Metatarsal Research Articles

Long Term Patient Reported Outcomes of Tarsal Coalition Resection in Pediatric Patients

Category:Hindfoot; Midfoot/ForefootIntroduction/Purpose:Tarsal Coalition has been known to be associated with pes planovalgus, unrelenting pain, recurrent sprains, and arthrosis due to an abnormal connection between two or more bones of the feet following failure of segmentation during development. Three entities of coalition exist fibrous, cartilaginous and osseous. Most commonly patients present with pain during activity. On exam range of motion is usually limited and there may be valgus or varus malalignment of the hindfoot. Patients are often offered surgical resection following failure of conservative management. Few large cohort studies exist analyzing complications and patient reported outcomes of pediatric patients undergoing operative treatment.Methods:After IRB approval, patients under the age of 18 undergoing excision of tarsal coalition at a single academic center from 2010-2019 were identified. Medical records were reviewed for variables such as demographics, surgical technique, coalition characteristics, postoperative complications, and coalition recurrence. Patients were contacted via telephone to complete a PROMIS Physical Function and Pain Interference in addition to the Foot Function Index. Contact was attempted at least 3 times before a patient was considered non-respondent. A total of 44 patients and 54 feet were included in the analysis with 17 patients (22 feet) completing patients reported outcomes.Results:The median age at the time of surgery was 12 (IQR 3). Thirty-five feet (64.8%) were from male patients, while 19 feet (35.2%) were from female patients. Pain was the presenting symptom in 49 (90.7%) of feet. Pes planovalgus was present in 25 feet (46.3%). Forty feet (74.1%) had calcaneonavicular coalition compared to 12 feet (22.2%) with talocalcaneal coalition and 2 feet (3.7%) with both. Fibrous coalition was found in 19 feet (35.2%) and the most common. Interposition material was used in 49/54 (90.7%) feet. Wound complications or temporary neuropraxias were seen in 7/54 feet (13.0%), and coalition recurrence occurred in 3/54 feet (5.6%). At a median of 6 years (6.0 IQR) postoperatively, the median postoperative outcomes scores were as follows: PROMIS Physical Function 54.7 (17.9 (IQR)), PROMIS Pain Interference 38.7 (10.0), FFI Pain 14.0 (30.0), FFI Disability 1.0 (9.0), FFI Activity Limitation 3.0 (8.0), and FFI Total 6.0 (12.0).Conclusion:Our study investigated complications and long-term patient outcomes following coalition resection. At follow-up, pediatric patients who underwent excision of tarsal coalition had higher physical function and less pain than the average U.S. population (PROMIS population mean is score of 50). Our recurrence rate of 5.6% is lower than reported in literature. Infection rate was similar to reports in literature at 3.1%. Overall, Coalition resection in pediatrics is a well-tolerated procedure that improves both physical and emotional health.

Morphometric Study of the Navicular Bone in a Nigerian Population: A Direct Measurement Study

Background: The human foot, containing approximately 26 bones, is highly developed for movement, balance, and weightbearing. It is modified into medial longitudinal, lateral longitudinal, and transverse arches which, in addition to the above functions, play a role in protecting the plantar tissues and neurovascular structures. Morphometry of the navicular bone, one of the bones of the foot that plays an important role in the medial longitudinal arch, was investigated in this study. Methods: One hundred fifty adult dry navicular bones were used. Navicular breadth, height, maximum thickness, maximum talar facet height and breadth, maximum cuneiform facet height and breadth, and maximum navicular tuberosity projection height were measured using digital Vernier callipers. The anatomical features were used to determine the side. Bones with features that suggested previous fractures or any previous disease were excluded from this study. Ethical approval was obtained from the Research Ethics Committee of the Department of Anatomy, Ebonyi State University, Abakaliki, Nigeria. Results: The navicular bone showed great variations in its left and right sides, with the values of the dimensions on the left being higher than the right. Conclusions: An understanding of these variations will be helpful to medical scientists, osteologists, and orthopedic surgeons during surgical interventions on navicular bone fracture and accessory navicular syndrome.

Cavovarus Foot: Conservative Management Techniques/Case Studies

Category:OtherIntroduction/Purpose:The cavovarus foot is a true challenge for both the patient and the surgeon. This complex deformity can be a result of many different causal factors including genetics, Charcot-Marie-Tooth disease, diabetes and spina bifida. It may also be caused or worsened by trauma or surgical procedures. The cavovarus foot is difficult to manage conservatively as it tends to be rigid, is not a good shock absorber and causes the joints of the foot to process abnormal stresses. The mechanical construct of a cavus foot makes it susceptible to a multitude of complications and injuries like inversion ankle sprains and metatarsal stress fractures.Methods:While foot orthoses would likely be the most commonly considered conservative treatment option for the symptomatic cavus foot, other modalities like shoe modification, bespoke and/or therapeutic footwear and bracing have also proven effective. Oftentimes, a combination of the aforementioned options is employed. Given the individual complexities of each cavus foot, the conservative treatment plan is typically custom tailored to fit a particular patient's foot structure, biomechanical and corrective needs, and occupational or recreational demands. A so-called 'cookie cutter' approach is not appropriate for management of the cavovarus foot.Results:A review of published research demonstrates that foot orthoses - and other conservative modalities - are effective in the treatment of the cavus foot. These devices work by correcting the varus foot alignment (when applicable), offloading painful areas such as ball of the foot or the base of the fifth metatarsal, providing shock absorption and replacing lost motion. These applications work together to provide a more normal, safer and energy-efficient gait.Conclusion:Conservative management, specifically pedorthics, is not only a viable treatment option for the cavovarus foot but should be considered integral to the overall management of the cavus foot patient. Pedorthic modalities are successfully used post-operatively or in lieu of surgical intervention. Modern pedorthics (technological advances in shoe and orthotic design, construction and materials) allows for cosmetically pleasing, affordable and comfortable management allowing patients to return to a healthy and active lifestyle in many cases.

Calcaneal Facet of Talus: An Osseo-morphological Study in the Population of West Bengal, India

Introduction: Calcaneal articular facet of talus plays an important role in joint stability as well as in mobility. In many diseases of foot viz., talocalcaneal arthritis, coalition, intra-articular fracture, congenital flatfoot, valgus deformity; as well as in different surgical procedures viz., triple arthrodesis, internal and external fixation, osteotomy, and anatomic reduction; the size and shape of bones, the inter-relationship of talus and calcaneum with other bones of foot is an important clinical consideration. Aim: To explore the variability of the types of the calcaneal facets of talus in population of West Bengal, India. Materials and Methods: An observational descriptive study was conducted with dry specimens of tali preserved in Department of Anatomy of medical teaching institutions of Kolkata for six months; with 144 tali of unknown age and sex (69 right and 75 left-sided), collected from bone libraries of seven different medical colleges of West Bengal by non probability sampling. The borders of the calcaneal articular facets were traced with colour sketch pen, following which authors unanimously agreed upon the ‘type’ of the calcaneal facets on visual impression as was guided in the mostly used classification standard method as described by Arora AK et al., and Kaur M et al. Data was extrapolated and analysed in Microsoft excel software 2010. Results: Out of 144 tali (right=69, left=75) maximum number of type II (47.92%) was observed. For right-side, type I, II and V facets in 47.83%, 43.48% and 8.70% were observed respectively. On left-side, type I- 36%, type II- 52%, type III, IV, V 4% was observed each. Authors did not find any type III or type IV on right-side. Conclusion: Maximum prevalence of the type II articular facet was found and absence of type III/IV facets in the right-side in the current study population provides us a reflection of the anthropometric data for the population of West Bengal, but there remains scope of further study with larger sample size supported by imaging facilities.

Weightbearing CT Analysis of Hallux Rigidus: Does Metatarsus Primus Elevatus Really Exist?

Category:Midfoot/ForefootIntroduction/Purpose:The etiology of hallux rigidus has been unknown. Metatarsus primus elevates (MPE), elevated first metatarsal has been controversial. Recent studies have supported significantly elevated first metatarsal in hallux rigidus patients. Bouaicha reported MPE greater than 5 mm could be a predictive factor of hallux rigidus. Lateral weightbearing radiographs has been used to evaluate MPE, However, there are limitations of conventional radiography including variation in X-ray projection angle and foot position and superimposition of metatarsals. Cheung assessed foot alignment utilizing 3D reconstructions from WBCT and concluded that hallux rigidus patients had increased MPE. Our objective was to assess MPE and anatomical characteristics in foot alignment of hallux rigidus patients compared to a control group using WBCT. This is the first study measuring MPE on WBCT.Methods:This is a single-center, retrospective study from prospectively collected data. 20 patients with hallux rigidus and WBCT data were enrolled from October 2014 to December 2020. As a control group, 20 patients with various foot and ankle pathologies were selected. Measured WBCT parameters included 1st TMT joint version, HVA, IMA, DMAA, 1st and 2nd metatarsal lengths, Foot width, Sesamoid station and rotation angle, 1st-5th Metatarsal Angle, Metatarsus adductus angle, 2nd cuneiform-2nd metatarsal angle, Talus-1st Metatarsal Angel, 1st Metatarsal-Proximal Phalanx Angle, 1st and 2nd metatarsal declination angles and ratio, and MPE. MPE was measured as a direct distance between 1st and 2nd metatarsals using a line tangential to the first metatarsal and another perpendicular line at the metadiaphyseal junction to reach second metatarsal on parasagittal view. A Cut-off value of MPE was calculated using receiver operating characteristic curve. Two investigators independently assessed each WBCT.Results:Mean age was 43.3 in control group (45% male, 55% female) and 55.9 in HR group (60% male, 40% female). Significant differences were found in several facets of foot anatomy between HR and control groups including HVA (7.57 in control vs 14.05 in HR), DMAA (3.89 vs 8.06), forefoot width (92.96 vs 95.47), 1st MT declination angle (20.17 vs 17.82), 1st/2nd MT declination ratio (83.52 vs 76.02), and MPE (3.24 mm vs 5.40 mm). MPE was significantly higher in hallux rigidus group in all three parasagittal views (unmodified, parallel to 1st metatarsal and 2nd metatarsal). Dorsal subluxation/translation of the first metatarsal was observed at 1st TMT joint in the parasagittal view of WBCT in 9 (45%) patients of hallux rigidus group suggesting sagittal instability. No patient in control group had dorsal subluxation/translation. A cut-off value of MPE was 4.56 mm with 80% sensitivity and 90% specificity.Conclusion:To evaluate MPE on WBCT, we used a new direct measurement on parasagittal views. We found a significant difference in MPE in HR. Our WBCT results are consistent with other studies using conventional radiographs. A cut-off value of WBCT MPE for diagnosis of HR was 4.56 mm in our cohort. Considering 45% patients of the HR group had dorsal subluxation/translation of first metatarsal at 1st TMT and increased HVA, Hallux rigidus may be associated with first ray instability predominantly in sagittal plane with resultant MPE with varying degree of combined coronal plane instability resulting in increased HVA.

Comparison of outcomes of different osteotomy sites for hallux valgus: A systematic review and meta-analysis.

Hallux valgus (HV) is a common foot deformity for which several corrective surgical procedures, with different osteotomy sites, have been reported. The purpose of the present study was to systematically review randomized (RCTs) or controlled (CCTs) clinical trials and perform meta-analysis on outcomes of different osteotomy sites of the first metatarsal. An extensive literature search was conducted in PubMed and the Cochrane Library from January 1983 to July 2020. Studies were identified using the terms "hallux valgus" and "osteotomy". We included RCTs or CCTs comparing different locations of osteotomy for the first metatarsal bone (distal vs. mid-shaft, distal vs. proximal, and mid-shaft vs. proximal). The surgical outcomes included postoperative hallux valgus angle (HVA), intermetatarsal angle (IMA), American Orthopaedic Foot and Ankle Society (AOFAS) score, pain visual analog scale (VAS) score, perioperative complications and recurrence of deformity. We enrolled 10 studies with a total of 793 feet in the qualitative synthesis following full-text screening. A majority of patients included in the enrolled trials showed mild to moderate deformity, with mean HVA <40°. Out of the 10 enrolled studies; six compared distal osteotomies with mid-shaft osteotomies and showed no significant differences in the surgical outcomes between the scarf and chevron groups; three RCTs compared distal osteotomies with proximal osteotomies with conflicting results, one RCT showed the superiority of proximal osteotomy while the other two RCTs showed equivalent outcomes; one study that compared between mid-shaft and proximal osteotomies showed equivalent outcomes between the groups. For the management of mild to moderate HV deformity, we found no significant clinical and radiological differences between patients treated with scarf and chevron osteotomies. Further controlled trials comparing different sites of osteotomies for moderate to severe HV deformity are needed.

Metatarsal Bone Marrow Edema on Magnetic Resonance Imaging and Its Correlation to Bone Stress Injuries in Male Collegiate Basketball Players

Background:The presence of bone marrow edema (BME) on magnetic resonance imaging (MRI) has been used to evaluate for bone stress injuries in athletes.Purpose:To examine the prevalence of MRI findings, including BME, in a single male collegiate basketball team before and after a single season and to assess its association with clinically symptomatic metatarsal bone stress injuries.Study Design:Cohort Study; Level of evidence, 3.Methods:A total of 16 men on a single collegiate basketball team (mean age, 20.0 ± 1.8 years) underwent 1.5-T MRI focused on both midfeet during the preseason, and 13 underwent repeat MRI during the postseason. MRI findings included the presence of BME and the radiographic classification of the bone stress injury (grades 1-4). Injury surveillance performed by athletic trainers was used to identify metatarsal bone stress injuries over the course of the season.Results:Preseason MRI demonstrated metatarsal BME in 5 of the 16 participants, and postseason MRI demonstrated metatarsal BME in 4 of the 13 participants. All 4 of the participants with postseason BME had MRI findings of BME in the same metatarsals. Compared to those without BME, participants with metatarsal BME had a shorter history of basketball exposure (preseason: 10.4 ± 4.1 vs 14.2 ± 1.9 years, respectively [P = .023]; postseason: 9.6 ± 4.1 vs 14.0 ± 2.1 years, respectively [P = .024]), and those with postseason BME had started playing at an older age (9.8 ± 4.3 vs 6.2 ± 1.6 years, respectively; P = .050). The preseason MRI classification for metatarsals included grade 1 (n = 3), followed by grades 2 and 3 (n = 2 each). In the 4 participants with postseason MRI findings, the grade increased from 1 to 4 in 1 participant and was stable in the other 3. No participants were diagnosed clinically with a metatarsal bone stress injury during the season. BME of the sesamoids was identified in 6 participants, who trended toward being older (21.0 ± 2.2 vs 19.4 ± 1.3 years, respectively; P < .10), with the abnormalities persisting on postseason MRI in all players.Conclusion:Collegiate male basketball players may have a high prevalence of BME, often without associated symptoms. The absence of foot pain or a corresponding diagnosis of a metatarsal bone stress injury in this study suggests that MRI findings of BME in asymptomatic athletes should be interpreted with caution.

Fourth metatarsal basis stress fracture after steroid use secondary to COVID-19

Joint Diseases and Related Surgery (JDRS), the official journal of the Turkish Joint Diseases Foundation, is an international, peer-reviewed, immediate open access journal. All published articles in JDRS has been free for everyone, without embargo, since 1990.

Calcitonin Gene-Related Peptide in Charcot Foot Neuroarthropathy

Category:Basic Sciences/Biologics; DiabetesIntroduction/Purpose:Charcot neuroarthropathy (CNA) is a destructive joint condition secondary to neuropathic deficiency. For more than a century, the pathogenesis of CNA has been interpreted as unprotected injury and/or uncontrollable inflammation in a neuropathic joint, with little understanding its cellular and molecular pathology. Histologically, a hallmark of CNA is bone and cartilage fragments engulfed by hyperplastic synovium. Synovium is richly innervated. Neuropeptides, such as calcitonin gene- related peptide (CGRP), are secreted by neuronal and non-neuronal cells of the nervous, endocrine, and immune systems, and regulate inflammation. This study investigated the expression of CGRP in the synovial samples collected from CNA and non-CNA joint conditions, and the effects of CGRP on the proliferation and collagenolysis of fibroblast-like synoviocytes (FLS) isolated from CNA synovium in vitro.Methods:For this study, six CNA and 14 non-CNA synovial samples were collected during foot and ankle surgery. The donors included 10 male and 10 female, age from 14 to 79 years (mean 48). The non-CNA conditions consisted of osteoarthritis, ankle instability, Os Trigonum and osteochondritis dissecans.Western blot and immunohistochemistry of CGRP were performed to detect and localize CGRP expression in the CNA and non- CNA synovium.FLS was isolated from CNA synovium and cultured with, or without, human CGRP (10nM) in the culture media, for comparison of cell proliferation. Additionally, FLS were seeded on the collagen-coated 24-well plate and simulated with CGRP (10nM) and recombinant human tumor necrosis factor-alpha (TNF-α). After 7 days, the residual collagen on the bottom of the culture plate were stained and imaged for area measurements.Data were analyzed with t test or one-way Analysis of Variance, followed with post hoc Tukey's test.Results:By western blot, there was significant CGRP expression in the CNA synovium (5/6; Fig1). Except of an intense CGRP band in one of the osteoarthritis samples, only recognizable CGRP bands were shown in the samples of other non-CNA conditions. The average density of CGRP (in greyscale) in the CNA group was about 2-fold of that in the non-CNA group (10126 +- 5346 vs. 5377+-3734; p < 0.05). Immunohistochemistry demonstrated intense CGRP staining in the intimal layer of the CNA synovium (arrows) but not in the non-CNA synovium (Fig1). Treated with CGRP, the number of FLS in tissue culture increased. Cell number doubling time was 1.0 day (+-0.4) for the CGRP treated FLS and 2.2 days (+-0.5) for the control (p < 0.05). When the culture media were supplemented with CGRP and TNF-α, FLS eroded a larger area of collagen coating comparing with TNF-α alone in the media (p < 0.05).Conclusion:A knowledge gap in understanding the molecular and cellular pathology of CNA hampers the development of disease-modifying therapies. This study showed an increased CGRP, with a concentration in the intimal layer, in the CNA synovium as compared with the synovium in the non-CNA foot conditions. The increased CGRP expression in CNA synovium may be part of the unbalanced neuropeptide signaling in the neuropathic pathology. Functionally, CGRP stimulated FLS proliferation and degrading collagen in vitro. These effects suggest that CGRP may play a role in bone and joint destruction in the Charcot foot.

Minimally Invasive Management of a Rare Giant Cell Tumor of Talus: A Case Report and Literature Review

Category:Ankle; Hindfoot; OtherIntroduction/Purpose:Giant cell tumor (GCT) of small bones of hand and feet is rare. A benign but locally aggressive neoplasm with a tendency for local recurrence with undifferentiated mesenchymal stromal cells and the presence of abundant, multinucleated giant cells. It occurs in a slightly younger age group with usually an expansile and eccentric epiphyseo-metaphyseal region lytic lesion. A 22 yrs. old patient, presenting as lytic expansile lesion of talus, suspected Giant cell tumor (GCT) of talus preoperatively and intraoperatively and proven subsequently, is presented along with review of literature. This patient is the young and nearly 24th case reported in the literature for GCT of talus.Methods:Author reviewed the literature for the GCT of talus from 1964 to till 2021. The author reported a case of left ankle joint pain and swelling for 6 months in a 22 yrs. old male, which turns out to be aneurysmal bone cyst of talus on radiographs, Computed tomography and aspiration cytology. Campanacci grade II lesion was planned for the curettage and autologous bone grafting.Results:Retrospectively, the intraoperative biopsy confirmed the lesion as giant cell tumor with aneurysmal bone cyst. After 4 years the lesion showed the near complete resolution on radiographs and CT scan. However, because of the historical recurrence and metastasis reports of GCT, author is continuously monitoring patient's ankle with yearly follow up. Author reviwed the literarue for the GCT of talus from 1964 to till 2021. Author found total of 23 reported cases for GCT of talus in literature, out of which 2 cases showed recurrence and distant metastasis to chest which is 8.69 percent of total cases.Conclusion:Author concludes that the Campanacci grade I and II can be managed with mini-open lesional curettage and autologous bone grafting while grade III and IV needed osteotomy, en-bloc excisions and tibio-calcaneal fusion or below knee amputation in recurrent or aggressive lesions. As author found 8.69 percent cases of distant pulmonary metastasis out of total reported cases, he recommends yearly follow up of the lesions and look for distant metastasis in suspected cases.

Comparative Assessment of Hallux Rigidus using Conventional Radiograph and Weightbearing CT

Category:Midfoot/ForefootIntroduction/Purpose:The etiology of hallux rigidus (HR) is not well understood and Its association with first-ray hypermobility, hallux valgus and metatarsus primus elevatus (MPE) has not been clearly proven. MPE, elevated first metatarsal has been a topic of debate since Lambrinudi`s first description. Recent studies have supported MPE in hallux rigidus by measuring with various methods on wightbearing lateral radiographs, but there are limitations of conventional radiography due to variation in X- ray projection and superimposed metatarsals regardless of the methods of measurement. Our objective was to assess MPE and other associated parameters with hallux rigidus via radiography and WBCT for convergent validity and to evaluate the use of classification system used in conventional radiography with WBCT.Methods:This is a single-center, retrospective study from prospectively collected data. 20 symptomatic hallux rigidus patient with weightbearing radiograph and WBCT were enrolled from October 2014 to December 2020. Measured parameters included hallux valgus angle (HVA), intermetatarsal angle (IMA), hallux interphalangeal angle (HIPA), distal metatarsal articular angle (DMAA), 1st TMT joint version, First and second metatarsal lengths, Metatarsus adductus angle, 2nd cuneiform-2nd metatarsal angle, Talus-1st Metatarsal Angel, First and second metatarsal declination angles, and MPE. MPE was measured as the direct distance between 1st and 2nd metatarsals (modified Horton index). All patients were graded according to the radiographic criteria of Coughlin and Shurnas classification on radiographs and WBCT, separately. Paired T-test was performed to compare radiographic measurements with WBCT.Results:Mean age was 55.9, 12 males and 8 females. HVA (15.73 in X-ray vs 14.04 in WBCT), AP first TMT version (16.25 vs 16.47), 2nd cuneiform-2nd metatarsal angle (24.54 vs 26.60), Talus-1st Metatarsal Angel (-7.67 vs -7.89) were not different between radiograph and WBCT. MPE was measured higher in WBCT by 0.86 mm compared to radiograph. First metatarsal declination angle was lower in WBCT by 2.9° indicating increased MPE. When graded with radiographic findings, 5 (25%) patients were grade 1, 5 (25%) patients were grade 2 and 10 (50%) grade 3, when graded with WBCT, 1 (5%) patient had grade 1, 3 (15%) patients were grade 2 and 16 (80%) grade 3. Dorsal subluxation/translation of first metatarsal at first TMT joint was observed 3 (15%) in radiograph and 9 (45%) in WBCT.Conclusion:HVA, AP first TMT version, 2nd cuneiform-2nd metatarsal angle, Talus-1st Metatarsal Angel demonstrated consistent measurements in radiograph and WBCT. MPE was measured higher in WBCT when measured with direct distance (0.86 mm) between the first and second metatarsals using modified Horton index and first metatarsal declination angle (2.9°). When graded with WBCT, the subchondral cyst in the proximal phalanx and metatarsal head were better delineated leading to higher grade in WBCT. Further studies are needed for inter-rater reliability and discriminant validity of the measurements determined by differences between different groups (HR vs control).

The Metatarsal Cortical Index as an Indicator of Insufficiency Fracture of the Foot

Category:Basic Sciences/Biologics; Midfoot/ForefootIntroduction/Purpose:The diagnosis of metatarsal stress fractures is challenging. Standard imaging often shows false negative results. The aim of this study was to create reliable radiologic outcome parameters to predict insufficiency fractures of the metatarsalsMethods:We performed an age- and sex-matched case-control study of patients with (n = 18) and without insufficiency fracture (n = 18) of the foot. To measure the ratio between the outer cortical border and the endosteal diameter, the MCI was developed as a novel radiographic measurement on dorsoplantar images. The MT was divided into thirds, and the width from the outer cortical border to the endosteal diameter was measured at the junction of the proximal to the middle third (proximal), at the midshaft (middle), and at the junction of the middle to the distal third (distal). The metatarsal cortical index (MCI) for each metatarsal was developed to predict an insufficiency fracture. The MTs were sequentially numbered as MT I-V. To correct for potential bias due to MT length, the Coughlin index and Maestro method were used in all patients.Results:The MCI of each metatarsal was significantly decreased in the insufficiency fracture group compared with the control group (p <.01). The MCI of the fourth ray yielded the highest area under the curve among the analyzed MCI values (area under the curve, 0.79; 95% confidence interval, 0.61-0.90). A cut-off value of 1.62 for the MCI of the fourth ray yielded a sensitivity of 78% and a specificity of 78% to predict insufficiency fracture of the foot (odds ratio, 12.25; 95% confidence interval, 2.54-58.97), and enabled accurate allocation to the insufficiency fracture group versus the control group in 74% of cases.Conclusion:A decreased MCI is associated with metatarsal insufficiency fractures and enables an accurate diagnosis in three out of four cases. Despite the highly variable anatomy and morphology of the MTs, we were able to show that the MCI is a reliable tool to determine insufficiency fracture of the MT on plain radiography. The MCI might aid clinicians in identifying insufficiency fracture, and raise the suspicion of the diagnosis without additional imaging studies.

Efficacy of enhanced Escherichia coli phytase on growth performance, bone quality, nutrient digestibility, and metabolism in nursery pigs fed corn-soybean meal diet low in calcium and digestible phosphorous.

Efficacy of Escherichia coli phytase (ASP) was evaluated in nursery pigs fed low Ca and digestible P corn and soybean meal diet. Piglets were weaned on day 21, fed a common commercial starter diet for 7 d, and assigned to pens (4 pigs/pen: 2 ♀ and 2 ♂) based on day 7 BW. Positive control (PC) and negative (NC) diets were formulated with similar energy and nutrients with exception of total Ca, total P, and digestible P concentrations being 79%, 67%, and 55% that of PC diet, respectively. Two other diets were formulated by adding ASP in NC at 500 and 1,000 FTU/kg. All diets had 0.2% TiO2 indigestible marker. The diets were allocated to pens to give 6 replicates per diet and fed for 42 d. Feed intake and body weight were monitored at 14-d intervals. On day 42, 1 pig/pen was bled and euthanized to access blood and tissue samples. Analyzed total Ca and P in NC diet was 71% and 69% of concentration in PC diet. Recovery of phytase in pelleted diets was 66.2% and 73.5% for NC+500 FTU/kg and NC+1,000 FTU/kg diets, respectively. Between days 15 and 42, pigs fed NC diet grew slower and ate less feed than pigs fed the other diets. Overall (days 0–42), phytase in NC increased (P ≤ 0.05) ADG linearly and quadratically. On day 42, pigs fed PC, NC+500 FTU/kg, and NC+1,000 FTU/kg were +6.1, +5.9, and +7.1 kg heavier (P < 0.05) than pigs fed NC, respectively. Pigs fed PC and NC plus phytase exhibited higher (P = 0.003) G:F relative to NC pigs between days 15 and 28. Pigs fed NC diet had lower (P < 0.001) plasma P concentration, apparent total tract digestibility (ATTD) of Ca and P, and metacarpal and metatarsal bone attributes than pigs fed any other diets. Supplementation of phytase in NC linearly increased (P < 0.05) plasma P concentration, ATTD of Ca and P, and bone attributes. Specifically, phytase increased (P ≤ 0.025) dry weight, length, and ash weight in metacarpals and metatarsals. In conclusion, low total Ca and digestible P diet depressed growth and P utilization in piglets. Supplemental phytase improved performance in pigs fed NC linked to enhanced nutrients uptake and metabolism commensurate to pigs fed adequate total Ca and digestible P from inorganic source.

A Case Report of Giant Cell Tumor of Bone Most Likely of Metatarsal Bone

A Case Report of Giant Cell Tumor of Bone Most Likely of Metatarsal Bone

Five-Year Prospective Roentgen Stereophotogrammetric and Clinical Outcomes of the BioPro MTP-1 Hemiarthroplasty.

Mixed results for functional outcomes and long-term fixation have been reported for first metatarsophalangeal arthroplasty. This prospective study was designed to evaluate the migration of the BioPro metatarsophalangeal-1 (MTP-1) joint hemiprosthesis with Roentgen stereophotogrammetric analysis (RSA). Migration patterns of the prosthesis, prosthesis-induced erosion of the metatarsal bone, and clinical outcomes were evaluated sequentially to 5 years postoperation (PO). Eleven female patients received the BioPro-1 hemiprosthesis. Prosthesis translation and metatarsal erosion were measured with RSA at immediately PO, 6 weeks, and 3, 6, 12, 36, and 60 months postoperatively. Clinical assessment was done by patient questionnaires. RSA data of 9 patients were available for analysis. Median (range) number of markers used in RSA analysis, condition number, and mean error of markers around the prosthesis were 4 (3-7), 320 (208-862), and 0.13 (0.02-0.28), respectively. Progressive subsidence was seen up to 3 years PO (mean 2.1 mm, SE 0.32). Progressive metatarsal erosion was found from 1 year PO (mean 0.49 mm, SE 0.15). Pain, function, and quality scores improved after surgery and did not deteriorate at later follow-up moments. Model-based RSA of the BioPro-1 prosthesis shows nonstabilizing medial and distal translation and metatarsal erosion. Despite the measured migration and erosion, clinical outcomes improved and remained similar up to 5 years postoperation. Level II, prospective analysis of MTP-1 hemiprosthesis.

Effect of the manual stretching maneuver for hallux valgus

BackgroundHallux valgus (HV), which is one of the most common musculoskeletal abnormalities of the foot, is defined as the medial deviation of the first metatarsophalangeal (MTP) joint and the lateral deviation of the great toe. ObjectsThis study aimed to investigate the immediate effects of a manual stretching maneuver (MSM) in subjects with HV. MethodsTwenty-five subjects with a total of 25 feet with mild HV participated in the study. The MSM, consisting of global stretching of the foot and toes, traction of the hallux, local stretching for hallux, and mobilization of the MTP joint of the hallux. The HV angle between the line of the first metatarsal bone and the proximal phalanx were measured using a goniometer. The cross-sectional area (CSA) of the AbdH was measured using ultrasonography. Zebris FDM was used to measure the static plantar pressure and the movement of the center of pressure (COP) standing on one foot. The dependent variables before and after treatment were compared using paired t-tests. The significance level was set at .05. ResultsThe HV angle significantly decreased from 20.25° to 16.96°. The CSA of the AbdH significantly increased from 14.00 mm2 to 16.11 mm2. The peak pressure on the hallux and 1st, 2nd and 3rd metatarsals increased significantly. The contact area and total pressure on the hallux significantly increased. The sway of the COP on the length of the minor axis and velocity significantly decreased. ConclusionThis study suggests that the MSM can be effective in decreasing the HV angle in subjects with mild HV. However, further longitudinal clinical studies are required to investigate the long-term effects of the MSM in subjects with HV.

Forensic DNA Typing From Femurs and Bones of the Foot: A Study of 3 Cases.

Evidence has been accumulating in the sense that femur may not always be the best option for DNA typing of skeletal remains. Recent studies have shown that bones of the hands and feet appear to be a superior source of preserved DNA. The current study reanalyzed DNA quantitation, degradation, and short tandem repeat typing in femurs, lateral cuneiforms, and distal foot phalanges. Data from 3 human identification cases involving corpses in an advanced decomposition state were collected. We found that in the studied cases, the femur provided equal or inferior results, recovering 84.9% of true alleles. Lateral cuneiforms (99.2%) and distal foot phalanges (96.8%) yielded higher percentages. In addition, more drop-ins and drop-outs were detected in femurs than cuneiforms and phalanges. This study adds to current findings that advocate for further investigation into bone selection for use in forensic practice. The impacts of our findings are limited by the small number of individuals studied and may not apply to old and degraded bones.

Hallux rigidus: clinical examination, radiology, and classification

The severity of hallux rigidus depends on the degree of joint involvement, from local pain to stress fractures of other bones of the foot due to hyper-support. Radiology is mandatory to have an accurate diagnosis and gives us a parameter of joint injury. We use the Coughlin and Shurnas classification as the gold standard for treatment. Level of Evidence IV.

Central polydactyly of the foot: An experience of a treatment of 22 patients

BackgroundThe central polydactyly of the foot is a rare congenital disorder, and its characteristics are not well known. This study aims to investigate its disease concept. MethodsWe obtained the medical records of patients who were treated surgically for central polydactyly of the foot at our hospital during a 32-year period from 1990 to 2021 retrospectively. We compared our clinical data with other case series reports to investigate the characteristics of this disorder further. ResultsThere were 22 patients (13 males and 9 females) included in our case series. Unilateral and bilateral involvements were observed in 19 (right side: 6 patients; left side: 13 patients) and 3 patients, respectively. The second toe is the commonest duplicated toe (observed in 19 toes). 19 patients had distally duplicated toes (with normal metatarsal bone). Proximally duplicated toes were observed in only two patients. ConclusionsThe incidence of central polydactyly of the foot is almost equal among male and female, and bilateral involvements are few. As this abnormality is rarely reported, further investigations are needed to clarify the clinical presentation of central polydactyly of the foot.

The improved approach to the development of parameters for the inner shape of military boots

In the work, anthropometric studies of the feet were performed by means of 3D scanning. The results of scanning have been used for two main purposes. Firstly, the features and morphological structure of the feet of young men aged 20-30 were studied, who are the representatives of the Ukrainian population that are subject to mobilization into the ranks of the Armed Forces. Apart from this, the quantitative distribution of the main morphological features of the feet of the sample population was analyzed. During measurements, it was noticed that a large number of men had hypertrophy of the heads of the 1st and 5th metatarsal bones. In order to rationalize the range of lasts with different sizes and fullness, while trying to fully satisfy the requirements of compliance with the anthropometric parameters of the feet of consumers, the parameters of the feet with the hypertrophy of the heads of the 1st and 5th metatarsal bones must be taken into account in the lasts with increased width. Furthermore, the results of scanning constitute the basis for calculating and developing basic parameters of lasts. For this, the work suggested the method of designing a last shape based on such types of input data as a digital foot model, dimensional foot parameters, and a foot print obtained as a result of mass 3D scanning of the feet.