Lateral Longitudinal Arch Research Articles

Plantar Pressure Characteristics with Foot Postures and Balance Abilities in Indigenous Taiwanese: A Preliminary Exploration.

BACKGROUND Although Indigenous Taiwanese are generally known for having excellent athleticism and balance abilities, the correlation between foot characteristics and balance abilities has rarely been discussed. This study aimed to explore the characteristics of plantar pressure profiles associated with foot posture and balance abilities among Indigenous Taiwanese. MATERIAL AND METHODS We recruited 165 Indigenous college students and 183 healthy age-matched students. Bipedal static plantar pressure distributions (PPDs) with arch index (AI) and centers of gravity balance were examined using the JC Mat. Foot posture was determined by estimating the rearfoot postural alignment. RESULTS Indigenous Taiwanese in the study generally had low-arched feet with increased plantar loads at the medial (left: 1.21±0.43%; right: 1.20±0.46%) and lateral longitudinal arches (left: 24.51±5.26%; right: 24.45±6.64) (P<0.01) and the medial metatarsals (left: 21.78±3.81%; right: 22.19±3.91) (P<0.01). Footprint images illustrated pronounced cuboid and navicular collapses. Performances of balance abilities (left: 49.53±4.38%; right: 50.47±4.38) (P<0.01) and rearfoot postural angles (left: 1.37±1.25°; right: 1.32±1.17°) (P<0.05) were better than those of controls. CONCLUSIONS The feet in Indigenous Taiwanese had low arches and higher plantar loads at the medial and lateral longitudinal arches and medial metatarsals, while their centers of gravity were symmetrical and rearfoot posture was normal. These results may facilitate further studies on the relationship between foot characteristics, potential athleticism, and musculoskeletal injuries in Indigenous Taiwanese.

Anatomical analysis of ligaments surrounding calcaneocuboid joint; implications for role in foot stability.

The calcaneocuboid joint is located in the lateral part of the foot and acts as a major stabilizer for the foot. Injuries to this joint often occur in association with ankle or foot injuries and are frequently overlooked, subsequently causing chronic pain or osteoarthritis. However, the relationship between ligaments surrounding the joint and joint instability remains unclear. Therefore, this study aimed to clarify the morphology and position of the ligaments surrounding the calcaneocuboid joint, and to reveal the relationship between the ligament structure. The position and morphology of the bifurcate ligament (subdivided into calcaneonavicular and calcaneocuboid ligaments), dorsal calcaneocuboid ligament, lateral calcaneocuboid ligament, long plantar ligament, and short plantar ligament were measured (N = 11 feet in 6 Japanese cadavers). The circumference of the joint was quartered, while the ligament-uncovered area and the estimated cross-sectional area of each ligament were compared between the four sides. Furthermore, the estimated cross-sectional area of each ligament was calculated as an index for the ligament strength. The inferolateral side of the calcaneocuboid joint had the most uncovered area (54.63%) by the ligaments. In addition, the cross-sectional area of the ligaments on the lateral side was considerably smaller than that on the medial side. Our results suggest that ligament weakness on the inferolateral side may cause instability of the calcaneocuboid joint, especially after an inversion sprain injury, and may decrease the lateral longitudinal arch function, which results in chronic foot pain.

Bipedal Static Supination and Dynamic Forefoot Loading Characteristics in Taiwanese College Badminton Players: A Cross-Sectional Study.

Badminton is a unilateral sport that involves repetitive jumping, lunging and quick changes of direction with the lower limb, thus, plantar pressure profiles and foot postural profiles are critical to maintaining balance and coordination. The purpose of this study was to explore the characteristics of static and dynamic plantar pressure profiles with rearfoot posture in elite and recreational badminton players as well as assess the transitional changes of plantar loads between static and dynamic states. A cross-sectional survey was conducted among 65 college-level elite male badminton players (mean age: 20.2 ± 1.2 years; mean height: 177.4 ± 4.6 cm; mean weight: 72.6 ± 4.6 kg) and 68 recreational badminton players of the same gender (mean age: 19.9 ± 0.8 years; mean height: 170.3 ± 3.9 cm; mean weight: 67.7 ± 3.2 kg). The JC Mat was used to evaluate the arch index (AI), plantar pressure distribution (PPD), centers of gravity, and the characteristics of the footprint. Static foot posture was determined by examining the rearfoot alignment. Both groups' AI fell within the normal range. The static plantar loads of the elite group were distributed at the bipedal lateral part of longitudinal arches and heels (p < 0.01), while the right foot experienced higher centers of gravity (p < 0.05). The elite group's static rearfoot postural alignment exhibited a higher degree of rearfoot varus than the recreational group (p < 0.05). In addition, the elite group's dynamic plantar loads were mainly exerted at the medial and lateral metatarsals of both feet (p < 0.05). During the transition state, the recreational group's plantar loads were mainly shifted to the bipedal lateral part of metatarsals and heels (p < 0.05), whereas the elite group's bipedal lateral longitudinal arches as well as the medial and lateral heels experienced a reduction in plantar loads (p < 0.01). For elite badminton players, the findings revealed a possible connection among the static supinated foot, centers of gravity tending towards the right foot, and increased forefoot plantar loads in the dynamic state. The finding merits further exploration of the possible links between transitional changes in plantar pressure distribution in both states and related foot injuries resulting from intense competition and regular training in badminton.

Interobserver Reliability in the Radiological Evaluation of Flatfoot (Pes Planus) Deformity: A Cross-Sectional Study

This study was planned for analyzing the interobserver reliability on the diagnosis of flatfoot. This study aims to evaluate the interobserver reliability of the digital radiography of flatfoot patients. Eight parameters were used in digital x-rays within the as statistically in 2 groups. Study group includes 34 patients. Two groups were formed four medical specialists as 2 orthopedists and 2 radiologists. Two orthopedists made measurements on x-ray viewing as calcaneal pitch (CP) as CP floor, calcaneus-1 metatarsal angle, calcaneus-5 metatarsal angle; longitudinal arch angles (LAAs) as medial and lateral LAAs, Tomeno-Meary angle (TMA), anteroposterior and lateral CYMA line. The intraclass correlation coefficient (ICC) analysis was performed. Fleiss Kappa and Kappa was used to investigate the reliability of qualitative data between 2 observers. ICCs were in high levels for CP floor, calcaneus-1 metatarsal angle, calcaneus-5 metatarsal angle. ICCs of TMA was in high levels, also. ICCs of LAA-medial and LAA-lateral were not in high levels as other measurements. In the CYMA line (anteroposterior and lateral) Kappa was 0.140 for right feet in the quadruple group (p = .045; .458; and .314). Kappa was 0.197 for left feet in the quadruple group (p = .005; .146; .377). The ICCs was excellent for CP angles and TMA in all groups. LAAs as medial and lateral longitudinal arch angle had not high ICC's. CYMA line had significant p values in the quadruple group. But not in orthopedists and radiologists.

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

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

A Study on the Contribution of Medial and Lateral Longitudinal Foot Arch to Human Gait.

This study aimed to investigate the contribution of medial longitudinal arch and lateral longitudinal arch in human gait and to study the correlation between foot features and gait characteristics. The foot arch plays a significant role in human movements, and understanding its contribution to spatiotemporal gait parameters is vital in predicting and rectifying gait patterns. To serve the objectives, the study developed a new foot feature measurement system and measured the foot features and spatiotemporal gait parameters of 17 young healthy subjects without any foot structure abnormality. The foot-feature parameters were measured under three movement conditions which were sitting, standing, and one-leg standing conditions. The spatiotemporal gait parameters were measured at three speeds which were fast, preferred, and slow speeds. The correlation study showed that medial longitudinal arch characteristics were found to be associated with temporal gait parameters while lateral longitudinal arch characteristics were found to be associated with spatial gait parameters. The developed system not only eases the burden of manual measuring but also secures accuracy of the collected data. Inviting variety of subjects including athletes and people with abnormal foot structures would extend the scope of this study in the future. The findings of this study break new ground in the field of the foot- and gait-related research work.Clinical Relevance-This study demonstrated that the medial longitudinal arch and lateral longitudinal arch characteristics were related to the temporal and spatial gait parameters, respectively. These underlying findings can be applied to investigate relationships between foot abnormality and gait characteristics.

Artificial Intelligence-Based Assessment System for Evaluating Suitable Range of Heel Height

High-heeled shoes of excessive height can severely injure shoe users. Such shoes may cause various injuries, including musculoskeletal pain, osteoarthritis, and hallux valgus. A physician can estimate an appropriate heel height limitation for an individual wearer by touching calcaneus to estimate deformation of the calcaneal varus. It would typically be impractical for a woman to seek the professional assistance of her physician when buying high-heeled shoes. A novel system was developed in this study for evaluating the maximum safe height of high-heeled shoes for female wearers. In this study, images of Achilles tendons, medial longitudinal arches, lateral longitudinal arches, and plantar pressure distributions served as the inputs in the proposed system. After the system had been trained with those images, the system could output the maximum height of high-heeled shoes for each individual wearer. In this study, two crucial methods were used for performing the evaluating system. First, Basic CNN, VGG16, and MobileNetV2 were used to evaluate images of feet. Through the experiments, the proposed artificial intelligence (AI) model achieved an accuracy of 0.88. Next, a statistics algorithm was used to modify the results obtained from the AI model. Subsequently, the error of the system declined. The mean absolute error of the proposed system which was used for evaluating the maximum height of high-heeled shoes was 1.21 cm, which is less than the typical increment for commercially available high-heeled shoes.

Plantar Pressure Profiles and Possible Foot Syndromes of Taiwanese College Elite Basketball Players

Plantar pressure assessments are useful for understanding the functions of the foot and lower limb and for predicting injury incidence rates. Musculoskeletal fatigue is likely to affect plantar pressure profiles. This study aimed to characterize college elite basketball players' plantar pressure profiles and pain profiles during static standing and walking. Fifty-one male elite basketball players and 85 male recreational basketball players participated in this study. An optical plantar pressure measurement system was used to collect the arch index (AI), regional plantar pressure distributions (PPDs), and footprint characteristics during static and dynamic activities. Elite basketball players' pain profiles were examined for evaluating their common musculoskeletal pain areas. The AI values were in the reference range in recreational basketball players and considerably lower in elite basketball players. Elite basketball players' static PPDs of both feet were mainly exerted on the lateral longitudinal arch and the lateral heel and were relatively lower on the medial longitudinal arch and medial and lateral metatarsal bones. The PPDs mainly transferred to the lateral metatarsal bone and lateral longitudinal arch and decreased at the medial heel during the midstance phase of walking. The footprint characteristics of elite basketball players illustrated the features of calcaneal varus (supinated foot) of high arches and dropped cuboid foot. The lateral ankle joints and anterior cruciate ligaments were the common musculoskeletal pain areas. Elite basketball players' AI values indicated high arches, and their PPDs tended to parallel the features of the high-arched supinated and dropped cuboid foot. Their pain profiles resonated with the common basketball injuries and reflected the features of Jones fracture and cuboid syndrome. The potential links among high-arched supinated foot, Jones fracture, and cuboid syndrome are worth further study.

Foot Function Disorders in Children with Severe Spondylolisthesis of L5 Vertebra

Background. In children with spondylolisthesis, there are still unexplained aspects in the relationship of the degree of displacement of the L5 vertebra with the severity of the clinical picture and neurological disorders. At the same time, aspects of the mutual aggravating influence of the indicated spinal disorder on the condition of the feet have not been studied. Therefore, the problem of identifying disorder of foot function in children with spinal spondylolisthesis of the L5 vertebra is relevant.Aim of the study — to evaluate the deviations in parameters of the transverse and longitudinal arches of feet in children suffering from severe spondylolisthesis of the L5 vertebra.Materials and Methods. In the period from 2016 to 2018, 12 children aged 14.1 y.o. [12,7; 15,5] were examined with spondylolisthesis of the L5 vertebral body of grade III-IV, accompanied by stenosis of the spinal canal at the same level and by compression of the roots of the spinal cord. Imaging diagnostics included multispiral computed tomography (MSCT) and magnetic resonance imaging (MRI). To estimate the function of the feet, double-bearing and single-bearing plantography was used. The data for the control group included only plantographic examinations of 12 healthy children of the same age.Results. In patients with spondylolisthesis, the mean value of the anterior t and intermediate s plantographic bearing indices were significantly lower than those of healthy children. At the same time, in tests with an increased load on the foot in patients, there was no significant increase in the mean anterior t and medial m indices, which indicates the dynamic rigidity of the transverse and medial longitudinal arches. The value of the lateral plantographic index l showed its significant pathological increase compared with the normal value at double-bearing load, which indicates the static rigidity of the lateral longitudinal arch. Correlation analysis demonstrated that, against the normal state, the bearing ability of the feet in sick children is realized through a pathological strengthening of the functional relationship between the arches of the foot at double-bearing load and a non-physiological reduction of the interaction between arches at single-bearing load.Conclusion. In children with severe forms of vertebra spondylolisthesis, the parameters of plantographic characteristics indicate the rigidity of the arches of the feet and the distortion of their bearing pattern. It is necessary to take into account the aggravating effect of rigid feet on the state of the spine and include the examination of the bearing function of the feet in the algorithm for the comprehensive diagnosis of children with spondylolisthesis.

The Relationship Between Foot Feature Parameters and Postural Stability in Healthy Subjects.

Little has been explored about the disparate contribution of medial longitudinal arch (MLA) and lateral longitudinal arch (LLA) to human gait and postural stability. This study aims to investigate the correlation of foot feature parameters including both MLA and LLA with postural stability. Thirteen young and healthy subjects participated in this study. The newly developed FFMS extracted foot feature parameters in nonweight-bearing (NWB) and weight-bearing (WB) conditions along with postural stability parameters in single-leg-standing (SLS) condition. A bivariate correlation analysis was carried out to investigate the correlation between the foot characteristics and the postural stability parameters. The foot length and width showed negative correlation with center of pressure (CoP) distance in medio-lateral (ML) and total direction, whereas the foot length in NWB and WB conditions, and the foot width in WB condition showed positive correlation with CoP distance in anterior-posterior (AP) direction. The height of the LLA curve and the area of the MLA were correlated with the postural stability parameters in AP direction. The ratios of the LLA height and area showed moderate correlation with the CoP distance in ML direction and total direction. The size of a foot, such as the length and width, is correlated with postural stability. Whereas the MLA features are associated with postural stability in AP direction, the LLA features are associated with that in ML and total direction. The findings suggest that the roles and contributions of the MLA and LLA features in and to the postural control are different.

Characteristics of Plantar Pressures and Related Pain Profiles in Elite Sprinters and Recreational Runners.

Plantar pressure measurement is effective for assessing plantar loading and can be applied to evaluating foot performance. We sought to explore the characteristics of plantar pressures in elite sprinters and recreational runners during static standing and walking. Arch index (AI) values, regional plantar pressure distributions (PPDs), and footprint characteristics were examined in 80 elite sprinters and 90 recreational runners using an optical plantar pressure measurement system. Elite sprinters' pain profiles were examined to evaluate their most common pain areas. In recreational runners, AI values in males were in the normal range and in females were high arch type. The AI values were significantly lower in elite sprinters than in recreational runners. In elite sprinters, particularly males, the static PPD of both feet was higher at the medial metatarsal bone and the lateral heel and lower at the medial and lateral longitudinal arches. Elite male sprinters' PPD of both feet was mainly transferred to the medial metatarsal bone and decreased at the lateral longitudinal arch and the medial heel during the midstance phase of walking. The lateral knee joint and biceps femoris were the most common sites of musculoskeletal pain in elite sprinters. Elite sprinters' AI values could be classified as high arches, and their PPD tended to parallel the features of runners and high-arched runners. These findings correspond to the profile of patellofemoral pain syndrome (PFPS)-related plantar pressure. The pain profiles seemed to resonate with the symptoms of high-arched runners and PFPS. A possible link between high-arched runners and PFPS warrants further study.

Longitudinal arch load-sharing system of the foot

The longitudinal arch of the human foot is a complex mechanical structure that must be compliant on uneven surfaces and also have sufficient stiffness to allow the foot to be an efficient propulsive organ during walking and running gait. To serve these functions, the longitudinal arch has a unique four-layer load-sharing system consisting of the plantar fascia, plantar intrinsic muscles, plantar arch extrinsic muscles and plantar ligaments. These four layers of tension load-bearing elements, working together with the osseous elements which serve as the framework of the longitudinal arch, work synergistically to increase longitudinal arch stiffness during weightbearing activities. The passive tension load-bearing elements of this load-sharing system, the plantar fascia and plantar ligaments, are not under direct central nervous system control and thus serve to stiffen the longitudinal arch with an automatic stiffening mechanism that is based on Achilles tendon tension and plantar forefoot loading. The active tension load-bearing elements, the plantar intrinsic and plantar extrinsic muscles, are under direct central nervous system control and serve to increase or decrease the stiffness of the medial and lateral longitudinal arches depending on the type and intensity of the prevailing weightbearing activity of the individual. Together, the elements of the longitudinal arch load-sharing system ensure that proper weightbearing function of the longitudinal arch, and the foot and lower extremity, can still occur even when a failure of one of these tension load-bearing elements occurs due to injury.

Sistema de reparto de cargas del arco longitudinal del pie

The longitudinal arch of the human foot is a complex mechanical structure that must be compliant on uneven surfaces and also have sufficient stiffness to allow the foot to be an efficient propulsive organ during walking and running gait. To serve these functions, the longitudinal arch has a unique four-layer load-sharing system consisting of the plantar fascia, plantar intrinsic muscles, plantar arch extrinsic muscles and plantar ligaments. These four layers of tension load-bearing elements, working together with the osseous elements which serve as the framework of the longitudinal arch, work synergistically to increase longitudinal arch stiffness during weightbearing activities. The passive tension load-bearing elements of this load-sharing system, the plantar fascia and plantar ligaments, are not under direct central nervous system control and thus serve to stiffen the longitudinal arch with an automatic stiffening mechanism that is based on Achilles tendon tension and plantar forefoot loading. The active tension load-bearing elements, the plantar intrinsic and plantar extrinsic muscles, are under direct central nervous system control and serve to increase or decrease the stiffness of the medial and lateral longitudinal arches depending on the type and intensity of the prevailing weightbearing activity of the individual. Together, the elements of the longitudinal arch load-sharing system ensure that proper weightbearing function of the longitudinal arch, and the foot and lower extremity, can still occur even when a failure of one of these tension load-bearing elements occurs due to injury.

An optimized design of in-shoe heel lifts reduces plantar pressure of healthy males

Conventional heel lift with a flat surface increases the risk of foot problems related to higher plantar pressure and decreased stability. In this study, an optimized design of in-shoe heel lifts developed to maintain the midfoot function was tested to investigate if the plantar pressure distribution was improved. The design was based on three dimensional foot plantar contour which was captured by an Infoot 3D scanning system while the heel was elevated by a heel wedge. To facilitate midfoot function, an arch support was designed to support the lateral longitudinal arch, while allowing functional movement of the medial longitudinal arch. Twenty healthy male subjects were asked to walk along an 8m walkway while wearing high-cut footwear with and without the optimized heel lift. Peak pressure, contact area and force–time integral were measured using the Pedar insole system. Range and velocity of medial-lateral center of pressure during forefoot contact phase and foot flat phase were collected using a Footscan pressure plate. Compared to the shoe only condition, peak pressure under the rearfoot decreased with the optimized heel lift, while no increase of peak pressure was observed under the forefoot and midfoot regions, indicating improved plantar pressure distribution. The findings of this study suggest that this optimized heel lift has better biomechanical performance than a conventional flat heel lift. Results from this study may have implications for insole and shoe last design, especially for people who need additional heel height without sacrificing midfoot function.

Normal values of foot arch parameters in adult Hausa population of Nigeria

Background: Deformities of foot arches have been implicated in various lower extremity injuries. Normal values of foot arch parameters have been studied in various populations. However, studies in Nigerian population are very limited and therefore require attention. Objective: The objectives of this study were to establish the normal values of foot arch parameters in adult Hausa population of Nigeria, to find the effect of gender on these parameters and to make comparison with previous studies in other populations. Materials and Methods: A total of 59 consented subjects (44 males, 15 females) that have no history of lower extremity deformity were recruited. Lateral radiograph of the right foot of each participant was taken in a bilateral standing position. For the medial longitudinal arch, navicular height (NH), first cuneiform height (FCH), calcaneal inclination angle (CIA), and calcaneal- first metatarsal angle (C1MA) were measured. Cuboid height (CH) and calcaneal-fifth metatarsal angle (C5MA) were measured for the lateral longitudinal arch. Measurements for angles and heights were performed using a universal plastic goniometer and a plastic ruler, respectively. Results: The mean (standard deviation [SD]) value of the NH was found to be 2.89 (0.54) cm, FCH 2.08 (0.44) cm, CIA 16.57° (3.30°), and C1MA 140.05° (5.63°). The mean (SD) of CH and C5MA was found to be 1.19 (0.31) cm and 160.96° (4.69°), respectively. There was no significant mean difference in those parameters between males and females. Conclusion: The mean values of foot arch parameters in adult Hausa population of Nigeria is comparable to previous studies on other populations, but generally lower than those of Caucasians. Similarly, our findings showed that gender has no significant effect on foot arch parameters.

Parametric study of orthopedic insole of valgus foot on partial foot amputation

Orthopedic insole was important for partial foot amputation (PFA) to achieve foot balance and avoid foot deformity. The inapposite insole orthosis was thought to be one of the risk factors of reamputation for foot valgus patient, but biomechanical effects of internal tissues on valgus foot had not been clearly addressed. In this study, plantar pressure on heel and metatarsal regions of PFA was measured using F-Scan. The three-dimensional finite element (FE) model of partial foot evaluated different medial wedge angles (MWAs) (0.0°–10.0°) of orthopedic insole on valgus foot. The effect of orthopedic insole on the internal bone stress, the medial ligament tension of ankle, plantar fascia tension, and plantar pressure was investigated. Plantar pressure on medial heel region was about 2.5 times higher than that of lateral region based on the F-Scan measurements. FE-predicted results showed that the tension of medial ankle ligaments was the lowest, and the plantar pressure was redistributed around the heel, the first metatarsal, and the lateral longitudinal arch regions when MWA of orthopedic insole ranged from 7.5° to 8.0°. The plantar fascias maintained about 3.5% of the total load bearing on foot. However, the internal stresses from foot bones increased. The simulation in this study would provide the suggestion of guiding optimal design of orthopedic insole and therapeutic planning to pedorthist.

Structural deformation of longitudinal arches during running in soccer players with medial tibial stress syndrome

The purpose of this study was to compare angular change and translational motion from the medial longitudinal arch (MLA) and lateral longitudinal arch (LLA) during running between medial tibial stress syndrome (MTSS) and non-MTSS subjects. A total of 10 subjects volunteered, comprising 5 subjects with MTSS and 5 subjects without injury (non-MTSS) as the control group. All subjects performed the test movement that simulated running. Fluoroscopic imaging was used to investigate bone movement during landing in running. Sagittal motion was defined as the angular change and translational motion of the arch. A Mann-Whitney U-test was performed to determine the differences in the measured values between the MTSS and non-MTSS groups. The magnitude of angular change for the MLA and LLA was significantly greater for subjects with MTSS than for control subjects. Translational motion of the MLA and LLA of the MTSS group was also significantly greater than that of the non-MTSS group (all p < 0.05). Soccer players with MTSS have an abnormal structural deformation of foot during support (or stance) phase of running, with a large decrease in both the MLA and LLA. This abnormal motion could be a risk factor for the development of MTSS in these subjects.

Maintenance of longitudinal foot arch after different mid/hind-foot arthrodesis procedures in a cadaveric model

BackgroundCurrently, the optimal treatment of flatfoot remains inconclusive. Our objectives were to understand the effect of different arthrodeses on maintenance of foot arch and provide experimental basis for rational selection in treatment of flatfoot. MethodsSixteen fresh-frozen cadaver feet amputated above the ankle along with a section of leg were studied from ten males and six females. We used standard clinical techniques and hardware for making the arthrodeses. Plantar pressure in the medial and lateral longitudinal arch distribution was measured with a plantar pressure mapping system under different loading conditions. FindingsValues of plantar pressure reaction, mean and maximum dynamic peak pressure between all group pairs were statistically significant (P<0.05). The plantar pressure reaction appeared at the load of 960N in the medial arch of the unoperated foot, compared with 1080N after subtalar arthrodesis, 1200N after talonavicular arthrodesis, 1080N after calcaneocuboid arthrodesis, 1320N after double arthrodesis, and 1560N after triple arthrodesis. The plantar pressure reaction appeared at the load of 360N in the lateral arch of the unoperated foot, compared with 600N after subtalar arthrodesis, 600N after talonavicular arthrodesis, 840N after calcaneocuboid arthrodesis, 960N after double arthrodesis, and 1440N after triple arthrodesis. InterpretationThe triple arthrodesis provided the highest support to both arches; the double arthrodesis appeared to be similar to talonavicular arthrodesis in supporting the medial arch and similar to calcaneocuboid arthrodesis in supporting the lateral arch; subtalar arthrodesis was less effective in supporting both arches.

Surgical Reconstruction of a Severe Crush Injury of the Lateral Part of the Forefoot with Use of a Cross-Leg Osteocutaneous Pedicled Fibular Graft: A Case Report.

The lateral part of the forefoot serves as part of the transverse and lateral longitudinal arches and therefore plays a key role in foot function1,2. Foot injuries resulting from high-energy trauma are increasingly common. These injuries are usually accompanied by extensive damage to the soft tissues, severely comminuted fractures or bone defects, and even injuries to the nerves and the main vessels. Limb salvage and reconstruction in these cases present great challenges for orthopaedic and plastic surgeons3. After high-energy trauma, substantial defects of the lateral part of the forefoot are commonly encountered during surgery, especially with injuries involving the four lateral metatarsal bones and the corresponding soft tissues. Limited information has been published about limb salvage surgery techniques for this region. We describe a case of a severe crush injury of the four lateral metatarsal bones with corresponding soft-tissue damage that was treated effectively with a cross-leg osteocutaneous pedicled fibular graft. The patient and his family were informed that data concerning the case would be submitted for publication, and they provided consent. A twenty-four-year-old man was admitted to the hospital and treated for injuries to the left lower extremity, which had been sustained in a motorcycle crash. Initial examination revealed extensive soft-tissue injury of the left foot associated with a Gustilo-Anderson type-IIIC comminuted fracture of the metatarsal bones (Fig. 1-A). The metatarsal bone fractures were fixed with Kirschner wire, and the wound was covered with a vacuum-assisted closure device during emergency treatment. Necrosis of the four lateral metatarsal bones was considered to …

Gender-based differences in the functional deformation of the foot longitudinal arch

BackgroundGender differences in physical characteristics are associated with differing incidences of sports-related injuries. However, functional differences in the foot arch, which acts as a shock absorber under dynamic conditions, have not been investigated. ObjectiveThis study investigated gender-based differences in the medial and lateral longitudinal arches under static and dynamic conditions. MethodsEleven males and 8 females participated in this study. Radiographic images of the subjects’ feet were obtained under static conditions, with and without weight bearing. In addition, each subject performed single leg landing from 10cm platform with the knee extended, and cineangiographic images in the sagittal plane were obtained during landing. ResultsIn the weight bearing position, the medial and lateral arch angles of the females were significantly greater than those of the males, but neither of the angles differed between the males and females without weight bearing. The magnitude of the angular changes of each arch was significantly greater in the females than in the males. ConclusionThese results suggest that females have a greater range of arch motion than males under static and dynamic loading conditions.