Medial Cuneiform Research Articles

Foot pain as first presenting symptom of renal cell carcinoma, due to metastatic lesion in medial cuneiform

Foot pain as first presenting symptom of renal cell carcinoma, due to metastatic lesion in medial cuneiform

A recommended sampling strategy for genetic identification of Second World War victims in Slovenia

Skeletonized human remains from Second World War mass graves in Slovenia are a major challenge in genetic identification, and bones with a high DNA yield must be selected for successful identification. The goal of this study was to construct skeletal sampling strategy recommendations through comparison of the most appropriate groups of skeletal elements. Altogether, 566 bones and teeth from the same mass grave were compared, half analyzed in this study and half in previous studies performed by our group. After anthropological examination, mechanical and chemical cleaning was performed, followed by bone and tooth powdering. Total demineralization of 0.5 g of bone and tooth was followed by extraction and purification of DNA with a Biorobot EZ1 device (Qiagen). The qPCR PowerQuant kit (Promega) was used to measure the amount of DNA, and statistical analysis was performed. Skeletal elements were selected according to known better preservation of DNA in the human body, and they were arranged in seven groups: petrous bone, long bones (femur and tibia), torso bones (first rib and 12th vertebra), metacarpals, metatarsals, short and sesamoid bones (talus, navicular, medial cuneiform, cuboid, calcaneus, and patella), and teeth. Sampling strategy recommendations were constructed based on DNA quantity and quality results. The petrous bone group, metacarpal group, torso bone group, and short and sesamoid bone group produced the highest DNA yields. Accordingly, in addition to standard sampling of long bones (femurs and tibias) and teeth, those additional bone types should be collected for Slovenian Second World War victim identification.

Tibialis Anterior Tendon Transfer for Clubfoot Deformity: Cuboid Versus Lateral Cuneiform.

Tibialis anterior tendon transfer in relapsing clubfoot deformity is a well-known treatment option for dynamic forefoot supination and adduction deformities. The tibialis anterior tendon can be anchored to the lateral cuneiform or the cuboid. A complication of this surgery is overcorrection to a flatfoot deformity or undercorrection that maintains the clubfoot deformity. We compared reoperation rates and clinical outcomes between these 2 groups. This is a retrospective study performed from 2005 to 2020. The primary outcome was repeat operation. The secondary outcome included clinical appearance scores described by Garceau and Palmer. There were 114 clubfeet (111 patients) treated in our study. Of them, 67 (58.8%) had a transfer to the lateral cuneiform, whereas 47 (41.2%) had a transfer to the cuboid. Nine patients had reoperations which included 4 (44.4%) in the lateral cuneiform group and 5 (55.6%) in the cuboid group which was not statistically significant (P=0.485). Clinical appearance scores revealed significantly better clinical appearance in the lateral cuneiform group after surgery compared with the cuboid group (P=0.0172). There were no clinically significant differences in reoperation rates between transfers to the lateral cuneiform versus the cuboid. We did find better clinical appearance in the lateral cuneiform group after surgery compared with the cuboid group. Level III retrospective comparative study.

Can early treatment of lisfranc injuries without planned re-intervention be safely performed

The Lisfranc complex is a unique combination of ligamentous and osseous relationships between the medial cuneiform and second metatarsal base that is often injured by high energy mechanisms. Fixation for these injuries is often operative; however, the optimal timing of surgical treatment has been debated. All patients who underwent operative fixation of a Lisfranc injury at a single urban tertiary care center were reviewed. Patient were split into two groups based on timing to fixation with one group being less than 24 h from presentation and a second group being greater than 24 h. There were 58 patients who underwent what was planned as final operative stabilization of their Lisfranc injury in less than 24 h and 41 patients who underwent fixation after more than 24 h. The early treatment of Lisfranc injuries did not lead to significant increases in follow up time, infections, time to weight bearing, union rates, or time to union compared patients treated with delayed fixation. There was a higher rate of superficial infection in the early intervention group, but it did not reach statistical significance. We believe our findings demonstrate that delayed fixation is not superior to early treatment of Lisfranc injuries. Level of evidenceLevel 3 Therapeutic retrospective comparative study.

Effect of dorsoplantar miniscrew fixation of the second metatarsal base fracture on residual diastases in acute lisfranc fracture-dislocation.

This study aimed to evaluate and compare the clinico-radiographic outcomes between two techniques for acute Lisfranc fracture-dislocation with a large, displaced second metatarsal base plantar fracture: isolated Lisfranc screw fixation versus Lisfranc joint fixation with dorsoplantar miniscrew fixation of the second metatarsal base. We retrospectively compared the clinico-radiographic outcome between patients who underwent isolated Lisfranc screw fixation (Group 1, 26 patients) and those who underwent Lisfranc joint fixation with dorsoplantar miniscrew fixation of the second metatarsal base (Group 2, 23 patients). The main outcome measurements were the postoperative distance between the medial cuneiform and second metatarsal base on standing anteroposterior foot radiographs, known as the C1-M2 distance. Residual diastasis was defined as C1-M2 distance ≥ 2mm on the affected side compared with that on the contralateral side. We also assessed the Foot and Ankle Ability Measure (FAAM)-activities of daily living (ADL) and sports subscale scores at three, six and ≥ 18 months postoperatively. At the final follow-up, the mean C1-M2 distance on the affected side compared with that on the contralateral side was significantly greater in Group 1 than in Group 2 (3.9 versus 0.7mm, P = 0.027). Furthermore, Group 1 showed a higher incidence of residual diastases at the final follow-up (69.2%) than the Group 2 (13.0%, P < 0.001). The FAAM-ADL scores at the final follow-up did not differ significantly between the groups (P = 0.518), but the FAAM Sports score was significantly higher in Group 2 than in Group 1 (P = 0.001). The postoperative C1-M2 distance was better maintained with Lisfranc joint fixation with dorsoplantar miniscrew fixation of the second metatarsal base than with isolated Lisfranc screw fixation. We recommend that surgeons exercise caution when dealing with a second metatarsal plantar fracture and consider performing secure fixation using the dorsoplantar miniscrew technique for improved clinical outcomes.

Lisfranc Injury: A Case Report and Literature Review

Lisfranc injuries are relatively rare, accounting for only 0.2% of all injuries, and few case reports have been published on this topic. In this report, we present a case of a Lisfranc injury in a healthy 30-year-old male who fell down a staircase, landing on his left foot. The diagnosis was made using X-rays and computed tomography (CT). The X-rays showed dislocation of the tarsometatarsal joint with lateral displacement of the M4, M3, M2, and M1 metatarsals. The CT scan revealed a fracture-dislocation of the second metatarsal, with detachment of intra- and extra-articular bone fragments associated with a fracture of the medial cuneiform bone. Surgical management, in the form of open reduction and internal fixation, was performed. The patient followed an expected postoperative course and was doing well, without pain or limitation of activities, at his 3-month postoperative visit. Additionally, we provide a brief review of similar published cases and an overview of Lisfranc injuries.

Méary's angle decoded: 3D analysis of first ray plantarflexion deformity in Charcot-marie-tooth disease

BackgroundThe typical cavovarus deformity seen in patients with Charcot-Marie-Tooth (CMT) involves plantarflexion of the first ray. The exact apex of the deformity has never been proven, although it is presumed to be within the medial cuneiform. The aim of this study was to utilize weight-bearing computed tomography (WBCT) to localize and quantify first ray plantarflexion deformity in CMT patients. MethodsWBCTs of 16 CMT patients with lateral Méary’s angle > 20 degrees were compared to controls utilizing semi-automated analysis software. A local coordinate system based on the first metatarsal was used to avoid bias of proximal deformity. The tarsometatarsal angle was subdivided into components (cuneiform-cuneiform joint normal, tarsometatarsal joint and metatarsal-metatarsal joint normal) and compared between CMT and controls. CMT patient’s first, second and third rays were also compared. Means were compared with a 2-sample t test (p < .05). ResultsCMT patients had significantly more plantarflexion of the first ray than controls (16.4 versus 8.8 degrees respectively(p < 0.001)). The largest difference of was found at the medial cuneiform with 20.6 degrees of plantarflexion in CMT patients versus 14.8 degrees in controls (p < .0001). There was also approximately 2 degrees of plantarflexion at the TMT joint (p < .001). ConclusionsPlantarflexion deformity in CMT patients is primarily an osseous deformity at the level of the medial cuneiform with a lesser contribution from the tarsometatarsal joint. Level of evidenceIII Retrospective comparative study

Morphological and morphometric analysis of tarsal bones according to sex.

Our aim in the study is to measure the area and volume of the tarsal bones and examine the typing of the talus and calcaneus joint surfaces according to sex. In our study, the area and volume measurements of 630 tarsal bones and the morphology of the talus/calcaneus were analyzed by transferring thin-section Computed Tomography (CT) images to the 3D Slicer program. The volume and area sizes of the foot bones are calcaneus, talus, cuboid, navicular, medial cuneiform, lateral cuneiform, and intermediate cuneiform, respectively. All area and volume values of males were statistically higher than females (p < 0.05). The right side calcaneus area, intermediate cuneiform area, and lateral cuneiform area values were statistically higher than the left side (p < 0.045, p < 0.044, p < 0.030, respectively). There was no statistical relationship between age and area/volume values (p > 0.05). Three different types were seen in the calcaneus and seven in the talus. The most common type in the calcaneus was B1 (40%), and the least common type was A (27.8%). Regardless of the subgroups, the most common type in the talus was type B (37.8%), while the least common type was E2 (1.1%). Although morphometric measurements of tarsal bones differed according to sex, they did not differ according to age. The frequency of occurrence of the types of articular surfaces of the talus and calcaneus varies according to populations. We think that the morphometry and morphology of tarsal bones will contribute to invasive procedures regarding tarsal bones and surrounding structures, and that three-dimensional bone modeling can be used to create educational materials.

The vertical mobility of the first tarsometatarsal joint during demi-plié with forced turnout in ballet dancers

The forced turnout has a perceived risk of development of hallux valgus (HV) in ballet dancers. We determined how the forced turnout affects the sagittal mobility of the first tarsometatarsal (TMT) joint, which is one of the pathogenic factors of HV development. Seventeen female ballet dancers (body mass index: 18.2 ± 1.8 kg/m2) were included and performed demi-plié in control, functional turnout, and forced turnout conditions. Ultrasound imaging synchronized with a three-dimensional motion analysis system was used for measuring the vertical locations of the first metatarsal and medial cuneiform (MC) to evaluate the first TMT joint mobility. Plantar displacement of MC and the first TMT joint mobility in the forced turnout were the greatest among the 3 conditions. Multiple regression analysis indicated that the greater extent of the forcing angle might increase the displacement of MC and the first TMT joint mobility. Evaluating the sagittal mobility of the first TMT joint in the forced turnout can assist in understanding the association between inappropriate techniques including the forced turnout and HV development in ballet dancers. Since the excessive mobility of the first TMT joint is a factor in HV development, the acquirement of adequate active turnout may have the potential to prevent HV development in ballet dancers.

Tarsals from the Sima de los Huesos Middle Pleistocene site (Atapuerca, Burgos, Spain).

Here, we provide a complete, updated, and illustrated inventory, as well as a comprehensive study, of the tarsals (rearfoot) recovered from the Middle Pleistocene site of Sima de los Huesos (SH, Atapuerca, Spain) in comparison to other Homo comparative samples, both extant and fossil. The minimum number of individuals (MNI) estimated from the tarsals has been established as 15, which represents 51.7% of the 29 dental individuals identified within the SH sample. Within the SH hominin foot sample, an exclusive combination of primitive or plesiomorphic and derived or autapomorphic traits can be observed when compared with other Homo individuals/populations. Other characters are shared among SH hominins and Neandertals that might represent shared derived or autapomorphic traits for this evolutionary line, and most are likely related to robusticity (e.g., rectangular-like trochlea of the talus, broad calcanei, broad naviculars, and short lateral cuneiforms). Additionally, we observed some exclusive autapomorphic traits in the SH tarsal sample (e.g., narrow head of the talus and short intermediate cuneiforms). A few exclusive traits in SH tarsal remains are even more robust than in Neandertals (e.g., broad lateral malleolar facet in talus, more projected sustentaculum tali, and broad medial cuneiform). These traits could suggest a slightly higher level of gracilization in the tarsal bones of Neandertals compared to the SH sample that is also supported by other anatomical postcranial skeleton elements. Additionally, some paleobiological inferences are made in relation to body size (stature and body mass) and some associations are proposed within the SH sample. In conclusion, the morphology of the SH tarsi confirms an evolutionary relationship of sister groups between this population and Neandertals, probably representing a morphotype similar to the Neandertal ancestors.

Synchronous fibrous tarsal coalition of the posterior subtalar joint and between the medial cuneiform and navicular in the same foot: An unusual case report and literature review

Tarsal coalition (TC) is a well-known abnormality of the foot articulations due to failure of embryonic mesenchymal segmentation presenting with pain or deformity in orthopedic clinics. However, simultaneous TC affecting separate tarsal joints in the same foot is rare. We report a rare case of synchronous fibrous TC of the posterior subtalar joint and between the medial cuneiform and navicular bone of the right foot in a 25-year-old male and review the literature exploring such a combination. The clinical presentation and radiological findings leading to effective diagnosis and management are highlighted.

Comparative Study of Functional Outcome of Posterior Tibialis Tendon Transfer to Middle Cuneiform Bone and Anterior Tibialis Tendon with Other Techniques for Management of Foot Drop

Comparative Study of Functional Outcome of Posterior Tibialis Tendon Transfer to Middle Cuneiform Bone and Anterior Tibialis Tendon with Other Techniques for Management of Foot Drop

EVALUATING THE UTILITY OF PLAIN RADIOGRAPH AND COMPUTERIZED TOMOGRAPHY SCANNING IN IDENTIFYING CONCOMITANT FOOT FRACTURES IN PATIENTS WITH UNSTABLE LISFRANC INJURIES

BackgroundLisfranc fracture dislocations are uncommon injuries, which frequently require surgical intervention. Currently, there is varying evidence on the diagnostic utility of plain radiographs (XR) and CT in identifying Lisfranc injuries and concomitant fractures. Our aim was to identify the utility of XR as compared to CT, with the nul hypothesis that there was no difference in fracture identification.MethodsA retrospective assessment of patients who had sustained a Lisfranc injury between 2013 and 2022 across two trauma centres within the United Kingdom who underwent surgery. Pre-operative XR and CT images were reviewed independently by 2 reviewers to identify the presence of associated fractures.ResultsA total of 175 patients were included. Our assessment identified that XR images significantly under-diagnosed all metatarsal and midfoot fractures. The largest discrepancies between XR and CT in their rates of detection were in fractures of the cuboid (5.7% vs 28%, p&lt;0.001), medial cuneiform (20% vs 51%, p=0.008), lateral cuneiform (4% vs 36%, p=0.113), second metatarsal (57% vs 82%, p&lt;0.001), third metatarsal (37% vs 61%, p&lt;0.001) and fourth metatarsal (26% vs 43%, p&lt;0.001). As compared to CT, the sensitivity of XR was low. The lowest sensitivity for identification however was lateral foot injuries, specifically fractures of the lateral cuneiform (sensitivity 7.94%, specificity 97.3%), cuboid (sensitivity 18.37%, specificity 99.21%), fourth (sensitivity 46.7%, specificity 89.80%) and fifth metatarsal (sensitivity 45.00%, specificity 96.10%).ConclusionFrom our analysis, we can determine that XR significantly under-diagnoses associated injuries in patient sustaining an unstable Lisfranc injury, with lateral foot injuries being the worst identified. We advised the use of CT imaging in all cases for appropriate surgical planning.

Relationship between joint structure of the first tarsometatarsal joint and its degeneration

This study aimed to elucidate the relationship between joint structures of the first tarsometatarsal and articular facet degeneration. A total of 100 feet from 50 cadavers were examined. The articular facets of the first metatarsal and medial cuneiform were categorized into four types based on the superior and inferior facets' separation, and the formation of the inferior lateral facet on the lateral plantar prominence: Type I, a single facet with no separation or inferior lateral facet; Type II-a, two facets with separation but no inferior lateral facet; Type II-b, two facets, no separation, but with an inferior lateral facet; Type III, three facets with separation and an inferior lateral facet. When both bone types matched, they were defined as Type I, Type II-a, Type II-b, and Type III joints, respectively; unmatched types were classified as Unpair joints. The severity of articular cartilage degeneration on both bones was assessed using a 5-point scale. The degeneration grade was compared among joint types. Type III joints exhibited significantly milder articular cartilage degeneration in medial cuneiform compared to Type II-a, II-b, Unpair joints. The formation of inferior lateral facet and separation of the superior and inferior facets might be crucial for the joint's stability.

Relationship between the medial cuneiform bone morphology and the severity of hallux valgus

BackgroundIt has been reported on the relationship between the medial cuneiform bone morphology, especially in terms of obliquity, and the severity of hallux valgus (HV), however, no consensus has been obtained. On the other hand, there are no reports on the relationship between the difference in height between the medial and intermediate cuneiforms and the severity of hallux valgus. The purpose of this study was to clarify the relationship between the medial cuneiform bone morphology and the severity of HV. MethodsThe authors retrospectively analyzed 200 feet of 116 patients who had a weightbearing anteroposterior foot radiograph taken between April 2017 and July 2022 and diagnosed with HV. Measurements included the hallux valgus angle (HVA), the intermetatarsal angle (IMA), the distal medial cuneiform angle (DMCA) and the cuneiform first-second length (C1-2D). HV groups were classified into one of three groups: mild (15 ≦ HVA<30°, 9 < IMA<13°), moderate (30 ≦ HVA<40°, 13 ≦ IMA≦20°) and severe groups (HVA≧40°, IMA>20°), and the relationship to DMCA or the difference in height between the medial and intermediate cuneiforms was analyzed. ResultsA total of 163 feet of 93 patients were included in this study. There were significant correlations between the HVA and the DMCA (r = 0.47, p <0.001) or the C1-2D (r = 0.64, p <0.001). There was no significant difference in DMCA between the mild and moderate groups (p = 0.14). On the other hand, significant differences in C1-2D were observed between the three groups (mild-moderate; p <0.001, moderate-severe; p = 0.03, mild-severe; p <0.001). IMA was also positively correlated with the DMCA (r = 0.30, p <0.001) or the C1-2D (r = 0.47, p <0.001). However, the DMCA (p = 0.07) and the C1-2D (p = 0.39) did not differ significantly from IMA between the moderate and severe groups. ConclusionsThe difference in height between the medial and intermediate cuneiforms, referred to as C1-2D, is closely associated with the HVA. The C1-2D may influence the progression of HV and be a novel radiographic parameter that indicates severity of HV.

Internal Brace Fixation Technique for Lisfranc Injury: A Retrospective Study.

BACKGROUND The Lisfranc ligament is crucial for maintaining the transverse and longitudinal arch of the foot. Owing to the disruption between the medial cuneiform bone and the base of the second metatarsal bone, the currently preferred fixation method remains controversial. Our fixation technique involves screwing one anchor to the medial and intermediate cuneiform bones and using the anchor to carry the ligament to bind the Lisfranc joint and first and second metatarsal joints altogether for elastic fixation. This study evaluated the clinical and functional outcomes of InternalBrace fixation for Lisfranc injury. MATERIAL AND METHODS This retrospective study included 58 patients who underwent InternalBrace fixation for Lisfranc injury between January 2019 and September 2022 by an experienced surgeon. One-way analysis of variance or t test was used. Preoperative classification was performed according to the Myerson classification with imaging data. Postoperative follow-up was performed based on intraoperative blood loss, fracture healing time, visual analog scale (VAS) score, the American Orthopedic Foot and Ankle Society (AOFAS) score, Tegner score, and complications. RESULTS Surgery was completed in all patients, and follow-up was performed. The patients' ages ranged from 19 to 62 years (average: 34.6±9.4 years). The postoperative follow-up time was 12-24 months (average: 16.9±3.0 months). The average time for fracture healing was 12.8±3.0 (10-24) weeks. The VAS, AOFAS, and Tegner scores significantly improved postoperatively (from 5.33±1.0 (3-7) to 1.24±0.57 (0-2); 28.02±6.70 (18-51) to 91.59±4.76 (82-96); and 2.40±0.67 (1-4) to 6.53±0.54 (6-7), respectively), which was statistically significant (P<0.01), and the good rate of AOFAS was 91.4%. The postoperative complications were traumatic arthritis, incision infection, and temporary dorsal foot numbness, which gradually recovered. No other rejection reactions or Lisfranc fracture/dislocations recurrence occurred during the follow-up period. CONCLUSIONS InternalBrace fixation for Lisfranc injury is beneficial for restoring Lisfranc joint stability and function and allows for early and more aggressive rehabilitation for patients, with fewer surgical complications.

Cuboid Bone for Distal Radius Reconstruction: An Anatomical Study by 3D Models

Abstract Background Distal radius (DR) reconstruction due to high-energy trauma, degenerative processes, and oncologic resections can be a challenge when the articular surface is destroyed or resected. This study investigates the possibility of using the cuboid bone of the foot to replace the osteoarticular surface of DR. Purposes We compared the three-dimensional (3D) morphology of the articular surface of three foot bones with that of the DR to analyze which one would be the most suitable to replace it. Methods 3D bone models were created from a computed tomography (CT) scan database. The articular surfaces of calcaneus, cuboid bone, and lateral cuneiform bone were compared with that of the DR using the Hausdorff-Besicovitch morphometry analysis. Mean, maximum, and minimum differences were obtained and statistically analyzed. Results The cuboid bone had a mean overall area difference with the DR of 0.72 mm (standard deviation [SD], 0.03 mm). The lateral cuneiform bone showed 0.89 mm (SD, 0.08 mm). The calcaneus presented 1.04 mm (SD, 0.06 mm). The differences and the variability of the articular surface were statistically lower in the cuboid bone. Conclusion The articular surface of the cuboid bone has many similarities to the articular surface of the DR and had the most similarities to the DR of the foot bones study. The cuboid bone could be considered as a replacement for the DR in cases where there is a need for osteoarticular replacement or reconstruction. Further investigations are warranted. Clinical Relevance A vascularized transfer of the cuboid bone may be a suitable option to replace a DR given the anatomical similarities reported.

Anatomy of the Naviculocuneiform Joint Complex.

The purpose of this study was to quantify the articular surfaces of the naviculocuneiform (NC) joint to help clinicians better understand common pathologies observed such as navicular stress fractures and arthrodesis nonunions. Twenty cadaver NC joints were dissected and the articular cartilage of the navicular, medial, middle, and lateral cuneiforms were quantified by calibrated digital imaging software. Statistical analysis included calculating the mean cartilage surface area dimensions of the distal navicular and proximal cuneiform bones. Length measurements on the navicular were obtained to estimate the geographic location of the interfacet ridges. Lastly, all facets of the articular surfaces were described in regard to the shape and location of cartilaginous or fibrous components. Results were compared using Student t tests. Navicular cartilage was present over 75.4% of the surface area of the proximal NC joint, compared with 72.6% of combined cuneiform cartilage distally. The mean height of the deepest (dorsal-plantar) measurement of navicular articular cartilage was 18 ± 3 mm. The mean heights of the distal medial, middle, and lateral cuneiform articular facets were 15 ± 1 mm, 17 ± 2 mm, and 15 ± 2 mm, respectively. There is significant variation among the articular surfaces of the NC joint. Additionally, the central third of the navicular was calculated to lie in the inter-facet ridge between the medial and middle articular facets of the navicular. Surgeons may consider this study data when performing joint preparation for NC arthrodesis as cartilage was present to a mean depth of 18 mm at the NC joint. Additionally, this study demonstrates that the central third of the navicular, where most navicular stress fractures occur, lies in the interfacet ridge between the medial and middle articular facets of the navicular.

First ray mobility in hallux rigidus, hallux valgus, and normal feet based on weightbearing computed tomography and three-dimensional analysis: A case-control study.

BackgroundHallux valgus and hallux rigidus are disorders affecting the first ray and are associated with hypermobility of this structure. This study aimed to investigate the three-dimensional mobility of each joint of the first ray between feet with hallux valgus or hallux rigidus and healthy feet using weightbearing and nonweightbearing computed tomography (CT). MethodsThis case-control study analyzed 17 feet of 11 healthy volunteers (control group), 16 feet of 16 patients with hallux valgus (HV group), and 16 feet of 11 patients with hallux rigidus (HR group). First, nonweightbearing foot CT imaging was performed in the supine position on a loading device with no load applied, with the legs extended and the ankle in the neutral position. Next, a load equivalent to body weight was applied for weightbearing CT imaging. Distal bone displacement relative to the proximal bone was quantified three-dimensionally under both conditions. ResultsIn the HV group, the talonavicular joint showed significantly greater eversion (P=.011) compared with the control group and significantly greater dorsiflexion (P=.027) and eversion (P<.01) compared with the HR group. In the medial cuneiform joint, the HV group showed significantly greater eversion (P<.01) and abduction (P=.011) than the control group. For the first tarsometatarsal joint, the HV group showed significantly greater dorsiflexion (P=.014), inversion (P=.028), and adduction (P<.01) than the control group, and greater inversion (P<.01) and adduction (P<.01) than the HR group. Dorsiflexion of the first tarsometatarsal joint was significantly greater in the HR group compared with the control group (P=.026). ConclusionHypermobility of the first ray appears to be three-dimensional: in hallux valgus, it is centered at the first tarsometatarsal joint, while in hallux rigidus it is mainly in the sagittal plane at the first tarsometatarsal joint only. This difference may explain the different deformities ultimately observed in each condition.

Evaluation of Foot and Ankle Trauma Registering to Emergency Department

In this study, we aimed to evaluate the demographic data and injured tissue of the patients who applied to the emergency department with foot and ankle injuries and to reveal the relationship between them. This study was conducted by retrospectively evaluating the data of the patients who applied to the emergency department of a tertiary hospital during the two months between 01.01.2019-28.02.2019. The fractured bones were grouped as tibia, fibula, talus, calcaneus, cuboid bone, navicular bone, cuneiform bone and 1st, 2nd, 3rd, 4th, 5th metatarsal bones, and proximal phalanx. Trauma mechanisms were grouped as falling from a height, falling from the same level, beating, sports injury, traffic accident and sprain. Of the 133 patients included in the study, 68 (51.1%) were female. The age ranged between 1 and 78 years, with a median of 28. The most common bone fracture was the fibula (42.9%). Patients with calcaneus fracture had a higher age than those without fractures (median: 44, inter quartile range (IQR): 42-58, versus median: 26, IQR: 13-41.5) and patients with fifth metatarsal bone had a higher age than those without fractures (median: 41, IQR: 22.5-63.5, versus median: 24.5, IQR: 13-41) but patients with first metatarsal bone had a lower age than those without fractures (median: 12, IQR: 6-14, versus median: 32, IQR: 14-44) (Mann-Whitney U test, for calcaneus, p=0.003, for first metatarsal bone, p