foot loading during a football-specific, resisted pushing task. Twenty competitive football players (age 14.7 ± 1.8 years, height 1.72 ± 0.10 m, and mass 71.8 ± 26.9 kg) completed three trials of pushing a weighted sled at maximal effort in a standard shoe (CLEAT) and artificial turf-specific shoe (TURF), with flexible in-shoe force measuring insoles. Repeated measures ANOVAs identified mean differences in maximum force and relative load under all regions of the foot. Results showed higher forces in the CLEAT under the medial (p < 0.001) and lateral (p = 0.004) midfoot, central (p = 0.007) and lateral (p < 0.001) forefoot, and lesser toes (p = 0.01), but lower forces in the hallux (p = 0.02) compared to the TURF shoe. Additionally, relative loading was higher in the CLEAT under the medial (p < 0.001) and lateral (p = 0.002) midfoot and lateral (p < 0.001) forefoot, but lower in the medial forefoot (p = 0.006) and hallux (p < 0.001) compared to the TURF shoe. The two shoes elicited distinct plantar loading profiles and may influence shoe selection decisions during injury prevention or rehabilitation practices.

The phylogeny of the red panda (Ailurus fulgens): evidence from the hindlimb.

PubMed

Fisher, Rebecca E; Adrian, Brent; Elrod, Clay; Hicks, Michelle

2008-11-01

The red panda (Ailurus fulgens) is an endangered carnivore living in the temperate forests of the Himalayas and southern China. The phylogeny of the red panda has been the subject of much debate. Morphological and molecular studies have supported a wide range of possible relationships, including close ties to procyonids, ursids, mustelids, and mephitids. This study provides additional morphological data, including muscle maps, for Ailurus. The hindlimbs of four cadavers from the National Zoological Park were dissected. Red pandas retain a number of muscles lost in other carnivore groups, including muscles and tendons related to their robust and weight-bearing hallux. Three features, including a single-bellied m. sartorius, a proximal insertion for m. abductor digiti V, and an absent m. articularis coxae, are found in all terrestrial arctoids, including Ailurus. In addition, red pandas are similar to ursids and canids in lacking a caudal belly of m. semitendinosus, while they resemble procyonids and mustelids in the degree of fusion observed between mm. gluteus medius and piriformis. Furthermore, Ailurus and procyonids are characterized by numerous subdivisions within the adductor compartment, while red pandas and raccoons share a variable m. semimembranosus, composed of one, two, or three bellies. Lastly, a deep plantar muscle inserting onto the metatarsophalangeal joint of the hallux is described for Ailurus. This muscle has not been previously described and is given the name m. flexor hallucis profundus. Additional dissections of the forelimb and axial musculature of red pandas may shed further light on the phylogeny of this species. In addition, the muscle maps presented here offer a valuable resource for interpreting the functional anatomy of fossil ailurids.

Cadence, age, and weight as determinants of forefoot plantar pressures using the Biofoot in-shoe system.

PubMed

Martínez-Nova, Alfonso; Pascual Huerta, Javier; Sánchez-Rodríguez, Raquel

2008-01-01

We evaluated normal plantar pressures and studied the effect of weight, cadence, and age on forefoot plantar pressures in healthy subjects by using the Biofoot (Instituto de Biomecánica de Valencia, Valencia, Spain) in-shoe measurement system. The feet of 45 healthy subjects with no evident foot or lower-limb diseases were measured with the Biofoot in-shoe system. The forefoot was divided into seven areas: the first through fifth metatarsal heads, the hallux, and the second through fifth lesser toes. Three trials of 8 sec each were recorded twice in each subject, and the mean was used to analyze peak and mean plantar pressures. A multiple regression model including weight, age, and cadence was run for each metatarsal head, the hallux, and the lesser toes. Intraclass correlation coefficients and coefficients of variation were also calculated to assess reliability. The second metatarsal head had the greatest peak (960 kPa) and mean (585.1 kPa) pressures, followed by the third metatarsal head. Weight and cadence combined explained 18% and 23% of peak plantar pressure at the second and third metatarsal heads, respectively (P < .001). The intraclass correlation coefficient varied from 0.76 to 0.96 for all variables. The coefficient of variation between sessions ranged from 5.8% to 9.0%. The highest peak and mean plantar pressures were found at the second and third metatarsal heads in healthy subjects. Weight, cadence, and age explained a low variability of this pressure pattern. The Biofoot in-shoe system has good reliability to measure plantar pressures. These data will have implications for the understanding of normal foot biomechanics and its determinants.

Ankle and toe muscle strength characteristics in runners with a history of medial tibial stress syndrome.

PubMed

Saeki, Junya; Nakamura, Masatoshi; Nakao, Sayaka; Fujita, Kosuke; Yanase, Ko; Morishita, Katsuyuki; Ichihashi, Noriaki

2017-01-01

A high proportion of flexor digitorum longus attachment is found at the posteromedial border of the tibia, which is the most common location of medial tibial stress syndrome (MTSS). Therefore, plantar flexion strength of the lesser toes could be related to MTSS; however, the relationship between MTSS and muscle strength of the hallux and lesser toes is not yet evaluated due to the lack of quantitative methods. This study investigated the muscle strength characteristics in runners with a history of MTSS by using a newly developed device to measure the muscle strength of the hallux, lesser toes, and ankle. This study comprised 27 collegiate male runner participants (20.0 ± 1.6 years, 172.1 ± 5.1 cm, 57.5 ± 4.0 kg). Maximal voluntary isometric contraction (MVIC) torque of the plantar flexion, dorsiflexion, inversion, and eversion of the ankle were measured by using an electric dynamometer. MVIC torque of the 1st metatarsophalangeal joint (MTPJ) and 2nd-5th MTPJ were measured by using a custom-made torque-measuring device. MVIC torques were compared between runners with and without a history of MTSS. MVIC torque of the 1st MTPJ plantar flexion was significantly higher in runners with a history of MTSS than in those without it. In contrast, there were no significant differences in the MVIC torque values of the 2nd-5th MTPJ plantar flexion and each MVIC torque of the ankle between runners with and without a history of MTSS. A history of MTSS increased the isometric FHL strength.

Movement coordination patterns between the foot joints during walking.

PubMed

Arnold, John B; Caravaggi, Paolo; Fraysse, François; Thewlis, Dominic; Leardini, Alberto

2017-01-01

In 3D gait analysis, kinematics of the foot joints are usually reported via isolated time histories of joint rotations and no information is provided on the relationship between rotations at different joints. The aim of this study was to identify movement coordination patterns in the foot during walking by expanding an existing vector coding technique according to an established multi-segment foot and ankle model. A graphical representation is also described to summarise the coordination patterns of joint rotations across multiple patients. Three-dimensional multi-segment foot kinematics were recorded in 13 adults during walking. A modified vector coding technique was used to identify coordination patterns between foot joints involving calcaneus, midfoot, metatarsus and hallux segments. According to the type and direction of joints rotations, these were classified as in-phase (same direction), anti-phase (opposite directions), proximal or distal joint dominant. In early stance, 51 to 75% of walking trials showed proximal-phase coordination between foot joints comprising the calcaneus, midfoot and metatarsus. In-phase coordination was more prominent in late stance, reflecting synergy in the simultaneous inversion occurring at multiple foot joints. Conversely, a distal-phase coordination pattern was identified for sagittal plane motion of the ankle relative to the midtarsal joint, highlighting the critical role of arch shortening to locomotor function in push-off. This study has identified coordination patterns between movement of the calcaneus, midfoot, metatarsus and hallux by expanding an existing vector cording technique for assessing and classifying coordination patterns of foot joints rotations during walking. This approach provides a different perspective in the analysis of multi-segment foot kinematics, and may be used for the objective quantification of the alterations in foot joint coordination patterns due to lower limb pathologies or following injuries.

Effect of flip-flops on lower limb kinematics during walking: a cross-sectional study using three-dimensional gait analysis.

PubMed

Sharpe, T; Malone, A; French, H; Kiernan, D; O'Brien, T

2016-05-01

Flip-flops are a popular footwear choice in warm weather however their minimalist design offers little support to the foot. To investigate the effect of flip-flops on lower limb gait kinematics in healthy adults, to measure adherence between the flip-flop and foot, and to assess the effect on toe clearance in swing. Fifteen healthy adults (8 male, mean age 27 years) completed a three-dimensional gait analysis assessment using Codamotion. Kinematic and lower limb temporal-spatial data were captured using the Modified Helen Hayes marker set with additional markers on the hallux and flip-flop sole. Compared to barefoot walking, there were no differences in temporal-spatial parameters walking with flip-flops. There was an increase in peak knee flexion in swing (mean difference 4.6°, 95 % confidence interval (CI) [-5.8°, -3.4°], p < 0.001) and peak ankle dorsiflexion at terminal swing (mean difference 2°, 95 % CI [-3°, -1°], p = 0.001). Other kinematic parameters were unchanged. Peak separation between foot and flip-flop was 8.8 cm (SD 1.48), occurring at pre-swing. Minimum toe clearance of the hallux in barefoot walking measured 4.2 cm (SD 0.8). Minimum clearance of the flip-flop was 1.6 cm (SD 0.56). Healthy adults adapted well to flip-flops. However, separation of the flip-flop from the foot led to increased knee flexion and ankle dorsiflexion in swing, probably to ensure that the flip-flop did not contact the ground and to maximise adherence to the foot. Minimum clearance of the flip-flop was low compared to barefoot clearance. This may increase the risk of tripping over uneven ground.

A prospective 24 months follow-up of a three component press-fit prosthesis for hallux rigidus.

PubMed

Wassink, S; Burger, B J; Saragas, N P; Asunción Márquez, J; Trtik, L; Harlaar, J

2017-09-01

The aim of this study was to evaluate the results following total first metatarsophalangeal (FMTP) joint replacement arthroplasty using a modular three component press fit prosthesis at two year follow up. All patient data was collected in a prospective way in four study centres. Both preoperative and postoperative evaluation consisted of an assessment using the AOFAS-HMI score, visual analogue scale for pain, evaluation of the range of motion and patient satisfaction scores. Postoperative X-rays were reviewed for loosening and radiolucency up to two years. Fifty-five feet were available for analysis at 24 months. Two implants were removed during the study. Six more feet had additional surgery due to stiffness or malalignment. Postoperative AOFAS-HMI scores improved significantly by 32.4 points at two year follow-up (p<0.001). The visual analogue scale for pain improved significantly from 6.8 (std 1,6) preoperatively to 1.6 (std 1,9) postoperatively (p<0.0001). Mean dorsiflexion improved from 12.6 (std 10,1) degrees preoperatively to 31.2 (std 16,8) degrees postoperatively. Eighty-seven percent of patients were moderately to well satisfied with the end result. Eighteen prostheses showed radiolucency at 24 months. Implantation of a Metis ® modular three component press fit prosthesis for the metatarsophalangeal joint in hallux rigidus shows significant improvement in AOFAS-HMI scores and a decrease in pain. Concerns remain with regard to early reoperation rate (14.5%) and long term survival of the implant. Future studies will have to address these aspects. Copyright © 2016 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.

Chevron osteotomy for the treatment of hallux valgus.

PubMed

Horne, G; Tanzer, T; Ford, M

1984-03-01

Seventy-six chevron osteotomies with follow-up periods ranging from six months to eight years were reviewed. The majority of patients had pain over the bunion prior to operation, and 27 also presented with second metatarsalgia. After surgery there was a marked decrease of pain in the first metatarsophalangeal joint, and in 18 feet the second metatarsalgia was either eliminated or markedly decreased. Most patients were pleased with the appearance of the feet after surgery, but almost one-third of the women complained of difficulty in wearing high heels. The surgical technique is straightforward, but careful attention to detail is necessary to obtain a consistent and satisfactory result.

Turf toe and sesamoiditis: what the radiologist needs to know.

PubMed

Schein, Aaron J; Skalski, Matthew R; Patel, Dakshesh B; White, Eric A; Lundquist, Ryan; Gottsegen, Christopher J; Forrester, Deborah M; Matcuk, George R

2015-01-01

The first metatarsophalangeal (MTP) joint complex is a critical weight-bearing structure important to biomechanics. An acute dorsiflexion injury, named "turf toe," is common among American football and soccer players. "Sesamoiditis" is a name often given for pain arising from the hallux sesamoids in the absence of acute trauma, and may result from a variety of causes. The first MTP joint complex can also be affected by degenerative or inflammatory arthritis, infarct, and infection. This review article will cover the anatomy and biomechanics of the first MTP joint complex, its patterns of injury and pathology, imaging techniques, and management. Copyright © 2015 Elsevier Inc. All rights reserved.

The chevron osteotomy and avascular necrosis.

PubMed

Rothwell, Matthew; Pickard, James

2013-03-01

Avascular necrosis (AVN) of the first metatarsal head following the chevron procedure for hallux valgus correction, has been reported widely in the literature; however, in practice it is rarely encountered and may be an over reported myth associated with the chevron technique. Although an infrequent complication, the consequences for those who develop post-operative AVN can be severe. This paper presents an overview of the pathogenesis and classification of AVN. It reviews the vascular anatomy of the first metatarsal with reference to the surgical technique of chevron osteotomy with lateral release. Imaging techniques are described and the management of AVN and revision surgery are also discussed. Copyright © 2012 Elsevier Ltd. All rights reserved.

Efficacy of Arnica montana D4 for healing of wounds after Hallux valgus surgery compared to diclofenac.

PubMed

Karow, Jens-Hagen; Abt, Hans-Peter; Fröhling, Markus; Ackermann, Hanns

2008-01-01

This study was undertaken to answer the question: "Is Arnica D4 as efficacious as diclofenac in relation to symptoms and wound healing after foot surgery?" In this randomized double-blinded, parallel-group study (GCP-standard), the efficacy of Arnica D4 10 pillules (taken orally, 3 times per day) and diclofenac sodium, 50 mg (taken orally, 3 times per day) were investigated for equivalence in 88 patients 4 days after hallux valgus surgery. Outcome parameters were (1) postoperative irritation, (2) patient mobility, (3) rated pain, and (4) use of analgesics. The hierarchic equivalence test based on one-sided Wilcoxon-Mann-Whitney-U confidence intervals (CIs) was used. Equivalence was perceived, when the lower margin of the 95% CI was > 0.36 corresponding to a range of equivalence of 1/2 standard deviation. Arnica D4 and diclofenac were equivalent for wound irritation (lower margin of the 95% CI on day 4: 0.4729 for rubor; 0.3674 for swelling; 0.4106 for calor) and patient mobility (0.4726). A descriptive analysis showed the superiority of Arnica D4 with respect to patient mobility (p = 0.045). With respect to pain, Arnica D4 was inferior to diclofenac (lower margin of the 95% CI 0.026). No significant differences were found regarding the use of additional analgesics during the 4 postoperative days (Dipidolor, Janssen-Cilag, Neuss, Germany; p = 0.54; Tramal, Grünenthal, Aachen, Germany; p = 0.1; and Novalgin, AVENTIS-Pharma, Bad Soden, Germany; p = 0.1). Arnica D4 was significantly better tolerated than diclofenac (p = 0.049). Nine (9) patients (20.45%) of the diclofenac group and 2 (4.5%) of the Arnica D4 group reported intolerance. There was no disturbance in wound healing in any of the patients. Arnica D4 is 60% cheaper than diclofenac. After foot operations, Arnica D4 can be used instead of diclofenac to reduce wound irritation.

Screw Versus Plate Fixation for Chevron Osteotomy: A Retrospective Study.

PubMed

Andrews, Boyd J; Fallat, Lawrence M; Kish, John P

2016-01-01

The chevron osteotomy is a popular procedure used for the correction of moderate hallux abducto valgus deformity. Fixation is typically accomplished with Kirschner wires or bone screws; however, in cystic or osteoporotic bone, these could be inadequate, resulting in displacement of the capital fragment. We propose using a locking plate and interfragmental screw for fixation of the chevron osteotomy that could reduce the healing time and decrease the incidence of displacement. We performed a retrospective cohort study for chevron osteotomies on 75 feet (73 patients). The control groups underwent fixation with 1 screw in 30 feet (40%) and 2 screws in 30 feet (40%). A total of 15 feet (20%) were included in the locking plate and interfragmental screw group. The patients were followed up until bone healing was achieved at a median of 7 (range 6 to 14) weeks. Our hypothesis was that those treated with the locking plate and interfragmental screw would have a faster healing time and fewer incidents of capital fragment displacement compared with the 1- or 2-screw groups. The corresponding mean intervals to healing for the 1-screw group was 7.71 ± 1.28 (range 6 to 10) weeks, for the 2-screw group was 7.27 ± 1.57 (range 6 to 14) weeks, and for the locking plate and interfragmental screw group was 7.01 ± 1.00 (range 6 to 9) weeks. One case of capital fragment displacement occurred in the single screw group and one in the 2-screw group. No displacement occurred in the locking plate and interfragmental screw group. Neither finding was statistically significant. However, we believe the locking plate and interfragmental screw could be a viable option in patients with osteoporotic and cystic bone changes for correction of hallux abducto valgus. Copyright © 2016 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

Second Metatarsal Transfer Lesions Due to First Metatarsal Shortening After Distal Chevron Metatarsal Osteotomy for Hallux Valgus.

PubMed

Ahn, Jiyong; Lee, Ho Seong; Seo, Jeong Ho; Kim, Ju Yeong

2016-06-01

The first metatarsal bone can shorten after a distal chevron metatarsal osteotomy (DCMO). This shortening can result in a postoperative second metatarsal transfer lesion. The aim of the present study was to investigate the occurrence of second metatarsal transfer lesions after DCMO. This study involved 185 feet (138 patients), with hallux valgus (HV) deformity, treated with DCMO with Akin osteotomy. The mean patient age was 51.7 years (range, 21 to 74). Patients were followed for an average of 28 months, between June 2004 and June 2010. We measured the length of first metatarsal relative to second metatarsal preoperatively and postoperatively, using Morton's and Hardy-Clapham's methods. A second metatarsal transfer lesion was defined as a newly developed lesion, including metatarsalgia, a painful callosity, or a painless callosity, which was not present prior to the DCMO. The relation of the shortened first metatarsal after DCMO with the occurrence of second metatarsal transfer lesion was evaluated. Second metatarsal transfer lesions (painless callosity) developed in 5 feet (2.7%) of 185 feet. Twenty-four preoperative second metatarsal lesions were improved postoperatively. The median shortening of the first metatarsal bone after DCMO was 0.6 mm according to Morton's method (range, -6.4 to 6.4), and 1.9 according to Hardy-Clapham's method (range, -5.8 to 5.8). According to the extent of first metatarsal shortening after DCMO by Hardy-Clapham's method and Morton's method, there was no significant difference of the occurrence of second transfer metatarsal lesions (P = .259 and P = .176, respectively). In our study, second metatarsal transfer lesions developed in 2.7% of feet after DCMO. The occurrence of second metatarsal transfer lesions did not appear to be correlated with the degree of first metatarsal shortening in cases with less than 5.8 mm shortening. Level IV, retrospective case series. © The Author(s) 2016.

Biomechanical Comparison Study of Three Fixation Methods for Proximal Chevron Osteotomy of the First Metatarsal in Hallux Valgus

PubMed Central

Kim, Jin Su; Young, Ki Won; Kim, Ji Soo; Lee, Kyung Tai

2017-01-01

Background Fixation of proximal chevron metatarsal osteotomy has been accomplished using K-wires traditionally and with a locking plate recently. However, both methods have many disadvantages. Hence, we developed an intramedullary fixation technique using headless cannulated screws and conducted a biomechanical study to evaluate the superiority of the technique to K-wire and locking plate fixations. Methods Proximal chevron metatarsal osteotomy was performed on 30 synthetic metatarsal models using three fixation techniques. Specimens in group I were fixated with K-wires (1.6 mm × 2) and in group II with headless cannulated screws (3.0 mm × 2) distally through the intramedullary canal. Specimens in group III were fixated with a locking X-shaped plate (1.3-mm thick) and screws (2.5 mm × 4). Eight metatarsal specimens were selected from each group for walking fatigue test. Bending stiffness and dorsal angulation were measured by 1,000 repetitions of a cantilever bending protocol in a plantar to dorsal direction. The remaining two samples from each group were subjected to 5 mm per minute axial loading to assess the maximal loading tolerance. Results All samples in group I failed walking fatigue test while group II and group III tolerated the walking fatigue test. Group II showed greater resistance to bending force and smaller dorsal angulation than group III (p = 0.001). On the axial loading test, group I and group II demonstrated superior maximum tolerance to group III (54.8 N vs. 47.2 N vs. 28.3 N). Conclusions Authors have demonstrated proximal chevron metatarsal osteotomy with intramedullary screw fixation provides superior biomechanical stability to locking plate and K-wire fixations. The new technique using intramedullary screw fixation can offer robust fixation and may lead to better outcomes in surgical treatment of hallux valgus. PMID:29201305

[Austin's horizontal V-shaped sliding osteotomy of the metatarsal head [Chevron-osteotomy) in the treatment of hallux valgus].

PubMed

Steinböck, G

1996-08-01

From 1983 to 1995, 1587 patients suffering from hallux abductovalgus were treated with the Austin bunionectomy. The operation consists of a medial exostosis removal, a V-shaped laterally directed displacement osteotomy of the metatarsal head, lateral release and medial reefing of the capsulo-ligamentous structures. Lateral transposition is facilitated by performing a sufficient lateral release consisting of dissection of the lateral metatarsophalangeal ligament and separation of the adductor tendon from the base of the phalanx and the lateral sesamoid. In the case of intermetatarsal angles greater than 15 degrees, the metatarsal-sesamoid ligament is also severed just above the lateral sesamoid. The periosteum is stripped in a limited fashion dorsally and toward the plantar, leaving its insertion at the metatarsal head intact. After this procedure, reposition of the metatarsal head onto the sesamoids is usually possible and is maintained by reconstruction of the medial metatarsal-sesamoid ligament. In the author's own research material, metatarsophalangeal angles larger than 50 degrees and intermetatarsal angles of over 20 degrees could be corrected. Pronation of the toe is usually corrected by tenotomy of the abductor tendon near the base of the phalanx. Avascular necrosis is extremely rare with a careful operative technique. In our extensive research material, four cases of AVN were recognized. Provided there is free motion of the joint (60-0-20), mild radiological signs of osteoarthritis are no contraindication for the operation. Even in the aged, good results can be achieved provided there are no trophic problems. The Austin bunionectomy has proved to be a versatile method for treating bunion problems. The possibility of transposing the metatarsal head laterally, toward the plantar, proximally and distally by altering the direction of the osteotomy, as well as tilting it medially or laterally, has made this osteotomy an invaluable tool for addressing various problems in bunion surgery.

RELIABILITY OF ANKLE-FOOT MORPHOLOGY, MOBILITY, STRENGTH, AND MOTOR PERFORMANCE MEASURES.

PubMed

Fraser, John J; Koldenhoven, Rachel M; Saliba, Susan A; Hertel, Jay

2017-12-01

Assessment of foot posture, morphology, intersegmental mobility, strength and motor control of the ankle-foot complex are commonly used clinically, but measurement properties of many assessments are unclear. To determine test-retest and inter-rater reliability, standard error of measurement, and minimal detectable change of morphology, joint excursion and play, strength, and motor control of the ankle-foot complex. Reliability study. 24 healthy, recreationally-active young adults without history of ankle-foot injury were assessed by two clinicians on two occasions, three to ten days apart. Measurement properties were assessed for foot morphology (foot posture index, total and truncated length, width, arch height), joint excursion (weight-bearing dorsiflexion, rearfoot and hallux goniometry, forefoot inclinometry, 1 st metatarsal displacement) and joint play, strength (handheld dynamometry), and motor control rating during intrinsic foot muscle (IFM) exercises. Clinician order was randomized using a Latin Square. The clinicians performed independent examinations and did not confer on the findings for the duration of the study. Test-retest and inter-tester reliability and agreement was assessed using intraclass correlation coefficients (ICC 2,k ) and weighted kappa ( K w ). Test-retest reliability ICC were as follows: morphology: .80-1.00, joint excursion: .58-.97, joint play: -.67-.84, strength: .67-.92, IFM motor rating: K W -.01-.71. Inter-rater reliability ICC were as follows: morphology: .81-1.00, joint excursion: .32-.97, joint play: -1.06-1.00, strength: .53-.90, and IFM motor rating: K w .02-.56. Measures of ankle-foot posture, morphology, joint excursion, and strength demonstrated fair to excellent test-retest and inter-rater reliability. Test-retest reliability for rating of perceived difficulty and motor performance was good to excellent for short-foot, toe-spread-out, and hallux exercises and poor to fair for lesser toe extension. Joint play measures had poor to fair reliability overall. The findings of this study should be considered when choosing methods of clinical assessment and outcome measures in practice and research. 3.

Study on the foot shape characteristics of the elderly in China.

PubMed

Luo, Xiang Dong; Xue, Chao-Hua; Li, Yan

2017-12-01

With aging, the feet of the elderly above 60 years old in China present degenerative changes, deformities, and diseases, which significantly affect their daily activities. The authors aimed to study the morphological characteristics of the feet and identify the foot type according to size (length and width) and defect characteristics of elderly feet in China. A convenient sample of 1000 subjects above 60 years old was recruited mainly in the regions of Shanghai, Shaanxi, Henan, Hebei, and Sichuan in China. Foot images were collected, and 800 (male 398, female 402) valid questionnaires were recovered. A total of 800 elderly subjects as the test group were invited to measure their foot sizes by means of a Footprint Collector (Tong Yuan Tang Health Management Limited, Qingdao in Shandong province). The foot type of the elderly was compared with that of the general adult Chinese population as the control group using the t-test for independent samples. Hallux valgus (46.9%) and flat foot (50.0%) were the most common foot shape deformities. The most frequent foot diseases were foot scaling (91.2%) and calluses (96.3%). The medial width of the first metatarsal-toe joint of the elderly was significantly higher (elderly female, 44.95±4.86mm; elderly male, 48.55±4.94mm) than that of the general adult population (adult female, 40.18±3.43mm; adult male, 43.22±3.20mm) (p<0.01). The foot length of the elderly was not significantly different from that of the general adult Chinese population. The width of the first metatarsal-toe joint in the forefoot of the elderly was significantly higher than that of the general adult Chinese population, which was consistent with the result that a high proportion of elderly subjects presented hallux valgus. Copyright © 2017 Elsevier Ltd. All rights reserved.

Foot Kinematics During a Bilateral Heel Rise Test in Participants With Stage II Posterior Tibial Tendon Dysfunction

PubMed Central

HOUCK, JEFF; NEVILLE, CHRISTOPHER; TOME, JOSHUA; FLEMISTER, ADOLPH

2010-01-01

STUDY DESIGN Experimental laboratory study using a cross-sectional design. OBJECTIVES To compare foot kinematics, using 3-dimensional tracking methods, during a bilateral heel rise between participants with posterior tibial tendon dysfunction (PTTD) and participants with a normal medial longitudinal arch (MLA). BACKGROUND The bilateral heel rise test is commonly used to assess patients with PTTD; however, information about foot kinematics during the test is lacking. METHODS Forty-five individuals volunteered to participate, including 30 patients diagnosed with unilateral stage II PTTD (mean ± SD age, 59.8 ± 11.1 years; body mass index, 29.9 ± 4.8 kg/m2) and 15 controls (mean ± SD age, 56.5 ± 7.7 years; body mass index, 30.6 ± 3.6 kg/m2). Foot kinematic data were collected during a bilateral heel rise task from the calcaneus (hindfoot), first metatarsal, and hallux, using an Optotrak motion analysis system and Motion Monitor software. A 2-way mixed-effects analysis of variance model, with normalized heel height as a covariate, was used to test for significant differences between the normal MLA and PTTD groups. RESULTS The patients in the PTTD group exhibited significantly greater ankle plantar flexion (mean difference between groups, 7.3°; 95% confidence interval [CI]: 5.1° to 9.5°), greater first metatarsal dorsiflexion (mean difference between groups, 9.0°; 95% CI: 3.7° to 14.4°), and less hallux dorsiflexion (mean difference, 6.7°; 95% CI: 1.7° to 11.8°) compared to controls. At peak heel rise, hindfoot inversion was similar (P = .130) between the PTTD and control groups. CONCLUSION Except for hindfoot eversion/inversion, the differences in foot kinematics in participants with stage II PTTD, when compared to the control group, mainly occur as an offset, not an alteration in shape, of the kinematic patterns. PMID:19648723

Foot kinematics during a bilateral heel rise test in participants with stage II posterior tibial tendon dysfunction.

PubMed

Houck, Jeff R; Neville, Christopher; Tome, Josh; Flemister, A Samuel

2009-08-01

Experimental laboratory study using a cross-sectional design. To compare foot kinematics, using 3-dimensional tracking methods, during a bilateral heel rise between participants with posterior tibial tendon dysfunction (PTTD) and participants with a normal medial longitudinal arch (MLA). The bilateral heel rise test is commonly used to assess patients with PTTD; however, information about foot kinematics during the test is lacking. Forty-five individuals volunteered to participate, including 30 patients diagnosed with unilateral stage II PTTD (mean +/- SD age, 59.8 +/- 11.1 years; body mass index, 29.9 +/- 4.8 kg/m2) and 15 controls (mean +/- SD age, 56.5 +/- 7.7 years; body mass index, 30.6 +/- 3.6 kg/m2). Foot kinematic data were collected during a bilateral heel rise task from the calcaneus (hindfoot), first metatarsal, and hallux, using an Optotrak motion analysis system and Motion Monitor software. A 2-way mixed-effects analysis of variance model, with normalized heel height as a covariate, was used to test for significant differences between the normal MLA and PTTD groups. The patients in the PTTD group exhibited significantly greater ankle plantar flexion (mean difference between groups, 7.3 degrees ; 95% confidence interval [CI]: 5.1 degrees to 9.5 degrees ), greater first metatarsal dorsiflexion (mean difference between groups, 9.0 degrees ; 95% CI: 3.7 degrees to 14.4 degrees ), and less hallux dorsiflexion (mean difference, 6.7 degrees ; 95% CI: 1.7 degrees to 11.8 degrees ) compared to controls. At peak heel rise, hindfoot inversion was similar (P = .130) between the PTTD and control groups. Except for hindfoot eversion/inversion, the differences in foot kinematics in participants with stage II PTTD, when compared to the control group, mainly occur as an offset, not an alteration in shape, of the kinematic patterns.

Chitayat syndrome: hyperphalangism, characteristic facies, hallux valgus and bronchomalacia results from a recurrent c.266A>G p.(Tyr89Cys) variant in the ERF gene.

PubMed

Balasubramanian, M; Lord, H; Levesque, S; Guturu, H; Thuriot, F; Sillon, G; Wenger, A M; Sureka, D L; Lester, T; Johnson, D S; Bowen, J; Calhoun, A R; Viskochil, D H; Bejerano, G; Bernstein, J A; Chitayat, D

2017-03-01

In 1993, Chitayat et al. , reported a newborn with hyperphalangism, facial anomalies, and bronchomalacia. We identified three additional families with similar findings. Features include bilateral accessory phalanx resulting in shortened index fingers; hallux valgus; distinctive face; respiratory compromise. To identify the genetic aetiology of Chitayat syndrome and identify a unifying cause for this specific form of hyperphalangism. Through ongoing collaboration, we had collected patients with strikingly-similar phenotype. Trio-based exome sequencing was first performed in Patient 2 through Deciphering Developmental Disorders study. Proband-only exome sequencing had previously been independently performed in Patient 4. Following identification of a candidate gene variant in Patient 2, the same variant was subsequently confirmed from exome data in Patient 4. Sanger sequencing was used to validate this variant in Patients 1, 3; confirm paternal inheritance in Patient 5. A recurrent, novel variant NM_006494.2:c.266A>G p.(Tyr89Cys) in ERF was identified in five affected individuals: de novo (patient 1, 2 and 3) and inherited from an affected father (patient 4 and 5). p.Tyr89Cys is an aromatic polar neutral to polar neutral amino acid substitution, at a highly conserved position and lies within the functionally important ETS-domain of the protein. The recurrent ERF c.266A>C p.(Tyr89Cys) variant causes Chitayat syndrome. ERF variants have previously been associated with complex craniosynostosis. In contrast, none of the patients with the c.266A>G p.(Tyr89Cys) variant have craniosynostosis. We report the molecular aetiology of Chitayat syndrome and discuss potential mechanisms for this distinctive phenotype associated with the p.Tyr89Cys substitution in ERF . Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Operative Outcomes of Grade 3 Turf Toe Injuries in Competitive Football Players.

PubMed

Smith, Kenneth; Waldrop, Norman

2018-06-01

Turf toe is a term used to describe a hyperextension injury to the first metatarsophalangeal joint. Although the vast majority of turf toe injuries can be treated successfully without operative intervention, there are instances where surgery is required to allow the athlete to return to play. Although there is a plethora of literature on turf toe injuries and nonoperative management, there are currently few reports on operative outcomes in athletes. We obtained all cases of turf toe repair according to the ICD-10 procedural code. The inclusion criteria included: age greater than 16, turf toe injury requiring operative management and at least a varsity level high school football player. The charts were reviewed for age, BMI, level of competition, injury mechanism, football position, setting of injury and playing surface. In addition, we recorded the specifics of the operative procedure, a listing of all injured structures, the implants used and the great toe range of motion at final follow-up visit. The AOFAS Hallux score and VAS was used postoperatively as our outcome measures. Our patient population included 15 patients. The average follow-up time was 27.5 months. The average patient was 19.3 years old with a body mass index of 32.3. The average playing time missed was 16.5 weeks. The average dorsiflexion range of motion at the final follow-up was 42.3 degrees. At final follow-up, the average AOFAS Hallux score was 91.3. The average VAS pain score was 0.7 at rest and 0.8 with physical activity. Complete turf toe injuries are often debilitating and may require operative management to restore a pain-free, stable, and functional forefoot. This study represents the largest cohort of operatively treated grade 3 turf toe injuries in the literature and demonstrates that good clinical outcomes were achieved with operative repair. Level IV, case series.

Plantar pressures are elevated in people with longstanding diabetes-related foot ulcers during follow-up

PubMed Central

Fernando, Malindu E.; Crowther, Robert G.; Lazzarini, Peter A.; Yogakanthi, Saiumaeswar; Sangla, Kunwarjit S.; Buttner, Petra; Jones, Rhondda; Golledge, Jonathan

2017-01-01

Objective High plantar pressures are implicated in the development of diabetes-related foot ulcers. Whether plantar pressures remain high in patients with chronic diabetes-related foot ulcers over time is uncertain. The primary aim of this study was to compare plantar pressures at baseline and three and six months later in participants with chronic diabetes-related foot ulcers (cases) to participants without foot ulcers (controls). Methods Standardised protocols were used to measure mean peak plantar pressure and pressure-time integral at 10 plantar foot sites (the hallux, toes, metatarsals 1 to 5, mid-foot, medial heel and lateral heel) during barefoot walking. Measurements were performed at three study visits: baseline, three and six months. Linear mixed effects random-intercept models were utilised to assess whether plantar pressures differed between cases and controls after adjusting for age, sex, body mass index, neuropathy status and follow-up time. Standardised mean differences (Cohen’s d) were used to measure effect size. Results Twenty-one cases and 69 controls started the study and 16 cases and 63 controls completed the study. Cases had a higher mean peak plantar pressure at several foot sites including the toes (p = 0.005, Cohen’s d = 0.36) and mid-foot (p = 0.01, d = 0.36) and a higher pressure-time integral at the hallux (p<0.001, d = 0.42), metatarsal 1 (p = 0.02, d = 0.33) and mid-foot (p = 0.04, d = 0.64) compared to controls throughout follow-up. A reduction in pressure-time integral at multiple plantar sites over time was detected in all participants (p<0.05, respectively). Conclusions Plantar pressures assessed during gait are higher in diabetes patients with chronic foot ulcers than controls at several plantar sites throughout prolonged follow-up. Long term offloading is needed in diabetes patients with diabetes-related foot ulcers to facilitate ulcer healing. PMID:28859075

The relationship between foot posture and plantar pressure during walking in adults: A systematic review.

PubMed

Buldt, Andrew K; Allan, Jamie J; Landorf, Karl B; Menz, Hylton B

2018-02-23

Foot posture is a risk factor for some lower limb injuries, however the underlying mechanism is not well understood. Plantar pressure analysis is one technique to investigate the interaction between foot posture and biomechanical function of the lower limb. The aim of this review was to investigate the relationship between foot posture and plantar pressure during walking. A systematic database search was conducted using MEDLINE, CINAHL, SPORTDiscus and Embase to identify studies that have assessed the relationship between foot posture and plantar pressure during walking. Included studies were assessed for methodological quality. Meta-analysis was not conducted due to heterogeneity between studies. Inconsistencies included foot posture classification techniques, gait analysis protocols, selection of plantar pressure parameters and statistical analysis approaches. Of the 4213 citations identified for title and abstract review, sixteen studies were included and underwent quality assessment; all were of moderate methodological quality. There was some evidence that planus feet display higher peak pressure, pressure-time integral, maximum force, force-time integral and contact area predominantly in the medial arch, central forefoot and hallux, while these variables are lower in the lateral and medial forefoot. In contrast, cavus feet display higher peak pressure and pressure-time integral in the heel and lateral forefoot, while pressure-time integral, maximum force, force-time integral and contact area are lower for the midfoot and hallux. Centre of pressure was more laterally deviated in cavus feet and more medially deviated in planus feet. Overall, effect sizes were moderate, but regression models could only explain a small amount of variance in plantar pressure variables. Despite these significant findings, future research would benefit from greater methodological rigour, particularly in relation to the use of valid foot posture measurement techniques, gait analysis protocols, and standardised approaches for analysis and reporting of plantar pressure variables. Copyright © 2018 Elsevier B.V. All rights reserved.

[Onychomycosis for Curvularia lunata var. aeria: presentation of a clinical case].

PubMed

Fraenza, Laura B; Druetta, Silvina Del V; Raga, Ariel J; Luque Aguada, Lizet; Zalazar, Viviana; Farfalli, Luciana

2015-01-01

We here report a clinical case of a female patient presenting with a three-month history of a white onychodystrophic lesion of both hallux. The infection was due to a mold, identified as Curvularia lunata var aeria. The Curvularia gender is related to the production of phaeohyphomycosis, Curvularia lunata cause onychomycosis occasionally. The patient was treated with itraconazole 200mg/day, during six month with complete remission of the lesions. In conclusion, it is important to consider these fungi as causative agent of nail mycosis since the initial site of infection may be a pathway for systemic dissemination in inmunocompromised patients. Copyright © 2014 Asociación Argentina de Microbiología. Publicado por Elsevier España, S.L.U. All rights reserved.

Prospective, Randomized, Multi-centered Clinical Trial Assessing Safety and Efficacy of a Synthetic Cartilage Implant Versus First Metatarsophalangeal Arthrodesis in Advanced Hallux Rigidus.

PubMed

Baumhauer, Judith F; Singh, Dishan; Glazebrook, Mark; Blundell, Chris; De Vries, Gwyneth; Le, Ian L D; Nielsen, Dominic; Pedersen, M Elizabeth; Sakellariou, Anthony; Solan, Matthew; Wansbrough, Guy; Younger, Alastair S E; Daniels, Timothy

2016-05-01

Although a variety of great toe implants have been tried in an attempt to maintain toe motion, the majority have failed with loosening, malalignment/dislocation, implant fragmentation and bone loss. In these cases, salvage to arthrodesis is more complicated and results in shortening of the ray or requires structural bone graft to reestablish length. This prospective study compared the efficacy and safety of this small (8/10 mm) hydrogel implant to the gold standard of a great toe arthrodesis for advanced-stage hallux rigidus. In this prospective, randomized non-inferiority study, patients from 12 centers in Canada and the United Kingdom were randomized (2:1) to a synthetic cartilage implant or first metatarsophalangeal (MTP) joint arthrodesis. VAS pain scale, validated outcome measures (Foot and Ankle Ability Measure [FAAM] sport scale), great toe active dorsiflexion motion, secondary procedures, radiographic assessment, and safety parameters were evaluated. Analysis was performed using intent-to-treat (ITT) and modified ITT (mITT) methodology. The primary endpoint for the study consisted of a single composite endpoint using the 3 primary study outcomes (pain, function, and safety). The individual subject's outcome was considered a success if all of the following criteria were met: (1) improvement (decrease) from baseline in VAS pain of ≥30% at 12 months; (2) maintenance of function from baseline in FAAM sports subscore at 12 months; and (3) absence of major safety events at 2 years. The proportion of successes in each group was determined and 1-sided 95% confidence interval for the difference between treatment groups was calculated. Noninferiority of the implant to arthrodesis was considered statistically significant if the 1-sided 95% lower confidence interval was greater than the equivalence limit (<15%). A total of 236 patients were initially enrolled; 17 patients withdrew prior to randomization, 17 patients withdrew after randomization, and 22 were nonrandomized training patients, leaving 152 implant and 50 arthrodesis patients. Standard demographics and baseline outcomes were similar for both groups. VAS pain scores decreased significantly in both the implant and arthrodesis groups from baseline at 12 and 24 months. Similarly, the FAAM sports and activity of daily living subscores improved significantly at 12 and 24 months in both groups. First MTP active dorsiflexion motion improvement was 6.2 degrees (27.3%) after implant placement and was maintained at 24 months. Subsequent secondary surgeries occurred in 17 (11.2%) implant patients (17 procedures) and 6 (12.0%) arthrodesis patients (7 procedures). Fourteen (9.2%) implants were removed and converted to arthrodesis, and 6 (12.0%) arthrodesis patients (7 procedures [14%]) had isolated screws or plate and screw removal. There were no cases of implant fragmentation, wear, or bone loss. When analyzing the ITT and mITT population for the primary composite outcome of VAS pain, function (FAAM sports), and safety, there was statistical equivalence between the implant and arthrodesis groups. A prospective, randomized (2:1), controlled, noninferiority clinical trial was performed to compare the safety and efficacy of a small synthetic cartilage bone implant to first MTP arthrodesis in patients with advanced-stage hallux rigidus. This study showed equivalent pain relief and functional outcomes. The synthetic implant was an excellent alternative to arthrodesis in patients who wished to maintain first MTP motion. The percentage of secondary surgical procedures was similar between groups. Less than 10% of the implant group required revision to arthrodesis at 2 years. Level I, prospective randomized study. © The Author(s) 2016.

The effect of foot orthoses and in-shoe wedges during cycling: a systematic review

PubMed Central

2014-01-01

Background The use of foot orthoses and in-shoe wedges in cycling are largely based on theoretical benefits and anecdotal evidence. This review aimed to systematically collect all published research on this topic, critically evaluate the methods and summarise the findings. Methods Study inclusion criteria were: all empirical studies that evaluated the effects of foot orthoses or in-shoe wedges on cycling; outcome measures that investigated physiological parameters, kinematics and kinetics of the lower limb, and power; and, published in English. Studies were located by data-base searching (Medline, CINAHL, Embase and SPORTDiscus) and hand-searching in February 2014. Selected studies were assessed for methodological quality using a modified Quality Index. Data were synthesised descriptively. Meta-analysis was not performed as the included studies were not sufficiently homogeneous to provide a meaningful summary. Results Six studies were identified as meeting the eligibility criteria. All studies were laboratory-based and used a repeated measures design. The quality of the studies varied, with Quality Index scores ranging from 7 to 10 out of 14. Five studies investigated foot orthoses and one studied in-shoe wedges. Foot orthoses were found to increase contact area in the midfoot, peak pressures under the hallux and were perceived to provide better arch support, compared to a control. With respect to physiological parameters, contrasting findings have been reported regarding the effect foot orthoses have on oxygen consumption. Further, foot orthoses have been shown to not provide effects on lower limb kinematics and perceived comfort. Both foot orthoses and in-shoe wedges have been shown to provide no effect on power. Conclusion In general, there is limited high-quality research on the effects foot orthoses and in-shoe wedges provide during cycling. At present, there is some evidence that during cycling foot orthoses: increase contact area under the foot and increase plantar pressures under the hallux, but provide no gains in power. Based on available evidence, no definitive conclusions can be made about the effects foot orthoses have on lower limb kinematics and oxygen consumption, and the effect in-shoe wedges have on power during cycling. Future well-designed studies on this topic are warranted. PMID:24955129

Interventions for treating osteoarthritis of the big toe joint.

PubMed

Zammit, Gerard V; Menz, Hylton B; Munteanu, Shannon E; Landorf, Karl B; Gilheany, Mark F

2010-09-08

Osteoarthritis affecting of the big toe joint of the foot (hallux limitus or rigidus) is a common and painful condition. Although several treatments have been proposed, few have been adequately evaluated. To identify controlled trials evaluating interventions for osteoarthritis of the big toe joint and to determine the optimum intervention(s). Literature searches were conducted across the following electronic databases: CENTRAL; MEDLINE; EMBASE; CINAHL; and PEDro (to 14th January 2010). No language restrictions were applied. Randomised controlled trials, quasi-randomised trials, or controlled clinical trials that assessed treatment outcomes for osteoarthritis of the big toe joint. Participants of any age or gender with osteoarthritis of the big toe joint (defined either radiographically or clinically) were included. Two authors examined the list of titles and abstracts identified by the literature searches. One content area expert and one methodologist independently applied the pre-determined inclusion and exclusion criteria to the full text of identified trials. To minimise error and reduce potential bias, data were extracted independently by two content experts. Only one trial satisfactorily fulfilled the inclusion criteria and was included in this review. This trial evaluated the effectiveness of two physical therapy programs in 20 individuals with osteoarthritis of the big toe joint. Assessment outcomes included pain levels, big toe joint range of motion and plantar flexion strength of the hallux. Mean differences at four weeks follow up were 3.80 points (95% CI 2.74 to 4.86) for self reported pain, 28.30 degrees (95% CI 21.37 to 35.23) for big toe joint range of motion, and 2.80 kg (95% CI 2.13 to 3.47) for muscle strength. Although differences in outcomes between treatment and control groups were reported, the risk of bias was high. The trial failed to employ appropriate randomisation or adequate allocation concealment, used a relatively small sample and incorporated a short follow up (four weeks). No adverse reactions were reported. The reviewed trial presented a high risk of bias, which limited conclusions that could be drawn from the presented data. The inclusion of only one trial indicates the need for more robust randomised controlled trials to determine the efficacy of interventions for this condition.

Non-surgical treatment of hallux valgus: a current practice survey of Australian podiatrists.

PubMed

Hurn, Sheree E; Vicenzino, Bill T; Smith, Michelle D

2016-01-01

Patients with hallux valgus (HV) frequently present to podiatrists for non-surgical management, with a wide range of concerns including pain, footwear difficulty and quality of life impacts. There is little research evidence guiding podiatrists' clinical decisions surrounding non-surgical management of HV. Thus practitioners rely largely upon clinical experience and expert opinion. This survey was conducted to determine whether a consensus exists among Australian podiatrists regarding non-surgical treatment of HV, and secondly to explore common presenting concerns and physical examination findings associated with HV. An online survey was distributed to Australian podiatrists in mid-2013 via the professional association in each state (approximately 1900 members). Podiatrists indicated common treatments recommended, presenting problems and physical examination findings associated with HV in juveniles, adults and older adults. Proportions were calculated to determine the most common responses, and Chi-squared tests were used to examine differences in treatment recommendations according to HV patient age group and podiatrist demographics. Of 210 survey respondents, 65 % (136) were female and 80 % (168) were private practitioners. Complete survey responses were received from 159 podiatrists for juvenile HV, 146 for adults and 141 for older adults. Seven different non-surgical treatment options were commonly recommended (by >50 % podiatrists), although recommendations differed between adult, older adult and juvenile HV. Common treatments included footwear advice or modification, custom and prefabricated orthotic devices, addition of padding, and muscle strengthening/retraining exercises. Padding was more likely to be utilised in older adults, while exercises were more likely to be prescribed for juveniles. A diverse range of presenting problems and physical examination findings were reported to be associated with HV. Despite the lack of empirical evidence in this area, there appears to be a consensus among Australian podiatrists regarding non-surgical management of HV, and these recommendations are largely aligned with available clinical consensus documents. Presenting concerns and physical examination findings associated with HV are diverse and have implications for treatment decisions. Management strategies differ across patient age groups, thus any updated clinical guidelines should differentiate between adult and juvenile HV. This study provides useful data to inform clinical practice, education, policy and future research.

Foot care for the aging.

PubMed

Edelstein, J E

1988-12-01

Age-related changes in the feet include alterations in the skin, which becomes dry, inelastic, and cool and often exhibits hyperkeratoses. Thickened and brittle toenails complicate pedicure. The contour of the foot widens with age and may have increased forefoot height in the presence of toe deformities. Sensory acuity diminishes, as does joint mobility, muscle-force production, and ability to withstand stress. The elderly person's gait is slower and less forceful, with shorter strides. Visual loss affects footwear donning and toenail trimming. Older individuals on a limited income are less likely to have appropriate shoes and hose. Preventive care begins with good hygiene and continues with selection of suitable hosiery and shoes. Conservative management of the podiatric conditions most often seen in geriatric patients (eg, metatarsalgia and hallux valgus) should be based on relating the pathomechanics of the disorder to the options available in shoe selection, modification, and insert design.

The foot of Homo naledi.

PubMed

Harcourt-Smith, W E H; Throckmorton, Z; Congdon, K A; Zipfel, B; Deane, A S; Drapeau, M S M; Churchill, S E; Berger, L R; DeSilva, J M

2015-10-06

Modern humans are characterized by a highly specialized foot that reflects our obligate bipedalism. Our understanding of hominin foot evolution is, although, hindered by a paucity of well-associated remains. Here we describe the foot of Homo naledi from Dinaledi Chamber, South Africa, using 107 pedal elements, including one nearly-complete adult foot. The H. naledi foot is predominantly modern human-like in morphology and inferred function, with an adducted hallux, an elongated tarsus, and derived ankle and calcaneocuboid joints. In combination, these features indicate a foot well adapted for striding bipedalism. However, the H. naledi foot differs from modern humans in having more curved proximal pedal phalanges, and features suggestive of a reduced medial longitudinal arch. Within the context of primitive features found elsewhere in the skeleton, these findings suggest a unique locomotor repertoire for H. naledi, thus providing further evidence of locomotor diversity within both the hominin clade and the genus Homo.

The foot of Homo naledi

PubMed Central

Harcourt-Smith, W. E. H.; Throckmorton, Z.; Congdon, K. A.; Zipfel, B.; Deane, A. S.; Drapeau, M. S. M.; Churchill, S. E.; Berger, L. R.; DeSilva, J. M.

2015-01-01

Modern humans are characterized by a highly specialized foot that reflects our obligate bipedalism. Our understanding of hominin foot evolution is, although, hindered by a paucity of well-associated remains. Here we describe the foot of Homo naledi from Dinaledi Chamber, South Africa, using 107 pedal elements, including one nearly-complete adult foot. The H. naledi foot is predominantly modern human-like in morphology and inferred function, with an adducted hallux, an elongated tarsus, and derived ankle and calcaneocuboid joints. In combination, these features indicate a foot well adapted for striding bipedalism. However, the H. naledi foot differs from modern humans in having more curved proximal pedal phalanges, and features suggestive of a reduced medial longitudinal arch. Within the context of primitive features found elsewhere in the skeleton, these findings suggest a unique locomotor repertoire for H. naledi, thus providing further evidence of locomotor diversity within both the hominin clade and the genus Homo. PMID:26439101

Ophthalmologic Findings in H Syndrome: A Unique Diagnostic Clue.

PubMed

Molho-Pessach, Vered; Mechoulam, Hadas; Siam, Rula; Babay, Sofia; Ramot, Yuval; Zlotogorski, Abraham

2015-01-01

H syndrome is an autosomal recessive histiocytosis with multisystemic involvement caused by mutations in the SLC29A3 gene. The term H syndrome was coined to denote the major clinical findings which include hyperpigmentation, hypertrichosis, hearing loss, hepatosplenomegaly, hypogonadism, hyperglycemia/diabetes mellitus and hallux valgus/flexion contractures. Almost 100 individuals affected with this disorder have been reported, however, a thorough evaluation of the ophthalmologic features of H syndrome has not yet been performed. Ophthalmic examination of a 50-year-old male with H syndrome. Mutation analysis of SLC29A3 was also performed in this patient. Ophthalmic findings included; shallow orbits with exorbitism, bilateral pterygium, limbal thickening, corneal arcus and cortical cataract. We also review ophthalmologic findings in previously reported H syndrome patients. The presence of dilated lateral scleral vessels, corneal arcus and shallow orbits should raise the suspicion of H syndrome, especially when seen in young age.

A system for the analysis of foot and ankle kinematics during gait.

PubMed

Kidder, S M; Abuzzahab, F S; Harris, G F; Johnson, J E

1996-03-01

A five-camera Vicon (Oxford Metrics, Oxford, England) motion analysis system was used to acquire foot and ankle motion data. Static resolution and accuracy were computed as 0.86 +/- 0.13 mm and 98.9%, while dynamic resolution and accuracy were 0.1 +/- 0.89 and 99.4% (sagittal plane). Spectral analysis revealed high frequency noise and the need for a filter (6 Hz Butterworth low-pass) as used in similar clinical situations. A four-segment rigid body model of the foot and ankle was developed. The four rigid body foot model segments were 1) tibia and fibula, 2) calcaneus, talus, and navicular, 3) cuneiforms, cuboid, and metatarsals, and 4) hallux. The Euler method for describing relative foot and ankle segment orientation was utilized in order to maintain accuracy and ease of clinical application. Kinematic data from a single test subject are presented.

[Influence of the posterior tibial tendon on the medial arch of the foot: an in vitro kinetic and kinematic study].

PubMed

Emmerich, J; Wülker, N; Hurschler, C

2003-04-01

The respective contributions of the active and passive structures of the foot to the stability of the medical arch were investigated using an in vitro kinetic and kinematic model. The effect of the tibialis posterior tendon on foot and ankle movements, and plantar pressure distribution of the foot were tested in a cadaveric human foot. The stance phase from heel-contact to toe-off of normal walking gait and after tibialis posterior tendon rupture was simulated in eight roentenographically normal human feet (age 66 +/- 19 years, males). Ground reaction force and tibial inclination was simulated by means of a tilting angle and force-controlled translation stage. Plantar pressure was measured using a pressure-measuring platform. The force developed by the flexors and extensor muscles of the foot were simulated via cables attached to 7 force-controlled hydraulic cylinders. Tibial rotation was produced by an electric servo-motor, and foot movements measured with an ultrasonic analysis system. The model was verified against the plantar distribution and kinematics of healthy subjects measured during normal gait. Tibialis posterior deficit did not result in any detectable changes in pressure or force-time integral in the medial regions of the foot--a common sign of flat foot (pressure: midfoot 0.2 < or = 0.9; medial forefoot 0.5 < or = p < or = 0.9; hallux 0.5 < or = p < or = 0.9; force-time integral: midfoot p = 0-871; medial forefoot p = 0.632; hallux p = 0.068). Only small tendential changes in the kinematics of the talus and calcaneus were observed in dorsiflexion (0-58 sec; talus 0.1 < or = p < or = 0.6; calcaneus 0.4 < or = p < or = 0.06) and eversion (talus: 0-60 sec. 0.1 < or = p < or = 0.6; calcaneus: 37-60 sec. 0.2 < or = p < or = 0.7). The results of this in vitro study show that defective tibialis posterior alone does not produce significant changes in the kinetics or kinematics of the stance phase of normal gait. This suggests that the development of flat foot observed in degeneration of the tibialis posterior tendon occurs only after fatigue of the passive structures of the foot.

Influence of shoe midsole hardness on plantar pressure distribution in four basketball-related movements.

PubMed

Lam, Wing-Kai; Ng, Wei Xuan; Kong, Pui Wah

2017-01-01

This study examined how shoe midsole hardness influenced plantar pressure in basketball-related movements. Twenty male university basketball players wore customized shoes with hard and soft midsoles (60 and 50 Shore C) to perform four movements: running, maximal forward sprinting, maximal 45° cutting and lay-up. Plantar loading was recorded using an in-shoe pressure measuring system, with peak pressure (PP) and pressure time integral (PTI) extracted from 10 plantar regions. Compared with hard shoes, subjects exhibited lower PP in one or more plantar regions when wearing the soft shoes across all tested movements (Ps < 0.05). Lower PTI was also observed in the hallux for 45° cutting, and the toes and forefoot regions during the first step of lay-up in the soft shoe condition (Ps < 0.05). In conclusion, using a softer midsole in the forefoot region may be a plausible remedy to reduce the high plantar loading experienced by basketball players.

Evaluation of an Innovative Fixation System for Chevron Bunionectomy.

PubMed

Bennett, Gordon L; Sabetta, James A

2016-02-01

Distal chevron metatarsal osteotomy bunionectomy is a commonly performed procedure for the treatment of mild to moderate hallux valgus deformity. There are several different methods to stabilize this osteotomy. We evaluated a new intramedullary plate system. We prospectively evaluated 57 consecutive patients who underwent distal chevron metatarsal osteotomy bunionectomy utilizing the intramedullary plate system. All operative procedures were performed by the senior author. Patients were evaluated preoperatively, postoperatively, and at a final follow-up utilizing the American Orthopaedic Foot & Ankle Society (AOFAS) forefoot scoring system. Sixty-three surgically corrected feet went on to heal the osteotomy site. There were no hardware failures. We had one patient that expressed mild discomfort over the plate. All patients significantly improved their AOFAS scores compared with preoperative values. We concluded that the distal chevron metatarsal osteotomy bunionectomy resulted in excellent function and pain relief. The new plate system was a reliable and stable implant with a low profile, good strength, and ease of use. Level IV, retrospective case series. © The Author(s) 2015.

Foot Structure in Boys with Down Syndrome.

PubMed

Puszczałowska-Lizis, Ewa; Nowak, Krzysztof; Omorczyk, Jarosław; Ambroży, Tadeusz; Bujas, Przemysław; Nosiadek, Leszek

2017-01-01

Down syndrome (DS) is associated with numerous developmental abnormalities, some of which cause dysfunctions of the posture and the locomotor system. The analysis of selected features of the foot structure in boys with DS versus their peers without developmental disorders is done. The podoscopic examination was performed on 30 boys with DS aged 14-15 years. A control group consisted of 30 age- and gender-matched peers without DS. The feet of boys with DS are flatter compared to their healthy peers. The hallux valgus angle is not the most important feature differentiating the shape of the foot in the boys with DS and their healthy peers. In terms of the V toe setting, healthy boys had poorer results. Specialized therapeutic treatment in individuals with DS should involve exercises to increase the muscle strength around the foot joints, enhancing the stabilization in the joints and proprioception. Introducing orthotics and proper footwear is also important. It is also necessary to monitor the state of the foot in order to modify undertaken therapies.

A comparison of the readability of two patient-reported outcome measures used to evaluate foot surgery.

PubMed

Alvey, James; Palmer, Simon; Otter, Simon

2012-01-01

Measuring the outcome of surgical intervention is an integral part of modern-day healthcare provision. The increasing requirement to monitor patient-reported outcomes highlights the need for patients to be able to read and understand health outcomes questionnaires. The present study compared the readability of 2 commonly used, validated, foot surgery outcome questionnaires (the Foot Health Status Questionnaire and the Manchester-Oxford Foot Questionnaire) using the Flesch Reading Ease score and the Flesch-Kincaid grade level score. The Manchester-Oxford Foot Questionnaire had a significantly greater (p < .003) score for reading ease and a significantly lower reading grade score (p < .005) than the Foot Health Status Questionnaire. These findings suggest the Manchester-Oxford Foot Questionnaire is a more suitable instrument in terms of readability and comprehension for a greater proportion of the population undergoing hallux valgus surgery. Copyright © 2012 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

The metatarsosesamoid joint: an in vitro 3D quantitative assessment.

PubMed

Jamal, Bilal; Pillai, Anand; Fogg, Quentin; Kumar, Senthil

2015-03-01

The anatomy of the first metatarsophalangeal (MTP) joint, particularly the metatarsosesamoid articulation, remains poorly understood. Our goal was to quantitatively define the excursion of the sesamoids. Seven cadavers were dissected to assess the articulating surfaces throughout a normal range of motion. The dissections were digitally reconstructed in various positions using a MicroScribe. For first MTP joint, excursion averaged 14.7mm for the tibial sesamoid in the sagittal plane and 7.5mm for the fibular sesamoid. The sesamoids also moved medially to laterally when the joint was dorsiflexed. For the maximally dorsiflexed joint, excursion averaged 2.8mm for the tibial sesamoid and 3.5mm for the fibular sesamoid. Hallucal sesamoids appear to have differential tracking: the tibial sesamoid has greater longitudinal excursion; the fibular sesamoid has greater lateral excursion. The anatomical data will interest those involved with the design of an effective hallux arthroplasty. Copyright © 2014 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.

Effects of footwear on plantar foot sensitivity: a study with Formula 1 shoes.

PubMed

Schlee, Günther; Sterzing, Thorsten; Milani, Thomas L

2009-05-01

The aim of this study was to investigate the influence of Formula 1 footwear on the ability of the plantar foot to detect vibration stimuli. Twenty-five male subjects participated in the study. Five foot/shoe conditions were analysed (barefoot and four shoe conditions). Vibration thresholds were measured at three anatomical locations of the plantar foot (heel, first metatarsal head and hallux) at two frequencies (30 and 200 Hz). The results show a frequency-dependent influence of footwear on foot sensitivity. The comparison between barefoot and shod conditions showed lower thresholds (P < 0.01) for the barefoot condition at 30 Hz, whereas lower thresholds (P < 0.01) were found for all shoe conditions at 200 Hz compared to barefoot. Lower thresholds (P < 0.01) were measured at 200 Hz in comparison to 30 Hz in all experimental conditions. The shoe outsole material seems to facilitate the transmission of high-frequent vibration stimuli to the skin, resulting in better vibration sensitivity at 200 Hz when wearing Formula 1 shoes compared to barefoot.

Reliability, validity and responsiveness of the Spanish Manchester-Oxford Foot Questionnaire (MOXFQ) in patients with foot or ankle surgery.

PubMed

Garcés, Juan B Gerstner; Winson, Ian; Goldhahn, Sabine; Castro, Michael D; Swords, Michael P; Grujic, Leslie; Rammelt, Stefan; Sands, Andrew K

2016-03-01

The Manchester-Oxford Foot Questionnaire (MOXFQ) has been validated in Spanish for use in patients undergoing foot and ankle surgery. 120 patients completed the MOXFQ and the SF-36 before surgery and 6 and 12 months postoperative. Surgeons completed the American Orthopaedic Foot and Ankle Society (AOFAS) Clinical Rating System. Psychometric properties were assessed for all three MOXFQ dimensions, and for the MOXFQ Index. The Spanish MOXFQ demonstrated consistency with Cronbach's alpha values between 0.65 and 0.90, and reliability ([ICCs] >0.95). It shows a moderate to strong correlation between the Walking/standing dimension and the related domains of the SF-36 (|r|>0.6), the AOFAS Ankle-Hindfoot Scale (|r|>0.47) and Hallux-MTP-IP Scale (|r|>0.64). Responsiveness was excellent, (effect sizes >2.1). The respective minimal detectable change (MDC90) was 14.18 for the MOXFQ Index. The Spanish version of the MOXFQ showed good psychometric properties in patients with foot and ankle disorders. Copyright © 2015 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.

Foot Structure in Boys with Down Syndrome

PubMed Central

Nowak, Krzysztof; Omorczyk, Jarosław; Ambroży, Tadeusz; Nosiadek, Leszek

2017-01-01

Introduction and Aim Down syndrome (DS) is associated with numerous developmental abnormalities, some of which cause dysfunctions of the posture and the locomotor system. The analysis of selected features of the foot structure in boys with DS versus their peers without developmental disorders is done. Materials and Methods The podoscopic examination was performed on 30 boys with DS aged 14-15 years. A control group consisted of 30 age- and gender-matched peers without DS. Results The feet of boys with DS are flatter compared to their healthy peers. The hallux valgus angle is not the most important feature differentiating the shape of the foot in the boys with DS and their healthy peers. In terms of the V toe setting, healthy boys had poorer results. Conclusions Specialized therapeutic treatment in individuals with DS should involve exercises to increase the muscle strength around the foot joints, enhancing the stabilization in the joints and proprioception. Introducing orthotics and proper footwear is also important. It is also necessary to monitor the state of the foot in order to modify undertaken therapies. PMID:28904967

Scarf versus chevron osteotomy for the correction of 1-2 intermetatarsal angle in hallux valgus: a systematic review and meta-analysis.

PubMed

Smith, Simon E; Landorf, Karl B; Butterworth, Paul A; Menz, Hylton B

2012-01-01

The chevron and scarf osteotomies are commonly used for the surgical management of hallux valgus (HV). However, there is debate as to whether one osteotomy provides more 1-2 intermetatarsal (1-2 IMA) correction than the other. The objective of this systematic review and meta-analysis was to compare the effectiveness of 3 types of first metatarsal osteotomy for reducing the 1-2 IMA in HV correction: the chevron osteotomy, the long plantar arm (modified) chevron osteotomy, and the scarf osteotomy. A systematic search for eligible studies was performed of the following databases: Medline, Embase (Ovid), CINAHL (EBSCO Host), and The Cochrane Database of Systematic Reviews and Cochrane Central Register of Controlled Clinical Trials. Only English-language studies previous to May 2010 were included in the review. Additional hand and electronic content searches of relevant foot and orthopaedic journals were performed. Criteria for inclusion in this analysis included systematic reviews of randomized controlled trials, prospective and retrospective cohort studies, and case-control studies, as well as case-series studies involving the chevron, scarf, or long plantar arm chevron osteotomy of >20 participants with a minimum of 80% follow-up. Quality of evidence of the included studies was assessed with the Grading of Recommendations Assessment, Development and Evaluation system. All pooled analyses were based on a fixed effects model. There was a total of 1351 participants who underwent either a chevron (n = 1028), scarf (n = 300), or long plantar arm chevron osteotomy (n = 23). Only one study for the long plantar arm chevron group fitted the eligibility criteria for this review; however, it was not amenable to meta-analysis. The chevron osteotomy was associated with a mean reduction of 1-2 IMA from preoperative to postoperative of 5.33° (95% confidence interval, 5.12 to 5.54, p < .001), and the scarf osteotomy was associated with a mean reduction of 6.21° (95% confidence interval, 5.70 to 6.72, p < .001). There was a statistically significant 0.88° increase in the correction of the 1-2 IMA in favor of the scarf osteotomy compared with the chevron osteotomy. The studies included in this review were of very low- to low-quality evidence. Our findings indicate that the scarf osteotomy provides greater correction of the 1-2 IMA when used for HV correction. However, only a weak recommendation in favor of the scarf osteotomy can be made based on the low quality of evidence of the studies included in this analysis. Copyright © 2012 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

Characteristics of Plantar Loads During Walking in Patients with Knee Osteoarthritis.

PubMed

Zhang, Zhiwang; Wang, Lin; Hu, Kaijun; Liu, Yu

2017-12-01

BACKGROUND Knee osteoarthritis (KOA) is a common disease that can change the load on lower limbs during walking. Plantar loads in patients with KOA may provide a basis for clinical decisions regarding footwear and foot orthoses. This study aimed to compare plantar loads in females with and without KOA during gait. MATERIAL AND METHODS Plantar pressure during walking was recorded in 23 females with KOA and 23 females without KOA. Maximum force (MF), contact area (CA), and peak pressure (PP) were measured at 7 different regions underneath the foot, named heel (M1), midfoot (M2), first metatarsophalangeal joint (MPJ) (M3), second MPJ (M4), third to fifth MPJ (M5), hallux (M6), and lesser toes (M7). RESULTS PPs for M2 and (M3) in females with KOA were higher than those in females without KOA. High PPs were also found in females with KOA for M2, M3, and M4. CONCLUSIONS Increased plantar loading in females with KOA may lead to foot pronation and gait changes during walking. Plantar loading may be offered to patients with KOA when considering footwear and foot orthoses.

Comorbidity between HTLV-1-associated adult T-cell lymphoma/leukemia and verrucous carcinoma: a case report

PubMed Central

Moreno, Luis

2017-01-01

Abstract Background: Adult T-cell Leukemia/Lymphoma (ATLL) is classified as a peripheral CD4+ T-cell neoplasm caused by the human T-cell lymphotropic virus type 1 (HTLV-1). Typical symptoms are associated with leukemic infiltration; however, atypical and exaggerated manifestations of verrucous carcinoma have also been described. Case report: We present here the case of a patient with multiple skin lesions, ischemic necrosis in the hallux and lymphadenopathies. Biopsies were taken, which showed verrucous epidermal carcinoma and cutaneous lymphoma. Splenomegaly and adenopathy in mesentery, retro peritoneum and lymph node chains in the limbs were observed. Bone marrow examination showed findings compatible with T-cell leukemia/lymphoma; and it was ELISA positive for HTLV-1/2. Treatment and outcome: The patient had a good initial response to a CHOP scheme (cyclophosphamide, doxorubicin, vincristine and prednisone) with filgrastim. However, the patient had a relapse and died before the second cycle. Clinical relevance: Comorbidity could lead to the associated risk factors model. According to this model, secondary immunodeficiency caused by HTLV-1 may induce the development of verrucous carcinomas; alternatively, the disease could be due to a correlation between HTLV-1 and the human papillomavirus (HPV). PMID:28559645

Three saints with deformed extremities in an Italian Renaissance altarpiece.

PubMed

Albury, W R; Weisz, G M

2017-03-01

A fifteenth-century Florentine altarpiece painted by the Pollaiuolo brothers, Antonio (1433-1498) and Piero (1443-1496), shows three saints with evident deformities of the hands and feet. The pathologies concerned are tentatively identified, and various rationales for their presence in the painting are discussed. Of particular importance is the location of the altarpiece in a chapel which houses the tomb of the Cardinal of Portugal, Prince James of Lusitania (1433-1459). It is argued that both the artistic style of the day and the religious symbolism of the Cardinal's funeral chapel contributed to the artists' decision to portray the saints with deformities. An unnatural curvature of the fifth finger was apparently considered elegant in fifteenth-century paintings, and the depiction of bare feet with hallux valgus gave them a shape which approximated and could have been caused by fashionable pointed shoes. But in addition, deformities in religious art could be symbolic of suffering and martyrdom, a theme which the Cardinal's chapel emphasised in a number of ways. It is suggested therefore that the Pollaiuolo altarpiece reconciles these two disparate factors, portraying genuine deformities in a way that was artistically stylish and symbolically meaningful.

Foot and ankle risk factors for falls in older people: a prospective study.

PubMed

Menz, Hylton B; Morris, Meg E; Lord, Stephen R

2006-08-01

Foot problems are common in older people and are associated with impaired balance and functional ability. Few prospective studies, however, have been undertaken to determine whether foot problems are a risk factor for falls. One hundred seventy-six people (56 men and 120 women, mean age 80.1, standard deviation 6.4 years) residing in a retirement village underwent tests of foot and ankle characteristics (including foot posture, range of motion, strength, and deformity) and physiological falls risk factors (including vision, sensation, strength, reaction time, and balance) and were followed for 12 months to determine the incidence of falls. Seventy-one participants (41%) reported falling during the follow-up period. Compared to those who did not fall, fallers exhibited decreased ankle flexibility, more severe hallux valgus deformity, decreased plantar tactile sensitivity, and decreased toe plantarflexor strength; they were also more likely to have disabling foot pain. Discriminant function analysis revealed that decreased toe plantarflexor strength and disabling foot pain were significantly and independently associated with falls after accounting for physiological falls risk factors and age. Foot and ankle problems increase the risk of falls in older people. Interventions to address these factors may hold some promise as a falls prevention strategy.

Identification, antifungal susceptibility and scanning electron microscopy of a keratinolytic strain of Rhodotorula mucilaginosa: a primary causative agent of onychomycosis.

PubMed

da Cunha, Marcel M L; dos Santos, Luana P B; Dornelas-Ribeiro, Marcos; Vermelho, Alane B; Rozental, Sonia

2009-04-01

Onychomycosis is a dermatological problem of high prevalence that mainly affects the hallux toenail. Onychomycosis caused by the yeast Rhodotorula mucilaginosa was identified using colony morphology, light microscopy, urease and carbohydrate metabolism in a 57-year-old immunocompetent patient from Rio de Janeiro, Brazil. High-resolution scanning electron microscopy of nail fragments, processed by a noncoating method, led to the observation with fine detail of the structures of both nail and fungus involved in the infection. Yeasts were mainly found inside grooves in the nail. Budding yeasts presented a spiral pattern of growth and blastoconidia were found in the nail groove region. Keratinase assays and keratin enzymography revealed that this isolate was highly capable of degrading keratin. Antifungal susceptibility tests showed that the fungus was susceptible to low concentrations of amphotericin B and 5-flucytosine and resistant to high concentrations of fluconazole, itraconazole, voriconazole and terbinafine. These findings showed data for the first time concerning the interaction of R. mucilaginosa in toenail infection and suggest that this emerging yeast should also be considered an opportunistic primary causative agent of onychomycosis.

Performance of mycology and histopathology tests for the diagnosis of toenail onychomycosis due to filamentous fungi: Dermatophyte and non-dermatophyte moulds.

PubMed

Lavorato, Fernanda G; Guimarães, Dávson A; Premazzi, Mario G; Piñeiro-Maceira, Juan M; Bernardes-Engemann, Andréa R; Orofino-Costa, Rosane

2017-09-01

Improvement of laboratory diagnosis of onychomychosis is important so that adequate treatment can be safely implemented. To evaluate and compare the performance of mycological and histopathological examinations in onychomycoses caused by dermatophyte and non-dermatophyte moulds. Patients with lateral/distal subungual onychomycosis in at least one hallux were enrolled in the protocol and assessed via mycological and histopathological tests. The isolation of filamentous fungi was considered the gold standard. Test performance was evaluated through sensitivity, specificity and positive and negative predictive values. A total of 212 patients were enrolled in the study. Direct microscopy (DM) was positive in 57.5% patients, and cultures in 34.4%. Among these patients, 23.3% were positive for dermatophytes, with Trichophyton rubrum the most frequently isolated, and 86.3% were positive for non-dermatophytes, with Neoscytalidium dimidiatum predominance. Histopathology was positive in 41.0% samples. Direct microscopy showed better sensitivity for non-dermatophyte moulds (P=.000) and nail clipping was more specific for dermatophyte (P=.018). Histopathology of the distal nail plate is a valuable complementary tool for the diagnosis of onychomycosis caused by dermatophytes and direct microscopy is especially useful for non-dermatophyte molds. © 2017 Blackwell Verlag GmbH.

Analysis of a kinetic multi-segment foot model. Part I: Model repeatability and kinematic validity.

PubMed

Bruening, Dustin A; Cooney, Kevin M; Buczek, Frank L

2012-04-01

Kinematic multi-segment foot models are still evolving, but have seen increased use in clinical and research settings. The addition of kinetics may increase knowledge of foot and ankle function as well as influence multi-segment foot model evolution; however, previous kinetic models are too complex for clinical use. In this study we present a three-segment kinetic foot model and thorough evaluation of model performance during normal gait. In this first of two companion papers, model reference frames and joint centers are analyzed for repeatability, joint translations are measured, segment rigidity characterized, and sample joint angles presented. Within-tester and between-tester repeatability were first assessed using 10 healthy pediatric participants, while kinematic parameters were subsequently measured on 17 additional healthy pediatric participants. Repeatability errors were generally low for all sagittal plane measures as well as transverse plane Hindfoot and Forefoot segments (median<3°), while the least repeatable orientations were the Hindfoot coronal plane and Hallux transverse plane. Joint translations were generally less than 2mm in any one direction, while segment rigidity analysis suggested rigid body behavior for the Shank and Hindfoot, with the Forefoot violating the rigid body assumptions in terminal stance/pre-swing. Joint excursions were consistent with previously published studies. Copyright © 2012 Elsevier B.V. All rights reserved.

Prevalence of podiatric conditions seen in Special Olympics athletes: a comparison of USA data to an international population.

PubMed

Jenkins, David W; Cooper, Kimbal; Heigh, Evelyn G

2015-03-01

Persons with intellectual disabilities frequently have podiatric conditions. Limited information exists on their prevalence in international cohorts of Special Olympics (SO) athletes. Findings from multiple United States (US) venues are compared to those from athletes screened at the 2011 Special Olympics World Summer Games in Athens, Greece (ATHENS). Data from Fit Feet screenings from 2096 ATHENS participants was compared to 7192 US participants. Frequently noted in the ATHENS population were motion restriction in both the ankle and the first metatarsal phalangeal joint (1st MTPJ), pes planus, metatarsus adductus, brachymetatarsia, hallux abducto valgus (HAV), onychomycosis, onychocryptosis, and tinea pedis. ATHENS differed from the US cohort as HAV and restricted ankle joint and 1st MTPJ joint motion was less frequent. Significantly more tinea pedis, xerosis, and hyperhidrosis were present in the ATHENS population. SO athletes have a higher prevalence of podiatric structural conditions compared to the general population, and some vary between ATHENS versus US. Less prevalent in ATHENS was HAV, and restricted motion in both the ankle and 1st MTPJ. This may reflect differences due to varied clinical observers. The higher rates of several dermatological conditions in ATHENS may reflect venue seasonal climate, or social factors. Copyright © 2014 Elsevier Ltd. All rights reserved.

A mechanical model of metatarsal stress fracture during distance running.

PubMed

Gross, T S; Bunch, R P

1989-01-01

A model of metatarsal mechanics has been proposed as a link between the high incidence of second and third metatarsal stress fractures and the large stresses measured beneath the second and third metatarsal heads during distance running. Eight discrete piezoelectric vertical stress transducers were used to record the forefoot stresses of 21 male distance runners. Based upon load bearing area estimates derived from footprints, plantar forces were estimated. Highest force was estimated beneath the second and first metatarsal head (341.1 N and 279.1 N, respectively). Considering the toe as a hinged cantilever and the metatarsal as a proximally attached rigid cantilever allowed estimation of metatarsal midshaft bending strain, shear, and axial forces. Bending strain was estimated to be greatest in the second metatarsal (6662 mu epsilon), a value 6.9 times greater than estimated first metatarsal strain. Predicted third, fourth, and fifth metatarsal strains ranged between 4832 and 5241 mu epsilon. Shear force estimates were also greatest in the second metatarsal (203.0 N). Axial forces were highest in the first metatarsal (593.2 N) due to large hallux forces in relationship to the remaining toes. Although a first order model, these data highlight the structural demands placed upon the second metatarsal, a location of high metatarsal stress fracture incidence during distance running.

Constitutional Mosaic Trisomy 13 in Two Germ Cell Layers is Different from Patau Syndrome? A Case Report.

PubMed

Kunwar, Fulesh; Pandya, Vidhi; Bakshi, Sonal R

2016-03-01

The heterogeneous phenotype of known syndromes is a clinical challenge, and harmonized description using globally accepted ontology is desirable. This report attempts phenotypic analysis in a patient of constitutional mosaic trisomy 13 in mesoderm and ectoderm to make globally comparable clinical description. Phenotypic features (minor/major abnormalities) were recorded and matched with the Human Phenotype Ontology terms that were used to query web-based tool Phenomizer. We report here a case of 24-year-old girl born to non consanguineous parents with history of one abortion. Her phenotypic evaluation included short columella, low-set ears, seizures, enlarged naris, bifid tongue, infra-orbital fold, smooth philtrum, microtia, microcephaly, carious teeth, downslanted palpebral fissures, proportionate short stature, high palate, thin upper lip vermilion, small for gestational age, broad fingertip, broad hallux, mandibular prognathia and dental malocclusion. Karyotype and interphase FISH (Fluorescence in situ hybridization) was done in blood cells. Interphase FISH was also performed on buccal epithelial cells. Cytogenetic analysis demonstrated trisomy 13 mosaicism in 25% cells i.e. 47, XX,+13(9)/46,XX(27). The interphase FISH in blood cells showed trisomy 13 in 15%, whereas in buccal mucosa cells showed nearly 6%. Mosaic aneuploidy in constitutional karyotype can be responsible for variation in clinical and morphological presentation of patient with genetic disorder.

First metatarsophalangeal joint arthrodesis: an evaluation of hardware failure.

PubMed

Bennett, Gordon L; Kay, David B; Sabatta, James

2005-08-01

First metatarsophalangeal joint (MTPJ) arthrodesis is commonly used for the treatment of a variety of conditions affecting the hallux. We used a method incorporating a ball-and-cup preparation of the first metatarsal and proximal phalanx, followed by fixation of the arthrodesis with a lag screw and a dorsal plate (Synthes Modular Hand Set). Ninety-five consecutive patients had first MTPJ arthrodesis using fixation with the Synthes Modular Hand Set. All patients were evaluated preoperatively, at regular intervals postoperatively, and at final followup. The American Orthopaedic Foot and Ankle Society (AOFAS) forefoot scoring system was used preoperatively and at final followup. Solid fusion occurred in 93 of 107 feet (86.9%). In the 14 that did not fuse, either the screws or plate, or both, broke. Ten of the 14 feet were symptomatic, but only three required further operative treatment. There were no hardware problems or failures in patients who had solid fusions. Preoperative AOFAS scores were improved after surgery in all patients. A solid first MTPJ fusion results in excellent function and pain relief, but the Synthes Modular Hand Set implants do not appear to be strong enough in all patients for this application; nonunion at the arthrodesis site and failure of hardware occurred in 13% of arthrodeses. We no longer recommend this implant for this application.

Ergonomic footwear for Sri Lankan primary schoolchildren: A review of the literature.

PubMed

Hettigama, I S; Punchihewa, H K G; Heenkenda, N K

2016-10-17

Foot ailments are common among schoolchildren, some of which may be attributed to wearing ill-fitting footwear. As schoolchildren often participate in athletic activity, they are doubly vulnerable to foot ailments, and are particularly vulnerable to conditions such as hallux valgus, Achilles tendonitis, athlete's foot, corns and calluses. Thus, there is an acute need for the design and manufacture of ergonomic footwear for this target group. While research on appropriate footwear for children has been carried out in relation to child populations in other societies, research on the circumstances of Sri Lankan schoolchildren is lacking. Neither the requisite design know-how nor the information for design is available to footwear manufacturers. This review of the literature is aimed at confirming the need for ergonomic footwear from the point of view of the effects of wearing ill-fitting shoes and at identifying the requirements in terms of design information, especially for schoolchildren of the age group five to ten years, to empower footwear manufacturers. PubMed, Google scholar and Science Direct were used for the literature search. 208 publications were read in full, 94 of which are referenced in this review. The review shows morphological measurements, behavior and activity patterns of schoolchildren and environmental conditions they are exposed to should be determined to formulate design information.

Analysis of Msx1; Msx2 double mutants reveals multiple roles for Msx genes in limb development.

PubMed

Lallemand, Yvan; Nicola, Marie-Anne; Ramos, Casto; Bach, Antoine; Cloment, Cécile Saint; Robert, Benoît

2005-07-01

The homeobox-containing genes Msx1 and Msx2 are highly expressed in the limb field from the earliest stages of limb formation and, subsequently, in both the apical ectodermal ridge and underlying mesenchyme. However, mice homozygous for a null mutation in either Msx1 or Msx2 do not display abnormalities in limb development. By contrast, Msx1; Msx2 double mutants exhibit a severe limb phenotype. Our analysis indicates that these genes play a role in crucial processes during limb morphogenesis along all three axes. Double mutant limbs are shorter and lack anterior skeletal elements (radius/tibia, thumb/hallux). Gene expression analysis confirms that there is no formation of regions with anterior identity. This correlates with the absence of dorsoventral boundary specification in the anterior ectoderm, which precludes apical ectodermal ridge formation anteriorly. As a result, anterior mesenchyme is not maintained, leading to oligodactyly. Paradoxically, polydactyly is also frequent and appears to be associated with extended Fgf activity in the apical ectodermal ridge, which is maintained up to 14.5 dpc. This results in a major outgrowth of the mesenchyme anteriorly, which nevertheless maintains a posterior identity, and leads to formation of extra digits. These defects are interpreted in the context of an impairment of Bmp signalling.

Kaufman oculo-cerebro-facial syndrome in a child with small and absent terminal phalanges and absent nails.

PubMed

Kariminejad, Ariana; Ajeawung, Norbert Fonya; Bozorgmehr, Bita; Dionne-Laporte, Alexandre; Molidperee, Sirinart; Najafi, Kimia; Gibbs, Richard A; Lee, Brendan H; Hennekam, Raoul C; Campeau, Philippe M

2017-04-01

Kaufman oculo-cerebro-facial syndrome (KOS) is caused by recessive UBE3B mutations and presents with microcephaly, ocular abnormalities, distinctive facial morphology, low cholesterol levels and intellectual disability. We describe a child with microcephaly, brachycephaly, hearing loss, ptosis, blepharophimosis, hypertelorism, cleft palate, multiple renal cysts, absent nails, small or absent terminal phalanges, absent speech and intellectual disability. Syndromes that were initially considered include DOORS syndrome, Coffin-Siris syndrome and Dubowitz syndrome. Clinical investigations coupled with karyotype analysis, array-comparative genomic hybridization, exome and Sanger sequencing were performed to characterize the condition in this child. Sanger sequencing was negative for the DOORS syndrome gene TBC1D24 but exome sequencing identified a homozygous deletion in UBE3B (NM_183415:c.3139_3141del, p.1047_1047del) located within the terminal portion of the HECT domain. This finding coupled with the presence of characteristic features such as brachycephaly, ptosis, blepharophimosis, hypertelorism, short palpebral fissures, cleft palate and developmental delay allowed us to make a diagnosis of KOS. In conclusion, our findings highlight the importance of considering KOS as a differential diagnosis for patients under evaluation for DOORS syndrome and expand the phenotype of KOS to include small or absent terminal phalanges, nails, and the presence of hallux varus and multicystic dysplastic kidneys.

A comparison of results from two mycology laboratories for the diagnosis of onychomycosis: a study of 85 cases in a geriatric population.

PubMed

Scherer, William P; Scherer, Michael D

2004-01-01

An investigative study was performed to compare the results from two mycology laboratories for the diagnosis of onychomycosis in a geriatric population and to determine the possible pharmacologic treatments based on the two laboratories' results. In this study, 85 cases of suspected onychomycosis involving men and women 65 years and older from a nursing home setting in South Florida were used. Samples were taken from the hallux toenail and sent to two different mycology laboratories for fluorescent potassium hydroxide preparation and microscopic examination of a fungal culture. Of the 85 cases studied, the two mycology laboratories reported similar potassium hydroxide preparation results for 58.8% of the patients and similar fungal culture results for genus and species identification for 37.6% of the patients. When the potassium hydroxide preparation and fungal culture results were combined, the two mycology laboratories reported similar results for only 27.1% of the patients. As a result of the two mycology laboratories' findings, the possible US Food and Drug Administration-approved pharmacologic treatments may differ for 43.5% of the patients studied. The discrepancy between the two independent laboratories leaves physicians to question the reproducibility of fluorescent potassium hydroxide preparation and fungal culture analysis in a geriatric patient population for the diagnosis of onychomycosis.

Energy neutral: the human foot and ankle subsections combine to produce near zero net mechanical work during walking.

PubMed

Takahashi, Kota Z; Worster, Kate; Bruening, Dustin A

2017-11-13

The human foot and ankle system is equipped with structures that can produce mechanical work through elastic (e.g., Achilles tendon, plantar fascia) or viscoelastic (e.g., heel pad) mechanisms, or by active muscle contractions. Yet, quantifying the work distribution among various subsections of the foot and ankle can be difficult, in large part due to a lack of objective methods for partitioning the forces acting underneath the stance foot. In this study, we deconstructed the mechanical work production during barefoot walking in a segment-by-segment manner (hallux, forefoot, hindfoot, and shank). This was accomplished by isolating the forces acting within each foot segment through controlling the placement of the participants' foot as it contacted a ground-mounted force platform. Combined with an analysis that incorporated non-rigid mechanics, we quantified the total work production distal to each of the four isolated segments. We found that various subsections within the foot and ankle showed disparate work distribution, particularly within structures distal to the hindfoot. When accounting for all sources of positive and negative work distal to the shank (i.e., ankle joint and all foot structures), these structures resembled an energy-neutral system that produced net mechanical work close to zero (-0.012 ± 0.054 J/kg).

Comparative morphology among northern populations of breeding Cooper's Hawks

USGS Publications Warehouse

Rosenfield, Robert N.; Rosenfield, Laura J.; Bielefeldt, John; Murphy, Robert K.; Stewart, Andrew C.; Stout, William E.; Driscoll, Timothy G.; Bozek, Michael A.

2010-01-01

Few studies at a broad geographical scale have characterized intraspecific variation in morphology of woodland hawks in the genus Accipiter. From 1999 to 2007 we investigated morphological variation in large samples of live Cooper's Hawks (A. cooperii) nesting in four study areas: coniferous woodland around Victoria, British Columbia, Canada, isolated deciduous woodlands in short-grass prairies of northwestern North Dakota, towns and rural deciduous woodlands along the border of North Dakota and Minnesota, and urban and rural mixed deciduous and coniferous landscapes of Wisconsin. These sites span 2660 km across the northern part of the species' breeding range. We measured body mass (i.e., size), wing chord, tail length, tarsus diameter, hallux length, and culmen length of breeding adults, finding significant and clinal variation in body mass (or size). The smallest and most similar-sized birds occurred in British Columbia and western North Dakota, larger birds along the border between North Dakota and Minnesota, and the largest birds in Wisconsin. Several other characters varied significantly when mass was used as a covariate. Variation by study site in mean indices of sexual size dimorphism was negligible and not significant. We speculate that the morphological differences we found, in part, are the result of geographic isolation, where diets, migratory behavior, and structural characteristics of nesting habitats vary across landscape types.

Treatment of onychomycosis using a 1064nm Nd:YAG laser.

PubMed

Noguchi, Hiromitsu; Miyata, Keishi; Sugita, Takashi; Hiruma, Midori; Hiruma, Masataro

2013-01-01

We investigated the efficacy of 1064nm Nd:YAG laser for the treatment of onychomycosis caused by dermatophytes. The study population consisted of 12 patients (6 male, 6 female ; average age 53.5 years), with onychomycosis confirmed by fungal culture and/or real-time PCR identification of the pathogen. The causative agent was identified as Trichophyton rubrum in 11 cases and a mixture of T. rubrum and T. mentagrophytes in 1 case. For each patient, laser treatment was given to a single hallux nail, with turbidity at baseline affecting <75% of the nail surface and thickness at baseline <3mm. Treatment was given in 3 sessions at 4-week intervals, and nail turbidity was evaluated 3 and 6 months after the first laser treatment. After 6 months the efficacy results were as follows: 3 cases, turbidity significantly improved ( >70%) ; 2 cases, turbidity improved (50-70%), 1 case, turbidity slightly improved (30-50%) ; 5 cases, no change in turbidity (<30% improvement) ; and 1 case, turbidity worsened. Overall, the total lesion area with turbidity in 12 patients decreased from 664.4mm(2) to 481.0mm(2), corresponding to a 27.6% improvement after treatment. Pain during laser treatment was well tolerated, and all patients underwent all 3 treatments. These results suggest that the 1064nm Nd:YAG laser could be a useful treatment alternative for patients with mild onychomycosis.

Estimation of foot pressure from human footprint depths using 3D scanner

NASA Astrophysics Data System (ADS)

Wibowo, Dwi Basuki; Haryadi, Gunawan Dwi; Priambodo, Agus

2016-03-01

The analysis of normal and pathological variation in human foot morphology is central to several biomedical disciplines, including orthopedics, orthotic design, sports sciences, and physical anthropology, and it is also important for efficient footwear design. A classic and frequently used approach to study foot morphology is analysis of the footprint shape and footprint depth. Footprints are relatively easy to produce and to measure, and they can be preserved naturally in different soils. In this study, we need to correlate footprint depth with corresponding foot pressure of individual using 3D scanner. Several approaches are used for modeling and estimating footprint depths and foot pressures. The deepest footprint point is calculated from z max coordinate-z min coordinate and the average of foot pressure is calculated from GRF divided to foot area contact and identical with the average of footprint depth. Evaluation of footprint depth was found from importing 3D scanner file (dxf) in AutoCAD, the z-coordinates than sorted from the highest to the lowest value using Microsoft Excel to make footprinting depth in difference color. This research is only qualitatif study because doesn't use foot pressure device as comparator, and resulting the maximum pressure on calceneus is 3.02 N/cm2, lateral arch is 3.66 N/cm2, and metatarsal and hallux is 3.68 N/cm2.

Kinematic repeatability of a multi-segment foot model for dance.

PubMed

Carter, Sarah L; Sato, Nahoko; Hopper, Luke S

2018-03-01

The purpose of this study was to determine the intra and inter-assessor repeatability of a modified Rizzoli Foot Model for analysing the foot kinematics of ballet dancers. Six university-level ballet dancers performed the movements; parallel stance, turnout plié, turnout stance, turnout rise and flex-point-flex. The three-dimensional (3D) position of individual reflective markers and marker triads was used to model the movement of the dancers' tibia, entire foot, hindfoot, midfoot, forefoot and hallux. Intra and inter-assessor reliability demonstrated excellent (ICC ≥ 0.75) repeatability for the first metatarsophalangeal joint in the sagittal plane. Intra-assessor reliability demonstrated excellent (ICC ≥ 0.75) repeatability during flex-point-flex across all inter-segmental angles except for the tibia-hindfoot and hindfoot-midfoot frontal planes. Inter-assessor repeatability ranged from poor to excellent (0.5 > ICC ≥ 0.75) for the 3D segment rotations. The most repeatable measure was the tibia-foot dorsiflexion/plantar flexion articulation whereas the least repeatable measure was the hindfoot-midfoot adduction/abduction articulation. The variation found in the inter-assessor results is likely due to inconsistencies in marker placement. This 3D dance specific multi-segment foot model provides insight into which kinematic measures can be reliably used to ascertain in vivo technical errors and/or biomechanical abnormalities in a dancer's foot motion.

Clinical comparison and complete cure rates of Terbinafine efficacy in affected onychomycotic toenails.

PubMed

Shemer, A; Sakka, N; Baran, R; Scher, R; Amichai, B; Norman, L; Farhi, R; Magun, R; Brazilai, A; Daniel, R

2015-03-01

Clinical studies regarding complete cure rate of onychomycosis using oral Terbinafine have a very broad range (14-90%) based solely on response to treatment on the big toenail. To evaluate the efficacy of Terbinafine in all affected onychomycotic toenails and, furthermore, to evaluate differences in mycological, clinical and complete cure rate between affected onychomycotic toenails. Inclusion criteria are as follows: distolateralsubungual onychomycotic involvement of the hallux and additional involvement of at least two more toenails of the same foot. Exclusion criteria are as follows: patients with nail traumata and hypersensitivity to Terbinafine. Patients were treated with oral Terbinafine 250 mg/day for 16 weeks. Mycological analysis was performed using direct microscopy and culture. Clinical improvement was assessed using digital photography. Statistically significant difference was found in clinical improvement between the great toenail and all other involved toenails. The rate of complete cure (100% clinical cure and mycological cure) of the big toenail was lower (23%) as compared to the second (65%), third (51%) and the fourth toenail (67%). This is a case series study that was based on a single-centre cohort. Our results support findings that efficacy of Terbinafine should be based on all involved onychomycotic toenails; the big toenail is not superior in response compared to other affected toenails. © 2014 European Academy of Dermatology and Venereology.

The Quasi-Linear Viscoelastic Properties of Diabetic and Non-Diabetic Plantar Soft Tissue

PubMed Central

Pai, Shruti; Ledoux, William R.

2011-01-01

The purpose of this study was to characterize the viscoelastic behavior of diabetic and non-diabetic plantar soft tissue at six ulcer-prone/load-bearing locations beneath the foot to determine any changes that may play a role in diabetic ulcer formation and subsequent amputation in this predisposed population. Four older diabetic and four control fresh frozen cadaveric feet were each dissected to isolate plantar tissue specimens from the hallux, first, third, and fifth metatarsals, lateral midfoot, and calcaneus. Stress relaxation experiments were used to quantify the viscoelastic tissue properties by fitting the data to the quasi-linear viscoelastic (QLV) theory using two methods, a traditional frequency-insensitive approach and an indirect frequency-sensitive approach, and by measuring several additional parameters from the raw data including the rate and amount of overall relaxation. The stress relaxation response of both diabetic and non-diabetic specimens was unexpectedly similar and accordingly few of the QLV parameters for either fit approach and none of raw data parameters differed. Likewise, no differences were found between plantar locations. The accuracy of both fit methods was comparable, however, neither approach predicted the ramp behavior. Further, fit coefficients varied considerably from one method to the other, making it hard to discern meaningful trends. Future testing using alternate loading modes and intact feet may provide more insight into the role that time-dependent properties play in diabetic foot ulceration. PMID:21327701

The influence of tennis court surfaces on player perceptions and biomechanical response.

PubMed

Starbuck, Chelsea; Damm, Loïc; Clarke, James; Carré, Matt; Capel-Davis, Jamie; Miller, Stuart; Stiles, Victoria; Dixon, Sharon

2016-09-01

This study aimed to examine player perceptions and biomechanical responses to tennis surfaces and to evaluate the influence of prior clay court experience. Two groups with different clay experiences (experience group, n = 5 and low-experience group, n = 5) performed a 180° turning movement. Three-dimensional ankle and knee movements (50 Hz), plantar pressure of the turning step (100 Hz) and perception data (visual analogue scale questionnaire) were collected for two tennis courts (acrylic and clay). Greater initial knee flexion (acrylic 20. 8 ± 11.2° and clay 32.5 ± 9.4°) and a more upright position were reported on the clay compared to the acrylic court (P < 0.05). This suggests adaptations to increase player stability on clay. Greater hallux pressures and lower midfoot pressures were observed on the clay court, allowing for sliding whilst providing grip at the forefoot. Players with prior clay court experience exhibited later peak knee flexion compared to those with low experience. All participants perceived the differences in surface properties between courts and thus responded appropriately to these differences. The level of previous clay court experience did not influence players' perceptions of the surfaces; however, those with greater clay court experience may reduce injury risk as a result of reduced loading through later peak knee flexion.

Constitutional Mosaic Trisomy 13 in Two Germ Cell Layers is Different from Patau Syndrome? A Case Report

PubMed Central

Kunwar, Fulesh; Pandya, Vidhi

2016-01-01

The heterogeneous phenotype of known syndromes is a clinical challenge, and harmonized description using globally accepted ontology is desirable. This report attempts phenotypic analysis in a patient of constitutional mosaic trisomy 13 in mesoderm and ectoderm to make globally comparable clinical description. Phenotypic features (minor/major abnormalities) were recorded and matched with the Human Phenotype Ontology terms that were used to query web-based tool Phenomizer. We report here a case of 24-year-old girl born to non consanguineous parents with history of one abortion. Her phenotypic evaluation included short columella, low-set ears, seizures, enlarged naris, bifid tongue, infra-orbital fold, smooth philtrum, microtia, microcephaly, carious teeth, downslanted palpebral fissures, proportionate short stature, high palate, thin upper lip vermilion, small for gestational age, broad fingertip, broad hallux, mandibular prognathia and dental malocclusion. Karyotype and interphase FISH (Fluorescence in situ hybridization) was done in blood cells. Interphase FISH was also performed on buccal epithelial cells. Cytogenetic analysis demonstrated trisomy 13 mosaicism in 25% cells i.e. 47, XX,+13(9)/46,XX(27). The interphase FISH in blood cells showed trisomy 13 in 15%, whereas in buccal mucosa cells showed nearly 6%. Mosaic aneuploidy in constitutional karyotype can be responsible for variation in clinical and morphological presentation of patient with genetic disorder. PMID:27134897

Z-plasty of the flexor hallucis longus tendon at tarsal tunnel for checkrein deformity.

PubMed

Lee, Jae Hoon; Kim, Young Jun; Baek, Jong Hun; Kim, Dong Hee

2016-12-01

To review the outcome of Z-plasty of the flexor hallucis longus (FHL) tendon at the tarsal tunnel for checkrein deformity in 8 patients. Records of 6 males and 2 females aged 14 to 67 (mean, 39.5) years who underwent Z-plasty (lengthening) of the FHL tendon at the tarsal tunnel for checkrein deformity in the first and second toes by a single surgeon were reviewed. All patients had undergone 3 months of conservative treatment. The mean time from injury to surgical treatment was 8.4 (range, 5-12) months. All patients had associated injuries including distal tibiofibular fracture (n=6), distal fibular fracture (n=1), and crush injury aroundthe ankle (n=1); they were treated with intramedullary nailing (n=6), long leg splinting (n=1), and short leg splinting (n=1). After a mean follow-up of 3.4 (range, 1-7) years, the FHL tendon was lengthened by a mean of 1.7 (range, 1.6-1.8) cm, and the mean American Orthopedic Foot and Ankle Society hallux score increased from 59 (range, 52-67) to 89 (range, 80-90). No patient had recurrence, nerve injury, or tarsal tunnel syndrome, although one patient had sensory disturbance of the posterior tibial nerve in the forefoot, which resolved spontaneously at week 2. Z-plasty of the FHL tendon at the tarsal tunnel is a viable option for correction of checkrein deformity.

Effectiveness of surgery for adults with hallux valgus deformity: a systematic review.

PubMed

Klugarova, Jitka; Hood, Victoria; Bath-Hextall, Fiona; Klugar, Miloslav; Mareckova, Jana; Kelnarova, Zuzana

2017-06-01

Hallux valgus (HV) is a common foot deformity. In severe stages of this condition, surgery is often necessary. Currently, there is no systematic review comparing the effectiveness of surgery over conservative treatment. The objective of this review was to establish the effectiveness of surgery compared to conservatory management for adults with HV. The current review included adults (18 years or over) with HV deformity, excluding adults with neurological problems causing foot deformities, for example, cerebral palsy, neuropathy, stroke and multiple sclerosis. The review included any type of HV surgery compared to no surgery, conservative treatment or different types of HV surgeries. The primary outcome was gait measurement, and secondary outcomes included quality of life, patient satisfaction, pain assessed using any validated assessment tool and adverse events. The review included randomized controlled trials. The search strategy aimed to find both published and unpublished studies. A three-step search strategy was utilized in 16 databases without language and date limitations. Papers selected for retrieval were assessed by two independent reviewers for methodological validity prior to inclusion in the review using standardized critical appraisal instruments developed by the Joanna Briggs Institute (JBI). Data were extracted from papers included in the review using the standardized data extraction tool developed by the JBI. Quantitative data were, where possible, pooled in statistical meta-analysis using RevMan5 (Copenhagen: The Nordic Cochrane Centre, Cochrane). Effect sizes expressed as risk ratio (for categorical data) and mean differences (MD) or standardized MD (for continuous data) and their 95% confidence intervals were calculated for analysis. Where statistical pooling was not possible, the findings have been presented in narrative form. Searching identified 2412 citations. After removal of duplicates, paper retrieval and critical appraisal, 25 studies were included in the review. The included trials were of medium-to-poor quality.Twenty-four trials compared the effectiveness of different types of surgeries. Meta-analysis revealed no difference in level of pain between distal chevron-type osteotomy and other surgical procedures (standard mean difference [SMD] 0.02, 95% confidence interval [CI] -0.24 to 0.28). One single trial reported that distal chevron osteotomy is more effective than Lindgren osteotomy in terms of walking speed (MD -0.24, 95% CI -0.43 to -0.05).One medium quality trial assessed the effectiveness of HV surgery compared to conservative or no treatment. This trial showed that surgery, specifically distal chevron osteotomy of the first metatarsal, is a more effective procedure for pain compared to conservative treatment (MD -15.00, 95% CI -22.79 to -7.21) and also no treatment in the first year (MD -18.00, 95% CI -25.62 to -10.38). The current systematic review showed that differences between various types of surgical procedures, specifically osteotomies of the first metatarsal on clinical outcomes, are minimal. There is evidence from one study, that surgery, specifically distal chevron osteotomy of the first metatarsal is a more effective procedure than conservative or no treatment in reducing pain in the first year following surgery. However, this systematic review has identified that there is a lack of high-quality studies comparing similar types of HV treatments that assess the same outcomes.

Interpreting the results of the Semmes-Weinstein monofilament test: accounting for false-positive answers in the international consensus on the diabetic foot protocol by a new model.

PubMed

Slater, Robert A; Koren, Shlomit; Ramot, Yoram; Buchs, Andreas; Rapoport, Micha J

2014-01-01

The Semmes-Weinstein monofilament is the most widely used test to diagnose the loss of protective sensation. The commonly used protocol of the International Consensus on the Diabetic Foot includes a 'sham' application that allows for false-positive answers. We sought to study the heretofore unexamined significance of false-positive answers. Forty-five patients with diabetes and a history of pedal ulceration (Group I) and 81 patients with diabetes but no history of ulceration (Group II) were studied. The three original sites of the International Consensus on the Diabetic Foot at the hallux, 1st metatarsal and 5th metatarsal areas were used. At each location, the test was performed three times: 2 actual and 1 "sham" applications. Scores were graded from 0 to 3 based upon correct responses. Determination of loss of protective sensation was performed with and without calculating a false-positive answer as a minus 1 score. False-positive responses were found in a significant percentage of patients with and without history of ulceration. Introducing false-positive results as minus 1 into the test outcome significantly increased the number of patients diagnosed with loss of protective sensation in both groups. False-positive answers can significantly affect Semmes-Weinstein monofilament test results and the diagnosis of LOPS. A model that accounts for false-positive answers is offered. Copyright © 2013 John Wiley & Sons, Ltd.

Radiographic evaluation for AVN following distal metatarsal Stoffella bunion osteotomy.

PubMed

Klein, Christian; Zembsch, Alexander; Dorn, Ulrich

2009-01-01

Avascular necrosis of the metatarsal head, delayed bone healing and nonunion are complications that may occur after distal first metatarsal osteotomies. Intraoperative damage to the extraosseous blood supply, the location of the osteotomy and postoperative vasospasm have been cited as possible causes of such changes. We evaluated Stoffella's subcapital osteotomies which were performed at our department for the correction of moderate to severe hallux valgus deformities. Standardized radiographs of 300 feet, taken 6weeks, 3 months, and 6 months postoperatively and at the final followup were examined with regard to postoperative AVN or signs of delayed bone healing. Of 228 patients, 202 were women and 26 were men. The patients' mean age was 49 years, and the mean followup was 12 months. In 278 cases the radiographs revealed an unremarkable first metatarsal head. Seventeen cases showed diffuse or localized osteopenia or small cysts in the subchondral bone. These changes fully resolved on subsequent radiographs. The X-rays of two patients revealed progressive narrowing of the joint space, irregular contours on the surface of the joint and an abnormal bone structure. The patients subsequently developed a characteristic picture of avascular necrosis, in one case combined with nonunion. Three patients had delayed bone healing, but ultimately healed successfully. Ischemic changes in bone are known to occur after distal first metatarsal osteotomies. There is a very low incidence of postoperative perfusion problems after Stoffella;s technique, even with lateral soft tissue release.

A new podiatry service for patients with arthritis.

PubMed

Rome, Keith; Erikson, Kathryn; Ng, Anthony; Gow, Peter J; Sahid, Hazra; Williams, Anita E

2013-03-01

The aims of this study were to identify the impact of a new podiatric rheumatology service on reducing foot pain, impairment and disability in patients with foot problems associated with rheumatic disease, and to report on patient satisfaction with the service. A retrospective study of 245 patients with rheumatic disease at Counties Manukau DHB was conducted. Foot pain, impairment and disability were measured using a self-reporting patient outcome measure, the Foot Function Index. A range of podiatric interventions were reported. A self-administered, postal patient satisfaction questionnaire was sent to 148 patients. Over two-thirds of patients were observed with hallux valgus (bunions). The results demonstrate a significant reduction in foot pain (p<0.001) from initial visit to second visit (18% reduction in pain). A significant decrease in foot disability (p=0.04) was found from initial visit to second visit. No significant differences were seen with foot impairment (p=0.78). A variety of intervention measures were used with 24% of patients being prescribed foot orthoses and 28% of patients given footwear advice. The patient satisfaction survey found 84% of patients reported they were satisfied with the new service and 80% of patients reported that the service helped with their foot problems. The current service meets the needs of patients who suffer from rheumatological foot conditions such as rheumatoid arthritis and gout. The need for good foot education, provision of foot orthoses and advice on footwear are crucial to reduce the burden on patients with rheumatological foot conditions.

Efficacy of preparation solutions and cleansing techniques on contamination of the skin in foot and ankle surgery: A systematic review and meta-analysis.

PubMed

Yammine, K; Harvey, A

2013-04-01

We report a systematic review and meta-analysis of published randomised and quasi-randomised trials evaluating the efficacy of pre-operative skin antisepsis and cleansing techniques in reducing foot and ankle skin flora. The post-preparation culture number (Post-PCN) was the primary outcome. The data were evaluated using a modified version of the Cochrane Collaboration’s tool. We identified eight trials (560 participants, 716 feet) that met the inclusion criteria. There was a significant difference in the proportions of Post-PCN between hallux nailfold (HNF) and toe web spaces (TWS) sites: 0.47 vs 0.22, respectively (95% confidence interval (CI) 0.182937 to 0.304097; p < 0.0001). Meta-analyses showed that alcoholic chlorhexidine had better efficacy than alcoholic povidone-iodine (PI) at HNF sites (risk difference 0.19 (95% CI 0.08 to 0.30); p = 0.0005); a two-step intervention using PI scrub and paint (S&P) followed by alcohol showed significantly better efficacy over PI (S&P) alone at TWS sites (risk difference 0.13 (95% CI 0.02 to 0.24); p = 0.0169); and a two-step intervention using chlorhexidine scrub followed by alcohol showed significantly better efficacy over PI (S&P) alone at the combined (HNF with TWS) sites (risk difference 0.27 (95% CI 0.13 to 0.40); p < 0.0001). No significant difference was found between cleansing techniques.

An anatomically based protocol for the description of foot segment kinematics during gait.

PubMed

Leardini, A; Benedetti, M G; Catani, F; Simoncini, L; Giannini, S

1999-10-01

To design a technique for the in vivo description of ankle and other foot joint rotations to be applied in routine functional evaluation using non-invasive stereophotogrammetry. Position and orientation of tibia/fibula, calcaneus, mid-foot, 1st metatarsal and hallux segments were tracked during the stance phase of walking in nine asymptomatic subjects. Rigid clusters of reflective markers were used for foot segment pose estimation. Anatomical landmark calibration was applied for the reconstruction of anatomical landmarks. Previous studies have analysed only a limited number of joints or have proposed invasive techniques. Anatomical landmark trajectories were reconstructed in the laboratory frame using data from the anatomical calibration procedure. Anatomical co-ordinate frames were defined using the obtained landmark trajectories. Joint co-ordinate systems were used to calculate corresponding joint rotations in all three anatomical planes. The patterns of the joint rotations were highly repeatable within subjects. Consistent patterns between subjects were also exhibited at most of the joints. The method proposed enables a detailed description of ankle and other foot joint rotations on an anatomical base. Joint rotations can therefore be expressed in the well-established terminology necessary for their clinical interpretation. Functional evaluation of patients affected by foot diseases has recently called for more detailed and non-invasive protocols for the description of foot joint rotations during gait. The proposed method can help clinicians to distinguish between normal and pathological pattern of foot joint rotations, and to quantitatively assess the restoration of normal function after treatment.

Strength of fixation constructs for basilar osteotomies of the first metatarsal.

PubMed

Lian, G J; Markolf, K; Cracchiolo, A

1992-01-01

Twenty-four pairs of fresh-frozen human feet had a proximal osteotomy of the first metatarsal that was fixed using either screws, staples, or K wires. Each metatarsal was excised and the specimen was loaded to failure in a cantilever beam configuration by applying a superiorly directed force to the metatarsal head using an MTS servohydraulic test machine. Specimens with a crescentic osteotomy that were fixed using a single screw demonstrated higher mean failure moments than pairs that were fixed with four staples or two K wires; staples were the weakest construct. All specimens fixed with staples failed by bending of the staples without bony fracture; all K wire constructs but one failed by wire bending. Chevron and crescentic osteotomies fixed with a single screw demonstrated equal bending strengths; the bending strength of an oblique osteotomy fixed with two screws was 82% greater than for a crescentic osteotomy fixed with a single screw. Basilar osteotomies of the first metatarsal are useful in correcting metatarsus primus varus often associated with hallux valgus pathology. Fixation strength is an important consideration since weightbearing forces on the head of the first metatarsal acting at a distance from the osteotomy site subject the construct to a dorsiflexion bending moment, as simulated in our tests. Our results show that screw fixation is the strongest method for stabilizing a basilar osteotomy. Based upon the relatively low bending strengths of the staple and K wire constructs, we would not recommend these forms of fixation.(ABSTRACT TRUNCATED AT 250 WORDS)

Effect of turf toe on foot contact pressures in professional American football players.

PubMed

Brophy, Robert H; Gamradt, Seth C; Ellis, Scott J; Barnes, Ronnie P; Rodeo, Scott A; Warren, Russell F; Hillstrom, Howard

2009-05-01

The relationship between turf toe and plantar foot pressures has not been extensively studied. Two hypotheses were tested in a cohort of professional American football players: first, that a history of turf toe is associated with increased peak hallucal and first metatarsophalangeal (MTP) plantar pressures; second, that decreased range of motion (ROM) of the first MTP correlates with increased peak hallucal and first MTP plantar pressures. Forty-four athletes from one National Football League (NFL) team were screened for a history of turf toe during preseason training. Dorsal passive MTP ROM and dynamic plantar pressures were measured in both feet of each player. Anatomical masking was used to assess peak pressure at the first MTP and hallux. First MTP dorsiflexion was significantly lower in halluces with a history of turf toe (40.6 +/- 15.1 degrees versus 48.4 +/- 12.8 degrees, p = 0.04). Peak hallucal pressures were higher in athletes with turf toe (535 +/- 288 kPa versus 414 +/- 202 kPa, p = 0.05) even after normalizing for athlete body mass index (p = 0.0003). Peak MTP pressure was not significantly different between the two groups tested. First MTP dorsiflexion did not correlate with peak hallucal or first MTP pressures. This study showed that turf toe is associated with decreased MTP motion. In addition, increased peak hallucal pressures were found. Further study is warranted to determine whether these pressures correlate with the severity of symptoms or progression of turf toe to first MTP arthritis.

Genetic diversity and antifungal susceptibility of Fusarium isolates in onychomycosis.

PubMed

Rosa, Priscila D; Heidrich, Daiane; Corrêa, Carolina; Scroferneker, Maria Lúcia; Vettorato, Gerson; Fuentefria, Alexandre M; Goldani, Luciano Z

2017-09-01

Fusarium species have emerged as an important human pathogen in skin disease, onychomycosis, keratitis and invasive disease. Onychomycosis caused by Fusarium spp. The infection has been increasingly described in the immunocompetent and immunosuppressed hosts. Considering onychomycosis is a difficult to treat infection, and little is known about the genetic variability and susceptibility pattern of Fusarium spp., further studies are necessary to understand the pathogenesis and better to define the appropriate antifungal treatment for this infection. Accordingly, the objective of this study was to describe the in vitro susceptibility to different antifungal agents and the genetic diversity of 35 Fusarium isolated from patients with onychomycosis. Fusarium spp. were isolated predominantly from female Caucasians, and the most frequent anatomical location was the nail of the hallux. Results revealed that 25 (71.4%) of isolates belonged to the Fusarium solani species complex, followed by 10 (28.5%) isolates from the Fusarium oxysporum species complex. Noteworthy, the authors report the first case of Neocosmospora rubicola isolated from a patient with onychomycosis. Amphotericin B was the most effective antifungal agent against the majority of isolates (60%, MIC ≤4 μg/mL), followed by voriconazole (34.2%, MIC ≤4 μg/mL). In general, Fusarium species presented MIC values >64 μg/mL for fluconazole, itraconazole and terbinafine. Accurate pathogen identification, characterisation and susceptibility testing provide a better understanding of pathogenesis of Fusarium in onychomycosis. © 2017 Blackwell Verlag GmbH.

Women's clitoris, vagina and cervix mapped on the sensory cortex: fMRI evidence

PubMed Central

Komisaruk, Barry R.; Wise, Nan; Frangos, Eleni; Liu, Wen-Ching; Allen, Kachina; Brody, Stuart

2011-01-01

Introduction The projection of vagina, uterine cervix, and nipple to the sensory cortex in humans has not been reported. Aims To map the sensory cortical fields of the clitoris, vagina, cervix and nipple, toward an elucidation of the neural systems underlying sexual response. Methods Using functional Magnetic Resonance Imaging (fMRI) we mapped sensory cortical responses to clitoral, vaginal, cervical, and nipple self-stimulation. For points of reference on the homunculus, we also mapped responses to the thumb and great toe (hallux) stimulation. Main Outcome Measures fMRI of brain regions activated by the various sensory stimuli. Results Clitoral, vaginal, and cervical self-stimulation activate differentiable sensory cortical regions, all clustered in the medial cortex (medial paracentral lobule). Nipple self-stimulation activated the genital sensory cortex (as well as the thoracic) region of the homuncular map. Conclusion The genital sensory cortex, identified in the classical Penfield homunculus based on electrical stimulation of the brain only in men, was confirmed for the first time in the literature by the present study in women, applying clitoral, vaginal, and cervical self-stimulation, and observing their regional brain responses using fMRI. Vaginal, clitoral, and cervical regions of activation were differentiable, consistent with innervation by different afferent nerves and different behavioral correlates. Activation of the genital sensory cortex by nipple self-stimulation was unexpected, but suggests a neurological basis for women’s reports of its erotogenic quality. PMID:21797981

Validation of hand and foot anatomical feature measurements from smartphone images

NASA Astrophysics Data System (ADS)

Amini, Mohammad; Vasefi, Fartash; MacKinnon, Nicholas

2018-02-01

A smartphone mobile medical application, previously presented as a tool for individuals with hand arthritis to assess and monitor the progress of their disease, has been modified and expanded to include extraction of anatomical features from the hand (joint/finger width, and angulation) and foot (length, width, big toe angle, and arch height index) from smartphone camera images. Image processing algorithms and automated measurements were validated by performing tests on digital hand models, rigid plastic hand models, and real human hands and feet to determine accuracy and reproducibility compared to conventional measurement tools such as calipers, rulers, and goniometers. The mobile application was able to provide finger joint width measurements with accuracy better than 0.34 (+/-0.25) millimeters. Joint angulation measurement accuracy was better than 0.50 (+/-0.45) degrees. The automatically calculated foot length accuracy was 1.20 (+/-1.27) millimeters and the foot width accuracy was 1.93 (+/-1.92) millimeters. Hallux valgus angle (used in assessing bunions) accuracy was 1.30 (+/-1.29) degrees. Arch height index (AHI) measurements had an accuracy of 0.02 (+/-0.01). Combined with in-app documentation of symptoms, treatment, and lifestyle factors, the anatomical feature measurements can be used by both healthcare professionals and manufacturers. Applications include: diagnosing hand osteoarthritis; providing custom finger splint measurements; providing compression glove measurements for burn and lymphedema patients; determining foot dimensions for custom shoe sizing, insoles, orthotics, or foot splints; and assessing arch height index and bunion treatment effectiveness.

[A case of 77-year-old male with spinocerebellar ataxia type 31 with left dominant dystonia].

PubMed

Saito, Rie; Kikuno, Shota; Maeda, Meiko; Uesaka, Yoshikazu; Ida, Masahiro

2014-01-01

We report on the case of a 77-year-old male with genetically proven spinocerebellar ataxia type 31 (SCA31) who had dystonia. He was referred to our hospital for evaluation following a 6-year history of slowly progressive unsteadiness of his left leg during walking and dysarthria at the age of 62 years old. On the basis of his symptoms, we diagnosed him as spinocerebellar degeneration (SCD), and prescribed taltirelin hydrate. However, his symptoms continued to worsen. He required a cane for walking at the age of 63 years, and a wheelchair at the age of 66 years. He was admitted to our hospital following acute cerebral infarction at the age of 77 years. On examination at admission, right hemiparesis and cerebellar ataxia were detected. And left hallux moved involuntarily toward the top surface of the foot at rest, that is dystonia. The dystonia was not associated with cerebral infarction, because it had been several years with dystonia that he got cerebral infarction. Genetic analysis revealed that this patient harbored a heterozygous SCA31 mutation. Previously there have been no reports of SCA31 associated with dystonia. Our case report support clinical heterogeneity of SCA31, and highlight the importance of considering this type in patients with dystonia and ataxia. Patients with the combination of dystonia and ataxia and a family history of a neurodegenerative disorder should be tested for SCA31.

First Tarsometatarsal Arthrodesis: An Anatomic Evaluation of Dorsomedial Versus Plantar Plating.

PubMed

Simons, Paul; Fröber, Rosemarie; Loracher, Clemens; Knobe, Matthias; Gras, Florian; Hofmann, Gunther O; Klos, Kajetan

2015-01-01

Fusion of the first tarsometatarsal joint is a widely used procedure for the correction of hallux valgus deformity. Although dorsomedial H-shaped plating systems are being increasingly used, fusion can also be achieved by plantar plating. The goal of the present study was to compare these 2 operative techniques based on the anatomic considerations and show the potential pitfalls of both procedures. Six pairs of deep-frozen human lower legs were used in the present cadaveric study. In a randomized manner, either dorsomedial arthrodesis or plantar plating through a medial incision was performed. With regard to arterial injury, the plantar technique resulted in fewer lesions (plantar, 4 injuries [66.7%] to the terminal branches of the first digital branch of the medial plantar artery; dorsomedial, 3 injuries [50%] to the main trunks of the plantar metatarsal arteries and the first dorsal metatarsal artery). With respect to injury to the veins, the plantar procedure affected significantly fewer high-caliber subcutaneous trunk veins. The nerves coursing through the operative field, such as the saphenous and superficial fibular nerves, were compromised more often by the dorsal approach. Neither the plantar plating nor the dorsomedial plating technique was associated with injury to the insertion of the tibialis anterior muscle. Both studied techniques are safe, well-established procedures. Arthrodesis with plantar plating, however, offers additional advantages and is a reliable tool in the foot and ankle surgeon's repertoire. Copyright © 2015 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

First metatarsalphalangeal joint arthrodesis: evaluation of plate and screw fixation.

PubMed

Bennett, Gordon L; Sabetta, James

2009-08-01

First metatarsalphalangeal joint (MTPJ) arthrodesis is a commonly performed procedure for the treatment of a variety of conditions affecting the hallux. There are several different methods to accomplish the fusion. We utilized a method incorporating a ball and cup preparation of the joint, followed by stabilization of the arthrodesis site utilizing the Accutrak congruent first MTPJ fusion set. We prospectively evaluated two hundred consecutive patients who underwent first MTPJ arthrodeses utilizing the Accutrak congruent first MTPJ fusion set. Patients were evaluated preoperatively, postoperatively, and at a final followup, utilizing the AOFAS forefoot scoring system. Two hundred consecutive patients underwent first MTPJ arthrodeses by the same surgeon. All but three feet (230/233) (98.7%) went on to solidly fuse. Three of the patients did not fuse solidly. One patient broke two of the screws, and the other two patients did not have hardware failure. All patients dramatically improved their AOFAS scores compared with pre-surgical values. There were three minor hardware problems in the group of patients who solidly fused their joint. We concluded that a solid first MTPJ fusion results in excellent function and pain relief. The Accutrak first MTPJ fusion system would appear to be an ideal implant system to accomplish a fusion because of its low profile, strength, and ease of use. Compared to other methods we have used, this procedure results in a very high rate of fusion, with minimal complications and excellent patient satisfaction.

Diagonal gaits in the feathertail glider Acrobates pygmaeus (Acrobatidae, Diprotodontia): Insights for the evolution of primate quadrupedalism.

PubMed

Karantanis, Nikolaos-Evangelos; Youlatos, Dionisios; Rychlik, Leszek

2015-09-01

Research on primate origins has revolved around arboreality and, more specifically, the adaptations that are linked to safe navigation in the fine-branch niche. To this end, extant non-primate mammals have been used as models to assess the significance of these adaptations. However, the size of these models is larger than that estimated for early primates. In contrast, the feathertail marsupial glider Acrobates pygmaeus, with a body mass of 12 g, a clawless opposable hallux, and terminal branch feeding habits appears more suited to modeling behavioral adaptations to the small branch milieu. Analysis of video recordings of 18 feathertail gliders walking on poles of variable diameter and inclination revealed that they preferentially used diagonal sequence gaits, fast velocities and low duty factors. Diagonal gaits did not correlate to duty factor, but increased as substrate size decreased, and from descending to ascending locomotion. Furthermore, the duty factor index increased in more diagonal gaits and ascending locomotion. Finally, velocities were lower on smaller substrates, and were mainly regulated by stride frequency and, to a lesser degree, stride length. Feathertail glider gaits displayed noteworthy behavioral convergences with primate quadrupedalism, but some of these results need additional investigation. Despite any discrepancies, these features appear to be favorable for quadrupedal progression on small branches, providing a selective advantage for navigating within a fine branch niche and highlighting the importance of small body size in early primate evolution. Copyright © 2015 Elsevier Ltd. All rights reserved.

Stress fractures of the foot and ankle, part 2: site-specific etiology, imaging, and treatment, and differential diagnosis.

PubMed

Mandell, Jacob C; Khurana, Bharti; Smith, Stacy E

2017-09-01

Stress fractures of the foot and ankle are a commonly encountered problem among athletes and individuals participating in a wide range of activities. This illustrated review, the second of two parts, discusses site-specific etiological factors, imaging appearances, treatment options, and differential considerations of stress fractures of the foot and ankle. The imaging and clinical management of stress fractures of the foot and ankle are highly dependent on the specific location of the fracture, mechanical forces acting upon the injured site, vascular supply of the injured bone, and the proportion of trabecular to cortical bone at the site of injury. The most common stress fractures of the foot and ankle are low risk and include the posteromedial tibia, the calcaneus, and the second and third metatarsals. The distal fibula is a less common location, and stress fractures of the cuboid and cuneiforms are very rare, but are also considered low risk. In contrast, high-risk stress fractures are more prone to delayed union or nonunion and include the anterior tibial cortex, medial malleolus, navicular, base of the second metatarsal, proximal fifth metatarsal, hallux sesamoids, and the talus. Of these high-risk types, stress fractures of the anterior tibial cortex, the navicular, and the proximal tibial cortex may be predisposed to poor healing because of the watershed blood supply in these locations. The radiographic differential diagnosis of stress fracture includes osteoid osteoma, malignancy, and chronic osteomyelitis.

Microduplication of 7q36.3 encompassing the SHH long-range regulator (ZRS) in a patient with triphalangeal thumb-polysyndactyly syndrome and congenital heart disease

PubMed Central

Liu, Zhenghua; Yin, Ni; Gong, Lianghui; Tan, Zhiping; Yin, Bangliang; Yang, Yifeng; Luo, Cheng

2017-01-01

Triphalangeal thumb-polysyndactyly syndrome (TPT-PS) is an autosomal dominant disorder with complete penetrance and a variable expression consisting of opposable triphalangeal thumbs, duplication of the distal thumb phalanx, pre-axial polydactyly and duplication of the big toes (hallux). The causative gene of TPT-PS has been mapped to 7q36.3. Sonic hedgehog (SHH) expressed in the zone of polarizing activity (ZPA) has an important role in defining the anterior-posterior axis and numbers of digits in limb bud development. Point mutation or duplication in the ZPA regulatory sequence (ZRS), a cis-regulator of SHH, will lead to TPT-PS. The present study describes a 1-year-old female congenital heart disease (CHD) patient with TPT-PS phenotype. In this Han Chinese family with TPT-PS, high resolution single nucleotide polymorphism array technology identified a novel 0.29 Mb duplication comprising ZRS at 7q36.3 where LMBR1 is located. Additionally, a novel deletion of 22q11.21 was detected in the proband with Tetralogy of Fallot. However, the parents and other relatives of the patient did not harbor this genomic lesion nor CHD. The findings supported the hypothesis that an increased copy number variation of ZRS is the genetic mechanism underlying the phenotype of TPT-PS, and corroborated that 22q11.21 deletion is a genetic cause of CHD. PMID:28035386

The effects of Vibro-medical insole on vibrotactile sensation in diabetic patients with mild-to-moderate peripheral neuropathy.

PubMed

Bagherzadeh Cham, Masumeh; Mohseni-Bandpei, Mohammad Ali; Bahramizadeh, Mahmood; Kalbasi, Saeed; Biglarian, Akbar

2018-06-01

Peripheral sensory neuropathy seems to be the main risk factor for diabetic foot ulceration. Previous studies demonstrated that stochastic resonance can improve the vibrotactile sensation of diabetic patients. The aim of this study was to evaluate the effects of Vibro-medical insole on pressure and vibration sensation in diabetic patients with mild-to-moderate peripheral neuropathy. A total of 20 patients with mild-to-moderate diabetic neuropathy were included in the pre-test and post-test clinical trial study. Vibro-medical insole consists of medical insole and vibratory system. Medical insole was made independently for each participant and vibratory system was inserted in it. Pressure and vibration sensation were evaluated before and after 30-min walking with Vibro-medical insole. Semmes-Weinstein monofilaments and tuning fork were used to evaluate pressure and vibration sensation, respectively. Pressure sensation showed significantly improvement using Vibro-medical insole at the heel, first and fifth metatarsophalangeal heads, and hallux of both feet in all participants (p < 0.001). Vibration sensation also improved at the big toe of both feet with 256 Hz tuning fork (p < 0.05) but no statistically significant effect was found with 128 Hz tuning fork (p > 0.05). Vibro-medical insole significantly improved pressure and vibration sensation of the foot in diabetic patients with mild-to-moderate peripheral neuropathy. The results suggest that Vibro-medical insole can be used for daily living activities to overcome sensory loss in diabetic neuropathy patients.

Effect of custom-made and prefabricated insoles on plantar loading parameters during running with and without fatigue.

PubMed

Lucas-Cuevas, Angel Gabriel; Pérez-Soriano, Pedro; Llana-Belloch, Salvador; Macián-Romero, Cecili; Sánchez-Zuriaga, Daniel

2014-01-01

Controversy exists whether custom-made insoles are more effective in reducing plantar loading compared to prefabricated insoles. Forty recreational athletes ran using custom-made, prefabricated, and the original insoles of their running shoes, at rest and after a fatigue run. Contact time, stride rate, and plantar loading parameters were measured. Neither the insole conditions nor the fatigue state modified contact time and stride rate. Addressing prevention of running injuries, post-fatigue loading values are of great interest. Custom-made insoles reduced the post-fatigue loading under the hallux (92 vs. 130 kPa, P < 0.05), medial midfoot (70 vs. 105 kPa, P < 0.01), and lateral midfoot (62 vs 96 kPa, P < 0.01). Prefabricated insoles provoked reductions in post-fatigue loading under the toes (120 vs. 175 kPa, P < 0.05), medial midfoot (71 vs. 105 kPa, P < 0.01), and lateral midfoot (68 vs. 96 kPa, P < 0.01). Regarding both study insoles, custom-made insoles reduced by 31% and 54% plantar loading under the medial and lateral heel compared to the prefabricated insoles. Finally, fatigue state did not influence plantar loading regardless the insole condition. In long-distance races, even a slight reduction in plantar loading at each foot strike may suppose a significant decrease in the overall stress experienced by the foot, and therefore the use of insoles may be an important protective mechanism for plantar overloading.

Gender differences in plantar loading during three soccer-specific tasks.

PubMed

Sims, E L; Hardaker, W M; Queen, R M

2008-04-01

Examine the effect of gender on plantar loading during three football-specific tasks. Thirty-four athletes (17 men, 17 women) ran an agility course five times while wearing the Nike Vitoria hard ground cleat. Plantar loading data were recorded during a side cut, a cross-over cut and a forward acceleration task using Pedar-X insoles. Controlled laboratory study. No history of lower extremity injury in the past 6 months, no previous foot or ankle surgery, not currently wearing foot orthotics and play a cleated sport at least two times per week. Contact area, maximum force and the force-time integral (FTI) in the medial and lateral midfoot, medial, middle and lateral forefoot as well as the hallux. A univariate ANCOVA (alpha = 0.05) was performed on each dependent variable (covariate was course speed). Significant gender differences existed in the force and force-time integral beneath the lateral midfoot and forefoot during the cross-over cut task as well as in the middle forefoot during the side cut task with the men demonstrating an increased force. No significant differences existed in the loading on the medial side of the foot during any tasks. The results of this study indicate that the increase in plantar loading on the lateral portion of the midfoot and forefoot in men could be one possible explanation for the increased incidence of fifth metatarsal stress fractures in men. Gender differences in loading patterns need to be considered when comparing different movements as well as different footwear conditions.

Factors Associated With Callus in Patients with Diabetes, Focused on Plantar Shear Stress During Gait.

PubMed

Hamatani, Masako; Mori, Taketoshi; Oe, Makoto; Noguchi, Hiroshi; Takehara, Kimie; Amemiya, Ayumi; Ohashi, Yumiko; Ueki, Kohjiro; Kadowaki, Takashi; Sanada, Hiromi

2016-11-01

The aim of this study is to identify whether plantar shear stress in neuropathic patients with diabetes with callus is increased compared with those without callus. The differences in foot deformity, limited joint mobility, repetitive stress of walking, and ill-fitting shoes between patients with callus and those without callus were also determined. Subjects were recruited from the Diabetic Foot Outpatient Clinic. A newly developed in-shoe measurement system, which has flexible and thin insoles, enabled measurement of both plantar pressure and shear stress simultaneously when subjects walked as usual on a 10 m walkway. It was found that plantar shear stress adjusted for weight during the push-off phase was increased by 1.32 times in patients with callus compared with those without callus (mean ± SD: 0.0500 ± 0.0160 vs 0.0380 ± 0.0144, P = .031). Moreover, hallux valgus deformity, reduction in dorsiflexion of the ankle joint and increase in plantar flexion were showed in feet with callus. Increased plantar shear stress may be caused by gait change that patients having callus push off with the metatarsal head instead of the toe as a result of foot deformity and limited joint mobility. It was found that plantar shear stress adjusted for weight during the push-off phase was increased in patients with callus compared with those without callus by using the newly developed measurement system. These results suggest that reduction of plantar shear stress during the push-off phase can prevent callus formation in neuropathic patients with diabetes. © 2016 Diabetes Technology Society.

The compressive mechanical properties of diabetic and non-diabetic plantar soft tissue.

PubMed

Pai, Shruti; Ledoux, William R

2010-06-18

Diabetic subjects are at an increased risk of developing plantar ulcers. Knowledge of the physiologic compressive properties of the plantar soft tissue is critical to understanding the possible mechanisms of ulcer formation and improving treatment options. The purpose of this study was to determine the compressive mechanical properties of the plantar soft tissue in both diabetic and non-diabetic specimens from six relevant locations beneath the foot, namely the hallux (big toe), first, third, and fifth metatarsal heads, lateral midfoot, and calcaneus (heel). Cylindrical specimens (1.905 cm diameter) from these locations were excised and separated from the skin and bone from 4 diabetic and 4 non-diabetic age-matched, elderly, fresh-frozen cadaveric feet. Specimens were then subjected to biomechanically realistic strains of approximately 50% in compression using triangle wave tests conducted at five frequencies ranging from 1 to 10 Hz to determine tissue modulus, energy loss, and strain rate dependence. Diabetic vs. non-diabetic results across all specimens, locations, and testing frequencies demonstrated altered mechanical properties with significantly increased modulus (1146.7 vs. 593.0 kPa) but no change in energy loss (68.5 vs. 67.9%). All tissue demonstrated strain rate dependence and tissue beneath the calcaneus was found to have decreased modulus and energy loss compared to other areas. The results of this study could be used to generate material properties for all areas of the plantar soft tissue in diabetic or non-diabetic feet, with implications for foot computational modeling efforts and potentially for pressure alleviating footwear that could reduce plantar ulcer incidence. Published by Elsevier Ltd.

Inter-segment foot motion in girls using a three-dimensional multi-segment foot model.

PubMed

Jang, Woo Young; Lee, Dong Yeon; Jung, Hae Woon; Lee, Doo Jae; Yoo, Won Joon; Choi, In Ho

2018-05-06

Several multi-segment foot models (MFMs) have been introduced for in vivo analyses of dynamic foot kinematics. However, the normal gait patterns of healthy children and adolescents remain uncharacterized. We sought to determine normal foot kinematics according to age in clinically normal female children and adolescents using a Foot 3D model. Fifty-eight girls (age 7-17 years) with normal function and without radiographic abnormalities were tested. Three representative strides from five separate trials were analyzed. Kinematic data of foot segment motion were tracked and evaluated using an MFM with a 15-marker set (Foot 3D model). As controls, 50 symptom-free female adults (20-35 years old) were analyzed. In the hindfoot kinematic analysis, plantar flexion motion in the pre-swing phase was significantly greater in girls aged 11 years or older than in girls aged <11 years, thereby resulting in a larger sagittal range of motion. Coronal plane hindfoot motion exhibited pronation, whereas transverse plane hindfoot motion exhibited increased internal rotation in girls aged <11 years. Hallux valgus angles increased significantly in girls aged 11 years or older. The foot progression angle showed mildly increased internal rotation in the loading response phase and the swing phase in girls aged <11 years old. The patterns of inter-segment foot motion in girls aged 11 years or older showed low-arch kinematic characteristics, whereas those in girls aged 11 years or older were more similar to the patterns in young adult women. Copyright © 2018 Elsevier B.V. All rights reserved.

Comparison of Multisegmental Foot and Ankle Motion Between Total Ankle Replacement and Ankle Arthrodesis in Adults.

PubMed

Seo, Sang Gyo; Kim, Eo Jin; Lee, Doo Jae; Bae, Kee Jeong; Lee, Kyoung Min; Lee, Dong Yeon

2017-09-01

Total ankle replacement (TAR) and ankle arthrodesis (AA) are usually performed for severe ankle arthritis. We compared postoperative foot segmental motion during gait in patients treated with TAR and AA. Gait analysis was performed in 17 and 7 patients undergoing TAR and AA, respectively. Subjects were evaluated using a 3-dimensional multisegmental foot model with 15 markers. Temporal gait parameters were calculated. The maximum and minimum values and the differences in hallux, forefoot, hindfoot, and arch in 3 planes (sagittal, coronal, transverse) were compared between the 2 groups. One hundred healthy adults were evaluated as a control. Gait speed was faster in the TAR ( P = .028). On analysis of foot and ankle segmental motion, the range of hindfoot sagittal motion was significantly greater in the TAR (15.1 vs 10.2 degrees in AA; P = .004). The main component of motion increase was hindfoot dorsiflexion (12.3 and 8.6 degrees). The range of forefoot sagittal motion was greater in the TAR (9.3 vs 5.8 degrees in AA; P = .004). Maximum ankle power in the TAR (1.16) was significantly higher than 0.32 in AA; P = .008). However, the range of hindfoot and forefoot sagittal motion was decreased in both TAR and AA compared with the control group ( P = .000). Although biomechanical results of TAR and AA were not similar to those in the normal controls, joint motions in the TAR more closely matched normal values. Treatment decision making should involve considerations of the effect of surgery on the adjacent joints. Level III, case-control study.

Does excessive flatfoot deformity affect function? A comparison between symptomatic and asymptomatic flatfeet using the Oxford Foot Model.

PubMed

Hösl, Matthias; Böhm, Harald; Multerer, Christel; Döderlein, Leonhard

2014-01-01

Treatment of asymptomatic flexible flatfeet is a subject of great controversy. The purpose of this study was to examine foot function during walking in symptomatic (SFF) and asymptomatic (ASFF) flexible flatfeet. Thirty-five paediatric and juvenile patients with idiopathic flexible flatfeet were recruited from an orthopaedic outpatient department (14 SFF and 21 ASFF). Eleven age-matched participants with typically developing feet served as controls (TDF). To study foot function, 3D multi-segment foot kinematics and ankle joint kinetics were captured during barefoot gait analysis. Overall, alterations in foot kinematics in flatfeet were pronounced but differences between SFF and ASFF were not observed. Largest discriminatory effects between flatfeet and TDF were noticed in reduced hindfoot dorsiflexion as well as in increased forefoot supination and abduction. Upon clinical examination, restrictions in passive dorsiflexion in ASFF and SFF were significant. During gait, the hindfoot in flatfeet (both ASFF and SFF) was more everted, but less flexible. In sagittal plane, limited hindfoot dorsiflexion of ASFF and SFF was compensated for by increased forefoot mobility and a hypermobile hallux. Concerning ankle kinetics, SFF lacked positive joint energy for propulsion while ASFF needed to absorb more negative ankle joint energy during loading response. This may risk fatigue and overuse syndrome of anterior shank muscles in ASFF. Hence, despite a lack of symptoms flatfoot deformity in ASFF affected function. Yet, contrary to what was expected, SFF did not show greater deviations in 3D foot kinematics than ASFF. Symptoms may rather depend on tissue wear and subjective pain thresholds. Copyright © 2013. Published by Elsevier B.V.

Multi-segment foot kinematics and ground reaction forces during gait of individuals with plantar fasciitis.

PubMed

Chang, Ryan; Rodrigues, Pedro A; Van Emmerik, Richard E A; Hamill, Joseph

2014-08-22

Clinically, plantar fasciitis (PF) is believed to be a result and/or prolonged by overpronation and excessive loading, but there is little biomechanical data to support this assertion. The purpose of this study was to determine the differences between healthy individuals and those with PF in (1) rearfoot motion, (2) medial forefoot motion, (3) first metatarsal phalangeal joint (FMPJ) motion, and (4) ground reaction forces (GRF). We recruited healthy (n=22) and chronic PF individuals (n=22, symptomatic over three months) of similar age, height, weight, and foot shape (p>0.05). Retro-reflective skin markers were fixed according to a multi-segment foot and shank model. Ground reaction forces and three dimensional kinematics of the shank, rearfoot, medial forefoot, and hallux segment were captured as individuals walked at 1.35 ms(-1). Despite similarities in foot anthropometrics, when compared to healthy individuals, individuals with PF exhibited significantly (p<0.05) (1) greater total rearfoot eversion, (2) greater forefoot plantar flexion at initial contact, (3) greater total sagittal plane forefoot motion, (4) greater maximum FMPJ dorsiflexion, and (5) decreased vertical GRF during propulsion. These data suggest that compared to healthy individuals, individuals with PF exhibit significant differences in foot kinematics and kinetics. Consistent with the theoretical injury mechanisms of PF, we found these individuals to have greater total rearfoot eversion and peak FMPJ dorsiflexion, which may put undue loads on the plantar fascia. Meanwhile, increased medial forefoot plantar flexion at initial contact and decreased propulsive GRF are suggestive of compensatory responses, perhaps to manage pain. Copyright © 2014 Elsevier Ltd. All rights reserved.

Comparison of three-dimensional multi-segmental foot models used in clinical gait laboratories.

PubMed

Nicholson, Kristen; Church, Chris; Takata, Colton; Niiler, Tim; Chen, Brian Po-Jung; Lennon, Nancy; Sees, Julie P; Henley, John; Miller, Freeman

2018-05-16

Many skin-mounted three-dimensional multi-segmented foot models are currently in use for gait analysis. Evidence regarding the repeatability of models, including between trial and between assessors, is mixed, and there are no between model comparisons of kinematic results. This study explores differences in kinematics and repeatability between five three-dimensional multi-segmented foot models. The five models include duPont, Heidelberg, Oxford Child, Leardini, and Utah. Hind foot, forefoot, and hallux angles were calculated with each model for ten individuals. Two physical therapists applied markers three times to each individual to assess within and between therapist variability. Standard deviations were used to evaluate marker placement variability. Locally weighted regression smoothing with alpha-adjusted serial T tests analysis was used to assess kinematic similarities. All five models had similar variability, however, the Leardini model showed high standard deviations in plantarflexion/dorsiflexion angles. P-value curves for the gait cycle were used to assess kinematic similarities. The duPont and Oxford models had the most similar kinematics. All models demonstrated similar marker placement variability. Lower variability was noted in the sagittal and coronal planes compared to rotation in the transverse plane, suggesting a higher minimal detectable change when clinically considering rotation and a need for additional research. Between the five models, the duPont and Oxford shared the most kinematic similarities. While patterns of movement were very similar between all models, offsets were often present and need to be considered when evaluating published data. Copyright © 2018 Elsevier B.V. All rights reserved.

The compressive mechanical properties of diabetic and non-diabetic plantar soft tissue

PubMed Central

Pai, Shruti; Ledoux, William R.

2010-01-01

Diabetic subjects are at an increased risk of developing plantar ulcers. Knowledge of the physiologic compressive properties of the plantar soft tissue is critical to understanding possible mechanisms of ulcer formation and improving treatment options. The purpose of this study was to determine the compressive mechanical properties of the plantar soft tissue in both diabetic and non-diabetic specimens from six relevant locations beneath the foot, namely the hallux (big toe), first, third, and fifth metatarsal heads, lateral midfoot, and calcaneus (heel). Cylindrical specimens (1.905cm diameter) from these locations were excised and separated from the skin and bone from 4 diabetic and 4 non-diabetic age-matched, elderly, fresh-frozen cadaveric feet. Specimens were then subjected to biomechanically realistic strains of ∼50% in compression using triangle wave tests conducted at five frequencies ranging from 1 to 10 Hz to determine tissue modulus, energy loss, and strain rate dependence. Diabetic vs. non-diabetic results across all specimens, locations, and testing frequencies demonstrated altered mechanical properties with significantly increased modulus (1146.7 vs. 593.0kPa) but no change in energy loss (68.5 vs. 67.9%). All tissue demonstrated strain rate dependence and tissue beneath the calcaneus was found to have decreased modulus and energy loss compared to other areas. The results of this study could be used to generate material properties for all areas of the plantar soft tissue in diabetic or non-diabetic feet, with implications for foot computational modeling efforts and potentially for pressure alleviating footwear that could reduce plantar ulcer incidence. PMID:20207359

Obese older adults suffer foot pain and foot-related functional limitation.

PubMed

Mickle, Karen J; Steele, Julie R

2015-10-01

There is evidence to suggest being overweight or obese places adults at greater risk of developing foot complications such as osteoarthritis, tendonitis and plantar fasciitis. However, no research has comprehensively examined the effects of overweight or obesity on the feet of individuals older than 60 years of age. Therefore we investigated whether foot pain, foot structure, and/or foot function is affected by obesity in older adults. Three hundred and twelve Australian men and women, aged over 60 years, completed validated questionnaires to establish the presence of foot pain and health related quality of life. Foot structure (anthropometrics and soft tissue thickness) and foot function (ankle dorsiflexion strength and flexibility, toe flexor strength, plantar pressures and spatiotemporal gait parameters) were also measured. Obese participants (BMI >30) were compared to those who were overweight (BMI=25-30) and not overweight (BMI <25). Obese participants were found to have a significantly higher prevalence of foot pain and scored significantly lower on the SF-36. Obesity was also associated with foot-related functional limitation whereby ankle dorsiflexion strength, hallux and lesser toe strength, stride/step length and walking speed were significantly reduced in obese participants compared to their leaner counterparts. Therefore, disabling foot pain and altered foot structure and foot function are consequences of obesity for older adults, and impact upon their quality of life. Interventions designed to reduce excess fat mass may relieve loading of the foot structures and, in turn, improve foot pain and quality of life for older obese individuals. Copyright © 2015 Elsevier B.V. All rights reserved.

Statin use and peripheral sensory perception: a pilot study.

PubMed

West, Brenton; Williams, Cylie M; Jilbert, Elise; James, Alicia M; Haines, Terry P

2014-06-01

Peripheral sensory neuropathy is a neurological deficit resulting in decreased detection of sensation through the peripheral nervous system. Peripheral sensory neuropathy is commonly diagnosed with the use of a monofilament and either a tuning fork or neurothesiometer. Statins are a widely used medication and there has been some debate of association with their use and peripheral sensory neuropathy. This pilot study aimed to test the sensory perception of participants with long-term statin use and compare these results to their peers who were not taking statins. Thirty participants were recruited and equally divided into a statin and non-statin group. Healthy participants were screened by their medical and medication history, Australian Type 2 Diabetes Risk assessment, and random blood glucose level. An assessor who was blinded to the participant group conducted sensory assessments using a 10 g monofilament and neurothesiometer. There was no difference in monofilament testing results between the groups. The statin group was less sensate at the styloid process (p = 0.031) and medial malleolus (p = 0.003) than the control group. Results at the hallux were not statistically significant (p = 0.183). This result is suggestive of a potential association between long-term statin use and a decrease in peripheral sensory perception. This may be because of peripheral sensory neuropathy. Limitations such as consideration of participant height, participant numbers, and inability to analyze results against statin groups are reported. As statins are a life-saving medication, careful consideration should be applied to these results and further research be conducted to determine if these results are applicable to larger populations.

Clinical features and prognosis of a sample of patients with trisomy 13 (Patau syndrome) from Brazil.

PubMed

Petry, Patrícia; Polli, Janaina B; Mattos, Vinícius F; Rosa, Rosana C M; Zen, Paulo R G; Graziadio, Carla; Paskulin, Giorgio A; Rosa, Rafael F M

2013-06-01

Trisomy 13 or Patau syndrome (PS) is a chromosomal disorder characterized by a well known presentation of multiple congenital anomalies. Our objective was to determine the clinical features and prognosis observed in a sample of patients with PS. The series was composed of patients with diagnosis of PS consecutively evaluated by a Clinical Genetics Service from a reference hospital of southern Brazil, in the period between 1975 and 2012. Statistical analysis was performed using PEPI program (version 4.0), with two-tailed Fisher's exact test for comparison of frequencies (P<0.05). The sample consisted of 30 patients, 60% male, median age at first evaluation of 9 days. Full trisomy of chromosome 13 was the main cytogenetic alteration (73%). The major clinical findings included: cryptorchidism (78%), abnormal auricles (77%), congenital heart defects (76%), polydactyly (63%), microphthalmia (60%) and micrognathia (50%). Four patients (13%) simultaneously had micro/anophthalmia, oral clefts and polydactyly. Some findings were only observed in our sample and included, among others, preauricular tags (10%), duplication of the hallux (3%) and spots following the lines of Blaschko (3%). Mosaicism (20% of cases) had a statistically significant association only with absence of cryptorchidism. The median of survival was 26 days. Patients with and without mosaicism had similar median of survival. Our findings, in agreement with the literature, show that the anomalies in patients with PS can be quite variable, sometimes even atypical. There is no pathognomonic finding, which may make the early identification of these patients challenging. Copyright © 2013 Wiley Periodicals, Inc.

Comparison of plantar pressure distribution in CAD-CAM and prefabricated foot orthoses in patients with flexible flatfeet.

PubMed

Khodaei, Banafsheh; Saeedi, Hassan; Jalali, Maryam; Farzadi, Maede; Norouzi, Ehsan

2017-12-01

The effect of foot orthoses on plantar pressure distribution has been proven by researchers but there are some controversies about advantages of custom-made foot orthoses to less expensive prefabricated foot orthoses. Nineteen flatfeet adults between 18 and 45 participated in this study. CAD-CAM foot orthoses were made for these patients according to their foot scan. Prefabricated foot orthoses were prepared according to their foot size. Plantar pressure, force and contact area were measured using pedar ® -x in-shoe system wearing shoe alone, wearing CAD-CAM foot orthoses and wearing prefabricated foot orthoses. Repeated measures ANOVA model with post-hoc, Bonferroni comparison were used to test differences. CAD-CAM and prefabricated foot orthoses both decreased pressure and force under 2nd, 3-5 metatarsal and heel regions comparing to shoe alone condition. CAD-CAM foot orthosis increased pressure under lateral toe region in comparison to shoe alone and prefabricated foot orthosis. Both foot orthoses increased pressure and contact area in medial midfoot region comparing to shoe alone condition. Increased forces were seen at hallux and lateral toes by prefabricated foot orthoses in comparison with CAD-CAM foot orthoses and control condition, respectively. According to the results, both foot orthoses could decrease the pressure under heel and metatarsal area. It seems that the special design of CAD-CAM foot orthoses could not make great differences in plantar pressure distribution in this sample. Further research is required to determine whether these results are associated with different scan systems or design software. Copyright © 2017 Elsevier Ltd. All rights reserved.

Effectiveness of Total Contact Orthosis for Plantar Pressure Redistribution in Neuropathic Diabetic Patients During Different Walking Activities.

PubMed

Nouman, Muhammad; Leelasamran, Wipawan; Chatpun, Surapong

2017-08-01

Using a total contact orthosis (TCO) is an effective method to offload in diabetic patients with foot neuropathy. However, the redistribution of peak plantar pressure is mostly observed during level walking, which may differ from other walking activities. The aim of this study was to investigate the plantar pressure from 4 regions of the foot during different walking activities (level walking, ramp ascending, ramp descending, stair ascending, and stair descending) in neuropathic diabetic patients with and without a TCO. Sixteen neuropathic diabetic patients aged 40 to 60 years with calluses and hallux valgus were included in this study and were provided with TCOs made up of multifoam, Plastazote, and microcellular rubber. The plantar pressure and contact area with the TCO and without the TCO were recorded using the Pedar X system during different walking activities. A significant reduction of plantar pressure during different walking activities at the toes and forefoot regions was observed while walking with the TCO compared with walking without the TCO (control condition). Plantar pressure increased at the midfoot region when walking with the TCO, and no significant difference was observed at the hindfoot region between the control and TCO conditions. Furthermore, maximum contact area was observed during level walking with the TCO compared with other walking activities. The TCO significantly reduced and redistributed the peak plantar pressure from the sites where the ulceration rate is higher at the toes and forefoot compared with the other regions of the foot. Therapeutic level II, lesser quality randomized controlled trial.

Hardness and posting of foot orthoses modify plantar contact area, plantar pressure, and perceived comfort when cycling.

PubMed

Bousie, Jaquelin A; Blanch, Peter; McPoil, Thomas G; Vicenzino, Bill

2018-07-01

To evaluate the effects of hardness and posting of orthoses on plantar profile and perceived comfort and support during cycling. A repeated measures study with randomised order of orthoses, hardness, and posting conditions. Twenty-three cyclists cycled at a cadence of 90rpm and a perceived exertion rating of twelve. Contoured soft and hard orthoses with or without a medial forefoot or lateral forefoot post were evaluated. Plantar contact area, mean pressure and peak pressure were measured for nine plantar regions using the pedar ® -X system and represented as a percentage of the total (CA%, MP%, and PP% respectively). Perceived comfort and support was rated on a visual analogue scale. The softer orthosis significantly increased CA% (p=0.014) across the midfoot and heel with a decrease in the toe region and forefoot. MP% (p=0.034) and PP% (p=0.012) were significantly increased at the mid and lateral forefoot with reductions in MP% at the midfoot and in PP% at the hallux and toes. Forefoot posting significantly increased CA% (p=0.018) at the toes and forefoot and decreased it at the heel. PP% was significantly altered (p=0.013) based on posting position. Lateral forefoot posting significantly decreased heel comfort (p=0.036). When cycling, a soft, contoured orthosis increased contact across the midfoot and heel, modulating forefoot and midfoot plantar pressures but not altering comfort or support. Forefoot postings significantly modified contact areas and plantar pressures and reduced comfort at the heel. Copyright © 2017. Published by Elsevier Ltd.

An initial evaluation of a proof-of-concept 128-Hz electronic tuning fork in the detection of peripheral neuropathy.

PubMed

O'Brien, Todd; Karem, Joseph

2014-03-01

Diabetic peripheral neuropathy (DPN) is an essential precursor leading to diabetic limb loss. Neurologic screening tests, including the 128-Hz tuning fork (TF), have long been used to identify and track the progression of DPN, thereby guiding the implementation of preventive strategies. Although a sensitive indicator of neuropathy, shortcomings of TF testing include the lack of standardization and quantification of clinical findings. In an attempt to overcome these limitations, a novel 128-Hz electronic TF (ETF) prototype has been developed that is capable of performing accurate timed vibration tests (TVTs). This study was designed to assess the ability of the ETF to detect sensory impairment compared with three established neurologic screening methods: the Semmes-Weinstein monofilament test, the biothesiometer, and the sharp/dull discrimination test. Fifty-five test patients were recruited from the primary author's practice and enrolled according to an approved protocol. The 10-g Semmes-Weinstein monofilament test and the sharp/dull discrimination test were administered in standard fashion to the plantar aspects of digits 1 and 5 bilaterally. The ETF and the biothesiometer (25-V setting) were applied to the dorsal aspects of the distal phalanx of the hallux and fifth metatarsal head bilaterally. The sensitivity and specificity of neuropathy detection for the ETF were 0.953 and 0.761, respectively, using conventional tests as reference standards. Performance of TVTs with the ETF detected sensory impairment compared with three conventional neurologic screening methods. Given these findings, the ETF could facilitate the use of standardized TVTs as an indicator of DPN progression.

The mechanism of force transference in feet of children ages two to six.

PubMed

Hu, Mingyu; Zhou, Nan; Xu, Bo; Chen, Wuyong; Wu, Jianxin; Zhou, Jin

2017-05-01

The aim of this study was to design an algorithm to quantify the plantar force transference of children from ages 2-6. In total, 319 healthy children without abnormal gait patterns, foot deformities or injuries, able to walk independently, and with normal BMIs were recruited, and their plantar force distributions were measured. Their plantar areas were divided into ten parts: the hallux, toes #2-5, the first to fifth metatarsal heads (1st-5th MTH), the mid-foot (MF), medial heel (MH) and lateral heel (LH), in which a relative force-time integral (FTIrel) (%) was calculated. Our results show that the FTIrel was significantly transferred along either the transverse or longitudinal arches. The middle of the forefoot and the toe areas were the two main loading regions in children aged 2-3, and posterior to anterior FTIrel shifting was typical. However, anterior to posterior and lateral to medial FTI transferences were found in children aged 5-6, and major loading was found in the heel area. Further, loading in the mid-foot varied with the child's development and was observed to tend to decrease over time. Overall, according to the algorithm designed in this study, these results demonstrated that the development of the arches, both in transverse and longitudinal directions, had already begun in early stages of toddlerhood. Meanwhile, the arches were an important attractor engaged in the windlass mechanism while walking, and they played a major role as bridges to promote posterior to anterior and medial to lateral force transference. Copyright © 2017 Elsevier B.V. All rights reserved.

Investigating the effect of external trauma through a dynamic system modeling approach for clustering causality in diabetic foot ulcer development.

PubMed

Salimi, Parisa; Hamedi, Mohsen; Jamshidi, Nima; Vismeh, Milad

2017-04-01

Diabetes and its associated complications are realized as one of the most challenging medical conditions threatening more than 29 million people only in the USA. The forecasts suggest a suffering of more than half a billion worldwide by 2030. Amid all diabetic complications, diabetic foot ulcer (DFU) has attracted much scientific investigations to lead to a better management of this disease. In this paper, a system thinking methodology is adopted to investigate the dynamic nature of the ulceration. The causal loop diagram as a tool is utilized to illustrate the well-researched relations and interrelations between causes of the DFU. The result of clustering causality evaluation suggests a vicious loop that relates external trauma to callus. Consequently a hypothesis is presented which localizes development of foot ulceration considering distribution of normal and shear stress. It specifies that normal and tangential forces, as the main representatives of external trauma, play the most important role in foot ulceration. The evaluation of this hypothesis suggests the significance of the information related to both normal and shear stress for managing DFU. The results also discusses how these two react on different locations on foot such as metatarsal head, heel and hallux. The findings of this study can facilitate tackling the complexity of DFU problem and looking for constructive mitigation measures. Moreover they lead to developing a more promising methodology for managing DFU including better prognosis, designing prosthesis and insoles for DFU and patient caring recommendations. Copyright © 2017 Elsevier Ltd. All rights reserved.

Tail function during arboreal quadrupedalism in squirrel monkeys (Saimiri boliviensis) and tamarins (Saguinus oedipus).

PubMed

Young, Jesse W; Russo, Gabrielle A; Fellmann, Connie D; Thatikunta, Meena A; Chadwell, Brad A

2015-10-01

The need to maintain stability on narrow branches is often presented as a major selective force shaping primate morphology, with adaptations to facilitate grasping receiving particular attention. The functional importance of a long and mobile tail for maintaining arboreal stability has been comparatively understudied. Tails can facilitate arboreal balance by acting as either static counterbalances or dynamic inertial appendages able to modulate whole-body angular momentum. We investigate associations between tail use and inferred grasping ability in two closely related cebid platyrrhines-cotton-top tamarins (Saguinus oedipus) and black-capped squirrel monkeys (Saimiri boliviensis). Using high-speed videography of captive monkeys moving on 3.2 cm diameter poles, we specifically test the hypothesis that squirrel monkeys (characterized by grasping extremities with long digits) will be less dependent on the tail for balance than tamarins (characterized by claw-like nails, short digits, and a reduced hallux). Tamarins have relatively longer tails than squirrel monkeys, move their tails through greater angular amplitudes, at higher angular velocities, and with greater angular accelerations, suggesting dynamic use of tail to regulate whole-body angular momentum. By contrast, squirrel monkeys generally hold their tails in a comparatively stationary posture and at more depressed angles, suggesting a static counterbalancing mechanism. This study, the first empirical test of functional tradeoffs between grasping ability and tail use in arboreal primates, suggests a critical role for the tail in maintaining stability during arboreal quadrupedalism. Our findings have the potential to inform our functional understanding of tail loss during primate evolution. © 2015 Wiley Periodicals, Inc.

Anchor enhanced capsulorraphy in bunionectomies using an L-shaped capsulotomy.

PubMed

Gould, John S; Ali, Sheriff; Fowler, Rachel; Fleisig, Glenn S

2003-01-01

The objective of this study was to investigate potential benefit of a suture anchor-enhanced capsulorraphy in the early maintenance of correction in bunionectomies. We compared, retrospectively, in successive series, the loss of correction of the Hallux Valgus (HV) and intermetatarsal (IM) angle, in those repaired with an L-shaped capsulorraphy enhanced with anchors to those without. Intraoperative and second week postoperative simulated weightbearing anterior posterior (AP) X-rays were used to evaluate results. By using only intraoperative and early postoperative X-rays, we should have effectively eliminated extraneous factors that might have influenced our results. A Total of 106 cases were investigated, 65 of which were repaired using anchors, the remaining 41 without. In the anchor group, 38 underwent a proximal metatarsal concentric shelf osteotomy (CSO)/modified McBride procedure, while the remaining 27 had a distal Chevron correction. In the without-anchor group, 21 had a CSO/modified McBride procedure while 20 underwent the Chevron procedure. In the without-anchor group, the average HV and IM loss of correction was 4.60 degrees (range, -2 to 21 degrees) and 0.6 degrees (range, -1 to 9 degrees) respectively. In the anchor group, the corresponding loss was 2.8 degrees (range, -3 to 17 degrees) and 0.6 degrees (range, -2 to 14 degrees) respectively. These results, when statistically analyzed, demonstrated that while the IM angle change was not statistically significant, the HV angle change was statistically significant, implying that the anchor plays a significant role in maintaining the surgical correction in both the distal Chevron and CSO/ modified McBride bunionectomies.

Progress on Botulinum Toxin Type A-Induced Pain Relief in the Field of Plastics.

PubMed

Lu, Xiaona; Chen, Guocheng; Ren, Pengjie; Yang, Yan; Fan, Fei

2017-11-01

To retrospectively evaluate the effectiveness of Botulinum Toxin Type A (BTX-A) injections relieve pain in the field of plastic surgery and postoperative rehabilitation, and discuss the analgesic mechanism of BTX- A in plastics and related research progress. From appearance to September 1, 2016, PUBMED, EMBASE, and Web of Science were searched, using the key words related to "Botulinum Toxin Type A" and "Pain." Furtherly, nonplastic surgery-related literature was excluded by manual screening. Eleven literatures met the inclusion criteria, including 6 prospective controlled cohorts, 4 patient series, and 1 retrospective cohort. These studies involved Lower Limb, Breast, Hallux, Amputees, and Temporomandibular joint disk disfigurement and enrolled 402 patients. Among the patients, 360 received intraoperative BTX-A injection at the time of the main surgical procedure, 16 injected postoperatively and 26 did not undergo surgery. And 85.32% reported pain alleviation and 69.96% got favorable side effects and no one occurred major adverse effects. But 1.83% accepted injections more than once. Mechanism analysis explained these studies' results and demonstrated the analgesic effectiveness of BTX-A in plastics with nociceptive pain, inflammatory pain, and neuropathic pain. The results suggest that BTX-A may induce postoperative pain associated with plastic surgeries relief. But the available data of outcome assessment involved in this review are inconsistent and failed to meet methodological rigor. And pain alleviations are influenced by many factors. So further randomized controlled clinical trials with large sample sizes are needed to support this practice, determine standard usage methods, and establish corresponding specification systems.

Effects of ballet training of children in Turkey on foot anthropometric measurements and medial longitudinal arc development.

PubMed

Ozdinc, Sevgi Anar; Turan, Fatma Nesrin

2016-07-01

To investigate the effects of ballet training on foot structure and the formation of the medial longitudinal arc in childhood, and the association of body mass index with structural change secondary to ballet training. This study was conducted at Öykü Ballet and Dance School and Trakya University, Edirne, Turkey, from September 2007 to November 2008, and comprised girl students who were taking ballet classes, and a group of those who were not taking such who acted as the controls. Static footprints of both feet of all participants were taken with an ink paedogram. Parameters evaluated from footprints included foot length, metatarsal width, heel width and medial longitudinal arch. The relationship between the parameters, the ballet starting age, training duration and body mass index was investigated. Of the 67 participants, there were 36(53.7%) in the experimental group and 31(48.3%) in the control group. The difference between age, height, weight and body mass index between the two groups was insignificant (p>0.05). The average ballet starting age was 6.47±1.55 years and duration was 4.36±2.002 years. Positive correlations were found between body mass index and foot length, metatarsal width, heel width, medial longitudinal arch contact width and halluxvalgus angle; between ballet starting age and metatarsal width, heel width; between duration of training and foot length, metatarsal width and hallux valgus angle (p?0.05 each). Evidence supporting the education in children on foot anthropometric measurements and medial longitudinal arc development could not be found.

Comparison of Chevron and Distal Oblique Osteotomy for Bunion Correction.

PubMed

Scharer, Brandon M; DeVries, J George

2016-01-01

The chevron osteotomy is a standard procedure by which bunions are corrected. One of us routinely performs a distal oblique osteotomy, which, to the best of our knowledge, has not been described for the correction of bunion deformities. The purpose of the present study was to compare the short- and medium-term results of the distal oblique and chevron osteotomies for bunion correction. We performed a retrospective clinical and radiographic comparison of patients who had undergone a distal oblique or chevron osteotomy for the correction of bunion deformity. In addition, a prospective patient satisfaction survey was undertaken. A total of 55 patients were included in the present study and were treated from January 2012 to November 2014. Of the 55 patients, 27 (49.2%) were in the chevron group and 28 (50.8%) in the distal oblique group. Radiographically, no statistically significant difference was found between the 2 groups with respect to postoperative first intermetatarsal angle (p < .0001) and hallux valgus angle (p < .0001), but a greater change was found in the intermetatarsal angle in the distal oblique group (p = .467). Prospective patient satisfaction scores were available for 33 patients (60%), 16 (29%) in the chevron group and 17 (31%) in the distal oblique group. When converting the satisfaction score to a numerical score, the chevron group scored 3.3 ± 1.1 and the distal oblique group scored 3.2 ± 0.8 (p = .812). We found that the distal oblique osteotomy used in the present study is simple and reliable and showed radiographic correction and patient satisfaction equivalent to those in the chevron osteotomy. Copyright © 2016 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

Preoperative Planning and Intraoperative Technique for Accurate Translation of a Distal First Metatarsal Osteotomy.

PubMed

Wynes, Jacob; Lamm, Bradley M; Andrade, Bijan J; Malay, D Scot

2016-01-01

We used preoperative radiographic and intraoperative anatomic measurements to predict and achieve, respectively, the precise amount of capital fragment lateral translation required to restore anatomic balance to the first metatarsophalangeal joint. Correlation was used to relate the amount of capital fragment translation and operative reduction of the first intermetatarsal angle (IMA), hallux abductus angle (HAA), tibial sesamoid position (TSP), metatarsus adductus angle, and first metatarsal length. The mean capital fragment lateral translation was 5.54 ± 1.64 mm, and the mean radiographic reductions included a first IMA of 5.04° ± 2.85°, an HAA of 9.39° ± 8.38°, and a TSP of 1.38 ± 0.9. These changes were statistically (p < .001) and clinically (≥32.55%) significant. The mean reduction of the metatarsus adductus angle was 0.66° ± 4.44° and that for the first metatarsal length was 0.33 ± 7.27 mm, and neither of these were statistically (p = .5876 and 0.1247, respectively) or clinically (≤3.5%) significant. Pairwise correlations between the amount of lateral translation of the capital fragment and the first IMA, HAA, and TSP values were moderately positive and statistically significant (r = 0.4412, p = .0166; r = 0.5391, p = .0025; and r = 0.3729, p = .0463; respectively). In contrast, the correlation with metatarsus adductus and the first metatarsal shortening were weak and not statistically significant (r = 0.2296, p = .2308 and r = -0.2394, p = .2109, respectively). The results of our study indicate that predicted preoperative and executed intraoperative lateral translation of the capital fragment correlates with statistically and clinically significant reductions in the first IMA, HAA, and TSP. Copyright © 2016 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

Effect of lateral wedge length on ambulatory knee kinetics.

PubMed

Fischer, Arielle G; Ulrich, Baptiste; Hoffmann, Laurent; Jolles, Brigitte M; Favre, Julien

2018-04-27

Lateral wedge insoles (LWI) were proposed to treat medial knee osteoarthritis through reductions of the ambulatory knee adduction moment (KAM). Limited attention was however paid to the LWI length, resulting in unclear understanding of its effect on KAM reductions. The knee flexion moment (KFM) was also shown to be important in knee osteoarthritis, but little is known about the effect of LWI length on it. This study aimed to compare the KAM and KFM of healthy subjects walking with four different lengths of LWI, explicitly without LWI and with LWI below the hindfoot (HF), below the hindfoot and forefoot (HF + FF) and below the hindfoot, forefoot and hallux (HF + FF + HX) segments. Nineteen healthy participants (63% male; 24 ± 3 years old) walked in an instrumented gait lab with LWI of four different lengths. Repeated one-way ANOVAs and post-hoc t-tests were used to compare knee kinetics among LWI lengths. The peak value of the KAM during the first half of stance and the KAM impulse differed with respect to the LWI length (p < 0.001). A length of at least HF + FF, but not necessarily longer, was needed to decrease both KAM parameters compared to walking without LWI. The LWI length had no effect on the peak value of the KFM during the first half of stance (p = 0.86). The results in this study could contribute to better selections of LWI for medial knee osteoarthritis and suggested that the length of the LWI could be a critical factor that should be considered in future research. Copyright © 2018 Elsevier B.V. All rights reserved.

Long-Term Effects of Habitual Barefoot Running and Walking: A Systematic Review.

PubMed

Hollander, Karsten; Heidt, Christoph; VAN DER Zwaard, Babette C; Braumann, Klaus-Michael; Zech, Astrid

2017-04-01

Barefoot locomotion is widely believed to be beneficial for motor development and biomechanics but are implied to be responsible for foot pathologies and running-related injuries. Although most of available studies focused on acute effects of barefoot running and walking little is known regarding the effects of long-term barefoot versus shod locomotion. The purpose of this study was to systematically review the literature to evaluate current evidence of habitual barefoot (HB) versus habitual shod locomotion on foot anthropometrics, biomechanics, motor performance, and pathologies. Four electronic databases were searched using terms related to habitually barefoot locomotion. Relevant studies were identified based on title, abstract, and full text, and a forward (citation tracking) and backward (references) search was performed. Risk of bias was assessed, data pooling, and meta-analysis (random effects model) performed and finally levels of evidence determined. Fifteen studies with 8399 participants were included. Limited evidence was found for a reduced ankle dorsiflexion at footstrike (pooled effect size, -3.47; 95% confidence interval [CI], -5.18 to -1.76) and a lower pedobarographically measured hallux angle (-1.16; 95% CI, -1.64 to -0.68). HB populations had wider (0.55; 95% CI, 0.06-1.05) but no shorter (-0.22; 95% CI, -0.51 to 0.08) feet compared with habitual shod populations. No differences in relative injury rates were found, with limited evidence for a different body part distribution of musculoskeletal injuries and more foot pathologies and less foot deformities and defects in HB runners. Only limited or very limited evidence is found for long-term effects of HB locomotion regarding biomechanics or health-related outcomes. Moreover, no evidence exists for motor performance. Future research should include prospective study designs.

A biomechanical investigation of right-forward lunging step among badminton players.

PubMed

Mei, Qichang; Gu, Yaodong; Fu, Fengqin; Fernandez, Justin

2017-03-01

This study presents the kinematics and plantar pressure characteristics of eight elite national-level badminton athletes and eight recreational college-level badminton players while performing a right-forward lunge movement in a laboratory-simulated badminton court. The hypothesis was that recreational players would be significantly different from elite players in kinematics and plantar pressure measures. Vicon ® motion capture and Novel ® insole plantar pressure measurement were simultaneously taken to record the lower extremity kinematics and foot loading during stance. Recreational players showed significantly higher peak pressure in the lateral forefoot (P = 0.002) and force time integral in the lateral forefoot (P = 0.013) and other toes (P = 0.005). Elite athletes showed higher peak pressure in the medial forefoot (P = 0.003), hallux (P = 0.037) and force time integral in the medial forefoot (P = 0.009). The difference in landing techniques for the lunge step between elite athletes and recreational players was observed with peak ankle eversion (-38.2°±2.4° for athletes and -11.1°±3.9° for players, P = 0.015); smaller knee range of motion in the coronal and transverse planes, with differences in peak knee adduction (28.9°±6.8° for athletes and 15.7°±6.2° for players, P = 0.031); peak knee internal rotation (20.3°±1.3° for athletes and 11.8°±3.2° for players, P = 0.029) and peak hip flexion (77.3°±4.1° for athletes and 91.3°±9.3° for players, P = 0.037).

Dynamic 3D scanning as a markerless method to calculate multi-segment foot kinematics during stance phase: methodology and first application.

PubMed

Van den Herrewegen, Inge; Cuppens, Kris; Broeckx, Mario; Barisch-Fritz, Bettina; Vander Sloten, Jos; Leardini, Alberto; Peeraer, Louis

2014-08-22

Multi-segmental foot kinematics have been analyzed by means of optical marker-sets or by means of inertial sensors, but never by markerless dynamic 3D scanning (D3DScanning). The use of D3DScans implies a radically different approach for the construction of the multi-segment foot model: the foot anatomy is identified via the surface shape instead of distinct landmark points. We propose a 4-segment foot model consisting of the shank (Sha), calcaneus (Cal), metatarsus (Met) and hallux (Hal). These segments are manually selected on a static scan. To track the segments in the dynamic scan, the segments of the static scan are matched on each frame of the dynamic scan using the iterative closest point (ICP) fitting algorithm. Joint rotations are calculated between Sha-Cal, Cal-Met, and Met-Hal. Due to the lower quality scans at heel strike and toe off, the first and last 10% of the stance phase is excluded. The application of the method to 5 healthy subjects, 6 trials each, shows a good repeatability (intra-subject standard deviations between 1° and 2.5°) for Sha-Cal and Cal-Met joints, and inferior results for the Met-Hal joint (>3°). The repeatability seems to be subject-dependent. For the validation, a qualitative comparison with joint kinematics from a corresponding established marker-based multi-segment foot model is made. This shows very consistent patterns of rotation. The ease of subject preparation and also the effective and easy to interpret visual output, make the present technique very attractive for functional analysis of the foot, enhancing usability in clinical practice. Copyright © 2014 The Authors. Published by Elsevier Ltd.. All rights reserved.

Estimation of foot joint kinetics in three and four segment foot models using an existing proportionality scheme: Application in paediatric barefoot walking.

PubMed

Deschamps, Kevin; Eerdekens, Maarten; Desmet, Dirk; Matricali, Giovanni Arnoldo; Wuite, Sander; Staes, Filip

2017-08-16

Recent studies which estimated foot segment kinetic patterns were found to have inconclusive data on one hand, and did not dissociate the kinetics of the chopart and lisfranc joint. The current study aimed therefore at reproducing independent, recently published three-segment foot kinetic data (Study 1) and in a second stage expand the estimation towards a four-segment model (Study 2). Concerning the reproducibility study, two recently published three segment foot models (Bruening et al., 2014; Saraswat et al., 2014) were reproduced and kinetic parameters were incorporated in order to calculate joint moments and powers of paediatric cohorts during gait. Ground reaction forces were measured with an integrated force/pressure plate measurement set-up and a recently published proportionality scheme was applied to determine subarea total ground reaction forces. Regarding Study 2, moments and powers were estimated with respect to the Instituto Ortopedico Rizzoli four-segment model. The proportionality scheme was expanded in this study and the impact of joint centre location on kinetic data was evaluated. Findings related to Study 1 showed in general good agreement with the kinetic data published by Bruening et al. (2014). Contrarily, the peak ankle, midfoot and hallux powers published by Saraswat et al. (2014) are disputed. Findings of Study 2 revealed that the chopart joint encompasses both power absorption and generation, whereas the Lisfranc joint mainly contributes to power generation. The results highlights the necessity for further studies in the field of foot kinetic models and provides a first estimation of the kinetic behaviour of the Lisfranc joint. Copyright © 2017 Elsevier Ltd. All rights reserved.

Foot posture is associated with kinematics of the foot during gait: A comparison of normal, planus and cavus feet.

PubMed

Buldt, Andrew K; Levinger, Pazit; Murley, George S; Menz, Hylton B; Nester, Christopher J; Landorf, Karl B

2015-06-01

Variations in foot posture are associated with the development of some lower limb injuries. However, the mechanisms underlying this relationship are unclear. The objective of this study was to compare foot kinematics between normal, pes cavus and pes planus foot posture groups using a multi-segment foot model. Ninety-seven healthy adults, aged 18-47 were classified as either normal (n=37), pes cavus (n=30) or pes planus (n=30) based on normative data for the Foot Posture Index, Arch Index and normalised navicular height. A five segment foot model was used to measure tri-planar motion of the rearfoot, midfoot, medial forefoot, lateral forefoot and hallux during barefoot walking at a self-selected speed. Angle at heel contact, peak angle, time to peak angle and range of motion was measured for each segment. One way ANOVAs with post-hoc analyses of mean differences were used to compare foot posture groups. The pes cavus group demonstrated a distinctive pattern of motion compared to the normal and pes planus foot posture groups. Effect sizes of significant mean differences were large and comparable to similar studies. Three key differences in overall foot function were observed between the groups: (i) altered frontal and transverse plane angles of the rearfoot in the pes cavus foot; (ii) Less midfoot motion in the pes cavus foot during initial contact and midstance; and (iii) reduced midfoot frontal plane ROM in the pes planus foot during pre-swing. These findings indicate that foot posture does influence motion of the foot. Copyright © 2015 Elsevier B.V. All rights reserved.

The influence of the Peroneus Longus muscle on the foot under axial loading: A CT evaluated dynamic cadaveric model study.

PubMed

Dullaert, K; Hagen, J; Klos, K; Gueorguiev, B; Lenz, M; Richards, R G; Simons, P

2016-05-01

Subtle hypermobility of the first tarsometatarsal joint can occur concomitantly with other pathologies and may be difficult to diagnose. Peroneus Longus muscle might influence stability of this joint. Collapse of the medial longitudinal arch is common in flatfoot deformity and the muscle might also play a role in correcting Meary's angle. A radiolucent frame was used to simulate weightbearing during CT examination. Eight pairs fresh-frozen lower legs were imaged in neutral position under non-weightbearing (75N), weightbearing (700N) and with 15kg weights hung from Peroneus Longus tendon. Measurements included first metatarsal rotation, intermetatarsal angle, first tarsometatarsal joint subluxation and Meary's angle. Weightbearing significantly increased Meary's angle and significantly decreased first tarsometatarsal joint subluxation (both P<0.01). Pulling Peroneus Longus tendon significantly increased first metatarsal rotation (P<0.01), significantly decreased the intermetatarsal angle (P<0.01) and increased non-significantly Meary's angle (P=0.52). A considerable effect weightbearing has on the medial longitudinal arch and first tarsometatarsal joint was observed. Pulling Peroneus Longus tendon improved first metatarsal subluxation but increased its rotation. The study calls into question the importance of this tendon in maintaining the medial longitudinal arch and raises concerns about rotational deformity of the first metatarsal following hallux valgus correction without first tarsometatarsal arthrodesis. Study outcomes will provide more insight in foot pathology. Weightbearing affects anatomy of the foot. No reliable information is available concerning the influence of the Peroneus muscle. This study investigates the influence of weightbearing and the impact the Peroneus muscle on the anatomy of the foot. Copyright © 2016. Published by Elsevier Ltd.

An Apparatus to Quantify Anteroposterior and Mediolateral Shear Reduction in Shoe Insoles

PubMed Central

Belmont, Barry; Wang, Yancheng; Ammanath, Peethambaran; Wrobel, James S.; Shih, Albert

2013-01-01

Background Many of the physiological changes that lead to diabetic foot ulceration, such as muscle atrophy and skin hardening, are manifested at the foot–ground interface via pressure and shear points. Novel shear-reducing insoles have been developed, but their magnitude of shear stiffness has not yet been compared with regular insoles. The aim of this study was to develop an apparatus that would apply shear force and displacement to an insole’s forefoot region, reliably measure deformation, and calculate insole shear stiffness. Methods An apparatus consisting of suspended weights was designed to test the forefoot region of insoles. Three separate regions representing the hallux; the first and second metatarsals; and the third, fourth, and fifth metatarsals were sheared at 20 mm/min for displacements from 0.1 to 1.0 mm in both the anteroposterior and mediolateral directions for two types of insoles (regular and shear reducing). Results Shear reduction was found to be significant for the intervention insoles under all testing conditions. The ratio of a regular insole’s effective stiffness and the experimental insole’s effective stiffness across forefoot position versus shear direction, gait instance versus shear direction, and forefoot position versus gait instance was 270% ± 79%, 270% ± 96%, and 270% ± 86%, respectively. The apparatus was reliable with an average measured coefficient of variation of 0.034 and 0.069 for the regular and shear-reducing insole, respectively. Conclusions An apparatus consisting of suspended weights resting atop three locations of interest sheared across an insole was demonstrated to be capable of measuring the insole shear stiffness accurately, thus quantifying shear-reducing effects of a new type of insole. PMID:23567000

Foot and ankle problems in Muay Thai kickboxers.

PubMed

Vaseenon, Tanawat; Intharasompan, Piyapong; Wattanarojanapom, Thongaek; Theeraamphon, Nipon; Auephanviriyakul, Sansanee; Phisitkul, Phinit

2015-01-01

Muay Thai kickboxing is a common sport that uses the foot and ankle in fighting. Muay Thai kickboxing trainees usually receive training in Thailand Foot and ankle problems in this group ofpeople who usually train barefoot remain unexplored To evaluate the prevalence of common foot and ankle problems in Muay Thai kick boxers. The present study is a cross-sectional survey of Muay Thai kick boxers practicing in northern Thailand. Interviews were conducted and foot and ankle examinations were evaluated Foot morphology was examined using a Harris mat footprint. One hundred and twenty-three Muay Thai kickbox ersinnine training gyms were included in this study. Common foot and ankle problems found in the Muay Thai kick boxers were callosity (59%), gastrocnemius contracture (57%), toe deformities (49.3%), wounds (10%) and heel pain (9%). Callosity was most commonly found on the forefoot (77.5%), on the plantar first metatarsal (55.3%) and on the big toe (33.3%). An association was found between a tight heel cord and a history of foot injury with prolonged periods of weekly training. Toe deformities such as hallux rigidus (37.6%) were also associated with prolonged periods of training (p = 0.001). No correlation was found between type of foot arch and foot and ankle problems. Plantar forefoot callosities and wounds as well as toe deformities including tight heel cords are some of the foot and ankle problems commonly found in Muay Thai kick boxers. They are associated with prolonged periods of barefoot training. The unique pattern of training and of the kicks in Muay Thai might be a path mechanism, leading to the development of foot and ankle problems.

Ultrasound-guided therapeutic injections for neural pathology about the foot and ankle: a 4 year retrospective review.

PubMed

Walter, William R; Burke, Christopher J; Adler, Ronald S

2017-06-01

To describe a 4-year clinical experience with ultrasound-guided therapeutic perineural injections of peripheral nerves about the foot and ankle. Retrospective analysis of foot and ankle perineural injections performed between January 2012 and August 2016. Demographics, clinical indications, presence of structural pathology, immediate and interval pain relief, as well as complications were recorded. Fifty-nine therapeutic injections were performed among 46 patients, accounting for multiple injections in a single visit or multiple visits [mean age = 43 years (range 18-75), 31 female (67%) and 15 male (33%)]. Most commonly, perineural injections involved the hallux branch of the medial plantar nerve (n = 17, 22%). Least commonly, perineural injections involved the saphenous nerve (n = 3, 4%). Other injections in our series include sural (10), superficial (11) and deep (7) peroneal, medial (5) and lateral (3) plantar nerves, and the posterior tibial nerve (3). Ultrasound evaluation revealed structural abnormality associated with the nerve in 30 cases (51%)-most commonly thickening with perineural scarring (n = 14). Of 45 injections with complete documentation, immediate relief of symptoms was reported in 43 (96%) cases. Interval symptom relief was achieved in 23 injections [short term (n = 12), intermediate (n = 6), and long term (n = 5)] out of 38 for which follow-up was available (61%). Complications are rare, occurring in only one case. Ultrasound-guided perineural injections about the foot and ankle are safe and provide lasting symptomatic relief for many indications. Concomitant sonographic evaluation identifies structural abnormalities that may contribute to neuropathic symptoms, allowing targeting of injection or clinical therapy.

The influence of cadence and power output on force application and in-shoe pressure distribution during cycling by competitive and recreational cyclists.

PubMed

Sanderson, D J; Hennig, E M; Black, A H

2000-03-01

The aim of this study was to determine the response of cyclists to manipulations of cadence and power output in terms of force application and plantar pressure distribution. Two groups of cyclists, 17 recreational and 12 competitive, rode at three nominal cadences (60, 80, 100 rev x min(-1)) and four power outputs (100, 200, 300, 400 W) while simultaneous force and in-shoe pressure data were collected. Two piezoelectric triaxial force transducers mounted in the right pedal measured components of the pedal force and orientation, and a discrete transducer system with 12 transducers recorded the in-shoe pressures. Force application was characterized by calculating peak resultant and peak effective pedal forces and positive and negative impulses. In-shoe pressures were analysed as peak pressures and as the percent relative load. The force data showed no significant group effect but there was a cadence and power main effect. The impulse data showed a significant three-way interaction. Increased cadence resulted in a decreased positive impulse, while increased power output resulted in an increased impulse. The competitive group produced less positive impulse but the difference became less at higher cadences. Few between-group differences were found in pressure, notable only in the pressure under the first metatarsal region. This showed a consistent pattern of in-shoe pressure distribution, where the primary loading structures were the first metatarsal and hallux. There was no indication that pressure at specific sites influenced the pedal force application. The absence of group differences indicated that pressure distribution was not the result of training, but reflected the intrinsic relationship between the foot, the shoe and the pedal.

The structure, organisation and perioperative management of ambulatory surgery and anaesthesia in France: Methodology of the SFAR-OPERA study.

PubMed

Albaladejo, Pierre; Aubrun, Frédéric; Samama, Charles-Marc; Jouffroy, Laurent; Beaussier, Marc; Benhamou, Dan; Romegoux, Pauline; Skaare, Kristina; Bosson, Jean-Luc; Ecoffey, Claude

2017-10-01

The organization of health care establishments and perioperative care are essential for ensuring the quality of care and safety of patients undergoing outpatient surgery. In order to correctly inventory these organizations and practices, in 2013-2014, the French society of anaesthesia and intensive care organized an extensive practical survey in French ambulatory surgery units entitled the "OPERA" study (Organisation periopératoire de l'anesthésie en chirurgie ambulatoire). From among all of the ambulatory surgery centres listed by the Agences régionales de santé (Regional health agencies, France), 206 public and private centres were randomly selected. A structural (typology, organization) survey and a medical-practice survey (focusing on the management of postoperative pain, nausea and vomiting as well as the prevention of venous thromboembolism) were collected and managed by a prospective audit of practices occurring on two randomly selected days. The latter was further accompanied by an additional audit specifically focussing on ten representative procedures: (1) stomatology surgery (third molar removal); (2) knee arthroscopy; (3) surgery of the abdominal wall (including inguinal hernia); (4) perianal surgery; (5) varicose vein surgery; (6) digestive laparoscopy-cholecystectomy; (7) breast surgery (tumourectomy); (8) uterine surgery; (9) hallux valgus and (10) hand surgery (excluding carpal tunnel). Over the 2 days of observation, 7382 patients were included comprising 2174 patients who underwent one of the procedures from the above list. The analysis of these data will provide an overview of the organization of health establishments, the modalities thus supported and compliance with standards. Copyright © 2016 Société française d'anesthésie et de réanimation (Sfar). Published by Elsevier Masson SAS. All rights reserved.

Surface electromyography and plantar pressure changes with novel gait training device in participants with chronic ankle instability.

PubMed

Feger, Mark A; Hertel, Jay

2016-08-01

Rehabilitation is ineffective at restoring normal gait in chronic ankle instability patients. Our purpose was to determine if a novel gait-training device could decrease plantar pressure on the lateral column of the foot in chronic ankle instability patients. Ten chronic ankle instability patients completed 30s trials of baseline and gait-training walking at a self-selected pace while in-shoe plantar pressure and surface electromyography were recorded from their anterior tibialis, peroneus longus, medial gastrocnemius, and gluteus medius. The gait-training device applied a medially-directed force to the lower leg via elastic bands during the entire gait cycle. Plantar pressure measures of the entire foot and 9 specific regions of the foot as well as surface electromyography root mean square areas were compared between the baseline and gait-training conditions using paired t-tests with a priori level of significance of p≤0.05. The gait-training device decreased pressure time integrals and peak pressures in the lateral midfoot (p=0.003 and p=0.003) and lateral forefoot (p=0.023 and p=0.005), and increased pressure time integrals and peak pressures for the total foot (p=0.030 and p=0.017) and hallux (p=0.005 and p=0.002). The center of pressure was shifted medially during the entire stance phase (p<0.003 for all comparisons) due to increased peroneus longus activity prior to (p=0.002) and following initial contact (p=0.002). The gait-training device decreased pressure on the lateral column of the foot and increased peroneus longus muscle activity. Future research should analyze the efficacy of the gait-training device during gait retraining for chronic ankle instability. Copyright © 2016 Elsevier Ltd. All rights reserved.

Foot and ankle kinematics in patients with posterior tibial tendon dysfunction.

PubMed

Ness, Mary Ellen; Long, Jason; Marks, Richard; Harris, Gerald

2008-02-01

The purpose of this study is to provide a quantitative characterization of gait in patients with posterior tibial tendon dysfunction (PTTD), including temporal-spatial and kinematic parameters, and to compare these results to those of a Normal population. Our hypothesis was that segmental foot kinematics were significantly different in multiple segments across multiple planes. A 15 camera motion analysis system and weight-bearing radiographs were employed to evaluate 3D foot and ankle motion in a population of 34 patients with PTTD (30 females, 4 males) and 25 normal subjects (12 females, 13 males). The four-segment Milwaukee Foot Model (MFM) with radiographic indexing was used to analyze foot and ankle motion and provided kinematic data in the sagittal, coronal and transverse planes as well as temporal-spatial information. The temporal-spatial parameters revealed statistically significant deviations in all four metrics for the PTTD population. Stride length, cadence and walking speed were all significantly diminished, while stance duration was significantly prolonged (p<0.0125). Significant kinematic differences were noted between the groups (p<0.002), including: (1) diminished dorsiflexion and increased eversion of the hindfoot; (2) decreased plantarflexion of the forefoot, as well as abduction shift and loss of the varus thrust in the forefoot; and (3) decreased range of motion (ROM) with diminished dorsiflexion of the hallux. The study provides an impetus for improved orthotic and bracing designs to aid in the care of distal foot segments during the treatment of PTTD. It also provides the basis for future evaluation of surgical efficacy. The course of this investigation may ultimately lead to improved treatment planning methods, including orthotic and operative interventions.

Foot health and self-care activities of older people in home care.

PubMed

Stolt, Minna; Suhonen, Riitta; Puukka, Pauli; Viitanen, Matti; Voutilainen, Päivi; Leino-Kilpi, Helena

2012-11-01

To assess the foot health of older people and their self-care activities in home care. The ultimate goal is to prevent foot problems in older people and to develop the assessment skills of nurses working in home care. Foot health problems are one reason why older people seek home care services. These problems are prevalent in older people, and they can impair performance of daily activities and threaten functional ability. However, studies in this field have concentrated on foot problems related to specific diseases. Non-disease-related research on foot health from the preventative perspective is lacking. A descriptive explorative design was used. The foot health of older people was assessed by visiting home nurses with the Foot Health Assessment Instrument, and older people's foot self-care activities were evaluated with the Foot Self-Care Activities Structured Interview in 2010. The data were analysed statistically. Older people in home care have multiple foot health problems. The most prevalent problems were oedema, dry skin, thickened and discoloured toenails and hallux valgus. Caring for one's feet was a problem for many older people. Older people's foot health needs to be assessed regularly to recognise foot health and self-care problems. Health care professionals have a vital role in preventing, recognising and caring for foot health in older people. The foot health of older people needs to be improved by supporting older people in foot self-care and developing preventive nursing interventions. Regular foot health assessments and their documentation are crucial in preventing serious foot problems in older people. Moreover, multiprofessional collaboration is important to promote foot health in older people. © 2012 Blackwell Publishing Ltd.

Prediction of plantar shear stress distribution by artificial intelligence methods.

PubMed

Yavuz, Metin; Ocak, Hasan; Hetherington, Vincent J; Davis, Brian L

2009-09-01

Shear forces under the human foot are thought to be responsible for various foot pathologies such as diabetic plantar ulcers and athletic blisters. Frictional shear forces might also play a role in the metatarsalgia observed among hallux valgus (HaV) and rheumatoid arthritis (RA) patients. Due to the absence of commercial devices capable of measuring shear stress distribution, a number of linear models were developed. All of these have met with limited success. This study used nonlinear methods, specifically neural network and fuzzy logic schemes, to predict the distribution of plantar shear forces based on vertical loading parameters. In total, 73 subjects were recruited; 17 had diabetic neuropathy, 14 had HaV, 9 had RA, 11 had frequent foot blisters, and 22 were healthy. A feed-forward neural network (NN) and adaptive neurofuzzy inference system (NFIS) were built. These systems were then applied to a custom-built platform, which collected plantar pressure and shear stress data as subjects walked over the device. The inputs to both models were peak pressure, peak pressure-time integral, and time to peak pressure, and the output was peak resultant shear. Root-mean-square error (RMSE) values were calculated to test the models' accuracy. RMSE/actual shear ratio varied between 0.27 and 0.40 for NN predictions. Similarly, NFIS estimations resulted in a 0.28-0.37 ratio for local peak values in all subject groups. On the other hand, error percentages for global peak shear values were found to be in the range 11.4-44.1. These results indicate that there is no direct relationship between pressure and shear magnitudes. Future research should aim to decrease error levels by introducing shear stress dependent variables into the models.

Increasing preferred step rate during running reduces plantar pressures.

PubMed

Gerrard, James M; Bonanno, Daniel R

2018-01-01

Increasing preferred step rate during running is a commonly used strategy in the management of running-related injuries. This study investigated the effect of different step rates on plantar pressures during running. Thirty-two healthy runners ran at a comfortable speed on a treadmill at five step rates (preferred, ±5%, and ±10%). For each step rate, plantar pressure data were collected using the pedar-X in-shoe system. Compared to running with a preferred step rate, a 10% increase in step rate significantly reduced peak pressure (144.5±46.5 vs 129.3±51 kPa; P=.033) and maximum force (382.3±157.6 vs 334.0±159.8 N; P=.021) at the rearfoot, and reduced maximum force (426.4±130.4 vs 400.0±116.6 N; P=.001) at the midfoot. In contrast, a 10% decrease in step rate significantly increased peak pressure (144.5±46.5 vs 161.5±49.3 kPa; P=.011) and maximum force (382.3±157.6 vs 425.4±155.3 N; P=.032) at the rearfoot. Changing step rate by 5% provided no effect on plantar pressures, and no differences in plantar pressures were observed at the medial forefoot, lateral forefoot or hallux between the step rates. This study's findings indicate that increasing preferred step rate by 10% during running will reduce plantar pressures at the rearfoot and midfoot, while decreasing step rate by 10% will increase plantar pressures at the rearfoot. However, changing preferred step rate by 5% will provide no effect on plantar pressures, and forefoot pressures are unaffected by changes in step rate. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Biomechanical Effects of Prefabricated Foot Orthoses and Rocker‐Sole Footwear in Individuals With First Metatarsophalangeal Joint Osteoarthritis

PubMed Central

Auhl, Maria; Tan, Jade M.; Levinger, Pazit; Roddy, Edward; Munteanu, Shannon E.

2016-01-01

Objective To evaluate the effects of prefabricated foot orthoses and rocker‐sole footwear on spatiotemporal parameters, hip and knee kinematics, and plantar pressures in people with first metatarsophalangeal (MTP) joint osteoarthritis (OA). Methods. A total of 102 people with first MTP joint OA were randomly allocated to receive prefabricated foot orthoses or rocker‐sole footwear. The immediate biomechanical effects of the interventions (compared to usual footwear) were examined using a wearable sensor motion analysis system and an in‐shoe plantar pressure measurement system. Results Spatiotemporal/kinematic and plantar pressure data were available from 88 and 87 participants, respectively. The orthoses had minimal effect on spatiotemporal or kinematic parameters, while the rocker‐sole footwear resulted in reduced cadence, percentage of the gait cycle spent in stance phase, and sagittal plane hip range of motion. The orthoses increased peak pressure under the midfoot and lesser toes. Both interventions significantly reduced peak pressure under the first MTP joint, and the rocker‐sole shoes also reduced peak pressure under the second through fifth MTP joints and heel. When the effects of the orthoses and rocker‐sole shoes were directly compared, there was no difference in peak pressure under the hallux, first MTP joint, or heel; however, the rocker‐sole shoes exhibited lower peak pressure under the lesser toes, second through fifth MTP joints, and midfoot. Conclusion Prefabricated foot orthoses and rocker‐sole footwear are effective at reducing peak pressure under the first MTP joint in people with first MTP joint OA, but achieve this through different mechanisms. Further research is required to determine whether these biomechanical changes result in improvements in symptoms. PMID:26640157

Foot posture is associated with plantar pressure during gait: A comparison of normal, planus and cavus feet.

PubMed

Buldt, Andrew K; Forghany, Saeed; Landorf, Karl B; Levinger, Pazit; Murley, George S; Menz, Hylton B

2018-03-05

Variations in foot posture, such as pes planus (low medial longitudinal arch) or pes cavus (high medial longitudinal arch) are associated with some lower limb injuries. However, the mechanism that links foot posture to injury is not clear. Research question The aim of this study was to compare plantar pressure between healthy individuals with normal, planus or cavus feet. Ninety-two healthy volunteers (aged 18 to 45) were classified as either normal (n = 35), pes planus (n = 31) or pes cavus (n = 26) based on the Foot Posture Index, Arch Index and normalised navicular height truncated. Barefoot walking trials were conducted using an emed ® -x400 plantar pressure system (Novel GmbH, Munich, Germany). An 11 region mask was used that included the medial heel, lateral heel, midfoot, 1st, 2nd, 3rd, 4th and 5th metatarsophalangeal joints, hallux, 2nd toe, and the 3rd, 4th and 5th toes. Peak pressure, pressure-time integral, maximum force, force-time integral and contact area were calculated for each region. One way analyses of variance and effect sizes were used to compare the three foot posture groups. Overall, the largest differences were between the planus and cavus foot groups in forefoot pressure and force. In particular, peak pressures at the 4th and 5th MTPJs in the planus foot group were lower compared to the normal and cavus foot groups, and displayed the largest effect sizes. Significance This study confirms that foot posture does influence plantar pressures, and that each foot posture classification displays unique plantar pressure characteristics. Copyright © 2018 Elsevier B.V. All rights reserved.

Immediate Weightbearing After First Metatarsophalangeal Joint Arthrodesis With Screw and Locking Plate Fixation: A Short-Term Review.

PubMed

Abben, Kyle W; Sorensen, Matthew D; Waverly, Brett J

2018-05-08

Historically, the postoperative protocol for patients undergoing first metatarsophalangeal joint arthrodesis has included 6 weeks of non-weightbearing, followed by protected weightbearing in a below-the-knee cast boot or postoperative shoe. This prolonged period of non-weightbearing predisposes the patient to disuse atrophy, osteopenia, deep vein thrombosis risk, and, overall, a prolonged time to recovery. The present study reports a retrospective review of a patient cohort that underwent first metatarsophalangeal joint fusion with immediate full weightbearing postoperatively. Thirty consecutive first metatarsophalangeal joint arthrodeses were performed during the study period. Five patients were excluded secondary to insufficient postoperative follow-up data or a lack of adequate radiographic evaluation at regular postoperative intervals. Conical reamers were used for joint preparation. Internal fixation, consisting of a single cannulated interfragmentary compression screw and a dorsal locking plate, was used in all patients. The results showed that patients achieved clinical healing at an average of 5.92 weeks and showed radiographic fusion at an average of 6.83 weeks. The patients in the present study had an overall union rate of 96%. Complications included 1 nonunion, 1 superficial wound infection, 1 wound dehiscence, 1 case of symptomatic hardware, and 2 patients with symptomatic hallux interphalangeal joint arthralgia. The mean visual analog pain score preoperatively was 6.64 (range 4 to 8) and postoperatively was 0.6 (range 0 to 4). In conclusion, we found that immediate full weightbearing after first metatarsophalangeal joint fusion in the context of interfragmentary compression and locked plating techniques is a safe, predictable postoperative protocol that allows for a successful fusion interval and an early return to regular activity. Copyright © 2018 The American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

Physiological complexity and system adaptability: evidence from postural control dynamics of older adults.

PubMed

Manor, Brad; Costa, Madalena D; Hu, Kun; Newton, Elizabeth; Starobinets, Olga; Kang, Hyun Gu; Peng, C K; Novak, Vera; Lipsitz, Lewis A

2010-12-01

The degree of multiscale complexity in human behavioral regulation, such as that required for postural control, appears to decrease with advanced aging or disease. To help delineate causes and functional consequences of complexity loss, we examined the effects of visual and somatosensory impairment on the complexity of postural sway during quiet standing and its relationship to postural adaptation to cognitive dual tasking. Participants of the MOBILIZE Boston Study were classified into mutually exclusive groups: controls [intact vision and foot somatosensation, n = 299, 76 ± 5 (SD) yr old], visual impairment only (<20/40 vision, n = 81, 77 ± 4 yr old), somatosensory impairment only (inability to perceive 5.07 monofilament on plantar halluxes, n = 48, 80 ± 5 yr old), and combined impairments (n = 25, 80 ± 4 yr old). Postural sway (i.e., center-of-pressure) dynamics were assessed during quiet standing and cognitive dual tasking, and a complexity index was quantified using multiscale entropy analysis. Postural sway speed and area, which did not correlate with complexity, were also computed. During quiet standing, the complexity index (mean ± SD) was highest in controls (9.5 ± 1.2) and successively lower in the visual (9.1 ± 1.1), somatosensory (8.6 ± 1.6), and combined (7.8 ± 1.3) impairment groups (P = 0.001). Dual tasking resulted in increased sway speed and area but reduced complexity (P < 0.01). Lower complexity during quiet standing correlated with greater absolute (R = -0.34, P = 0.002) and percent (R = -0.45, P < 0.001) increases in postural sway speed from quiet standing to dual-tasking conditions. Sensory impairments contributed to decreased postural sway complexity, which reflected reduced adaptive capacity of the postural control system. Relatively low baseline complexity may, therefore, indicate control systems that are more vulnerable to cognitive and other stressors.

Physiological complexity and system adaptability: evidence from postural control dynamics of older adults

PubMed Central

Costa, Madalena D.; Hu, Kun; Newton, Elizabeth; Starobinets, Olga; Kang, Hyun Gu; Peng, C. K.; Novak, Vera; Lipsitz, Lewis A.

2010-01-01

The degree of multiscale complexity in human behavioral regulation, such as that required for postural control, appears to decrease with advanced aging or disease. To help delineate causes and functional consequences of complexity loss, we examined the effects of visual and somatosensory impairment on the complexity of postural sway during quiet standing and its relationship to postural adaptation to cognitive dual tasking. Participants of the MOBILIZE Boston Study were classified into mutually exclusive groups: controls [intact vision and foot somatosensation, n = 299, 76 ± 5 (SD) yr old], visual impairment only (<20/40 vision, n = 81, 77 ± 4 yr old), somatosensory impairment only (inability to perceive 5.07 monofilament on plantar halluxes, n = 48, 80 ± 5 yr old), and combined impairments (n = 25, 80 ± 4 yr old). Postural sway (i.e., center-of-pressure) dynamics were assessed during quiet standing and cognitive dual tasking, and a complexity index was quantified using multiscale entropy analysis. Postural sway speed and area, which did not correlate with complexity, were also computed. During quiet standing, the complexity index (mean ± SD) was highest in controls (9.5 ± 1.2) and successively lower in the visual (9.1 ± 1.1), somatosensory (8.6 ± 1.6), and combined (7.8 ± 1.3) impairment groups (P = 0.001). Dual tasking resulted in increased sway speed and area but reduced complexity (P < 0.01). Lower complexity during quiet standing correlated with greater absolute (R = −0.34, P = 0.002) and percent (R = −0.45, P < 0.001) increases in postural sway speed from quiet standing to dual-tasking conditions. Sensory impairments contributed to decreased postural sway complexity, which reflected reduced adaptive capacity of the postural control system. Relatively low baseline complexity may, therefore, indicate control systems that are more vulnerable to cognitive and other stressors. PMID:20947715

Blood supply to the first metatarsal head and vessels at risk with a chevron osteotomy.

PubMed

Malal, J J George; Shaw-Dunn, J; Kumar, C Senthil

2007-09-01

Chevron osteotomy, a commonly performed procedure for the treatment of hallux valgus, results in osteonecrosis of the first metatarsal head in 0% to 20% of cases. The aim of this study was to map out the arrangement of the vascular supply to the first metatarsal head and its relationship to the limbs of the chevron osteotomy. Ten cadaveric lower limbs were injected with an India ink-latex mixture, and the feet were dissected to assess the blood supply to the first metatarsal head. The dissection was carried out by tracing the branches of the dorsalis pedis and posterior tibial vessels. A distal chevron osteotomy was mapped, with the limbs of the osteotomy set at an angle of 60 degrees from the geometric center of the first metatarsal head. The relationship of the limbs of the osteotomy to the blood vessels was recorded. The first metatarsal head was found to be supplied by branches from the first dorsal metatarsal, first plantar metatarsal, and medial plantar arteries. The first dorsal metatarsal artery was the dominant vessel among the three arteries in eight specimens. All of the vessels formed a plexus at the plantar-lateral aspect of the metatarsal neck, just proximal to the capsular attachment, with a varying number of branches from the plexus then entering the metatarsal head. The plantar limb of the proposed chevron cuts exited through this plexus of vessels in all specimens. Contrary to the widely held view, only minor vascular branches could be found entering the dorsal aspect of the neck. The identification of the plantar-lateral corner of the metatarsal neck as the major site of vascular ingress into the first metatarsal head suggests that constructing the chevron osteotomy with a long plantar limb exiting well proximal to the capsular attachment may decrease the postoperative prevalence of osteonecrosis of the first metatarsal head.

Determining the maximum diameter for holes in the shoe without compromising shoe integrity when using a multi-segment foot model.

PubMed

Shultz, Rebecca; Jenkyn, Thomas

2012-01-01

Measuring individual foot joint motions requires a multi-segment foot model, even when the subject is wearing a shoe. Each foot segment must be tracked with at least three skin-mounted markers, but for these markers to be visible to an optical motion capture system holes or 'windows' must be cut into the structure of the shoe. The holes must be sufficiently large avoiding interfering with the markers, but small enough that they do not compromise the shoe's structural integrity. The objective of this study was to determine the maximum size of hole that could be cut into a running shoe upper without significantly compromising its structural integrity or changing the kinematics of the foot within the shoe. Three shoe designs were tested: (1) neutral cushioning, (2) motion control and (3) stability shoes. Holes were cut progressively larger, with four sizes tested in all. Foot joint motions were measured: (1) hindfoot with respect to midfoot in the frontal plane, (2) forefoot twist with respect to midfoot in the frontal plane, (3) the height-to-length ratio of the medial longitudinal arch and (4) the hallux angle with respect to first metatarsal in the sagittal plane. A single subject performed level walking at her preferred pace in each of the three shoes with ten repetitions for each hole size. The largest hole that did not disrupt shoe integrity was an oval of 1.7cm×2.5cm. The smallest shoe deformations were seen with the motion control shoe. The least change in foot joint motion was forefoot twist in both the neutral shoe and stability shoe for any size hole. This study demonstrates that for a hole smaller than this size, optical motion capture with a cluster-based multi-segment foot model is feasible for measure foot in shoe kinematics in vivo. Copyright © 2011. Published by Elsevier Ltd.

Ultrasound guided injection inside the common sheath of the sciatic nerve at division level has a higher success rate than an injection outside the sheath.

PubMed

Lopez, A M; Sala-Blanch, X; Castillo, R; Hadzic, A

2014-01-01

The recommendations for the level of injection and ideal placement of the needle tip required for successful ultrasound-guided sciatic popliteal block vary among authors. A hypothesis was made that, when the local anesthetic is injected at the division of the sciatic nerve within the common connective tissue sheath, the block has a higher success rate than an injection outside the sheath. Thirty-four patients scheduled for hallux valgus repair surgery were randomized to receive either a sub-sheath block (n=16) or a peri-sheath block (n=18) at the level of the division of the sciatic nerve at the popliteal fossa. For the sub-sheath block, the needle was advanced out of plane until the tip was positioned between the tibial and peroneal nerves, and local anesthetic was then injected without moving the needle. For the peri-sheath block, the needle was advanced out of plane both sides of the sciatic nerve, to surround the sheath. Mepivacaine 1.5% and levobupivacaine 0.5% 30mL were used in both groups. The progression of motor and sensory block was assessed at 5min intervals. Duration of block was recorded. Adequate surgical block was achieved in all patients in the subsheath group (100%) compared to 12 patients (67%) in the peri-sheath group at 30min. Sensory block was achieved faster in the subsheath than peri-sheath (9.1±7.4min vs. 19.0±4.0; p<.001). Our study suggests that for successful sciatic popliteal block in less than 30min, local anesthetic should be injected within the sheath. Copyright © 2013 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Published by Elsevier España. All rights reserved.

Real-time subject-specific monitoring of internal deformations and stresses in the soft tissues of the foot: a new approach in gait analysis.

PubMed

Yarnitzky, G; Yizhar, Z; Gefen, A

2006-01-01

No technology is presently available to provide real-time information on internal deformations and stresses in plantar soft tissues of individuals during evaluation of the gait pattern. Because internal deformations and stresses in the plantar pad are critical factors in foot injuries such as diabetic foot ulceration, this severely limits evaluation of patients. To allow such real-time subject-specific analysis, we developed a hierarchal modeling system which integrates a two-dimensional gross structural model of the foot (high-order model) with local finite element (FE) models of the plantar tissue padding the calcaneus and medial metatarsal heads (low-order models). The high-order whole-foot model provides real-time analytical evaluations of the time-dependent plantar fascia tensile forces during the stance phase. These force evaluations are transferred, together with foot-shoe local reaction forces, also measured in real time (under the calcaneus, medial metatarsals and hallux), to the low-order FE models of the plantar pad, where they serve as boundary conditions for analyses of local deformations and stresses in the plantar pad. After careful verification of our custom-made FE solver and of our foot model system with respect to previous literature and against experimental results from a synthetic foot phantom, we conducted human studies in which plantar tissue loading was evaluated in real time during treadmill gait in healthy individuals (N = 4). We concluded that internal deformations and stresses in the plantar pad during gait cannot be predicted from merely measuring the foot-shoe force reactions. Internal loading of the plantar pad is constituted by a complex interaction between the anatomical structure and mechanical behavior of the foot skeleton and soft tissues, the body characteristics, the gait pattern and footwear. Real-time FE monitoring of internal deformations and stresses in the plantar pad is therefore required to identify elevated deformation/stress exposures toward utilizing it in gait laboratories to protect feet that are susceptible to injury.

Cortical Structure of Hallucal Metatarsals and Locomotor Adaptations in Hominoids

PubMed Central

Jashashvili, Tea; Dowdeswell, Mark R.; Lebrun, Renaud; Carlson, Kristian J.

2015-01-01

Diaphyseal morphology of long bones, in part, reflects in vivo loads experienced during the lifetime of an individual. The first metatarsal, as a cornerstone structure of the foot, presumably expresses diaphyseal morphology that reflects loading history of the foot during stance phase of gait. Human feet differ substantially from those of other apes in terms of loading histories when comparing the path of the center of pressure during stance phase, which reflects different weight transfer mechanisms. Here we use a novel approach for quantifying continuous thickness and cross-sectional geometric properties of long bones in order to test explicit hypotheses about loading histories and diaphyseal structure of adult chimpanzee, gorilla, and human first metatarsals. For each hallucal metatarsal, 17 cross sections were extracted at regularly-spaced intervals (2.5% length) between 25% and 65% length. Cortical thickness in cross sections was measured in one degree radially-arranged increments, while second moments of area were measured about neutral axes also in one degree radially-arranged increments. Standardized thicknesses and second moments of area were visualized using false color maps, while penalized discriminant analyses were used to evaluate quantitative species differences. Humans systematically exhibit the thinnest diaphyseal cortices, yet the greatest diaphyseal rigidities, particularly in dorsoplantar regions. Shifts in orientation of maximum second moments of area along the diaphysis also distinguish human hallucal metatarsals from those of chimpanzees and gorillas. Diaphyseal structure reflects different loading regimes, often in predictable ways, with human versus non-human differences probably resulting both from the use of arboreal substrates by non-human apes and by differing spatial relationships between hallux position and orientation of the substrate reaction resultant during stance. The novel morphological approach employed in this study offers the potential for transformative insights into form-function relationships in additional long bones, including those of extinct organisms (e.g., fossils). PMID:25635768

First metatarsal-phalangeal joint arthrodesis: a biomechanical assessment of stability.

PubMed

Politi, Joel; John, Hayes; Njus, Glen; Bennett, Gordon L; Kay, David B

2003-04-01

First metatarsal phalangeal joint (MTP) arthrodesis is a commonly performed procedure for the treatment of hallux rigidus, severe and recurrent bunion deformities, rheumatoid arthritis and other less common disorders of the joint. There are different techniques of fixation of the joint to promote arthrodesis including oblique lag screw fixation, lag screw and dorsal plate fixation, crossed Kirschner wires, dorsal plate fixation alone and various types of external fixation. Ideally the fixation method should be reproducible, lead to a high rate of fusion, and have a low incidence of complications. In the present study, we compared the strength of fixation of five commonly utilized techniques of first MTP joint arthrodesis. These were: 1. Surface excision with machined conical reaming and fixation with a 3.5 mm cortical interfragmentary lag screw. 2. Surface excision with machined conical reaming and fixation with crossed 0.062 Kirschner wires. 3. Surface excision with machined conical reaming and fixation with a 3.5 mm cortical lag screw and a four hole dorsal miniplate secured with 3.5 mm cortical screws. 4. Surface excision with machined conical reaming and fixation with a four hole dorsal miniplate secured with 3.5 mm cortical screws and no lag screw. 5. Planar surface excision and fixation with a single oblique 3.5 mm interfragmentary cortical lag screw. Testing was done on an Instron materials testing device loading the first MTP joint in dorsiflexion. Liquid metal strain gauges were placed over the joint and micromotion was detected with varying loads and cycles. The most stable technique was the combination of machined conical reaming and an oblique interfragmentary lag screw and dorsal plate. This was greater than two times stronger than an oblique lag screw alone. Dorsal plate alone and Kirschner wire fixation were the weakest techniques. First MTP fusion is a commonly performed procedure for the treatment of a variety of disorders of the first MTP joint. The most stable technique for obtaining fusion in this study was the combination of an oblique lag screw and a dorsal plate. This should lead to higher rates of arthrodesis.

The 2016 HIGh Heels: Health effects And psychosexual BenefITS (HIGH HABITS) study: systematic review of reviews and additional primary studies.

PubMed

Barnish, Max; Morgan, Heather May; Barnish, Jean

2017-08-01

High-heeled shoes (high heels) are frequently worn by many women and form an important part of female gender identity. Issues of explicit and implicit compulsion to wear high heels have been noted. Previous studies and reviews have provided evidence that high heels are detrimental to health. However, the evidence base remains fragmented and no review has covered both the epidemiological and biomechanical literature. In addition, no review has considered the psychosexual benefits that offer essential context in understanding the public health challenge of high heels. We searched seven major bibliographic databases up to November 2016, in addition to supplementary searches. We initially identified all review articles of any design that assessed either the psychosexual benefits or negative musculoskeletal health effects of high heels, the latter looking at both the epidemiological and biomechanical perspectives. We additionally considered additional primary studies on areas that had not been reviewed before or in which a marked lack of evidence had been noted. Data were extracted onto standardised forms. Proportionate second review was conducted. A total of 506 unique records were identified, 27 full-text publications were screened and 20 publications (7 reviews and 13 additional studies) were included in our evidence synthesis. The most up-to-date epidemiological review provides clear evidence of an association between high heel wear and hallux valgus, musculoskeletal pain and first-party injury. The body of biomechanical reviews provides clear evidence of changes indicative of increased risk of these outcomes, as well as osteoarthritis, which is not yet evidenced by epidemiological studies. There were no reviews on psychosexual benefits, but all five identified original studies provided evidence of increased attractiveness and/or an impact on men's behaviour associated with high heel wear. With regard to second-party injury, evidence is limited to one descriptive study and eight case reports. Our evidence synthesis clearly shows that high heels bring psychosexual benefits to women but are detrimental to their health. In light of this dilemma, it is important that women's freedom of choice is respected and that any remaining issues of explicit or implicit compulsion are addressed.

Ichnotaxonomy of the Laetoli trackways: The earliest hominin footprints

NASA Astrophysics Data System (ADS)

Meldrum, D. J.; Lockley, Martin G.; Lucas, Spencer G.; Musiba, Charles

2011-04-01

At 3.6 Ma, the Laetoli Pliocene hominin trackways are the earliest direct evidence of hominin bipedalism. Three decades since their discovery, not only is the question of their attribution still discussed, but marked differences in interpretation concerning the footprints' qualitative features and the inferred nature of the early hominin foot morphology remain. Here, we establish a novel ichnotaxon, Praehominipes laetoliensis, for these tracks and clarify the distinctions of these footprints from those of later hominins, especially modern humans. We also contrast hominin, human, and ape footprints to establish morphological features of these footprints correlated with a midtarsal break versus a stiff longitudinal arch. Original photos, including stereo photographs, and casts of footprints from the 1978 Laetoli excavation, confirm midtarsal flexibility, and repeatedly indicate an associated midfoot pressure ridge. In contrast, the modern human footprint reflects the derived arched-foot architecture, combined with a stiff-legged striding gait. Fossilized footprints of unshod modern human pedestrians in Hawaii and Nicaragua unambiguously illustrate these contrasts. Some points of comparisons with ape footprints are complicated by a variable hallucal position and the distinct manner of ape facultative bipedalism. In contrast to the comparatively rigid platform of the modern human foot, midtarsal flexibility is present in the chimpanzee foot. In ape locomotion, flexion at the transverse tarsal joint, referred to as the "midtarsal break," uncouples the respective functions of the prehensile forefoot and the propulsive hindfoot during grasp-climbing. At some point after the transition to habitual bipedalism, these grasp-climb adaptations, presumed to be present in the last common ancestor of apes and humans, were initially compromised by the loss of divergence of the hallux. An analogous trajectory is evident along an array of increasingly terrestrial extant ape species. However, a flexible midfoot was retained, presumably to spare lateral toes from bending stresses by concentrating push-off from the forefoot, beneath the metatarsals. Only later did the evolution of the longitudinal arch permit increased mechanical advantage of the plantarflexors for speed and improved economy of endurance distance walking and running.

Plantar pressures are higher in cases with diabetic foot ulcers compared to controls despite a longer stance phase duration.

PubMed

Fernando, Malindu E; Crowther, Robert G; Lazzarini, Peter A; Sangla, Kunwarjit S; Wearing, Scott; Buttner, Petra; Golledge, Jonathan

2016-09-15

Current international guidelines advocate achieving at least a 30 % reduction in maximum plantar pressure to reduce the risk of foot ulcers in people with diabetes. However, whether plantar pressures differ in cases with foot ulcers to controls without ulcers is not clear. The aim of this study was to assess if plantar pressures were higher in patients with active plantar diabetic foot ulcers (cases) compared to patients with diabetes without a foot ulcer history (diabetes controls) and people without diabetes or a foot ulcer history (healthy controls). Twenty-one cases with diabetic foot ulcers, 69 diabetes controls and 56 healthy controls were recruited for this case-control study. Plantar pressures at ten sites on both feet and stance phase duration were measured using a pre-established protocol. Primary outcomes were mean peak plantar pressure, pressure-time integral and stance phase duration. Non-parametric analyses were used with Holm's correction to correct for multiple testing. Binary logistic regression models were used to adjust outcomes for age, sex and body mass index. Median differences with 95 % confidence intervals and Cohen's d values (standardised mean difference) were reported for all significant outcomes. The majority of ulcers were located on the plantar surface of the hallux and toes. When adjusted for age, sex and body mass index, the mean peak plantar pressure and pressure-time integral of toes and the mid-foot were significantly higher in cases compared to diabetes and healthy controls (p < 0.05). The stance phase duration was also significantly higher in cases compared to both control groups (p < 0.05). The main limitations of the study were the small number of cases studied and the inability to adjust analyses for multiple factors. This study shows that plantar pressures are higher in cases with active diabetic foot ulcers despite having a longer stance phase duration which would be expected to lower plantar pressure. Whether plantar pressure changes can predict ulcer healing should be the focus of future research. These results highlight the importance of offloading feet during active ulceration in addition to before ulceration.

Treatment of Athlete's Plantar Warts Using a Botanical Blend: A Case Report.

PubMed

Nelson, Erik O; Kozin, Adam F; Ruiz, Guillermo; Lasku, Arben; Langland, Jeffrey O

2017-05-01

Context • Viral plantar warts, or verruca plantaris, are a benign epithelial tumor caused by various strains of the human papilloma virus (HPV). Current treatments have had mixed degrees of success, are moderately invasive, and are often incompatible with participation in sports. Objective • The study intended to examine the benefits of treating plantar warts with a topical, botanical blend that has had clinical success treating herpes simplex virus cold sores. Methods • A synergistic botanical blend was applied topically. Setting • The case report was completed at the Southwest College of Naturopathic Medicine (Tempe, Arizona, USA). Participant • The participant was a 24-y-old male soccer player, 177.8 cm tall, and weighing 69 kg with previously diagnosed, viral mosaic warts. Intervention • The patient used a pumice stone during bathing for the first week to remove dead tissue and ensure sufficient contact and entry of the botanical gel into infected tissue. After drying the area, the patient applied the botanical gel blend 1 to 2 times daily postshower, spreading it evenly across the surface of the entire lesion. The patient discontinued the exfoliation technique after the first week. Results • Within the first week of treatment, the patient noted changes to the infected area of the hallux epidermal tissue. The combination of exfoliation and application of the gel caused marked, visible differences in presentation by the fifth day of treatment. At 1-mo postintervention, or day 90, the epidermal tissue was asymptomatic and devoid of petechiae, malformations, or visible infection. Conclusions • The results of the current case study directly contrast with the drawbacks of commonly accepted, first-line interventions in the treatment of viral plantar warts and, in many respects, demonstrate better efficacy and fewer side effects than the standard of care. The positive results also highlight the necessity for additional study in the fields of sports medicine and podiatry to further establish the botanical blend when treating viral plantar in athletes, an overall at-risk population for the condition.

Morphofunctional changes in distribution of pressure center in multiple sclerosis.

PubMed

Neamţu, Marius Cristian; Neamţu, Oana Maria; Enescu Bieru, Denisa; Marin, Mihnea Ion; Rusu, Mihai Robert; Tudorache, Ştefania; Brăila, Anca Daniela; Poiană, Cătălina; Rusu, Ligia

2018-01-01

Gait evaluation and assessment of motor performance are of utmost importance in the clinical management of multiple sclerosis (MS). A new approach to the analysis of static and dynamic balance of MS patients is the use of complex biomechanical analysis that includes an analysis of the distribution of the center of pressure (DCP) and loading, measured by using the pressure and force platforms. The study was conducted on a total of 18 patients with MS, with the mean age of 41.2 years old, divided into two groups, according to the presence of clinically detectable gait disturbances. The biomechanical analysis that included the assessment of the loading and DPC was performed using the platform of force distribution. DPC represented the center of all the forces applied and its value could appreciate the mediolateral stability, hence the pronation or, respectively, the supination. Group 1, consisting of 12 patients with MS with clinically detectable gait disorders, including six men and six women, and group 2, of six MS patients without clinically detectable gait disorders, including two men and four women. For group 1, the center of pressure had a left-right asymmetric distribution, and also an anterior-posterior one. There was a predominant distribution at the medial heel, at metatarsals 1-3 and at the hallux. For group 2, the analysis of the plantograms recorded in our study indicated a tendency of the distribution of the pressure center in the metatarsals 2, 3 and less in the heel. The analysis of the loading and distribution of the pressure center was important not only to appreciate the static equilibrium disorders but also to appreciate how these disorders affected the gait initiation, since the patients suffered from anterior-posterior and mediolateral disorders, which produced spatial and temporal distortion preventing gait initiation. In the study of pressure and force, we noticed a predominant distribution on the lateral region of the heel, explained by an attempt of the body to compensate the disorders of balance and orientation of the reaction force of the ground to normalize the gait.

[Vascular crisis after multiple tissue transplantation for thumb and other finger reconstruction by toe-to-hand transfer].

PubMed

Zhang, Jian; Huang, Jian; Pan, Jiadong; Zhou, Danya; Yin, Shanqing; Li, Junjie; Wang, Xin

2017-03-01

To explore the causes of vascular crisis after thumb and other finger reconstruction by toe-to-hand transfer and effective treatment methods so as to improve the survival rate of transplanted tissues. Between February 2012 and October 2015, 59 cases of thumb and other finger defects were repaired with different hallux nail flaps with the same vascular pedicle flap to reconstruct thumb and other fingers and repair skin defect. The donor site was repaired by a perforator flap. A total of 197 free tissues were involved. There were 46 males and 13 females with the average age of 30.6 years (range, 18-42 years). Vascular crisis occurred in 21 free tissues (10.7%) of 17 patients, including 9 arterial crisis (4.6%) of 8 cases, and 12 venous crisis (6.1%) of 10 cases. Conservative treatment was performed first; in 8 free tissues of 7 cases after failure of conservative treatment, anastomotic thrombosis was found in 5 free tissues of 4 cases, twisted vascular pedicle in 1 free tissue of 1 case, surrounding hematoma in 1 free tissue of 1 case, and anastomotic thrombosis associated with hematoma in 1 free tissue of 1 case, which underwent clearing hematoma, resecting embolization, regulating vascular tension, re-anastomosis or vascular transplantation. In 8 cases of arterial crisis, 5 free tissues of 5 cases survived after conservative treatment; partial necrosis occurred in 1 free tissue (1 case) of 4 free tissues (3 cases) undergoing surgical exploration. In 10 cases of venous crisis, 1 free tissue necrosis and 1 free tissue partial necrosis occurred in 8 free tissues (6 cases) undergoing conservative treatment; partial necrosis occurred in 1 free tissue of 4 free tissues (4 cases) undergoing surgical exploration. Free flap and skin graft were performed on 2 free tissues of 4 cases having flap necrosis respectively. Vascular crisis is complex and harmful to survival of transplanted tissue in reconstruction of the thumb and other fingers. Immediate intervention is helpful to obtain a higher survival rate.

A cross-sectional observational study comparing foot and ankle characteristics in people with stroke and healthy controls.

PubMed

Kunkel, Dorit; Potter, Julia; Mamode, Louis

2017-06-01

The purpose of this study was to explore and compare foot and ankle characteristics in people with stroke and healthy controls; and between stroke fallers and non-fallers. Participants were recruited from community groups and completed standardized tests assessing sensation, foot posture, foot function, ankle dorsiflexion and first metatarsal phalangeal joint range of motion (1st MPJ ROM), hallux valgus presence and severity. Twenty-three stroke participants (mean age 75.09 ± 7.57 years; 12 fallers) and 16 controls (mean age 73.44 ± 8.35 years) took part. Within the stroke group, reduced 1st MPJ sensation (p = 0.016) and 1st MPJ ROM (p = 0.025) were observed in the affected foot in comparison to the non-affected foot; no other differences were apparent. Pooled data (for both feet) was used to explore between stroke/control (n = 78 feet) and stroke faller/non-faller (n = 46 feet) group differences. In comparison to the control group, stroke participants exhibited reduced sensation of the 1st MPJ (p = 0.020), higher Foot Posture Index scores (indicating greater foot pronation, p = 0.008) and reduced foot function (p = 0.003). Stroke fallers exhibited significantly greater foot pronation in comparison to non-fallers (p = 0.027). Results indicated differences in foot and ankle characteristics post stroke in comparison to healthy controls. These changes may negatively impact functional ability and the ability to preserve balance. Further research is warranted to explore the influence of foot problems on balance ability and falls in people with stroke. Implications for Rehabilitation Foot problems are common post stroke. As foot problems have been linked to increased fall risk among the general population we recommend that it would be beneficial to include foot and ankle assessments or a referral to a podiatrist for people with stroke who report foot problems. Further research is needed to explore if we can improve functional performance post stroke and reduce fall risk if treatment or prevention of foot problems can be included in stroke rehabilitation.

Effects of strengthening, stretching and functional training on foot function in patients with diabetic neuropathy: results of a randomized controlled trial

PubMed Central

2014-01-01

Background Foot musculoskeletal deficits are seldom addressed by preventive medicine despite their high prevalence in patients with diabetic polyneuropathy. AIM: To investigate the effects of strengthening, stretching, and functional training on foot rollover process during gait. Methods A two-arm parallel-group randomized controlled trial with a blinded assessor was designed. Fifty-five patients diagnosed with diabetic polyneuropathy, 45 to 65 years-old were recruited. Exercises for foot-ankle and gait training were administered twice a week, for 12 weeks, to 26 patients assigned to the intervention group, while 29 patients assigned to control group received recommended standard medical care: pharmacological treatment for diabetes and foot care instructions. Both groups were assessed after 12 weeks, and the intervention group at follow-up (24 weeks). Primary outcomes involved foot rollover changes during gait, including peak pressure (PP). Secondary outcomes involved time-to-peak pressure (TPP) and pressure–time integral (PTI) in six foot-areas, mean center of pressure (COP) velocity, ankle kinematics and kinetics in the sagittal plane, intrinsic and extrinsic muscle function, and functional tests of foot and ankle. Results Even though the intervention group primary outcome (PP) showed a not statistically significant change under the six foot areas, intention-to-treat comparisons yielded softening of heel strike (delayed heel TPP, p=.03), better eccentric control of forefoot contact (decrease in ankle extensor moment, p<.01; increase in function of ankle dorsiflexion, p<.05), earlier lateral forefoot contact with respect to medial forefoot (TPP anticipation, p<.01), and increased participation of hallux (increased PP and PTI, p=.03) and toes (increase in PTI, medium effect size). A slower COP mean velocity (p=.05), and an increase in overall foot and ankle function (p<.05) were also observed. In most cases, the values returned to baseline after the follow-up (p<.05). Conclusions Intervention discreetly changed foot rollover towards a more physiological process, supported by improved plantar pressure distribution and better functional condition of the foot ankle complex. Continuous monitoring of the foot status and patient education are necessary, and can contribute to preserving the integrity of foot muscles and joints impaired by polyneuropathy. Trial registration ClinicalTrials.gov Identifier: NCT01207284, registered in 20th September 2010. PMID:24767584

Effects of strengthening, stretching and functional training on foot function in patients with diabetic neuropathy: results of a randomized controlled trial.

PubMed

Sartor, Cristina D; Hasue, Renata H; Cacciari, Lícia P; Butugan, Marco K; Watari, Ricky; Pássaro, Anice C; Giacomozzi, Claudia; Sacco, Isabel C N

2014-04-27

Foot musculoskeletal deficits are seldom addressed by preventive medicine despite their high prevalence in patients with diabetic polyneuropathy. To investigate the effects of strengthening, stretching, and functional training on foot rollover process during gait. A two-arm parallel-group randomized controlled trial with a blinded assessor was designed. Fifty-five patients diagnosed with diabetic polyneuropathy, 45 to 65 years-old were recruited. Exercises for foot-ankle and gait training were administered twice a week, for 12 weeks, to 26 patients assigned to the intervention group, while 29 patients assigned to control group received recommended standard medical care: pharmacological treatment for diabetes and foot care instructions. Both groups were assessed after 12 weeks, and the intervention group at follow-up (24 weeks). Primary outcomes involved foot rollover changes during gait, including peak pressure (PP). Secondary outcomes involved time-to-peak pressure (TPP) and pressure-time integral (PTI) in six foot-areas, mean center of pressure (COP) velocity, ankle kinematics and kinetics in the sagittal plane, intrinsic and extrinsic muscle function, and functional tests of foot and ankle. Even though the intervention group primary outcome (PP) showed a not statistically significant change under the six foot areas, intention-to-treat comparisons yielded softening of heel strike (delayed heel TPP, p=.03), better eccentric control of forefoot contact (decrease in ankle extensor moment, p<.01; increase in function of ankle dorsiflexion, p<.05), earlier lateral forefoot contact with respect to medial forefoot (TPP anticipation, p<.01), and increased participation of hallux (increased PP and PTI, p=.03) and toes (increase in PTI, medium effect size). A slower COP mean velocity (p=.05), and an increase in overall foot and ankle function (p<.05) were also observed. In most cases, the values returned to baseline after the follow-up (p<.05). Intervention discreetly changed foot rollover towards a more physiological process, supported by improved plantar pressure distribution and better functional condition of the foot ankle complex. Continuous monitoring of the foot status and patient education are necessary, and can contribute to preserving the integrity of foot muscles and joints impaired by polyneuropathy. ClinicalTrials.gov Identifier: NCT01207284, registered in 20th September 2010.

Body size and scaling of the hands and feet of prosimian primates.

PubMed

Lemelin, Pierre; Jungers, William L

2007-06-01

The hands and feet of primates fulfill a variety of biological roles linked with food acquisition and positional behavior. Current explanations of shape differences in cheiridial morphology among prosimians are closely tied to body size differences. Although numerous studies have examined the relationships between body mass and limb morphology in prosimians, no scaling analysis has specifically considered hand and foot dimensions and intrinsic proportions. In this study, we present such an analysis for a sample of 270 skeletal specimens distributed over eight prosimian families. The degree of association between size and shape was assessed using nonparametric correlational techniques, while the relationship between each ray element length and body mass (from published data and a body mass surrogate) was tested for allometric scaling. Since tarsiers and strepsirrhines encompass many taxa of varying degrees of phylogenetic relatedness, effective degrees of freedom were calculated, and comparisons between families were performed to partially address the problem of statistical nonindependence and "phylogenetic inertia." Correlational analyses indicate negative allometry between relative phalangeal length (as reflected by phalangeal indices) and body mass, except for the pollex and hallux. Thus, as size increases, there is a significant decrease in the relative length of the digits when considering all prosimian taxa sampled. Regression analyses show that while the digital portion of the rays scales isometrically with body mass, the palmar/plantar portion of the rays often scales with positive allometry. Some but not all of these broadly interspecific allometric patterns remain statistically significant when effective degrees of freedom are taken into account. As is often the case in interspecific scaling, comparisons within families show different scaling trends in the cheiridia than those seen across families (i.e., lorisids, indriids, and lemurids exhibit rather different allometries). The interspecific pattern of positive allometry that appears to best characterize the metapodials of prosimians, especially those of the foot, parallels differences found in the morphology of the volar skin. Indeed, relatively longer metapodials appear to covary with flatter and more coalesced volar pads, which in turn slightly improve frictional force for animals that are at a comparative disadvantage while climbing because of their larger mass. Despite the essentially isometric relationship found between digit length and body mass across prosimians, examination of the residual variation reveals that tarsiers and Daubentonia possess, relative to their body sizes, remarkably long fingers. Such marked departures between body size and finger length observed in these particular primates are closely linked with specialized modes of prey acquisition and manipulation involving the hands.

[DORSALIS PEDIS FLAP SERIES-PARALLEL BIG TOE NAIL COMPOSITE TISSUE FLAP TO REPAIR HAND SKIN OF DEGLOVING INJURY WITH THUMB DEFECT].

PubMed

Shi, Pengju; Zhang, Wenlong; Zhao, Gang; Li, Zhigang; Zhao, Shaoping; Zhang, Tieshan

2015-07-01

To investigate the effectiveness of dorsalis pedis flap series-parallel big toe nail composite tissue flap in the repairment of hand skin of degloving injury with tumb defect. Between March 2009 and June 2013, 8 cases of hand degloving injury with thumb defect caused by machine twisting were treated. There were 7 males and 1 female with the mean age of 36 years (range, 26-48 years). Injury located at the left hand in 3 cases and at the right hand in 5 cases. The time from injury to hospitalization was 1.5-4.0 hours (mean, 2.5 hours). The defect area was 8 cm x 6 cm to 15 cm x 1 cm. The thumb defect was rated as degree I in 5 cases and as degree II in 3 cases. The contralateral dorsal skin flap (9 cm x 7 cm to 10 cm x 8 cm) combined with ipsilateral big toe nail composite tissue flap (2.5 cm x 1.8 cm to 3.0 cm x 2.0 cm) was used, including 3 parallel anastomosis flaps and 5 series anastomosis flaps. The donor site of the dorsal flap was repaired with thick skin grafts, the stumps wound was covered with tongue flap at the shank side of big toe. Vascular crisis occurred in 1 big toe nail composite tissue flap, margin necrosis occurred in 2 dorsalis pedis flap; the other flaps survived, and primary healing of wound was obtained. The grafted skin at dorsal donor site all survived, skin of hallux toe stump had no necrosis. Eight cases were followed up 4-20 months (mean, 15.5 months). All flaps had soft texture and satisfactory appearance; the cutaneous sensory recovery time was 4-7 months (mean, 5 months). At 4 months after operation, the two-point discrimination of the thumb pulp was 8-10 mm (mean, 9 mm), and the two-point discrimination of dorsal skin flap was 7-9 mm (mean, 8.5 mm). According to Society of Hand Surgery standard for the evaluation of upper part of the function, the results were excellent in 4 cases, good in 3 cases, and fair in 1 case. The donor foot had normal function. Dorsalis pedis flap series-parallel big toe nail composite tissue flap is an ideal way to repair hand skin defect, and reconstructs the thumb, which has many advantages, including simple surgical procedure, no limitation to recipient site, soft texture, satisfactory appearance and function of reconstructing thumb, and small donor foot loss.

Somatosensory Psychophysical Losses in Inhabitants of Riverside Communities of the Tapajós River Basin, Amazon, Brazil: Exposure to Methylmercury Is Possibly Involved

PubMed Central

Khoury, Eliana Dirce Torres; Souza, Givago da Silva; da Costa, Carlos Araújo; de Araújo, Amélia Ayako Kamogari; de Oliveira, Cláudia Simone Baltazar; Silveira, Luiz Carlos de Lima; Pinheiro, Maria da Conceição Nascimento

2015-01-01

The purpose of this work was to evaluate the somatosensory system of methylmercury-exposed inhabitants living in the communities of the Tapajós river basin by using psychophysical tests and to compare with measurements performed in inhabitants of the Tocantins river basin. We studied 108 subjects from Barreiras and São Luiz do Tapajós, two communities of the Tapajós river basin, State of Pará, Amazon, Brazil, aged 13–53 years old. Mercury analysis was performed in head hair samples weighting 0.1–0.2 g by using atomic absorption spectrometry. Three somatosensory psychophysical tests were performed: tactile sensation threshold, vibration sensation duration, and two-point discrimination. Semmes-Weinstein 20 monofilaments with different diameters were used to test the tactile sensation in the lower lip, right and left breasts, right and left index fingers, and right and left hallux. The threshold was the thinner monofilament perceived by the subject. Vibration sensation was investigated using a 128 Hz diapason applied to the sternum, right and left radial sides of the wrist, and right and left outer malleoli. Two trials were performed at each place. A stopwatch recorded the vibration sensation duration. The two-point discrimination test was performed using a two-point discriminator. Head hair mercury concentration was significantly higher in mercury-exposed inhabitants of Tapajós than in non-exposed inhabitants of Tocantins (p < 0.01). When all subjects were divided in two groups independently of age—mercury-exposed and non-exposed—the following results were found: tactile sensation thresholds in mercury-exposed subjects were higher than in non-exposed subjects at all body parts, except at the left chest; vibration sensation durations were shorter in mercury-exposed than in non-exposed subjects, at all locations except in the upper sternum; two-point discrimination thresholds were higher in mercury-exposed than in non-exposed subjects at all body parts. There was a weak linear correlation between tactile sensation threshold and mercury concentration in the head hair samples. No correlation was found for the other two measurements. Mercury-exposed subjects had impaired somatosensory function compared with non-exposed control subjects. Long-term mercury exposure of riverside communities in the Tapajós river basin is a possible but not a definitely proven cause for psychophysical somatosensory losses observed in their population. Additionally, the relatively simple psychophysical measures used in this work should be followed by more rigorous measures of the same population. PMID:26658153

Somatosensory Psychophysical Losses in Inhabitants of Riverside Communities of the Tapajós River Basin, Amazon, Brazil: Exposure to Methylmercury Is Possibly Involved.

PubMed

Khoury, Eliana Dirce Torres; Souza, Givago da Silva; da Costa, Carlos Araújo; de Araújo, Amélia Ayako Kamogari; de Oliveira, Cláudia Simone Baltazar; Silveira, Luiz Carlos de Lima; Pinheiro, Maria da Conceição Nascimento

2015-01-01

The purpose of this work was to evaluate the somatosensory system of methylmercury-exposed inhabitants living in the communities of the Tapajós river basin by using psychophysical tests and to compare with measurements performed in inhabitants of the Tocantins river basin. We studied 108 subjects from Barreiras and São Luiz do Tapajós, two communities of the Tapajós river basin, State of Pará, Amazon, Brazil, aged 13-53 years old. Mercury analysis was performed in head hair samples weighting 0.1-0.2 g by using atomic absorption spectrometry. Three somatosensory psychophysical tests were performed: tactile sensation threshold, vibration sensation duration, and two-point discrimination. Semmes-Weinstein 20 monofilaments with different diameters were used to test the tactile sensation in the lower lip, right and left breasts, right and left index fingers, and right and left hallux. The threshold was the thinner monofilament perceived by the subject. Vibration sensation was investigated using a 128 Hz diapason applied to the sternum, right and left radial sides of the wrist, and right and left outer malleoli. Two trials were performed at each place. A stopwatch recorded the vibration sensation duration. The two-point discrimination test was performed using a two-point discriminator. Head hair mercury concentration was significantly higher in mercury-exposed inhabitants of Tapajós than in non-exposed inhabitants of Tocantins (p < 0.01). When all subjects were divided in two groups independently of age-mercury-exposed and non-exposed-the following results were found: tactile sensation thresholds in mercury-exposed subjects were higher than in non-exposed subjects at all body parts, except at the left chest; vibration sensation durations were shorter in mercury-exposed than in non-exposed subjects, at all locations except in the upper sternum; two-point discrimination thresholds were higher in mercury-exposed than in non-exposed subjects at all body parts. There was a weak linear correlation between tactile sensation threshold and mercury concentration in the head hair samples. No correlation was found for the other two measurements. Mercury-exposed subjects had impaired somatosensory function compared with non-exposed control subjects. Long-term mercury exposure of riverside communities in the Tapajós river basin is a possible but not a definitely proven cause for psychophysical somatosensory losses observed in their population. Additionally, the relatively simple psychophysical measures used in this work should be followed by more rigorous measures of the same population.

[Upright posture of man and morphologic evolution of the musculi extensores digitorum pedis with reference to evolutionary myology. III].

PubMed

Kaneff, A

1986-01-01

The following anatomical objects were studied with regard to myology during evolution: M. extensor hallucis longus (MEHL), M. extensor digitorum longus (MEDL) with M. peroneus tertius (MP III), M. peroneus brevis (MPB) with M. peroneus digiti V (MPD V), M. extensor hallucis brevis (MEHB), M. extensor digitorum brevis (MEDB), and the Retinaculum musculorum extensorum imum (RMEI). The study was carried out by the preparation of 3 different groups of material. The 1st group consists of lower extremities of humans. The number of the extremities differs for the particular objects between 151 and 358 (see page 381). The 2nd group of material consists of 122 Membra pelvina from Marsupialia, Insectivora, and Primates. Table 1 shows as well the mammalian species as the number of the studied extremities. The extremities of the 1st and 2nd group were preserved in an manner suitable for a macroscopic preparation. The 3rd group of material consists of 71 lower extremities from embryos and fetus. The lower legs and feet were stained either according to the method described by Morel and Bassal with eosin added or according to Weigert. From this material, complete series of cross sections were prepared. Table 2 shows the age of the embryos (VCL [mm]) as well as the number of the studied extremities. It is important that up to the age of 46 mm VCL the difference in the age of the embryos usually amounts from 0.5 to 1.0 mm. This small difference in the age of the embryos and fetus allows a very good follow up of the changes in construction during the organogenesis. The comparison of the 3 different groups shows the following changes for the above mentioned muscles: The M. extensor hallucis longus (MEHL) is a muscle which is not split. The same result applies for its tendon which inserts at the distal phalanx of the hallux. This primitive form of the muscle amounts actually to 51.12% in human beings. In 48.88% of the cases, additional tendons and muscles are formed by the MEHL. Most of these supplements are positioned on the medial side of the main tendon, only a few lie to the lateral side. For the supplement tendons, the medial one as well as the lateral one occasionally possess a muscle belly. The muscle of the medial tendon is split off from the proximal margin of the MEHL. The muscle of the lateral tendon is split off from the distal margin of the MEHL.(ABSTRACT TRUNCATED AT 400 WORDS)