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Foot & Ankle International Dec 2023To compare the clinical, radiologic, and functional outcomes between shockwave and operative treatments for proximal fifth metatarsal stress fractures in soccer players... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
To compare the clinical, radiologic, and functional outcomes between shockwave and operative treatments for proximal fifth metatarsal stress fractures in soccer players in a pilot study.
METHODS
Between 2017 and 2019, 18 soccer players with fifth metatarsal stress fractures attended at Mutualidad de Futbolistas Españoles-Delegación Catalana were included. Patients were randomly assigned into 2 groups receiving either surgery with an intramedullary screw (group 1) or high-energy focused extracorporeal shockwave treatment (group 2 performed once a week for 3 weeks using 2000 impulses at an energy flux density of 0.21 mJ/mm and 4 Hz frequency). Clinical (pain), radiologic (bone healing), and functional (Tegner Activity Scale and American Orthopaedic Foot & Ankle Society [AOFAS] ankle-hindfoot scales) outcomes before and after receiving the treatment were compared between both groups. In addition, ability and time to return to play was also compared between groups.
RESULTS
No patients were lost to follow-up. There were no statistically significant differences at last follow-up between surgery and extracorporeal shockwave treatment for bone healing, pain relief, AOFAS ankle-hindfoot score, Tegner score, and time return to play. No complications were reported in either of the 2 groups.
CONCLUSION
In this pilot study, extracorporeal shockwave treatment and operative treatment were found to be equally effective at reducing pain, achieving bone healing, and allowing the soccer players to return to play after proximal fifth metatarsal stress fractures. This study suggests that ESWT may be a good option for the management of proximal fifth metatarsal stress fractures in soccer players. If this approach proves successful in larger trials, the shockwave approach might help avoid known complications of the surgical treatment like wound problems, nerve injury, and hardware intolerance. Further investigations with larger sample size should be conducted in order to confirm the present conclusions.
LEVEL OF EVIDENCE
Level II, therapeutic, pilot randomized controlled trial.
Topics: Humans; Fractures, Stress; Metatarsal Bones; Soccer; Pilot Projects; Bone Diseases; Pain; Fractures, Bone
PubMed: 37905784
DOI: 10.1177/10711007231199094 -
Skeletal Radiology Sep 2023Hallux valgus surgery concerns many patients and various techniques are performed. The assessment of the first toe deformity correction is mainly visual and imaging is... (Review)
Review
Hallux valgus surgery concerns many patients and various techniques are performed. The assessment of the first toe deformity correction is mainly visual and imaging is required to analyze the intermetatarsal angle and depict complications. However, it is often difficult for the radiologist to distinguish normal and pathological conditions, especially in case of osteotomies which may show various aspects of bone mineralization and healing. In this review, the most relevant imaging features of the post-operative hallux valgus are summarized.
Topics: Humans; Hallux Valgus; Osteotomy; Foot Deformities; Diagnostic Imaging; Radiologists; Metatarsal Bones; Treatment Outcome; Retrospective Studies
PubMed: 36949167
DOI: 10.1007/s00256-023-04322-7 -
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 -
Archives of Orthopaedic and Trauma... Oct 2023The current minimally invasive distal metatarsal osteotomy for hallux valgus (HV) is V-shaped, which prevents the correction of the rotational metatarsal head deformity... (Review)
Review
BACKGROUND
The current minimally invasive distal metatarsal osteotomy for hallux valgus (HV) is V-shaped, which prevents the correction of the rotational metatarsal head deformity and reduction of the sesamoid bones. We sought to determine the optimal method for sesamoid bone reduction during HV surgery.
METHODS
We reviewed the medical records of 53 patients who underwent HV surgery between 2017 and 2019 using one of three techniques: open chevron osteotomy (n = 19), minimally invasive V-shaped osteotomy (n = 18), and a modified straight minimally invasive osteotomy (n = 16). The sesamoid position was graded using the Hardy and Clapham method on weight-bearing radiographs.
RESULTS
When compared to open chevron and V-shaped osteotomies, the modified osteotomy resulted in significantly lower postoperative sesamoid position scores (3.74 ± 1.48, 4.61 ± 1.09, and 1.44 ± 0.81, respectively, P < 0.001). Furthermore, the mean change in postoperative sesamoid position score was greater (P < 0.001).
CONCLUSION
The modified minimally invasive osteotomy was superior to the other two techniques in correcting HV deformity in all planes, including sesamoid reduction.
Topics: Humans; Hallux Valgus; Retrospective Studies; Osteotomy; Sesamoid Bones; Metatarsal Bones; Treatment Outcome
PubMed: 37202550
DOI: 10.1007/s00402-023-04868-0 -
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 -
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 -
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 -
The American Journal of Sports Medicine May 2022Fractures of the proximal fifth metatarsal bone are common injuries in elite athletes and are associated with high rates of delayed union and nonunion. Structural...
BACKGROUND
Fractures of the proximal fifth metatarsal bone are common injuries in elite athletes and are associated with high rates of delayed union and nonunion. Structural features of the foot may increase fracture risk in some individuals, emphasizing the need for intervention strategies to prevent fracture. Although orthotic devices have shown promise in reducing fractures of the fifth metatarsal bone, the effect of orthosis on fifth metatarsal strains is not well understood.
PURPOSE
To quantify the effects of different foot orthotic constructs on principal tensile strains in the proximal fifth metatarsal bone during cadaveric simulations of level walking. An additional purpose was to investigate the relationships between structural features of the foot and corresponding strains on the fifth metatarsal bone during level walking.
STUDY DESIGN
Controlled laboratory study.
METHODS
A total of 10 midtibial cadaveric specimens were attached to a 6 degrees of freedom robotic gait simulator. Strain gauges were placed at the metaphyseal-diaphyseal junction (zone II) and the proximal diaphysis (zone III) during level walking simulations using 11 different foot orthotic configurations. Images of each specimen were used to measure structural features of the foot in an axially loaded position. The peak tensile strains were measured and reported relative to the sneaker-only condition for each orthotic condition and orthotic-specific association between structural features and principal strains of both zones.
RESULTS
In total, 2 of the 11 orthotic conditions significantly reduced strain relative to the sneaker-only condition in zone II. Further, 6 orthotic conditions significantly reduced strain relative to the sneaker-only condition in zone III. Increased zone II principal strain incurred during level walking in the sneaker-only condition showed a significant association with increases in the Meary's angle. Changes in zone III principal strain relative to the sneaker-only condition were significantly associated with increases in the Meary's angle and fourth-fifth intermetatarsal angle.
CONCLUSION
The use of orthotic devices reduced principal strain relative to the condition of a sneaker without any orthosis in zone II and zone III. The ability to reduce strain relative to the sneaker-only condition in zone III was indicated by increasing values of the Meary's angle and levels of the fourth-fifth intermetatarsal angle.
CLINICAL RELEVANCE
Clinicians can use characteristics of foot structure to determine the proper foot orthosis to potentially reduce stress fracture risk in high-risk individuals.
Topics: Cadaver; Fractures, Bone; Fractures, Stress; Humans; Metatarsal Bones; Orthotic Devices; Walking
PubMed: 35302902
DOI: 10.1177/03635465221079652 -
Surgical and Radiologic Anatomy : SRA Feb 2023It was aimed to reveal whether the positions and dimensions of the extrinsic and intrinsic muscle tendons related to the hallux around the first metatarsal bone are...
PURPOSE
It was aimed to reveal whether the positions and dimensions of the extrinsic and intrinsic muscle tendons related to the hallux around the first metatarsal bone are affected by the severity of hallux valgus (HV) and whether tendon positional changes and tendon sizes affect each other.
METHODS
In formalin-fixed 46 feet, three HV angle subgroups (normal, mild, and moderate/severe) were defined. Width, thickness, and cross-sectional area (CSA) of tendons of the extensor hallucis longus (EHL) and brevis (EHB), abductor hallucis (AH), and flexor hallucis longus (FHL) were measured. On the clock model created in coronal plane, positional variations of each tendon were determined.
RESULTS
In the moderate/severe HV group, thickness and CSA of the EHB, width and CSA of the AH were smaller, compared to mild HV. Width and CSA of the FHL were smaller in moderate/severe HV than in the normal. Regardless of HV, the width and CSA of the FHL were greater in cases where the FHL was located more lateral, and the width of both FHL and AT were greater in cases where AH located was more plantar.
CONCLUSION
The smaller tendon size of two intrinsic (one plantar and one dorsal) and one extrinsic muscle in the moderate/severe HV group indicates that changes in the tendons are evident in cases of high severity of HV but not in cases of mild HV. Accordingly, the changes do not appear to be due to a factor limited to only one aspect of the foot. It is recommended to consider the possible biomechanical effects of AH, FHL, and EHB tendon dimensional weakness in surgical planning in moderate/severe HV cases.
Topics: Humans; Hallux Valgus; Metatarsal Bones; Tendons; Foot; Muscle, Skeletal; Hallux
PubMed: 36581705
DOI: 10.1007/s00276-022-03066-8 -
BMC Veterinary Research Dec 2021This study aimed to measure the length of metacarpal and metatarsal bones in five Iranian sheep breeds and to correlate the length of the bones with ungula measurements....
BACKGROUND
This study aimed to measure the length of metacarpal and metatarsal bones in five Iranian sheep breeds and to correlate the length of the bones with ungula measurements. Thoracic and pelvic limbs of 2-year-old, previously untrimmed, pastured Afshari, Moghani, Kurdi, Makoui, and Lori-Bakhtiari ewes, (n = 20 ewes per breed) were collected after slaughter. The following lengths were recorded in the metacarpal and metatarsal bones: from the margo proximalis lateralis to the lateral (L1) and medial (D1) cartilago physialis; from the margo proximalis lateralis to the margo abaxialis of the lateral (L2) and medial (D2) caput; from the cartilago physialis lateralis to the margo abaxialis of the lateral caput (X1); from the cartilago physialis medialis to the margo distalis of the caput ridge (X2) and from the margo axialis of cartilago physialis to the margo axialis of the lateral caput (X3). Additionally, measurements of the ungula including pars dorsalis length, pars mobilis lateralis and medialis height, pars dorsalis height to the ground and to the solea cornea, thickness of the solea in the pars dorsalis, pars mobilis lateralis and medialis, solea cornea length and angulus dorsalis were recorded in the medial and lateral digits of the thoracic and pelvic limbs. Data on length of the metatarsal and metacarpal bones were analysed using mixed model equations while Pearson correlations were calculated between metacarpal and metatarsal bones and ungula measurements.
RESULTS
Lori- Bakhtiari and Moghani ewes had greater L1, L2, and D1 and D2 while X1, X2 and X3 was greater in Kurdi ewes (P < 0.05). Measurements such as L1, L2, D1 and D2 were greater in the metatarsal than in metacarpal bones (P < 0.05) and the opposite was observed for X1, X2 and X3 (P < 0.05). No asymmetry was observed between the lateral and medial measurements (P > 0.05). Low to moderate correlations were observed between bone and ungula measurements (P < 0.05).
CONCLUSION
Under the conditions of this study, differences in metacarpal and metatarsal bone measurements were observed between breeds but no asymmetry was observed between lateral and medial bones. Results indicate an association between metacarpal and metatarsal bones ungula measurements. This could provide baseline information for the development and/or improvement of current ungula health protocols in the studied sheep breeds.
Topics: Animals; Breeding; Female; Iran; Metacarpal Bones; Metatarsal Bones; Sheep
PubMed: 34872547
DOI: 10.1186/s12917-021-03076-5