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Zhongguo Xiu Fu Chong Jian Wai Ke Za... Sep 2022To analyze the biomechanical changes of hallux valus after Swanson prosthesis-arthroplasty of the 1st metatarsophalangeal joint combined with osteotomy and bone grafting...
[Three-dimensional finite element analysis of Swanson prosthesis-arthroplasty of the first metatarsophalangeal joint combined with osteotomy and bone grafting of the first metatarsal bone for hallux valgus].
OBJECTIVE
To analyze the biomechanical changes of hallux valus after Swanson prosthesis-arthroplasty of the 1st metatarsophalangeal joint combined with osteotomy and bone grafting of the 1st metatarsal bone by three-dimensional finite element analysis, so as to provide data basis for studying the changes of foot morphology and physiological function after hallux valus correction surgery.
METHODS
A 65-year-old female patient with severe hallux valus admitted in January 2013 was selected as the research object. The CT data of the right foot was obtained, and the three-dimensional finite element models before and after Swanson prosthesis-arthroplasty of the 1st metatarsophalangeal joint combined with osteotomy and bone grafting of the 1st metatarsal bone were established by Mimics10.01, Geomagic Studio, and ANSYS12.0 software. ANSYS 12.0 software was used for nonlinear static stress analysis, and the hallux valgus angle (HVA), the intermetatarsal angle (IMA), and the von Mises stress distributions of the forefoot plantar surface and the 1st to 5th metatarsal bones were observed before and after operation.
RESULTS
The HVA and IMA were 56.3° and 16.3° before operation and 9.2° and 9.8° after operation, respectively. Before operation, the stress on the forefoot was the largest in the 4th metatarsal head zone and the smallest in the 1st metatarsal head zone; the stress on the medial side of the forefoot was significantly smaller than that on the lateral side, and the center of forefoot pressure was located on the lateral side. After operation, the stress on the forefoot was the largest in the 1st metatarsal head zone and the smallest in the 5th metatarsal head zone; the stress on the lateral side of the forefoot was significantly smaller than that on the medial side, and the center of forefoot pressure was located on the medial side. Before operation, the stress of the 5th metatarsal bone was the largest, and the 1st metatarsal bone was the smallest. After operation, the stress of the 1st metatarsal bone was the largest, and the 4th metatarsal bone was the smallest.
CONCLUSION
Swanson prosthesis-arthroplasty of the 1st metatarsophalangeal joint combined with osteotomy and bone grafting of the 1st metatarsal bone can effectively correct hallux valgus and make HVA, IMA, and plantar pressure distribution close to normal. However, postoperative stresses of the 1st to 5th metatarsal bones elevate, which may lead to associated complications.
Topics: Aged; Arthroplasty; Artificial Limbs; Bone Transplantation; Female; Finite Element Analysis; Hallux; Hallux Valgus; Humans; Metatarsal Bones; Metatarsophalangeal Joint; Osteotomy
PubMed: 36111474
DOI: 10.7507/1002-1892.202204126 -
Journal of Foot and Ankle Research 2018The area beneath the metatarsal heads is a common location of foot pain, which is often associated with high plantar pressures. Current plantar pressure assessment... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
The area beneath the metatarsal heads is a common location of foot pain, which is often associated with high plantar pressures. Current plantar pressure assessment protocols focus mainly on the gross area of the forefoot with minimal attention paid to specific areas such as the metatarsal heads. The aim of this study was to develop and assess a new anatomically-based masking protocol that is clinically relevant to measure forefoot plantar pressure during shod conditions based on the anatomical positions of the metatarsal heads.
METHODS
Initially, we developed a masking protocol to measure forefoot plantar pressure during shod conditions based on the anatomical positions of the metatarsal heads. This new masking protocol divided the forefoot into three sub-areas (proximal, beneath, and distal to the metatarsal heads) as determined by the position of each metatarsal head. Following development of the new masking protocol, we compared the new protocol against a traditional protocol, which defines the forefoot as between 51 and 81% of the foot length. To compare the two masking protocols, we tested two experimental conditions: (i) a control condition (i.e. no metatarsal pad), and (ii) a metatarsal pad condition. We then compared plantar pressure differences between the two experimental conditions for the two masking protocols. Participants for this component of the study included 36 community dwelling older adults (mean age 75.6 years ±5.4) with a history of forefoot pain. Forefoot plantar pressure data were measured while walking using the pedar-X in-shoe system. Peak pressure, maximum force and contact area at the time of peak pressure were determined and results were compared between the two masking protocols.
RESULTS
The traditional masking protocol showed that the metatarsal pad significantly decreased peak pressure and increased contact area in the forefoot area (i.e. within the entire mask area), but maximum force was not significantly different between the two conditions. In contrast, the newly developed anatomically-based masking protocol indicated that the metatarsal pad decreased peak plantar pressures distal to and beneath the metatarsal heads by increasing force and contact area proximal to the metatarsal heads.
CONCLUSIONS
An anatomically-based masking protocol that is clinically relevant was developed to assess forefoot plantar pressure during shod conditions based on the anatomical positions of metatarsal heads. We propose that the new forefoot masking protocol will provide greater interpretability of forefoot plantar pressure data, which will aid clinicians and researchers for diagnostic, prognostic and therapeutic purposes.
Topics: Aged; Aged, 80 and over; Clinical Protocols; Equipment Design; Female; Foot Orthoses; Forefoot, Human; Humans; Male; Metatarsal Bones; Pain; Pressure; Shoes; Single-Blind Method; Weight-Bearing
PubMed: 29983748
DOI: 10.1186/s13047-018-0271-4 -
Orthopaedic Surgery Oct 2019To report the radiological and clinical outcomes of the modified scarf osteotomy for the treatment of hallux valgus deformity in adolescents.
OBJECTIVE
To report the radiological and clinical outcomes of the modified scarf osteotomy for the treatment of hallux valgus deformity in adolescents.
METHODS
This retrospective study analyzed 21 patients (31 feet) who underwent a modified scarf osteotomy for correcting juvenile hallux valgus deformity between March 2015 and January 2017. There were 3 male (3 feet) and 18 female (28 feet) patients. The average age at the time of surgery was 28.6 years (range, 20-35). Patients were postoperatively followed up in the outpatient department for 12-18 months. Clinical and radiological assessments were performed preoperatively and postoperatively at 1 year. Moreover, postoperative complications were recorded. Statistical analyses for differences between preoperative and postoperative values were performed.
RESULTS
All the 21 patients were postoperatively followed up for 12-18 months, with an average of 13.2 ± 2.5 months. Clinical assessment showed that the American Orthopaedic Foot and Ankle Society score was increased from preoperative 58.0 ± 5.8 to postoperative 94.2 ± 6.6 points, respectively, and the visual analog scale score was remarkably decreased from preoperative 6.0 ± 2.0 to postoperative 1.5 ± 2.0 points at 1 year follow-up. Further radiological assessment showed that the hallux valgus angle was 37.5° ± 9.2°, 14.1° ± 6.5°, and 14.5° ± 6.5° before surgery, half a year after surgery, and 1 year after surgery, respectively; the intermetatarsal angle was 14.1° ± 4.4°, 4.8° ± 3.2°, and 5.5° ± 4.9°, respectively; and the distal metatarsal articular angle was 31.0° ± 3.5°, 7.2° ± 2.3°, and 7.5° ± 2.1°, respectively. They were significantly improved at half a year after surgery and 1 year after surgery compared to those before surgery. Complications occurred in two patients (9.5%) who had numbness on the skin of the edge of the medial incision, and the symptoms were relieved after 10 months. There was no clinical recurrence in all patients. One of the 31 feet had hallux varus, which was corrected in a second operation. Notably, a postoperative radiograph of a typical case whose both feet had hallux valgus deformity and underwent modified scarf osteotomy and additional Akin osteotomy showed adequate correction of the hallux valgus angle (HVA, 11°), intermetatarsal angle (IMA, 6°), and distal metatarsal articular angle (DMAA, 8°) on left foot compared to preoperative HVA (28°), IMA (13°), and DMAA (35°).
CONCLUSION
The modified scarf osteotomy can effectively correct the adolescent hallux valgus deformity, which is worth popularizing.
Topics: Adult; Disability Evaluation; Female; Hallux Valgus; Humans; Male; Metatarsal Bones; Osteotomy; Pain Measurement; Radiography; Retrospective Studies; Young Adult
PubMed: 31663288
DOI: 10.1111/os.12539 -
Clinical Orthopaedics and Related... Apr 2011Primary metatarsalgia of the lesser metatarsals is common and caused by mechanical overload of the affected metatarsal heads. Increased metatarsal length generally is...
BACKGROUND
Primary metatarsalgia of the lesser metatarsals is common and caused by mechanical overload of the affected metatarsal heads. Increased metatarsal length generally is believed to be a factor in the development of primary metatarsalgia. However, there is no clear biomechanical evidence supporting this theory.
QUESTIONS/PURPOSES
We asked whether metatarsal length correlated with plantar-loading parameters under the corresponding metatarsal heads.
PATIENTS AND METHODS
We prospectively followed two groups of patients 46 (51 feet) with and 45 (51 feet) without metatarsalgia. Each foot was physically examined and underwent standardized full-weightbearing radiography and dynamic pedobarography to assess maximal peak pressure and maximal force under the first, second, and third metatarsal heads. We correlated the relative length of the first and third metatarsals with the corresponding two plantar-loading parameters. We compared maximal peak pressure and maximal force in patients with metatarsalgia with those of symptom-free patients.
RESULTS
The relative length of the first and third metatarsals did not correlate (r < 0.13) with the maximal peak pressure or maximal force under the corresponding metatarsal heads. Maximal force under the first metatarsal head was decreased in the metatarsalgia group. There was no difference in maximal peak pressure between the metatarsalgia and nonmetatarsalgia groups.
CONCLUSIONS
Relative metatarsal length had no influence on plantar-loading parameters. Shortening of a symptomatic ray to decrease plantar-loading parameters cannot be supported from a biomechanical rationale.
Topics: Biomechanical Phenomena; Case-Control Studies; Female; Humans; Male; Metatarsal Bones; Metatarsalgia; Middle Aged; Pressure; Prospective Studies; Radiography; Risk Factors; Stress, Mechanical; Switzerland; Weight-Bearing
PubMed: 20945122
DOI: 10.1007/s11999-010-1615-y -
Der Unfallchirurg Apr 2022Fractures of the metatarsal bones are common injuries of the foot and particularly occur in patients aged 40-50 years. Especially multiple metatarsal fractures can lead...
BACKGROUND
Fractures of the metatarsal bones are common injuries of the foot and particularly occur in patients aged 40-50 years. Especially multiple metatarsal fractures can lead to permanent limitations. Therefore, the aim of this study was to investigate the functional outcome of metatarsal fractures after conservative and surgical treatment using a validated self-reported patient-based outcome questionnaire.
MATERIAL AND METHODS
All patients suffering from metatarsal fractures between 2003 and 2015 were enrolled in this retrospective analysis. The following data were collected: demographic data, AO classification, treatment, reoperation rate and the foot and ankle outcome score (FAOS). For outcome analysis, the nonparametric Mann-Whitney U‑test and Fisher's exact test were performed.
RESULTS
In total the functional outcome of 111 patients with metatarsal fractures were analyzed, 81 patients suffered of an isolated metatarsal fracture and 30 of multiple fractures. The mean age of the patients was 45 ± 15.2 years with a total of 48 men (43%) and 63 women (57%). Patients with an isolated metatarsal fracture had an FAOS of 88 ± 17.1, while patients with multiple metatarsal fractures achieved an FAOS of 78 ± 17.7 (p = 0.046). In the group of isolated metatarsal fractures 43 patients (53%) were surgically treated and of these 36 patients showed a type C fracture (84%). In the group of multiple metatarsal fractures 16 patients (53%) underwent operative treatment.
CONCLUSION
Overall, the functional outcome of isolated metatarsal fractures following operative as well as conservative treatment is good to very good. Simple fractures can be successfully treated conservatively and complex multifragment fractures can be safely managed surgically. If more than one metatarsal bone is fractured, the functional outcome is significantly worse with patients reporting lasting limitations involving the range of motion and stiffness.
Topics: Adult; Female; Fracture Fixation, Internal; Fractures, Bone; Humans; Male; Metatarsal Bones; Middle Aged; Retrospective Studies; Treatment Outcome
PubMed: 34023925
DOI: 10.1007/s00113-021-01006-6 -
Clinics (Sao Paulo, Brazil) Nov 2016To compare ultrasound propagation velocity with densitometry in the diaphyseal compact cortical bone of whole sheep metatarsals.
OBJECTIVE:
To compare ultrasound propagation velocity with densitometry in the diaphyseal compact cortical bone of whole sheep metatarsals.
METHODS:
The transverse ultrasound velocity and bone mineral density of 5-cm-long diaphyseal bone segments were first measured. The bone segments were then divided into four groups of 15 segments each and demineralized in an aqueous 0.5 N hydrochloric acid solution for 6, 12, 24 or 36 hours. All measurements were repeated after demineralization for each time duration and the values measured before and after demineralization were compared.
RESULTS:
Ultrasound velocity and bone mineral density decreased with demineralization time, and most differences in the pre- and post-demineralization values within each group and between groups were significant: A moderate correlation coefficient (r=0.75956) together with a moderate agreement was determined between both post-demineralization parameters, detected by the Bland-Altman method.
CONCLUSION:
We conclude that both ultrasound velocity and bone mineral density decrease as a result of demineralization, thus indicating that bone mineral content is of great importance for maintaining the acoustic parameters of cortical bone, as observed for cancellous bone. Ultrasound velocity can be used to evaluate both compact cortical bone quality and bone mineral density.
Topics: Animals; Bone Demineralization Technique; Bone Density; Cortical Bone; Densitometry; Metatarsal Bones; Osteoporosis; Sheep; Time Factors; Ultrasonography
PubMed: 27982167
DOI: 10.6061/clinics/2016(11)07 -
Anatomical Record (Hoboken, N.J. : 2007) Feb 2011Moose (Alces alces) appear to be different from most other cervids in that a well-developed metatarsal splint bone is present. It is found apposed to the plantolateral...
Moose (Alces alces) appear to be different from most other cervids in that a well-developed metatarsal splint bone is present. It is found apposed to the plantolateral portion of the cannon bone in over 70 % of adults. It averages 3.3 mm in width and extends about 22% of the total length of the metatarsal. It may be derived through calcification of connective tissue or by elongation of the vestigial metatarsal V.
Topics: Animals; Data Interpretation, Statistical; Deer; Female; Male; Metatarsal Bones; Sex Characteristics
PubMed: 21234996
DOI: 10.1002/ar.21323 -
The Journal of Biological Chemistry May 2012To identify the genes involved in chondrocytic differentiation, we applied gene trap mutagenesis to a murine mesenchymal chondrogenic cell line ATDC5 and isolated a...
To identify the genes involved in chondrocytic differentiation, we applied gene trap mutagenesis to a murine mesenchymal chondrogenic cell line ATDC5 and isolated a clone in which the gene encoding vinculin was trapped. The trapped allele was assumed to express a fusion protein containing a truncated vinculin lacking the tail domain and the geo product derived from the trap vector. The truncated vinculin was suggested to exert a dominant negative effect. Impaired functioning of vinculin caused by gene trapping in ATDC5 cells or knockdown in primary chondrocytes resulted in the reduced expression of chondrocyte-specific genes, including Col2a1, aggrecan, and Col10a1. The expression of Runx2 also was suppressed by the dysfunctional vinculin. On the other hand, the expression of Sox9, encoding a key transcription factor for chondrogenesis, was retained. Knockdown of vinculin in metatarsal organ cultures impaired the growth of the explants and reduced the expression of Col2a1 and aggrecan. Gene trapping or knockdown of vinculin decreased the phosphorylation of ERK1/2 but increased that of Src homology 2 domain-containing tyrosine phosphatase 2 (SHP2) and Akt during chondrocytic differentiation, suggesting a disturbance of signaling by insulin-like growth factor I (IGF-I). Knockdown of vinculin in the metatarsal organ culture abrogated the IGF-I-induced growth and inhibited the up-regulation of Col2a1 and aggrecan expression by IGF-I. Loss of vinculin function in differentiating chondrocytes impaired the activation of the p38 MAPK pathway also, suggesting its involvement in the regulation of chondrogenesis by vinculin. Our results indicate a tissue-specific function of vinculin in cartilage whereby it controls chondrocytic differentiation.
Topics: Aggrecans; Animals; Blotting, Western; COS Cells; Cell Differentiation; Cell Line; Cells, Cultured; Chlorocebus aethiops; Chondrocytes; Chondrogenesis; Clone Cells; Collagen Type II; Collagen Type X; Gene Expression; Gene Knockdown Techniques; Insulin-Like Growth Factor I; Metatarsal Bones; Mice; Mutation; Organ Culture Techniques; RNA Interference; Reverse Transcriptase Polymerase Chain Reaction; SOX9 Transcription Factor; Vinculin
PubMed: 22416133
DOI: 10.1074/jbc.M111.308072 -
Zhongguo Xiu Fu Chong Jian Wai Ke Za... Apr 2022To investigate the application and effectiveness of metatarsal mortise and tenon shortening osteotomy in the treatment of macrodactyly in children.
OBJECTIVE
To investigate the application and effectiveness of metatarsal mortise and tenon shortening osteotomy in the treatment of macrodactyly in children.
METHODS
The clinical data of 17 children with macrodactyly (18 feet and 27 toes) admitted between January 2018 and January 2020 were retrospectively analyzed. There were 12 males (12 feet and 18 toes) and 5 females (6 feet and 9 toes); the age ranged from 1 to 13 years, with a median age of 5 years. All children were treated with metatarsal mortise and tenon shortening osteotomy. Ten cases of single-segment metatarsals were shortened, 7 cases of 2-segment metatarsals, and 1 case of 3-segment metatarsals; involved 1 foot of single toe, 9 feet of 2 toes, 3 feet of 3 toes, 3 feet of 4 toes, and 2 feet of 5 toes. Five cases had lameness, and 1 case had limited walking with the big toes of both feet, and there was no obvious pain in all children. X-ray films showed that the involved phalanges were thickened and increased in 18 feet, and the deformity of the distal segment was heavier than that of the proximal segment in 13 feet, and the two were similar in 5 feet. The length of metatarsal shortening was 0.7-2.5 cm, with an average of 1.2 cm. The clinical healing of shortened metatarsal fractures in children was observed after operation, and the occurrence of related complications was recorded.
RESULTS
All 17 children were followed up 6-22 months, with an average of 14 months. All incisions healed by first intention. The osteotomy ends of 27 toes were clinically healed after operation, and the healing time was 4-8 weeks. No nonunion, fracture displacement, malunion, epiphyseal plate premature closure, and needle tract infection occurred.
CONCLUSION
Metatarsal mortise and tenon shortening osteotomy is a good osteotomy method. It can improve the stability of the osteotomy end and increase the contact surface of the osteotomy end, which is conducive to the healing of the osteotomy end and is suitable for the treatment of macrodactyly.
Topics: Adolescent; Child; Child, Preschool; Female; Fingers; Fractures, Bone; Hallux Valgus; Humans; Infant; Limb Deformities, Congenital; Male; Metatarsal Bones; Metatarsus; Osteotomy; Retrospective Studies; Treatment Outcome
PubMed: 35426277
DOI: 10.7507/1002-1892.202112066 -
PloS One 2021To establish normative values of vibration perception thresholds (VPTs), using multi-frequency vibrometry at finger pulps and at metatarsal heads of the foot in healthy...
AIMS
To establish normative values of vibration perception thresholds (VPTs), using multi-frequency vibrometry at finger pulps and at metatarsal heads of the foot in healthy adults. We also aimed to investigate factors that could potentially affect VPTs such as age, sex, height, weight, foot- or handedness and skin temperature.
METHODS
VPTs were examined in 924 healthy and randomly selected subjects in the southern Sweden (mean 46 years; 628 women and 296 men). Inclusion criterias were adult subjects (>18 years) in considerable health without diabetes mellitus or other nerve affecting disorders. VPTs were measured at the finger pulps of index and little finger, as well as the first and fifth metatarsal heads of the foot, through multi-frequency vibrometry using the VibroSense Meter® I device. Patient characteristics were recorded and skin temperature was measured before assessment of VPTs.
RESULTS
We present normative values of VPTs for a large population of both male and female subjects in various ages. VPTs detoriated as age increased (0.09-0.59 dB per year; p<0.001), i.e. progressing with normal aging. Increasing skin temperature affected VPTs in finger pulps, but not at metatarsal heads, with -0.2 to -1.6 dB, i.e. vibration perception improved with higher temperatures. Height was only found to affect the VPTs of metatarsal heads (250 Hz: 0.42 dB per cm). Sex, weight and handedness did not affect the VPTs.
CONCLUSION
We investigated the normative values of VPTs and presented affecting factors as age, skin temperature and height. With these results, VPT testing through multi-frequency vibrometry is enabled to be used in a clinical practice as a diagnostic tool when investigating neuropathy and other neurological disorders.
Topics: Adolescent; Adult; Female; Fingers; Healthy Volunteers; Humans; Male; Metatarsal Bones; Middle Aged; Reference Standards; Touch Perception; Vibration; Young Adult
PubMed: 33822804
DOI: 10.1371/journal.pone.0249461