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Foot & Ankle International Jun 2024Even with the best conservative care, patients with Charcot neuroarthropathy (CN) of the foot and ankle often ulcerate, increasing their risk of infection, amputation,...
BACKGROUND
Even with the best conservative care, patients with Charcot neuroarthropathy (CN) of the foot and ankle often ulcerate, increasing their risk of infection, amputation, and death. Surgical fixation has been associated with risk of recurrent ulceration, potentially due to poor bone quality prone to recurrent deformity and ulceration. We propose midfoot beam reconstruction with PMMA augmentation as a novel means of improving fixation.
METHODS
A protocol was developed to create characteristic CN midfoot fragmentation both visually and fluoroscopically in each of 12 matched-pair cadaveric feet. Afterward, the pairs were divided into 2 groups: (1) midfoot beam fusion surgery alone, and (2) midfoot beam fusion surgery augmented with PMMA. A solid 7.0-mm beam was placed into the medial column and a solid 5.5-mm beam was placed across the lateral column. In the PMMA group, 8 to 10 mL of PMMA was inserted into the medial column. The hindfoot of each specimen was potted and the metatarsal heads were cyclically loaded for 1800 cycles, followed by load to failure while load and displacement were continually recorded.
RESULTS
One specimen in the beam alone group failed before reaching the 1800th cycle and was not included in the failure analysis. The midfoot beam only group demonstrated greater mean displacement during cycle testing compared with the PMMA group, < .05. The maximum force (N), stiffness (N/mm), and toughness (Nmm) were all significantly greater in the group augmented with PMMA, < .05.
CONCLUSION
In a CN cadaveric model, PMMA augmentation significantly decreased gapping during cyclic loading and nearly doubled the load to failure compared with midfoot beams alone.
CLINICAL RELEVANCE
The results of this biomechanical study demonstrate that augmentation of midfoot beams with PMMA increases the strength and stiffness of the fusion construct. This increased mechanical toughness may help reduce the risk of nonunion and infection in patients with neuropathic midfoot collapse.
Topics: Humans; Polymethyl Methacrylate; Cadaver; Arthropathy, Neurogenic; Biomechanical Phenomena; Bone Cements; Arthrodesis; Aged
PubMed: 38501724
DOI: 10.1177/10711007241237804 -
Foot & Ankle International May 2024Plantar transfer ulcers (TUs) underneath the second metatarsal head are frequent after first metatarsal ray amputations due to diabetic foot infections. Whether the...
BACKGROUND
Plantar transfer ulcers (TUs) underneath the second metatarsal head are frequent after first metatarsal ray amputations due to diabetic foot infections. Whether the second metatarsal length (2ML) is associated with TU occurrence in these patients is unclear. This study evaluated whether 2ML is associated with TU occurrence after first-ray amputations and whether ulcer-free survival is shorter in patients with "excess" 2ML.
METHODS
Forty-two patients with a mean age of 67 (range 33-93) years, diabetes, and first metatarsal ray amputation (first amputation at the affected foot) were included. Two independent readers measured the 2ML using the Coughlin method. A protrusion of more than 4.0 mm of the second metatarsal was defined as "excess" 2ML. The effect of 2ML on ulcer occurrence was analyzed using a multivariate Cox regression model. A Kaplan-Meier curve for TU-free survival was constructed comparing the 2 groups of "normal" (n = 21) and "excess" 2ML (n = 21).
RESULTS
Interrater reliability was excellent. TUs underneath the second metatarsal occurred in 15 (36%) patients. In agreement with our hypothesis, 2ML was nonsignificantly different in patients with TUs, recording a mean of 5.3 (SD 2.5) mm, compared to patients without 4.0 (SD 2.3) mm (hazard ratio [HR] 1.12, 95% CI 0.89-1.41), whereas insulin dependence was associated with ulcer occurrence (HR 0.33, 95% CI 0.11-0.99).
CONCLUSION
In our relatively small study population with a cutoff level of 4 mm for excess 2ML, ulcer-free survival was similar in patients with "normal" and "excess" 2ML.
LEVEL OF EVIDENCE
Level III, retrospective comparative study.
Topics: Humans; Diabetic Foot; Amputation, Surgical; Metatarsal Bones; Aged; Middle Aged; Female; Male; Retrospective Studies; Aged, 80 and over; Adult
PubMed: 38497521
DOI: 10.1177/10711007241232970 -
Surgical and Radiologic Anatomy : SRA Apr 2024To identify the variations in the location of the nerves that may be at risk in hallux valgus (HV) surgery, and to reveal whether these nerves are affected by the...
OBJECTIVE
To identify the variations in the location of the nerves that may be at risk in hallux valgus (HV) surgery, and to reveal whether these nerves are affected by the anatomical changes associated with HV.
METHOD
In the formalin fixed, 46 lower extremities (19 female, 27 male) (9 normal, 14 mild HV, 21 moderate/severe HV), extensor hallucis longus tendon (EHL), deep plantar artery, medial dorsal cutaneous (MDCN), deep fibular (DFN), common plantar digital (CPDN) and proper plantar digital (PPDN) nerves were examined. The branches of MDCN extending to the medial side of foot were recorded in three segments. The positional topography of nerves according to EHL were analyzed on 360° circle and clock models.
RESULTS
Sex-related differences observed in some parameters in direct measurements were not found in the clock model comparisons. In advanced HV angles (> 20°), DFN was closer to EHL in the distal part of the metatarsal bone, while there was no difference in the proximal. The intersection of the medial branch of the MDCN with the EHL was more proximal in HV cases than in normal feet. The location of the nerves in the clock pattern did not change in HV. Of the nerve branches reaching the medial side of the foot, 65.2% were in Part I, 71.7% in Part II, and 4.3% in Part III.
CONCLUSION
Sex differences in the distance of the nerves to the EHL disappeared when the size effect of the cross-section of the first metatarsal bone region was eliminated with the clock model. Only in advanced HVA (>20°) (not in mild HV), the DFN being closer to the EHL distally and the intersection of the medial branch of the MDCN with the EHL in HV being more proximal than in normal can be interpreted as specific reflections of HV progress. The variations we revealed in the number of branches reaching the inside of the foot may explain the diversity of neuromas or nerve injuries associated with HV surgery.
Topics: Female; Male; Humans; Hallux Valgus; Metatarsal Bones; Foot; Hallux; Tendons
PubMed: 38492026
DOI: 10.1007/s00276-024-03318-9 -
Foot & Ankle International Jun 2024There is no consensus whether the primary surgical method should be open reduction and internal fixation (ORIF) or primary arthrodesis (PA) for Lisfranc injuries. The... (Randomized Controlled Trial)
Randomized Controlled Trial Comparative Study
BACKGROUND
There is no consensus whether the primary surgical method should be open reduction and internal fixation (ORIF) or primary arthrodesis (PA) for Lisfranc injuries. The aim of our randomized controlled trial was to compare ORIF and PA for displaced Lisfranc injuries.
METHODS
This study was a national multicenter randomized controlled trial. Altogether 43 displaced Lisfranc injuries were enrolled in this trial. The primary outcome measure was Visual Analogue Scale Foot and Ankle (VAS-FA) at a 24-months follow-up. The secondary outcome measures were VAS-FA pain, function, and other complaints subscales and the American Orthopaedic Foot & Ankle Society (AOFAS) Midfoot Scale. All outcomes were measured at 6, 12, and 24 months. We were unable to reach the planned sample size of 60 patients; thus, the study remains underpowered.
RESULTS
The mean VAS-FA Overall score in the ORIF group was 86.5 (95% CI 77.9, 95.1) and 80.1 (95% CI 72.0, 88.1) in the PA group at the 24-month follow-up. We did not find eligible evidence of a difference in VAS-FA Overall scores (mean between-group difference 6.5 [95% CI -5.3, 18.2], Cohen = 0.100).
CONCLUSION
We did not find evidence of a difference in VAS-FA between ORIF and PA in patients with displaced Lisfranc injuries, and thus both are viable options for the initial surgical method. The trial is underpowered; however, the data may be included in a meta-analysis of similarly designed randomized controlled trials.ClinicalTrials.gov identifier: NCT02953067 24 October 2016.
Topics: Humans; Arthrodesis; Fracture Fixation, Internal; Open Fracture Reduction; Female; Male; Adult; Middle Aged; Metatarsal Bones; Foot Injuries; Fractures, Bone; Pain Measurement
PubMed: 38482816
DOI: 10.1177/10711007241232667 -
Cureus Feb 2024Osteomyelitis, which is a bone inflammation brought on by an infectious agent, is a challenging clinical issue. Chronic osteomyelitis, characterized by persistent...
Osteomyelitis, which is a bone inflammation brought on by an infectious agent, is a challenging clinical issue. Chronic osteomyelitis, characterized by persistent inflammation and infection of the bone tissue, poses significant challenges to both physical health and functional well-being. A 20-year-old male came with complaints of pus discharge from an ulcer present on the dorsum of the right foot with pain and swelling around it. He was unable to stand or walk properly so he came to Acharya Vinoba Bhave Rural Hospital, Wardha, India, where investigations were done which confirmed the diagnosis of chronic osteomyelitis of the secondmetatarsal. The patient then underwent debridement and curettage due to which he had trouble walking, his ankle joint's range of motion was restricted, and his ability to carry out everyday tasks was compromised. Physiotherapy rehabilitation was administered, and outcome measures were assessed, revealing notable enhancements in the patient's range of motion and muscular strength. A physiotherapy routine helped the patient overcome this, which is crucial to a quick and complete recovery. It also aided the patient's functional mobility and independent ambulation.
PubMed: 38481904
DOI: 10.7759/cureus.54041 -
Sensors (Basel, Switzerland) Feb 2024This study explored the effects of a modular overground exoskeleton on plantar pressure distribution in healthy individuals and individuals with Acquired Brain Injury...
This study explored the effects of a modular overground exoskeleton on plantar pressure distribution in healthy individuals and individuals with Acquired Brain Injury (ABI). The research involved 21 participants, including ABI patients and healthy controls, who used a unique exoskeleton with adaptable modular configurations. The primary objective was to assess how these configurations, along with factors such as muscle strength and spasticity, influenced plantar pressure distribution. The results revealed significant differences in plantar pressures among participants, strongly influenced by the exoskeleton's modularity. Notably, significant distinctions were found between ABI patients and healthy individuals. Configurations with two modules led to increased pressure in the heel and central metatarsus regions, whereas configurations with four modules exhibited higher pressures in the metatarsus and hallux regions. Future research should focus on refining and customizing rehabilitation technologies to meet the diverse needs of ABI patients, enhancing their potential for functional recovery.
Topics: Humans; Exoskeleton Device; Heel; Metatarsal Bones; Health Status
PubMed: 38474971
DOI: 10.3390/s24051435 -
Scientific Reports Mar 2024The peopling of Europe during the Middle Pleistocene is a debated topic among paleoanthropologists. Some authors suggest the coexistence of multiple human lineages in...
The peopling of Europe during the Middle Pleistocene is a debated topic among paleoanthropologists. Some authors suggest the coexistence of multiple human lineages in this period, while others propose a single evolving lineage from Homo heidelbergensis to Homo neanderthalensis. The recent reassessment of the stratigraphy at the Sedia del Diavolo (SdD) site (Latium, Italy), now dated to the beginning of marine isotope stage (MIS) 8, calls for a revision of the human fossils from the site. In this paper, we present the morphometric, biomechanical and palaeopathological study of the second right metatarsal SdD2, to both re-evaluate its taxonomical affinities and possibly determine the levels of physical activity experienced by the individual during lifetime. Results demonstrate the persistence of archaic features in SdD2 suggesting new insights into the technology and hunting strategies adopted by Homo between MIS 9 and MIS 8.
Topics: Animals; Humans; Rome; Metatarsal Bones; Hominidae; Italy; Neanderthals; Fossils; Biological Evolution
PubMed: 38472259
DOI: 10.1038/s41598-024-55045-1 -
BMC Veterinary Research Mar 2024The 3D render volume reconstruction CT (3D-RVCT) produced detailed images of the PES region, determining its relationships with the surrounding structures. Despite...
The 3D render volume reconstruction CT (3D-RVCT) produced detailed images of the PES region, determining its relationships with the surrounding structures. Despite extensive research in veterinary studies on the PES through gross anatomy and CT, there is a lack of studies on the PES of zebu cattle. The study aimed to analyze the PES of Zebu cattle using gross cross-sectional, radiographic, CT, and morphometric methods, with the use of 3D-RVCT to provide anatomical guidance for surgeons and students. The study was performed on sixteen PES regions to provide hard and soft tissues in CT images. Three are five tarsal bones and two large fused (III and IV) metatarsal bones that were completely fused except for their distal extremities, which were divided distally by the intertrochlear notch. The cortical thickness of the metatarsal bone was equal on both sides. The bony septum divided the medullary cavity between the two fused large metatarsal bones in the proximal distal half only and disappeared in the middle part. The reconstruction showed similar sizes in the right and left limbs, confirming the pes bones. The radiographic and CT images could be used as a normal reference for the interpretation of some clinical diseases in the PES. The 3D CT reconstruction of the pes bones was described by various CT oblique dorsal and plantar views. The study focuses on diagnosing PES disorders using CT imaging, improving medical interventions, improving Zebu cattle health outcomes, and empowering students to contribute to veterinary medicine research and advancements.
Topics: Cattle; Animals; Cross-Sectional Studies; Tomography
PubMed: 38459515
DOI: 10.1186/s12917-024-03940-0 -
Foot and Ankle Surgery : Official... Jul 2024First metatarsophalangeal joint (MTPJ) arthrodesis is a commonly utilised procedure. In this study, the authors aim to explore functional outcomes of patients undergoing...
BACKGROUND
First metatarsophalangeal joint (MTPJ) arthrodesis is a commonly utilised procedure. In this study, the authors aim to explore functional outcomes of patients undergoing nonsynchronous bilateral first MTPJ arthrodesis under the care of a single surgeon using a compression screw/locking plate construct.
METHODS
This is a prospectively collected, retrospectively analysed case series of fifty five patients who underwent bilateral nonsynchronous first MTPJ arthrodesis. Clinical and radiological outcomes were assessed preoperatively and at a minimum of two years postoperatively. Clinical outcomes were assessed using the Foot and Ankle Outcome Score (FAOS), the Self-Reported Foot and Ankle Score (SEFAS) and the Sports Questionnaire version 1 (SQ). Postoperative radiographs were used to assess evidence of union and compare both hallux valgus and intermetatarsal angles. Removal of hardware, revision surgery and correction of deformities were also recorded.
RESULTS
Fifty five patients were included in the study. There was statistically significant improvements in all five facets of the FAOS (p value < 0.05). The mean postoperative SEFAS was 45.1. In total, patients participated in thirteen different sporting activities. This represented 92 patient specific activities preoperatively and 104 postoperatively. The most common activities were walking, cycling and swimming. Overall, 94.5% (N = 52) of the cohort were satisfied with their return to sport while 98.2% (N = 54) would recommend bilateral first MTPJ arthrodesis. Mean reductions in hallux valgus angles and intermetatarsal angles were noted at 18.87 and 4.69 degrees respectively. There was one non-union in the cohort which required revision surgery. One patient required removal of hardware.
CONCLUSIONS
Bilateral first MTPJ arthrodesis is a safe and effective surgical option for patients with bilateral first MTPJ pathology. It has a high union rate, low complication rate and significantly improves clinical outcomes and allows patients reliably return to physical activities.
Topics: Humans; Arthrodesis; Metatarsophalangeal Joint; Female; Male; Middle Aged; Retrospective Studies; Hallux Valgus; Adult; Aged; Treatment Outcome; Radiography; Bone Screws; Bone Plates
PubMed: 38458912
DOI: 10.1016/j.fas.2024.02.014 -
Parasites, Hosts and Diseases Feb 2024Halicephalobus gingivalis is a free-living nematode that occasionally causes infections in horses. We report a rare case of limb fracture of horse caused by infection...
Halicephalobus gingivalis is a free-living nematode that occasionally causes infections in horses. We report a rare case of limb fracture of horse caused by infection with H. gingivalis. An 8-year-old mare was referred to the Veterinary Hospital of the Federal University of Lavras with claudication grade 5 of the right hind limb, that had been started 3 months ago. The patient had aseptic arthritis in the tarsal joint and edema that extended to the quartile. The radiographic examination showed punctate osteolysis with exacerbation of bone trabeculation along the calcaneus, talus, proximal epiphysis of the third metatarsal and distal epiphysis of the tibia. Treatment for arthritis was initiated, and the animal showed a slight improvement in limb function. However, 21 days after hospitalization, due to a comminuted fracture of the tibia, it was euthanized. At necropsy, yellowish masses were found from the metatarsal to the tibia, and around the tarsal bones and joint. Similar masses were also found in the left kidney. Numerous nematodes compatible with H. gingivalis were identified. This is the first description of a pathological fracture caused by H. gingivalis infection in an equine limb.
Topics: Animals; Female; Arthritis; Fractures, Bone; Fractures, Spontaneous; Horses; Lower Extremity; Rhabditida
PubMed: 38443776
DOI: 10.3347/PHD.23066