Medial Arch Research Articles

巻き上げ作用時の足内側アーチと後足部内反との関係

This study analysed whether in version of the posterior foot was related to the medial arch in the Windlass action. Subjects comprised 10 normal adult males. Roentgenogram were taken in a siting position, adding passive dorsiflexion. Calcaneo-first metatarsal angle (Hibbs angle) was measured on the lateral view of the foot, Tibio-calcaneal angle (TB-C angle) and Ankle mortice-heel contact angle (A-H angle) were measured on the posterior roentgenogram of the foot according to Cobeys method. We then compared the Hibbs angle, TB-C angle and A-H angle with the control group. When the toes were dorsiflexed Hibbs angle was significantly lower than in the Control group when all the toes except the fifth toe were dorsiflexed and the medial arch off the foot was elevated. However no significat differences were seen between the Control group and the TB-C angle and A-H angle in the Windlass action. We concluded that there was no inversion of the posterior foot in the Windlass action.

Kidner procedure for symptomatic accessory navicular and its relation to pes planus.

The role of relocation of tibialis posterior tendon insertion in the treatment of symptomatic accessory navicular and its relation to the pes planus was studied in 28 patients with symptomatic accessory navicular. Two hundred non-affected individuals were used as control. The calcaneal pitch angle measured radiographically, was used as an indicator of pes planus. All patients had had an excision of the accessory navicular and relocation of the tibialis posterior tendon insertion (Kidner procedure). The average follow-up was 3.2 years. The results were good in 27 patients, and fair in 1 patient, and there were no poor results. Most of the patients demonstrated that the pain and the fatigue signs of the foot and the leg have been improved. Only 3 of 25 patients clinically showed an improvement of the medial longitudinal arch. The calcaneal pitch angle in patients with symptomatic accessory navicular was significantly (14.8 degrees) lower than that in normal subjects (21.4 degrees). An association of pes planus and symptomatic accessory navicular was shown. The Kidner procedure gave good results in the relief of pain and fatigue in patients with symptomatic accessory navicular. The procedure did not significantly restore the height of the medial arch.

Organized chaos? Computed tomographic evaluation of the neuropathic diabetic foot

Accurate radiographic evaluation of diabetic neuroarthropathy is increasingly difficult as the disease becomes more florid. 22 patients with a known diabetic neuroarthropathy of one or both feet were prospectively examined by computed tomography (CT) in the axial and coronal planes. Bilateral changes of a neuroarthropathy were present in 75% of cases. Distinct patterns of disease were seen and categorized into five types in order of increasing severity. Changes at the medial tarsometatarsal joints and adjacent intercuneiform joints were seen in all affected feet. More extensive disease involved the medial arch more commonly than the lateral. Fractures of the tarsal bones were found in 32% of cases and were associated with neuroarthropathic changes in adjacent joints. Calcaneal fractures were seen in four feet. A Lisfranc fracture-dislocation was present in 41% of cases and a bilateral in only 21%. A single CT examination of the foot, while an accurate method of demonstrating the extent of the disease, is an insensitive indicator of disease activity.

Effects of conditioning cutaneomuscular stimulation on the soleus H-reflex in normal and spastic paretic subjects during walking and standing.

1. The modulation of the soleus H-reflex by a conditioning cutaneomuscular stimulation was investigated in 10 normal and 10 spastic paretic subjects who suffered from incomplete spinal cord lesions. The different motor tasks examined were standing, locomotion, and the maintenance of static limb postures to mimic critical gait events. The test soleus H-reflex was obtained by stimulating the tibial nerve in the popliteal fossa with a single 1-ms pulse at an intensity that produced a barely detectable M wave. The conditioning stimulus, consisting of an 11-ms train of three 1-ms pulses at 200 Hz, was delivered to the ipsilateral medial plantar arch, stimulating predominantly the medial plantar nerve, at an innocuous intensity of 2.5-3.0 X sensory threshold and at a conditioning-test delay of 45 ms. 2. During quiet standing, the H-reflex amplitude was inhibited only marginally by the conditioning cutaneomuscular stimulation, not reaching statistical significance in either the normal or spastic group of subjects. Although there was a trend of reflex inhibition in the normal subjects as the conditioning intensity was increased, a reversed trend of reflex facilitation was observed in the spastic patients. 3. During treadmill walking, the conditioned H-reflex was inhibited significantly during all phases in all the normal subjects and in one mildly impaired patient. In the moderately and severely impaired patients, cutaneomuscular stimulation selectively inhibited the soleus H-reflex in the early stance and swing phases, thereby producing a near normal phasic modulation pattern. Such modulatory effects were not present under static gait-mimicking conditions. 4. The task-specific and phase-dependent effects of cutaneomuscular stimulation on the soleus H-reflex in the spinal cord-injured patients revealed strong inhibitory influence on Ia afferents from cutaneomuscular inputs. It is plausible that inhibition occurs at both pre- and postsynaptic levels. 5. It is concluded that normal Ia modulatory mechanisms during locomotion are deficient in spastic spinal cord-injured patients and can partially and artificially be restored by cutaneomuscular stimulation applied to the sole of the foot. This can be used as a functional electrical stimulation (FES) regime in gait rehabilitation.

Shaping and positioning the nasal tip without structural disruption: a new, systematic approach.

This paper presents a new, comprehensive, and systematic approach to analysis, planning, and techniques of primary nasal tip rhinoplasty, emphasizing techniques that limit uncontrollable variables before proceeding to techniques which increase uncontrollable variables and risk secondary deformity, including (1) maintenance of structural integrity of the alar rim strips, limiting use of scoring or morselization techniques which reduce support and introduce potential secondary deformities, (2) shaping and positioning the lateral and medial crura in a reversible, nondestructive manner using permanent suture and nonvisible control graft techniques, (3) minimizing uncontrollable postoperative variables by decreasing the need for visible grafts to shape the tip complex in primary rhinoplasty, achieving the same results with existing alar structural elements, (4) integrating these concepts with specific sequences of surgical techniques--bilateral alar arch components individually positioned, then shaped and unified for symmetry, and finally positioned for rotation and projection--and (5) introducing an integrated set of surgical techniques and sequencing of tip surgery to achieve the objectives listed above in most primary and some secondary rhinoplasties. The concepts and techniques of this approach are based on the principle that preservation of structural integrity of alar complex elements (medial and lateral crural arch elements) preserves support and reduces the incidence of secondary deformities (kinking, buckling, discontinuity) that can result from shaping techniques which disrupt that integrity. If shaping and positioning of the tip can be achieved with reversible, nondestructive techniques, the need for placement of visible grafts (with their additional variables) is greatly reduced. Shaping and positioning can be performed incrementally and reversibly without jeopardizing structural integrity and support in the surgical process. Ten fresh cadaver dissections were utilized in the development of the surgical techniques. A total of 233 rhinoplasties (220 primary and 13 secondary) with 1 to 9 years of follow-up have been performed using this approach. Only two secondary procedures for tip deformity have been performed.

Resection of tarsal coalition

Calcaneonavicular and talocalcaneal bar are the most common types of tarsal coalition, which is the predominant cause of rigid or peroneal spastic flatfoot. The presenting symptoms of frequent sprains, pain around the subtalar joint, loss of varying degrees of the medial arch, and progressive loss of subtalar motion are common to both forms. Roentgenographic diagnosis can be made with the lateral oblique for the calcaneonavicular bar and the posterior oblique for the talocalcaneal bar. Computerized axial tomography (CT) is perhaps the most diagnostic radiologic evaluation for both types. The treatment regimen for both forms is a trial of casting and orthotics; surgery is indicated when conservative therapy fails. Surgical treatment consists of resection with interpositional arthroplasty or arthrodesis, either limited or the triple arthrodesis. Resection with interposition of the extensor digitorum brevis for calcaneonavicular bar is the most accepted surgical treatment. Resection with fat graft for talocalcaneal bars, which occupy less than one half of the subtalar joint with no other degenerative changes, is a newer technique that has favorable results.

Anatomical basis of a fascio-cutaneous pedicle flap based on the infero-lateral collateral artery of the leg.

An anatomical study of 30 cases has been performed on the vascularisation of the distal third of the antero-lateral compartment of the leg, with particular reference to the relations of the infero-lateral collateral artery of the anterior tibial artery, the perforating branch of the peroneal artery, and the antero-lateral malleolar artery. A fascio-cutaneous pedicle flap based on the infero-lateral collateral artery is described noting that the superior, anterior, and posterior limits are similar to those of the lateral supramalleolar flap of Masquelet. The inferior limit of this new flap is 15 mm distal to the site of emergence of the perforating branch of the peroneal artery. The advantages of this flap are; a large surface area for cover, antegrade vascularisation, and no significant vascular sacrifice. The distal half of the calf can be covered both medially and posteriorly as well as the proximal half of the dorsum of the foot, the medial and lateral arch areas, the perimalleolar region, and the region behind the Achilles tendon. The flap requires the presence of the infero-lateral collateral artery of the tibialis anterior which can be confirmed either peroperatively or preoperatively by angiography.

The management of a complex midfoot fracture with circular external fixation

Midfoot injuries are uncommon, accounting for only 0.5 per cent of all fracture dislocations (Wilson, 1933). The cuboid articulates with five other bones within the foot and is therefore an integral part of the lateral arch. This is a rigid structure, important in maintaining the anatomy and strength of the foot, and has a tendency to ‘snap’ under duress, producing comminuted fractures of the cuboid (Helal and Wilson, 1988). The navicular lies within the more mobile medial arch, disruption of which will lead to functional disability, as its role within the foot is one of propulsion A major study of midfoot fractures and dislocation was published in 1975 by Main and Jbwett. They designed a classification based upon mechanism of injury, with crushing trauma forming one of the smaller groups. Distinct mechanisms of injury are not described within this group, but in general, there is usually more than one fracture, and the injury is commonly open in nature. Medial arch injuries lead to degenerative changes in the long term, causing pain and stiffness on walking, and in Main and Jowett’s study, damage to the lateral arch resulted in nothing better than poor to fair outcomes. Recognized treatment involves open reduction and internal fixation followed by the use of a plaster, with or without weight bearing. Nevertheless the injury is notoriously difficult to bring to a satisfactory conclusion, due to collapse of the lateral arch. We present a new method which allows early mobilization by the patient whilst still maintaining good fracture reduction.

肢位の違いによる足アーチの変化

This study investigated the stable position of the medial arch of the foot for roentgenographic examination.The length of the medial arch was measured using the electric arch gauge (EAG) in thirty feet of fifteen normal adults in the following positions: sitting (control), both-legs standing, one-leg standing without support, Yokokura's-position, one-leg standing with support, and Yokokura's position with sunnort.The sway of the medial arch in both-legs standing position was the least among the six positions except for the sitting position.It was thought that standing on both lets was the most stable position for radiographic examinations in the evaluation of the medial arch of the foot.

Biomechanical evaluation of longitudinal arch stability.

In spite of the common occurrence of pes planus and multiple operations that have been reported to relieve the associated symptoms, there is little published on the relative contribution of various structures to stabilization of the arch of the foot. Twelve fresh-frozen human cadaveric feet were loaded along the tibial axis with compressive loads of 230, 460, and 690 newtons with the specimens intact and after sequential sectioning of plantar fascia, plantar ligaments, and spring ligament. Structures were sectioned in six different sequences and changes in vertical and horizontal dimensions of the medial arch were measured. The highest relative contribution to arch stability was provided by the plantar fascia, followed by plantar ligaments and spring ligament. Plantar fascia was a major factor in maintenance of the medial longitudinal arch. Its division in the cadaveric feet decreased arch stiffness by 25%.

下腿の回旋と足内側アーチの関連

This is study analysesthe relatinship between leg rotatin and the maedial arch of the foot. Materials were three amputated legs. Which were rotated internally and externally 15 times. We measured the angles of the ankle and subtalar joint and the length of hte medial arch simultaneously. When the leg was rotated internally, the subtalar joint became everted and the medial arch lengthensd. However when the leg rotated externally, the subtalar joint inverted and the medal arch shortend. The angle of the ankle joint was not changed. Therefore rotatin of the leg related to change in the medial arch.

Footprint Analysis Between Three and Seventeen Years of Age

Footprints of both feet were analyzed from 1676 schoolchildren of both sexes (1013 girls and 663 boys), aged between 3 and 17 years. The sample was divided into five age groups. In each footprint the Footprint Angle and the Chippaux-Smirak Index were obtained. Classification of individual shapes of foot arches and different types of foot morphology followed that used by Jaworski and Puch in 1987. A high percentage of lowered longitudinal medial arch in the youngest age group of the study was found. The percentage is lower in the older age groups. The longitudinal medial arch has a physiological development in the earlier years of growth.

The Ballet Technique Shoe: A Preliminary Study of Eleven Differently Modified Ballet Technique Shoes Using Force and Pressure Plates

Ballet dancers are vulnerable to various stress-related injuries; foot and ankle injuries are the most common. This study determined if the pressure across the foot could be more evenly distributed by wearing various modified technique shoes padded with PPT, Spenco, or Sorbathane, alone or in combinations. A professional ballet dancer performed a jump by taking a single step on his left foot, jumping and landing with his right foot on the force and pressure plates with each modified shoe plus one unmodified shoe. The results of this study revealed: (1) total force cannot be reduced, (2) center of gravity and the majority of the pressure is maintained over the first and second metatarsal heads, and (3) the modified technique shoe can more evenly distribute pressure to the medial arch and away from the toes, metatarsal heads, and heel.

Influence of activities of foot and lower leg muscles to length of medial foot arch

Influence of activities of foot and lower leg muscles to length of medial foot arch

Microevolutionary changes in the skeleton of the foot of Japanese: Special reference to the medial longitudinal arch

This study concerns secular changes of the foot of Japanese, from the prehistoric Jomon period to early modern times. The size of the talus, calcaneus and first metatarsal changed in parallel with the estimated stature, during this period. In the case of the calcanues, length-height-index, length-tuberosity height-index, Bohler's tuber-joint angle and angle of cuboidal articular surface gradually increased with time. Thus, all may take part in elevation of the longitudinal arch. With time, the relative height of the subtalar, talonavicular, cuneonavicular and first tarsometatarsal joints in the reconstructed medial arch enlarged, in parallel with the increase in the inclination angles of both the calcaneus and the first metatarsal. In addition, valgus deviation of the distal phalanx of the great toe became conspicuous in comparatively recent times. These changes no doubt were accelerated by modification in life style.

Use of liquid crystal thermography in the evaluation of the diabetic foot.

Liquid crystal thermography (LCT) was used to determine temperature variations on the plantar surface of feet. The purpose was to identify thermal emission patterns associated with diabetic foot ulcers. Three population groups were screened: group I, 16 nondiabetic controls; group II, 21 diabetic patients with no history of pedal ulcers; and group III, 28 diabetic patients with active pedal ulceration or history of foot ulcerations. The results demonstrate a generalized increase in plantar foot temperature in group III compared with groups I and II. Temperature readings under metatarsal heads 1-5, great toe, heel, and lateral band were significantly increased (P less than .01) in group III. Additionally, the warm lateral surface displayed by group III patients was not significantly different in temperature from the medial arch of the foot. In groups I and II, the lateral band was significantly cooler (P less than .01) than the medial arch. In group III patients with active ulceration on only one foot, no significant difference in temperature was found between the foot with active ulceration compared with the contralateral nonulcerated foot. When patients with active pedal ulceration were compared with patients with a history of foot ulcers, no significant difference in temperature was seen at five of seven sites tested. A warm concentric color band surrounding active plantar ulcers was identified in group III. This pattern extended from the center of the ulcer to a distance of 8 mm. A significant change in temperature (P less than .01) was noted at 6- and 8-mm distances from the center of the ulcer. In addition, a mottled thermographic pattern was observed more frequently in group III patients than in groups I and II.(ABSTRACT TRUNCATED AT 250 WORDS)

Functional differences of three ligaments of the transverse tarsal joint in Hominoids

Differences among the Hominoidea in the morphology and placement of three major ligaments of the transverse tarsal joint are examined. Humans alone possess the posterior portion of the long plantar ligament. In Homo , this ligament acts as a truss preventing dorsi-flexion of the transverse tarsal joint under load. A second ligament, the plantar cuboideo-navicular ligament is variable in the Hominoidea. Of the specimens used in this study it was absent in a female gorilla and a female orang. This ligament is an important component of the medial arch in Homo , preventing medio-lateral spreading of the cuboideo-navicular joint. The bifurcated ligament also contributes to the stability of the medial arch in Homo . This ligament was also variable in the pongids examined. In the chimpanzee and gorilla specimens the calcaneo-navicular band was reduced, while in the orang specimen the calcanco-cuboid band was reduced.

幼児足部集団検診について

The medial longitudinal arch of the 331 feet of 166 infants between the ages of one year and five years were radiologically examined. They were radiographed in the standing position.Talo-calcaneal angle and talo-1st metatarsal angle were measured in the anteroposterior projection, whereas talo-calcaneal angle, talo-1st metatarsal angle and calcaneal angle were measured in the lateral projection.The result indicates that the medial longituinal arch of the foot rises progressively between one and five years.

Gait analysis. Alterations in support phase forces using supportive devices.

This study documents changes in momentary distribution of forces under the foot, comparing barefoot gait to that with heel cups, medial arch supports, and low-dye taping. Cholesterol crystal force plate analysis and a computerized Kistler force platform were used in the study. Low-dye taping or a heel cup significantly diminished the duration of forces under the midfoot, medializing the instant center of forces. A medial arch support shifted the instant center of forces laterally, though it did not diminish the duration of forces under the arch. The relationship between these alterations of force distribution and the treatment of common runner's ailments such as plantar fasciitis, posterior tibial tendinitis, metatarsalgia, and shin splints is much clearer in the light of these results.

Evidence for a direct spinal mechanism in morphine-induced inhibition of nociceptive reflexes in humans

A better understanding of autonomic influence on motor reflex pathways in spinal cord injury is important to the clinical management of autonomic dysreflexia and spasticity in spinal cord injured patients. The purpose of this study was to examine the modulation of flexor reflex windup during episodes of induced sympathetic activity in chronic human spinal cord injury (SCI). We simultaneously measured peripheral vascular conductance and the windup of the flexor reflex in response to conditioning stimuli of electrocutaneous stimulation to the opposite leg and bladder percussion. Flexor reflexes were quantified using torque measurements of the response to a noxious electrical stimulus applied to the skin of the medial arch of the foot. Both bladder percussion and skin conditioning stimuli produced a reduction (43–67%) in the ankle and hip flexor torques (p < 0.05) of the flexor reflex. This reduction was accompanied by a simultaneous reduction in vascular conductance, measured using venous plethysmography, with a time course that matched the flexor reflex depression. While there was an overall attenuation of the flexor reflex, windup of the flexor reflex to repeated stimuli was maintained during periods of increased sympathetic activity. This paradoxical depression of flexor reflexes and minimal effect on windup is consistent with inhibition of afferent feedback within the superficial dorsal horn. The results of this study bring attention to the possible interaction of motor and sympathetic reflexes in SCI above and below the T5 spinal level, and have implications for clinicians in spasticity management and for researchers investigating motor reflexes post SCI.