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Castellini JLA, Chan DM, Ratti MFG. Biokinetic gait differences between Hallux valgus patients and asymptomatic subjects. Gait Posture 2024; 117:212-219. [PMID: 39778333 DOI: 10.1016/j.gaitpost.2024.12.027] [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] [Received: 04/12/2024] [Revised: 09/20/2024] [Accepted: 12/27/2024] [Indexed: 01/11/2025]
Abstract
BACKGROUND Hallux valgus (HV) is the most prevalent foot condition, associated with a decline in quality of life and a high rate of complications. Pedobarography can be a diagnostic tool, although controversies exist due to differences in measurement scales, type of capture, software, and hardware used. Deformity level differences have not been thoroughly explored. This study aimed to compare the functional parameters using pedobarography between asymptomatic subjects and HV cases. RESEARCH QUESTION METHODS: Cross-sectional study with a consecutive sample of 240 asymptomatic subjects and 156 HV cases, captured between 2014 and 2020 using Matscan. Time, force, and pressure parameters were analyzed by comparing 3-foot regions (heel, midfoot, and metatarsal). Maximum force and pressure were analyzed according to HV severity with 16-foot subregions. RESULTS Differences in functional parameters were observed between asymptomatic subjects and HV cases (52 mild, 52 moderate, 52 severe). Stance time was prolonged in HV, especially in severe cases. Maximum force increased in midfoot and decreased in heel and metatarsal, resulting in functional impairment. Maximum pressures and forces by subregions increased in M1(P = 0.01), and decreased in T1(P = 0.01), according to the severity of deformity, altering the intrinsic foot muscles and the windlass mechanism. Lateral metatarsal transfer was not observed. SIGNIFICANCE SECTION Pedobarography can be a diagnostic tool for HV. Functional parameters are modified in HV cases (even in mild deformity) compared to asymptomatic subjects and could have predictive value. The Midfoot changes could be linked to tarsometatarsal instability and progressive collapse of the foot's arch. Early detection of functional changes can accelerate the indication of functional or surgical treatments.
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Affiliation(s)
- Jorge Luis Alberto Castellini
- Ciudad Autónoma de Buenos Aires, Argentina; Argentine Association of Orthopedics and Traumatology, Argentina; AOFAS CHORD Committee, USA; SAMECIPP, Argentina.
| | - Débora Mirta Chan
- Facultad de Ciencias Biomédicas, Universidad Austral, Pilar (Buenos Aires), Argentina
| | - María Florencia Grande Ratti
- Internal Medicine Research Unit, Department of Internal Medicine, Hospital Italiano de Buenos Aires, Argentina; CONICET (Consejo Nacional de Investigaciones Científicas y Técnicas), Hospital Italiano de Buenos Aires, Argentina
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Robb KA, Sutherland K, Perry SD. Normative Extensor Hallucis Brevis Muscle Activity During Locomotion Following the Development of a Novel Ultrasound-Guided Fine-Wire Electromyography Protocol. J Appl Biomech 2024; 40:477-483. [PMID: 39481370 DOI: 10.1123/jab.2023-0298] [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: 12/07/2023] [Revised: 06/13/2024] [Accepted: 07/29/2024] [Indexed: 11/02/2024]
Abstract
Fine-wire electromyography (EMG) is a traditional laboratory technique to estimate muscle activity of the small foot muscles, however, recordings have not been reported from extensor hallucis brevis (EHB). As an extensor of the great toe, EHB is an important muscle when studying physiological changes associated with foot pathologies such as hallux valgus. The purpose of this study was to develop an ultrasound-guided fine-wire EMG protocol to record EHB muscle activity and report normative EMG profiles of healthy young adults during locomotion. Sixteen asymptomatic young adults completed 20 walking trials at a self-selected velocity. Ensemble averages were calculated from the time normalized linear envelopes and represented from 0% to 100% of the single stance phase of gait. EHB muscle bursts were observed between 0% and 20% of the stance phase of gait in all participants. A second burst of EMG was observed between 80% and 100% of stance in 50% of the participants. This study introduces a novel ultrasound-guided EMG protocol and normative data from EHB recordings suggest a synergistic role to anterior compartment musculature at contact. These results provide preliminary insights into understanding the functional role of EHB and may help elucidate the biomechanical factors exacerbating the progression of hallux pathologies.
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Affiliation(s)
- Kelly A Robb
- Department of Kinesiology and Physical Education, Faculty of Science, Wilfrid Laurier University, Waterloo, ON, Canada
| | - Keara Sutherland
- Department of Kinesiology and Physical Education, Faculty of Science, Wilfrid Laurier University, Waterloo, ON, Canada
| | - Stephen D Perry
- Department of Kinesiology and Physical Education, Faculty of Science, Wilfrid Laurier University, Waterloo, ON, Canada
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Panchbhavi M, Poliner MC, Finegan PM, Jupiter DC. A New Clinical Test to Evaluate Intrinsic Foot Muscle Function. FOOT & ANKLE ORTHOPAEDICS 2024; 9:24730114241303172. [PMID: 39668974 PMCID: PMC11635877 DOI: 10.1177/24730114241303172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2024] Open
Abstract
Background Intrinsic foot muscle weakness has been implicated in a wide range of forefoot conditions and is typically measured by the paper grip test. The proposed "knuckle test" is intended to evaluate intrinsic foot muscle function, in which active flexion of toes makes the metatarsal heads ("knuckles") prominent in the forefoot. This study seeks to compare prevalence of negative knuckle test results and intrinsic muscle weakness in patients, primarily by association with a positive paper grip test result and secondarily with presence of toe deformities. Methods Ninety-eight patients, 55 with toe deformity and 43 without, were evaluated for ability to flex their toes to the extent of knuckle prominence (knuckle test) and grip paper on the ground with their toes (paper grip test). Variables were compared between those with positive and negative knuckle test results. Results A negative knuckle test result is significantly associated with the inability to grip a paper strip (P < .05). Conclusion Given that the paper grip test outcomes are a well-established sign of intrinsic muscle weakness, the significant association between knuckle and paper grip test outcomes substantiates the use of the knuckle test to detect intrinsic muscle weakness. The knuckle test is a potentially quick, simple, and cost-effective clinical maneuver to indicate intrinsic foot muscle weakness in a patient. Level of Evidence Level III, diagnostic test development.
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Affiliation(s)
| | | | - Patrick M. Finegan
- Department of Anesthesiology, The University of Texas Medical Branch, Galveston, TX, USA
| | - Daniel C. Jupiter
- Department of Biostatistics and Data Science, The University of Texas Medical Branch, Galveston, TX, USA
- Department of Orthopaedic Surgery and Rehabilitation, The University of Texas Medical Branch, Galveston, TX, USA
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Zhang X, Sun R. Joint synergy and muscle activity in the motion of the ankle-foot complex. J Exp Biol 2024; 227:jeb248069. [PMID: 39034687 DOI: 10.1242/jeb.248069] [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: 05/28/2024] [Accepted: 07/15/2024] [Indexed: 07/23/2024]
Abstract
The movement of the ankle-foot complex joints is coupled as a result of various physiological and physical constraints. This study introduces a novel approach to the analysis of joint synergies and their physiological basis by focusing on joint rotational directions and the types of muscle contractions. We developed a biomimetic model of the ankle-foot complex with seven degrees of freedom, considering the skeletal configuration and physiological axis directions. Motion capture experiments were conducted with eight participants performing dorsiflexion and plantarflexion in open-chain states, as well as various walking tasks in closed-chain states, across different ground inclinations (±10, ±5, 0 deg) and walking speeds (3 and 4 km h-1). Hierarchical cluster analysis identified joint synergy clusters and motion primitives, revealing that in open-chain movements, plantarflexion of the ankle, tarsometatarsal and metatarsophalangeal joints exhibited synergy with the inversion of the remaining joints in the complex; meanwhile, dorsiflexion was aligned with eversion. During closed-chain movements, the synergies grouping was exchanged in the subtalar, talonavicular and metatarsophalangeal joints. Further analysis showed that in open-chain movements, synergy patterns influenced by multi-joint muscles crossing oblique joint axes contribute to foot motion. In closed-chain movements, these changes in synergistic patterns enhance the propulsion of the center of mass towards the contralateral leg and improve foot arch compliance, facilitating human motion. Our work enhances the understanding of the physiological mechanisms underlying synergistic motion within the ankle-foot complex.
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Affiliation(s)
- Xinyue Zhang
- Institute of Medical Equipment Science and Engineering, State Key Laboratory of Intelligent Manufacturing Equipment and Technology, School of Mechanical Science and Engineering , Huazhong University of Science and Technology, Wuhan, Hubei Province, 430074, China
| | - Ronglei Sun
- Institute of Medical Equipment Science and Engineering, State Key Laboratory of Intelligent Manufacturing Equipment and Technology, School of Mechanical Science and Engineering , Huazhong University of Science and Technology, Wuhan, Hubei Province, 430074, China
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Wang SP, Shih CM, Wu YH, Chen YS. Radiographic Assessment of Transverse Tarsometatarsal Instability Complicated by Metatarsus Adductus in Hallux Valgus Patients. Life (Basel) 2024; 14:718. [PMID: 38929701 PMCID: PMC11204477 DOI: 10.3390/life14060718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Revised: 05/20/2024] [Accepted: 05/29/2024] [Indexed: 06/28/2024] Open
Abstract
Objective evaluations of transverse tarsometatarsal (TMT) hypermobility/instability are lacking. This study aims to radiographically explore the relationship between transverse TMT instability and metatarsus adductus (MA) in hallux valgus (HV). This study retrospectively analyzed 207 feet with varying degrees of HV, employing the distance between the first and second metatarsals (M1-2 distance) to assess transverse TMT instability of the first ray. Participants were categorized into MA and non-MA groups. It was found that the M1-2 distance significantly increased with the hallux valgus angle (HVA) and metatarsus adductus angle (MAA), demonstrating significant differences between the MA and non-MA groups. The measurement of M1-2 distance showed high reliability, and its cutoff value was determined to be 4.05 mm. Additionally, the results suggest that the widening of the M1-2 distance may be a predisposing factor for MA in HV patients, highlighting its role in the pathogenesis of this foot condition. These findings highlight the need for a comprehensive assessment of TMT instability on both the axial and sagittal planes for the surgical planning of HV, particularly when complicated by a large MAA. Based on these insights, reoriented first-TMT arthrodesis might be recommended for HV with significant MA to address potential multiplanar instability.
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Affiliation(s)
- Shun-Ping Wang
- Department of Orthopaedic Surgery, Taichung Veterans General Hospital, Taichung 407219, Taiwan; (S.-P.W.); (C.-M.S.); (Y.-H.W.)
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung 402202, Taiwan
| | - Cheng-Min Shih
- Department of Orthopaedic Surgery, Taichung Veterans General Hospital, Taichung 407219, Taiwan; (S.-P.W.); (C.-M.S.); (Y.-H.W.)
- Department of Physical Therapy, HungKuang University, Taichung 433304, Taiwan
| | - Yu-Hsien Wu
- Department of Orthopaedic Surgery, Taichung Veterans General Hospital, Taichung 407219, Taiwan; (S.-P.W.); (C.-M.S.); (Y.-H.W.)
| | - Yuan-Shao Chen
- Department of Orthopaedic Surgery, Taichung Veterans General Hospital, Taichung 407219, Taiwan; (S.-P.W.); (C.-M.S.); (Y.-H.W.)
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Dygut J, Piwowar M. Torques in the human upper ankle joint level and their importance in conservative and surgical treatment. Sci Rep 2024; 14:7525. [PMID: 38553519 PMCID: PMC10980753 DOI: 10.1038/s41598-024-57698-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 03/20/2024] [Indexed: 04/02/2024] Open
Abstract
The paper deals with the torques of external muscles acting on the upper ankle joint under weight-bearing conditions and their importance in diagnosing and treating the human foot. Experimental data were collected and calculations were performed. Based on the experiments with the biomechanical model of the foot and upper ankle joint, it was shown how the changes in the force arms of the external muscles of the foot under weight-bearing conditions, change the torque. The real values of muscle forces and torques of the external muscles of the foot were calculated. Taking into account the distance of the lines of muscle action from the axis of rotation of the upper ankle joint the rotational force of the muscles was calculated. The influence of changing the force arm on the rotational efficiency of the muscle balancing the moment of gravity was shown. Knowledge of muscle torque under weight-bearing conditions is crucial for correctly assessing foot biomechanics. It has been shown that torque (gravitational and muscular), not pure force, is crucial when assessing the rotational capacity of the analyzed joint. A change in the approach to diagnostics and treating paresis or weakness of extrinsic foot muscles was proposed through the manipulation of the distance of their action line from the axis of joint rotation.
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Affiliation(s)
- Jacek Dygut
- KAL-Med Consulting, Broom House Quarrywood Court, Livingston, EH54 6AX, Scotland
| | - Monika Piwowar
- Department of Bioinformatics and Telemedicine, Faculty of Medicine, Jagiellonian University Medical College, Kopernika 7e St., 31-034, Kraków, Poland.
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Cruz EP, Sanhudo JAV, Iserhard WB, Eggers EKM, Camargo LM, de Freitas Spinelli L. Midfoot width changes after first metatarsal osteotomy in hallux valgus surgery: A biomechanical effect? Foot (Edinb) 2024; 58:102070. [PMID: 38382165 DOI: 10.1016/j.foot.2024.102070] [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: 06/20/2023] [Revised: 01/23/2024] [Accepted: 02/04/2024] [Indexed: 02/23/2024]
Abstract
Hallux valgus is a challenging pathology characterized by a valgus deformity in the metatarsophalangeal area of the first ray. The aim of this study was to analyze the influence of first metatarsal osteotomy on the relationship between midfoot bones in patients with hallux valgus. The sample consisted of patients from the orthopedics and traumatology outpatient clinic who underwent surgical treatment for hallux valgus. Preoperative and postoperative X-rays were compared regarding the width of the midfoot and the tarsometatarsal joint. The sample consisted of 17 women, with 22 feet assessed in each group. The distance from the medial cuneiform to the cuboid, the distance from the intermediate cuneiform to the cuboid, the distance between the first and fifth metatarsals, and the distance between the second and fifth metatarsals reduced significantly between pre- and postoperative assessments. Hallux valgus correction through osteotomy of the first metatarsal leads to a structural change in the midfoot. Further studies should determine whether these changes persist over time.
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Affiliation(s)
- Eduardo Pedrini Cruz
- Department of Orthopedics, Department of Orthopedics and Trauma, Hospital Santa Casa de Misericórdia de Porto Alegre, Rua Professor Annes Dias, 295, Centro Histórico, 90020-090 Porto Alegre, RS, Brazil.
| | - José Antônio Veiga Sanhudo
- Department of Orthopedics, Department of Orthopedics and Trauma, Hospital Moinhos de Vento, Rua Ramiro Barcelos, 910, 90035000 Porto Alegre, RS, Brazil
| | - Walter Brand Iserhard
- Department of Orthopedics, Santa Casa de Misericordia de Porto Alegre, Hospital Santa Casa de Misericórdia de Porto Alegre, Rua Professor Annes Dias, 295, Centro Histórico, 90020-090 Porto Alegre, RS, Brazil
| | - Esthefani Katherina Mendes Eggers
- Department of Orthopedics, Santa Casa de Misericordia de Porto Alegre, Hospital Santa Casa de Misericórdia de Porto Alegre, Rua Professor Annes Dias, 295, Centro Histórico, 90020-090 Porto Alegre, RS, Brazil
| | - Leandro Marcantônio Camargo
- Department of Orthopedics, Department of Orthopedics and Trauma, Hospital Santa Casa de Misericórdia de Porto Alegre, Rua Professor Annes Dias, 295, Centro Histórico, 90020-090 Porto Alegre, RS, Brazil
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