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Journal of the American Academy of... Jun 2020Hallux valgus deformity is a multiplanar deformity, where the rotational component has been recognized over the past 5 to 10 years and given considerable importance.... (Review)
Review
Hallux valgus deformity is a multiplanar deformity, where the rotational component has been recognized over the past 5 to 10 years and given considerable importance. Years ago, a rounded shape of the lateral edge of the first metatarsal head was identified as an important factor to detect after surgery because a less rounded metatarsal head was associated to less recurrence. More recently, pronation of the metatarsal bone was identified as the cause for the rounded appearance of the metatarsal head, and therefore, supination stress was found to be useful to achieve a better correction of the deformity. Using CT scans, up to 87% of hallux valgus cases have been shown to present with a pronated metatarsal bone, which highlights the multiplanar nature of the deformity. This pronation explained the perceived shape of the metatarsal bone and the malposition of the medial sesamoid bone in radiological studies, which has been associated as one of the most important factors for recurrence after treatment. Treatment options are discussed briefly, including metatarsal osteotomies and tarsometatarsal arthrodesis.
Topics: Bunion; Hallux; Hallux Valgus; Humans; Metatarsal Bones; Pronation
PubMed: 32656482
DOI: 10.5435/JAAOSGlobal-D-20-00091 -
Foot and Ankle Clinics Sep 2015First metatarsophalangeal joint disorder is a common cause of chronic forefoot pain that is frequently encountered in the orthopedic clinic. Numerous surgical techniques... (Review)
Review
First metatarsophalangeal joint disorder is a common cause of chronic forefoot pain that is frequently encountered in the orthopedic clinic. Numerous surgical techniques have been described to improve patient pain and function in this regard, including prosthetic joint replacement, resection arthroplasty, and arthrodesis. When these procedures fail, surgeons can be confronted with significant first metatarsal bone loss/defects. First metatarsophalangeal joint fusion remains the gold standard, and, in the setting of significant bone loss, the use of structural bone graft must be considered in order to restore length to the first ray and the normal biomechanics of the foot.
Topics: Aged; Arthritis, Rheumatoid; Arthrodesis; Arthroplasty, Replacement; Bone Resorption; Bone Transplantation; Female; Follow-Up Studies; Humans; Male; Metatarsal Bones; Metatarsophalangeal Joint; Middle Aged; Osteoarthritis; Pain Measurement; Radiography; Range of Motion, Articular; Reoperation; Risk Assessment; Severity of Illness Index; Toe Joint; Treatment Outcome
PubMed: 26320561
DOI: 10.1016/j.fcl.2015.04.009 -
Birth Defects Research Sep 2018Human lower limb congenital long bone deficiencies cluster primarily at three distinct skeletal locations. Proximal femoral and fibular reductions are known phenomena.... (Review)
Review
Human lower limb congenital long bone deficiencies cluster primarily at three distinct skeletal locations. Proximal femoral and fibular reductions are known phenomena. In contrast, midline metatarsal deficiencies have been misrepresented as lateral. The popular term, "fibular hemimelia," is inaccurate and its use is discouraged. All three locations correspond to discrete sites of evolving angiogenesis during transition from a single embryonic axial limb artery to the familiar and complex adult arterial pattern. Initiation of bone formation of cartilaginous primordia of the long bones at all three sites occurs in proximity to, and depends upon, successful invasion by mature nutrient vessels, formed during the 6th and 7th weeks of embryonic development. The adult arterial pattern is fully established by 8th embryonic week. Arterial transitions occur later in development, around the time of cessation of the molecular processes of patterning/specification of the embryonic limb. Evidence of flawed embryonic arterial transitions, involving missing, reduced and/or retained primitive vessels in association with congenital skeletal reductions have been demonstrated at all three sites. Current molecular models of limb development do not explain the distribution of this triad of congenital skeletal reductions. These dysmorphologies are most accurately described as post-specification errors of limb development. Recognition of this distinctive model of limb maldevelopment demands further investigation to create a more exact taxonomy, one consistent with both clinical and molecular criteria. The established terminologies originated by Frantz and O'Rahilly should be reconsidered or abandoned. Designation of this clinical triad as a syndrome of proximal femur, fibula, and midline metatarsal dystrophisms initiates that endeavor.
Topics: Embryonic Development; Femur; Fibula; Foot Deformities; Humans; Lower Extremity Deformities, Congenital; Metatarsal Bones; Syndrome
PubMed: 30152124
DOI: 10.1002/bdr2.1349 -
Der Unfallchirurg Apr 2019Metatarsal and toe fractures are the most frequent injuries of the foot skeleton. Nondislocated fractures can be conservatively treated with good success. Long-term...
Metatarsal and toe fractures are the most frequent injuries of the foot skeleton. Nondislocated fractures can be conservatively treated with good success. Long-term relief and immobilization including the ankle joint are unnecessary. Metatarsal fractures close to the base are nearly always associated with Lisfranc luxation and treatment must also take the instability of the tarsometatarsal joints into consideratíon. Basal fractures of the 5th metatarsal bone require a differentiated consideration. The correct classification is necessary in order to initiate an adequate treatment. In general, intra-articular layer formation, inclination >10° and shortening between 3 mm and 5 mm, taking the position of the head of the metatarsal bone into consideration, are recommended as indications for surgery. Operative treatment of toe fractures is only rarely necessary.
Topics: Foot Injuries; Fracture Fixation, Internal; Fractures, Bone; Humans; Metatarsal Bones; Toes
PubMed: 30847497
DOI: 10.1007/s00113-019-0620-1 -
Annals of Biomedical Engineering Apr 2021Bone lengthening and bone transport are regeneration processes that commonly rely on distraction osteogenesis, a widely accepted surgical procedure to deal with numerous...
Bone lengthening and bone transport are regeneration processes that commonly rely on distraction osteogenesis, a widely accepted surgical procedure to deal with numerous bony pathologies. Despite the extensive study in the literature of the influence of biomechanical factors, a lack of knowledge about their mechanobiological differences prevents a clinical particularization. Bone lengthening treatments were performed on sheep metatarsus by reproducing the surgical and biomechanical protocol of previous bone transport experiments. Several in vivo monitoring techniques were employed to build an exhaustive comparison: gait analysis, radiographic and CT assessment, force measures through the fixation, or mechanical characterization of the new tissue. A significant initial loss of the bearing capacity, quantified by the ground reaction forces and the limb contact time with the ground, is suffered by the bone lengthening specimens. The potential effects of this anomaly on the musculoskeletal force distribution and the evolution of the bone callus elastic modulus over time are also analyzed. Imaging techniques also seem to reveal lower bone volume in the bone lengthening callus than in the bone transport one, but an equivalent mineralization rate. The simultaneous quantification of biological and mechanical parameters provides valuable information for the daily clinical routine and numerical tools development.
Topics: Animals; Biomechanical Phenomena; Bone Regeneration; Bony Callus; Elastic Modulus; Female; Gait; Metatarsal Bones; Osteogenesis, Distraction; Sheep; Tomography, X-Ray Computed
PubMed: 33111968
DOI: 10.1007/s10439-020-02665-z -
Foot and Ankle Clinics Dec 2019The use of a Shannon burr facilitates an osteotomy of the lesser metatarsals without requiring an open approach to the metatarsal. The end result that is aimed for is... (Review)
Review
The use of a Shannon burr facilitates an osteotomy of the lesser metatarsals without requiring an open approach to the metatarsal. The end result that is aimed for is the same as for open surgery and therefore care needs to be taken to perform the bone cut in the appropriate manner. A description is provided of the surgical technique for distal minimally invasive osteotomy and its newer modifications-the distal intracapsular minimally invasive osteotomy and the distal oblique metatarsal osteotomy.
Topics: Humans; Metatarsal Bones; Metatarsalgia; Minimally Invasive Surgical Procedures; Osteotomy
PubMed: 31653366
DOI: 10.1016/j.fcl.2019.08.011 -
Foot and Ankle Clinics Dec 2019Brachymetatarsia is a rare deformity with controversial clinical presentation. Multiple acute and gradual lengthening surgical techniques have been described for... (Comparative Study)
Comparative Study Review
Brachymetatarsia is a rare deformity with controversial clinical presentation. Multiple acute and gradual lengthening surgical techniques have been described for correction of this type of foot deformity. All techniques try to create a better appearance, facilitate shoeing, or solve possible transfer metatarsalgia. Either acute lengthening (1-stage procedure) or gradual lengthening (2 stages) is selected based on the patient's deformities, concerns, and clinical needs.
Topics: Bone Lengthening; Bone Transplantation; Foot Deformities; Humans; Metatarsal Bones; Metatarsalgia; Osteotomy
PubMed: 31653372
DOI: 10.1016/j.fcl.2019.08.010 -
PM & R : the Journal of Injury,... Nov 2021Metatarsal bone stress injuries (BSIs) are common in athletic populations. BSIs are overuse injuries that result from an accumulation of microdamage that exceeds bone... (Review)
Review
Metatarsal bone stress injuries (BSIs) are common in athletic populations. BSIs are overuse injuries that result from an accumulation of microdamage that exceeds bone remodeling. Risk for metatarsal BSI is multifactorial and includes factors related to anatomy, biology, and biomechanics. In this article, anatomic factors including foot type, metatarsal length, bone density, bone geometry, and intrinsic muscle strength, which each influence how the foot responds to load, are discussed. Biologic factors such as low energy availability and impaired bone metabolism influence the quality of the bone. Finally, the influence of biomechanical loads to bone such as peak forces, load rates, and loading cycles are reviewed. General management of metatarsal BSI is discussed, including acute care, rehabilitation, treatment of refractory metatarsal BSI, and evaluation of healing/return to sport. Finally, we identify future research priorities and emerging treatments for metatarsal BSI.
Topics: Athletic Injuries; Biomechanical Phenomena; Foot; Fractures, Stress; Humans; Metatarsal Bones; Sports
PubMed: 33155355
DOI: 10.1002/pmrj.12518 -
Foot & Ankle Specialist Feb 2022. Bunionette is a deformity of the fifth metatarsal in which there is a painful lateral bony prominence of the distal region of this bone caused by various anatomical...
. Bunionette is a deformity of the fifth metatarsal in which there is a painful lateral bony prominence of the distal region of this bone caused by various anatomical and biomechanical changes. The aim of this study is to report on a minimally invasive technique without the use of hardware to treat these deformities. . This is a case series of 18 patients, 25 feet, who underwent bunionette percutaneous surgical treatment. All patients answered the American Orthopaedic Foot and Ankle Society (AOFAS) scale and the visual analogue pain scale (VAS) preoperatively and at the last follow-up. Standard radiological evaluation included measurement of intermetatarsal (4-5 IMA) and fifth toe metatarsophalangeal (5-MTTP) angles. Time to radiographic consolidation, complications, and satisfaction rate were also documented. . The average follow-up was 15.9 months, the AOFAS increased from 49.6 to 92.4 and the VAS decreased from 7.7 to 1.2. It was observed that average 5-MTTP decreased from 15° to 2.7° and that 4-5-IMA decreased from 9.1° to 3.3°. These outcomes showed a statistically significant difference ( < .001). The most common observed complication was the formation of a hypertrophic bone callus in the third postoperative month in three operated feet (12%). One patient had algodystrophy, which improved after conservative treatment. There were no cases of infection, neuropraxis, or recurrences. Fifteen patients rated the result as excellent, 2 as good, and 2 as regular. . Percutaneous osteotomy of the fifth metatarsal without the use of hardware is a safe, reproducible technique and presents good clinical and radiographic results for the treatment of bunionette. Therapeutic studies, Level IV: Case series.
Topics: Bunion, Tailor's; Hallux Valgus; Humans; Metatarsal Bones; Osteotomy; Retrospective Studies; Treatment Outcome
PubMed: 32608244
DOI: 10.1177/1938640020937501 -
Clinics in Sports Medicine Oct 2020Proximal fifth metatarsal fractures, specifically zones 2 and 3, are often treated surgically to lower risk of nonunion and shorten recovery and rehabilitation period.... (Review)
Review
Proximal fifth metatarsal fractures, specifically zones 2 and 3, are often treated surgically to lower risk of nonunion and shorten recovery and rehabilitation period. However, even with the advancement of surgical strategies, techniques, and implants, nonunions remain a challenge. One notable risk factor for a primary or recurrent Jones fracture is the cavovarus foot. If this is identified and a recurrent fifth metatarsal base fracture occurs, the surgeon should strongly consider addressing the malalignment in addition to revision open reduction internal fixation. This article provides guidelines for treatment of a recurrent fracture or nonunion with a concomitant cavovarus foot deformity.
Topics: Bone Malalignment; Foot Injuries; Fracture Fixation, Internal; Fractures, Bone; Fractures, Ununited; Humans; Metatarsal Bones; Open Fracture Reduction; Recurrence; Reoperation
PubMed: 32892967
DOI: 10.1016/j.csm.2020.07.006