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Surgical and Radiologic Anatomy : SRA Jan 2024The present study aimed to evaluate the accuracy of anthropometric foot measurements in predicting the diameter of the intramedullary screw for fifth metatarsal fracture...
PURPOSE
The present study aimed to evaluate the accuracy of anthropometric foot measurements in predicting the diameter of the intramedullary screw for fifth metatarsal fracture fixation. Secondary aim was to identify whether the fifth metatarsal intramedullary canal diameter is correlated to the fifth metatarsal length and the foot dimensions.
METHODS
In 29 cadaveric feet, the maximum length of the plantar surface of the foot (PL) and the perimeter of the foot at the level of the fifth metatarsal base (PBFM) were measured using a measuring tape. Subsequently, the fifth metatarsal was excised. Using Computed Tomography scan, the metatarsal length (FML), and the horizontal (HDI) and vertical diameter (VDI) at the isthmus level were measured. The HDI values were grouped in 5 mm increments to correspond to the recommended screw diameter (RSD) for intramedullary fixation. A univariate linear regression analysis considered RSD and HDI as the dependent variables and FML, PL, PBFM as the independent variables. A multivariate regression analysis was performed to examine the predictive value of the two anthropometric measurements. A p-value < 0.05 was considered statistically significant.
RESULTS
All six univariate analyses revealed that the dependent variable was significantly correlated with the independent variable. However, the multivariate regression models showed that the anthropometric measurements were not significantly correlated with the RSD and HDI.
CONCLUSION
The current study found an association between the fifth metatarsal intramedullary canal diameter and the fifth metatarsal length and foot anthropometric dimensions. However, the anthropometric measurements of the foot presented a low predictive value for the decision of an intramedullary screw diameter in the treatment of fractures of the base of the fifth metatarsal.
Topics: Humans; Metatarsal Bones; Fracture Fixation, Internal; Fluorometholone; Fractures, Bone; Foot Injuries; Ankle Injuries; Knee Injuries; Bone Screws
PubMed: 38055036
DOI: 10.1007/s00276-023-03267-9 -
Cureus Aug 2023The calcaneal lengthening procedure (CLP) is a well-known surgical technique used for the correction of symptomatic planovalgus foot deformities. Literature shows a...
INTRODUCTION
The calcaneal lengthening procedure (CLP) is a well-known surgical technique used for the correction of symptomatic planovalgus foot deformities. Literature shows a significant rate of relapse and undercorrection of the foot post-operatively. Factors determining the failure or success of CLP are still not well understood. The purpose of this retrospective study was to assess the most significant factors related to the failure of this procedure.
METHODS
A case-control retrospective study was conducted on 50 patients (80 feet) aged 12.4±2.5 years who underwent CLP. A clinical (demographic parameters, etiology, Gross Motor Function Classification System (GMFCS) level) and radiological evaluation were assessed preoperatively and repeated postoperatively at 56.5±32.5 months. Two methods of osteotomy bone fixation were studied: K-wires vs. eight-plate. Standing anteroposterior (AP) and lateral (L) radiographs were done, and the following radiographic parameters were measured: calcaneocuboid (CC) joint subluxation classified into normal, moderate, and severe (L); AP and L talo-first metatarsal (T1MT) angle; AP talonavicular (TN) coverage angle; AP and L talocalcaneal (TC) angle; calcaneal pitch (CP) angle; and L talo-horizontal (TH) angle. Mosca's criteria were used for clinical and radiological assessments. The association between demographic data, clinical and radiological results, and the variation between preoperative and postoperative angles were studied. The main risk factors affecting clinical results and CC joint subluxation were investigated (logistic regression and analysis of covariance (ANCOVA)).
RESULTS
Satisfactory clinical results were associated with satisfactory radiological ones on Mosca's criteria (p<0.001). The use of an eight-plate for osteotomy fixation gave better results than K-wires (79% vs. 59%). Radiological angles were improved in both techniques postoperatively (increase of CP and L-TC and decrease of AP-T1MT, AP-TC, AP-TN, and L-T1MT, all p<0.05). Non-satisfactory clinical results were associated with a high GMFCS level, a low preoperative AP-TN coverage angle, and a low preoperative CP angle (R=0.45). Both a young age and a low CP angle preoperatively were associated with CC subluxation (R=0.31).
CONCLUSION
The neurological status and the severity of the planovalgus foot deformity preoperatively were the main risk factors affecting clinical outcomes after CLP. However, young age and the severity of the deformity preoperatively were the main risk factors behind CC joint subluxation affecting CLP outcomes.
PubMed: 37692710
DOI: 10.7759/cureus.43157 -
Scientific Reports Jun 2024This study aimed to elucidate the relationship between joint structures of the first tarsometatarsal and articular facet degeneration. A total of 100 feet from 50...
This study aimed to elucidate the relationship between joint structures of the first tarsometatarsal and articular facet degeneration. A total of 100 feet from 50 cadavers were examined. The articular facets of the first metatarsal and medial cuneiform were categorized into four types based on the superior and inferior facets' separation, and the formation of the inferior lateral facet on the lateral plantar prominence: Type I, a single facet with no separation or inferior lateral facet; Type II-a, two facets with separation but no inferior lateral facet; Type II-b, two facets, no separation, but with an inferior lateral facet; Type III, three facets with separation and an inferior lateral facet. When both bone types matched, they were defined as Type I, Type II-a, Type II-b, and Type III joints, respectively; unmatched types were classified as Unpair joints. The severity of articular cartilage degeneration on both bones was assessed using a 5-point scale. The degeneration grade was compared among joint types. Type III joints exhibited significantly milder articular cartilage degeneration in medial cuneiform compared to Type II-a, II-b, Unpair joints. The formation of inferior lateral facet and separation of the superior and inferior facets might be crucial for the joint's stability.
Topics: Humans; Female; Male; Aged; Middle Aged; Aged, 80 and over; Cadaver; Cartilage, Articular; Metatarsal Bones; Tarsal Joints; Foot Joints
PubMed: 38866886
DOI: 10.1038/s41598-024-64064-x -
The American Journal of Case Reports Dec 2023BACKGROUND Tarsometatarsal joint (TMJ) arthrodesis is common method used for correcting hallux abductus valgus (HAV). Its popularity has grown due to studies revealing...
A 28-Year-Old Woman with Down Syndrome, Congenital Heart Disease, and a History of Knee Surgery and Plantar Fasciitis, with Hallux Abducto Valgus (Bunion) and Lapiplasty Three-Dimensional Correction Surgery.
BACKGROUND Tarsometatarsal joint (TMJ) arthrodesis is common method used for correcting hallux abductus valgus (HAV). Its popularity has grown due to studies revealing HAV's triplanar deformity with frontal plane rotation. This case report presents a 28-year-old woman with Down syndrome, congenital heart disease, and a history of knee surgery and plantar fasciitis, with severe HAV deformity and flexible valgus flatfoot associated with ligamentous hyperlaxity. CASE REPORT Examination revealed severe foot deformities, and radiographic studies confirmed the condition. A surgical intervention was planned, and the patient's cardiologist confirmed she was fit for the procedure. The modified Lapidus technique with frontal plane rotational correction included realigning the metatarsal joint, resecting spurs, osteosynthesis material, and arthrosis in the sinus tarsi. After surgery, the patient underwent a recovery period without support for 8 weeks and received appropriate medical care. Radiographs showed successful alignment, and the patient gradually resumed her daily activities. The patient had an uneventful recovery, and postoperative radiographs showed good alignment in all planes. CONCLUSIONS The hyperlaxity associated with Down syndrome makes the incidence of HAV more frequent, and TMJ fusion is preferable to correction by osteotomy. The modified Lapidus technique with frontal plane rotational correction could be a good technique to achieve satisfactory correction in patients with severe HAV deformity and flexible valgus flatfoot associated with ligamentous hyperlaxity. TMJ fusion is indicated when severe or recurrent rotational component is observed in X-rays.
Topics: Female; Humans; Adult; Hallux; Down Syndrome; Flatfoot; Fasciitis, Plantar; Bunion; Hallux Valgus; Joint Instability; Heart Defects, Congenital; Metatarsal Bones
PubMed: 38091276
DOI: 10.12659/AJCR.940879 -
Journal of Orthopaedic Case Reports Jan 2024Osteoblastoma is a rare, benign, bone-forming tumor accounting for <1% of all primary bone tumors. It has a predilection for the posterior elements of the spine and...
INTRODUCTION
Osteoblastoma is a rare, benign, bone-forming tumor accounting for <1% of all primary bone tumors. It has a predilection for the posterior elements of the spine and metaphysis and diaphysis of long bones. The occurrence of this tumor in the metatarsal region is rare. We report such the case of a metatarsal osteoblastoma which was treated with wide excision and non-vascularized fibular autograft: a reliable method of reconstruction.
CASE REPORT
A 25-year-old woman presented with progressive pain and swelling over the right foot for 4 years. On examination, there was a gross swelling over the fourth metatarsal region over the dorsum of the foot. Radiographs revealed a osteoblastic lesion of the fourth metatarsal bone expanding into the intermetatarsal region. Magnetic resonance imaging (MRI) revealed an expansile altered signal intensity lesion which was hypointense on both T1 and T2 - weighted images with no soft-tissue component. With a working diagnosis of locally aggressive bone-forming tumor, she underwent wide excision of the tumor with reconstruction using a non-vascularized fibular autograft. Intraoperative samples sent for histopathological examination confirmed the diagnosis of osteoblastoma. After 2 years of follow-up, the patient is able to weight bear with no pain and imaging shows graft incorporation with no signs of recurrence.
CONCLUSION
Osteoblastoma of the metatarsal region can present a diagnostic conundrum to the treating clinician due to its rare nature. Proper evaluation and reconstruction at an early stage with wide excision and reconstruction with non-vascularized fibular autograft are a reliable treatment option.
PubMed: 38292114
DOI: 10.13107/jocr.2024.v14.i01.4130 -
Cureus Aug 2023Tuberculosis affecting the smaller bones of the foot is relatively infrequent. There is a paucity of data related to the tubercular involvement of cuboid and metatarsal...
Tuberculosis affecting the smaller bones of the foot is relatively infrequent. There is a paucity of data related to the tubercular involvement of cuboid and metatarsal bones. Diagnosis is challenging, especially in the absence of pulmonary involvement, a history of trauma, and contact with tuberculosis. We present a rare case of primary tuberculosis of the cuboid and fifth metatarsal without pulmonary involvement. The patient was started on anti-tubercular chemotherapy. A detailed literature search revealed that no such case with concomitant involvement of the cuboid and fifth metatarsal without pulmonary seeding has ever been reported.
PubMed: 37680440
DOI: 10.7759/cureus.43049 -
Trauma Case Reports Jun 2024In severe foot trauma, it is difficult to determine the level of amputation when the crush injury is severe. We report a case of amputation near Lisfranc that achieved...
In severe foot trauma, it is difficult to determine the level of amputation when the crush injury is severe. We report a case of amputation near Lisfranc that achieved forefoot amputation-like results by using bone and soft tissue reconstruction while considering tendon balance. The patient was a 40-year-old male. The patient's left leg was caught in a garbage truck and sustained a crush injury. The second to fifth metatarsals were amputated at the diaphysis, and a high degree of instability of the Lisfranc joint was observed. A high degree of contamination was detected in the patient's wound, and the second to fifth toes were amputated at the Lisfranc joint during the initial treatment. The ends of the tibialis anterior, tibialis posterior and peroneus longus were preserved. On day 5 in the hospital, Lisfranc joint fixation of the hallux, amputation of the first metatarsal and reconstruction of the peroneus brevis were performed. On day 13, extensor hallucis longus tendon transfer and free anterolateral thigh flap were performed. On day 80, the patient was able to walk in regular shoes or non-orthopedic shoes. One year after reconstructive surgery, the patient had an average SAFE-Q score of 86.2 and mild varus deformity of the foot remained. In cases of severe foot trauma, the aim of reconstruction should be partial forefoot amputation whenever possible.
PubMed: 38586861
DOI: 10.1016/j.tcr.2024.101000 -
Medicina (Kaunas, Lithuania) Jul 2023: The aim of this study was to investigate under dynamic loading the potential biomechanical benefit of simulated first tarsometatarsal (TMT-1) fusion with low-profile...
First Tarsometatarsal Joint Fusion in Foot-A Biomechanical Human Anatomical Specimen Analysis with Use of Low-Profile Nitinol Staples Acting as Continuous Compression Implants.
: The aim of this study was to investigate under dynamic loading the potential biomechanical benefit of simulated first tarsometatarsal (TMT-1) fusion with low-profile superelastic nitinol staples used as continuous compression implants (CCIs) in two different configurations in comparison to crossed screws and locked plating in a human anatomical model. : Thirty-two paired human anatomical lower legs were randomized to four groups for TMT-1 treatment via: (1) crossed-screws fixation with two 4.0 mm fully threaded lag screws; (2) plate-and-screw fixation with a 4.0 mm standard fully threaded cortex screw, inserted axially in lag fashion, and a 6-hole TMT-1 Variable-Angle (VA) Fusion Plate 2.4/2.7; (3) CCI fixation with two two-leg staples placed orthogonally to each other; (4) CCI fixation with one two-leg staple and one four-leg staple placed orthogonally to each other. Each specimen was biomechanically tested simulating forefoot weightbearing on the toes and metatarsals. The testing was performed at 35-37 °C under progressively increasing cyclic axial loading until construct failure, accompanied by motion tracking capturing movements in the joints. : Combined adduction and dorsiflexion movement of the TMT-1 joint in unloaded foot condition was associated with no significant differences among all pairs of groups ( ≥ 0.128). In contrast, the amplitude of this movement between unloaded and loaded foot conditions within each cycle was significantly bigger for the two CCI fixation techniques compared to both crossed-screws and plate-and-screw techniques ( ≤ 0.041). No significant differences were detected between the two CCI fixation techniques, as well as between the crossed-screws and plate-and-screw techniques ( ≥ 0.493) for this parameter of interest. Furthermore, displacements at the dorsal and plantar aspects of the TMT-1 joint in unloaded foot condition, together with their amplitudes, did not differ significantly among all pairs of groups ( ≥ 0.224). : The low-profile superelastic nitinol staples demonstrate comparable biomechanical performance to established crossed-screws and plate-and-screw techniques applied for fusion of the first tarsometatarsal joint.
Topics: Humans; Alloys; Biomechanical Phenomena; Bone Plates; Cadaver; Foot; Metatarsal Bones
PubMed: 37512121
DOI: 10.3390/medicina59071310 -
Asian Journal of Surgery Nov 2023
Topics: Humans; Metatarsal Bones; Fractures, Bone; Fracture Fixation, Internal; Ankle Joint
PubMed: 37596216
DOI: 10.1016/j.asjsur.2023.06.038 -
BMC Musculoskeletal Disorders Jan 2024The first metatarsophalangeal joint (MTPJ), which includes the first metatarsal and proximal phalanx, plays a crucial role in gait and impacts the windlass mechanism....
BACKGROUND
The first metatarsophalangeal joint (MTPJ), which includes the first metatarsal and proximal phalanx, plays a crucial role in gait and impacts the windlass mechanism. Disruptions to this mechanism are implicated in various foot pathologies. Jack's Test serves as a valuable tool for clinicians to assess the functionality of the MTPJ. Varus rearfoot wedges (VRFWs) are a common treatment employed in the management of lower limb pathologies. The impact of VRFWs on the resistance of the first MTPJ during Jack´s Test is currently unknown. This study aimed to measure the influence of VRFWs on the resistance of the first MTPJ during Jack´s Test. The secondary objective was to validate a new measurement method using a digital force gauge.
METHODS
Thirty participants (17 women and 13 men) were enrolled. A digital force gauge measured the weight-bearing force needed for Jack's Test, thereby evaluating the effects of VRFWs of different angulations. The Kolmogorov-Smirnov test confirmed that the data followed a normal distribution (p > 0.05). The nonparametric Friedman test (p < 0.001) showed that there were significant differences among all VRFWs, while the Wilcoxon test (p < 0.001) showed that there were differences between barefoot conditions and 3°, 5°, and 8° VRFWs.
RESULTS
The use of 8° VRFWs yielded a statistically significant reduction in the passive dorsiflexion force of hallux during Jack's Test (12.51 N ± 4.12, p < 0.001).
CONCLUSIONS
The use of VRFWs has been observed to reduce dorsiflexion resistance in the proximal phalanx of the first MTPJ during Jack's Test. Additionally, the digital force gauge was proven to be a valid tool for conducting Jack's Test, thus offering a reliable measurement method.
Topics: Male; Female; Humans; Hallux; Lower Extremity; Foot; Gait; Metatarsal Bones
PubMed: 38254082
DOI: 10.1186/s12891-024-07182-x