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BMC Musculoskeletal Disorders Nov 2023To evaluate the radiographic diagnostic criteria and propose standardised radiographic criteria for Lisfranc injuries.
PURPOSE
To evaluate the radiographic diagnostic criteria and propose standardised radiographic criteria for Lisfranc injuries.
METHODS
A systematic review of the PubMed and Embase databases was performed according to the PRISMA guidelines. The various radiographic criteria for the diagnosis of Lisfranc injuries were extracted. Descriptive statistics were presented for all continuous (as mean ± standard deviation) and categorical variables (as frequencies by percentages).
RESULTS
The literature search included 29 studies that totalled 1115 Lisfranc injuries. The risk of bias ranged from "Low" to "Moderate" risk according to the ROBINS-I tool. The overall recommendations according to the GRADE assessment ranged from "Very Low" to "High". 1 metatarsal to 2 metatarsal diastasis was the most common of the 12 various radiographic diagnostic criteria observed, as was employed in 18 studies. This was followed by 2 cuneiform to 2 metatarsal subluxation, as was employed in 11 studies.
CONCLUSION
The radiographic diagnostic criteria of Lisfranc injuries were heterogeneous. The proposition for homogenous radiographic diagnostic criteria is that the following features must be observed for the diagnosis of Lisfranc injuries: 1 metatarsal to 2 metatarsal diastasis of ≥ 2 mm on anteroposterior view or 2 cuneiform to 2 metatarsal subluxation on anteroposterior or oblique views. Further advanced imaging by CT or MRI may be required in patients with normal radiographs but with continued suspicion for Lisfranc injuries.
LEVEL OF EVIDENCE
4, systematic review.
Topics: Humans; Joint Dislocations; Magnetic Resonance Imaging; Radiography; Metatarsal Bones; Foot Injuries
PubMed: 38012651
DOI: 10.1186/s12891-023-07043-z -
Foot (Edinburgh, Scotland) Sep 2023First-Ray (FR) stability allows for foot propulsion in-stance, taking 60% weight. First-ray instability (FRI) is associated with middle column overload, synovitis,... (Observational Study)
Observational Study
BACKGROUND
First-Ray (FR) stability allows for foot propulsion in-stance, taking 60% weight. First-ray instability (FRI) is associated with middle column overload, synovitis, deformity and osteoarthritis. Clinical detection can still be challenging. We propose to develop a clinical test that helps identify FRI using two simple manual manoeuvres.
METHODS
10 patients with unilateral FRI were recruited. Unaffected contralateral feet were used as controls. Stringent exclusion criteria were applied including hallux MTP pain, laxity, inflammatory arthropathy and collagen disorders. A Klauemeter directly measured the sagittal plane dorsal first metatarsal head translation of affected vs unaffected feet. Maximum passive proximal phalanx 1st MTP joint dorsiflexion was measured using a video capture and Tracker motion software analysis with and without applying a dorsal force at the 1st metatarsal head using a Newton meter. Proximal phalanx motion was compared in affected vs unaffected feet with and without dorsal metatarsal head force application and compared to direct measurements using the Klaumeter. P value of < 0.05 was considered significant.
RESULTS
FRI feet had dorsal translation greater than 8 mm (median, 11.94; interquartile range [IQR], 10.23-13.81) vs 1.77 for unaffected control feet was (median, 1.77; interquartile range [IQR], 1.23-2.96) using the Klauemeter. The percentage reduction in 1st MTP joint dorsiflexion ROM when applying the double dorsiflexion test FRI (mean reduction of 67.98%) when compared to control feet (mean reduction of 28.44%)(P < 0.01). Receiver operating characteristic (ROC) analysis showed that a 50% reduction in dorsiflexion ROM of 1st MTPJ when performing the double dorsiflexion test achieved a specificity of 100% and sensitivity of 90% (AUC =0.990, 95%CI [0.958-1.000], P > 0.0001).
CONCLUSION
The double dorsiflexion (DDF) is easy to perform with two relatively simple manual manoeuvres that avoids the need for complex instrumented and radiation-based assessment. Greater than 50% decrease in proximal phalanx motion has an over 90% sensitivity in identifying feet with FRI.
LEVEL OF EVIDENCE
This was a prospective case-controlled study of consecutive cases of a level II evidence.
Topics: Humans; Metatarsophalangeal Joint; Foot; Metatarsal Bones; Hallux; Arthritis; Range of Motion, Articular
PubMed: 36966560
DOI: 10.1016/j.foot.2023.102019 -
BMJ Open Jul 2023Hallux valgus (HV) is one of the most prevalent forefoot deformities, and its frequency increases with age, reaching nearly 23% in adulthood (females are usually more...
INTRODUCTION
Hallux valgus (HV) is one of the most prevalent forefoot deformities, and its frequency increases with age, reaching nearly 23% in adulthood (females are usually more affected). Studies on customised insoles and orthoses for HV showed inconclusive results. There is no consensus in literature regarding the ideal insole or length of use for pain relief or functional improvement in individuals with HV. This study will assess the effects of a customised insole with retrocapital bar associated with an infracapital bar of the first metatarsal on pain and function of individuals with symptomatic HV.
METHODS
This is the protocol for a blinded, sham-controlled randomised clinical trial. Eighty participants with symptomatic HV will be randomised into two groups (40 per group): customised insole or sham insole. Assessments will be performed at baseline (T0), six (T6) and 12 weeks (T12) of intervention. A follow-up will occur after 4 weeks of intervention (T16). The primary and secondary outcomes will be pain (Numerical Pain Scale) and function (Foot Function Index), respectively.
STATISTICAL ANALYSIS
Analysis of variance with a mixed design or Friedman's test will be considered according to data distribution; post-hoc analyses will be performed using Bonferroni test. Time × group interaction and within-group and between-group differences will also be assessed. The intent-to-treat analysis will be used. A significance level of 5% and 95% s will be adopted for all statistical analyses.
ETHICS AND DISSEMINATION
This protocol was approved by the research ethics committee of the Faculty of Health Sciences of Trairi/Federal University of Rio Grande do Norte (UFRN/FACISA; opinion number 5411306). The study results will be disseminated to participants, submitted to a peer-reviewed journal and presented in scientific meetings.
TRIAL REGISTRATIONS NUMBER
NCT05408156.
Topics: Female; Humans; Hallux Valgus; Foot; Pain; Orthotic Devices; Metatarsal Bones; Treatment Outcome; Randomized Controlled Trials as Topic
PubMed: 37400239
DOI: 10.1136/bmjopen-2022-069872 -
Journal of Orthopaedic Surgery (Hong... 2023The combination of distal osteotomy with lateral dissection in joint-preserving surgery for severe hallux valgus deformity has recently begun to yield encouraging... (Observational Study)
Observational Study
BACKGROUND
The combination of distal osteotomy with lateral dissection in joint-preserving surgery for severe hallux valgus deformity has recently begun to yield encouraging results. We examined the frequency of complications and risk factors of those for joint-preserving surgery in patients with and without rheumatoid arthritis (RA).
METHODS
A retrospective, observational study of 72 feet (27 patients with RA) was performed. The inclusion criteria were patients who underwent joint-preserving surgery for hallux valgus deformity at our hospital between January 2008 and March 2016 who could be followed up with for longer than 12 months.
RESULTS
The mean preoperative and immediate postoperative hallux valgus angles (HVA) were 41.8 and 4.4, respectively. The mean preoperative and immediate postoperative intermetatarsal angles between the first and second metatarsal bones (M1-M2A) were 14.6 and 5.8, respectively. At the final postoperative evaluation, the mean HVA was 8.8 and the mean M1-M2A was 6.4.Data were compared among the patients with complications (recurrent valgus deformity, varus deformity), and those without complications (normal HVA) at the final postoperative evaluation. The rate of RA in the varus deformity group was 71.4%, which tended to be higher than in other groups ( = .058). The mean preoperative HVA were 48.2 and 52.6 in the group of recurrent valgus deformity and varus deformity, which was higher than the normal HVA group ( = .001).
CONCLUSIONS
High preoperative HVA was a risk factor for the recurrence of valgus deformity. Most of the varus deformities were observed in the RA group with high preoperative HVA; therefore, caution should be exercised in operating on patients with severe deformity or those with RA.
LEVEL OF EVIDENCE
III.
Topics: Humans; Hallux Valgus; Retrospective Studies; Treatment Outcome; Metatarsophalangeal Joint; Radiography; Arthritis, Rheumatoid; Metatarsal Bones
PubMed: 37807826
DOI: 10.1177/10225536231206536 -
Life (Basel, Switzerland) Sep 2023Syndactyly is the most common congenital malformation of the hand, leading to the fusion of the digits and frequently affecting the ring and middle fingers. The...
Syndactyly is the most common congenital malformation of the hand, leading to the fusion of the digits and frequently affecting the ring and middle fingers. The incidence is 1 out of 2500 children, predominantly occurring in boys and Caucasians. Clinically, the malformation may present as a soft tissue or bony fusion, resulting in the union of the fingers characterised as complete or incomplete. This fusion may involve the phalanges but may also extend to the carpal/tarsal bones, even to the metacarpal or metatarsal level, rarely to the distal end of the forearm and lower leg. The malformation is mostly isolated but may occur together with other disorders or malformations such as synostosis, acro-syndactyly, cleft hand, clinodactyly, or polydactyly. Syndromic syndactyly can be observed in cases of Apert syndrome, Poland's syndrome, Pfeiffer syndrome, and many others. A girl born in June of 2019 was diagnosed with congenital malformation of the right hand at birth-affecting the right middle, ring, and little fingers, respectively. After X-ray imaging, the fusion of the third and fourth proximal phalanges to a common metacarpal was identified, forming a unique diagnosis of clino-syndactyly with metacarpal aplasia. Surgical intervention was advocated for, including a wedge osteotomy to correct the synchondrosis at the phalangeal base and a dorsal flap to close the interdigital space created during the correction of the III and IV. fingers. A trapezoid flap for the release of the syndactyly of the IV and V. fingers was applied. The paper aims to present this surgical correction and its results regarding an atypical case of syndactyly with clinodactyly and metacarpal aplasia.
PubMed: 37763346
DOI: 10.3390/life13091943 -
Chinese Medical Journal Sep 2023
Topics: Metatarsal Bones; Thumb; Metacarpal Bones; Plastic Surgery Procedures
PubMed: 37341652
DOI: 10.1097/CM9.0000000000002552 -
Journal of Medical Case Reports Dec 2023Tarlov's cyst is often underdiagnosed since it is difficult to identify without imaging assistance. Herein, we report the case of a young girl who presented with an...
BACKGROUND
Tarlov's cyst is often underdiagnosed since it is difficult to identify without imaging assistance. Herein, we report the case of a young girl who presented with an 8-year history of chronic osteomyelitis of bilateral proximal phalanges and metatarsal bones caused by a Tarlov's cyst that did not contain a nerve root. The chronic wound in the forefoot is an unusual presentation and resulted from the Tarlov's cyst accompanied with tethered conus syndrome.
CASE PRESENTATION
A 10-year-old Asian girl presented with an 8-year history of chronic osteomyelitis of bilateral proximal phalanges and metatarsal bones. She received sequestrectomy five times, however the immune function tests were all normal. A neurological examination revealed diminished sensation and a slapping gait pattern. Magnetic resonance imaging (MRI) demonstrated a lobulated cyst at the right aspect of the sacrum (S) 1 to sacrum (S) 3 canal near the dorsal root ganglion. Tethered conus syndrome was highly suspected. She received laminectomy of lumbar (L) 5 and S1-S2, which led to the diagnosis of a right S1-S3 epidural cyst. The final diagnosis from the histopathological examination was a right sacral Tarlov's cyst. The clinical conditions of diminished sensation and slapping gait pattern greatly improved after successful surgical treatment.
CONCLUSION
In children who present with a recalcitrant chronic wound in the forefoot accompanied with a slapping gait pattern and foot hypoesthesia to pain, aggressive imaging examinations such as spine MRI should be arranged for further evaluation, especially in immunocompetent children.
Topics: Female; Child; Humans; Tarlov Cysts; Cysts; Magnetic Resonance Imaging; Laminectomy; Osteomyelitis
PubMed: 38057903
DOI: 10.1186/s13256-023-04232-1 -
Veterinary Medicine International 2024Greater cane rats () are now being captive reared and domesticated in the sub-Saharan Africa because of increase in their demand for biomedical research and traditional...
Greater cane rats () are now being captive reared and domesticated in the sub-Saharan Africa because of increase in their demand for biomedical research and traditional medicine and as a source of meat. This research was performed to provide the normal radiological anatomy of the pelvis and pelvic limb in greater cane rats for a reference in biomedical research, in anatomical studies, and in clinical use. Radiological examination of the pelvis and right pelvic limb was done in five greater cane rats. Radiological results were correlated with bones of the pelvis and right pelvic limb. The pelvic bone had a prominent caudoventral iliac spine. The pelvic symphysis was long and obturator foramina appeared teardrop-shaped elongated craniocaudally. The prominent major trochanter extended proximally higher than the femoral head. The middle third of the body of the tibia presented a very prominent tuberosity. In all specimens, the tarsal sesamoid bone was visualised. Mineralised popliteal sesamoid bone was not visualised. In male greater cane rats, the os penis was visualised. The lateral and medial menisci of the stifle joint were seen with ossicles. The first metatarsal bone was rudimentary with greater plantar divergence. Despite of the pelvic limb and pelvis of greater cane rats sharing anatomical structures with other rodents, it retains some exceptional anatomical features. Findings of this study will serve as a reference for anatomical studies, clinical veterinary practice, and in biomedical research.
PubMed: 38420289
DOI: 10.1155/2024/5998717 -
Foot (Edinburgh, Scotland) Sep 2023The provision of therapeutic footwear, to prevent the development of diabetic foot ulcers by re-distributing high peak plantar pressure is frequently prescribed for...
BACKGROUND
The provision of therapeutic footwear, to prevent the development of diabetic foot ulcers by re-distributing high peak plantar pressure is frequently prescribed for patients with diabetes. Areas of interest (ROI) are identified by placing boxes on the visualised pressure movie. The aims were to evaluate the inter-reliability of the placements of seven ROI boxes and to explore how the box placement affected peak pressure in the seven ROIs.
METHODS
Plantar pressure movies from 20 of a total of 40 movies were selected for the analysis. Boxes were placed at ROIs, the heel, the lateral midfoot, the metatarsal phalangeal heads (5, 3-4, 2 and 1) and the hallux. The box placements were registered for the left vertical position (L) and the top horizontal position (T) for each of the ROIs, based on registrations by two certified prosthetists and orthotists.
FINDINGS
The inter correlation coefficient of the placement of the boxes ranged from 1.00 to 0.12 (heel_L and metatarsal phalangeal head 2_L respectively). Of the 14 positions of the boxes; four were excellent, four were good, two were moderate and four were poor. No significant differences in the mean peak pressure corresponding to the box placements were found between the CPOs.
INTERPRETATION
The inter-reliability of eight of the 14 registered placements, made by prosthetists and orthotists, of the boxes in Scan® was good to excellent. A variation of 1.00-0.12 was present. Despite the variation, no significant differences in the corresponding mean peak pressure between prosthetists and orthotists was found.
Topics: Humans; Diabetic Foot; Shoes; Reproducibility of Results; Foot; Metatarsal Bones; Diabetes Mellitus
PubMed: 37004466
DOI: 10.1016/j.foot.2023.102027 -
BMC Musculoskeletal Disorders Apr 2024Fractures of hands and feet are common in children, but relevant epidemiological studies are currently lacking. We aim to study the epidemiological characteristics of...
BACKGROUND
Fractures of hands and feet are common in children, but relevant epidemiological studies are currently lacking. We aim to study the epidemiological characteristics of hand and foot fractures and growth plate injuries in children and provide a theoretical basis for their prevention, diagnosis, and treatment.
METHODS
We retrospectively analyzed the data of children with hand and foot fractures who were hospitalized at Shenzhen Children's Hospital between July 2015 and December 2020. Data on demographic characteristics, fracture site, treatment method, etiology of injury, and accompanying injuries were collected. The children were divided into four age groups: infants, preschool children, school children, and adolescents. The fracture sites were classified as first-level (the first-fifth finger/toe, metacarpal, metatarsal, carpal, and tarsal) and second-level (the first-fifth: proximal phalanx, middle phalanx, distal phalanx, metacarpal, and metatarsal) sites. The changing trends in fracture locations and injury causes among children in each age group were analyzed.
RESULTS
Overall, 1301 children (1561 fractures; 835 boys and 466 girls) were included. The largest number of fractures occurred in preschool children (n = 549, 42.20%), with the distal phalanx of the third finger being the most common site (n = 73, 15.57%). The number of fractures in adolescents was the lowest (n = 158, 12.14%), and the most common fracture site was the proximal phalanx of the fifth finger (n = 45, 29.61%). Of the 1561 fractures, 1143 occurred in the hands and 418 in the feet. The most and least common first-level fracture sites among hand fractures were the fifth (n = 300, 26.25%) and first (n = 138, 12.07%) fingers, respectively. The most and least common first-level foot fracture locations were the first (n = 83, 19.86%) and fourth (n = 26, 6.22%) toes, respectively. The most common first-level and second level etiologies were life related injuries (n = 1128, 86.70%) and clipping injuries (n = 428, 32.90%), respectively. The incidence of sports injuries gradually increased with age, accounting for the highest proportion in adolescents (26.58%). Hand and foot fractures had many accompanying injuries, with the top three being nail bed injuries (570 cases, 36.52%), growth plate injuries (296 cases, 18.96%), and distal severed fracture (167 cases, 10.70%). Among the 296 growth plate injuries, 246 occurred on the hands and 50 on the feet.
CONCLUSIONS
In contrast to previous epidemiological studies on pediatric hand and foot fractures, we mapped the locations of these fractures, including proximal, shaft, distal, and epiphyseal plate injuries. We analyzed the changing trends in fracture sites and injury etiologies with age. Hand and foot fractures have many accompanying injuries that require attention during diagnosis and treatment. Doctors should formulate accident protection measures for children of different ages, strengthen safety education, and reduce the occurrence of accidental injuries.
Topics: Male; Child, Preschool; Infant; Female; Adolescent; Child; Humans; Retrospective Studies; Salter-Harris Fractures; Fractures, Bone; Hand Injuries; Metacarpal Bones; Foot Injuries
PubMed: 38589862
DOI: 10.1186/s12891-024-07407-z