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Archives of Rheumatology Sep 2018This study aims to evaluate the static and dynamic balance disorders of patients with rheumatoid arthritis (RA) and to disclose the relationships with clinical,...
Static and Dynamic Balance Disorders in Patients With Rheumatoid Arthritis and Relationships With Lower Extremity Function and Deformities: A Prospective Controlled Study.
OBJECTIVES
This study aims to evaluate the static and dynamic balance disorders of patients with rheumatoid arthritis (RA) and to disclose the relationships with clinical, functional, and radiological findings of lower extremities.
PATIENTS AND METHODS
A total of 81 patients with RA (15 males, 66 females; mean age 48.9±10.4 years; range 22 to 67 years) were compared with 84 age and sex-matched healthy controls (14 males, 70 females; mean age 45.9±12.1 years; range 24 to 70 years). Radiographic assessments of feet were performed to evaluate the presence of pes planus, hallux valgus, metatarsus primus varus, and splaying foot deformities. Foot functions of patients were determined with Foot and Ankle Outcome Score. The balance disorders of the subjects were evaluated with three static (modified clinical test of sensory interaction and balance, unilateral stance, weight bearing squat) and three dynamic (step-up-and-over, sit-to-stand, tandem walk) balance tests via the 'Neurocom Balance Master' device.
RESULTS
Rheumatoid arthritis patients had significantly higher sway velocity in unilateral stance and modified clinical test of sensory interaction and balance tests, higher step width and lower speed when walking on a line, lower rising index and higher movement time in step-up-and-over test compared to healthy controls (p<0.05). Performances on the sit-to-stand and weight bearing squat tests were comparable between both groups. Of the patients, although 61% had hallux valgus, 52% had metatarsus primus varus, 33% had pes planus, and 26% had splaying foot, these deformities were not correlated with Foot and Ankle Outcome Score or balance disorders. Presence of swollen joint was determined as the most relevant factor for balance disorders of RA patients.
CONCLUSION
Patients with RA may have increased risk for balance disorders due to cumulative effect of the lower extremity impairments seen in the course of disease.
PubMed: 30632523
DOI: 10.5606/ArchRheumatol.2018.6720 -
Foot & Ankle Specialist Oct 2019Lateralizing calcaneal osteotomy (LCO) is a common procedure used to correct hindfoot varus. Several complications have been described in the literature, but only a few...
Lateralizing calcaneal osteotomy (LCO) is a common procedure used to correct hindfoot varus. Several complications have been described in the literature, but only a few articles describe tibial nerve palsy after this procedure. Our hypothesis was that tibial nerve palsy is a common complication after LCO. A retrospective study of patients undergoing LCO for hindfoot varus between 2007 and 2013 was performed. A total of 15 patients (18 feet) were included in the study. The patients were examined for tibial nerve deficit, and all the patients were examined with a computed tomography (CT) scan of both feet. Patients with a preexisting neurological disease were excluded. The primary outcome was tibial nerve palsy, and the secondary outcomes were reduction of the tarsal tunnel volume, the distance from subtalar joint to the osteotomy, and the lateral step at the osteotomy evaluated by CT scans. Three of the 18 feet examined had tibial nerve palsy at a mean follow-up of 51 months. The mean reduction in tarsal tunnel volume when comparing the contralateral nonoperated foot to the foot operated with LCO was 2732 mm in the group without neurological deficit and 2152 mm in the group with neurological deficit (P = .60). 3 of 18 feet had tibial palsy as a complication to LCO. We were not able to show that a larger decrease in the tarsal tunnel volume, a more anterior calcaneal osteotomy, or a larger lateral shift of the osteotomy is associated with tibial nerve palsy. Level IV: Retrospective case series.
Topics: Calcaneus; Follow-Up Studies; Humans; Incidence; Metatarsus Varus; Osteotomy; Paralysis; Postoperative Complications; Retrospective Studies; Tibial Nerve; Tibial Neuropathy; Time Factors; Tomography, X-Ray Computed
PubMed: 30499329
DOI: 10.1177/1938640018816363 -
Zhongguo Xiu Fu Chong Jian Wai Ke Za... Nov 2018To evaluate the short-term effectiveness of Scarf osteotomy and Akin osteotomy combined with soft tissue procedures for hallux valgus associated with mild to moderate...
[Short-term effectiveness of Scarf osteotomy and Akin osteotomy combined with soft tissue procedures in treatment of hallux valgus associated with mild to moderate metatarsus adductus].
OBJECTIVE
To evaluate the short-term effectiveness of Scarf osteotomy and Akin osteotomy combined with soft tissue procedures for hallux valgus associated with mild to moderate metatarsus adductus.
METHODS
The clinical data of 30 patients (48 feet) who were diagnosised hallux valgus associated with mild to moderate metatarsus adductus and treated by Scarf osteotomy and Akin osteotomy combined with soft tissue procedures between February 2013 and May 2015 were analyzed retrospectively. There were 2 males (2 feet) and 28 females (46 feet) with an average age of 29.4 years (range, 18-50 years). The disease duration was 3-12 years (mean, 6.1 years). The degree of metatarsal adductus was assessed by Sgarlato's measurement and Yu classification criteria, and the degree of metatarsal adductus was mild in 20 feet and moderate in 28 feet. Preoperative X-ray examination showed that the hallux valgus angle (HVA) was (39.4±5.6)°, the first-second intermetatarsal angle (1-2IMA) was (15.2±3.5)°, the metatarsus adductus angle (MAA) was (21.2±3.7)°. The American Orthopaedic Foot and Ankle Society (AOFAS) score was 51.7±10.0, and visual analogue scale (VAS) score was 4.9±2.7 before operation. Postoperative complications and the union time of osteotomies were recorded. At last follow-up, the HVA, 1-2IMA, and MAA were measured on X-ray films, and the AOFAS scores and VAS scores were recorded, then compared them with preoperative ones. Roles - Maudsley score was used to investigate patients' satisfaction.
RESULTS
All the incisions healed by first intention. Thirty patients were followed up 24-27 months (mean, 26.4 months). Three patients (4 feet) occured metatarsalgia, and the pain relieved after treated by Custom-Made Orthotics. All the osteotomies were unoin, the healing time was 2-4 months (mean, 2.7 months). At last follow-up, the HVA and the 1-2IMA were (13.2±3.1)° and (5.1±2.3)°, respectively, showing significant differences when compared with preoperative ones ( =14.606, =0.000; =22.356, =0.000); the MAA was (21.0±3.4)° and there was no significant difference when compared with preoperative one ( =0.789, =0.434). The AOFAS and VAS scores were 91.8±7.5 and 1.1±1.0, respectively, showing signifiant differences when compared with preoperative ones ( =13.787, =0.000; =14.781, =0.000). Satisfaction survey showed that 28 patients were very satisfied and satisfied (93.3%), and 2 cases were not satisfied (6.7%).
CONCLUSION
The short-term effectiveness of Scarf osteotomy and Akin osteotomy combined with soft tissue procedures for hallux valgus associated with mild to moderate metatarsus adductus is satisfactory, and no correction is required for metatarsal adductus.
Topics: Adolescent; Adult; Female; Hallux Valgus; Humans; Male; Metatarsal Bones; Metatarsus Varus; Middle Aged; Osteotomy; Radiography; Retrospective Studies; Treatment Outcome; Young Adult
PubMed: 30417613
DOI: 10.7507/1002-1892.201804046 -
Child Neurology Open 20181q43q44 microdeletion syndrome is characterized by intellectual disability/global developmental delay, epilepsy, dysmorphic facies, stereotypic movement, language delay,...
1q43q44 microdeletion syndrome is characterized by intellectual disability/global developmental delay, epilepsy, dysmorphic facies, stereotypic movement, language delay, recurrent infections, dental anomalies, and hand and foot anomalies. Microcephaly and corpus callosum dysplasia are present in some cases depending on gene content. 3q29 microduplication syndrome is characterized by intellectual disability, language delay, microcephaly, and dental anomalies. We report the first case with 4 de novo copy number variations with clinical features which overlap 1q43q44 microdeletion and 3q29 microduplication syndromes. Our case presented with global developmental delay, epilepsy, recurrent infections, stereotypic movements, speech delay, microcephaly, facial dysmorphism, bilateral clinodactyly, and small puffy feet with metatarsus varus; however, she had no corpus callosum dysplasia. Our case highlights the role of multiple copy number variations in the occurrence of a certain phenotype. Moreover, it supports the theory that the loss of gene function cannot explain the occurrence of microcephaly and abnormalities of the corpus callosum in 1q43q44 microdeletion syndrome.
PubMed: 30263904
DOI: 10.1177/2329048X18798200 -
Medical Science Monitor : International... Sep 2018BACKGROUND The aim of this study was to compare the effect of 2 methods for treating toe-in gait in children (reverse-shoe wearing and orthopedic insoles) and to...
BACKGROUND The aim of this study was to compare the effect of 2 methods for treating toe-in gait in children (reverse-shoe wearing and orthopedic insoles) and to determine whether reverse-shoe wearing results in hallux valgus. MATERIAL AND METHODS Between July 2012 and July 2014, 337 children diagnosed with toe-in gait over 2 years were recruited. For 139 children, parents selected use of reverse-shoe wearing treatment (RS group) and for 198 children, parents selected orthopedic insoles treatment (OI group). There were 98 children in the RS group and 167 in the OI group who completed the 12-month therapy and follow-up. We excluded 28 children who failed to complete the study, and 44 children who ceased treatment within the first month were selected as controls. Patients were assessed for up to 24 months after the cessation of treatment. Foot progression angle (FPA) and presence and degree of hallux valgus angle (HVA) were recorded. RESULTS FPA was significantly reduced after 6 months in both RS and OI groups (P<0.05). FPA returned to almost normal after 12 months of treatment, with no significant difference between the 2 groups. There were 29 cases (51 feet) of hallux valgus in the RS group after 12-month treatment; the HVA had significantly declined by 2 years after treatment with normal shoe wearing but did not return to normal. CONCLUSIONS Corrective treatment should be used with children diagnosed with toe-in gait over 2 years showing no remission. Both reverse-shoe wearing and orthopedic insoles show similar levels of treatment success, but reverse-shoe wearing has a significant adverse effect of hallux valgus.
Topics: Child; Child, Preschool; Female; Foot; Foot Orthoses; Gait; Hallux Valgus; Humans; Male; Metatarsus Varus; Shoes; Toes; Treatment Outcome
PubMed: 30180153
DOI: 10.12659/MSM.909072 -
Journal of Orthopaedic Case Reports 2018Crossover deformity of the first and second toes is not uncommon of a severe hallux valgus (HV) deformity. It can be corrected by adequate realignment of the hallux....
INTRODUCTION
Crossover deformity of the first and second toes is not uncommon of a severe hallux valgus (HV) deformity. It can be corrected by adequate realignment of the hallux. However, the crossover deformity may be complicated by also a concomitant varus deformity of the second toe. Although the pathoanatomy of second toe varus deformity has been well described, its pathogenesis is still unclear. Consequently, its treatment has been mostly symptomatic and notspecific to its pathogenesis. This is a 1-year follow-up report of spontaneous correction of the second toe varus deformity after a soft tissue procedure for HV and metatarsus primus varus (MPV) deformities correction.
CASE REPORT
A patient had bilateral HV and crossover deformities of her feet. She opted for a bilateral surgical treatment when conservation management failed to be helpful anymore. A soft tissue non-osteotomy technique called syndesmosis procedure was chosen for her deformities correction. Her crossover deformity was caused mainly by varus deformity of the second toe. Intraoperatively, the second toe varus deformity was found to correct itself spontaneously once the first metatarsal was realigned by a non-osteotomy intermetatarsal cerclage suture technique to correct the MPV deformity. Only themore severe second toe deformity of right foot required additional soft tissue release to help correct its mild residual varus deformity. The patient enjoyed excellent cosmetic and functional results. The possible pathogenesis of second toe varus deformity and its unexpected spontaneous correction is discussed.
CONCLUSION
The pathogenic deforming force of second toe varus deformity may originate from the first ray HV deformity complex. Consequently, the satisfactory anatomical correction of her HV deformity and also function restoration of the first ray by the syndesmosis procedure might have been the mechanism of spontaneous correction of the second toe varus deformity and its recurrence prevention.
PubMed: 30167411
DOI: 10.13107/jocr.2250-0685.1042 -
Knee Surgery, Sports Traumatology,... May 2019The purpose of this study was to define various anteroposterior axes of the tibial component as references and to evaluate their accuracy and variability using virtual...
PURPOSE
The purpose of this study was to define various anteroposterior axes of the tibial component as references and to evaluate their accuracy and variability using virtual surgery. It was hypothesized that (1) Akagi's Line could result in high accuracy and low variability in varus osteoarthritic knees; (2) anteroposterior axes defined by using the tibial bony cutting surface as a landmark might be good substitutes for Akagi's Line; and (3) extra-articular bony landmarks might influence the variability of the anteroposterior axis.
METHODS
Three-dimensional bone models were reconstructed from the preoperative computed tomography data of 111 osteoarthritic knees with varus deformities. Seven different anteroposterior axes of the tibial component were defined: Akagi's Line, Axis MED, Axis 1/6MED, Axis 1/3MED, Axis of Oval Shape, Axis of Anterior Crest, and Axis Second Metatarsus. The rotational mismatch angle was measured between the tibial anteroposterior axis and the line perpendicular to the transepicondylar axis projected on the cutting surface (positive value: external rotation of the tibial anteroposterior axis).
RESULTS
The average rotational mismatch angles (referring to the projected anatomical/surgical epicondylar axes) were - 2.7° ± 5.8°/1.0° ± 6.0° (Akagi's Line), - 4.2° ± 7.7°/- 0.5° ± 7.8°, 2.9° ± 7.2°/6.6° ± 7.2°, 9.8° ± 7.0°/13.5° ± 6.8° (Axis MED, Axis 1/6MED, Axis 1/3MED), - 5.1° ± 7.9°/- 1.4° ± 7.8° (Axis of Oval Shape), and 19.3 ± 9.5°/23.0° ± 9.6°, - 2.0° ± 11.3°/1.7° ± 11.4° (Axis Anterior Crest, Axis Second Metatarsus), respectively.
CONCLUSIONS
Akagi's Line provided the best accuracy and least variability in varus osteoarthritic knees. Axis 1/6MED and Axis MED are good substitutes for Akagi's Line due to the difficulty of identifying the attachment site of the posterior cruciate ligament after the proximal tibia has been cut. Extra-articular bony landmarks should not be used for alignment due to their high variability. This study will aid surgeons in choosing the proper anteroposterior axis of the tibial component to reduce rotational mismatch and thus achieve good clinical knee outcomes.
LEVELS OF EVIDENCE
III.
Topics: Aged; Aged, 80 and over; Arthroplasty, Replacement, Knee; Female; Humans; Imaging, Three-Dimensional; Knee Joint; Male; Metatarsal Bones; Middle Aged; Osteoarthritis, Knee; Posterior Cruciate Ligament; Plastic Surgery Procedures; Reproducibility of Results; Rotation; Tibia; Tomography, X-Ray Computed
PubMed: 29995165
DOI: 10.1007/s00167-018-5052-x -
Journal of Foot and Ankle Research 2018Metatarsus adductus is the most common congenital foot deformity in newborns. It involves adduction of the metatarsals at the Lisfranc joint. A systematic literature... (Review)
Review
BACKGROUND
Metatarsus adductus is the most common congenital foot deformity in newborns. It involves adduction of the metatarsals at the Lisfranc joint. A systematic literature review was conducted to investigate the following question: What tools are used to identify and quantify metatarsus adductus and how reliable, valid and responsive are they?
METHODS
The following electronic databases were searched for studies describing tools for the identification and quantification of metatarsus adductus in adults and children published from inception to June 2016: Ovid MEDLINE, Embase, CINAHL, Scopus, Web of Science and AMED. Two researchers initially searched all articles by screening titles and abstracts. If there was any doubt as to an article's eligibility, the full text paper was retrieved. Reference lists and citations of all retained studies were examined in an attempt to locate further studies. Articles were excluded if they were not in English or described other congenital foot conditions that did not include metatarsus adductus. Studies included in the review reporting measurement properties of measurement tools were critically appraised using the Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) critical appraisal tool.
RESULTS
There were 282 articles screened by title and abstract and 28 articles screened from full text. Fifteen articles were included and nine had data that were extractable for appraisal using the COSMIN critical appraisal tool. Techniques to measure metatarsus adductus included the heel bisector method, photocopies, ultrasound, footprints, dynamic foot pressure and radiographs. There was a paucity of quality data reporting the reliability, validity or responsiveness for measuring metatarsus adductus. Several radiographic angles showed good reliability (intraclass correlation (ICC) - 0.84, 0.97) in adults during pre-operative planning.
CONCLUSION
There have been multiple assessment techniques proposed for quantification of metatarsus adductus, but there is paucity of reliability, validity or responsiveness to measurement data about these techniques, especially in relation to the paediatric population. Further consideration of measurement testing is required to determine if the most common non-radiographic measures of metatarsus adductus are acceptable for clinical use.
Topics: Foot Deformities, Congenital; Humans; Metatarsal Bones; Metatarsus Varus; Observer Variation; Radiography; Reproducibility of Results
PubMed: 29881466
DOI: 10.1186/s13047-018-0268-z -
Foot and Ankle Clinics Jun 2018Rotational deformity in hallux valgus is a recognized component and a demonstrated recurrence factor in patients who have undergone surgery. More than 20 years ago,... (Review)
Review
Rotational deformity in hallux valgus is a recognized component and a demonstrated recurrence factor in patients who have undergone surgery. More than 20 years ago, publications started reporting metatarsal pronation as part of the hallux valgus pathology. Identifying metatarsal pronation should be part of the preoperative angular measurements. The proximal metatarsal rotational osteotomy and Lapidus fusion are some of the few techniques that reliably correct metatarsal pronation. They have good results, with more nonunions reported for the Lapidus. The authors present their hallux valgus treatment algorithm that includes metatarsus varus severity, tarsometatarsal instability, and rotational deformity among its variables.
Topics: Decision Making; Hallux Valgus; Humans; Osteotomy; Rotation
PubMed: 29729795
DOI: 10.1016/j.fcl.2018.01.009 -
Operative Orthopadie Und Traumatologie Jun 2018Bunionette or 'tailor's bunion' is a deformity of the fifth ray, which comes along with a metatarsus quintus valgus and a varus deformity of the fifth toe with... (Review)
Review
OBJECTIVE
Bunionette or 'tailor's bunion' is a deformity of the fifth ray, which comes along with a metatarsus quintus valgus and a varus deformity of the fifth toe with subluxation of the metatarsophalangeal joint. A minimally invasive osteotomy of the fifth metatarsal without internal fixation using burrs is an increasingly used alternative for symptomatic tailor's bunion deformity. Similar to open surgery procedures the type of osteotomy complies with the underlying pathology. Minimally invasive surgical (MIS) procedures allow comprehensive treatment of various types of tailor's bunion deformities.
INDICATIONS
Symptomatic tailor's bunion deformity, failed conservative treatment, a closed epiphyseal gap.
CONTRAINDICATIONS
Osteoporotic bone, poor patient compliance.
SURGICAL TECHNIQUE
The technique comprises percutaneous resection of the lateral exostosis of the fifth metatarsal head with a straight burr and an osteotomy of the fifth metatarsal, either distally, diaphyseal or proximally with a conical burr due to the shape of the deformity, usually without internal fixation.
POSTOPERATIVE MANAGEMENT
Redressive wrapping, partial pain-adapted weight bearing. Non-steroidal anti-inflammatory drugs for 3-5 days, lymphatic drainage, intermittent cooling. Radiographic assessment on postoperative day 1; radiographic follow-up 6 weeks postoperatively. Thromboembolic prophylaxis.
RESULTS
The clinical outcome is comparable to standard surgical procedures with the advantages of MIS. Based on our results and the current literature, the minimally invasive distal metatarsal osteotomy without fixation is becoming a reliable treatment for tailor's bunion.
Topics: Bunion, Tailor's; Hallux Valgus; Humans; Metatarsal Bones; Minimally Invasive Surgical Procedures; Osteotomy; Treatment Outcome
PubMed: 29704103
DOI: 10.1007/s00064-018-0542-z