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Blackwood V, Jeans KA, Zide JR, Riccio AI. Effect of Body Mass Index on Pedobarographic and Patient-Reported Outcome Measures in Adolescent Flexible Flat Feet. J Pediatr Orthop 2024; 44:e732-e737. [PMID: 38708592 DOI: 10.1097/bpo.0000000000002720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/07/2024]
Abstract
BACKGROUND Although adolescent flexible flatfoot deformity (FFD) is common, little is known regarding the effect of weight on associated symptomatology. This study uses pedobarography and patient-reported outcome measures (PROs) to determine if overweight adolescents with FFD have more severe alterations in dynamic plantar pressures than normal body mass index percentiles (wnBMI) with FFD and if such alterations correlate with pain and activity. METHODS A retrospective review of patients aged 10 to 18 years with nonsyndromic symptomatic FFD was performed. Overweight (BMI percentile ≥ 85%) patients were compared with wnBMI patients with regard to dynamic plantar pressure measures and PRO scores. Pedobarographic data were subdivided into regions: medial/lateral hindfoot and midfoot, and first, second, and third to fifth metatarsals. Plantar pressure variables were normalized to account for differences in foot size, body weight, and walking speed. Contact area (CA%), maximum force by body weight (MF%), and contact time as a percentage of the rollover process (CT%) were calculated. Two foot-specific PROs were assessed, including the Foot and Ankle Outcome Score and the Oxford Ankle Foot Measure for Children. RESULTS Of the 48 adolescents studied, 27 (56%) were overweight and 21 (44%) were wnBMI. After normalization of the data, overweight patients had significantly greater medial midfoot MF%, whereas CT% was increased across the medial and lateral midfoot and hindfoot regions. Correlations showed positive trends: as BMI percentile increases, so will CA and MF in the medial midfoot, as well as CT in the medial and lateral midfoot and hindfoot. Significant differences were seen between groups, with the overweight group reporting lower sports and recreation subscores than the wnBMI group. No significant differences were seen in the pain and disability subscores. CONCLUSIONS Although overweight adolescents with FFD exhibit greater forces and more time spent during the rollover process in the medial midfoot than normal-weight patients, they did not report worse pain or disability associated with their flat foot deformity. LEVEL OF EVIDENCE Therapeutic level 3.
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Affiliation(s)
| | | | - Jacob R Zide
- Scottish Rite for Children
- Baylor University Medical Center
| | - Anthony I Riccio
- Scottish Rite for Children
- The University of Texas Southwestern Medical Center, Dallas, TX
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Moharrami A, Mirghaderi SP, Hoseini Zare N, Tabatabaei Irani SP, Moazen-Jamshidi MM, Kalantar SH. Transverse pinning of concomitant first and second metatarsal fractures using 1.5mm K-wires; case report and technical note. Ann Med Surg (Lond) 2022; 79:103906. [PMID: 35860082 PMCID: PMC9289254 DOI: 10.1016/j.amsu.2022.103906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 05/29/2022] [Accepted: 06/02/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction and importance Here we represented a new technique of closed reduction and transverse pinning to address first metatarsal comminuted fractures in patients with a concomitant second metatarsal shaft fracture. Case presentation The first metatarsal comminuted fracture coincides with the second metatarsal simple fracture in this forefoot injury case. In a new technique, we used close reduction and percutaneous pinning (CRPP) in a transverse direction of pins to achieve a satisfactory outcome. After performing traditional CRPP to fix the second metatarsal fracture, it served as physical support for the first metatarsal fixation. We drilled two 1.5mm pins through the first metatarsal bone at each proximal and distal side of the fracture site, transversely passed to the second metatarsal bone. Transverse pins came along from the first metatarsal medial side to the lateral. After six-week and 12-month follow-up, the patients had minimal pain with complete radiological and clinical fracture healing and no complication. Clinical discussion Here, internal fixation was unsuitable due to extensive soft-tissue injury and inadequate bone support. Despite the many advantages of external fixators, they have drawbacks that persuade us to perform our new technique: using K-wires for transverse pinning fixation of the first metatarsal fracture using an adjacent metatarsal as support. This minimally invasive approach is profitable because of its minimal soft tissue damage, affordable price, and convenient access. Conclusion The transfixation technique with K-wires is rarely used to treat metatarsal fractures. It may be helpful in similar cases of comminuted first metatarsal fracture with satisfactory outcomes. We introduced an applicable method for fixing comminuted first metatarsal fracture. Transverse pinning has appropriate clinical and radiological healing. Transfixation technique with K-wires is rarely used to treat metatarsal fractures.
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Affiliation(s)
- Alireza Moharrami
- Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Peyman Mirghaderi
- Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Students' Scientific Research Center (SSRC), Tehran University of Medical Sciences, Tehran, Iran
| | - Nima Hoseini Zare
- Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | | | - Seyed Hadi Kalantar
- Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Corresponding author. Tehran University of Medical Sciences, Joint Reconstruction Research Center, Imam Khomeini Complex Hospital, End of Keshavarz Blvd, Tehran, Iran.
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Samaila EM, Ditta A, Negri S, Leigheb M, Colò G, Magnan B. Central metatarsal fractures: a review and current concepts. ACTA BIO-MEDICA : ATENEI PARMENSIS 2020; 91:36-46. [PMID: 32555075 PMCID: PMC7944817 DOI: 10.23750/abm.v91i4-s.9724] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 05/06/2020] [Indexed: 02/08/2023]
Abstract
Central metatarsal fractures (CMF) are common injuries. More frequently fractures are those of the fifth metatarsal, followed by CMF and therefore by the first metatarsal. Third metatarsal is injured most frequently than the others and up to 63% is associated with second or fourth metatarsal fractures and up to 28% with both. Anatomy and metatarsal kinematics merits attention due to its influence on function, injuries and treatment options. Diagnosis is based on the history of trauma and clinical examination, relating with instrumental exams. Fractures with less than 10° of angulation and 3-4 mm of translation in any plane are typically treated conservatively, while operative treatment is generally reserved for fractures out if these values. Intramedullary fixation with K-wires seem to be the most common and valid surgical treatment in simple fractures. Spiral fractures should be treated by interfragmentary screws, which positioning may result difficult due to the adjacent metatarsals. Therefore, an alternative approach is an osteosynthesis with a dorsal plate. Multiple metatarsal fractures often occur in the contiguous bones, so clinicians will also have to carefully inspect metatarsals and adjacent joints such as Lisfranc articulation. The clinical and functional outcomes are often influenced by the pattern of fractures and patient conditions and are reported in the literature up to 39% of poor results.
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Affiliation(s)
| | - Alessandro Ditta
- Department of Orthopedics and Trauma Surgery, University of Verona.
| | - Stefano Negri
- Department of Orthopedics and Trauma Surgery, University of Verona.
| | - Massimiliano Leigheb
- Orthopedics and Traumatology, A.O.U. "Maggiore d.c." University of Eastern Piedmont, Novara.
| | - Gabriele Colò
- Department of Orthopedics and Traumatology, Regional Center for Joint Arthroplasty, Alessandria.
| | - Bruno Magnan
- Department of Orthopedics and Trauma Surgery, University of Verona.
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Outcomes of Nonoperative Treatment of Forefoot Fractures: Casting Versus Off-Loading Shoes. Trauma Mon 2016. [DOI: 10.5812/traumamon.27533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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5
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Abstract
A turf toe injury encompasses a wide spectrum of traumatic problems that occur to the first metatarsophalangeal joint. Most of these injuries are mild and respond well to nonoperative management. However, more severe injuries may require surgical management, including presence of diastasis or retraction of sesamoids, vertical instability, traumatic hallux valgus deformity, chondral injury, loose body, and failed conservative treatment.
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Affiliation(s)
- Lyndon W Mason
- Foot and Ankle Unit, University Hospital Aintree, Lower Lane, Liverpool L9 7AL, UK.
| | - Andrew P Molloy
- Foot and Ankle Unit, University Hospital Aintree, Lower Lane, Liverpool L9 7AL, UK
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Abstract
The frequency and extent of rheumatic forefoot deformities have been greatly reduced since the introduction of disease-modifying antirheumatic drugs (DMARD). The accompanying reduction in arthritic destruction of joints opens up new treatment options whereby priority is given to joint preservation. This is true for the first middle foot ray as well as for the small toe rays. Whereas resection arthroplasty of the metatarsophalangeal joints II-V was previously considered the gold standard treatment, joint-preserving operative procedures (e.g. metatarsal osteotomy and periarticular soft tissue interventions) are now being increasingly more propagated. Resection arthroplasty of the first midfoot ray has major biomechanical disadvantages so that it is not surprising that reconstructive procedures are given priority. In patients with severe arthritic destruction of the first metatarsophalangeal joint, arthrodesis has substantial biomechanical advantages compared to resection arthroplasty. Nevertheless, it has not yet been confirmed that fusion leads to superior clinical results.
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Abstract
It is estimated that approximately 23.6 million people in the United States have diabetes mellitus. With adequate control of this disease and appropriate foot care and basic surveillance, many patients can lead active and healthy lifestyles. However, some patients experience complications associated with poorly controlled glucose levels, including lower-extremity ulcerations and infections. When conservative measures have failed in treating these conditions, a lower-extremity amputation is an option for patients seeking to gain maximal functional recovery. A complete preoperative workup includes assessment of healing potential and preoperative ambulatory status, control or optimization of comorbidities when possible, and determination of amputation level using modern diagnostic modalities. Once the decision to proceed with an amputation has been made, it is important to choose an appropriate level of amputation and practice sound surgical technique. This article describes the preoperative evaluation and operative techniques involved in performing amputations on diabetic patients and reviews the current literature on the most common lower-extremity amputations performed in the care of infections in the feet of patients with diabetes mellitus.
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Babazadeh S, Su D, Blackney MC. Hallux IP arthritis after MP arthrodesis managed with interpositional arthroplasty of MP joint and IP fusion: case report. Foot Ankle Int 2011; 32:900-4. [PMID: 22097167 DOI: 10.3113/fai.2011.0900] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Level of Evidence: V, Expert Opinion
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Affiliation(s)
- Sina Babazadeh
- Department of Orthopaedics, University of Melbourne, St. Vincent's Hospital, Fitzroy, Australia
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Tharayil J, Patil RK. Salvage of foot with extensive giant cell tumour with transfer of vascularised fibular bone graft. Indian J Plast Surg 2011; 44:150-6. [PMID: 21713205 PMCID: PMC3111110 DOI: 10.4103/0970-0358.81469] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Though giant cell tumor is not uncommon in young adults, simultaneous involvement of multiple mid-foot bones is very uncommon and very difficult to treat. For reconstruction of large segmental bony defects following tumour excision, free vascularized bone graft is an excellent surgical option. We report a case with extensive involvement of all the tarsal bones and metatarsal bases in a young adult. After excision his foot was reconstructed with vascularised bone flap. We were able to save his foot after a wide local excision and reconstruction with free fibula graft. Graft united early and showed excellent remodelling because of good vascularity. We feel that this method deserves consideration as a last attempt to salvage functional foot in disease like this.
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Affiliation(s)
- Jose Tharayil
- Department of Plastic and Reconstructive Surgery, Lakeshore Hospital, Cochin, India
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Abstract
Metatarsal fractures can present with a variety of situations. Ranging from the relatively benign, isolated central metatarsal fracture to the crush injury leading to extensive damage of the soft tissue and osseous components, these fractures can cause a significant inconvenience to the patient. With the exception of fifth metatarsal base fractures, little standardization is available for the treatment of metatarsal fractures. Controversy still exists regarding the proper treatment of various patient populations for junctional fifth metatarsal fractures. This article discusses the fractures of the first, central, and fifth metatarsals, as well as the treatment for the same.
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Roll C, Prantl L, Nerlich M, Kinner B. Osteo-fasciocutaneous parascapular flap transfer for reconstruction of the first ray of the foot. Arch Orthop Trauma Surg 2008; 128:857-63. [PMID: 18297296 DOI: 10.1007/s00402-008-0592-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2007] [Indexed: 02/08/2023]
Abstract
BACKGROUND Severe bone and soft tissue defects of the first metatarsal bone after trauma, tumor resection or osteomyelitis are challenging to treat. Partial amputation of the foot may be the consequence. However, due to its significance for gait, salvage of the first ray should be considered, whenever possible. One option for bone and soft tissue reconstruction, therefore, might be an osteo-fasciocutaneous parascapular flap transfer. METHODS Five patients with bone and soft tissue defects of the first ray of the foot but intact MTP joint were treated with osteo- fasciocutaneous parascapular flap transfer, two after tumor resection, and three after severe bone and soft tissue trauma. Patients were followed for 12-36 months clinically and radiologically. RESULTS All flaps survived. One revision was necessary because of venous thrombosis, which was treated successfully by thrombectomy and patch plastic. All osteosyntheses united and the scapular bone transplant adapted nicely to the new loading conditions. All patients were content with the result and would agree to have the operation again. Two patients were able to stand tiptoe and go jogging, one patient still had limitations of ADLs due to the concomitant injuries. CONCLUSION The osteo- fasciocutaneous flap proved to be very versatile and safe for foot reconstruction due to its favorable vascular anatomy. In all patients (partial), amputation of the foot could be avoided.
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Affiliation(s)
- C Roll
- Department of Trauma and Reconstructive Surgery, University of Regensburg Medical Center, Franz-Josef-Strauss-Allee 11, 93042 Regensburg, Germany
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Abstract
Forefoot problems in patients who have rheumatoid arthritis are common. The progressive joint destruction causes a redistribution of weight about the forefoot, with a diminished weightbearing capacity of the first metatarsophalangeal (MTP) joint. Changes around the first MTP joint include synovitis, joint instability with subluxation, and arthritic change. Hallux MTP fusion in patients who have rheumatoid arthritis acts to permanently restore alignment and restore the medial column support of the foot, while at the same time enabling the first MTP to resume its original weightbearing role. Rheumatoid hallux MTP fusion and its rationale are reviewed.
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Affiliation(s)
- Benjamin W Stevens
- Grand Rapids Medical Education and Research Center/Michigan State University Orthopaedic Surgery Residency Program, 300 Lafayette, Suite 3400, Grand Rapids, MI 49503, USA.
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Toma CD, Dominkus M, Pfeiffer M, Kotz R, Giovanoli P, Assadian O. Metatarsal Reconstruction with Use of Free Vascularized Osteomyocutaneous Fibular Grafts Following Resection of Malignant Tumors of the Midfoot. J Bone Joint Surg Am 2007. [DOI: 10.2106/00004623-200707000-00020] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
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