Metatarsal Research Articles

Clubfoot: Congenital Talipes Equinovarus.

Congenital talipes equinovarus (CTEV), also known as clubfoot, is a common musculoskeletal entity that affects one to two per 1000 live births worldwide. Imaging modalities including radiography, US, and MRI have emerged as valuable tools for the diagnosis, treatment, and monitoring of CTEV. The deformity is characterized by midfoot cavus, forefoot adductus, and hindfoot varus and equinus. The Ponseti method of manipulation and serial casting is the standard treatment of CTEV. Radiography shows the anatomy, position, and relationships of the different bones of the foot. US allows accurate assessment of cartilaginous and bony structures, in addition to its inherent advantages such as absence of ionizing radiation exposure. One of the indications for US is to monitor the response to Ponseti method treatment. MRI enables visualization of bones, cartilage, and soft tissues and allows multiplanar evaluation of deformities, providing a comprehensive imaging analysis of CTEV. An integrated approach that combines clinical examination and imaging findings is essential for effective management of CTEV. The authors provide a comprehensive overview of CTEV with a review of imaging modalities to help evaluate CTEV, focusing on radiography, US, and MRI. Using this article as a guide, radiologists involved in the assessment and treatment of CTEV can contribute to the management of the condition. ©RSNA, 2024 Supplemental material is available for this article.

Extended finite element analysis for the 2nd and 3rd metatarsals stress fracture during push-off

Metatarsal stress fractures (MSF), particularly the 2nd and 3rd MSF, are common injuries among athletes. Although there are several practices to reduce foot and ankle injuries, there is no injury prevention program specifically designed to minimize MSF. This is mainly due to the lack of information about the loadings/postures that cause MSF. Therefore, this study aimed to investigate dangerous loadings/postures potentially causing MSF during push-off (PO). The analysis was conducted with Finite Element Modelling (FEM), calibrated with the three-point bending test, and validated with peak plantar pressure (PPP) and fracture force measurement. Extended Finite Element Method was used for MSF simulation such that ten different foot and ankle configurations were designed, with five for each of the 2nd and 3rd MSF under pure vertical loadings. A more complex loading, ankle eversion/inversion during PO, was also examined for the MSF. The average error percentage for the calibration of the model with the three-point bending test was 3.05%. The average error percentages for the validation of the model with PPP and fracture force measurements were 18% and 30%, respectively. The outcomes of pure vertical loadings indicated the higher potential for the 2nd and 3rd MSF at 30% PO and 70% PO, respectively. The results of ankle eversion/inversion loadings represented that the most dangerous posture for MSF was 30° ankle eversion for the 3rd metatarsal at 70% PO. These results provide a guide, including what postures to avoid for the 2nd and 3rd MSF among people who are at high risk of MSF.

Navigating Beyond Neuromas: A Riveting Case Report Unveiling Intriguing Differential Diagnoses

The purpose of this research was to evaluate the pathophysiology, diagnosis, and differentialdiagnosis of metatarsalgia by describing a clinical case of a rare lower limb injury, fibrolipomatous hamartoma of the plantar nerve (HFL). Material and Method: We present thecase of a 47-year-old patient with a one-year history of pain in the anterior region of the right foot, associated with paresthesia of the lesser toes and no history of trauma. Physical examination revealed hyperkeratosis on the third rocker over the 2nd metatarsal (MTT), localpain, and neuritic symptoms, along with a doubtful Mulder sign. X-rays showed a negative index with narrowing of the space in the second toe. Magnetic resonance imaging described findings suggestive of a possible Morton's neuroma in the second space. Initial conservative management was chosen. After the lack of response to conservative treatment, surgical intervention was decided, during which the digital nerve was visualized and excised. Subsequently, a Triple Weil osteotomy was performed on the second and third MTT to prevent transfer metatarsalgia. The postoperative period was uncomplicated, and the patient showed complete relief of symptoms without recurrence after surgical excision. HFL presentsas a rare benign tumor with an atypical location in the foot, generating symptoms similar to Morton's neuroma. The imperative need for a differential diagnosis with this entity is emphasized.

Modern issues of surgical anatomy of the ligamentary apparatus and metatarsal bones of the human foot

The article presents an analysis of scientific literature devoted to the study of surgical anatomy of the ligamentous apparatus and metatarsal bones of the human foot. The literature covers the issues of macroanatomy and histology of the ligaments and metatarsal bones of the foot quite fully. At the same time, issues related to the same shape and size of bones, the relative position of ligaments, their histotopographic features are contradictory, which is associated with high variability, individual and age variability in combination with a number of social factors and features of the regions of residence. The work shows that at present, the data of domestic and foreign scientific literature on the anatomy and topography of the bones and ligaments of the metatarsal bones of the human foot are presented either by sectional studies or by the results of clinical observations using diagnostic equipment. The existing studies do not provide a comprehensive picture of the surgical anatomy of the ligamentous apparatus and metatarsal bones of the human foot. The article reflects the need for widespread use in fundamental anatomical studies of ligaments and metatarsal bones using the histotopographic method of research, quantitative and qualitative assessment of morphological parameters, which open up new possibilities for diagnosing pathological processes and developing new surgical techniques.

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.

3D reconstruction of foot metatarsal bones of women using CT images

Bone morphology is a fundamental factor in human anatomy. However, foot and ankle bones have yet to be adequately evaluated in 3-dimensional. It is essential to present the biometric data of anatomical structures. This study formed 3D models of the metatarsal bones of the feet of young women using image processing techniques to examine biometric measurements and determine morphology on these 3D models. This study investigated bone lengths in the metatarsal bones of women feet in Türkiye. A total of ten young female subjects were included as the test group to measure the lengths of their foot metatarsal bones using CT (Computed Tomography) scans, and 20 feet (left/right) were examined. The parameters that were used for the analyses were detector collimation of 64x0.5 mm, section thickness of 0.5 mm, current of 100 mA, tube voltage of 120 kVp, and pixel spacing of 512x512 pixels with a monochrome resolution providing 16-bit gray levels. CT images were processed, and a 3D metatarsal reconstruction was gathered. Then, the biometric measurements were calculated on this 3D model. For the lengths of the volunteers' right/left foot metatarsal bones, statistically significant differences were calculated using a one-sample t-test. For the female metatarsal bones of the left and right feet, statistically significant differences in length were calculated on 3D models. The mean results of the metatarsal length measurements were MT1(metatarsal): 59.52±1.42 mm, MT2: 70.45±1.82 mm, MT3: 66.25±1.82 mm, MT4: 65.12±1.81 mm and MT5: 63.63±1.81 mm. The level of statistical significance was accepted as p <0.05 for the one-sample t-test conducted for each metatarsal bone. The lengths of the right foot metatarsal bones were different from those of the left foot metatarsal bones in the sample. However, this difference was approximately one-tenth of a millimeter. The shortest bone was MT1, and the longest bone was MT2. These measurements are consistent with the anatomical information in the literature. The 3D models from the CT images and the biometric measurements of the metatarsal bones were found to be reliable and accurate.

Curved carbon-plated shoe may further reduce forefoot loads compared to flat plate during running

Using a curved carbon-fiber plate (CFP) in running shoes may offer notable performance benefit over flat plates, yet there is a lack of research exploring the influence of CFP geometry on internal foot loading during running. The objective of this study was to investigate the effects of CFP mechanical characteristics on forefoot biomechanics in terms of plantar pressure, bone stress distribution, and contact force transmission during a simulated impact peak moment in forefoot strike running. We employed a finite element model of the foot-shoe system, wherein various CFP configurations, including three stiffnesses (stiff, stiffer, and stiffest) and two shapes (flat plate (FCFP) and curved plate (CCFP)), were integrated into the shoe sole. Comparing the shoes with no CFP (NCFP) to those with CFP, we consistently observed a reduction in peak forefoot plantar pressure with increasing CFP stiffness. This decrease in pressure was even more notable in a CCFP demonstrating a further reduction in peak pressure ranging from 5.51 to 12.62%, compared to FCFP models. Both FCFP and CCFP designs had a negligible impact on reducing the maximum stress experienced by the 2nd and 3rd metatarsals. However, they greatly influenced the stress distribution in other metatarsal bones. These CFP designs seem to optimize the load transfer pathway, enabling a more uniform force transmission by mainly reducing contact force on the medial columns (the first three rays, measuring 0.333 times body weight for FCFP and 0.335 for CCFP in stiffest condition, compared to 0.373 in NCFP). We concluded that employing a curved CFP in running shoes could be more beneficial from an injury prevention perspective by inducing less peak pressure under the metatarsal heads while not worsening their stress state compared to flat plates.

Evaluation of Conservative Treatment or Osteosynthesis in the Treatment of Cats with Metacarpal and/or Metatarsal Fractures: A Retrospective Study

Aim: This study aims to assess the merits, drawbacks, and postoperative outcomes associated with conservative treatment and osteosynthesis methods employed in managing metacarpal (MC) and/or metatarsal (MT) bone fractures resulting from trauma in cats. Materials and Methods: The research encompassed a sample of fifty-two cats of varying breeds, genders, and ages, all presenting with metacarpal and/or metatarsal bone fractures between 2022 and 2023. Conservative treatment was administered in 46 cases, while osteosynthesis was applied in the remaining 6 cases. Results: In the group treated conservatively, 29 cases (63.04%) exhibited no signs of lameness at the 6-week examination, indicating a successful recovery with unimpeded mobility. In contrast, mild lameness was observed in the remaining cases (36.96%) at the 6-week check-up. Upon reassessment at the 12-month examination, 43 cases (93.47%) demonstrated unimpeded walking, with only 3 cases (6.53%) experiencing occasional mild lameness. Conversely, 2 cases (33.3%) showed a complication-free recovery among the cats undergoing osteosynthesis, while postoperative issues emerged in 4 cases (66.6%). In one complication-free case (50%), mild lameness was noted at the 6-week examination, and in the other case (50%), occasional mild lameness was observed. Importantly, all cases exhibited uneventful walking during the 12-month assessment. Conclusion: Conservative treatment proves to yield favorable outcomes in cats, both independently and when osteosynthesis applications fall short. However, the limited number of surgical cases examined in the study constrains the findings' generalizability

Skeletal malformation in growing milk sheep.

Two six-month old female Lacaune lambs with severe skeletal malformations of both front limbs were presented to the Department of Farm Animals, University of Zurich. The clinical examination showed alert animals with a high body weight and body condition score as well as a valgus deformation without pain or swelling. Radiographic examination showed severe irregularities in the epiphysial plate of the metacarpal bones in both lambs. Delayed growth in the lateral aspects of the physis was evident and resulted in valgus deformation. Nutritional causes were considered as the main reason for this presentation and a nutritional consultation was performed by the Institute of Animal Nutrition and Dietetics, University of Zurich. The estimated energy intake of these lambs was 65 % higher than the recommended maximum for growing sheep and the estimated vitamin D content of the diet was 71 % below the recommended allowance. Both animals were euthanized, and peripheral quantitative computed tomography (pQCT) was performed postmortem to measure total bone mineral density (BMD), trabecular bone mineral density (tBMD) and cortical bone mineral density (cBMD) of the left and right metatarsal bone of both animals. The BMD and the tBMD at 10 % of bone length were below the reference values and the BMD at 50 % was above the reference values. In addition, postmortem examination revealed a Salter-Harris-Typ-1 facture in the right caput humeri of one lamb. Histological evaluation showed defects in the articular cartilage with an eburnation in the metacarpal region and a disrupted area of columnar cartilage. This case report supports the fact that a high dietary energy intake leads to damage to the cartilage and the epiphyseal zone in sheep. In addition, insufficient dietary vitamin D intake contributed to the incomplete bone mineralization, as well as delayed growth and skeletal malformation.

Effects of functional treatment of V metatarsal bone fracture in athletes – an evaluation of cases

This study presents the rehabilitation process for the management of six cases of fractures of the fifth metatarsal bone in players of various sports playing at high levels of competition in Poland. The course of treatment was based on an intensive rehabilitation protocol with the need for orthopaedic shoe inserts, with full weight bearing on the limb and under close supervision of a physiotherapist. The effectiveness of rehabilitation was assessed by physical examination, X-ray examination and the numerical pain rating scale - NRS. This study focuses on the rehabilitation process for managing fractures of the fifth metatarsal bone in high-level athletes in Poland. The treatment involved an intensive rehabilitation protocol with orthopaedic shoe inserts, full weight bearing, and physiotherapist supervision. The effectiveness of rehabilitation was evaluated through physical exams, X-rays, and the numerical pain rating scale. Introduction Fractures of the fifth metatarsal bone are common in athletes aged 10-29, especially in football, basketball, and dance. Complications include delayed bone fusion and repeat fractures, emphasizing the importance of quick return to fitness. The involvement of physiotherapists and patient positivity is crucial. The debate among clinicians stems from classification variations and interpretations of 'Jones fractures'. Diagnostic and Classification Methods The Lawrence and Bottle classification distinguishes three types of metatarsal fractures: avulsion, Jones, and fatigue fractures. The study presents six cases of conservative treatment for these fractures, showing positive outcomes in returning athletes to competition. Rehabilitation Procedure Patients underwent functional treatment with orthopaedic insoles, immediate weight-bearing, and various therapies like Orthokine®, Exogen, hyperbaric chamber sessions, ESWT, and EPTA. Post-workout treatments included Game Ready®, flossing, manual therapy, dry needling, and lymphatic drainage. Patients also engaged in self-managed rehabilitation exercises. Treatment Results Radiographic examinations showed progressive healing in all cases, with reduced pain and no edema after two weeks. Patients returned to sports within three weeks, with no complaints after 13 months. The study highlights the success of functional treatment in achieving full recovery without complications. Conclusion The study challenges the need for surgical intervention and immobilization in treating fifth metatarsal fractures. Functional treatment led to excellent outcomes and quick return to sports. Literature review supports early mobilization and functional therapy for optimal results. Further research is needed to establish a standard treatment protocol based on evidence-based medicine.

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.

Comparison of in-shoe plantar pressure between Korean combat boots and running shoes

IntroductionCombat boots are special shoes designed for soldiers to wear during activities in rough terrain, such as long marches or military training. Combat boots have been known to cause high...

Morton's Metatarsalgia: The Current State of the Issue

A typical complaint with Morton's neuroma is a burning paroxysmal pain in the area of the plantar surface of the metatarsal bones with irradiation into the III interdigital space, which forces the patient to take off his shoes and massage the foot in the most inappropriate situations. Given that women are mostly ill, clinical manifestations reduce the quality of life of patients, limit their daily professional and work activities. The paper presents the etiology, pathogenesis and clinical picture of this disease, diagnostic features. A radical method of treatment is surgery, which is relatively simple in technique and consists in dissecting the tissues that compress the nerve and creating optimal conditions for the nerve trunk, preventing its subsequent traumatization.

Awareness of fifth metatarsal stress fractures among soccer coaches in Japan: A cross-sectional study.

Although a fifth metatarsal stress fracture is the most frequent stress fracture in soccer players, awareness of fifth metatarsal stress fractures among soccer coaches is unclear. Therefore, we performed an online survey of soccer coaches affiliated with the Japan Football Association to assess their awareness of fifth metatarsal stress fractures. A total of 150 soccer coaches were invited for an original online survey. Data on participants' age, sex, types of coaching licence, coaching category, types of training surface, awareness of fifth metatarsal stress fractures, and measures employed to prevent fifth metatarsal stress fractures were collected using the survey. Data from 117 coaches were analysed. Eighty-seven of the 117 coaches were aware of fifth metatarsal stress fractures; however, only 30% reported awareness of preventive and treatment measures for fifth metatarsal stress fractures. Licensed coaches (i.e., licensed higher than level C) were also more likely to be aware of fifth metatarsal stress fractures than unlicensed coaches were. Furthermore, although playing on artificial turf is an established risk factor for numerous sports injuries, soccer coaches who usually trained on artificial turf were more likely to be unaware of the risks associated with fifth metatarsal stress fractures than coaches who trained on other surfaces were (e.g., clay fields). Soccer coaches in the study population were generally aware of fifth metatarsal stress fractures; however, most were unaware of specific treatment or preventive training strategies for fifth metatarsal stress fractures. Additionally, coaches who practised on artificial turf were not well educated on fifth metatarsal stress fractures. Our findings suggest the need for increased awareness of fifth metatarsal stress fractures and improved education of soccer coaches regarding injury prevention strategies. .

CT reconstruction based 3D model of the digital cushion's blood supply in the hind foot of an African savanna elephant (Loxodonta africana).

Foot health is crucial for elephants, as pathological lesions of the feet are a leading cause of euthanasia in captive elephants, which are endangered species. Proper treatment of the feet, particularly in conditions affecting the digits and the digital cushion, requires a thorough understanding of the underlying anatomy. However, only limited literature exists due to the small population and the epidemiological foot diseases which often precludes many deceased elephants from scientific study. The aim of this study was to provide a detailed anatomical description of the blood supply to the African elephant's hindfoot. The healthy right hindlimb of a 19-year-old deceased female African savanna elephant was examined using computed tomography. Following a native sequence, 48 mL of barium-based contrast agent was injected into the caudal and cranial tibial arteries, and a subsequent scan was performed. The images were processed with 3D Slicer software. The medial and lateral plantar arteries run in a symmetrical pattern. They each have a dorsal and a plantar branch, which reach the plantar skin before turning toward the axial plane of the sole to reach the digital cushion from the proximal direction. An accurate 3D model of the arteries and the bones of the foot, a set of labeled images and an animation of the blood supply have been created for ease of understanding. In contrast to domestic ungulates, the digital cushion of the hindlimb is supplied differently from that of the forelimb. The lack of large vessels in its deeper layers indicates a slow regeneration time. This novel anatomical information may be useful in the planning of surgical interventions and in emergency medical procedures.

261 Relationship between dietary calcium and available phosphorus in growing pigs

Abstract The amount of and relationship between dietary total calcium (tCa) and available phosphorus (avP) are critical for lean and bone growth in pigs. Our objective was to evaluate the relationship between tCa and avP in nursery-grower pigs. Mixed sex pigs [n = 117; initial body weight (BW) = 11 ± 0.17 kg] were blocked by BW to individual pens and assigned to 1 of 18 dietary treatments (n = 6 to 7 pigs/trt). Treatments were divided into 4 titrations containing 5 treatments each. Each titration had the same tCa:avP of 1.52, 1.77, 2.12, 2.64, and 3.50. In titration 1(T1), tCa was set at NRC recommendation of 0.68% and avP ranged from 0.46 to 0.20%. Titration 2(T2), tCa was set at 14% below NRC recommendation at 0.56% and avP ranged from 0.38 to 0.16%. Titration 3(T3), avP was set at NRC recommendation of 0.33% and tCa ranged from 0.49 to 1.12%. In titration 4(T4), avP was set at 0.26% with tCa ranging from 0.39 to 0.90%. Pig BW and feed disappearance were recorded at the beginning and the end to calculate average daily gain (ADG), average daily feed intake (ADFI) and feed efficiency gain to feed ratio (G:F) performance parameters over the 40-d study duration. Thereafter, whole body, femur, and 3rd metatarsal bone mineral density (BMD) and contents (BMC) were measured using a dual-energy X-ray absorptiometry (DXA). Within each titration, data were analyzed with pig as the experimental unit, random effect of block and the fixed effect of diet. In T1, performance parameters did not differ (P &amp;gt; 0.10). However, body BMD decreased (0.843, 0.841, 0.804, 0.706, and 0.585 g/cm2) as tCa:avP increased (P &amp;lt; 0.001). In T2, as tCa:avP increased, ADG decreased (0.85, 0.85, 0.77, 0.73, and 0.67 kg/d; P &amp;lt; 0.001). Similarly, whole body BMD decreased as tCa:avP increased (0.800, 0.803, 0.668, 0.616, and 0.558 g/cm2; P &amp;lt; 0.001). ADG, ADFI and whole and individual BMC did not differ in T3 and T4. Consequentially, body BMD ranged from 0.756 to 0.808 g/cm2 in T3 and 0.656 to 0.703 g/cm2 in T4. Breakpoint analysis reported tCa:avP of 2.321 and 1.849 or less was optimal for BMD in T1 and T2, respectively. No optimal breakpoints could be determined for whole BMD within T3 and T4. Breakpoint analysis for ADG reported tCa:avP of 2.311 and 2.341 or less was optimal in T2 and T3, respectively. No optimal breakpoints could be determined for ADG within T1 and T4.

257 Estimating bone mineral replenishment following phosphorus deficiency in growing pigs

Abstract Available phosphorus (avP) is essential for bone health and strength in growing pigs. Our objective was to evaluate growth performance and replenishment of bone mineral in avP deficient pigs when fed diets adequate in avP. Over a 42-d test period, mixed sex pigs [n = 48; initial body weight (BW) = 13.1 ± 0.7 kg], were randomly assigned to one of three dietary treatments consisting of two experimental periods. In period 1(28 d), 8 pens/trt (2 pigs/pen) were fed diets formulated to 0.36, 0.17 and 0.08% avP and at a total calcium to avP ratio of 2.91, 3.15 or 6.40, respectively, representing adequate, marginally deficient, or deficient avP. In period 2 (14 d), marginally deficient and deficient pigs were then fed diets formulated to be above requirement at 0.54% avP and a 2.19 Ca:avP, while the adequate pigs staying on the same period 1 diet (n = 8 pens/trt). Pig BW and pen feed disappearance were recorded during each phase to calculate average daily gain (ADG), average daily feed intake (ADFI) and feed efficiency gain to feed (G:F). At the end of each period, 1 pig per pen was removed to assess whole body, femur, and 3rd metatarsal bone mineral content (BMC) and bone mineral density (BMD) via dual-energy X-ray absorptiometry (DXA). All data were analyzed with pen as the experimental unit and the fixed effect of diet within each period. At the end of period 1, adequate avP and marginally deficient fed pigs were heavier than the deficient avP fed pigs (41.9 and 41.2 vs 33.4 kg, respectively, P &amp;lt; 0.001). Consequently, ADG and ADFI were significantly reduced as avP decreased (P &amp;lt; 0.001). Compared with the adequate avP pigs, whole body BMD was reduced by 22% and 65% in marginal and deficient avP pigs (P &amp;lt; 0.001), respectively. At the end of period 2, adequate, marginal, and deficient avP pigs weighed 53.4, 53.2 vs 43.1 kg (P &amp;lt; 0.001), respectively. Within period 2, ADG, ADFI, and G:F did not differ. However, adequate avP fed pigs continued to have a greater body BMD compared with marginal and deficient avP pigs (0.928, 0.850, and 0.732 g/cm2; P &amp;lt; 0.001), respectively. Whole body BMD and BMC increased from period 1 to peiod 2, resulting in period 2 whole body BMC accretion rates of 2.31, 23.28, and 9.30 g/d (P &amp;lt; 0.007) for deficient, marginal, and adequate diets, respectively. In conclusion, pigs fed marginally deficient avP diets reduced body BMD while pigs fed deficient avP diets reduced body BMD and performance. Following this period of deficiency, marginal deficient avP pigs recovered growth and BMC within 14 d when fed increased dietary avP. However, compared with adequate avP fed pigs, the deficient pigs only partially recovered BMC and BW within the 14-d replenishment period.

A RARE CASE OF GIANT CELL TUMOUR (OSTEOCLASTOMA) OF THE TALUS: A CASE REPORT

Aim and Objective:This study aims to describe a rare case of giant cell tumor (GCT) of the talus. Background:Giant cell tumors rarely present around bones of the foot and involvement of the talus is infrequent. In comparison to long bones,diagnosis and management of talus GCT is challenging and is sparsely reported in the literature. Case Description: We report a case of GCT arising from the talus in a 23-year-old male, presenting as non-specific ankle pain and instability for the past 2 years.The diagnosis was established by CT and MRI and was treated with excisional curettage and antibiotic impregnated bone cement application. At 6 months of follow-up, the symptoms of the patient had resolved clinically and no sign of recurrence at last clinico-radiological examination. Conclusion: Diagnosis and management of GCT talus is challenging and can be treated with excisional curettage and antibiotic impregnated bone cement application. Clinical Significance: Presentation of GCT talus may be missed at early stages. A high index of suspicion can help in diagnosis and appropriate management.

Cuboid Bone for Distal Radius Reconstruction: An Anatomical Cadaver Study

Abstract Background The cuboid bone (CB) of the foot has been suggested as a potential source of autologous reconstruction of the distal radius (DR). This study sought to examine the feasibility of harvesting the CB as a vascularized bone transfer for DR reconstruction. Purposes We evaluated the feasibility of a vascularized bone transfer of the CB by performing the flap dissection, analyzing its pedicle and demonstrating its perfusion using indocyanine green (ICG) fluorescence angiography. Methods Ten feet from five fresh-frozen cadaver specimens were dissected. The lateral tarsal artery (LTA) mean diameter, length, and emerging point were described. The CB mean length and the mean length of the bone segment harvested were reported. ICG injection was used to demonstrate its blood supply. Results The average length of the pedicle was 68.26 ± 3.12 mm. The mean diameter was 1.43 ± 0.15 mm. The CB had a mean anterior–posterior length of 40.81 ± 5.05 mm. The harvested bone had a mean length of 15.05 ± 2.03 mm. All CBs showed enhancement after ICG injection. Conclusion The CB presented reasonable anatomical similarities with the DR and a long and consistent pedicle with an adequate blood supply observed during ICG injection. Clinical Relevance This study supports the possibility of using the CB as a vascularized bone transfer for autologous reconstruction of the articular surface of the DR. Further study is warranted.

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.