Cuneo-metatarsal Joint Research Articles

First Cuneo-Metatarsal Arthrodesis (Modified Lapidus) with Plantar Plate for the Treatment of Hallux Valgus: Clinical and Radiological outcomes at One Year Follow-up

IntroductionThe modified Lapidus arthrodesis, involving the first cuneo-metatarsal joint, is a well-established surgical method and widely utilized for treating moderate to severe hallux valgus deformities with hypermobility in the first tarsometatarsal joint. The purpose of this study was to assess the rate of union following the Lapidus procedure using a plantar plate and an immediate full weight-bearing protocol. Secondary objectives included examining radiological corrections and potential associated complications. MethodsA retrospective study included 66 patients (80 feet) who underwent a modified Lapidus procedure for the treatment of hallux valgus associated with hypermobility of the first ray, performed by a single senior surgeon at our institution between May 2013 and November 2019. All patients had a minimum follow-up of 12 months. Patients were clinically assessed at 3 weeks, 3 months, and 1 year. Radiological measurements were taken on weight-bearing dorsoplantar views preoperatively, at 3 months, and at 12 months postoperatively. ResultsBone union was achieved in 79 cases (98.75%). There was one case of non-union, two wound complications (one infection and one dehiscence), two cases of symptomatic hardware requiring hardware removal, and one stress fracture associated with recurrence of hallux valgus that required revision. The mean hallux valgus angle (HVA) improved from 30.5 ° ±10.4 ° to 10.1 ° ±6.6 ° (p < .001), the mean intermetatarsal angle (IMA) improved from 13.4 ° ±3.6 ° to 5.6 ° ±2.9 (p < .001), The average sesamoid position improved from stage 5.9 ± 1.6 to stage 2.6 ± 1.2 (p < .001). The mean shortening of the first metatarsal was 3.6 mm ± 1.8. There was no significant difference between measurements at 3 and 12 months postoperatively. ConclusionModified Lapidus with a planter plate and compression screw is a reliable method of fixation with a high union rate, permit an immediate protected weight bearing and a low complications rate. Level of evidenceIV; Retrospective study

High-Heel Wearing Does Not Change The Forefoot Alignment In Non-Frequent Users Without Hallux Valgus: 3D Weight-Bearing Scan Study

Category: Lesser Toes; Midfoot/Forefoot Introduction/Purpose: Women wearing high heels for 20 years without Hallux valgus angle alterations make it debatable that causes Hallux valgus deformation. A recent systematic review determined that 4.13 ± 0.34 cm of heel height would improve foot weight-bearing . Wearing high heels would realign the foot, causing an inversion of the foot, which locked the navicular-cuneiform and cuneo-metatarsal joints rather than primarily rotate the metatarsophalangeal joint. Nowadays, weight-bearing scans could favor understanding the alignment mechanism involved in the foot and ankle with different shoe heights. Therefore, we aimed to determine the acute foot alignment in non-frequent HH users without Hallux valgus during stand posture. Here, we hypothesize that high heels studied by weight-bearing scans shows radiology changes linked to hindfoot alignment rather than primary forefoot rotation. Methods: This comparative cross-sectional study, participants were randomly submitted to a tridimensional weight-bearing CT. Foot alignment for barefoot and wearing custom high heels of 3, 6, and 9 cm. Forty-one feet from twenty-one participants (11 males and 10 females, aged 30.8 ± 8.9 years, and Body Mass Index 25.5 ± 2.0 m kg-2) were submitted to a tridimensional weight- bearing scan in barefoot and wearing high heels of 3, 6, and 9 cm. The inclusion criteria were: Aged between 20 and 50 years, and no regular wearing of heels.Participants were instructed to bear weight in their regular standing upright posture, dispensing the body weight uniformly between the lower limbs with the feet set at shoulder width. Declination talar, forefoot arch, foot ankle offset, 1st, 2nd, and 3rd metatarsophalangeal dorsiflexion, and metatarsal rotation and sesamoid rotation angles were compared with repeated measurement analysis and multiple comparisons as well as the raters intraclass coefficient. Results: When height increases, the declination talar angle decrease (p &lt; 0.001), the foot ankle offset decreases (p &lt; 0.001), the 1st, 2nd, and 3rd dorsiflexion angle increases (p &lt; 0.001), and metatarsal rotation angle (p=0.696) and sesamoid rotation angles (p=0.649) did not change. The forefoot arch for 6 cm was higher than 3 cm (p &lt; 0.001) and then 9 cm (p=0.001), and the forefoot arch for 9 cm was higher than 3 cm (p=0.049). Conclusion: The main finding was that increased forefoot arch, lower ankle offset, no metatarsal rotation angle, and no sesamoid rotation angle strongly suggest an acute primary hindfoot alignment adaptation mechanism rather than forefoot rotation with increase of heel heigth. The most critical mechanism combines the activation of the windlass mechanism together with a stiffer alignment of Hindfoot. Our interpretation here is supported by the lower FAO, and increased forefoot arch and metatarsophalangeal joints, giving insight into pathology foot deformation like Hallux valgus. Thus, our findings suggest that it is debatable that wearing high heels can trigger forefoot deformity,

Classification of the interosseous tarsometatarsal ligaments of the foot

BackgroundThe aim of this study was to clarify the anatomical features of the interosseous tarsometatarsal ligaments of foot and to classify their types based on the combinations of their ligamentous components. MethodsFifty feet from 27 adult Korean cadavers were dissected. ResultsThe interosseous tarsometatarsal ligaments were observed in the first, second, and third cuneometatarsal joint spaces. The interosseous tarsometatarsal ligament of the first cuneometatarsal space consistently connected the medial cuneiform and the second metatarsal, and was accompanied by one or two accessory ligaments above (34%) and/or below (6%) the Lisfranc ligament. The interosseous tarsometatarsal ligaments of the second and third cuneometatarsal joint spaces comprised seven and five components, and were classified into five and three types depending on the number and combination of the components, respectively. ConclusionsThese results are expected to advance the current knowledge on the tarsometatarsal joint and provide helpful information for more accurate and successful diagnosis and treatment of lesions at this joint.

Manejo de las complicaciones del hallux valgus

The first metatarsal is often deviated in varus from the axis of the second metatarsal, rotated on its longitudinal axis and often shorter than the second. The first x-ray may show a valgus deviation at the level of the interphalangeal joint, a deformity known as interphalangeal hallux valgus.Varus deviation is observed in the cuneo-metatarsal joint and a valgus deviation is observed in the distal joint facet of the metarsophalangeal.There are changes in the soft tissues surrounding the MT-F joint. The medial capsule is attenuated and the lateral contracted. Tendons flexors and extensors are laterally aligned by the valgus of the phalanx. When the tendons contract, the deformity increases.The abductor muscle of the hallux is placed plantarly, and the adductor with its two insertions in the lateral sesamoid moves to the first intermetatarsal space, altering its articulate relation with the metatarsal head.All these described deformities vary in intensity, and increase if the patient presents with joint hypermobility or severe pronation of the foot.

Sesamoid complex angle correction after arthrodesis of the first cuneometatarsal joint in the treatment of hallux valgus

Objective: To evaluate the degree of sesamoid complex correction in patients with moderate and severe hallux valgus undergoing cuneometatarsal arthrodesis by comparing general pre- and postoperative values and also post-reduction outcomes between moderate and severe cases. Methods: The radiographs of 24 patients (83.3% females and 16.7% males) who underwent arthrodesis of the first cuneometatarsal joint wereretrospectively analysed. The patients’ mean age was 52.58 years. The metatarsophalangeal, intermetatarsal and sesamoid dislocation angles were measured on the preoperative and immediate postoperative radiographs, with the former measured in the standing position and the latter measured intraoperatively, all in the anteroposterior incidence. The first metatarsal lateralization necessary to centralize the sesamoids wasmeasured in degrees. We refer to this angle as the “angle to be corrected”. Results: We achieved sesamoid dislocation correction, reducing the indicated angles in relation to their preoperative values. Both moderate and severe cases showed statistically significant differences in angular correction after surgery, with p=0.018 and p&lt;0.001, respectively. Comparing the moderate and severe cases, a statistically significant difference was observed preoperatively, with p=0.007; however, the results were not statistically significant postoperatively (p=0.227). Conclusion: We achieved effective correction of the ABC in terms of both the total patient sample and the isolated analysis of the moderate and severe groups. Preoperatively, the moderate cases had smaller angles than the severe cases, but both groups exhibited reductions in these angles in the postoperative period and had similar outcomes.&#x0D; Level of Evidence III; Retrospective Study.

Non-restricted weight-bearing after modified Lapidus arthrodesis

Category: Bunion, Midfoot/Forefoot Introduction/Purpose: Modified lapidus arthrodesis is performed in the treatment of different pathologies, including hallux valgus and osteoarthritis of the first cuneo-metatarsal joint. Complications of this procedure include delayed union and non-union, reported to be between 5 to 20%. To prevent them, prolonged foot unloading and rigid fixation methods have been proposed. We sought to investigate our clinical results and complications in patients operated on with a modified Lapidus arthrodesis and inmediate weight bearing in a rigid post-operative shoe. Methods: After IRB approval, we conducted a retrospective patient chart review in a single center. Dedicated foot and ankle orthopaedic surgeons performed all procedures. Patients were included if they were older than 18 years, had a minimum follow up of one year and agreed to participate in the study. Patients with neuropathy, revision arthrodesis or those with concomitant midfoot/hindfoot procedures were excluded. All patients were operated on with an inter-articular lag screw and a locking neutralization plate. Patients were allowed to weight bear without restriction in a rigid post-operative shoe from postoperative day one. An independent musculoskeletal radiologist evaluated bone consolidation of the arthrodesis in x-rays or CT scan, when available. Results: Fifteen patients (18 feet) with an average age of 47 years (15-66) met inclusion criteria. All patients were female. Mean follow up was 19 months (12-24). Surgical indications were: hallux valgus in 14 cases and cuneo-metatarsal osteoarthritis in one case. Consolidation rate was 94% (14/15). Average time for radiological consolidation was 11 weeks (7-27). One patient (6%) developed non-union and required a revision arthrodesis with bone grafting. No loss of radiological correction or malalignment of the first ray was observed at last follow-up. Conclusion: Our results suggest that modified lapidus arthrodesis with rigid fixation methods and non restricted weight bearing is a safe and effective alternative to manage first ray pathology. This approach may not increase non-union rates or affect the reduction obtained.

Joint-specific distance thresholds for patient-specific approximations of articular cartilage modeling in the first ray of the foot.

The addition of cartilage elements in a finite element model prevents bone-on-bone articulation during simulation, thus providing more accurate information about joint kinematics. We present a semi-automated method for identifying joint articulation surfaces and creating volumetric articular cartilage elements based on patient-specific bone information. The approach identifies contact surfaces based on a joint-specific, user-specified distance threshold criterion applied to a polygonized set of bones. Volumetric cartilage elements are generated using half of the minimum inter-joint distance. We present the method and then apply it to the first ray of the human foot, which includes the medial cuneiform, first metatarsal, and first proximal and distal phalanges. Distance thresholds for the first ray ranged from 3.0 to 4.25mm depending on the joint and the desired contact surface coverage. Inter-joint distances were found and applied to the contact surfaces to generate uniformly thick cartilage models. Average inter-joint distances of 0.46, 0.72 and 0.51mm were foundfor the first interphalangeal, metatarsophalangeal, and cuneometatarsal joints, respectively. The values cited are one half of the minimum inter-joint difference, as identified by the proximity algorithm. This is taken to represent the (uniform) cartilage thickness at each joint.

Patterns of joint involvement in foot osteoarthritis: findings from the clinical assessment study of the foot

Patterns of joint involvement in foot osteoarthritis: findings from the clinical assessment study of the foot

Clinical recognition of symptomatic midfoot osteoarthritis: findings from the clinical assessment study of the foot

s / Osteoarthritis and Cartilage 22 (2014) S57–S489 S386 685 CLINICAL RECOGNITION OF SYMPTOMATIC MIDFOOT OSTEOARTHRITIS: FINDINGS FROM THE CLINICAL ASSESSMENT STUDY OF THE FOOT M.J. Thomas y, E. Roddy y, T. Rathod y, A. Moore y, H.B. Menz yz, G. Peat y. yKeele Univ., Staffordshire, United Kingdom; z La Trobe Univ., Melbourne, Australia Purpose: Osteoarthritis (OA) is a common yet poorly understood cause of disabling foot pain. In the absence of radiographic confirmation of OA, clinical diagnosis in primary care is inhibited by lack of evidence informing clinical examination. This study aimed to determine whether the presence of symptomatic midfoot OA (SMOA) can be clinically identified in older adults with midfoot pain presenting to primary care. Methods: A diagnostic model using brief clinical assessments was developed using cross-sectional data from 274 adults aged 50 years who had self-reported midfoot pain in the last month and attended a research assessment clinic between 2010-2011. All clinical assessment data were collected by trained physiotherapy or podiatry assessors adhering to a standardised, quality-controlled protocol. Presence of radiographic midfoot OA in at least one of four scored joints (1st and 2nd cuneo-metatarsal joint, navicular-first cuneiform joint, and talonavicular joint) was ascertained by a single reader using a validated atlas and scoring system, and who was blinded to the clinical assessment data. Radiographic OA was defined as a score of 2 for osteophytes or joint space narrowing on either weight-bearing dorso-plantar or lateral views. SMOAwas defined as co-occuring radiographic OA and midfoot pain. One foot per participant was entered into the analysis. The selection of predictor variables was based on known associations with OA or mechanically-driven putative links to SMOA. Significant predictor variables (p<0.25 from likelihood ratio tests) from univariable analyses were simultaneously entered into a multivariable logistic regression model and backward elimination (p1⁄40.05) was performed. The Hosmer-Lemeshow statistic assessed the calibration of the refitted model and the area under the curve (AUC) evaluated discrimination. Histograms visually summarised discrimination. Internal validation of the model was performed using 1000 bias-corrected bootstrap samples with replacement. Results: 274 participants without inflammatory disease comprised 125 men and 149 women (mean age 65 yrs, SD 9). Of these 155 had midfoot pain and 119 had SMOA. 16 univariable analyses identified 9 significant predictors and no collinearity was observed. In addition to forceentered variables (age, gender, body mass index (BMI)), only two independent predictors of SMOA were retained in the multivariable analysis: (i) reduced ankle dorsiflexion with the knee flexed and (ii) absence of a midfoot exostosis. Based on the strength of univariable association, the Foot Posture Index, subtalar inversion and ankle dorsiflexionwith the knee extended appeared tooweak to contribute to the final model, whereas the removal of the Arch Index and foot lengthcorrected navicular height was due to the stronger influence of age explaining these relationships. The final fitted model was well calibrated (p1⁄40.79) but discrimination was poor (AUC, 0.69; 95%CI: 0.62, 0.75). Bootstrapping revealed a small degree of overfitting. The use of categorical predictor variables in continuous form did not identify any other predictors, nor did it improve model performance. Conclusions: Brief clinical assessments offer only marginal improvement to age, gender and BMI for identifying SMOA. Milder severity in a Table: Associations between baseline MRI sum scores and changes of pain and physi

The population prevalence of symptomatic radiographic foot osteoarthritis in community-dwelling older adults: cross-sectional findings from the Clinical Assessment Study of the Foot

ObjectivesTo estimate the population prevalence of symptomatic radiographic osteoarthritis (OA) affecting the 1st metatarsophalangeal joint (MTPJ), 1st and 2nd cuneometatarsal joints (CMJs), navicular first cuneiform joint (NCJ) and talonavicular joint...

OP0032 Population Prevalence of Symptomatic Radiographic Foot Osteoarthritis in Community-Dwelling Older Adults: The Clinical Assessment Study of the Foot (CASF)

BackgroundSymptomatic osteoarthritis (OA) affects the daily lives of 10% of people aged >60 years. Although foot pain is common, the foot is the least studied joint complex affected by OA....

Axial rotation of the first metatarsal head in a normal population and hallux valgus patients

Does metatarsal pronation exist and, if so, what is its impact? Hallux valgus is a deformity associating angulation and a rotational component. The present study sought to investigate the nature and origin of the coronal plane displacement. A prospective single-center radiological and anatomic study was conducted on 100 feet operated on for hallux valgus. Baseline X-ray determined the preoperative position of the 1st metatarsal head in the coronal plane. The range of motion (ROM) of the cuneometatarsal joint in pronation-supination was measured peroperatively. An anatomic study investigated possible diaphyseal torsion. Mean radiologic pronation in hallux valgus was 12.7° (range, 0°-40°). Cuneometatarsal rotational ROM was determined by adding peroperative ROM in pronation (mean, 9.3°; range, 0°-30°) and in supination (mean, 8.7°; range, 0°-20°). Intermetatarsal divergence showed no correlation with radiologic pronation or ROM in pronation. Radiologic pronation showed no correlation with peroperative ROM in pronation. Pronation of the metatarsal head was never observed without associated sesamoid pronation; the latter, however, was in some cases observed without the former. Twenty randomly selected metatarsal cadaver specimens from the anatomy laboratory of the University of Nice (France) showed diaphyseal torsion in 80% of cases, with the metatarsal head in neutral position or in supination with respect to the base. In hallux valgus, 1st ray pronation appears to be systematic, in contrast to the typical supination found in the general population. Metatarsal rotation is always associated with sesamoid rotation, whereas the converse is not the case: displacement of the sesamoids appears to displace the metatarsal head via the metatarsosesamoid ligaments. This "drive-belt" effect, however, varies in its mechanical properties and the transmission is imperfect and likely subject to progressive ligament stretching, so that head rotation does not exactly follow and may even become independent of the sesamoid displacement. Radiologic and clinical rotation thus do not match any longer. The anatomic study showed that, while diaphyseal torsion cannot be ruled out, the metatarsal pronation mainly derives from cuneometatarsal joint rotational instability, the evolution of which does not parallel lateral instability, no correlation being found between degree of varus and rotational instability. The present study found metatarsal pronation to be associated with hallux valgus, making a preoperative AP view useful; the underlying mechanism was generally cuneometatarsal instability. Although difficult to specify exactly without correlation between radiological and clinical data, any such pronation raises the question of whether replacing the metatarsal head on its sesamoid supports is sufficient to achieve stability in all planes, or whether on the contrary derotation should be associated to metatarsal valgization osteotomy to restore horizontal support. Level IV.

Hypermobility of the first metatarsal bone in patients with Rheumatoid arthritis treated by lapidus procedure

BackgroundFoot deformities and related problems of the forefoot are very common in patients with rheumatoid arthritis. The laxity of the medial cuneometatarsal joint and its synovitis are important factors in the development of forefoot deformity. The impaired joint causes the first metatarsal bone to become unstable in the frontal and sagittal planes. In this retrospective study we evaluated data of patients with rheumatoid arthritis who underwent Lapidus procedure. We evaluated the role of the instability in a group of patients, focusing mainly on the clinical symptoms and X-ray signs of the instability.MethodsThe study group included 125 patients with rheumatoid arthritis. The indications of the Lapidus procedure were a hallux valgus deformity greater than 15 degrees and varus deformity of the first metatarsal bone with the intermetatarsal angle greater than 15 degrees on anterio-posterior weight-bearing X-ray.ResultsData of 143 Lapidus procedures of 125 patients with rheumatoid arthritis, who underwent surgery between 2004 and 2010 was evaluated. Signs and symptoms of the first metatarsal bone instability was found in 92 feet (64.3%) in our group. The AOFAS score was 48.6 before and 87.6 six months after the foot reconstruction. Nonunion of the medial cuneometatarsal joint arthrodesis on X-rays occurred in seven feet (4.9%).ConclusionThe Lapidus procedure provides the possibility to correct the first metatarsal bone varus position and its instability, as well as providing the possibility to achieve a painless foot for walking. We recommend using the procedure as a preventive surgery in poorly symptomatic patients with rheumatoid arthritis in case of the first metatarsal bone hypermobility.

Coalition of first cuneometatarsal joints: Three cases 2 feet

Coalition of first cuneometatarsal joints: Three cases 2 feet

Corrección del Hallux valgus en metatarso adductus

Background To describe the frequent association of Metatarsus adductus and Hallux valgus in the adult foot as a cause of insufficient correction after application of common surgical techniques. Method and material A retrospective review was made of 16 cases in 15 patients with clinical and radiologic metatarsus adductus operated by Hallux valgus from 2006 to 2008. In all cases, a correction of the deformity lower than 10° was observed. Results The mean postoperative correction was 9°. The mean inclination of first cuneometatarsal joint was 65°. We did not find any relationship between Metatarsus adductus magnitude and postoperative Hallux valgus correction. The best results were observed with Scarf Osteotomy. Discussion There is controversy on the Metatarsus adductus and Hallux valgus relationship. Although poor application of the surgical techniques is the most important cause of correction failure, the limited literature references and the comparison with similar results, may show this association as a cause of the difficulty in the application of conventional surgical techniques. Poor performance of these techniques is an important cause of correction failure and must be evaluated. Conclusion Metatarsus adductus in the adult foot with Hallux valgus to be operated must be detected and seen as a deformity that is difficult to correct. Preoperative planning and choice of surgical technique must assess these angular deformities to avoid a poor result for the patient.

Radiographic evaluation of foot osteoarthritis: sensitivity of radiographic variables and relationship to symptoms

To evaluate a radiographic atlas for grading foot osteoarthritis (OA) in relation to the relative sensitivity of different radiographic and views and features, and to examine the relationship between radiographic OA and foot symptoms. Weightbearing dorso-plantar (DP) and lateral foot radiographs were obtained from 197 people (126 women and 71 men) aged 62-94 years (mean age 75.9, standard deviation [SD] 6.6). The prevalence of OA in five joints (the first metatarsophalangeal joint [1st MPJ], the first cuneo-metatarsal joint [1st CMJ], the second cuneo-metatarsal joint [2nd CMJ], the navicular-first cuneiform joint [N1st CJ] and the talo-navicular joint [TNJ]) was then determined using both views in combination (as recommended in the atlas), or by using either view in isolation. Associations between radiographic OA in individual foot joints and symptoms were then explored. Joint-specific prevalence of OA using both DP and lateral views was 1st MPJ (42.4%), 1st CMJ (22.6%), 2nd CMJ (60.2%), N1st CJ (39.1%) and TNJ (32.7%). Using only the DP view detected almost all cases of 1st MPJ OA (94.6%), however, the sensitivity was lower for the other joints (31.0-60.7%). Using only the lateral view detected almost all cases of OA (83.8 to 86.9%), with the exception of the 1st MPJ and 1st CMJ (50.9% and 60.7%, respectively). Using either osteophytes (OP) alone or joint space narrowing (JSN) alone showed low sensitivity for all joints (14.3-63.0%), with the exception of OP alone in the DP view for the 1st MPJ and JSN in the lateral view for the 2nd CMJ (83.8% and 84.0%, respectively). Radiographic OA in individual foot joints and the total number of joints affected were both moderately associated with foot symptoms. Epidemiological and clinical studies should incorporate observation of both OP and JSN from both DP and lateral views to determine the presence of OA in the foot, as the number of cases detected is reduced if only one radiographic feature or view is used. Radiographic foot OA is common in older people and is moderately associated with foot symptoms.

Behavior of the first cuneiform in the surgical correction of metatarsus adductus

Purpose Metatarsus adductus is an adduction deformity of the forefoot. Our purpose is to uphold the claim that the main anomaly is to be found on the cuneiform side of the cuneo-metatarsal joint and that the growth of the medial cuneiform is fundamental for correction further to capsulotomy. Materials and methods This is a radiological study of 23 children with idiopathic or clubfoot-related metatarsus adductus subjected between 1982 and 2000 to a release of the cuneiform metatarsal joint. X-rays were taken of the 30 operated feet and of 12 contralateral feet used as controls. The following measurements were made: cuneiform-metatarsal angle, distal inclination angle of the medial cuneiform bone, angle formed between the latter surface and the first metatarsal and the proximal articular angle of the first metatarsal. The mean pre-op, immediate post-op and post-op final values of these angles were compared using the relevant statistical tests. Results As regards idiopathic metatarsus adductus, the cuneiform metatarsal angle went from a preop value of 150.4° to 170.2° at the end of follow-up; the distal inclination angle of the medial cuneiform went from 62° to 81.1°; and the angle formed between the latter surface and the first metatarsal and the proximal articular angle of the first metatarsal went from 88.4° to 89.1°. With respect to clubfoot-related metatarsus adductus, the cuneiform metatarsal angle went from a preop value of 155.3° to 169.7°, the distal inclination angle of the medial cuneiform went from 61.9° to 79.7°, and the angle formed between the latter surface and the first metatarsal and the proximal articular angle of the first metatarsal went from 88.3° to 90°. On the healthy side, the angle values showed virtually no changes. Conclusions The obliqueness of the medial cuneiform-metatarsal joint is closely related to metatarsus adductus. Post-surgical correction also takes place at the expense of this bone, which tends to fill the space created by the capsulotomy.

Radiographic classification of osteoarthritis in commonly affected joints of the foot

To develop a radiographic atlas for the classification of osteoarthritis (OA) in commonly affected joints of the foot based on observations of osteophytes and joint space narrowing, and to assess its intra- and inter-examiner reliability. Weightbearing dorso-plantar and lateral foot radiographs from people aged over 65 years were examined, and an atlas was developed incorporating characteristic OA features of five foot joints: the first metatarsophalangeal joint, the first cuneo-metatarsal joint (1(st) CMJ), the second cuneo-metatarsal (2(nd) CMJ), the navicular-first cuneiform joint and the talonavicular joint. To assess the reliability of the atlas, two examiners independently rated 50 radiographs on two separate occasions. Observations using the atlas demonstrated moderate to excellent reliability within examiners (percentage agreement from 86 to 99% and weighted kappa from 0.45 to 0.95), and, with the exception of joint space narrowing of the 2(nd) CMJ from the lateral projection, fair to excellent reliability between examiners (percentage agreement from 86 to 97% and weighted kappa from 0.32 to 0.87). Intra-class correlation coefficients for the overall foot OA score (representing the sum of observations for all joints from both feet) ranged between 0.83 and 0.89 for intra-examiner comparisons, and between 0.72 and 0.74 for inter-examiner comparisons. Radiographic features of OA in commonly affected foot joints can be documented with high levels of agreement within examiners and moderate levels of agreement between examiners. Provided single examiners or consensus gradings are used, the atlas appears to be a useful tool to assist in the standardization of foot OA assessment for epidemiological and clinical studies.

Congenital Metatarsus Adductus in Early Human Fetal Development A Histologie Study

Two feet with congenital metatarsus adductus from fetuses at early development (16 and 19 weeks of gestation) were studied by making serial histologic sections in the horizontal plane of the foot. It was observed that the shape of the medial cuneiform was altered and the first cuneometatarsal joint tilted toward the medial and dorsal directions. The first metatarsal appeared normal, whereas the other metatarsals were deformed in slight adduction at the metaphyseal level. Subluxation at the other cuneometatarsal joints and naviculocuneiform joint was not observed, and the navicular showed no signs of medial or lateral displacement in relation to the head of the talus. No histologic abnormalities of the joint capsules, ligaments, or tendons were observed. On the basis of these pathologic findings, the possibility of a developmental abnormality of the medial cuneiform as a pathogenic factor for the congenital metatarsus adductus deformity should be considered.

The first cuneometatarsal joint exostosis. Clinical and etiological considerations.

The first cuneometatarsal joint exostosis. Clinical and etiological considerations.