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Musculoskeletal Surgery Jun 2022Brachymetatarsia (BM), or hypoplastic metatarsal, is an abnormal shortening of one or more metatarsal bones with a female-to-male ratio of 10.53:1. Different causes are... (Review)
Review
Brachymetatarsia (BM), or hypoplastic metatarsal, is an abnormal shortening of one or more metatarsal bones with a female-to-male ratio of 10.53:1. Different causes are described in the literature, such as congenital, acquired, or iatrogenic, associated with different conditions and syndromes. Its presence may develop deformity and pain; however, often feet are pain free and the major worries of patients are cosmetics. Non-operative treatments aim to improve the comfort of metatarsal heads and the possible dorsal conflict through comfortable shoes or the use of specific orthotics. The surgical treatment is anything but straightforward, with "one-stage" or "two stage" techniques, the latter better called "by gradual distraction". One-stage procedures are more rapid techniques but have limited ability to restore the desired length due to neurovascular compromise caused by acute lengthening. Insufficient correction is also possible. On the contrary, by gradual distraction procedures allow gradual distraction lengthening of more than 1.5 cm, but require the use of an external fixator, with a higher risk of complications in more than about 50% of surgeries. The adjacent metatarsal shortening should be considered in combination with other techniques, to diminish the excessive lengthening. In each case, surgeries should be always decided on each patient's concerns, deformities, and clinical needs.
Topics: External Fixators; Female; Foot; Foot Deformities, Congenital; Humans; Male; Metatarsal Bones; Osteogenesis, Distraction
PubMed: 34268706
DOI: 10.1007/s12306-021-00720-z -
Foot and Ankle Clinics Mar 2020Coronal malalignment is an important deformity parameter in hallux valgus feet. Approximately 90% of patients with hallux valgus have some degree of metatarsal... (Review)
Review
Coronal malalignment is an important deformity parameter in hallux valgus feet. Approximately 90% of patients with hallux valgus have some degree of metatarsal pronation. In operated hallux valgus, persistent metatarsal pronation is an independent deformity relapse factor. Coronal malalignment can be identified through an anteroposterior (AP) weight-bearing foot radiograph and a weight-bearing forefoot scan. The AP foot view can identify 3 levels of rotation: mild, moderate and severe metatarsal pronation. Regarding the treatment options, some techniques are capable of rotational correction, such as the proximal rotational metatarsal osteotomy, Lapidus, dome osteotomy, and proximal oblique sliding closing wedge.
Topics: Bone Malalignment; Hallux Valgus; Humans; Metatarsal Bones; Osteotomy; Pronation
PubMed: 31997748
DOI: 10.1016/j.fcl.2019.10.009 -
Foot and Ankle Clinics Sep 2014Metatarsal fractures are those most frequently encountered in the foot. More than half of these are of the 5th metatarsal. The incidence is increasing, along with the... (Review)
Review
Metatarsal fractures are those most frequently encountered in the foot. More than half of these are of the 5th metatarsal. The incidence is increasing, along with the activity levels of the general population. Fractures of the 5th metatarsal require careful evaluation and classification to ensure selection of the optimum treatment plan. Distal fractures rarely require fixation, even when displacement is wide. Cases of established nonunion or refracture require fixation.
Topics: Bone Screws; Foot Injuries; Fractures, Bone; Fractures, Ununited; Humans; Metatarsal Bones; Radiography
PubMed: 25129358
DOI: 10.1016/j.fcl.2014.06.009 -
Foot and Ankle Clinics Mar 2021Proximal fifth metatarsal fractures are common in the athlete and can be a source of significant, temporary disability and missed playing time. The pattern of fracture... (Review)
Review
Proximal fifth metatarsal fractures are common in the athlete and can be a source of significant, temporary disability and missed playing time. The pattern of fracture can vary, and the type of fracture leads to a significantly different prognosis and treatment. Jones fractures of the fifth metatarsal are particularly common and difficult to treat in the athlete, can have recurrence and refracture, and require expertise to heal. Intramedullary screw fixation is currently the preferred method of fixation. Most other (non-Jones fractures and os vesalianum) proximal fifth metatarsal fractures can be treated successfully without surgery.
Topics: Athletes; Athletic Injuries; Fracture Fixation, Internal; Fractures, Bone; Humans; Metatarsal Bones
PubMed: 33487243
DOI: 10.1016/j.fcl.2020.10.007 -
Injury Dec 2014Fifth metatarsal fractures are common and the outcome has been reported; however, prospective studies reporting the functional outcome using validated questionnaires are... (Review)
Review
INTRODUCTION
Fifth metatarsal fractures are common and the outcome has been reported; however, prospective studies reporting the functional outcome using validated questionnaires are lacking in the literature. The aims of this study were to determine whether fifth metatarsal fractures remain symptomatic in the medium term and whether the fracture type influences outcome.
METHODS
Over the course of a year, 117 patients (62 avulsion fractures, 26 Jones fractures, 29 shaft fractures) were followed up (1 month, 4 months, 12 months), with functional outcome assessed using the Foot Function Index (FFI)- and Short Form 36 (SF36)-validated questionnaires.
RESULTS
The FFI reduced (function improved) over the course of the year from 22.0 (8.4-38.5) at 1 month to 0.0 (0.0-4.2) at 4 months, to 0.0 (0.0-1.3) at 1 year. There was no significant difference in the FFI scores with regard to gender or fracture type. Pain scores were also observed to decline over the year, with no significant differences between fracture types. However, while the severity of pain was low, the numbers of people reporting pain were relatively high. At 1 month, >80% of patients reported ongoing pain (83% avulsion, 88% Jones and 83% shaft), reducing to 38% at 4 months and 28% at 1 year. At final follow-up, 25% with an avulsion fracture, 28% with a Jones fracture and 33% with a shaft fracture reported pain.
CONCLUSIONS
While 25-33% of patients continue to experience pain at 1 year, <10% experience any limitation of their activities. At the final follow-up at 1 year, there were no significant differences in functional outcome by fracture type, gender or patient age. Patients should be advised about the likelihood of ongoing low-level symptoms, even after a year from injury in this previously presumed innocuous injury.
Topics: Follow-Up Studies; Foot Injuries; Fracture Fixation, Internal; Fracture Healing; Fractures, Bone; Humans; Metatarsal Bones; Radiography; Time Factors; Trauma Severity Indices; United Kingdom
PubMed: 25150752
DOI: 10.1016/j.injury.2014.06.010 -
The Physician and Sportsmedicine Nov 2014There is an increasing prevalence of osteoporosis, and with it a rise in the diagnosis of stress fractures. Postmenopausal women are particularly at risk of stress... (Review)
Review
INTRODUCTION
There is an increasing prevalence of osteoporosis, and with it a rise in the diagnosis of stress fractures. Postmenopausal women are particularly at risk of stress fractures. This review article describes the pathophysiology of foot stress fractures and the latest diagnostic and treatment strategies for these common injuries.
DISCUSSION
There are numerous risk factors for stress fractures that have been identified in the literature. Reduced bone mineral density is an independent risk factor for delayed union. Prevention of stress fractures with training periodization and nutritional assessment is essential, especially in females. Diagnosis of stress fractures of the foot is based on history and diagnostic imaging, which include radiographs, ultrasound, therapeutic ultrasound, computed tomography, and bone scans; however, magnetic resonance imaging is still the gold standard. Treatment depends on the bone involved and the risk of nonunion, with high-risk fractures requiring immobilization or surgical intervention. Patients presenting with underlying bone mineral deficiency treated without surgery require a longer period of activity modification. Training rehabilitation protocols are described for those with low-risk stress fractures.
RESULTS
A useful algorithm is presented to guide the clinician in the diagnosis and management of such injuries.
Topics: Algorithms; Body Mass Index; Calcaneus; Female Athlete Triad Syndrome; Foot; Foot Bones; Fractures, Stress; Humans; Magnetic Resonance Imaging; Metatarsal Bones; Orthotic Devices; Osteoporosis, Postmenopausal; Risk Factors; Sesamoid Bones; Talus; Tarsal Bones
PubMed: 25419892
DOI: 10.3810/psm.2014.11.2095 -
The Journal of Foot and Ankle Surgery :... 2022Charcot neuroarthropathy (CN) is a highly destructive, pathologic process with devastating consequences to foot structure and viability. The use of intramedullary...
Charcot neuroarthropathy (CN) is a highly destructive, pathologic process with devastating consequences to foot structure and viability. The use of intramedullary fixation "superconstructs" allows for "re-bar" support of compromised bone and allows for some dynamic fixation. This study examines radiodensity in Hounsfield units (HU) to compare bone quality of medial column fixation targets using computed tomography scans between patients with and without midfoot CN. A retrospective chart review identified control (nondiabetic, non-CN; n = 29) and midfoot CN (n = 21) groups. Patient demographics and medical history were collected. Two reviewers measured the mean HU of a circular region of interest centered on the first metatarsal head and the anterior, middle, and posterior thirds of the talar body. Radiodensity was compared between groups, and among talar locations, Eichenholtz stages and Brodsky types, with statistical significance set at p ≤ .05. Age and body mass index were not significantly different between groups. The CN group maintained greater mean HU than the control group at the metatarsal head (p < .001), and talar body locations (p < .019). The difference in mean HU of these bones was not statistically significant between Stages 0 to 1 and Stages 2 to 3 or Brodsky Types 1 and 2. Mean HU differences among talus positions were not statistically significant. Indirect bone density analysis using HU showed an increased density in CN patients with no significant difference among talar body locations or midfoot Charcot stages and types. These results may assist in optimizing fixation length. Future studies may examine these densities in ankle CN.
Topics: Arthropathy, Neurogenic; Diabetic Foot; Foot; Humans; Metatarsal Bones; Retrospective Studies
PubMed: 35181205
DOI: 10.1053/j.jfas.2022.01.023 -
Foot & Ankle International Aug 2022Classification of fifth metatarsal base fractures has been a source of confusion since originally described by Jones in 1902. Zone classifications have been described...
BACKGROUND
Classification of fifth metatarsal base fractures has been a source of confusion since originally described by Jones in 1902. Zone classifications have been described but never evaluated for reliability. The most recent classification, metaphyseal vs meta-diaphyseal, may be unknown to many surgeons. The purpose of this study was to evaluate reliability of American Orthopaedic Foot & Ankle Society (AOFAS) members classifying fifth metatarsal base fractures and current management of these fractures.
METHODS
A survey was emailed to AOFAS members including radiographs of 18 fifth metatarsal base fractures. Demographic information was collected in addition to evaluation of the radiographs. Interrater reliability was assessed for each measurement: presence of Jones fracture, zone classification, and metaphyseal vs metaphyseal-diaphyseal, using Fleiss kappa. After 3 weeks, a second email was sent to the members asking to retake the survey to evaluate intrarater reliability. Respondents were asked which region is a Jones fracture, which classification is used, if symptomatic zone 2 and 3 fractures are treated similarly, and what fractures are operative in healthy symptomatic acute fractures.
RESULTS
A total of 223 AOFAS members, with a median time in practice of 12 years (range 0-50), completed the initial survey. Eighty members (36%) repeated the survey for intrarater comparison. Interrater reliability was moderate for Jones and zone classification but substantial for the 2-zone metaphyseal/meta-diaphyseal classification. The median intrarater kappa was 0.78, 0.75, and 0.78 for Jones, zone, and metaphyseal/meta-diaphyseal respectively. Seventy percent of respondents treat zones 2 and 3 similarly, and approximately 60% consider an acute symptomatic fracture identified as Jones, zone 2 or zone 3 operative.
CONCLUSION
A 2-zone system may be the best available classification for fifth metatarsal base fractures given high interrater reliability and 70% of AOFAS members treat zones 2 and 3 in similar fashion.
LEVEL OF EVIDENCE
Level III, diagnostic study.
Topics: Ankle Injuries; Epiphyses; Foot Injuries; Fractures, Bone; Humans; Metatarsal Bones; Reproducibility of Results
PubMed: 35502535
DOI: 10.1177/10711007221092755 -
Clinics in Podiatric Medicine and... Apr 2022Fusion of the first metatarsophalangeal joint has been used by foot and ankle surgeons as a reproducible and useful means of treating end-stage arthritis of the great... (Review)
Review
Fusion of the first metatarsophalangeal joint has been used by foot and ankle surgeons as a reproducible and useful means of treating end-stage arthritis of the great toe. However, the overall utility and successful outcomes of this procedure have led to its incorporation into the treatment of more significant bunion deformities, reconstruction forefoot, and salvage procedures. The authors review surgical fixation methods, offer insightful technical pearls for challenging cases and share examples of complex reconstructive and salvage procedures.
Topics: Arthritis, Rheumatoid; Arthrodesis; Foot Deformities, Acquired; Humans; Metatarsal Bones; Metatarsophalangeal Joint
PubMed: 35365321
DOI: 10.1016/j.cpm.2021.11.002 -
International Journal of Environmental... Nov 2022This study aims to propose a regression equation for estimating stature in the Korean population using metatarsal bones from cadavers and to validate the appropriateness...
This study aims to propose a regression equation for estimating stature in the Korean population using metatarsal bones from cadavers and to validate the appropriateness of the Korean-specific equation by comparing it to equations from other populations. A total of 81 adult formalin-fixed cadavers (51 males and 30 females) were evaluated. The first and second metatarsal bones' physiological and maximal lengths were measured, and the cadaveric stature of the subjects was determined as the distance from the vertex to the plantar face of the heel. In all measurements, the correlation coefficient between real stature and metatarsal length was statistically significant ( < 0.001). Additionally, both sexes showed a correlation between stature and metatarsal bone length. For unknown sex, M1 (first metatarsal maximal length) showed the strongest association between stature and metatarsal length. The following is the appropriate regression equation: 1172.4913 + 7.3275M1 (R = 0.703). The current equation demonstrated a statistically significant appropriateness for the Korean population when compared to equations for other populations ( < 0.001). In conclusion, we proposed a Korean-specific regression equation for estimating stature using metatarsal length, and this formula may be more appropriate and useful in forensic science for the Korean population.
Topics: Adult; Male; Female; Humans; Metatarsal Bones; Forensic Anthropology; Body Height; Cadaver; Republic of Korea
PubMed: 36429841
DOI: 10.3390/ijerph192215124