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Acta Orthopaedica Scandinavica.... 1989Roentgen stereophotogrammetric analysis has been used to study ankle/foot kinematics in eight healthy volunteers. All the joints between the tibia and the first... (Review)
Review
Roentgen stereophotogrammetric analysis has been used to study ankle/foot kinematics in eight healthy volunteers. All the joints between the tibia and the first metatarsal as well as the talo-calcaneal and tibio-fibular joints were analysed in input plantar flexion/dorsiflexion and pronation/supination of the foot as well as internal/external rotation of the leg. The findings included the following: INDIVIDUAL JOINTS 1. The joint axis of the talo-crural joint varied with varying kinds of input motion. Substantial amounts of rotation occurred about axes close to the vertical; this occurred particularly when the input motion was in the internal rotation part of the arc of leg rotation and in pro-/supination of the foot. 2. The total amount of rotation in the talo-calcaneal joint was small in internal rotation of the leg and in pronation of the foot compared to external rotation of the leg and supination of the foot. 3. The talo-navicular joint showed a limited ball-and-socket joint pattern in all subjects. The total amounts of rotation were larger than in the talo-calcaneal joint in all subjects. Plantar flexion axes were more transverse than the axes seen in other kinds of input motion. 4. The talo-calcaneal and talo-navicular joint axes were seldom parallel, indicating that these joints do not necessarily behave as a simple hinge. JOINT INTERACTION Joint interaction varied in different qualities of input motion. Plantar flexion induced rotation in the talo-crural joint, and to some extent in the joints of the arch. Dorsiflexion mainly induced talo-crural joint motion. Pronation/supination induced motion in all joints. The distal joints of the arch displayed more rotation in pronation than in supination, while the talo-calcaneal joint showed less motion in pronation than in supination. Internal leg rotation induced little rotation in the joints of the ankle/foot complex. External rotation induced external rotation, dorsiflexion, and supination in the talo-navicular and talo-calcaneal joints. The distal joints of the arch displayed compensatory plantar flexion and pronation. TRANSFERRAL OF ROTATION The ankle/foot complex showed ability to transform leg rotation into pro-/supination and vice versa. This function was most pronounced in external leg rotation. MOTIONS OF THE FIBULA The fibula showed consistent lateral and posterior translation from input plantar flexion to dorsiflexion of the foot.
Topics: Adult; Ankle Joint; Calcaneus; Female; Humans; Male; Metatarsal Bones; Movement; Photogrammetry; Radiography; Rotation; Talus; Tarsal Bones; Tibia
PubMed: 2686345
DOI: 10.1186/1757-1146-5-s1-k5 -
Journal of Foot and Ankle Research May 2020The aim of this study was to assess the diagnostic value of point-of-care bedside ultrasound (PoCUS) as in usual clinical practice in suspected ankle and fifth... (Randomized Controlled Trial)
Randomized Controlled Trial
Point-of-care bedside ultrasound examination for the exclusion of clinically significant ankle and fifth metatarsal bone fractures; a single blinded prospective diagnostic cohort study.
OBJECTIVE
The aim of this study was to assess the diagnostic value of point-of-care bedside ultrasound (PoCUS) as in usual clinical practice in suspected ankle and fifth metatarsal bone fractures, compared to the standard of radiographic imaging.
METHODS
This prospective study included patients ≥17 years presenting to the Emergency Department with ankle trauma and positive Ottawa Ankle Rules. All patients underwent PoCUS of the ankle by a (resident) emergency physician, the images were assessed by an ultrasound expert. Both were blinded for the medical history and clinical findings of the patients. Radiography of the ankle followed, evaluated by a radiologist blinded from the PoCUS findings. Primary outcome measures were sensitivity and specificity of PoCUS.
RESULTS
A total of 242 patients were included, with 35 (22%) clinically significant (non-avulsion) fractures observed with radiography. The sensitivity of PoCUS in detecting clinically significant fractures by all sonographers was 80.0% (95% Confidence Interval (CI) 63.0 to 91.6%), specificity 90.3% (95% CI 83.7 to 94.9%), positive predictive value 70.0% (95% CI 57.0 to 80.3%) and the negative predictive value 94.1% (95% CI 89.1 to 96.9%). The sensitivity of PoCUS in detecting clinically significant fractures by the expert was 82.8% (95% CI 66.3 to 93.4%), specificity 99.2% (95% CI 95.5 to 99.9%), positive predictive value 96.7% (95% CI 80.3 to 99.5%) and the negative predictive value 95.3% (95% CI 91.0 to 98.2%).
CONCLUSION
PoCUS combined with the OAR has a good diagnostic value in usual clinical practice in the assessment of suspected ankle and fifth metatarsal bone fractures compared to radiographic imaging. More experience with PoCUS will improve the diagnostic value.
TRIAL REGISTRATION
Registered in the local Research Register, study number 201500597.
Topics: Adult; Ankle; Ankle Fractures; Female; Fractures, Bone; Humans; Male; Metatarsal Bones; Middle Aged; Point-of-Care Systems; Predictive Value of Tests; Radiography; Sensitivity and Specificity; Single-Blind Method; Ultrasonography; Young Adult
PubMed: 32381048
DOI: 10.1186/s13047-020-00387-y -
La Pediatria Medica E Chirurgica :... Oct 2018Metatarsal fractures make up the greatest portion of foot fractures in children. Most of them are treated with closed reduction and non-weightbearing cast...
Metatarsal fractures make up the greatest portion of foot fractures in children. Most of them are treated with closed reduction and non-weightbearing cast immobilization.Usually, these fractures heal uneventfully and delay union and pseudoarthrosis are rare. We report a case of a 10-year-old child with non-union of the second metatarsal following a traumatic fracture, caused by an accident 10 months before, and treated successfully by osteosynthesis with plate and screws. Good clinical outcome was achieved at 2 years follow-up.
Topics: Bone Plates; Bone Screws; Child; Fracture Fixation, Internal; Fractures, Bone; Fractures, Ununited; Humans; Male; Metatarsal Bones; Pseudarthrosis; Treatment Outcome
PubMed: 30514075
DOI: 10.4081/pmc.2018.205 -
Journal of Biomechanics May 2020Stress fracture of the second metatarsal is a common and problematic injury for runners. The choice of foot strike pattern is known to affect external kinetics and...
Stress fracture of the second metatarsal is a common and problematic injury for runners. The choice of foot strike pattern is known to affect external kinetics and kinematics but its effect on internal loading of the metatarsals is not well understood. Subject-specific models of the second metatarsal can be used to investigate internal loading in a non-invasive manner. This study aimed to compare second metatarsal stress between habitual rearfoot and non-rearfoot strikers during barefoot running, using a novel subject-specific mathematical model, including accurate metatarsal geometry. Synchronised force and kinematic data were collected during barefoot overground running from 20 participants (12 rearfoot strikers). Stresses were calculated at the plantar and dorsal periphery of the midshaft of the metatarsal using a subject-specific beam theory model. Non-rearfoot strikers demonstrated greater external loading, bending moments and compressive forces than rearfoot strikers, but there were no differences in peak stresses between groups. Statistical parametric analysis revealed that non-rearfoot strikers had greater second metatarsal stresses during early stance but that there was no difference in peak stresses. This emphasises the importance of bone geometry when estimating bone stress and supports the suggestion that external forces should not be assumed to be representative of internal loading.
Topics: Biomechanical Phenomena; Foot; Humans; Metatarsal Bones; Pressure; Running
PubMed: 32327192
DOI: 10.1016/j.jbiomech.2020.109792 -
The Journal of Foot and Ankle Surgery :... 2020Bisphosphonates (BP) are used to treat osteoporosis, although rare atypical femur fractures have occurred with long-term exposure, especially among Asians. Metatarsal...
Bisphosphonates (BP) are used to treat osteoporosis, although rare atypical femur fractures have occurred with long-term exposure, especially among Asians. Metatarsal fractures have also been reported with atypical femur fracture. We examined the epidemiology of metatarsal fractures among 48,390 females aged ≥50 years who initiated oral BP and were followed for a median 7.7 years, including 68 females who experienced an atypical femur fracture. Incident metatarsal fractures after BP initiation were identified by clinical diagnoses and validated by record review. The association of BP, clinical risk factors, race/ethnicity, and metatarsal fracture was examined by using Cox proportional hazard analyses. Among 1123 females with incident metatarsal fracture, 61.0% had an isolated fifth metatarsal fracture. The incidence of metatarsal fracture was 312 per 100,000 person-years of follow-up and was substantially lower for Asians. The adjusted relative rate for metatarsal fractures was 0.5 (95% confidence interval 0.4 to 0.6) for Asians compared with whites. Younger age, prior fracture, other risk factors, and current BP were associated with an increased relative rate of metatarsal fracture, but BP duration was not. Females with atypical femur fracture were not more likely to experience metatarsal fracture (2.9% versus 2.3%, p = .7), but only 68 females had an atypical fracture and stress fracture of the metatarsals was not examined. Except for age, the demographic profile for metatarsal fracture after initiating BP was similar to that for osteoporotic fracture, with Asians at a much lower risk. Although metatarsal fractures were not associated with BP duration or atypical femur fracture, the subset of metatarsal stress fractures was not specifically examined.
Topics: Aged; Aged, 80 and over; Ankle Fractures; Bone Density Conservation Agents; Diphosphonates; Female; Follow-Up Studies; Humans; Incidence; Metatarsal Bones; Middle Aged; Osteoporosis; Retrospective Studies; Risk Factors; Time Factors; United States
PubMed: 32130989
DOI: 10.1053/j.jfas.2019.02.008 -
Injury Jun 2022To compare diagnostic parameters for Lisfranc instability on WB and NWB radiographs and to assess the inter-observer reliability of a standardized diagnostic protocol.
BACKGROUND
To compare diagnostic parameters for Lisfranc instability on WB and NWB radiographs and to assess the inter-observer reliability of a standardized diagnostic protocol.
PATIENTS AND METHODS
Patients who had undergone surgical treatment for subtle, purely ligamentous Lisfranc injury with both WB and NWB post-injury, pre-surgery films (n = 26) were included in this multicentre, retrospective comparative study. Also included was a control group (n = 26) of patients with isolated fifth metatarsal avulsion fractures who similarly had both WB and NWB films. Multiple midfoot distance and alignment measurements were used to evaluate the Lisfranc joint on both WB and NWB views. To evaluate interobserver reliability, measurements were made by two independent observers across a cohort subset.
RESULTS
When comparing the NWB views between groups, only C1M2 (medial cuneiform- second metatarsal) distance was found to be significantly larger (∆ = 1.35 mm, p <0.001) for Lisfranc injuries. Most notably, C2M2 (Intermediate cuneiform - second metatarsal) step off-caused by lateral translation of the second metatarsal base-was not significantly different (∆ = 0.39 mm, p = 0.101) between Lisfranc patients and controls. On WB views, Lisfranc patients had significantly larger changes to C1M2 distance and C2M2 step-off as compared to controls (∆ = 2.97 mm, p <0.001 and ∆ = 1.98 mm, p <0.001 respectively). M1M2 (first to second intermetatarsal) distance was not significantly different between patients and controls in WB films. Within the cohort of ligamentous Lisfranc patients, C1M2 distance and C2M2 step-off were significantly larger in WB when compared to NWB films (∆ = 1.77 mm, p <0.001 and ∆ = 1.58 mm, p <0.001 respectively). For these parameters, inter-observer reliability scores (ICC) of >0. 90 were found when interpreting WB radiographs and ICC's ranging between 0.61 and 0.80 were found when interpreting NWB radiographs.
CONCLUSION
Using WB imaging for diagnosing subtle Lisfranc instability reveals larger diastasis in the tarsometatarsal joint and has a higher interobserver reliability compared to NWB imaging. Clinical concern for subtle or occult Lisfranc instability in any patient should therefore trigger WB radiographic assessment since such injuries may be missed on NWB views.
Topics: Ankle Injuries; Foot Injuries; Fractures, Bone; Humans; Metatarsal Bones; Radiography; Reproducibility of Results; Retrospective Studies; Weight-Bearing
PubMed: 35227511
DOI: 10.1016/j.injury.2022.02.040 -
American Journal of Veterinary Research Apr 2006To determine via histologic examination and scintigraphy the effect of focused extracorporeal shock wave therapy (ESWT) on normal bone and the bone-ligament interface in...
OBJECTIVE
To determine via histologic examination and scintigraphy the effect of focused extracorporeal shock wave therapy (ESWT) on normal bone and the bone-ligament interface in horses.
ANIMALS
6 horses without lameness.
PROCEDURE
Origins of the suspensory ligament at the metacarpus (35-mm probe depth) and fourth metatarsal bone (5-mm probe depth) were treated twice (days 0 and 16) with 2,000 shocks (energy flux density, 0.15 mJ/mm2). One forelimb and 1 hind limb were randomly treated, and the contralateral limbs served as nontreated controls. Bone scans were performed on days -1 (before ESWT), 3, 16, and 19. Histomorphologic studies of control and treated tissues were performed on day 30.
RESULTS
ESWT significantly increased the number of osteoblasts but caused no damage to associated soft tissue structures and did not induce cortical microfractures. A significant correlation between osteoblast numbers and radiopharmaceutical uptake was noticed on lateral views of the hind limb on days 3 and 16 and on caudal views of the forelimb on day 3.
CONCLUSIONS AND CLINICAL RELEVANCE
Results suggested that ESWT has the potential to increase osteoblast numbers in horses. The correlation between increased osteoblast numbers and radio-pharmaceutical uptake 3 days and 16 days after the first ESWT suggested that stimulation of osteogenesis occurred soon after ESWT. No damage to bone or the bone-ligament interface should occur at the settings used in this study, and ESWT can therefore be administered safely in horses.
Topics: Animals; Horse Diseases; Horses; Lameness, Animal; Ligaments; Lithotripsy; Metatarsal Bones; Reference Values
PubMed: 16579748
DOI: 10.2460/ajvr.67.4.577 -
Orthopaedics & Traumatology, Surgery &... Oct 2021Hallux valgus (HV) in adults is an acquired pathology related to 1 metatarsal (M1) abduction. In children, it is related to abnormal M1 joint surface orientation.
BACKGROUND
Hallux valgus (HV) in adults is an acquired pathology related to 1 metatarsal (M1) abduction. In children, it is related to abnormal M1 joint surface orientation.
HYPOTHESIS
HV deformities in children and adults differ.
OBJECTIVE
Descriptive study of radiologic abnormalities in a pediatric population of symptomatic HV, with comparison to a population without symptomatic HV.
MATERIALS AND METHODS
Weight-bearing X-rays were studied in pediatric patients undergoing surgery for HV and in a control population. Measurements comprised M1P1, M1M2, DMAA, DM2AA, MPAA, and sesamoid subluxation index.
RESULTS
Twenty-five patients (42 feet) were included in the HV group, and 16 patients (29 feet) in the control group. Mean age was 13 years in both. Interobserver reproducibility was excellent for M1P1, and good for M1M2, DMAA and DM2AA. In HV, 71% of feet showed M1M2 angle>12° and 98% DMAA>10°; DM2AA was>0°, except in 1 foot.
DISCUSSION
Normal values are the same in children and adults: M1P1<15°, DMAA<10° and M1M2<12°. In the HV group, DMAA was systematically pathological, while M1M2 was pathological in only 71% of cases. Childhood HV is related to abnormal DMAA, sometimes associated with increased M1M2 angle, especially in severe forms. DM2AA assesses distal M1 joint surface orientation with respect to the M2 axis; in the HV group, it was systematically>0° (except in 1 foot). Thus, in case of concomitant DMAA and M1M2 abnormalities, DMAA is more severely abnormal than M1M2 (DM2AA=DMAA-M1M2).
CONCLUSION
Childhood HV is mainly due to abnormal M1 joint surface orientation, sometimes associated with increased 1 metatarsal abduction. DM2AA reflects the balance between 1 metatarsal abduction and M1 joint surface orientation abnormality.
LEVEL OF EVIDENCE
III.
Topics: Adolescent; Adult; Child; Hallux Valgus; Humans; Metatarsal Bones; Metatarsophalangeal Joint; Osteotomy; Reproducibility of Results; Treatment Outcome
PubMed: 33895388
DOI: 10.1016/j.otsr.2021.102938 -
Journal of Orthopaedic Surgery and... Jan 2022Fifth metatarsal base fracture (fifth MBF) and lateral collateral ankle ligament (LCAL) injury are mainly caused by plantar flexion and inversion of the foot. However,...
BACKGROUND
Fifth metatarsal base fracture (fifth MBF) and lateral collateral ankle ligament (LCAL) injury are mainly caused by plantar flexion and inversion of the foot. However, there is no relevant report on the incidence, injury type and treatment principle of the fifth MBF combined with an LCAL injury.
MATERIALS AND METHODS
We retrospectively analyzed 61 patients with fifth MBF. After admission, patients were given the symptomatic treatment and underwent standard anteroposterior (AP), 30-degree oblique foot radiographs, ankle MR and/or ultrasonic examination. The type of surgery varied base on the individual patients (type of fracture with/without lateral collateral ankle ligament injury).
RESULTS
In 61 patients, there were 39 patients with LCAL injury. Among the 39 patients with LCAL injury, 24 patients with Grade I-II injury, 6 patients with Grade III injury, and 9 patients with avulsion fractures. There was no significant difference between the patients without LCAL injury and the patients with LCAL injury in terms of age (p = 0.67) and gender (p = 0.575). The incidence of fifth MBF with LCAL injury accounted for 63.93% of fifth metatarsal base fracture; the most common causes of injury included sprains and falls. The average fracture healing time was 8.3 (range, 6-12) weeks. For fifth MBF with displaced more than 2 mm, hook plate or lag screw was used for fixation; for complete rupture of LCAL, suture anchor was used to repairing the ligament; for partial LCAL injury, plaster was used for fixation after surgery; for avulsion fractures, cannulated screw or suture anchor was used for repair. None of the patients had complications such as delayed union, nonunion, and incision infection.
CONCLUSION
Early diagnosis and appropriate treatment can obtain good therapeutic results in fifth MBF patients combined with LCAL injury. Moreover, defining a treatment plan for ligament injury is essential for reducing postoperative complications. This study provides a basis for epidemiology, diagnosis, and treatment of fifth MBF with LCAL injury.
Topics: Adult; Aged; Female; Fracture Fixation, Internal; Fractures, Avulsion; Fractures, Bone; Humans; Lateral Ligament, Ankle; Male; Metatarsal Bones; Middle Aged; Retrospective Studies; Tomography, X-Ray Computed
PubMed: 35073951
DOI: 10.1186/s13018-022-02935-7 -
The Journal of Foot and Ankle Surgery :... 2021A transmetatarsal amputation (TMA) is a widely utilized procedure to address foot gangrene and infection. Although a common procedure, so too are the associated... (Review)
Review
A transmetatarsal amputation (TMA) is a widely utilized procedure to address foot gangrene and infection. Although a common procedure, so too are the associated complications. The purpose of this review was to evaluate TMA healing and to explore if there were associated variables correlating with healed vs. failed to heal TMA sites. To do so, the Medical Department Orthopaedics Division Electronic Database, West Virginia University, College of Medicine was retrospectively searched to identify all cases of TMAs (CPT code 28805) during the period of January 2011 through June 2019, and those variables that might impact TMA healing. Then both univariate and multivariable logistic regression analyses were performed to investigate the associations between these variables and TMA healing, and sensitivity analyses were also conducted to determine if the results resisted the influence of one unmeasured confounder. There were 39 patients (41 procedures) who would undergo a TMA. The mean average patient age was 53 (range 29-73) years old. The median postoperative follow-up period was 617 (range 199-3632) days. TMA mortality data revealed 0 deaths at 30 days, 2 (5.1%) at 1 year, 8 (20.5%) at 5 years. In our study, 29 (70.7%) of the TMAs would achieve primary healing at a median of 31 (range 16-253) days. When comparing the TMA healed group to the failed to heal group the following independent variables were considered: diabetes mellitus, HgA1c >8%, neuropathy, peripheral arterial disease, chronic kidney disease, active smoking status, previous surgery, and a clean margin metatarsal bone pathology specimen positive for osteomyelitis. Of the aforementioned, only neuropathy (odds ratio [OR] = 0.056, 95% confidence interval [CI] = 0-0.501, p = .0062) and positive bone margin (OR = 0.144, 95% CI = 0.022-0.835, p = .0385) were found to be significant in univariate logistic regression analysis. In multivariable logistic regression analyses where the potential confounders age, gender, and body mass index were accounted for, of the 8 independent variables of interest, only neuropathy (OR = 0.037, 95% CI = 0-0.497, p = .0036) remained significantly associated with the healing status. Neuropathy was present in 17 (58.6%) of the healed TMAs and in 12 (100%) of the failed to heal TMAs. However, the positive bone margin failed to reach statistical significance (OR = 0.079, 95% CI = 0-1.39, p = .1331). Results from another multivariable logistic regression model where a quadratic term for age was added revealed that positive bone specimen correlated with the TMA healing status with significance (OR = 0.051, 95% CI = 0.001- 0.560, p = .0404). A positive clean margin bone specimen was found in 3 (10.3%) of the healed TMAs and in 4 (44.4%) of the failed to heal TMAs. The sensitivity analysis where current ulceration was used as an unmeasured confounder indicated that the results regarding the association between neuropathy or positive bone margin and TMA healing, though inconclusive, resisted the influence of this unmeasured confounder. Hopefully these findings will be a beneficial addition to the current TMA literature and as such, further assist with informed surgical decision making.
Topics: Adult; Aged; Amputation, Surgical; Diabetic Foot; Foot; Gangrene; Humans; Metatarsal Bones; Middle Aged; Retrospective Studies
PubMed: 33218867
DOI: 10.1053/j.jfas.2020.08.006