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Ishihara H, Maeda N, Komiya M, Tashiro T, Tsutsumi S, Arima S, Kawai M, Tamura Y, Ikuta Y, Urabe Y. The vertical mobility of the first tarsometatarsal joint during demi-plié with forced turnout in ballet dancers. Sci Rep 2024; 14:15321. [PMID: 38961097 PMCID: PMC11222447 DOI: 10.1038/s41598-024-64304-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 06/06/2024] [Indexed: 07/05/2024] Open
Abstract
The forced turnout has a perceived risk of development of hallux valgus (HV) in ballet dancers. We determined how the forced turnout affects the sagittal mobility of the first tarsometatarsal (TMT) joint, which is one of the pathogenic factors of HV development. Seventeen female ballet dancers (body mass index: 18.2 ± 1.8 kg/m2) were included and performed demi-plié in control, functional turnout, and forced turnout conditions. Ultrasound imaging synchronized with a three-dimensional motion analysis system was used for measuring the vertical locations of the first metatarsal and medial cuneiform (MC) to evaluate the first TMT joint mobility. Plantar displacement of MC and the first TMT joint mobility in the forced turnout were the greatest among the 3 conditions. Multiple regression analysis indicated that the greater extent of the forcing angle might increase the displacement of MC and the first TMT joint mobility. Evaluating the sagittal mobility of the first TMT joint in the forced turnout can assist in understanding the association between inappropriate techniques including the forced turnout and HV development in ballet dancers. Since the excessive mobility of the first TMT joint is a factor in HV development, the acquirement of adequate active turnout may have the potential to prevent HV development in ballet dancers.
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Affiliation(s)
- Honoka Ishihara
- Department of Sports Rehabilitation, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1‑2‑3 Kasumi, Minami‑ku, Hiroshima, 734‑8553, Japan
| | - Noriaki Maeda
- Department of Sports Rehabilitation, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1‑2‑3 Kasumi, Minami‑ku, Hiroshima, 734‑8553, Japan
| | - Makoto Komiya
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Shimami-cho, 1398, Kita-ku, Niigata City, Niigata, 950-3198, Japan
- Athlete Support Medical Center, Niigata University of Health and Welfare, Niigata, 950-3198, Japan
| | - Tsubasa Tashiro
- Department of Sports Rehabilitation, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1‑2‑3 Kasumi, Minami‑ku, Hiroshima, 734‑8553, Japan
| | - Shogo Tsutsumi
- Department of Sports Rehabilitation, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1‑2‑3 Kasumi, Minami‑ku, Hiroshima, 734‑8553, Japan
| | - Satoshi Arima
- Department of Sports Rehabilitation, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1‑2‑3 Kasumi, Minami‑ku, Hiroshima, 734‑8553, Japan.
| | - Miki Kawai
- Department of Sports Rehabilitation, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1‑2‑3 Kasumi, Minami‑ku, Hiroshima, 734‑8553, Japan
| | - Yuki Tamura
- Department of Sports Rehabilitation, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1‑2‑3 Kasumi, Minami‑ku, Hiroshima, 734‑8553, Japan
| | - Yasunari Ikuta
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1‑2‑3 Kasumi, Minami‑ku, Hiroshima, 734‑8553, Japan
- Sports Medical Center, Hiroshima University Hospital, Hiroshima, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8553, Japan
| | - Yukio Urabe
- Department of Sports Rehabilitation, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1‑2‑3 Kasumi, Minami‑ku, Hiroshima, 734‑8553, Japan.
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Tashiro T, Ikuta Y, Maeda N, Arima S, Morikawa M, Kaneda K, Ishihara H, Tsutsumi S, Kawai M, Brand A, Nakasa T, Adachi N, Komiya M, Urabe Y. First tarsometatarsal joint mobility in hallux valgus during gait: A synchronized ultrasound and three-dimensional motion capture analysis. J Med Ultrason (2001) 2024; 51:331-339. [PMID: 38546904 PMCID: PMC11098882 DOI: 10.1007/s10396-024-01414-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 01/28/2024] [Indexed: 05/19/2024]
Abstract
PURPOSE To quantify the vertical translation between the first metatarsal and medial cuneiform during the stance phase of gait in young individuals with and without hallux valgus. DESIGN This cross-sectional observational study included 34 young adults (male, n = 4; female, n = 30) who were divided into three groups according to the hallux valgus angle: control (< 20°, n = 13), mild hallux valgus (≥ 20° to < 30°, n = 12), and moderate hallux valgus (≥ 30°, n = 9). The mobility of the first tarsometatarsal joint was evaluated during the stance phase using B-mode ultrasound synchronized with a motion analysis system. RESULTS The medial cuneiform shifted more plantar during the early phase in mild hallux valgus and during the middle and terminal phases in moderate hallux valgus than in control. The severity of the hallux valgus was correlated with a trend toward plantar shift of the medial cuneiform. The first metatarsal was located more dorsal than the medial cuneiform; however, there was no significant variation. No significant differences in the peak ankle plantarflexion angle and moment were noted between the groups. CONCLUSION The hypermobility of the first tarsometatarsal joint, especially plantar displacement of the medial cuneiform in the sagittal plane, was found in young individuals with hallux valgus during the stance phase of gait, and the mobility increased with the severity of hallux valgus. Our findings suggest the significance of preventing hallux valgus deformity early in life.
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Affiliation(s)
- Tsubasa Tashiro
- Department of Sports Rehabilitation, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8553, Japan
| | - Yasunari Ikuta
- Department of Orthopedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, 734-8551, Japan
- Sports Medical Center, Hiroshima University Hospital, Hiroshima, 734-8551, Japan
| | - Noriaki Maeda
- Department of Sports Rehabilitation, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8553, Japan
| | - Satoshi Arima
- Department of Sports Rehabilitation, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8553, Japan
| | - Masanori Morikawa
- Department of Preventive Gerontology, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Aichi, 474-8511, Japan
| | - Kazuki Kaneda
- Department of Sports Rehabilitation, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8553, Japan
| | - Honoka Ishihara
- Department of Sports Rehabilitation, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8553, Japan
| | - Shogo Tsutsumi
- Department of Sports Rehabilitation, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8553, Japan
| | - Miki Kawai
- Department of Sports Rehabilitation, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8553, Japan
| | - Andreas Brand
- Institute for Biomechanics, BG Unfallklinik Murnau, Murnau, Germany
- Institute for Biomechanics, Paracelsus Medical Private University Salzburg, Salzburg, Austria
| | - Tomoyuki Nakasa
- Department of Orthopedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, 734-8551, Japan
- Medical Center for Translational and Clinical Research, Hiroshima University Hospital, Hiroshima, 734-8551, Japan
| | - Nobuo Adachi
- Department of Orthopedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, 734-8551, Japan
- Sports Medical Center, Hiroshima University Hospital, Hiroshima, 734-8551, Japan
| | - Makoto Komiya
- Department of Sports Rehabilitation, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8553, Japan
| | - Yukio Urabe
- Department of Sports Rehabilitation, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8553, Japan.
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Austin IS, Norrish A, Lloyd R, Brassett C, Pasapula C. Differential contribution of lateral plantar foot ligaments to lateral column stability - A cadaver based sectioning analysis. Foot (Edinb) 2023; 56:102003. [PMID: 36966558 DOI: 10.1016/j.foot.2023.102003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 03/02/2023] [Accepted: 03/05/2023] [Indexed: 06/18/2023]
Abstract
Lateral column (LC) instability occurs in adult acquired flatfoot deformity (AAFD). Differential ligament contribution to LC stability is unknown. The primary aim was to quantify this by using cadaver sectioning of lateral plantar ligaments. We also determined the relative contribution of each ligament to dorsal translation of the metatarsal head in the sagittal plane. 17 below-knee cadaveric specimens, preserved by vascular embalming method, were dissected to expose plantar fascia, long/short plantar ligaments (L/SPL), calcaneocuboid (CC) capsule and inferior 4th/5th tarsometatarsal (TMT) capsule. Dorsal forces of 0 N, 20 N and 40 N were applied to the plantar 5th metatarsal head after sequential ligament sectioning in different orders. Pins provided linear axes on each bone, allowing relative angular bone displacements to be calculated. Photography and ImageJ processing software were then used for analysis. The LPL (and CC capsule) had the greatest contribution to metatarsal head motion (107 mm) after isolated sectioning. In the absence of other ligaments, sectioning these resulted in significantly increased hindfoot-forefoot angulation (p ≤ 0.0003). Isolated TMT capsule sectioning demonstrated significant angular displacement even when other ligaments remained intact (with intact L/SPL, p = 0.0005). CC joint instability required both LPL and capsular sectioning for significant angulation to occur, whilst TMT joint stability was largely dependent on its capsule. The relative contribution of static restraints to the lateral arch has not yet been quantified. This study provides useful information on relative ligament contribution to both CC and TMT joint stability, which may in turn improve understanding of surgical interventions used to restore arch stability.
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Affiliation(s)
| | | | | | | | - Chandra Pasapula
- Queen Elizabeth Hospital King's Lynn NHS Foundation Trust, United Kingdom
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Chrastek D, El-Mousili M, Al-Sukaini A, Austin IS, Yanduru T, Cutts S, Pasapula C. Quantifying increased lateral column instability in Adult Acquired Flatfoot Deformity (AAFD). Foot (Edinb) 2023; 56:102036. [PMID: 37271102 DOI: 10.1016/j.foot.2023.102036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 04/16/2023] [Accepted: 05/06/2023] [Indexed: 06/06/2023]
Abstract
AAFD comprises ligamentous failure and tendon overload, mainly focused on the symptomatic posterior tibial tendon and the spring ligament. Increased lateral column (LC) instability arising in AAFD is not defined or quantified. This study aims to quantify the increased LC motion in unilateral symptomatic planus feet, using the contralateral unaffected asymptomatic foot as an internal control. In this case matched analysis, 15 patients with unilateral stage 2 AAFD foot and an unaffected contralateral foot were included. Lateral foot translation was measured as a guide to spring ligament competency. Medial and LC dorsal sagittal instability were assessed by direct measurement of dorsal 1st and 4th/5th metatarsal head motion and further video analysis. The mean increase in dorsal LC sagittal motion (between affected vs unaffected foot) was 5.6 mm (95% CI [4.63-6.55], p < 0.001). The mean increase in the lateral translation score was 42.8 mm (95% CI [37.48-48.03], p < 0.001). The mean increase in medial column dorsal sagittal motion was 6.8 mm (95% CI [5.7-7.8], p < 0.001). Video analysis also showed a statistically significant increase in LC dorsal sagittal motion between affected and unaffected sides (p < 0.001). This is the first study that quantifies a statistically significant increased LC dorsal motion in feet with AAFD. Understanding its pathogenesis and its link to talonavicular/spring ligament laxity improves foot assessment and may allow the development of future preventative treatment strategies.
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Affiliation(s)
- David Chrastek
- Norfolk and Norwich University Hospital, Colney Lane, Norwich, Norfolk NR4 7UY, UK.
| | - Mahmoud El-Mousili
- Queen Elizabeth Hospital King's Lynn, Gayton Road, King's Lynn, Norfolk PE30 4ET, UK
| | - Ahmad Al-Sukaini
- Norfolk and Norwich University Hospital, Colney Lane, Norwich, Norfolk NR4 7UY, UK
| | - Isabel S Austin
- University of Cambridge, The Old Schools, Cambridge CB2 1TN, UK
| | - Trisha Yanduru
- Canyon Crest Academy, 5951 Village Centre Loop Rd, San Diego, CA 92130, USA
| | - Steve Cutts
- James Paget University Hospital, Lowestoft Road, Gorleston-on-Sea, Great Yarmouth NR31 6LA, UK
| | - Chandra Pasapula
- Queen Elizabeth Hospital King's Lynn, Gayton Road, King's Lynn, Norfolk PE30 4ET, UK
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Blake RL. Application of Biomechanics in Treating the Athlete: The All Important Measurements of Relaxed Calcaneal Stance Position, Achilles Flexibility, and First Ray Range of Motion. Clin Podiatr Med Surg 2023; 40:97-115. [PMID: 36368850 DOI: 10.1016/j.cpm.2022.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Biomechanics is a crucial component of treating lower extremity pathology. The relaxed calcaneal stance position, the Achilles flexibility, and the first ray motion and position tests are demonstrated and should be mastered. The relaxed calcaneal stance position is crucial in children's flat feet treatment, adult acquired flat feet, and all pronatory symptoms. The Achilles flexibility measurement demonstrates normality, tightness, or overflexibility. Tightness and overflexibility denote weakness owing to the contractile properties of the tendon. The first ray motion and position examination elucidates whether the first ray is normal or part of a pronatory problem or a supinatory problem.
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Affiliation(s)
- Richard L Blake
- Orthopedic and Sports Institute, Saint Francis Memorial Hospital, 900 Hyde Street, San Francisco, CA 94109, USA.
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6
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Glasoe WM. An Operational Definition of First Ray Hypermobility. Foot Ankle Spec 2022; 15:494-496. [PMID: 35656787 DOI: 10.1177/19386400221093864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The first ray (metatarsocuneiform) behaves as a load-bearing strut in supporting weight. Due to its functional importance, stress-testing techniques are used to assess the stability of the first ray and objectify evidence of hypermobility. The test and measurement of first ray hypermobility (FRH) is of interest to clinicians and researchers. The condition itself, however, has proven elusive to diagnose. This article defines FRH for the purpose of improving the consistency by which the diagnosis is made. Currently, the lack of a consensus definition prevents research from determining the incidence rates and prevalence of FRH, a commonly reported medical condition. THE DEFINITION Symptomatic FRH presents as dorsal displacement that measures greater than 8 mm, accompanied with signs and symptoms consistent with loading insufficiency of the first ray. The operational definition is objective and if adopted across health care professions, the criterion could become the standard for identifying FRH in patients and research participants. LEVEL OF EVIDENCE Level V, expert opinion.
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Affiliation(s)
- Ward M Glasoe
- Division in Physical Therapy, Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, Minnesota (WMG)
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Maeda N, Ikuta Y, Tashiro T, Arima S, Morikawa M, Kaneda K, Ishihara H, Brand A, Nakasa T, Adachi N, Urabe Y. Quantitative evaluation of the vertical mobility of the first tarsometatarsal joint during stance phase of gait. Sci Rep 2022; 12:9246. [PMID: 35655091 PMCID: PMC9163033 DOI: 10.1038/s41598-022-13425-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 05/24/2022] [Indexed: 11/09/2022] Open
Abstract
We determined how the in vivo mobility of the first tarsometatarsal (TMT) joint can be quantified during gait. Twenty-five healthy participants (12 females) with no history of foot disorders were included. Non-invasive ultrasound (US) with a three-dimensional motion analysis (MA) system was used to evaluate the kinematic characteristics of first TMT joint during stance phase of gait. US probe was positioned longitudinally above the first TMT joint and adjusted to its proximal dorsal prominence. Gait analysis was conducted by the MA system starting with the activation of B-mode US video at 80 frames per second and 60-mm depth for simultaneous capture. During stance phase, the first metatarsal was translated dorsally with respect to the medial cuneiform, returning to a neutral level at toe-off in all subjects. During middle stance phase, the medial cuneiform was stable in males but displaced in the plantar direction in females and was the primary contributor to the differences in sagittal mobility observed between groups. Quantitatively measuring sagittal mobility of the first TMT joint could be useful for the early detection of foot abnormalities. The dynamic characteristics of the medial cuneiform during gait in healthy females may be associated with a high prevalence of hallux valgus.
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Affiliation(s)
- Noriaki Maeda
- Department of Sports Rehabilitation, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8553, Japan.
| | - Yasunari Ikuta
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8553, Japan.
- Sports Medical Center, Hiroshima University Hospital, Hiroshima, Japan.
| | - Tsubasa Tashiro
- Department of Sports Rehabilitation, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8553, Japan
| | - Satoshi Arima
- Department of Sports Rehabilitation, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8553, Japan
| | - Masanori Morikawa
- Department of Preventive Gerontology, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Aichi, Japan
| | - Kazuki Kaneda
- Department of Sports Rehabilitation, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8553, Japan
| | - Honoka Ishihara
- Department of Sports Rehabilitation, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8553, Japan
| | - Andreas Brand
- Institute for Biomechanics, BG Unfallklinik Murnau, Murnau, Germany
- Institute for Biomechanics, Paracelsus Medical Private University Salzburg, Salzburg, Austria
| | - Tomoyuki Nakasa
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8553, Japan
- Medical Center for Translational and Clinical Research, Hiroshima University Hospital, Hiroshima, Japan
| | - Nobuo Adachi
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8553, Japan
- Sports Medical Center, Hiroshima University Hospital, Hiroshima, Japan
| | - Yukio Urabe
- Department of Sports Rehabilitation, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8553, Japan
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Morgan OJ, Hillstrom R, Turner R, Day J, Thaqi I, Caolo K, Song J, Russell R, Ellis S, Deland JT, Hillstrom HJ. Comparative Reliability of a Novel Electromechanical Device and Handheld Ruler for Measuring First Ray Mobility. Foot Ankle Int 2021; 42:1613-1623. [PMID: 34112024 DOI: 10.1177/10711007211020345] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Quantifying first ray mobility is crucial to understand aberrant foot biomechanics. A novel device (MAP1st) that can perform measurements of first ray mobility in different weightbearing conditions, foot alignments, and normalization was tested. The reliability of these measurement techniques was assessed in comparison to a handheld ruler considered representative of the common clinical examination. METHODS The study included 25 participants (50 feet). Two independent raters performed baseline, test-retest, and remove-replace measurements of first ray mobility with MAP1st and the handheld device. The effects of non-, partial, and full weightbearing in subtalar joint neutral and the resting calcaneal stance position were assessed. Measurement normalization relative to foot size was also investigated. Intra- and interclass correlation coefficients (ICCs) were calculated for each device between the 2 raters. In addition, Bland-Altman plots were constructed to determine if fixed biases or substantial outliers were present. RESULTS Similar intrarater ICC values were found for both devices (≥0.85). However, interrater ICC values were substantially improved by MAP1st compared with the handheld device (0.58 vs 0.06). Bland-Altman plots demonstrated biases of 1.27 mm for the handheld ruler, and 2.88 to 0.05 mm and -1.16 to 0.00 for linear and normalized MAP1st measurements, respectively. Improved reliability was achieved with MAP1st for normalized assessments of first ray mobility while the foot was placed in partial- and full-weightbearing resting calcaneal stance positions. CONCLUSION MAP1st provided reliable assessments of partial- and full-weightbearing first ray mobility. It should help investigators to explore the potential relationships between first ray function and aberrant foot biomechanics in future research. LEVEL OF EVIDENCE Level II, prospective cohort study.
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Affiliation(s)
- Oliver J Morgan
- Medical Engineering Research Group, Faculty of Science and Engineering, Anglia Ruskin University, Chelmsford, Essex, UK
| | - Rajshree Hillstrom
- Leon Root, MD, Motion Analysis Laboratory, Hospital for Special Surgery, New York, NY, USA.,Biomed Consulting, Inc. New York, New York, USA
| | - Robert Turner
- Leon Root, MD, Motion Analysis Laboratory, Hospital for Special Surgery, New York, NY, USA
| | - Jonathan Day
- Department of Foot and Ankle Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Ibadet Thaqi
- Leon Root, MD, Motion Analysis Laboratory, Hospital for Special Surgery, New York, NY, USA
| | - Kristin Caolo
- Department of Foot and Ankle Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Jinsup Song
- School of Podiatric Medicine, Temple University, Philadelphia, PA, USA
| | | | - Scott Ellis
- Department of Foot and Ankle Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Jonathan T Deland
- Department of Foot and Ankle Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Howard J Hillstrom
- Leon Root, MD, Motion Analysis Laboratory, Hospital for Special Surgery, New York, NY, USA
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Biz C, Maso G, Malgarini E, Tagliapietra J, Ruggieri P. Hypermobility of the First Ray: the Cinderella of the measurements conventionally assessed for correction of Hallux Valgus. ACTA BIO-MEDICA : ATENEI PARMENSIS 2020; 91:47-59. [PMID: 32555076 PMCID: PMC7944838 DOI: 10.23750/abm.v91i4-s.9769] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 05/11/2020] [Indexed: 12/27/2022]
Abstract
Background and aim of the work: hypermobility of the first ray (FRH) began to be considered as a pathological entity from Morton’s studies and was associated as a primary cause of hallux valgus (HV). Currently, this relationship is in discussion, and various authors consider FRH as a consequence of the deformity. The purpose of this narrative review is to summarise the most influential publications relating to First Ray Mobility (FRM) to increase knowledge and promote its conventional assessment during clinical practice. Methods: papers of the last century were selected to obtain a homogeneous and up-to-date overview of I-MTCJ mobility and HV, as well as their relationship and management. Results: in recent years, FRH was studied from a biomechanical and pathophysiologic point of view. There is still not enough data regarding the aetiology of FRM. The higher rate of instability found in HV lacks an explanation of which is the cause and which is the effect. However, the Lapidus arthrodesis is still a valid method in cases of FRH and HV, even if is not rigorously indicated to treat both. When approaching FRH, radiographic or clinical findings are mandatory for the right diagnosis. Conclusions: FRM is an important factor that must be considered in routine clinical practice and prior and post HV surgery, as much as the conventional parameters assessed. Surgeons should consider performing I-MTCJ arthrodesis only if strictly necessary, also paying attention to soft tissue balancing. Improving the measurement of FRH could be useful to determine if it is a cause or effect of the HV deformity. (www.actabiomedica.it)
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Affiliation(s)
- Carlo Biz
- Orthopaedic Clinic, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padua, Padova, Italy.
| | - Giacomo Maso
- Orthopaedic, Traumatological and Oncological Clinic, Department of Surgical, Oncological and Gastroenterological Sciences, DiSCOG, University of Padova, via Giustiniani 2; 35128 Padova, Italy.
| | - Enrico Malgarini
- Orthopaedic, Traumatological and Oncological Clinic, Department of Surgical, Oncological and Gastroenterological Sciences, DiSCOG, University of Padova, via Giustiniani 2; 35128 Padova, Italy.
| | - Jacopo Tagliapietra
- Orthopaedic, Traumatological and Oncological Clinic, Department of Surgical, Oncological and Gastroenterological Sciences, DiSCOG, University of Padova, via Giustiniani 2; 35128 Padova, Italy.
| | - Pietro Ruggieri
- Orthopaedic, Traumatological and Oncological Clinic, Department of Surgical, Oncological and Gastroenterological Sciences, DiSCOG, University of Padova, via Giustiniani 2; 35128 Padova, Italy.
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10
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Di Caprio F, Meringolo R, Navarra MA, Mosca M, Ponziani L. Five Centimeters Morton's Neuroma in a 46-Year-Old Woman Affected by Macrodactily. JOINTS 2020; 7:127-130. [PMID: 34195540 PMCID: PMC8236321 DOI: 10.1055/s-0040-1712112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Accepted: 04/13/2020] [Indexed: 11/30/2022]
Abstract
The present article described the case of a voluminous Morton's neuroma of the third intermetatarsal space in a patient affected by macrodactily. The case was unique because of its dimensions, the uncommon surgical approach which was needed for removal, the association with macrodactily of the fourth toe with Raynaud's phenomenon, and the postoperative defect in the intrinsic muscles. The patient was operated in February 2016 by transverse plantar approach. Twelve months after surgery, the patient complained for hypoesthesia on third and fourth toes with inability to actively spread the toes and enlargement in the second interdigital space. The dimensions of the lesions may be explained with the presence of macrodactily in the fourth toe with occasional Raynaud's phenomenon, which may have caused an abnormal arrangement of the nerve branches for the fourth interspace with related microtrauma. A plantar approach was highly recommended as the size of the lesion forced it to the plantar surface of the foot. The inability to actively spread the toes and the enlargement of the second interdigital space are likely to be related to a deficiency of the interosseous muscles, innervated by the deep branch of the lateral plantar nerve, which had probably been sacrificed because of the size of the lesion and the subversion of the surrounding anatomical relationships.
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Affiliation(s)
- Francesco Di Caprio
- Operating Unit of Orthopedics and Traumatology, Istituto per la Sicurezza Sociale di San Marino, San Marino, Italy
| | - Renato Meringolo
- AUSL of Romagna, Operating Unit of Orthopedics and Traumatology, Ceccarini Hospital, Riccione, Italy
| | - Maria Adiletta Navarra
- AUSL of Romagna, Operating Unit of Orthopedics and Traumatology, Ceccarini Hospital, Riccione, Italy
| | - Massimiliano Mosca
- First Orthopedics and Traumatology Clinic, Rizzoli Orthopedic Institute, Bologna, Italy
| | - Lorenzo Ponziani
- Operating Unit of Orthopedics and Traumatology, Istituto per la Sicurezza Sociale di San Marino, San Marino, Italy
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Thomas RL, Kuiper JH, Knight TP. Properties and Function of the Flexor Hallucis Capsularis Interphalangeus Tendon. Clin Anat 2019; 33:689-695. [PMID: 31581316 DOI: 10.1002/ca.23490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 09/18/2019] [Accepted: 09/24/2019] [Indexed: 11/06/2022]
Abstract
INTRODUCTION The fibrocartilagenous plantar plates of the forefoot are biomechanically important, forming the primary distal attachment for the plantar aponeurosis. They are integral to the function of the windlass mechanism in supporting the arches of the foot in gait. Dissection of the cadaveric hallux revealed an organised sagittal thickening of the dorsal side of the flexor hallucis longus (FHL) sheath, which attached the interphalangeal plantar plate to the metatarsophalangeal (MTP) plantar plate. A description of a similar structure was made in 1984 when it was termed the flexor hallucis capsularis interphalangeus (FHCI) - however, it has not been researched since, and we aim to study it further and identify its characteristics. METHOD Eight specimens were dissected from four cadavers. Two were stained and examined under magnification in both polarized and non polarized light. The remaining 6 were subjected to micrometer testing of their tensile properties. RESULTS Both the histological features and mechanical properties were consistent with tendon; with cross sectional area, ultimate tensile strength and stiffness varying between specimens. CONCLUSIONS Based on its location and properties, the FHCI tendon may be involved in limiting dorsiflexion of the first MTP joint and could have clinical relevance in pathological processes around both the first and second MTP joints. Clin. Anat., 33:689-695, 2020. © 2019 Wiley Periodicals, Inc.
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Affiliation(s)
- R L Thomas
- Plastic Surgery Department, Derriford Hospital, Plymouth, United Kingdom
| | - Jan H Kuiper
- Institute for Science and Technology in Medicine, Keele University, Staffordshire, United Kingdom
| | - Timothy P Knight
- The Robert Jones and Agnes Hunt Orthopaedic Hospital, NHS Foundation Trust, Oswestry, United Kingdom
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Pérez Pico AM, Mingorance Álvarez E, Caballé Cervigón N, Mayordomo Acevedo R. Importance of Preexisting Physical Factors in the Development of Dermatological and Muscular Lesions During Hiking. INT J LOW EXTR WOUND 2019; 18:161-170. [DOI: 10.1177/1534734619845600] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Hiking has become very popular due to the physical and mental health benefits it provides. Skin lesions may occur with hiking and various factors contribute to their development. Although some lesions may appear to have little importance, something as simple as chaffing can cause serious ulcers in people with at-risk feet. Few studies have analyzed preexisting physical characteristics in hiking and addressed the development of lesions in hikers. This observational and longitudinal study examines the development of foot lesions during hiking, taking into account the influence of existing skin disorders, nail disorders, and/or toe deformities and other intrinsic factors of participants. The feet of 109 hikers doing a 29.6-km hike were analyzed, considering the intrinsic factors of participants and the possible influence of these factors in the development of foot lesions during the walk. The results show that some preexisting physical factors of participants such as gender, existing systemic disease, preexisting keratosis, dermatosis, nontraumatic and traumatic onychopathies, and toe deformities significantly predispose to the development of skin lesions. These factors also predispose to muscle lesions except for nontraumatic and traumatic onychopathies and toe deformities. Due to the influence of preexisting physical factors, such as preexisting keratosis, dermatosis, and toe deformities, in the development of foot lesions in hikers, it is worthwhile and advisable to check these factors before a hike to reduce the incidence of foot disorders. Ensuring adequate podiatry treatment a few days before the walk and warmup of muscles properly before starting are recommended.
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Affiliation(s)
- Ana Maria Pérez Pico
- Podiatrist, Department of Nursing, University of Extremadura, Plasencia, Cáceres, Spain
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13
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Glasoe WM, Michaud TC. Measurement of Dorsal First Ray Mobility: A Topical Historical Review and Commentary. Foot Ankle Int 2019; 40:603-610. [PMID: 30902026 DOI: 10.1177/1071100719839692] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Despite evidence that instability of the first ray (first metatarsal and medial cuneiform) alters the loading mechanics of the foot, surprisingly few studies have linked the condition with disorders of the foot. A factor limiting this research is the difficulty associated with measuring first ray mobility (FRM). To quantify dorsal FRM, clinicians and researchers have devised a variety of methods that impose a dorsally directed load, and record displacement. The methods include manual examination, radiographs, mechanical devices, and handheld rulers. Since different methods yield different results; each of these methods is worthy of scrutiny. This article reviews the methods used to quantify dorsal FRM and offers commentary on how the testing procedures could be standardized. The measurement of dorsal FRM informs surgical decisions, orthotic prescriptions, and research design strategies mostly as it pertains to the identification and treatment of first ray hypermobility. This review found sufficient support to recommend continued use of radiographs and mechanical devices for quantifying dorsal displacement, whereas measurements acquired with handheld rulers are prone to the same subjective error attributed to manual examination procedures. Since measures made with radiographs and existing mechanical devices have their own drawbacks, the commentary recommends ideas for standardizing the testing procedure and calls for the development of a next-generation device to measure dorsal FRM. This future device could be modeled after arthrometers that exist and are used to quantify stability at the knee and ankle. Level of Evidence: Level V, expert opinion.
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Affiliation(s)
- Ward M Glasoe
- 1 Division in Physical Therapy, Department of Rehabilitation Medicine, Medical School, University of Minnesota, Minneapolis, MN, USA
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14
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Static Range of Motion of the First Metatarsal in the Sagittal and Frontal Planes. J Clin Med 2018; 7:jcm7110456. [PMID: 30469349 PMCID: PMC6262388 DOI: 10.3390/jcm7110456] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 11/16/2018] [Accepted: 11/17/2018] [Indexed: 12/03/2022] Open
Abstract
The first metatarsal and medial cuneiform form an important functional unit in the foot, called “first ray”. The first ray normal range of motion (ROM) is difficult to quantify due to the number of joints that are involved. Several methods have previously been proposed. Controversy exists related to normal movement of the first ray frontal plane accompanying that in the sagittal plane. The objective of this study was to investigate the ROM of the first ray in the sagittal and frontal planes in normal feet. Anterior-posterior radiographs were done of the feet of 40 healthy participants with the first ray in a neutral position, maximally dorsiflexed and maximally plantarflexed. They were digitalized and the distance between the tibial malleolus and the intersesamoid crest in the three positions mentioned was measured. The rotation of the first ray in these three positions was measured. A polynomic function that fits a curve describing the movement observed in the first ray was obtained using the least squares method. ROM of the first ray in the sagittal plane was 6.47 (SD 2.59) mm of dorsiflexion and 6.12 (SD 2.55) mm of plantarflexion. ROM in the frontal plane was 2.69 (SD 4.03) degrees of inversion during the dorsiflexion and 2.97 (SD 2.72) degrees during the plantarflexion. A second-degree equation was obtained, which represents the movement of the first ray. Passive dorsiflexion and plantarflexion of the first ray were accompanied by movements in the frontal plane: 0.45 degrees of movement were produced in the frontal plane for each millimeter of displacement in the sagittal plane. These findings might be useful for the future design of instruments for clinically quantifying first ray mobility.
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Ali Z, Karim H, Wali N, Naraghi R. The inter- and intra-rater reliability of the Maestro and Barroco metatarsal length measurement techniques. J Foot Ankle Res 2018; 11:47. [PMID: 30127858 PMCID: PMC6097434 DOI: 10.1186/s13047-018-0289-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Accepted: 07/31/2018] [Indexed: 11/10/2022] Open
Abstract
Background The relationship between metatarsal length and various forefoot pathologies is a topic of contention in Orthopaedics. The results of such investigations have been shown to depend on the method of metatarsal length measurement used. The aim of this study was to assess the inter- and intra-rater reliability of the Maestro and Barroco metatarsal length measurement techniques. Methods A retrospective and quantitative study was performed on 15 randomly selected radiographs to determine the reliability of the two measurement techniques across all five metatarsals (M1 to M5). This was done at one week apart for three weeks by three raters. The intraclass correlation coefficient (ICC), and the 95% lower confidence limit (95% LCL) were calculated. Results The Maestro and Barroco techniques produced high to very high ICC vlaues for length measurements across all metatarsals. The 95% lower confidence limit for inter-rater measurements ranged between 0.92–0.98 for Maestro’s and 0.86–0.99 for Barroco’s technique. For intra-rater measurements the 95% LCL ranged between 0.83–0.99 for Maestro’s and 0.75–0.99 for Barroco’s technique. Conclusions Our study found that both the Maestro and Barroco methods of measurements produced high to very high inter- and intra-rater reliability. Both methods may be suitable for the use of peri-operative planning and clinical research relating metatarsal length and forefoot pathology. Besides having a more simplistic method of application, the novel Barroco technique is comparable to the more established Maestro method in both repeatability and reproducibility.
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Affiliation(s)
- Zainab Ali
- University of Western Australia, School of Surgery, Podiatric Medicine, Crawley, Western Australia 6009 Australia
| | - Hassan Karim
- University of Western Australia, School of Surgery, Podiatric Medicine, Crawley, Western Australia 6009 Australia
| | - Navid Wali
- University of Western Australia, School of Surgery, Podiatric Medicine, Crawley, Western Australia 6009 Australia
| | - Reza Naraghi
- University of Western Australia, School of Surgery, Podiatric Medicine, Crawley, Western Australia 6009 Australia
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Di Caprio F, Meringolo R, Shehab Eddine M, Ponziani L. Morton's interdigital neuroma of the foot: A literature review. Foot Ankle Surg 2018; 24:92-98. [PMID: 29409221 DOI: 10.1016/j.fas.2017.01.007] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 11/15/2016] [Accepted: 01/27/2017] [Indexed: 02/04/2023]
Abstract
Morton's neuroma is one of the most common causes of metatarsalgia. Despite this, it remains little studied, as the diagnosis is clinical with no reliable instrumental diagnostics, and each study may deal with incorrect diagnosis or inappropriate treatment, which are difficult to verify. The present literature review crosses all key points, from diagnosis to surgical and nonoperative treatment, and recurrences. Nonoperative treatment is successful in a limited percentage of cases, but it can be adequate in those who want to delay or avoid surgery. Dorsal or plantar approaches were described for surgical treatment, both with strengths and weaknesses that will be scanned. Failures are related to wrong diagnosis, wrong interspace, failure to divide the transverse metatarsal ligament, too distal resection of common plantar digital nerve, an association of tarsal tunnel syndrome and incomplete removal. A deep knowledge of the causes and presentation of failures is needed to surgically face recurrences.
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Affiliation(s)
- Francesco Di Caprio
- Operating Unit of Orthopedics and Traumatology, AUSL of Romagna, Ceccarini Hospital, Riccione 47838, Italy.
| | - Renato Meringolo
- Operating Unit of Orthopedics and Traumatology, AUSL of Romagna, Ceccarini Hospital, Riccione 47838, Italy
| | - Marwan Shehab Eddine
- Operating Unit of Orthopedics and Traumatology, AUSL of Romagna, Ceccarini Hospital, Riccione 47838, Italy
| | - Lorenzo Ponziani
- Operating Unit of Orthopedics and Traumatology, AUSL of Romagna, Ceccarini Hospital, Riccione 47838, Italy
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Naraghi R, Bremner A, Slack-Smith L, Bryant A. Radiographic Analysis of Feet With and Without Morton's Neuroma. Foot Ankle Int 2017; 38:310-317. [PMID: 27837053 DOI: 10.1177/1071100716674998] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The aim of this research was to investigate the association of various structural measurements of the forefoot with Morton's neuroma (MN). METHODS Weightbearing anteroposterior and lateral foot radiographs of subjects attending the University of Western Australia (UWA) Podiatry Clinic and the first author's private practice were included in this study. A single assessor measured the following angles: lateral intermetatarsal angle (LIMA), intermetatarsal angle (IMA), hallux valgus angle (HVA), digital divergence between the second and third digits (DD23), digital divergence between the third and fourth digits (DD34) and relative metatarsal lengths of the first to fifth metatarsals (Met1-5), and the effect of MN size as measured by ultrasonograph on digital divergence. Intratester reliability of all radiographic measurements was assessed on all radiographic measurements. The study included 101 subjects, of whom 69 were diagnosed with MN and 32 were control subjects without MN. The mean (± standard deviation) age of MN subjects was 52 (±15) years and for control subjects, 48 (±12) years. RESULTS When comparing all feet, there were no significant differences in the LIMA, HVA, IMA, digital divergence angles and the relative metatarsal distances between subjects with MN and control subjects. No relationship between MN size and digital divergence was found in either foot, or in either neuroma location. CONCLUSION We were unable to demonstrate any relationship in this study between radiographic metatarsal length and angular measurements in a symptomatic MN group compared to a control group. In addition, we did not find any correlation between the size of MN as measured from ultrasonographic images and radiographic evidence of digital divergence. LEVEL OF EVIDENCE Level III, case control study.
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Affiliation(s)
- Reza Naraghi
- 1 Podiatric Medicine Unit M422, School of Surgery, University of Western Australia, Crawley, Western Australia, Australia
| | - Alexandra Bremner
- 2 School of Population Health M431, University of Western Australia, Crawley, Western Australia, Australia
| | - Linda Slack-Smith
- 3 School of Dentistry M512, University of Western Australia, Crawley, Western Australia, Australia
| | - Alan Bryant
- 1 Podiatric Medicine Unit M422, School of Surgery, University of Western Australia, Crawley, Western Australia, Australia
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18
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Gallagher SM, Rodriguez NA, Andersen CR, Granberry WM, Panchbhavi VK. Anatomic predisposition to ligamentous Lisfranc injury: a matched case-control study. J Bone Joint Surg Am 2013; 95:2043-7. [PMID: 24257663 DOI: 10.2106/jbjs.k.01142] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Subtle, or ligamentous, Lisfranc injuries occur following low-energy trauma to the midfoot and can be debilitating. Since they are ligamentous, they may not heal, requiring arthrodesis in some cases. Certain mortise anatomic characteristics on radiographs have been shown to be associated with a predisposition to the ligamentous subtype of Lisfranc injuries. It is not known whether there are other morphometric characteristics, such as arch height or the relative length of the second metatarsal, that can similarly influence the predisposition to these injuries. METHODS The present retrospective matched case-control study involved fifty-two control subjects and twenty-six patients with ligamentous Lisfranc injuries treated from 2006 to 2010 at two institutions. Clinical and radiographic data (second metatarsal length relative to foot length, first intermetatarsal angle, navicular-cuboid overlap relative to cuboid vertical height, first metatarsal-talus angle, and calcaneal pitch angle) were examined for the existence of significant differences between control and Lisfranc subjects. Logistic regression analysis was then performed to evaluate potential risk for injury on the basis of these anatomic variables. RESULTS Compared with matched controls, patients with a ligamentous Lisfranc injury were found to have a significantly smaller ratio of second metatarsal length to foot length (p < 0.001) on weight-bearing radiographs. CONCLUSIONS Occurrence of a ligamentous Lisfranc injury was shown to be associated with a smaller ratio of second metatarsal length to foot length; >50% of patients in the injury group had a ratio of <29%.
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Affiliation(s)
- Sean M Gallagher
- Department of Orthopaedic Surgery and Rehabilitation, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX 77555-0165. E-mail address for V.P. Panchbhavi:
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19
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Quinn G. Normal genetic variation of the human foot: part 1: the paradox of normal anatomical alignment in an evolutionary epigenetic context. J Am Podiatr Med Assoc 2013; 102:64-70. [PMID: 22232324 DOI: 10.7547/1020064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Molecular genetics is changing our understanding of the developmental translation of genotype to phenotype between and within different phylogenetic groups. Together with a growing understanding of our own evolutionary relationships to common ancestors, the epigenetic processes involved enforce a reexamination of what is regarded as a normal foot structure. A revised populationist approach is proposed and supported by paleoanthropologic evidence that reflects a picture of emerging suitability for bipedalism that is driven by natural genetic divergence.
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Affiliation(s)
- Greg Quinn
- Podiatric Surgery, Holywell Healthcare, Chesterfield, England.
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20
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Martin H, Bahlke U, Dietze A, Zschorlich V, Schmitz KP, Mittlmeier T. Investigation of first ray mobility during gait by kinematic fluoroscopic imaging--a novel method. BMC Musculoskelet Disord 2012; 13:14. [PMID: 22316084 PMCID: PMC3331851 DOI: 10.1186/1471-2474-13-14] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2011] [Accepted: 02/09/2012] [Indexed: 11/18/2022] Open
Abstract
Background It is often suggested that sagittal instability at the first tarso-metatarsal joint level is a primary factor for hallux valgus and that sagittal instability increases with the progression of the deformity. The assessment of the degree of vertical instability is usually made by clinical evaluation while any measurements mostly refer to a static assessment of medial ray mobility (i.e. the plantar/dorsal flexion in the sagittal plane). Testing methods currently available cannot attribute the degree of mobility to the corresponding anatomical joints making up the medial column of the foot. The aim of this study was to develop a technique which allows for a quantification of the in-vivo sagittal mobility of the joints of the medial foot column during the roll-over process under full weight bearing. Methods Mobility of first ray bones was investigated by dynamic distortion-free fluoroscopy (25 frames/s) of 14 healthy volunteers and 8 patients with manifested clinical instability of the first ray. A CAD-based evaluation method allowed the determination of mobility and relative displacements and rotations of the first ray bones within the sagittal plane during the stance phase of gait. Results Total flexion of the first ray was found to be 13.63 (SD 6.14) mm with the healthy volunteers and 13.06 (SD 8.01) mm with the patients (resolution: 0.245 mm/pixel). The dorsiflexion angle was 5.27 (SD 2.34) degrees in the healthy volunteers and increased to 5.56 (SD 3.37) degrees in the patients. Maximum rotations were found at the naviculo-cuneiform joints and least at the first tarso-metatarsal joint level in both groups. Conclusions Dynamic fluoroscopic assessment has been shown to be a valuable tool for characterisation of the kinematics of the joints of the medial foot column during gait. A significant difference in first ray flexion and angular rotation between the patients and healthy volunteers however could not be found.
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Affiliation(s)
- Heiner Martin
- Institute for Biomedical Engineering, University of Rostock, F. Barnewitz-Str, 4, D-18119 Rostock, Germany.
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21
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Evaluation and biomechanics of the first ray in the patient with limited motion. Clin Podiatr Med Surg 2011; 28:245-67, vii. [PMID: 21669338 DOI: 10.1016/j.cpm.2011.03.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Adequate first ray function is essential to healthy human gait. Controversies still exist about aspects of human structure and function and many newer answers and theories have been proposed by a new generation of experts. Examples include the sagittal plane facilitation, tissue stress, and preferred movement pathway theories. This article also presents a summary of how to provide a thorough, detailed, and accurate first ray examination on the individual with limited motion. This article explores functional first ray mechanics in both a theoretic and biomechanical perspective, as well as a practical, hands-on examination perspective.
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22
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Meyr AJ. A 5-year review of statistical methods presented in The Journal of Foot & Ankle Surgery. J Foot Ankle Surg 2010; 49:471-4. [PMID: 20619692 DOI: 10.1053/j.jfas.2010.05.005] [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] [Received: 11/18/2009] [Indexed: 02/03/2023]
Abstract
This article presents a review of the statistical analyses used by authors and published in The Journal of Foot & Ankle Surgery from January 2004 to December 2008. Of the 215 articles reviewed, descriptive statistics were used in 84% and comparative statistics in 68%. The most commonly used comparative statistical tests were Student t test (30%), analysis of variance (14%), the Mann Whitney U test (Wilcoxon rank sum) test (13%), chi-squared analyses (11%), and Fisher's exact test (10%). The aim of this investigation was to review the prevalences of various statistical methods used by foot and ankle surgeons, as reported in The Journal of Foot & Ankle Surgery, and to serve as a primer of the most common methods used in the analysis of surgical data and the development of a scientific basis for the practice of foot and ankle surgery.
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Affiliation(s)
- Andrew J Meyr
- Department of Podiatric Surgery, Temple University School of Podiatric Medicine, Philadelphia, PA 19107, USA.
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23
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Coughlin MJ. "Instability of the first metatarsal-cuneiform joint: diagnosis and discussion of an independent pain generator in the foot". Foot Ankle Int 2010; 31:560-1. [PMID: 20557826 DOI: 10.3113/fai.2010.0560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Michael J. Coughlin
- Coughlin Clinic at Saint Alphonsus Medical Center, 901 N. Curtis Rd., Suite 503, Boise, ID 83706,
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24
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Budny AM, Masadeh SB, Lyons MC, Frania SJ. The opening base wedge osteotomy and subsequent lengthening of the first metatarsal: an in vitro study. J Foot Ankle Surg 2009; 48:662-7. [PMID: 19857822 DOI: 10.1053/j.jfas.2009.07.021] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2009] [Indexed: 02/03/2023]
Abstract
UNLABELLED Traditionally, the opening base wedge osteotomy has been indicated in a moderate to severe hallux abducto valgus deformity with a short first metatarsal. This in vitro study aimed to address the question of how much lengthening is inherent to the geometric design of an opening wedge in the first metatarsal. The preosteotomy length of a first metatarsal segment was compared with postosteotomy length after performing transverse and oblique basilar osteotomies while maintaining the opening wedge with a prefabricated spacer. In the current bench study, it was found that the opening base wedge osteotomy does indeed lengthen the first metatarsal, albeit a small percentage of the total length (1%-2.8%), and there was no significant difference between the lengths achieved through a transverse or oblique osteotomy based on a confidence interval of 95%. LEVEL OF CLINICAL EVIDENCE 5.
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Affiliation(s)
- Adam M Budny
- Blair Orthopedic Associates and Sports Medicine, 3000 Fairway Drive, Altoona, PA 16602, USA.
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Abstract
Selecting the appropriate surgical procedure for the treatment of hallux valgus not always is clear. Every procedure has its merits depending on the individual and circumstances. Correcting pain and deformity, avoiding recurrence, and preserving or re-establishing normal foot function should be the goals of bunion surgery. Although radiographic measurements can be helpful, their weight is not as important as understanding the function of the first ray in each patient. This article attempts to guide procedure selection based on re-establishing normal foot function as much as possible while meeting patients' goals and expectations.
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The outcome of Morton's neurectomy in the treatment of metatarsalgia. INTERNATIONAL ORTHOPAEDICS 2009; 34:511-5. [PMID: 19484237 DOI: 10.1007/s00264-009-0812-3] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2009] [Revised: 05/08/2009] [Accepted: 05/11/2009] [Indexed: 01/09/2023]
Abstract
Morton's neuroma is a common cause of metatarsalgia caused by intermetarsal digital nerve thickening. This study reviews the pathology, presentation, symptoms and signs, and patient satisfaction with surgical treatment. Seventy-eight patients (82 feet) were treated for Morton's metatarsalgia by excision of the interdigital nerve. The patients were followed-up for a mean of 4.6 years (range 0.8-8.1 years) and scored using the Foot Functional Index and the American Orthopedic Foot Ankle Society scoring system. In 74 patients the Foot Functional Index was more than 85 (maximum score 100). Seventy-one patients scored more than 90 on the American Orthopedic Foot Ankle Society scoring system with two patients scoring 100 (maximum score). Postoperatively, 82% reported excellent or good results, 10% had a fair result with restriction of activities or pain and 8% had no improvement at all after surgery while 71% had restrictions with footwear.
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Affiliation(s)
- Mark E Easley
- Duke Health Center, 3116 North Duke Street, Room 243, Durham, NC 27705, USA.
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Easley ME, Trnka HJ. Current concepts review: hallux valgus part 1: pathomechanics, clinical assessment, and nonoperative management. Foot Ankle Int 2007; 28:654-9. [PMID: 17559782 DOI: 10.3113/fai.2007.0654] [Citation(s) in RCA: 93] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Mark E Easley
- Duke Health Center, 3116 North Duke Street, Room 243, Durham, NC 27705, USA.
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