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Foot and Ankle Surgery : Official... Dec 2022This study proposes a treatment algorithm based on the correction of symptomatic metatarsus adductus (MA) associated with hallux abducto-valgo (HAV) through...
BACKGROUND
This study proposes a treatment algorithm based on the correction of symptomatic metatarsus adductus (MA) associated with hallux abducto-valgo (HAV) through tarsometatarsal joint 2-3 (TMTJ) shortening arthrodesis. Our hypothesis is that the proposed algorithm leads to realignment of the forefoot rays from two to five and reduction of the talonavicular coverage angle (TNCA) with good clinical and radiographic results.
METHODS
Clinical and radiographic evaluations were performed before and after surgery at 1-year follow-up on forty-six consecutive adult patients with MA, midfoot pain, HAV and osteoarthritis and/or instability of the TMTJ 2-3 in whom shortening of the 2nd and 3rd TMT joints according to MAA and treatment of the HV according to deformity was undertaken.
RESULTS
Talus-first metatarsal angle (TFMA) was the only parameter which did not statistically significantly postoperatively change. All other clinical (AOFAS score) and radiological outcomes significantly improved postoperatively.
CONCLUSION
Although further studies are needed to confirm the proposed data, it would seems that the shortening arthrodesis of rays two and three has consequences on the forefoot and hindfoot by realigning the longitudinal axis of the foot. The consequent application of the algorithm and adequate correction of the HAV allow good clinical and radiographic results to be obtained.
LEVEL OF EVIDENCE
IV prospective cases series.
Topics: Humans; Adult; Hallux Valgus; Osteotomy; Metatarsus Varus; Metatarsal Bones; Arthrodesis; Treatment Outcome; Retrospective Studies
PubMed: 35810124
DOI: 10.1016/j.fas.2022.06.008 -
Foot and Ankle Surgery : Official... Jun 2021Foot bones in children have more rounded shapes in radiograms than adults. Thus, the goal of this work was assessing inter- and intra-observer reliability in paediatric...
BACKGROUND
Foot bones in children have more rounded shapes in radiograms than adults. Thus, the goal of this work was assessing inter- and intra-observer reliability in paediatric forefoot angle measurements.
MATERIAL AND METHODS
Six forefoot angles in 34 AP standing paediatric foot radiographs were measured by 5 researchers. A classic statistical analysis with use of IBM SPSS Statistics 25 was performed and a new method with two-way analysis of variance was applied.
RESULTS
Results of statistical analysis revealed the properties of a subjective assessment related to specific angles. Kilmartin's angle, calcaneus-fifth metatarsal angle and first ray angle are the most reliable; metatarsus adductus angle should be used with great caution in pediatric population. Engel's angle is the most difficult for measuring and measurement error is the highest.
CONCLUSION
The power of paediatric forefoot measurements is various. Several angles are reliable, while Engle's angle is the most doubtful.
Topics: Adolescent; Child; Child, Preschool; Female; Flatfoot; Foot; Foot Bones; Humans; Male; Metatarsus Varus; Observer Variation; Radiography; Reproducibility of Results; Retrospective Studies; Standing Position
PubMed: 32456981
DOI: 10.1016/j.fas.2020.04.015 -
The Journal of Foot and Ankle Surgery :... 2021The presence of metatarsus adductus (MTA) adds complexity to the diagnosis and treatment of hallux valgus (HV). Identification and careful analysis of these combined...
The presence of metatarsus adductus (MTA) adds complexity to the diagnosis and treatment of hallux valgus (HV). Identification and careful analysis of these combined deformities is of paramount importance. The inability to completely correct HV and an increased incidence of recurrence has been established when MTA deformity is present. We present an option for correction of the combined deformities with multiplanar angular correction arthrodesis of the first, second, and third tarsometatarsal (TMT) joints.
Topics: Arthrodesis; Bunion; Hallux Valgus; Humans; Metatarsal Bones; Metatarsus; Metatarsus Varus
PubMed: 34167887
DOI: 10.1053/j.jfas.2020.11.010 -
Sensors (Basel, Switzerland) Apr 2022Foot progression angle (FPA) analysis is one of the core methods to detect gait pathologies as basic information to prevent foot injury from excessive in-toeing and...
Foot progression angle (FPA) analysis is one of the core methods to detect gait pathologies as basic information to prevent foot injury from excessive in-toeing and out-toeing. Deep learning-based object detection can assist in measuring the FPA through plantar pressure images. This study aims to establish a precision model for determining the FPA. The precision detection of FPA can provide information with in-toeing, out-toeing, and rearfoot kinematics to evaluate the effect of physical therapy programs on knee pain and knee osteoarthritis. We analyzed a total of 1424 plantar images with three different You Only Look Once (YOLO) networks: YOLO v3, v4, and v5x, to obtain a suitable model for FPA detection. YOLOv4 showed higher performance of the profile-box, with average precision in the left foot of 100.00% and the right foot of 99.78%, respectively. Besides, in detecting the foot angle-box, the ground-truth has similar results with YOLOv4 (5.58 ± 0.10° vs. 5.86 ± 0.09°, p = 0.013). In contrast, there was a significant difference in FPA between ground-truth vs. YOLOv3 (5.58 ± 0.10° vs. 6.07 ± 0.06°, p < 0.001), and ground-truth vs. YOLOv5x (5.58 ± 0.10° vs. 6.75 ± 0.06°, p < 0.001). This result implies that deep learning with YOLOv4 can enhance the detection of FPA.
Topics: Biomechanical Phenomena; Deep Learning; Foot; Gait; Humans; Metatarsal Valgus; Metatarsus Varus
PubMed: 35408399
DOI: 10.3390/s22072786 -
Foot & Ankle Orthopaedics Jul 2023Hallux valgus deformity consists of a lateral deviation of the great toe, metatarsus varus, and pronation of the first metatarsal. Most osteotomies only correct varus,...
BACKGROUND
Hallux valgus deformity consists of a lateral deviation of the great toe, metatarsus varus, and pronation of the first metatarsal. Most osteotomies only correct varus, but not the pronation of the metatarsal. Persistent postoperative pronation has been shown to increase deformity recurrence and have worse functional outcomes. The proximal rotational metatarsal osteotomy (PROMO) technique reliably corrects pronation and varus through a stable osteotomy, avoiding fusing any healthy joints. The objective of this research is to show a prospective series of the PROMO technique.
METHODS
Twenty-five patients (30 feet) were operated with the PROMO technique. The sample included 22 women and 3 men, average age 46 years (range 22-59), for a mean prospective follow-up of 1 year (range 9-14 months). Inclusion criteria included symptomatic hallux valgus deformities, absence of severe joint arthritis, or inflammatory arthropathies, with a metatarsal malrotation of 10 degrees or more, with no tarsometatarsal subluxation or arthritis on the anteroposterior or lateral foot radiograph views. The mean preoperative and postoperative Lower Extremity Functional Scale (LEFS) score, metatarsophalangeal angle, intermetatarsal angle, metatarsal malrotation, complications, satisfaction, and recurrence were recorded.
RESULTS
The mean preoperative and postoperative LEFS scores were 56 and 73. The median pre-/postoperative metatarsophalangeal angle was 32.5/4 degrees and the intermetatarsal angle 15.5/5 degrees. The metatarsal rotation was satisfactorily corrected in 24 of 25 patients. An Akin osteotomy was needed in 27 of 30 feet. All patients were satisfied with the surgery, and no recurrence or complications were found.
CONCLUSIONS
PROMO is a reliable technique, with good short-term results in terms of angular correction, satisfaction, and recurrence. Long-term studies are needed to determine if a lower hallux recurrence rate occurs with the correction of metatarsal rotation in comparison with conventional osteotomies.
LEVEL OF EVIDENCE
IV, prospective case series.
PubMed: 37590285
DOI: 10.1177/24730114231195049 -
The Journal of Foot and Ankle Surgery :... 2022Underlying metatarsus adductus (MA) is commonly seen in patients with hallux valgus (HV) deformity, with implications regarding procedure selection and hallux valgus...
Underlying metatarsus adductus (MA) is commonly seen in patients with hallux valgus (HV) deformity, with implications regarding procedure selection and hallux valgus recurrence. Lapidus, or first tarsometatarsal fusion, is commonly performed allowing reduction in intermetatarsal angle (IMA) but this procedure has not been established as an approach to provide partial correction of MA deformity. Retrospective assessment of preoperative and postoperative metatarsus adductus angle (MAA), IMA and hallux abductus angle (HAA) in patients treated with Lapidus fusion for HV. Significance was determined via paired t test with a p value of <.05. All cases involved manual transverse plane manipulation to reduce both IMA and MAA during screw insertion. Intermetatarsal angle and Engel's angle were measured on preoperative AP radiographs to determine the presence of underlying MA in patients undergoing Lapidus fusion for HV. Ten weeks and 1 year postoperative radiographs were measured to determine degree of correction of IMA, HAA, and MAA. Thirty-four patients met inclusion criteria, which is approximately 46% of our sample population. The average preoperative IMA was 19.4˚ (range 12-32) and the average postoperative IMA was 9.7˚ (range 6-14). The average preoperative Engel's angle was 27.4˚ (range 24-34) and the average postoperative Engel's angle was 22.6˚ (range 15-28) with mean improvement in MA of 6.6˚. Of the 34, 27 (79.4%) patients had a normal Engel's angle at 10 weeks postoperatively. All measures of change met level of significance (p < .05). Of the 34 patients, 21 had radiographs taken beyond the 1 year mark (average 53 weeks). These patients were found to have an average Engel's angle of 23.0˚, which is not statistically significantly different from their 10 week measurements. Of the 21 patients, 17 (81%) maintained normal Engel's angle past 1 year. Metatarsus adductus varies regarding degree of reducibility and complicates preoperative angular measurement and correction of HV. Based on these findings, we recommend Lapidus fusion using this specified manipulation technique to obtain comprehensive transverse plane correction.
Topics: Bunion; Hallux; Hallux Valgus; Humans; Metatarsal Bones; Metatarsus Varus; Retrospective Studies
PubMed: 34963517
DOI: 10.1053/j.jfas.2020.04.029 -
The Bone & Joint Journal Oct 2019Abnormal femoral torsion (FT) is increasingly recognized as an additional cause for femoroacetabular impingement (FAI). It is unknown if in-toeing of the foot is a... (Comparative Study)
Comparative Study
Prevalence and diagnostic accuracy of in-toeing and out-toeing of the foot for patients with abnormal femoral torsion and femoroacetabular impingement: implications for hip arthroscopy and femoral derotation osteotomy.
AIMS
Abnormal femoral torsion (FT) is increasingly recognized as an additional cause for femoroacetabular impingement (FAI). It is unknown if in-toeing of the foot is a specific diagnostic sign for increased FT in patients with symptomatic FAI. The aims of this study were to determine: 1) the prevalence and diagnostic accuracy of in-toeing to detect increased FT; 2) if foot progression angle (FPA) and tibial torsion (TT) are different among patients with abnormal FT; and 3) if FPA correlates with FT.
PATIENTS AND METHODS
A retrospective, institutional review board (IRB)-approved, controlled study of 85 symptomatic patients (148 hips) with FAI or hip dysplasia was performed in the gait laboratory. All patients had a measurement of FT (pelvic CT scan), TT (CT scan), and FPA (optical motion capture system). We allocated all patients to three groups with decreased FT (< 10°, 37 hips), increased FT (> 25°, 61 hips), and normal FT (10° to 25°, 50 hips). Cluster analysis was performed.
RESULTS
We found a specificity of 99%, positive predictive value (PPV) of 93%, and sensitivity of 23% for in-toeing (FPA < 0°) to detect increased FT > 25°. Most of the hips with normal or decreased FT had no in-toeing (false-positive rate of 1%). Patients with increased FT had significantly (p < 0.001) more in-toeing than patients with decreased FT. The majority of the patients (77%) with increased FT walk with a normal foot position. The correlation between FPA and FT was significant (r = 0.404, p < 0.001). Five cluster groups were identified.
CONCLUSION
In-toeing has a high specificity and high PPV to detect increased FT, but increased FT can be missed because of the low sensitivity and high false-negative rate. These results can be used for diagnosis of abnormal FT in patients with FAI or hip dysplasia undergoing hip arthroscopy or femoral derotation osteotomy. However, most of the patients with increased FT walk with a normal foot position. This can lead to underestimation or misdiagnosis of abnormal FT. We recommend measuring FT with CT/MRI scans in all patients with FAI. Cite this article: 2019;101-B:1218-1229.
Topics: Adult; Analysis of Variance; Arthroscopy; Chi-Square Distribution; Cohort Studies; Female; Femoracetabular Impingement; Femur; Follow-Up Studies; Humans; Imaging, Three-Dimensional; Linear Models; Magnetic Resonance Imaging; Male; Metatarsal Valgus; Metatarsus Varus; Middle Aged; Osteotomy; Prevalence; Range of Motion, Articular; Retrospective Studies; Risk Assessment; Time Factors; Tomography, X-Ray Computed; Torsion Abnormality; Treatment Outcome; Young Adult
PubMed: 31564157
DOI: 10.1302/0301-620X.101B10.BJJ-2019-0248.R1 -
The Journal of Foot and Ankle Surgery :... 2022This study aims to assess a novel minimally invasive surgical technique that addresses hallux valgus accompanied by metatarsus adductus. We retrospectively analysed the...
This study aims to assess a novel minimally invasive surgical technique that addresses hallux valgus accompanied by metatarsus adductus. We retrospectively analysed the results of 20 patients (21 feet) that underwent a newly developed percutaneous osteotomy procedure of the lesser metatarsal bones in order to correct hallux valgus deformities accompanied by metatarsus adductus. We used x-ray studies in order to evaluate changes in the hallux valgus angle, the first intermetatarsal angle, and the metatarsal angle (using the modified Sgarlato method). We also compared the pre- and postoperative American Orthopaedic Foot and Ankle Society scores when available. The paired sample t test was used to compare variables. At a 1-y follow-up the mean hallux valgus angle, inter-metatarsal angle and the metatarsal angle have been reduced by 31.62 (-3 to 9), 3.86 (11-52) and 14.69 (4-36) respectively (p < .001 for all). The mean American Orthopaedic Foot and Ankle Society score (n = 15 feet available) has been improved by a mean of 44.53 (22-72, p < .001). In addition, the patient satisfaction rates were high. Patients suffered from mild to moderate midfoot pain during the first few weeks following surgery, which resolved when union occurred. No cases of lesser metatarsal nonunion have been documented. The presented minimally invasive method can be used effectively to correct hallux valgus that is associated with metatarsus adductus. Proximal minimally invasive metatarsal osteotomy can effectively correct hallux valgus accompanied by metatarsus adductus.
Topics: Bunion; Hallux Valgus; Humans; Metatarsal Bones; Metatarsus Varus; Minimally Invasive Surgical Procedures; Retrospective Studies; Treatment Outcome
PubMed: 35260325
DOI: 10.1053/j.jfas.2022.01.027 -
Journal of the American Academy of... Aug 2023Ankle fractures are among the most common fractures sustained in the pediatric population. Given the frequency of physeal involvement of the distal fragment,... (Review)
Review
Ankle fractures are among the most common fractures sustained in the pediatric population. Given the frequency of physeal involvement of the distal fragment, complications including growth arrest, overgrowth, and rotational deformities are not uncommon. This case report describes a 12-year-old adolescent boy who presented after an acute right ankle injury sustained while playing. He noted right ankle pain, swelling, and in-toeing of his foot. Radiographs of the ankle demonstrated a distal tibia Salter-Harris type II fracture that appeared nondisplaced. However, a CT scan of the ankle demonstrated a 60° difference in the rotational profile between the injured and noninjured tibias. The patient's acute rotational deformity was corrected with closed reduction and percutaneous pinning. Pediatric distal tibia physis fractures presenting with in-toeing are rare and difficult to diagnose accurately with radiographs alone. Accordingly, a detailed history, physical examination, comparison radiographs, and CT scans are imperative in making the correct diagnosis and determining the appropriate treatment.
Topics: Male; Adolescent; Humans; Child; Tibia; Metatarsus Varus; Growth Plate; Tibial Fractures; Ankle Fractures
PubMed: 37535815
DOI: 10.5435/JAAOSGlobal-D-22-00134 -
Journal of Pediatric OrthopedicsSlipped capital femoral epiphyses (SCFE) is associated with out-toeing of the foot and external rotation gait. But it is unknown if SCFE patients treated with the...
BACKGROUND
Slipped capital femoral epiphyses (SCFE) is associated with out-toeing of the foot and external rotation gait. But it is unknown if SCFE patients treated with the modified Dunn procedure have out-toeing at follow up.Therefore, we used instrumented gait analysis and questioned (1) do severe SCFE patients treated with a modified Dunn procedure have symmetrical foot progression angle (FPA) compared with contralateral side and compared with asymptomatic volunteers (2) what is the prevalence of out-toeing gait and what are the outcome socres at follow up.
METHODS
Gait analysis of 22 patients (22 hips) treated with an unilateral modified Dunn procedure for severe SCFE (slip angle >60 degrees, 2002 to 2011) was retrospectively evaluated. Of 38 patients with minimal 5-year follow up, 2 hips (4%) had avascular necrosis of the femoral head and were excluded for gait analysis. Twenty-two patients were available for gait analysis at follow up (mean follow up of 9±2 y). Mean age at follow up was 22±3 years. Mean preoperative slip angle was 64±8 degrees (33% unstable slips) and decreased postoperatively (slip angle of 8±4 degrees). Gait analysis was performed with computer-based instrumented walkway system (GAITRite) to measure FPA with embedded pressure sensors. Patients were compared with control group of 18 healthy asymptomatic volunteers (36 feet, mean age 29±6 y).
RESULTS
(1) Mean FPA of SCFE patients (3.6±6.4 degrees) at follow up was not significantly different compared with their contralateral side (5.6±5.5 degrees) and compared with FPA of controls (4.0±4.5 degrees). (2) Of the 22 SCFE patients, most of them (19 hips, 86%) had normal FPA (-5 to 15 degrees), 2 patients had in-toeing (FPA<-5 degrees) and 1 had out-toeing (FPA >15 degrees) and was not significantly different compared with control group. (3) Mean modified Harris hip score (mHHS) was 93±11 points, mean Hip Disability and Osteoarthritis Outcome Score (HOOS) score was 91±10 points. Three patients (14%) had mHHS <80 points and walked with normal FPA. The 2 patients with in-toeing and one patient with out-toeing had mHHS >95 points.
CONCLUSIONS
Patients with severe SCFE treated with modified Dunn procedure had mostly symmetrical FPA and good hip scores at long term follow up. This is in contrast to previous studies. Although 1 patient had out-toeing and 2 patients had in-toeing at follow up, they had good hip scores.
LEVEL OF EVIDENCE
Level III-retrospective comparative study.
Topics: Adult; Follow-Up Studies; Fracture Fixation, Intramedullary; Humans; Metatarsal Valgus; Metatarsus Varus; Retrospective Studies; Slipped Capital Femoral Epiphyses; Treatment Outcome; Young Adult
PubMed: 35250015
DOI: 10.1097/BPO.0000000000002127