Three-Dimensional Analysis of the Windlass Mechanism Using Weightbearing Computed Tomography in Healthy Volunteers.

IF 2.4 2区 医学 Q2 ORTHOPEDICS Foot & Ankle International Pub Date : 2023-06-01 DOI:10.1177/10711007231161011
Takumi Kihara, Tadashi Kimura, Mitsuru Saito, Naoki Suzuki, Asaki Hattori, Makoto Kubota
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Abstract

Background: The windlass mechanism (WM) increases the longitudinal arch of the foot via tension of the plantar aponeurosis during dorsiflexion of the metatarsophalangeal (MTP) joint. The purpose of this study was to perform a 3-dimensional evaluation of the displacement of each joint and the height of the navicular during dorsiflexion of the first MTP joint by using weightbearing computed tomography (CT).

Methods: Participants were 6 men and 8 women with 23 healthy feet. CT of the foot with a load equivalent to the participant's body weight was performed. The first MTP joint was in the neutral position and dorsiflexed 30 degrees. Between the conditions, we measured the (1) rotation of each bone, (2) rotation of the distal bone with respect to the proximal bone at each joint, and (3) height of the navicular.

Results: With respect to the tibia, the calcaneus was at 0.8 ± 0.7 degrees dorsiflexion and 1.4 ± 0.9 degrees inversion, while the talus was at 2.0 ± 1.2 degrees dorsiflexion and 0.1 ± 0.8 degrees eversion. The navicular was at 1.3 ± 1.2 degrees dorsiflexion and 3.2 ± 2.1 degrees inversion, whereas the medial cuneiform was at 0.3 ± 0.6 degrees plantarflexion and 1.3 ± 1.1 degrees inversion. At the talonavicular joint, the navicular was at 0.7 ± 1.3 degrees plantarflexion, whereas at the cuneonavicular joint, the medial cuneiform bone was at 1.4 ± 1.4 degrees plantarflexion. The height of the navicular increased by 1.1 ± 0.6 mm.

Conclusion: We 3-dimensionally confirmed the dynamics of WM and found that the calcaneus, navicular, and medial cuneiform moved in all 3 planes. The results suggest that the cuneonavicular joint has the greatest movement among the joints. We believe that these findings will help to elucidate the pathogenesis of WM-related diseases and lead to advances in treatments for pathologies involving the longitudinal arch.

Level of evidence: Level IV, case series.

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健康志愿者负重计算机断层扫描对卷绕机机制的三维分析。
背景:windlass机制(WM)通过跖趾趾(MTP)关节背屈时足底腱膜的张力增加足的纵向弓。本研究的目的是通过负重计算机断层扫描(CT)对第一MTP关节背屈时每个关节的位移和舟状关节的高度进行三维评估。方法:参与者6男8女,23只健康足。在与受试者体重相当的负荷下对足部进行CT扫描。第一个MTP关节处于中立位,背屈30度。在这些条件之间,我们测量了(1)每个骨的旋转,(2)每个关节的远端骨相对于近端骨的旋转,以及(3)舟骨的高度。结果:胫骨跟骨背屈0.8±0.7度,内翻1.4±0.9度,距骨背屈2.0±1.2度,外翻0.1±0.8度。舟状骨背屈度为1.3±1.2度,内翻度为3.2±2.1度,内侧楔状骨跖屈度为0.3±0.6度,内翻度为1.3±1.1度。距舟关节舟骨跖屈度为0.7±1.3度,而凸舟关节内侧楔形骨跖屈度为1.4±1.4度。舟骨高度增加1.1±0.6 mm。结论:我们三维确认了WM的动力学,发现跟骨、舟状骨和内侧楔形骨在所有三个平面上都有运动。结果表明,在所有关节中,凹舟关节的活动量最大。我们相信这些发现将有助于阐明wm相关疾病的发病机制,并导致涉及纵弓的病理治疗的进展。证据等级:四级,案例系列。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Foot & Ankle International
Foot & Ankle International 医学-整形外科
CiteScore
5.60
自引率
22.20%
发文量
144
审稿时长
2 months
期刊介绍: Foot & Ankle International (FAI), in publication since 1980, is the official journal of the American Orthopaedic Foot & Ankle Society (AOFAS). This monthly medical journal emphasizes surgical and medical management as it relates to the foot and ankle with a specific focus on reconstructive, trauma, and sports-related conditions utilizing the latest technological advances. FAI offers original, clinically oriented, peer-reviewed research articles presenting new approaches to foot and ankle pathology and treatment, current case reviews, and technique tips addressing the management of complex problems. This journal is an ideal resource for highly-trained orthopaedic foot and ankle specialists and allied health care providers. The journal’s Founding Editor, Melvin H. Jahss, MD (deceased), served from 1980-1988. He was followed by Kenneth A. Johnson, MD (deceased) from 1988-1993; Lowell D. Lutter, MD (deceased) from 1993-2004; and E. Greer Richardson, MD from 2005-2007. David B. Thordarson, MD, assumed the role of Editor-in-Chief in 2008. The journal focuses on the following areas of interest: • Surgery • Wound care • Bone healing • Pain management • In-office orthotic systems • Diabetes • Sports medicine
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