1st Metatarsophalangeal Joint Research Articles

Return to activities in younger individuals (

Arthrodesis is a common procedure in the treatment of forefoot conditions affecting the first metatarsophalangeal (MTP) joint. Although this procedure has been shown to significantly improve individuals’ activities of daily living and effectively relieve pain, there is a lack of research specifically investigating younger patients below 60 yrs of age wishing to return to sports. Our aim is to evaluate their ability to return to sports after 1st MTP joint arthrodesis. A retrospective analysis of clinical records of 159 patient that had undergone first MTP arthrodesis performed by a single surgeon was undertaken to determine pre- and postoperative sf-FAOS and sporting activity scores. The Tobit constant censoring limit model was used to analyze change in sf-FAOS scores. After the application of inclusion and exclusion criteria, 58 patients (median age 54 years, range 30 – 59) were included in the final cohort with a mean follow up of 5.3 years (range 2.0 to 9.44, SD 2.10). There was a significant improvement in the mean pain score (p<0.001), as well as an improvement in the mean function score (p<0.001). The number of hours spent in sporting activities per week were significantly higher (p<0.001) post-surgery (5.29 hours, SD 5.0) in comparison to preoperative levels (4.26 hours, SD 3.1). There was no significant change in the intensity of sporting activities (p=0.176). First MTP joint arthrodesis remains a good treatment option for younger individuals wishing to achieve a satisfactory return to sports. Level of evidenceLevel 4

Comparison of a handheld ultrasound device with cart-based ultrasound for the assessment of gout lesions in people with established gout

ObjectivesUse of handheld portable ultrasound is increasing and would improve access for people with rheumatic disease when conventional, cart-based ultrasound is unavailable. This study compared handheld and cart-based ultrasound for the assessment of gout lesions in people with gout. MethodsThe lower limbs of 21 participants with gout were independently scanned at six sites (1st and 2nd metatarsophalangeal joints, knee, patellar ligament, Achilles tendon, and peroneal tendons) using cart-based (LOGIQ P9) and handheld (Vscan Air™) ultrasound by two rheumatologists. One rheumatologist was randomized to scan the right or left leg first with the cart-based or handheld ultrasound. The other rheumatologist scanned the legs in the opposite order with the imaging devices reversed. Images were saved and blinded images scored for double contour, tophus, erosion and aggregates using OMERACT definitions by two rheumatologists experienced in gout ultrasound. ResultsOn handheld ultrasound, 90% of participants had at least one site with double contour, tophus and erosions, and 100% had at least one site with aggregates. There were similar findings using cart-based ultrasound. However, site-level inter-device analysis showed only fair-good agreement: kappa (percentage agreement) for double contour 0.22 (67%), tophus 0.46 (77%), erosion 0.63 (83%) and aggregates 0.37 (75%). There were more aggregates detected by cart-based ultrasound in joints and more tophi detected by handheld ultrasound in ligaments and tendons. ConclusionsHandheld ultrasound can detect gout lesions in people with established gout. However, concordance between cart-based and handheld ultrasound in detection of some gout lesions is low, particularly double contour and aggregates.

Physical Therapy Management for a Patient with Hallux Rigidus in a Baseball Player.

Hallux rigidus is a common condition affecting the foot. There is a paucity of evidence describing the management of patients with hallux rigidus with manual physical therapy consisting of hands-on manual therapy techniques and movement reinforcing exercise. This case highlights the management of a patient with hallux rigidus by a physical therapist. The patient was a 60-year-old male baseball player with pain, loss of metatarsophalangeal joint motion, and radiographically visible degenerative changes suggesting a diagnosis of hallux rigidus. Treatment involved non-thrust joint manual distraction mobilization to the 1st metatarsophalangeal joint. Improvements were noted immediately in the patient's ability to run with decreased symptoms. I carefully instructed the patient to perform the manual distraction techniques at home. After 4 clinical visits, the patient returned to baseball the following spring. Outcomes were maintained 8 years after initial evaluation.

Outcomes following minimally invasive dorsal cheilectomy for hallux rigidus: A systematic review.

Cheilectomy of the 1st metatarsophalangeal joint (MTPJ) is one of the most common procedures for the management of hallux rigidus. However, there is no consensus regarding outcomes following minimally invasive dorsal cheilectomy (MIDC) for the management of hallux rigidus. To evaluate outcomes following MIDC for the management of hallux rigidus. During November 2023, the PubMed, EMBASE and Cochrane Library databases were systematically reviewed to identify clinical studies examining outcomes following MIDC for the management of hallux rigidus. Six studies were included. In total, 348 patients (370 feet) underwent MIDC for hallux rigidus at a weighted mean follow-up of 37.9 ± 16.5 months. The distribution of patients by Coughlin and Shurna's classification was recorded in 4 studies as follows: I (58 patients, 27.1%), II (112 patients, 52.3%), III (44 patients, 20.6%). Three studies performed an additional 1st MTPJ arthroscopy and debridement following MIDC. Retained intra-articular bone debris was observed in 100% of patients in 1 study. The weighted mean American orthopedic foot and ankle society score improved from a preoperative score of 68.9 ± 3.2 to a postoperative score of 87.1. The complication rate was 8.4%, the most common of which was persistent joint pain and stiffness. Thirty-two failures (8.7%) were observed. Thirty-three secondary procedures (8.9%) were performed at a weighted mean time of 8.6 ± 3.2 months following the index procedure. This systematic review demonstrated improvements in subjective clinical outcomes together with a moderate complication rate following MIDC for the management of hallux rigidus at short-term follow-up. A moderate re-operation rate at short-term follow-up was recorded. The marked heterogeneity between included studies and paucity of high quality comparative studies limits the generation of any robust conclusions.

Long term follow up on treatment of hallux sesamoid fracture with temporary first metatarsal joint internal fixation

Fracture of the hallucial sesamoids is a pathology that causes difficulty for surgeons and patients. Because of the low incidence and the fact that up to 64–90 % heal with non-operative management, there is a lack of clear guidance in the literature for the surgical treatment of sesamoid fracture in cases of failure of non-operative management. Here long term follow up of an alternative method of surgical treatment of sesamoid fracture recalcitrant to nonoperative management is presented.32 individuals were treated with temporary surgical immobilisation of the 1st metatarsophalangeal joint using either crossed wires or two orthogonally placed two hole plates. The patients then underwent removal of the construct at 8 weeks post op after confirmation of healing on a CT scan. There was a 94 % union rate. Return to work was 61 days (15–90) return to sport 80 days (64–112) with no immediate complications and no recurrence. At last follow up mean 10 years (4–16) only 2 patients had gone on to asymptomatic non-union and one patient developed arthritis between the sesamoid and the metatarsal head. No patient has required further surgical intervention.This retrospective cohort of patients demonstrate that this method of treatment is a valuable option in the management of sesamoid fracture which does not alter the biomechanics of the foot and has none of the long term complications of sesamoidectomy or partial sesamoidectomy.

Musculoskeletal ultrasound abnormalities in asymptomatic hyperuricemic patients: Association with cardiovascular risk factors

To assess the relation between musculoskeletal ultrasound (MSUS) abnormalities and cardiovascular risk factors in asymptomatic and symptomatic hyperuricemic patients. The study included 66 hyperuricemic patients. 33 were asymptomatic and 33 were symptomatic. The socio-demographic features, body mass index (BMI), blood pressure measurement and musculoskeletal examination were recorded. Serum uric acid (SUA), serum creatinine (s.Cr.), total cholesterol, high density lipoprotein (HDL) and triglycerides (TG) were measured and estimated glomerular filtration rate (e GFR) was calculated using chronic kidney disease-epidemiology collaboration (CKD-EPI). Cardiovascular risk was calculated using Systematic Coronary Risk Evaluation of the European Society of Cardiology (SCORE/ESC) and Atherosclerotic Cardiovascular Disease of American College of Cardiology (ASCVD/ACC). MSUS of the knees, ankles and 1st metatarsophalangeal joints (MTPs) was performed and specific gout signs (aggregates, double contour and tophi) were assessed. There was no association between MSUS abnormalities and either individual or overall cardiovascular risk factors except the negative correlation between the age and the high density lipoprotein (HDL) level and the positivity of the patients (presence of at least one of the specific gout sign "aggregates, double contour or tophi" in at least one out of the six assessed joints "both knees, ankles and 1st MTPs" among the symptomatic group. The association between MSUS abnormalities and cardiovascular risk factors in the hyperuricemic patients is not yet clear and further studies are needed to introduce it as a screening modality for these patients.

Evolution of the first metatarsophalangeal joint replacement

Introduction The diseases of the first metatarsophalangeal (1 MTP) joint that require surgical treatment include osteoarthritis (69 %), rheumatoid arthritis (26 %), tumors, tumor-like diseases and purulent arthritis (5 %). The treatment of arthritic 1 MTP is aimed at reducing pain and improving function. Joint replacement implants are meant to support body weight, maintain the length of the first metatarsal, provide metatarsal‑sesamoid joint functioning and restore joint motion. The purpose of the work was to analyze data from foreign and domestic literature on endoprosthetics of the 1 MTP, and briefly present analytical data on the results of using various implants.Material and methods The article presents the summary of the Russian and foreign publications on 1 MTP joint replacement. The original literature search was conducted on key resources including PubMed, eLIBRARY, MedLine, Scopus. The search strategy was comprised of keywords: “replacement of the first metatarsophalangeal joint”, “surgical treatment of hallux rigidus”, “osteoarthrosis of the first metatarsophalangeal joint”, “results of endoprosthetics of the 1st metatarsophalangeal joint”, "modernization of implants of the 1st metatarsophalangeal joint". Publications brought out between 1968 and 2022 inclusive were analyzed.Results and discussion The ideal implant should restore functional range of motion, improve function, maintain joint stability, distribute the stress across joint surfaces being wear-resistant. Over the years, various materials have been used to provide simple and reliable designs. Implants have been improved and divided into groups based on material and design, limited degrees of freedom, tribological pair composition, and the amount of articular surface replacement.Conclusion New generation implants have a more durable design, anatomical shape and improved osseointegration. The advances in joint replacement have resulted in greater patient satisfaction and increased service life. The complication rate for replacement of the 1 MTP joint remains high. This indicates the need for continued research and further work to improve implants to make them more effective and easier to use.

Long-term outcomes of first metatarsophalangeal hemiarthroplasty for hallux rigidus

Hallux rigidus (HR) is arthritis of the first metatarsophalangeal joint.First metatarsophalangeal joint hemiarthroplasty surgery is one of the treatment options for end stage hallux rigidus.The aim of this study is to evaluate the long-term outcomes of hemiarthroplasty of the first MTPJ with a metallic implant in patients with end-stage HR. Patients who underwent hemiarthroplasty surgery with the diagnosis of HR were included in the study. Self-Administered Foot Evaluation Questionnaire (SAFE-Q) and Foot and Ankle Disability Index (FADI) scores were used in pre-operative and post-operative final follow-ups to evaluate the clinical status of the patients. Post-operative 1st metatarsophalangeal joint range of motion was measured and recorded separately for each patient. The intra-hospital and follow-up complications and revision surgeries of the patients were recorded. Thirty-five patients with a mean follow-up of 8.1 years were included in the study. There was a statistically significant positive change in both FADI and SAFE-Q scores compared to the pre-operative process(p = 0.0001). The average dorsiflexion angle at the final follow-up was 22.0 ± 8.2. Thus, it was determined that the 5-year and 8-year survival rates of patients in this study were 97.1% and 87.8%, respectively. In conclusion, the long-term results show that the use of hemiarthroplasty in the treatment of end-stage HR leads to high patient satisfaction, increased range of motion and a high survival rate.

Novel Vibrating Foot Orthoses for Improving Tactile Sensation in Type 2 Diabetes With Peripheral Neuropathy.

Improving tactile sensation by vibrating insoles was recommended to prevent foot ulcers in diabetic peripheral neuropathy (DPN). Lack of an insole design for diabetics was a challenge. Clinical trials on applying vibrating insoles with noise and stochastic resonance (SR) stimulating tactile were also required. In this study, vibrating foot orthoses (VFO) with a total contact design based on orthotics were proposed to provide proper insoles for diabetes. This study aimed to determine if VFO were beneficial at enhancing tactile in DPN. VFO were developed in combination with individual's custom-made foot orthoses and stimulation signals-integrating random 0-100 Hz square wave pulse signals with pseudorandom white noise by a SR approach. Sixty patients with mild-to-severe DPN were randomized to conduct crossover experiments: using and without VFO for 60 minutes stimulation at 90% of individuals' vibration perception threshold (VPT) level. VPT values when using VFO at the 1st and 5th metatarsophalangeal joints of the left foot decreased by 9.35% ( [Formula: see text].001); 9.04% ( [Formula: see text].001), and of the right foot decreased by 7.63% ( [Formula: see text].001); 7.24% ( [Formula: see text].001), respectively. Without VFO, there was no significant difference. Subgroups of mild and moderate DPN tended to benefit greatly from utilizing VFO. VFO can improve tactile in DPN. VFO may contribute to restoring/prolonging tactile and protective sensations, also decreasing peripheral nervous system deterioration. VFO might be useful for neurorehabilitation, and help prevent foot ulcers and disabilities.

High-resolution ultrasound and MRI in the evaluation of the forefoot and midfoot.

Radiography is the appropriate initial imaging modality to assess for midfoot and forefoot pathology before turning to advanced imaging techniques. While most lesions of the mid- and forefoot can be diagnosed clinically, the exact nature and severity of the pathology is often unclear. This review addresses the use of the ultrasound, as well as the added value of magnetic resonance imaging, in diagnosing conditions of the midfoot and forefoot. Ultrasound allows a dynamic assessment as well as enabling imaging-guided interventions for diagnostic and therapeutic purposes. Practical tips for optimal examination of this area with ultrasound and magnetic resonance imaging are provided. Metatarsal stress fracture, Chopart's injury, Lisfranc injury, as well as the 1st metatarsophalangeal joint injury and lesser metatarsophalangeal plantar plate injury are injuries unique to the mid- and forefoot. The imaging anatomy of the 1st and lesser metatarsophalangeal joints is reviewed, as such knowledge is key to correctly assessing injury of these joints. Characteristic imaging features of masses commonly encountered in the mid- and forefoot, such as ganglion cyst, Morton neuroma, gouty tophus, plantar fibroma, foreign body granuloma, and leiomyoma are reviewed. The use of ultrasound and magnetic resonance imaging in assessing degenerative and inflammatory joint disorders, and in particular rheumatoid arthritis, of the mid- and forefoot region is also reviewed. In summary, when necessary, most lesions of the mid-and forefoot can be adequately assessed with ultrasound, supplemented on occasion with radiographs, computed tomography, or magnetic resonance imaging.

Comparable Outcomes of Cartiva Implant, Cheilectomy, and Fusion for Hallux Rigidus of the 1st Metatarsophalangeal Joint: A Matched Cohort Study

Category: Midfoot/Forefoot; Other Introduction/Purpose: The primary goal of treating hallux rigidus of the 1st metatarsophalangeal (MTP) joint of the foot is to reduce pain. Treatment options include cheilectomy, interposition arthroplasty, and arthrodesis for more severe disease. Recently, the use of a synthetic cartilage implant (Cartiva, Stryker Inc., MI, USA) has been introduced with the advantage of motion preservation. While a Level 1 study has demonstrated similar outcomes of fusion and Cartiva, other comparative studies have shown less favorable results for the Cartiva implant. The purpose of this study was to evaluate minimum 2-year patient reported outcomes (PROs) of the Cartiva implant for the treatment of hallux rigidus in the 1st MTP joint in comparison to a matched cohort of patients treated with fusion or cheilectomy. Methods: Patients &gt;18 years old who underwent surgery for treatment of 1st MTP joint hallux rigidus with Cartiva implant, cheilectomy, or fusion performed by two surgeons (T.O.C. or C.T.H.) between January 2009 and January 2020 were identified. A 2:1 matched control cohort of patients who underwent cheilectomy or fusion was constructed using a nearest neighbor, greedy algorithm based on age, sex, prior surgery, and Coughlin osteoarthritis grade. Minimum 2-year follow-up was obtained with patients completing subjective questionnaires including Foot and Ankle Ability Measure (FAAM) with Activities of Daily Living (ADL) and Sport subscales, Short Form-12 (SF-12), Tegner activity scale, and patient satisfaction with surgical outcome. Demographics and patient-reported outcomes were compared between groups. Results: Follow-up was obtained for 22/27 (82%) Cartiva patients (mean age 54±19) at median 4.3 years and 41/49 (84%) control patients (mean age 58±11) at median 3.5 years. Prevalence of Coughlin grade was similar between Cartiva and control groups (6 vs 10 grade 1, 8 vs 15 grade 2, 2 vs 6 grade 4, 6 vs 10 grade 5; p=.93), respectively. There was no significant difference in median post-operative FAAM-ADL (96 vs 95, p=.53), FAAM-Sport (92 vs 89, p=.89), SF-12 PCS (56 vs 51, p=.054), SF-12 MCS (56.3 vs 57.5, p=.50), Tegner score (4 vs 3, p=.30), or patient satisfaction (9 vs 9, p=.91) between Cartiva and control cohorts, respectively. Revision surgery was required for 3 (14%) Cartiva patients and 4 (10%) control patients (p=.70). Conclusion: Patients treated with a Cartiva synthetic cartilage implant for 1st MTP joint hallux rigidus had similar patient-reported outcomes and revision rate compared to patients treated with cheilectomy or fusion for Coughlin grade 2-5 osteoarthritis.

Three-Dimensional Analysis of Windlass Mechanism Using Loading Computed Tomography in Patients With Hallux Rigidus and Healthy Volunteers

Category: Midfoot/Forefoot; Basic Sciences/Biologics Introduction/Purpose: The windlass mechanism (WM) increases the height of the medial longitudinal arch (MLA) of the foot by tensing the plantar aponeurosis during dorsiflexion of the metatarsophalangeal (MTP) joint. We speculated that this mechanism may be deeply involved in the pathogenesis of forefoot diseases such as hallux rigidus (HR). These conditions are three- dimensional (3D) deformities including rotational deformity, but the role of the WM has been evaluated only two-dimensionally by measuring the height of the navicular on lateral plain radiographs. The purpose of this study was to analyze in detail the WM of normal and HR feet in 3D. Methods: Participants were 14 patients with HR (17 feet) and 13 volunteers (21 feet). The volunteers had no history of foot disease or trauma, whereas the patients with HR had Coughlin and Shurnas classification I or II. Computed tomography (CT) of the foot with a load equivalent to the participant’s body weight was performed. Imaging was performed with the 1st MTP joint in the neutral position and dorsiflexed 30 degrees. 3D models were created using the software Mimics Research 17.0. Next, we used the iterative closest point (ICP) algorithm, which allows 3D objects to be superimposed without specifying anatomical feature points. Then, we performed 3D measurements of the (1) rotation of each bone in the MLA with respect to the tibia, (2) rotation of the distal bone in each joint of the MLA, and (3) changes in the height of the geometric center of the navicular. Results: At the calcaneus, navicular and medial cuneiform, the HR group showed less inversion, adduction than healthy group. (P &lt; 0.05) At the talonavicular joint, the navicular was 3.7° inversion, 2.9° adduction in the healthy group and 2.4°inversion, 1.3° adduction in the HR group. At the talocalcaneal joint, the calcaneus was 1.7° inversion, 1.5° adduction in the healthy group and 0.9°inversion, 0.6° adduction in the HR group. In the talonavicular and talocalcaneal joint, the HR group showed less inversion and adduction than control. (P &lt; 0.05) With dorsiflexion of the hallux, the height of the navicular increased by 2.1 mm in the healthy group and 1.3 mm in the HR group. There was a significant difference (P &lt; 0.05) between the two groups. Conclusion: In both groups, the calcaneus, navicular, and medial cuneiform bones moved not only in the sagittal plane but also in the frontal plane. But the movement of the talonavicular and talocalcaneal joints and the change in height of the navicular were significantly reduced compared with the healthy group. In other words, in the HR group, the motion of the midfoot and hindfoot was limited, suggesting that there may be a close relationship between WM dysfunction and midfoot and hindfoot motion. This study indicates that the dysfunction of the WM may have been a clue to the cause of HR.

Three-dimensional Weight-Bearing CT Distance and Coverage Mapping Assessment of the 1st MTPJ and Sesamoid Joints in Patients with Hallux Valgus Deformity

Category: Bunion Introduction/Purpose: Three-dimensional (3D) Distance-Mapping (DM) and Coverage-Mapping (CM) use WBCT images to evaluate multiplanar elements of Hallux Valgus (HV), such as sesamoid subluxation, through analyzing joint space and joint coverage across entire bony interfaces. Previous methods have struggled to characterize sesamoid subluxation consistently, and the reliable assessment of these deformity patterns is essential in guiding HV treatment and impacts recurrence rates following correction. The objective was to (1) develop a 3D WBCT CM and DM algorithm to characterize the surface interaction of the 1st metatarsophalangeal-joint (MTPJ) and metatarsal-sesamoid joints in HV patients and controls (2) correlate DM and CM measurements with WBCT semi-automatic angular measurements in HV patients and controls (3) correlate DM, CM, and angular measurements with Visual Analog Scale (VAS) scores in HV patients. Methods: Retrospective case-control study assessing HV patients. 51-feet with HV who underwent a WBCT of the affected foot and 54-feet were included. Semi-automatic segmentation protocol extracted bone models, which were analyzed with specialized software. The 1st-MTPJ surface was divided into two-by-two grids to provide a more detailed analysis. Distance measurements obtained were used to create color-coded distance maps. Blue color represented expected distances in joint interaction (1 to 5 mm), red or yellow color represented arthritis or impingement (0 to 1mm), and pink color represented subluxation (&gt;5mm). Further, color-coded coverage maps highlighted areas of relative coverage ( &lt; 5mm) or uncoverage (&gt;5mm) contrasting areas with normal joint interaction or subluxation (Figure). Pearson’s correlations were used to describe association between intraarticular distances, or JSW (joint space width), and coverage measurements with the following: intermetatarsal angle (IMA), Hallux-Valgus- Angle (HVA), Distal-Metatarsal-Articulation-Angle (DMAA), Visual-Analog-Scale (VAS), and Body-Mass-Index (BMI). P-values less than 0.05 were statistically significant. Results: Interobserver reliability was high for 1st-metatarsal-head (ICC 0.846,p &lt; 0.001), medial-sesamoid-articulation (ICC 0.854,p &lt; 0.001), and lateral-sesamoid-articulation (ICC 0.832,p &lt; 0.001). HV patients demonstrated significantly decreased coverage in comparison to controls (42.7% vs. 50.1%,p &lt; 0.001) and a relative decrease in 1st-MTPJ-coverage (-14.7%,p &lt; 0.001) in comparison to controls. In HV, articular coverage was higher in patients for the plantar lateral quadrant (HV 88.6% vs. 83.0% Controls,p=0.0002) and decreased in dorsal-medial (HV 8.8% vs. 18.7% Controls,p &lt; 0.0001) and plantar-medial quadrants. (HV 46.2% vs. 78.8% Controls,p &lt; 0.0001). Significantly decreased coverage was observed in HV-patients in both the medial sesamoid- articulation (HV 31.1% vs. 54.4%, p&lt; 0.0001) and lateral sesamoid-articulation (HV 22.6% vs. 46.0%,p &lt; 0.0001). Correlations between the first-metatarsal-head distance/coverage measurements and BMI, pre-op VAS, IMA, HVA, and DMAA are summarized in figure. Conclusion: We developed a quantifiable WBCT distance and coverage map algorithm to assess 3D-joint-interaction, joint- coverage, and subluxation in patients with HV. We observed significant subluxation of the 1st-MTPJ in patients with HV when compared to controls, as well as significant subluxation of the metatarsal-sesamoid joint at the medial and lateral sesamoid-joints, with an apparent medial and dorsal deviation of the first-metatarsal, lateral and plantar deviation of the proximal-hallux-phalanx and Lateral subluxation of the sesamoids. Increased coverage of the 1st-metatarsal-head was associated with decreased IMA and DMAA. However, we found no significant correlation between the Visual-Analogue-Scale-(VAS) and DM, CM, and semi-automatic measurements.

Treatment of hallux rigidus with percutaneous metatarsophalangeal arthrodesis: a case series with a minimum follow-up of 2 years.

Percutaneous metatarsophalangeal arthrodesis is an option for the treatment of hallux rigidus in more advanced cases. The aim of this study was to investigate the clinical and radiographic results at least 2 years after percutaneous metatarsophalangeal arthrodesis in patients with hallux rigidus. This is a case series of consecutive patients undergoing percutaneous metatarsophalangeal arthrodesis in patients with hallux rigidus grades III and IV with a minimum of 24months of clinical and radiographic follow-up. The primary outcome was clinical assessment using the Visual Analog Scale for Pain (VAS). Secondary outcomes included American Orthopedic Foot & Ankle Society (AOFAS) score, patient satisfaction, complications, and bone healing (radiographic analysis). Between August 2017 and February 2020, 29 feet (24 patients) underwent percutaneous metatarsophalangeal arthrodesis. The mean follow-up was 38.4 (range 24-54) months. There was an improvement in the pain (VAS) from 7.8 to 0.6 (p < 0.001) and in the AOFAS score from 49.9 to 83.6 (p < 0.001). There was a rate of bone union of 82.8% and screw removal of 13.8%. All patients considered the result to be excellent or good. The treatment of grade III and IV hallux rigidus with percutaneous metatarsophalangeal arthrodesis demonstrated high patient satisfaction and significantly improves in clinical outcomes but the nonunion rate was higher than reported outcomes for open 1st metatarsophalangeal joint arthrodesis. IV, case series.

Postoperative Opioid Consumption Following Hallux Valgus and Rigidus Surgery: A Guide to Postoperative Prescription Writing

Prescribing post-operative pain medications is essential to foot and ankle surgery, however, prescribing an amount that results in an excess of pills has shown to lead to opioid abuse. The opioid epidemic has forced surgeons to analyze how we manage post-operative pain with a goal to prescribe the optimal number of pills that will reduce a patient's pain while limiting the amount that is left over. The purpose of this study was to develop a guideline for prescribing post-operative pain medication for hallux valgus and rigidus procedures. One hundred eighty-five opioid naive patients were followed after undergoing surgery for hallux valgus or hallux rigidus. The number of opioids consumed was obtained and compared to a number of variables. There were 28 different prescriptions given during the study. As the number of pills given decreased, so did the number of pills consumed (p=0.08). Of the 185 patients, 14 (7.56%) received a refill.Ninety-five patients were available for opioid consumption data analysis. Those patients consumed a median of 36.7% and 39.1% of their prescription for hallux valgus and hallux rigidus procedures respectively. Smokers consumed 2.4 times the number of narcotics compared to nonsmokers (p=0.002). The median number of 5-325 mg hydrocodone-acetaminophen pills consumed was 8.5 for distal metatarsal osteotomies and 10 for 1st metatarsophalangeal joint procedures.Body mass index, gender, number of procedures performed did not have a statistical difference in the number of opioids taken.Foot and ankle surgeons can reduce the amount of excess opioids by decreasing the initial prescription and educating the patient on proper pain management modalities. Level of Evidence III.

Converting 1st metatarsophalangeal joint fusion to interposition arthroplasty. Mid-term results of a case series

BackgroundFusion of the first metatarsophalangeal (MTP) joint has been considered as the gold standard for treatment of advanced hallux rigidus. The main disadvantage is the restriction of movement which may not be as favorable as anticipated by several patients. The purpose of this study was to report clinical and functional outcomes on patients who were treated with interposition arthroplasty after a 1st MTP joint fusion which had not fulfilled their expectations. MethodsBetween 2009 and 2014, 11 patients who were not satisfied by 1st MTP joint fusion for hallux rigidus, underwent a conversion to interposition arthroplasty. After removal of hardware, the fusion was taken down by removal of a bone block from the fused joint. A fascia lata graft was interposed. Intraoperative and postoperative complications, range of motion of the first MTP joint, length of first ray, and patients’ satisfaction were recorded as the primary outcomes. ResultsMean age was 34 years (range, 24–42 y). The mean ± SD AOFAS/H/MTP/IP score was 61 ± 5.5 preoperatively, 90.5 ± 4.5 at one year and 92 ± 4 at five years postoperatively (p < 0.001). The mean ± SD VAS-FA score was 91 ± 3.5 preoperatively, 94.5 ± 2.5 at one year and 95 ± 2.5 at five years postoperatively (p > 0.05). Mean ROM at the final follow-up was 58° ± 5° of dorsiflexion and 27° ± 4° of plantarflexion. No inter- or postoperative complications were encountered. The length of the hallux was decreased by a mean of 1.5 mm (range, 1–2.5 mm). All patients were satisfied with the overall outcome, walking ability and shoe-wear convenience and graded their condition as excellent (9 cases) or good (2 cases). ConclusionsConverting a 1st MTP joint fusion to interposition arthroplasty with a fascia lata allograft could be a safe alternative with promising results in selected cases especially in relatively young and athletic population. Level of evidenceLevel IV retrospective case series.

발 내재근 운동이 엄지발가락가쪽휨증의 엄지벌림근에 미치는 효과 비교

This study aimed to investigate the most effective exercise in relation to the effect on the cross-sectional area (CSA) and muscle tone of the abductor hallucis in patients with hallux valgus. Thirty-six patients (18 men, 18 women )with a mean age of 22.14 years (standard deviation of 2.47 years) participated voluntarily in this study. Hallux valgus was defined as an angle >15° of the 1st metatarsophalangeal joint(MPJ). A goniometer was used to determine the angle of the 1st MPJ. In addition, an ultrasound system and Myotone Pro were used to collect the CSA and muscle tone of the abductor hallucis of the dominant foot. CSA and muscle tone of the abductor hallucis were measured in four positions: resting position, during short foot (SF) exercise, during toe-spread-out (TSO) exercise, and during towel-curl(TC) exercise. For all data, one-way repeated analysis of variance test was used to compare the dependent variables according to the three exercise methods, and a post-hoc test was performed using the Bonferroni modification method. The significance level was set to p < .05. The CSA and muscle tone of the abductor hallucis were significantly increased in the TSO and SF exercises. In addition, a more significant increase was found in the TSO than in the SF exercise. However, no significant difference was found in TC. In conclusion, the TSO exercise is the most effective for selectively contracting the abductor hallucis than other exercises.

Effects of foot and ankle mobilisations combined with home stretches in people with diabetic peripheral neuropathy: a proof-of-concept RCT

IntroductionPeople with diabetic peripheral neuropathy (DPN) and limited joint mobility syndrome (LJMS) can experience increased forefoot peak plantar pressures (PPPs), a known risk factor for ulceration. The aim of this study was to investigate whether ankle and 1st metatarsophalangeal (MTP) joint mobilisations and home-based stretches in people with DPN improve joint range of motion (ROM) and reduce forefoot PPPs.Design and methodsSixty-one people with DPN (IWGDF risk 2), were randomly assigned to a 6-week programme of ankle and 1st MTP joint mobilisations (n = 31) and home-based stretches or standard care only (n = 30). At baseline (T0); 6-week post intervention (T1) and at 3 months follow-up (T2), a blinded assessor recorded dynamic ankle dorsiflexion range using 3D (Codamotion) motion analysis and the weight bearing lunge test, static 1st MTP joint dorsiflexion ROM, dynamic plantar pressure and balance.ResultsAt T1 and T2 there was no difference between both groups in ankle dorsiflexion in stance phase, plantar pressure and balance. Compared to the control group, the intervention group showed a statistically significant increase in static ankle dorsiflexion range (Left 1.52 cm and 2.9cms, Right 1.62 cm and 2.7 cm) at 6 (T1) and 18 weeks (T2) respectively p < 0.01). Between group differences were also seen in left hallux dorsiflexion (2.75°, p < 0.05) at T1 and in right hallux dorsiflexion ROM (4.9°, p < 0.01) at T2 follow up. Further, functional reach showed a significant increase in the intervention group (T1 = 3.13 cm p < 0.05 and T2 = 3.9 cm p < 0.01). Intervention adherence was high (80%).ConclusionsCombining ankle and 1st MTP joint mobilisations with home-based stretches in a 6-week programme in people with DPN is effective in increasing static measures of range. This intervention may be useful for improving ankle, hallux joint mobility and anteroposterior stability limits in people with diabetes and neuropathy but not for reducing PPP or foot ulcer risk.Trial registrationhttps://classic.clinicaltrials.gov/ct2/show/NCT03195855.

Comparative study of internal fixation and external fixation after osteotomy of hallux valgus: A protocol for meta-analysis of comparative studies.

Hallux valgus (HV) is a common clinical deformity of the forefoot, primarily a deformity of the 1st metatarsophalangeal joint in which the bunion is deflected laterally relative to the 1st metatarsal, often in combination with a medial bunion or pain at the head of the 1st metatarsal. For HV bunions that do not respond to conservative treatment, surgical intervention is required, which generally involves osteotomy of the first metatarsal or the first phalanx. However, the choice of fixation method after osteotomy is controversial. Most scholars choose screws or plates for internal fixation (IF) to achieve strong and reliable fixation, while some experts do not perform IF after osteotomy, but reposition the osteotomized end and perform external fixation (EF) with a figure-of-eight bandage between the 1st and 2nd toes, which has been advocated by some scholars because it requires only local anesthesia and has the characteristics of minimally invasive and no additional material for IF, and has achieved good clinical results. Therefore, it is necessary to compare the choice of IF or EF after HV osteotomy to evaluate whether there is a difference between the 2 and to conduct a meta-analysis to provide a reliable basis for clinical guidance. We will search articles in 7 electronic databases including Chinese National Knowledge Infrastructure, Wanfang Data, Chinese Scientific Journals Database, Chinese databases SinoMed, PubMed, Embase, and Cochrane Library databases. All the publications, with no time restrictions, will be searched without any restriction of language and status, the time from the establishment of the database to October 2022. We will apply the risk-of-bias tool of the Cochrane Collaboration for randomized controlled trials to assess the methodological quality. Risk-of-Bias Assessment Tool for Non-randomized Studies was used to evaluate the quality of comparative studies. Statistical analysis will be conducted using RevMan 5.4 software. This systematic review will evaluate the functional outcomes and radiographic results of internal versus EF after HV osteotomy. The findings of this study will provide evidence to determine whether IF or external fixation is more effective after HV osteotomy.

Double Contour Sign In Early Detection Of Gout Among Asymptomatic Hyperuricemic Filipino Patients: A Single Center Tertiary Hospital Observational Study

Objective. Double contour sign (DCS) is considered part of the new gout classification. This study aims to determine the agreement of blinded musculoskeletal sonologists in identifying the double contour sign among asymptomatic hyperuricemic patients. Methods. Participants with asymptomatic hyperuricemia (n=65) underwent a gray-scale ultrasound assessment of both of their 1st metatarsophalangeal joints (MTPJs) done on 3 positions (dorsal, medial, plantar) in longitudinal view. The static images were read by 2 independent blinded sonologists for presence of double contour sign. Results. Among the 130 1st MTPJs, the sonologists were able to positively identify DCS on 48R and 52L, negative in 10R and 10L, with discordant readings in 7R, 3L. The overall kappa agreement was statistically significant at 0.674 (substantial agreement) and 0.842 (almost perfect agreement) on the right and left respectively, (both p&lt;0.001). Conclusion and Recommendation. There is a high proportion of positive double contour sign seen among persistently asymptomatic hyperuricemic patients. It might be prudent to perform musculoskeletal ultrasound early on to detect monosodium urate crystal deposits in similar patients. A close follow up to monitor clinical gouty arthritis may be necessary or consider utility of urate lowering drugs in crystal dissolution in prospective studies.