Foot最新文献

Introduction

Plantar fasciopathy is a common foot-related musculoskeletal disorder. It has been hypothesized that this disorder could be linked to a dysfunctional windlass mechanism. However, no study to date has quantified this link to validate or refute this hypothesis. The first metatarsophalangeal joint (1st MPJ) dorsiflexion resistance test is a reliable test to evaluate the force required to initiate the windlass mechanism. Comparing the results of this test in individuals with and without plantar fasciopathy will allow for a better understanding of the relationship between plantar fasciopathy and the windlass mechanism. Thus, this study aimed to compare 1st MPJ dorsiflexion resistance in individuals with plantar fasciopathy and healthy controls. Additionally, this study aimed to explore the correlations between 1st MPJ dorsiflexion resistance and other commonly used foot orthopedic tests, specifically the supination resistance test and the Foot Posture Index.

Material and methods

Twenty participants with plantar fasciopathy and 20 healthy controls were recruited in this case-control study. First MPJ dorsiflexion resistance was quantified and compared between groups and between feet using a repeated measures ANOVA with one within-subject factor with two levels and one between-subject factor with two levels. It was also correlated with supination resistance and the Foot Posture Index.

Results

There were no significant differences in 1st MPJ dorsiflexion resistance between injured and healthy feet as well as control and plantar fasciopathy groups. There was a moderate to strong correlation (r = 0.674 to 0.891) between 1st MPJ dorsiflexion resistance and supination resistance in both groups. There was no significant correlation between 1st MPJ dorsiflexion resistance and the Foot Posture Index.

Conclusions

The lack of alterations in 1st MPJ dorsiflexion resistance among individuals with plantar fasciopathy implies a potential need to reconsider the biomechanical model, proposing that a dysfunctional windlass mechanism is associated with the development of plantar fasciopathy, may need reconsideration.

The aim of the study was to measure and compare plantar pressures, forces and gait parameters in athletes with and without hallux valgus. It was a cross sectional study with the sample Size: 106 [53 for each group (Hallux valgus and without hallux valgus)]. Hallux valgus angle was calculated with digital photographs uploaded on Karasunpo software. Participants only with the moderate and severe hallux valgus angle were selected. For participant having hallux valgus in both the feet, one with the greater angle of hallux valgus was selected. Participants without hallux valgus were the ones whose hallux valgus angle was less than 15 degrees. The participants of both groups were asked to walk on predetermined speed of 4.8 kmph. The device used was Zebris FDM-T (Zebris® Medical GmbH, Germany) for the pedobarographic and gait parameter measurement. On an average, measurement was recorded for 20 steps during the different phases of gait in all subjects and corresponding mean values were calculated. Mean values for all the readings were documented and statistically calculated. Statistical analysis was done using SPSS (v.27.0.1) with unpaired t-test to compare between both the groups. Shapiro-Wilk test was used to check normality of data. Significant p-values for forefoot forces (0.001), forefoot pressures (<0.001) and midfoot pressures (0.002) were found. There is clear evidence of increased foot loading in young adult athletes with hallux valgus on the forefoot and midfoot regions while performing activities.

Background

Böhler’s angle (BA) is used for identifying calcaneal fractures and evaluating calcaneal collapse after reconstruction. This study investigates whether it is possible to determine BA with the help of Computed Tomography (CT).

Methods

A retrospective study was performed to compare the BA on conventional radiograph (Gold Standard, GS) versus measurements on CT. Two groups were studied: one group consisted of 11 subjects with a diagnosed calcaneal fracture, the other group of 11 subjects with a fracture of the lower extremities but no calcaneal fracture. A lateral Böhler angle (LBA), central Böhler angle (CBA) and a medial Böhler angle (MBA) were defined on CT. Furthermore, BA was reconstructed out of a 3D reconstruction (3DBA).

Results

CBA approached the GS with a mean difference of 3.78° (95 %CI: 2.82–4.75) with no significant difference in variance (p = 1.000). 3DBA approached the GS with a mean difference of 2.14° (95 %CI: 1.57–2.70) with a significant difference in variance (p = 0.014). No relevant correlations were found between LBA/MBA and the GS. ICC between raters was considered as good or excellent for both CBA and 3DBA.

Conclusion

Giving the high accuracy and better capability to visualize the anatomy in the case of severe injury, measuring BA on 3D reconstruction is a suggested alternative to the traditional technique.

Level of evidence

III, Retrospective

Heel pain is a prevalent issue in young athletes, often arising from overuse and increased sporting demands. While Sever's Disease is the predominant cause, various other entities, including stress-related injuries and pathologies like tumors and bone lesions, contribute to this condition. The complex hind foot anatomy, encompassing ossicles, physis, and soft tissues, may lead to heel pain. This study aims to provide physicians with a clinically oriented narrative review of adolescent heel pain, supported by illustrative cases.

Conclusion

This study aims to offer physicians a comprehensive understanding of the concepts surrounding heel pain in adolescents. By presenting clinically relevant information and illustrated cases, it seeks to enhance medical practitioners' ability to diagnose and manage heel pain effectively in this specific demographic

Although the ankle is often involved in low energy trauma, high-energy trauma may occur, being this considered more serious and more common of affecting young and active men. The purpose of the present study was to evaluate and compare the functionality, pain and quality of life of active and inactive adult individuals whose ankle fracture was surgically treated. Seventy-six patients split into two groups (active, n = 58 X inactive, n = 18), of the men (active, n = 38; inactive, n = 9) and women (active, n = 20; inactive, n = 9) gender participated in this prospective study. The IPAQ, MMSE, SF-36, VAS, sociodemographic and clinical questionnaires were applied in person right after surgery. The SF-36 and VAS questionnaires were reapplied 3 months in average after the surgery. Active and inactive patients of both genders show significant differences (p ≤ 0.05) in the functional capacity and physical aspect domains; and the bodily pain domain revealed significant difference in active and inactive men (p ≤ 0.05) between the periods post-surgical and 3 months after surgery (on average). Moderate and significant correlations were found (p ≤ 0.05) between functional capacity, physical aspect and bodily pain domains of the SF-36 and the VAS pain scores for active and inactive patients of both genders in the final follow-up period. Other significant correlations (p < 0.05) for inactive men (physical aspect and bodily pain) and inactive women (functional capacity and bodily pain) are observed (after 3 months of surgery). Three months after surgery (on average), active and inactive men had functional limitations and pain symptoms. These factors seem to have negatively influenced the patient's social involvement, worsening their quality of life. Most active and inactive patients had a positive self-perception of their general health status, emotional aspects and mental health domains. Regarding active women, we observed lower energy and vitality after the same postoperative period.

Charcot neuroarthropathy (CN) of the ankle joint can cause marked bone resorption of the talus resulting in severe deformity and instability. The utilisation of a 3-D printed bespoke titanium porous block that allows the use of an intramedullary calcaneo-tibial nail is an attractive option in such cases that has been reported for use in post-trauma deformities, following tumour resections, in avascular necrosis of talus and for revision of failed total ankle replacements, however has not previously been reported for Charcot ankle reconstructions. We present a novel case and surgical technique illustrating the use of a 3-D printed titanium porous block and hindfoot nail for reconstruction of a deformed and unstable Charcot hindfoot.

Introduction

Iatrogenic shortening and elevation of the first metatarsal (MT1) is a common complication of hallux valgus surgery, inducing metatarsalgia underneath the lesser rays, a reason for patient dissatisfaction. For resolving this problem, different types of revision surgery are described, of which lengthening MT1 by distraction osteogenesis is underreported and therefore undervalued.

Materials and methods

We present three cases with iatrogenic shortening after hallux valgus surgery treated by distraction osteogenesis of MT1 using a custom-made frame, made of Ilizarov equipment. To evaluate the amount of lengthening, the length of the first and second metatarsal (MT2) and the parabolic distribution of the metatarsal heads were compared before and after distraction. To evaluate correction in the sagittal plane, Meary’s angle was measured pre- and post-lengthening. Pain was noted by a visual analogic score during follow-up.

Results

In our series of three cases, lengthening of MT1 between 7 mm and 18 mm, resulted in an improved parabolic distribution of the MT heads. The average difference between the second and first MT-head, relative to the SM4 axis (M2–M1) improved from 9.4 mm ($\pm$ 0.9 mm) to 2.8 mm ($\pm$ 0.7 mm) resolving corresponding pain in all patients. Meary’s angle was normalized in one case. The average duration of treatment was 116 days ($\pm$ 9 days). Minimal follow up was 11 years.

Conclusion

Using Ilizarov equipment for distraction osteogenesis of MT1 is a low-cost and effective method. Over time, this technique has proven its utility in pronounced iatrogenic shortening of MT1. The possibility to lengthen more than 1 cm, to correct in multiple planes, as well as early mobilization and weight bearing are additional advantages, but one must be careful to avoid overcorrection. The need for strict follow-up with multiple radiographs and rigorous patient selection is mandatory.

Background

Arthrodesis of the naviculocuneiform joint (NCJ) can be performed in isolation or in conjunction with arthrodesis of other joints, often in the presence of deformity. In the literature there is relative rarity of articles reporting on results and complications of NCJ arthrodesis.

Patients and methods

Thirty-six patients (36 feet) with symptomatic NCJ arthritis underwent arthrodesis. Mean age was 59.1 years (SD 13.1; range 26–78) and 24 were women. Adjuvant procedures were performed simultaneously in 29 patients, whilst 17 had planovalgus and 1 had cavovarus foot deformity.

Results

Union of the NCJ arthrodesis was achieved in 35 out of 36 (97.2 %) patients, whilst one patient developed non-union. Mean time to union was 13.1 weeks (SD 3.8; range 8–24). Two patients (5.6 %) developed deep infection and 5 patients (13.9 %) required secondary surgical procedures. Twenty-three patients (63.9 %) rated the outcome as good or excellent, 11 (30.6 %) as fair and 2 (5.6 %) as poor.

Conclusions

NCJ arthrodesis was part of a more complex procedure in most of the patients. Whilst union was achieved in almost all patients and complication rate was acceptable, only 64 % rated their outcome as good or excellent.

Level of clinical evidence

IV

Background

This randomised crossover study with repeated measures examined the influence of the three most common foot starting positions used in conducting the calf raise test (CRT) on test outcomes. This study also accounted for the potential influence of gender, age, body mass index (BMI), and level of physical activity on test outcomes.

Methods

Forty-nine healthy individuals (59 % female, 21 ± 4 years) performed single-leg calf raise repetitions in a human movement laboratory in three randomised foot starting positions: flat, 10° incline, and step. The validated Calf Raise application was used to track the vertical displacement of a marker placed on the foot using computer vision. The application extracted the following CRT outcomes from the vertical displacement curve: number of repetitions, peak vertical height, total vertical displacement, and total positive work. Data were analysed using mixed-effects models and stepwise regression.

Results

There was a significant main effect (P < 0.001) of foot starting position on all outcomes, with all paired comparisons being statistically significant (P ≤ 0.023). Repetitions, total vertical displacement, and total positive work were greatest in flat and lowest in step, whereas peak vertical height was greatest in incline and lowest in step. Gender (P = 0.021; males>females) and BMI (P = 0.002; lower BMI>higher BMI) significantly influenced the number of repetitions. Gender (P < 0.001; males>females) also influenced total positive work. Age and physical activity levels did not significantly influence CRT outcomes.

Conclusions

CRT foot starting position mattered and significantly affected all CRT outcomes. CRT foot starting position needs consideration when contrasting data in research and practice.

The aim of the current study was to understand the importance of the joint alignment following triple arthrodesis by analysing the contact characteristics in a normal and arthritic ankle joint using a patient-specific numerical model developed using open source software. The alignment of the hindfoot with respect to tibia is calculated from CT scans and the ankle joint model was numerically analysed for neutral, valgus and varus positions in both normal and arthritic conditions. The contact area, the magnitude and distribution of the contact pressure on the articular surface of the talar dome was evaluated using a cell-centred Finite Volume Method implemented in open-source software OpenFOAM. It was found that all positions of the hindfoot predict higher lateral pressures during heel strike. The varus position predicts the maximum increase in lateral pressures. Comparing the valgus and neutral positions, although the neutral position predicts 9.1 % higher increase in lateral pressures during heel strike than valgus, it predicts 33.6 % decrease in pressures during heel-rise and the distribution is more medial during toe-off. In the case of arthritic ankle, it could be observed that the neutral and varus hindfoot fusion positions result in a concentrated increase of lateral pressures in heel strike and flat-foot. In the case of toe-off, the neutral alignment results in an increase of 62.3 % in the contact pressures compared to the arthritic pressure of the unfused foot and is 20.8 % higher than the valgus alignment. The study helps to conclude that the fusion is more beneficial at the neutral position of the hindfoot for the patient specific ankle. However, the 5° valgus position of hindfoot alignment could be more beneficial in the arthritic ankle. Patient-specific approach to the placement of the hindfoot with the help of numerical analysis could help address the issue of ankle degradation following arthrodesis.