Kinematics of the first metatarsophalangeal joint

The kinematics of both the first metatarsophalangeal joint and the articulation of the hallux sesamoid bones with the metatarsal head were investigated with fifteen fresh-frozen below-the-knee amputation specimens using a radiographic technique. Six feet were of normal structural anatomy, six displayed hallux valgus, and three had hallux rigidus. Normal specimens demonstrated an average total range of motion in the sagittal plane of 111 degrees, with about 76 degrees of dorsiflexion and 34 degrees of plantar flexion. The abnormal specimens revealed a decreased total arc of motion, with a limitation of plantar flexion in feet with hallux valgus and a loss of dorsiflexion in feet with hallux rigidus. Motion analysis of the normal metatarsophalangeal joints demonstrated minimum scattering of instant centers of rotation. This was in contrast to the diseased articulations, which displayed markedly displaced instant centers of rotation located eccentrically about the metatarsal head. Surface motion in the normal joints was characterized as tangential sliding from maximum plantar flexion to moderate dorsiflexion, with some compression at maximum dorsiflexion. The feet with hallux valgus and the feet with hallux rigidus displayed distinctive patterns of distraction and jamming throughout specific portions of the range of motion in the sagittal plane. Motion of the metatarsophalangeal joint in the transverse plane concomitant with motion in the sagittal plane, which has been hypothesized by other investigators, was confirmed and quantified in this study. The feet with hallux rigidus displayed a reduction in this motion.(ABSTRACT TRUNCATED AT 250 WORDS)

Resistant metatarsus adductus deformity (illustrated surgical reconstructive techniques)

The dilemma of metatarsus adductus was reviewed in this clinically illustrated essay. A modification of the traditional Berman-Gartland procedure was also reported, along with 5 methods of osseous fixation. A retrospective analysis of 17 surgical cases, performed at Atlanta Hospital, revealed adherence to published indications and guidelines.

The roentgenographic appearance of the "corrected clubfoot"

Roentgenographic changes associated with a corrected clubfoot may not be readily apparent. In some individuals with minimal residual deformity, these roentgenographic changes are quite subtle. The roentgenographic abnormalities of the corrected clubfoot are described.

Stress fractures of the second metatarsal involving Lisfranc's joint in ballet dancers. A new overuse injury of the foot

We reviewed the cases of four female ballet dancers with a stress fracture of a type that has not been reported previously. This fracture occurs in the proximal portion of the second metatarsal and involves the volar and medial aspects of Lisfranc's joint. A differential diagnosis of pain in the middle part of the foot in a dancer should include a consideration of this entity, which can be very difficult to diagnose on initial assessment. Oblique radiographs, tomograms, and a bone scan may be necessary to confirm the diagnosis. With early recognition and diagnosis, in three of the four patients the fracture healed with immobilization and modified training. One patient required surgical resection because of persistent non-union of the necrotic fracture fragment.

Axial computed tomographic anatomy of the foot. Part II: Midfoot

Osseous and soft tissue anatomy of the human midfoot is presented as visualized on high resolution axial computed tomography (CT). Because of the proven and potential capabilities of CT in the diagnosis of midfoot disorders, this report serves as an important standard for comparison with clinical studies.

CT evaluation of tarsometatarsal fracture-dislocation injuries

Fracture-dislocation in the tarsometatarsal region (Lisfranc) may be subtle and difficult to recognize on standard radiographic projections. Computed tomography (CT) was used to study the normal anatomy of the forefoot and to evaluate three patients with suspected tarsometatarsal fracture dislocation. The advantages of CT in the evaluation of forefoot trauma are emphasized.

Roentgenographic and mathematical analysis of first metatarsal osteotomies for metatarsus primus varus: a comparative study

The operative effectiveness of five different first metatarsal osteotomies for nonarthritic hallux valgus and metatarsus primus varus were objectively evaluated roentgenographically. The series consisted of 120 feet (75 patients) seen over a 5-year period. The osteotomies were biplanar neck, Chevron, biplanar basilar, basilar concentric, and basilar concentric combined with a lateral closing wedge. All the osteotomies except for the Chevron had varying degrees of plantar displacement of the distal fragment and crossed Kirschner wire fixation. The operative techniques and failures are discussed. Special x-ray studies confirmed misleading pseudocorrections caused by bandage compression and intraoperative and early postoperative roentgenographic distortion. The Chevron gave the least correction, 2 degrees, and did not permit plantar displacement to obviate late metatarsal transfer lesions. The biplanar neck osteotomies were technically the simplest, giving 86% satisfactory corrections, averaging 4.3 degrees. The biplanar basilar osteotomies yielded the most erratic results. The poor results were due to medial tilt during fixation, thereby negating any correction. The technical difficulties with the basilar concentric osteotomy were overcome by the addition of a small lateral closing wedge. This procedure gave by far the most consistently good results with corrections of up to 12 degrees, averaging 7.9 degrees.

A radiographic study of infant metatarsus adductus treatment by serial casting

Although many papers have been written on metatarsus adductus, few have used radiographic criteria for either the diagnosis of or in determining correction of metatarsus adductus. Most use objective clinical appearance as their sole criteria for diagnosis and correction. This paper establishes radiographic criteria for both the diagnosis and correction of metatarsus adductus.

Pedal dislocations. An overview

Identification of the mechanism of injury is the hallmark of dislocation management. If the mechanism can be established by history, anatomic disruptions can be logically explained and identified. Conversely, the injury pattern clinically may help deduce the mechanism. Once the mechanism is established, either historically or clinically, relocation maneuvers can be planned and executed. A review of pedal dislocations has been presented with emphasis on anatomic relationships and mechanism of injury. These principles encompass diagnosis, treatment, and management. They must be understood to manage not only the acute emergency situation but the chronic disability of post-traumatic arthritis.

Tarsometatarsal fracture-dislocation

Closed and open treatment were compared in 12 cases of tarsometatarsal dislocation. When the dislocation involved the lateral component only, good results were observed in one of three cases treated closed and six of seven cases treated open. It is essential to reduce and stabilize the dislocation which is often overlooked unless carefully analyzed clinically and radiographically.

Avascular necrosis after first metatarsal head osteotomies

Thirty patients who were surgically treated for hallux valgus by first metatarsal head osteotomies between 1975 and 1980 were reviewed. The average follow-up was 41 months, with the longest being 78 months and the shortest 16 months. Radiographs were obtained to determine if avascular necrosis of the first metatarsal head had occurred. Two cases of avascular necrosis were discovered.

Distal splint bone fractures in the horse: an experimental and clinical study

An experimental and clinical study to investigate the aetiology of distal splint bone fractures is described. In vitro, extension of the fetlock did not appear to alter the position of the distal ends of the splint bones, although tension in the interosseous tendons increased. Flexion of the fetlock resulted in slight outward displacement of the distal ends of the splint bones. It is suggested that concurrent desmitis of the suspensory ligament can cause movement of the ends of the splint bones thus predisposing to a fatigue fracture. In a clinical study of 87 horses, 114 splint bone fractures were identified. In at least 70 per cent of horses, suspensory desmitis was present. Follow up information was available in 24 horses in which more than 80 per cent of the fractures healed spontaneously. Non-union fractures were not painful and did not cause lameness.

Medial condylar fractures of the third metatarsal bone in horses

Fifteen longitudinal fractures involving the medial condyle of the third metatarsal bone were diagnosed in racing Thoroughbreds and Standardbreds. Twelve were repaired surgically with lag screws placed through stab incisions. Two of the horses suffered catastrophic fracture of the third metatarsal bone during recovery from anesthesia, and 3 more sustained complete fractures within 4 days of the repair. Of 3 horses with fractures treated without surgery, 2 healed without complication. Preoperative radiography did not demonstrate a nonlongitudinal fracture component in any of the horses that sustained complete fractures. The complete fractures were uniformly "Y" shaped. Horses in which the fractures healed had a good prognosis for return to racing.

[Segregation of figural units by the proximity and resemblance of their components]

In this second paper about structural analysis of the radiological image, we propose to teach three figural sets thanks to the practical application of resemblance and proximity. It consists in cervical triplet, metatarsal triplet and two metacarpal doublets.

Primary acute haematogenous osteomyelitis of an isolated metatarsal in children

Acute haematogenous osteomyelitis of an isolated metatarsal is a rare condition in childhood. Fourteen children diagnosed with this condition were followed up for an average of 3 years. Organisms responsible were found to be either Staphylococcus aureus or Streptococcus pyogenes. Growth disturbances of the metatarsal were seen in the majority, but the radiographic features were not serious in the long term, and no child was subsequently disabled. Since these children often present with symptoms akin to trauma, a better recognition of the condition is required to avoid misdiagnosis.

Injuries of the ankle and foot

The important points in evaluation of the traumatized foot and ankle are discussed in detail. Also considered are specific injuries, including contusion; injuries of the musculotendinous unit, ligaments, and capsule; stress fractures; and puncture wounds.