Forefoot Width Research Articles

Dynamic tightrope fixation for the correction of the 1,2 intermetatarsal angle in hallux valgus surgery

Introduction Hallux valgus is a common foot deformity that causes forefoot widening, difficulty fitting shoes, bunion pain, and transfer metatarsalgia. Studies have shown that correcting the 1,2 intermetatarsal angle (IMA) can significantly reduce forefoot width and improve symptoms. This study aims to review the radiological and functional outcomes of hallux valgus reconstruction with IMA closure using mini-tightrope suture buttons. Methods A case series of 52 consecutive patients who underwent minimally invasive surgical reconstruction of hallux valgus deformity utilising the dynamic tightrope fixation was included. All patients had >1 year follow-up with interim assessments at baseline, 3 months, 6 months, and 1 year. Primary outcomes included IMA in weight-bearing feet X-rays, and secondary outcomes included the hallux valgus angle (HVA) and clinical function via the Foot and Ankle Outcome Score. Results Based on radiological analysis, the 1,2 IMA and the HVA significantly improved. Clinical function also showed significant improvement in symptoms, pain, activities of daily living, and quality of life subsection. No major intra-operative complications occurred in this series; however, ∼5% of the patients required revision surgery due to a recurrence of the hallux valgus or overcorrection into hallux varus. Conclusion Dynamic tightrope fixation is a simple surgical technique that effectively corrects the 1,2 IMA during hallux valgus surgery.

Effectiveness of minimally invasive treatment of hallux valgus with small incision external articular osteotomy

To compare the effectiveness of small incision external articular minimally invasive osteotomy and traditional Chevron osteotomy in the treatment of hallux valgus. A retrospective analysis was conducted on the clinical data of 58 patients (58 feet) with hallux valgus who were admitted between April 2019 and June 2022 and met the selection criteria. Among them, 28 cases were treated with small incision external articular minimally invasive osteotomy (minimally invasive group), and 30 cases were treated with traditional Chevron osteotomy (traditional group). There was no significant difference in baseline data such as age, gender, disease duration, Mann classification, and preoperative inter metatarsal angle (IMA), hallux valgus angle (HVA), distal metatarsal articular angle (DMAA), forefoot width, tibial sesamoid position (TSP) score, American Orthopaedic Foot and Ankle Society (AOFAS) forefoot score, visual analogue scale (VAS) score, psychological score (SF-12 MCS score) and physiological score (SF-12 PCS score) of short-form 12 health survey scale, and range of motion (ROM) of metatarsophalangeal joint between the two groups ( P>0.05). The incision length, operation time, intraoperative blood loss, intraoperative fluoroscopy frequency, weight-bearing walking time, fracture healing time, and incidence of complications were recorded and compared between the two groups; as well as the changes of imaging indexes at last follow-up, and the clinical function score and ROM of metatarsophalangeal joint before operation, at 6 weeks after operation, and at last follow-up. All patients were followed up 11-31 months, with an average of 22 months. The incision length and intraoperative blood loss in the minimally invasive group were significantly less than those in the traditional group ( P<0.05), and the intraoperative fluoroscopy frequency and operation time in the minimally invasive group were significantly more than those in the traditional group ( P<0.05); but no significant difference was found in weight-bearing walking time and fracture healing time between the two groups ( P>0.05). There was 1 case of skin injury in the minimally invasive group and 3 cases of poor incision healing in the traditional group; all patients had good healing at the osteotomy site, and no complication such as infection, nerve injury, or metatarsal head necrosis occurred. At last follow-up, the imaging indexes of the two groups significantly improved when compared with those before operation ( P<0.05). The changes of DMAA and TSP score in the minimally invasive group were significantly better than those in the traditional group ( P<0.05), and there was no significant difference in the changes of IMA, HVA, and forefoot width between the two groups ( P>0.05). The clinical scores and ROM of metatarsophalangeal joint significantly improved in the two groups at 6 weeks after operation and at last follow-up when compared with preoperative ones ( P<0.05), and the indicators in the minimally invasive group were significantly better than those in the traditional group ( P<0.05). Compared with traditional Chevron osteotomy, small incision external articular minimally invasive osteotomy can effectively improve HVA, IMA, and forefoot width, correct foot deformities, and has less trauma. It can better correct the first metatarsal pronation deformity and restore the anatomical position of the sesamoid bone, resulting in better effectiveness.

Midterm outcomes of the modified Lapidus arthrodesis using the Phantom® Intramedullary Nail System for the treatment of hallux valgus

BackgroundLapidus arthrodesis is one of the most commonly used techniques in the correction of moderate and severe hallux valgus. We analyzed the clinical and radiological outcomes after using the Phantom® Lapidus intramedullary nail to find an effective technique with low complications. MethodsWe retrospectively analyzed data of 52 patients who underwent a modified Lapidus arthrodesis with an intramedullary nail at our center from November 2019 to September 2022. The mean follow-up period was 27 (range, 18–34) months. Clinical results were evaluated using the visual analog scale (VAS), the European Foot and Ankle Society score (EFAS) and the American Orthopaedic Foot and Ankle Society score (AOFAS); three different radiological measures were analyzed. ResultsThe mean AOFAS score increased from 44.8 to 82 points. The mean EFAS score increased from 11.2 to 20.1 points. The mean VAS score decreased by 4.7 points. The mean EFAS Sport score was increased from 9.2 (SD 4.6) to 12.6 (SD 5.4) points. The intermetatarsal angle decreased from 15° to 6.9° and the hallux valgus angle by a mean of 17.9°. The forefoot width reduced from 93.6 to 84.7 mm. All results were statistically significant (p < .001). One case of nonunion was recorded. No implant-related complications were observed. ConclusionsThis device was effective in correcting moderate to severe hallux valgus, with significant patient satisfaction. Its complication rate was not higher than that of other fixation devices. Correct compression of the arthrodesis, absence of extraosseous material, and multidirectional stability are important qualities of this implant for the correct treatment of this pathology. Level of EvidenceLevel IV, retrospective case series

Forensic measurement comparison of foot insole impressions

In forensic podiatry, footprints have been shown to provide a valuable source of discriminatory information. Footprints may be found in various forms, such as bare footprints, sock-clad footprints, or as impressions on insoles within footwear. This study utilized quantitative measures of foot impressions on pairs of insoles from shoes worn by the same person from a population of 31 adults. The measurements were determined by using the Reel method and comprised measurements from the heel to the tips of the toes and width of the ball. The purpose of the study was to assess the margin of error for these measurements to determine whether they were sufficiently accurate for forensic use.A secondary purpose of this study was to determine whether the analyst’s experience or lack thereof in forensic podiatry had an impact on the precision of measurement data. The insole foot impressions were assessed by two podiatrists with forensic podiatry experience in footprint analysis, footprint research, and in using the Reel method of footprint measurement, as well as by three students of podiatric medicine without any such experience. A statistical analysis of the data from the study was performed using SPSS v28 (IBM SPSS Statistics for Windows, Version 28.0. Armonk, NY: IBM Corp). The most reliable measurements were of forefoot width, heel to first toe, heel to second toe, and heel to fourth toe. The greatest variation occurred in the measurements of the heel to the third and fifth toes. The measurements of the forensic podiatrist analysts showed less variability than those of the podiatry students, suggesting that measurement precision is related to the experience of the analyst.

Does Hallux Valgus Correction with Chevron-Akin Osteotomies Reduce the Length of the First Ray

Category: Bunion; Midfoot/Forefoot Introduction/Purpose: Patients who undergo a successful surgical correction of hallux valgus have relieved toe pain and improvements in foot appearance. Prior studies have shown hallux valgus correction using a distal Chevron osteotomy with a concomitant Akin osteotomy has the potential to reduce forefoot width. There are no studies evaluating if similar changes occur in the length of the foot. The objective of this study is to check if similar reduction occurs in the patient's foot length. Methods: The operating room schedule of Dr. Panchbhavi and Dr. Chen were reviewed for Chevron/Akin Osteotomies from 2017-2022. Patient charts were excluded for contaminant operations of the foot. The preoperative and postoperative radiographs were then evaluated by one medical student with oversight from a Board-Certified Foot and Ankle Orthopedic Surgeon. The Hallux Valgus Angle (HVA), Intermetatarsal Angle (IMA), Metatarsal Span (MS), first/second ray of the foot, and difference between first and second ray were all be measured based on predetermined methods. All variables were analyzed utilizing an unpaired t-test. Results: In total 12 Chevron/Akin patients met the criteria. The results indicated that with chevron/akin osteotomy measurements of the foot were affected in HVA, IMA, MS, and length of first ray relative to second ray. The average results for each of these values were a decrease of 9.2 degrees (SD 4.32), 7.93 degrees (SD 4.33), 11.63mm (SD 2.26) respectively. For results of change in difference of first and second ray, average results for those who underwent Chevron/Akin Osteotomy was -2.23mm (SD 2.23, p = 0.0281). Both changes to MS and length were statistically significant (p &lt; 0.05). Conclusion: Our results were consistent with existing evidence, Chevron with contaminant Akin Osteotomy will produce statistically significant changes in width of the foot; however, also a significant decrease in the length of the first ray relative to the second ray. All measurements were done utilizing PACS software and can be reliably used in clinics as a clinical tool to gauge post- operative outcomes alongside providing adequate patient education on the potential changes in foot length and width.

Hallux Valgus Repair with Chevron Osteotomy Significantly Narrows Forefoot Width

Hallux valgus (HV) is a common adult foot deformity. There is uncertainty concerning the effect of HV surgery on foot width. We examined the effect of chevron first metatarsal osteotomy on forefoot width using calibrated pre and postoperative standing radiographs. A retrospective cohort of 50 patients underwent chevron osteotomy HV surgery. All had HVA > 30°, IMA > 11°, DMMA > 3°, >6-month follow-up, and calibrated pre and postoperative standing foot radiographs. Bony width (BW) and soft tissue width (STW) were used to measure the surgery's effect on foot width. Measurements were made preoperatively and 3-6 months following surgery. The study group included 42 women with an average age of 63.4 (±8.3) and a mean BMI of 28.7 (±4.9). Preoperative HVA and IMA were 31.7° (±6.8°) and 13.4° (±2.8°), respectively. Following surgery, HVA and IMA improved significantly, by 15.6° (±5.7°) and 8.7° (±2.3°), respectively. The preoperative average BW was 9.4 cm (±0.6), and the STW was 10.6 cm (±0.7). Following surgery, significant changes in BW and STW were measured, with a mean narrowing of 1.2 cm (±0.4) in BW (p < 0.001) and 0.95 cm (±0.5) in STW (p < 0.001). Paradoxically, an increase in age led to a lower correction of the IMA (p = 0.04, r = 0.57), but higher BW and STW reductions (p = 0.01, r = 0.35 and p = 0.008, r = 0.37, respectively). This study reinforced chevron osteotomy as a valid treatment option that significantly narrows forefoot width; it is thus expected to improve cosmetic outcomes, shoe selection options, and quality of life. This study also found that older age correlates with better forefoot narrowing following hallux valgus repair, possibly due to stiffer soft tissues.

Impact of forefoot width variation on clinical and functional outcomes following the Lapidus procedure.

This study aimed to evaluate the effect of variations in bony and soft tissue foot widths on clinical and functional outcomes after hallux valgus correction with the Lapidus procedure. Forty-three feet in 35 patients with a mean follow-up of 18.5months undergoing the LP were reviewed. Clinical and functional data were assessed with the VAS for pain, AOFAS Scale, LEFS and SF-12 health survey, which is divided into physical and mental health composite scales (PCS-12 and MCS-12). Radiographic analysis of forefoot width was based on bony and soft tissue limits. Intermetatarsal-angle and HV-angle were also assessed. Bony width changed significantly from 95.5mm to 84.2mm (11.8%) and soft tissue width from 107.12mm to 100.84mm (5.86%) (p < 0.001). IMA and HVA improved significantly. Significant clinical and functional improvements were observed, except in MCS-12. In simple linear regression, correlation was found between variations of bony width with Δ-AOFAS and Δ-PCS-12, meaning that as the forefoot narrows, their values increase (p = 0.02 and p = 0.005, respectively). It was also related to Δ-IMA, meaning that the forefoot narrows as these parameters improve (p < 0.001 and p < 0.001). Soft tissue width was related to Δ-PCS-12 and Δ-AIM. In multiple linear regression, the strongest correlation was between bony width variation and Δ-IMA (p = 0.029, r2 = 0.22). Forefoot narrowing was correlated with improved clinical and functional outcomes, as measured by AOFAS and PCS-12. In addition, correction of the radiographic parameters, mainly IMA, reflected on a significant decrease in the forefoot width.

Effects of Toe Separators on Women's Balance, Gait and Plantar Pressure during Walking

&lt;p&gt;目的：本研究旨在佐證穿著市售分趾套對成年女性行走平衡、步態與足底壓力之具體效益，供消費者選購輔具時參考依據。方法：隨機招募40位自願參與的女性受試者，於穿著前、後測量前足寬度，透過足底壓力跑步機收取穿著與未穿著時之最大與最小水平、內外晃動軌跡、整體壓力面積與步幅長、步寬、足部旋轉和擺盪期百分比，將行走速度統一設定為3.8 (km/h)，以成對樣本t檢定考驗赤足與穿著分趾套行走時之前足寬度、水平與內、外軸向壓力晃動軌跡、壓力晃動面積與各項步態參數，接著以相依樣本二因子變異數分析，考驗赤足與穿著分趾套行走時三足區足底壓力差異 (a =.05)。結果：穿著分趾套前足寬顯著大於赤足，然最大、最小水平及內、外軸向晃動軌跡、整體面積、步幅長度、步寬、足部旋轉角度皆無顯著差異，但顯著降低擺盪期百分比。此外，穿著分趾套前足區足底壓力顯小於赤足，壓力峰值皆以中足區最低，其次為足跟區，最高為前足區。結論：分趾套因穿著時僅接觸到前足與腳趾區，故對提供中足區足弓支撐相當有限，在穿著後相較赤足之水平、內、外軸向與整體平衡表現的效果相似，但藉由穿著時提供腳趾區適當的包覆，可協助降低行走過程中前足區壓力峰值。建議女性消費者於行走過程中，若著重降低前足區壓力，則可選購此類分趾套於行走運動前穿著，進而提升運動品質。&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt;&lt;p&gt;Purpose: The purpose of this study was to demonstrate the specific benefits as the references for consumers when purchasing aids. Finding out the influence on the walking balance, gait and plantar pressure while female adult wearing the commercially available split-toe aids. Methods: Forty voluntary female subjects were randomly recruited to measure the before and after of forefoot width. Using the plantar pressure treadmill to collect the maximum and minimum of horizontal, internal and external sway trajectories, overall force area, and the percentages of stride length, stride width, foot rotation and oscillation periods with and without the aids. Using two-way ANOVA to test the differences of plantar pressure (a = .05) between barefoot and walking with a split-toe aids in the three-foot region. Results: The width of the foot with the split-toe aids was significantly larger than that of the barefoot, but there were no significant differences in the maximum and minimum of horizontal, internal and external axial sway trajectories, overall area, stride length, stride width, and foot rotation angle. However, the percentage of swing period was significantly declined. In addition, the plantar pressure in the forefoot area was significantly less than that in barefoot, and the lowest peak rate of pressure was in the mid-foot area, followed by the heel area and the highest is in the forefoot area.The split-toe aids only attaches the forefoot and toe area, so it provides limited arch support to the mid-foot area. As to the horizontal, internal and external axial and overall balance performance is similar to barefoot condition. Conclusion: However, providing the proper coverage of the toe area when wearing the any item, it can help reduce the peak rate of pressure in the forefoot area during walking. It is recommended that female consumers who focus on reducing the pressure in the forefoot area during walking can purchase this type of split-toe aids to wear before doing the walking exercises in order to improve the quality of movement.&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt;

Radiographic Forefoot Width Following Minimally Invasive Chevron Akin Bunionectomy.

Hallux valgus (HV) is a common cause of pain and deformity of the forefoot. Minimally invasive chevron Akin (MICA) bunionectomy is a method for HV correction associated with less pain and swelling, with early return to weightbearing in a regular shoe. The purpose of this study was to determine how the MICA procedure affects forefoot width. Twenty-eight patients (26 female, 2 male; 9 left, 19 right) at a single institution who underwent primary MICA for HV correction by 3 treating surgeons were retrospectively reviewed. Pre- and postoperative hallux valgus angle (HVA), intermetatarsal angle (IMA), distal metatarsal articular angle (DMAA), bony forefoot width, and soft tissue forefoot width were measured by 2 independent observers. Radiographic measurements were calibrated using fifth metatarsal length. Wilcoxon signed rank test compared changes in HVA, IMA, DMAA, and forefoot widths. Pearson correlation coefficient evaluated association between HVA, IMA, DMAA, and changes in forefoot width. At mean follow-up of 5.4 (range 3-13.7) months, bony forefoot width decreased significantly by 3.7 mm (4%, P < .001) and soft tissue forefoot width decreased by 2.5 mm (2%, P < .01). Decrease in HVA was moderately correlated with change in bony forefoot width (r = .38, P < .05) and change in soft tissue forefoot width (r = .45, P < .05). Decrease in IMA was moderately correlated with change in bony forefoot width (r = .45, P < .05) and change in soft tissue forefoot width (r = .44, P < .05). The MICA procedure resulted in modest, yet significant, decrease in both bony and soft tissue forefoot width. Decrease in HVA and IMA demonstrated moderate correlation with changes in forefoot width. Patients can be counseled on these changes leading up to, and after, MICA bunionectomy surgery. Level III, retrospective comparative series.

The interrelationship between three-dimensional foot mobility and bodyweight bearing.

[Purpose] To clarify the three-dimensional nature of foot mobility and its interrelationships within the foot due to bodyweight bearing. [Participants and Methods] Data regarding left foot mobility due to body weight bearing were collected from 31 healthy adults. Foot shape differences while sitting and standing, and their interrelationship were examined. The same examiner reapplied the landmark stickers when misaligned during measurement position changes. [Results] The foot length, heel width, forefoot width, hallux valgus angle, and calcaneus eversion angle were significantly larger in the standing than in sitting position. The digitus minimus varus angle was significantly smaller in the standing than in sitting position. The medial and lateral malleoli, navicular, and dorsum of the foot were displaced medially and inferiorly; the other indices, except for the midfoot, were displaced anteriorly. The interrelationships within the foot showed a positive correlation between the calcaneus eversion angle and the medial displacement of the medial and lateral malleoli, navicular, and dorsum of the foot points. There was a negative correlation between the calcaneus eversion angle and inferior displacement of the medial malleolus, navicular, and dorsum of the foot. [Conclusion] The intra-foot coordination relationship in response to bodyweight bearing was clarified.

Effects of supportive and minimalist footwear on standing balance and walking stability in older women

BackgroundFootwear has been shown to influence balance and is an important consideration in relation to the prevention of falls. However, it remains unclear as to what type of footwear is most beneficial for balance in older people: sturdy, supportive footwear, or minimalist footwear to maximise plantar sensory input. The objectives of this study were therefore to compare standing balance and walking stability in older women wearing these two footwear styles, and to investigate participants’ perceptions in relation to comfort, ease of use and fit.MethodsOlder women (n = 20) aged 66 to 82 years (mean 73.4, SD 3.9) performed a series of laboratory tests of standing balance (eyes open and closed on floor and foam rubber mat, near tandem standing) and walking stability (treadmill, level and irregular surface) using a wearable sensor motion analysis system. Participants were tested wearing supportive footwear (incorporating design features to improve balance) and minimalist footwear. Perceptions of the footwear were documented using structured questionnaires.ResultsThere were no statistically significant differences in balance performance between the supportive and minimalist footwear. Participants perceived the supportive footwear to be significantly more attractive to self and others, easier to put on and off but heavier compared to the minimalist footwear. Overall comfort was similar between the footwear conditions, although the supportive footwear was reported to be significantly more comfortable in the heel, arch height, heel cup, heel width and forefoot width regions. Eighteen participants (90%) reported that they felt more stable in the supportive footwear and 17 (85%) reported that they would consider wearing them to reduce their risk of falling.ConclusionBalance performance and walking stability were similar in supportive footwear designed to reduce the risk of falling and minimalist footwear, although participants preferred the supportive footwear in relation to aesthetics, ease of use, comfort and perceived stability. Prospective studies are now required to ascertain the longer-term advantages and disadvantages of these footwear styles on comfort and stability in older people.Trial registrationAustralian New Zealand Clinical Trials Registry. ACTRN12622001257752p, 20/9/2022 (prospectively registered).

Forefoot width correction in patients with hallux valgus after rotational scarf osteotomy

Objective: Our objective was to compare foot width (bony and soft tissues) in radiological images pre- vs. post-corrective scarf osteotomy in patients with hallux valgus. Methods: We retrospectively performed measurements of forefoot width (both bony diameter and total diameter including soft tissues) on anterior posterior standard radiographs of 30 patients, totaling 42 feet, pre- and postoperatively, at three months. These measurements were performed by two evaluators and their reliability was calculated. Results: Radiologically, preoperative mean of the 1-5 metatarsal bony width was 89.30mm (SD ± 5.8), reduced to 80.42mm postoperatively (SD ± 3.5; p&lt;0.001). Regarding the soft tissue width, preoperative mean was 102.45mm (SD ± 6.4) and postoperative, 98.3mm (SD ± 5.1; p&lt;0.001). The interclass correlation coefficient between both observers was excellent in most measurements (range, 0.884-0.973). Conclusion: We report an objective reduction in forefoot width, in both bony and soft tissue diameter, finding means of 8.88 mm (10%) and 4.12mm (4.1%), respectively, after scarf-Akin osteotomy. Level of Evidence IV; Case Series.

Forefoot Width Correction in Hallux Valgus after Rotational Scarf Osteotomy

Category: Bunion; Other Introduction/Purpose: Hallux valgus is a common deformity represented by a wider forefoot, associated with pain, shoe restrictions, and cosmetic problems. The goal of hallux valgus surgery is to achieve a painless foot by realigning the deviated first ray, thereby reducing friction between bony prominences and regular footwear. There is limited evidence on the effect of osseous procedures after hallux valgus surgery on the width of the resulting foot. Methods: We retrospectively performed measurements of forefoot width (bony and soft tissues) on AP standard x-ray from the first metatarsal head to the fifth metatarsal head, pre-and postoperatively at 3 months. Results: Thirty patients met the inclusion criteria, with a total of 42 feet. Radiographically, the preoperative mean 1-5 metatarsal bony width was 89.30mm SD (5.8) to 80.42mm postoperative SD (3.5). Regarding the soft tissue width, the preoperative average was 102.45mm SD (6.4) to 98.3mm postoperative SD (5.1). The ICC between both observers was 'excellent' in most measures (range, 0.884-0.973). Values obtained had a significance of p&lt;0.001. Size effect was considered medium-high, with 0.87 power. Conclusion: We report an objective reduction in the forefoot width, both bony and soft tissue, by means of 8.88mm (10%) and 4.12mm (4.1%), respectively after scarf akin osteotomy. These results are represented by better shoe comfort and aesthetics.

Effect of Forefoot Width Variation on Clinical and Functional Outcomes Following the Lapidus Procedure

Category: Midfoot/Forefoot Introduction/Purpose: The Lapidus procedure (LP) is a powerful technique that often provides significant corrections of the hallux valgus (HV) deformities. In addition, it is described that forefoot width alters considerably with this technique, impacting in shoe wear. However, it has not yet been reported whether foot narrowing reflects on clinical and functional outcomes. This study aimed to evaluate the effect of variations in bony and soft tissue foot widths (BSFW) on clinical and functional outcomes after HV correction with the LP. Secondarily, we also tried to assess the relationship of standard radiographic measurements of HV with changes in BSFW. Methods: Forty-three feet in 35 patients with a mean follow-up of 18.5-months who underwent the LP were retrospectively reviewed. Bony width was measured from the most medial extent of the first metatarsal head to the most lateral extent of the fifth metatarsal head. Soft tissue width was measured considering the most medial and lateral shadow of the foot (Figure 1). Clinical and functional data were assessed with the VAS for pain, AOFAS, LEFS and SF-12. SF-12 comprises physical and mental health scales (PCS-12 and MCS-12). HV radiographic parameters as intermetatarsal-angle (IMA), HV-angle (HVA) and sesamoid- subluxation (SS) were assessed. Intraclass Correlation Coefficients (ICC) were calculated for BSFW. Clinical, functional and radiographic measurements were compared. Linear regression was used to assess the correlation of Δ-BSFW with clinical, functional and radiographic results. We also evaluated our sample at the cut-off point of quartile-50% to assess whether a given measure of Δ-BSFW was related to clinical and functional outcomes. Results: Pre- and postoperative ICC was 0.95 for bony and soft tissue width measurements. Bony width changed significantly from 95.5mm to 84.2mm (11.8%) and soft tissue width from 107.12mm to 100.84mm (5.86%) (p&lt;.001 and p&lt;.001). IMA, HVA and SS improved significantly. Significant clinical and functional improvements were observed, except in MCS-12. In simple linear regression, a correlation was found between variations of bony width with Δ-AOFAS and Δ-PCS-12, meaning that as the forefoot narrows, their values increase (p=.02 and p=.005). It was also related to Δ-IMA and Δ-SS, meaning that the forefoot narrows as these parameters improve (p&lt;001 and p&lt;0.001). Soft tissue width was related only to Δ-PCS-12 and Δ-IMA. In multiple linear regression, the strongest correlation observed was between bony width variation and Δ-IMA (P=.029,r2=0.22). At the quartile- 50%, in which our sample was divided equally, we have not found a given measure of Δ-BSFW that was significantly related to the clinical and functional questionnaires (Figure 2). Conclusion: The present study showed that narrowing of the forefoot after the LP improves clinical and functional outcomes, as measured by AOFAS and PCS-12. Besides, it also presented that correction of the radiographic parameters of the HV, mainly IMA, reflects on a significant decrease of the forefoot width. Further prospective and comparative studies with larger populations are required to evaluate the effects of forefoot width changes on clinical and functional outcomes.

Associations of muscle volume of individual human plantar intrinsic foot muscles with morphological profiles of the foot.

Human plantar intrinsic foot muscles consist of 10 muscles that originate and insert within the sole of the foot. It is known that the anatomical cross-sectional area (ACSA) and muscle thickness of two plantar intrinsic foot muscles, the flexor hallucis brevis (FHB) and abductor hallucis (ABH), associate with morphological parameters of the foot, such as total and truncated foot length and navicular height. However, it is unclear how the size for each of the plantar intrinsic foot muscles associates with various morphological profiles of the foot. This study aimed to elucidate this subject. By using magnetic resonance imaging (MRI), serial images of the right foot were obtained in 13 young adult men without foot deformities. From the obtained MR images, ACSA for each of the individual plantar intrinsic foot muscles was analyzed along the foot length, and then its muscle volume (MV) was calculated. The analyzed muscles were the abductor digiti minimi (ABDM), ABH, adductor hallucis oblique head (ADDH-OH), adductor hallucis transverse head (ADDH-TH), flexor digitorum brevis (FDB), FHB, and quadratus plantae (QP). Furthermore, MV of the whole plantar intrinsic foot muscle (WHOLE) was defined as the total MVs of all the analyzed muscles. As morphological parameters, total foot length, truncated foot length, forefoot width, ball circumference, instep circumference, navicular height, great toe eversion angle, and little toe inversion angle were measured using a laser three-dimensional foot scanner in standing and sitting conditions. In addition, navicular drop (ND) and normalized truncated navicular height (NTNH) were also calculated as medial longitudinal arch (MLA) height indices. The MV of WHOLE was significantly associated with the forefoot width, ball circumference, and instep circumference (r=0.647-0.711, p=0.006-0.013). Positive correlations were found between the forefoot width and MV of FHB, FDB, and QP (r=0.564-0.653, p=0.015-0.045), between the ball circumference and MV of QP (r=0.559, p=0.047), between the instep circumference and MV of FHB (r=0.609, p=0.027), and between the little toe inversion angle and MV of QP (r=0.570, p=0.042). The MVs of ABH, ABDM, and ADDH-OH were not significantly correlated with any morphological parameters of the foot. Similarly, no significant correlations were found between MV of each muscle and either of the MLA height indices (ND and NTNH). Thus, the current results indicate that forefoot width and circumferential parameters (instep and ball circumference), not MLA height, associate with the size of the whole plantar intrinsic foot muscles, especially those specialized in toe flexion (FHB, FDB, and QP).

How barefoot and conventional shoes affect the foot and gait characteristics in toddlers.

ObjectivesBarefoot shoes have recently become a popular alternative to conventional shoes among the parents of pre-school children. As the long-term effect of habitual shoe-wearing on the foot is still unclear, the aim of this study was to compare the arch index, dynamic foot anthropometry and gait parameters in toddlers who had been habitually wearing barefoot shoes or conventional shoes since their first steps.Methods30 toddlers– 15 habitually wearing barefoot shoes (BF group) and 15 habitually wearing conventional shoes (N-BF group)–participated in this study. Each child was measured twice during the study. The first data collection session occurred within one month after the first five consecutive unsupported steps were performed by the toddler. The second data collection session occurred seven months after this event. At each data collection session, the toddler was instructed to walk barefooted at its natural speed over an Emed® platform (Novel GmbH, Germany). The Emed ® software generated data regarding the arch index, dynamic foot anthropometry, foot progression angle, contact area, contact time, peak pressure and maximum force. The Wilcoxon signed-rank test was used to compare the differences between the 1st and 2nd data collections. The Mann-Whitney U test was used to compare the differences between the BF and N-BF groups.ResultsThe results of this study show a higher plantar arch and a smaller foot progression angle in the BF group. The forefoot width in both the BF and N-BF groups remained proportional to the foot length after seven months of independent walking.ConclusionsThese findings may encourage parents and caregivers to introduce barefoot shoes or create a habitual barefoot time for their child.

Minimally Invasive Distal Chevron Osteotomy for Symptomatic Bunionette: Clinical and Radiologic Results of a 31-Case Retrospective Study.

Background:Bunionette is a common forefoot deformity that usually leads to significant discomfort. Multiple surgical techniques have been described for correcting bunionette. The purpose of this study is to analyze the clinical and radiologic outcomes of a new surgical technique via minimally invasive distal Chevron osteotomy of the fifth metatarsal without fixation, trying to find an effective technique with fewer complications.Methods:We retrospectively analyzed the data of 28 patients (31 feet) who presented with symptomatic bunionette that was resistant to conservative treatment and who underwent surgery at our center from February 2018 to February 2020. A minimum follow-up of 20 months was obtained (mean follow-up 26 months, range 20–37). Clinical results were evaluated using the visual analog scale (VAS) and the American Orthopaedic Foot & Ankle Society (AOFAS) score; 5 different radiologic parameters were analyzed.Results:After surgery, the mean AOFAS score increased by 29 points (P < .001) and the mean VAS scores decreased by 6 points (P < .001). An adequate radiologic correction was observed with a decrease in the M4–M5 intermetatarsal angle from 10.3 to 4.8 degrees (P < .001), metatarsophalangeal angle by a mean of 16.05 degrees (P < .001), and lateral deviation angle of the fifth metatarsal from 8.5 to 0.97 degrees (P < .001). Moreover, the length of the fifth metatarsal and the forefoot width was reduced (P < .001). The only complication was an asymptomatic delay in bone healing, but a complete bone consolidation was achieved after therapy.Conclusion:The proposed surgical technique shows a good correction capacity with excellent clinical and radiologic results and low complication rates.Level of Evidence: Level IV, retrospective case series.

Surgical outcomes of untreated congenital polysyndactyly of the foot in adult patients

Purpose: Polydactyly of the foot is a common congenital anomaly. The goal of surgery for polydactyly is to increase similarity to the contralateral foot, with a well-aligned arcade of toes that allows patients to wear normal footwear and ambulate painlessly. Foot appearance is especially important in Asian countries where people remove their shoes indoors. This study reviewed the surgical results in patients who underwent surgery for correction of untreated foot polydactyly after the age of 18 years. Methods: We retrospectively analyzed the data of 11 patients who underwent surgery between 2006 and 2019. The forefoot width, angulation difference, and toe length ratios between the affected and unaffected feet were compared before and after the operation. In addition, the purpose of the surgery and postoperative cosmetic satisfaction were collected for each patient.Results: The median age at the time of the operation was 25 years (interquartile range, 22–32 years) and most patients presented with postaxial polydactyly. The primary reasons to undergo surgery were both functional and cosmetic. The forefoot width and angle difference ratios became significantly more similar to the contralateral side postoperatively (p&lt;0.05). No significant difference was found in the toe length ratio. Postoperative Global Aesthetic Improvement Scale scores showed satisfactory results. Conclusion: The main reasons for surgery in adulthood included the diverse consequences of functional and cosmetic aspects of the anomaly. Surgery for patients with untreated polydactyly of the foot can yield satisfactory objective and subjective results regardless of the intervention timing.

Effect of Weight Bearing Variations &amp; Heel Height on Forefoot Width for Orthopaedic Imaging

Category:Basic Sciences/Biologics; Midfoot/ForefootIntroduction/Purpose:The biomechanics of a foot when weight bearing change significantly due to the changes in the function through the gait cycle. Variations in heel height are known to influence load distribution in weightbearing, thus affecting change in forefoot widths. Weight bearing in radiographs are commonly used to identify these changes, which may have clinical relevance. However, there are limited studies that accurately quantify the extent of these differences in the forefoot to be analysed effectively. Hence, there is a need to investigate different weight bearing conditions and its influence on forefoot width changes required for accurate analysis of imaging. This study's aim is to evaluate the significance and degree of foot splaying with different modes of weight-bearing and heel height to achieve optimum increase in forefoot width.Methods:32 volunteers with no clinical issues with their feet were selected for this study. Weight bearing photographs of their feet were reviewed by 2 foot and ankle surgeons (under blinded conditions) to ensure they were normal morphologically. The forefoot width is measured using sliding callipers between the medial margin of the first metatarsal head and lateral margin of the fifth metatarsal head when non weight bearing - NWB, partial weight bearing - PWB (dual leg stance) and full weight bearing - FWB (single leg stance). Single leg stance measurement is also taken at increasing heel heights of 2cm (FWB1), 4cm (FWB2) and 6cm (FWB3) using polyurethrane blocks. Each individual foot non weight-bearing width will act as its own control for the changes in the differing positions measured.Results:Statistical analysis of data demonstrated the results with the use of student t-test analysis via SPSS which showed statistically significant differences in forefoot width in both genders(p<0.05). There is an increasing trend of forefoot width as weightbearing conditions increase up to 2cm of elevated heel height. However, forefoot width decreases as heel height increases beyond 2cm in both genders. Female subjects have a higher trend of percentage of increase in mean forefoot width compared to males in all weightbearing conditions except for full weightbearing with 6cm heel height elevation.Conclusion:In conclusion, there is a linear trend of increase in forefoot width with increase from non-weightbearing up to 2cm heel height inclination. Full weightbearing with 2cm heel height inclination produces the widest foot splaying in this study. Larger future studies will need to be conducted to validate these findings.

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.