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Journal of Foot and Ankle Research Oct 2023This prospective study aimed to test the reliability and validity of hallux valgus angle (HVA) measurement on smartphone digital photographs compared with the standard...
BACKGROUND
This prospective study aimed to test the reliability and validity of hallux valgus angle (HVA) measurement on smartphone digital photographs compared with the standard radiographic evaluation.
METHODS
Twenty Seven female patients (45 feet) with forefoot deformity were evaluated with weight-bearing anteroposterior foot radiographs and smartphone photographs. Radiographic hallux valgus angle (rHVA) was measured on digital radiographs. Two different photographic HVA measurement methods were used. In the first, the longitudinal axes of the first metatarsal and proximal phalanx were determined, and the angle between these axes was measured (pHVA), similar to the radiographic method. In the other method, the angle of the margo medialis pedis was measured on the photograph (pMMP). Two independent observers performed all measurements twice on two different occasions. Reliability analysis was performed using the interclass correlation coefficient. Agreement between the measurements was tested using Bland-Altman analysis.
RESULTS
The repeated rHVA, pHVA and pMMP measurements showed excellent intra and inter-observer reliability, with ICC values above 0.900. The mean rHVA, pHVA, and pMMP were statistically similar (p:0.929, 27.03°±8.7°, 27.11°±8.8° and 26.5°±9.0° respectively). The mean difference between the rHVA and pHVA was - 0.07°±5.1° (range, --9.67 to 9.56°), and the mean difference between the rHVA and pMMP was 0.53°±4.4° (range, -9.76° to 8.22°). There was a strong positive correlation between both photographic methods and radiographic measurements (rho = 0.809, p = 0.001 and rho = 0.872, p = 0.001). In the Bland Altman plot, the upper and lower LOAs (95%CI) ranged from - 10.11° to 9.93° for rHVA and pHVA, and from - 8.26° to 9.33° for rHVA and pMMP. Linear regression analysis showed a proportional bias for pHVA but not for the pMMP (p:0.010 versus p:0.633, respectively). The range of the mean difference (prediction interval) between the pMMP and rHVA was 17.59° and 20° for pHVA and rHVA. Simple linear regression showed that the rHVA was predicted by the following equation: rHVA = 4.73 + 0.84 × pMMP (r2 = 0.761, p < 0.001).
CONCLUSIONS
Although measuring HVA through smartphone photographs is reliable, it is not a valid prediction method.
LEVEL OF EVIDENCE
Level II, diagnostic assessment.
Topics: Humans; Female; Hallux Valgus; Smartphone; Reproducibility of Results; Prospective Studies; Foot; Metatarsal Bones
PubMed: 37840128
DOI: 10.1186/s13047-023-00670-8 -
Journal of Clinical Medicine Nov 2023Various modifications of distal chevron metatarsal osteotomy (DCMO) have been introduced for correcting moderate hallux valgus deformity; however, the amount of...
Various modifications of distal chevron metatarsal osteotomy (DCMO) have been introduced for correcting moderate hallux valgus deformity; however, the amount of correction may be limited, and complications, such as the recurrence of the deformity and avascular necrosis of the metatarsal head, have been a problem. This study aimed to present a modified 90-degree DCMO technique that overcomes the previously reported shortcomings and to report a successful short-term radiographic outcome. Sixty-eight consecutive patients who underwent the operation with our modified DCMO technique and twenty-two consecutive patients with the conventional DCMO technique (control group) were retrospectively analyzed. The radiographic measurements were evaluated preoperatively, at two months post operation, and at the final follow-up. Both groups showed a significant correction of the hallux valgus angle, first-second intermetatarsal angle, distal metatarsal articular angle, and sesamoid position at the final follow-up, while the amount of correction was significantly greater in the modified DCMO group. In both groups, there were no cases of complications such as avascular necrosis of the metatarsal head, nonunion, and surgical site infection appearing throughout the follow-up period. Therefore, the modified 90-degree DCMO technique is effective and safe, which could serve as a favorable option to treat moderate hallux valgus deformity.
PubMed: 37959367
DOI: 10.3390/jcm12216902 -
International Journal of... 2023Tuberculosis (TB) is a major cause of morbidity and mortality, representing a challenge for health-care providers worldwide. Extraspinal osteoarticular tuberculosis...
Tuberculosis (TB) is a major cause of morbidity and mortality, representing a challenge for health-care providers worldwide. Extraspinal osteoarticular tuberculosis (ESOTB) represents a rare location of TB. We aim to describe ESOTB focusing on clinical, diagnostic, and therapeutic characteristics of this entity. We report a retrospective case series of patients diagnosed with ESOTB, treated, and followed up between 2015 and 2022. The diagnosis was based either on bacteriological results (culture and polymerase chain reaction [PCR]) or histological analysis. Five patients with confirmed ESOTB, three women and two men, with a mean age of 46.4 (16-72), were enrolled in study. The affected sites were the elbow (one case), the shoulder (one case), the greater trochanter (one case), the second metatarsal (one case), and the distal interphalangeal joint (one case). The mean delay to diagnosis was 5.8 months (3-10)]. The most common symptoms on presentation were pain (all cases), swelling (all cases), and limited joint range of motion (all cases). One case presented with a draining sinus (20%). Radiological findings were soft tissue swelling (two cases) and periarticular bone destruction (all cases). Four patients presented with pathognomonic histology. PCR was performed in two patients and was positive in both of them. All cases were cured after 9-12 months of oral TB treatment without relapse for the 12-18 months of follow-up. Only one patient underwent surgery for abscess drainage to gain local infection control. ESOTB is a mysterious condition that must not be overlooked and should be suspected in cases of long-standing bone and joint pain and swelling.
Topics: Male; Humans; Female; Middle Aged; Retrospective Studies; Tuberculosis, Osteoarticular; Joints; Inflammation; Tuberculosis, Oral
PubMed: 38149552
DOI: 10.4103/ijmy.ijmy_154_23 -
Annals of Biomedical Engineering Oct 2023Mechanical loading has been described as having the potential to affect bone growth. In order to experimentally study the potential clinical applications of mechanical...
Mechanical loading has been described as having the potential to affect bone growth. In order to experimentally study the potential clinical applications of mechanical loading as a novel treatment to locally modulate bone growth, there is a need to develop a portable mechanical loading device enabling studies in small bones. Existing devices are bulky and challenging to transfer within and between laboratories and animal facilities, and they do not offer user-friendly mechanical testing across both ex vivo cultured small bones and in vivo animal models. To address this, we developed a portable loading device comprised of a linear actuator fixed within a stainless-steel frame equipped with suitable structures and interfaces. The actuator, along with the supplied control system, can achieve high-precision force control within the desired force and frequency range, allowing various load application scenarios. To validate the functionality of this new device, proof-of-concept studies were performed in ex vivo cultured rat bones of varying sizes. First, very small fetal metatarsal bones were microdissected and exposed to 0.4 N loading applied at 0.77 Hz for 30 s. When bone lengths were measured after 5 days in culture, loaded bones had grown less than unloaded controls (p < 0.05). Next, fetal rat femur bones were periodically exposed to 0.4 N loading at 0.77 Hz while being cultured ex vivo for 12 days. Interestingly, this loading regimen had the opposite effect on bone growth, i.e., loaded femur bones grew significantly more than unloaded controls (p < 0.001). These findings suggest that complex relationships between longitudinal bone growth and mechanical loading can be determined using this device. We conclude that our new portable mechanical loading device allows experimental studies in small bones of varying sizes, which may facilitate further preclinical studies exploring the potential clinical applications of mechanical loading.
Topics: Rats; Animals; Mechanical Phenomena; Bone Development; Fetus; Metatarsal Bones; Weight-Bearing; Stress, Mechanical
PubMed: 37314663
DOI: 10.1007/s10439-023-03258-2 -
Acta Ortopedica Mexicana 2023Complex clubfoot is a term used to describe a subset of patients that received previous treatment, and have distinctive anatomical features: severe equinus, with short... (Review)
Review
Complex clubfoot is a term used to describe a subset of patients that received previous treatment, and have distinctive anatomical features: severe equinus, with short first metatarsal, hyperextended big toe, severe plantar flexion of all metatarsals and deep folds through the sole of the foot and above the heel. Most complex clubfeet appear to be idiopathic and is usually associated with a poor casting technique. Complex clubfoot requires an early recognition and an adjustment of the casting protocol using the four finger Ponseti technique. This article gives the treating physician a general overview of the evaluation, treatment, and outcomes of complex clubfoot with the Ponseti method.
Topics: Humans; Infant; Clubfoot; Treatment Outcome; Casts, Surgical; Heel; Metatarsal Bones
PubMed: 38373734
DOI: No ID Found -
Biomedicines Oct 2023Increased ulcer risk diminishes the quality of life in diabetes. This study assessed abnormalities in foot plantar pressure distribution in adolescents with T1D to...
Increased ulcer risk diminishes the quality of life in diabetes. This study assessed abnormalities in foot plantar pressure distribution in adolescents with T1D to detect early signs of ulcer risk. A total of 102 T1D patients, without diabetic neuropathy, were included (mean age 17.8 years, mean diabetes duration 7.4 year). Pedography was captured using Novel emed. Data from the study group were compared with reference data. The study revealed a statistically significant reduced foot contact area in both feet in the entire foot and under the head of the fifth metatarsal bone and the second toe. In both feet, the peak pressure was increased under the entire foot, hindfoot, midfoot, first metatarsal head, big toe, and second toe. There was no statistically significant difference in peak pressure. The mean plantar pressure rating was statistically significantly increased in both feet across the entire sole, in the hindfoot, midfoot, and first metatarsal head. T1D patients of age near adulthood without neuropathy have increased values in mean pressure and reduced contact area, pointing to the need of monitoring and preventive measures. These results point to the need of further research and analysis which should include various risk factor such as foot anatomy, body posture, or certain metabolic factors.
PubMed: 38001902
DOI: 10.3390/biomedicines11112901 -
Journal of Wrist Surgery Apr 2024Treatment of post-traumatic osteochondral defects in the radiocarpal and distal radioulnar joint with nonvascularized metatarsal articular bone grafting is an option...
Treatment of post-traumatic osteochondral defects in the radiocarpal and distal radioulnar joint with nonvascularized metatarsal articular bone grafting is an option to restore the joint (cartilage) surface and wrist function. To evaluate the clinical midterm results of 10 consecutive patients who were treated with a nonvascularized metatarsal bone graft for cartilage bone defects of the lunate facet, scaphoid facet, sigmoid notch, or the radial part of the ulnar head. Patients with isolated osteochondral defects of the lunate facet, scaphoid facet, sigmoid notch, or radial part of the ulnar head, respectively, as a result of wrist trauma were retrospectively identified in a prospectively collected database. The patients symptoms were limited wrist motion and/or pain. Clinical results and complications were extracted from patient's medical files and two questionnaires consisting of the Patient-Rated Wrist Evaluation and additional questions regarding patient satisfaction and return to work and/or hobby. Minor complications occurred in three cases and required surgery. In five cases an acceptable donor site foot morbidity was seen at 1 year. One patient was not satisfied due to persistent wrist pain despite adequate range of motion. One patient could not return to its prior work. Another patient could not resume its hobby. Retrospective evaluation of 10 cases with resurfacing of the scaphoid facet, sigmoid notch, and/or lunate facet, or radial part of the ulnar head has shown that osseointegration was possible without a vascular pedicle to the graft in all cases with a (mean) follow-up of 5 years. This technique may become an alternative treatment when implants become less available. Level III.
PubMed: 38505203
DOI: 10.1055/s-0043-1768923 -
World Journal of Orthopedics Dec 2023In the field of minimally invasive surgery (MIS) for the treatment of hallux valgus (HV), different techniques have begun to emerge in the literature concerning the...
BACKGROUND
In the field of minimally invasive surgery (MIS) for the treatment of hallux valgus (HV), different techniques have begun to emerge in the literature concerning the distal osteotomy of the first metatarsal bone, the synthesis or not of the metatarsal head, the possible association with lateral soft tissues release (LSTR) and osteotomy of the base of the first phalanx.
AIM
To evaluate the role of LSTR on percutaneous HV correction, evaluating functional and radiographical results.
METHODS
From January 2012 to May 2016 a total of 396 patients with mild to moderate symptomatic HV treated with the MIS technique were included in this retrospective study. The technique provides no internal fixation (WOS). Patients were divided into the LSTR group and no LSTR group (LSTR N). This surgical procedure (LSTR) was reserved for insufficient HV angle (HVA) correction during fluoroscopic control. Patients were evaluated at each follow-up by two other authors after appropriate training by senior authors (first practitioners). Clinical evaluation was performed before surgery, 6 mo after surgery, and 48 mo follow-up. American Orthopaedic Foot and Ankle Society (AOFAS) and visual analog scale (VAS) score was used to evaluate pain and function, and complications were recorded. In addition, the incidence of relapses and the degree of joint range of motion (ROM) with the association with the LSTR (capsule, adductor tendon, phalanx-sesamoid ligament, and the deep transverse metatarsal ligament) were evaluated. Radiological parameters included HVA and intermetatarsal angle (IMA). Patient satisfaction was assessed. Student -test and Fisher exact test were used to assess statistical analysis.
RESULTS
From our study it is clear that no differences in term of HVA, VAS, IMA correction, rate of complications, and AOFAS score were found between groups, while a significant improvement of the same variables was found in each group between pre and postoperative values. A significant improvement in ROM at 6 mo ( 0.018) and 48 mo ( = 0.02) of follow-up was found in LSTR N group. Complications were rare in both groups.
CONCLUSION
LSTR procedure on percutaneous HV correction seems to increase postoperative joint stiffness with a comparable incidence of relapse and a low incidence of complications.
PubMed: 38173806
DOI: 10.5312/wjo.v14.i12.843 -
Frontiers in Endocrinology 2023Children with inflammatory bowel disease (IBD) often suffer from poor bone growth and impaired bone health. Humanin is a cytoprotective factor expressed in bone and...
OBJECTIVE
Children with inflammatory bowel disease (IBD) often suffer from poor bone growth and impaired bone health. Humanin is a cytoprotective factor expressed in bone and other tissues and we hypothesized that humanin levels are suppressed in conditions of chronic inflammation. To address this, humanin levels were analyzed in serum samples from IBD patients and in cultured human growth plate tissue specimens exposed to IBD serum or TNF alone.
METHODS
Humanin levels were measured by ELISA in serum from 40 children with IBD and 40 age-matched healthy controls. Growth plate specimens obtained from children undergoing epiphysiodesis surgery were cultured for 48 hours while being exposed to IBD serum or TNF alone. The growth plate samples were then processed for immunohistochemistry staining for humanin, PCNA, SOX9 and TRAF2 expression. Dose-response effect of TNF was studied in the human chondrocytic cell line HCS-2/8. cultured fetal rat metatarsal bones were used to investigate the therapeutic effect of humanin.
RESULTS
Serum humanin levels were significantly decreased in children with IBD compared to healthy controls. When human growth plate specimens were cultured with IBD serum, humanin expression was significantly suppressed in the growth plate cartilage. When cultured with TNF alone, the expression of humanin, PCNA, SOX9, and TRAF2 were all significantly decreased in the growth plate cartilage. Interestingly, treatment with the humanin analog HNG prevented TNF-induced bone growth impairment in cultured metatarsal bones.
CONCLUSION
Our data showing suppressed serum humanin levels in IBD children with poor bone health provides the first evidence for a potential link between chronic inflammation and humanin regulation. Such a link is further supported by the novel finding that serum from IBD patients suppressed humanin expression in cultured human growth plates.
Topics: Child; Rats; Humans; Animals; Proliferating Cell Nuclear Antigen; TNF Receptor-Associated Factor 2; Inflammation; Inflammatory Bowel Diseases; Intracellular Signaling Peptides and Proteins
PubMed: 38322155
DOI: 10.3389/fendo.2023.1142310 -
Archives of Orthopaedic and Trauma... Aug 2023To evaluate the clinical and radiological results after fixation of the first metatarsal head (MTH) with one or two screws as part of the third-generation minimally...
INTRODUCTION
To evaluate the clinical and radiological results after fixation of the first metatarsal head (MTH) with one or two screws as part of the third-generation minimally invasive Chevron-Akin osteotomy (MICA) for hallux valgus deformities.
MATERIALS AND METHODS
Between August 2020 and November 2021, 55 MICA procedures (50 patients, male:female = 7:43), 22 with two (MICA2), 33 with one screw (MICA1) were performed for mild to severe hallux valgus deformities. Exclusion criteria were a concomitant pes adductus (Sgarlato angle > 20°) or hindfoot/midfoot deformities requiring treatment. In 27 cases, additional procedures on the forefoot (small toe corrections or metatarsal osteotomies II-V) were necessary. Pre- and post-operatively, hallux valgus angle (HVA) and intermetatarsal I/II angle (IMA) were measured. Clinically, subjective satisfaction, range of motion (ROM) of the first metatarsophalangeal joint (MTPJ), and pain level (NRS score) were evaluated. The minimum follow-up was 12 months.
RESULTS
Displacement of MTH was 70-90% on average, all osteotomies showed full consolidation at latest follow-up. In one case of either group, a slight subsidence of MTH was documented. The radiological and clinical parameters showed no differences between the groups. The pain level improved by an average of three points. The mobility of the MTPJ showed a slight reduction in nine cases after three months (4 MICA2, 5 MICA1) which persisted in three cases. Fifty-two of 55 patients (95%) would opt again for the operation.
CONCLUSIONS
Fixation of the first MTH with a single bicortical screw in MICA with moderate lateralization of MTH shows stable anchoring and good clinical results. The routine use of a second metatarsal screw can be omitted.
Topics: Humans; Male; Female; Metatarsal Bones; Hallux Valgus; Case-Control Studies; Treatment Outcome; Bone Screws; Osteotomy; Pain
PubMed: 36577799
DOI: 10.1007/s00402-022-04740-7