Metatarsal Research Articles

Cone-beam computed tomography in the diagnosis of flatfoot deformity: prospective study: a prospective study

INTRODUCTION: Flat deformities are one of the most common pathological changes of the feet. Flatfeet is a disease with high social significance, since it not only affects on the quality of life, but is also an important factor in classification of fitness for military service. The main method of diagnosis of these diseases is radiography of the feet in a lateral projection in the standing position. Despite numerous publications describing various methods for assessing the ratio of the bones of the foot, there is no consensus in the scientific community about the exact criteria for flatfoot and its degrees. At the same time, it is noted that the final conclusion is influenced not only by the method of evaluating the finished image, but also by the method of conducting the study. The construction of modern digital X-ray systems in most cases is not adapted for classical X-ray podography, and the study without special devices and the impossibility of strict adherence to the methodology lead to significant distortions of the results. It follows from this that specialized equipment is required for the diagnosis of flatfoot deformities, which allows developing a unified methodology for conducting research and limiting the possibilities of simulations and aggravations.OBJECTIVE: To determine the possibilities of cone-beam computed tomography in the diagnosis of flatfoot deformities in a standing position with a natural load.MATERIALS AND METHODS: This study included 100 patients underwent examination at the S.M.Kirov Military Medical Academy. All patients were examined using the classical radiography and using the cone-beam computed tomograph (CBCT) «ATRISS» (Electron, Russia). Tomograms were evaluated by two methods: using an averaged image and using a thin slice. The study was conducted by two doctors with the determination of the height and angle of the arch of the foot, followed by an assessment of the degree of flatfoot. Statistics. Statistical analysis was performed using Medcalc software (version 18.2.1). The absolute results of measurements for longitudinal and transverse flatfoot obtained by various methods were compared, as well as the time spent on the study (Wilcoxon and Friedman criteria), the degree of correlation between measurements (Spearman’s criterion), as well as the degree of consistency of the conclusions of two experts to identify longitudinal and transverse flat feet (Kappa-Cohen coefficient). RESULTS: Angle measurements in absolute values did not differ significantly between all the methods used (p=0.1803). There were significant differences between measurements of the height of the arch of the foot between the X-ray method and CBCT (p<0.01). In a comparative analysis of radiography and CBCT, two experts noted a high consistency of research results. CBCT made it possible to perform studies with less time (p<0.01). The effective dose for CBCT is significantly higher than for radiography (p<0.01), but does not exceed 0.12 mSv.DISCUSSION: According to the results of the study, it was found that the effectiveness of CBCT in the diagnosis of flatfoot deformities is not worse than classical radiography. At the same time, the CBCT allows you to avoid positioning errors, stacking and cases of attempted simulation. The effective dose for CBCT allows using the technique as a preventive study. Also, CBCT has a high throughput and allows you to get significantly more information in one scan than with radiography.CONCLUSION: CBCT in a standing position with a natural load is not worse then classical radiography techniques in the accuracy of diagnosis of flatfoot deformities. At the same time, the CBCT has extensive postprocessing capabilities, higher throughput, low radiation load, and also reduces the likelihood of methodological errors and cases of aggravation. CBCT is promising in the consciousness of a universal methodology for measuring and classifying of flatfoot with a more precise formulation of setting points for measuring the angles of the arch and deviation of the hallux.

Comparison of triplanar chevron osteotomy with chevron osteotomy in hallux valgus treatment for the prevention of transfer metatarsalgia.

Hallux valgus (HV) is often accompanied by metatarsalgia. This study compared the radiological and clinical outcomes of new triplanar chevron osteotomy (TCO) and chevron osteotomy (CO) in the treatment of HV, especially for patients with plantar callosities and metatarsalgia. In this retrospective analysis, 90 patients (45 patients per group) with mild to moderate HV and plantar callosities were treated with TCO and CO from July 2020 to January 2022. In both procedures, the apex was located in the center of the head of the first metatarsal bone, and the CO was oriented towards the fourth MTPJ at a 60° angle. Plantar-oblique chevron osteotomy was defined as chevron osteotomy and a 20° plantar tilt; TCO was defined as plantar-oblique chevron osteotomy-based metatarsal osteotomy with a 10° tilt towards the metatarsal head. Primary outcome measures included preoperative and postoperative hallux valgus angle, 1 to 2 intermetatarsal angle (IMA), distal metatarsal articular angle (DMAA), first metatarsal length (FML), and second metatarsal head height X-ray images; clinical measurements, including visual analogue scale and American Orthopaedic Foot & Ankle Society (AOFAS) scores; changes in callosity grade and area; and changes in the number of people with metatarsalgia. Secondary outcomes included complications, recurrence rates, and cosmetic appearance. The hallux valgus angle, IMA, and DMAA were significantly lower after surgery (P < .001) in all patients. In the TCO group, the mean FML and second metatarsal head height increased significantly postoperatively (P < .001). The AOFAS and visual analogue scale scores improved postoperatively in both groups (P < .001). All patients experienced satisfactory pain relief and acceptable cosmesis. The plantar callosity areas were smaller postoperatively in both the TCO and CO groups, but the change in the area (Δarea) in the TCO group significantly differed from that in the CO group (P < .001). The number of postoperative patients with metatarsalgia and the plantar callosity grade were both significantly lower in the TCO group than in the CO group after osteotomy (P < .05). TCO prevents dorsal shift of the metatarsal head and preserves and even increases FML, thereby preventing future metatarsalgia in patients. Therefore, compared with CO, TCO has better orthopedic outcomes and is an effective method for treating mild to moderate HV and preventing transfer metatarsalgia.

Pathobiochemical mechanisms of Morton’s neuroma

The article highlights the difficulties that a doctor may encounter when managing a patient with Morton's neuroma. Rationale. Tunnel, or compression, syndromes/neuropathies are one of the most common groups of diseases of the peripheral nerves and, according to various authors, account for 25% to 40% of all diseases of the peripheral nervous system. In 1876, Thomas Morton first described a syndrome in which he observed “a peculiar and painful affection of the fourth metatarso-phalangeal articulation” in 12 patients. When studying this pathology, Morton suggested that mechanical compression of the nerve by the heads of the metatarsal bones was the main mechanism for the development of the disease. Purpose of the work: to summarize and present material demonstrating the features of managing patients with Morton's neuroma. Materials and methods: a literature search of Russian and foreign authors was carried out; the obtained data were analyzed and summarized. Results. Summary information on the management of patients with Morton's neuroma is provided. The main issues of diagnosis and treatment of this pathology are demonstrated. Conclusion. An analysis of the effectiveness of surgical treatment of Morton's neuroma showed excellent results in 45% of cases, good results in 32%, satisfactory results in 15%, and unsatisfactory results in 8% of cases. The low effectiveness of surgical interventions is associated with the formation of a true amputation neuroma in the area of the proximal section of the intermetatarsal nerve.

Humanin Treatment Protects Against Venetoclax-Induced Bone Growth Retardation in Ex Vivo Cultured Rat Bones.

Recent preclinical studies reported that the BCL-2 inhibitor venetoclax can impair bone growth. A strategy to prevent such a side effect of this promising anticancer drug is highly desired. Earlier in vitro and in vivo studies suggested that the mitochondrial peptide humanin has the potential to prevent drug-induced growth impairment. We hypothesized that co-treatment with the humanin analog HNG may prevent venetoclax-induced bone growth impairment. Ex vivo studies were performed in fetal rat metatarsal bones and human growth plate samples cultured for 12 and 2 days, respectively, while in vivo studies were performed in young neuroblastoma mice being treated daily for 14 days. The treatment groups included venetoclax, HNG, venetoclax plus HNG, or vehicle. Bone growth was continuously monitored and at the end point, histomorphometric and immunohistochemical analyses were performed in fixed tissues. Venetoclax suppressed metatarsal bone growth and when combined with HNG, bone growth was rescued and all histological parameters affected by venetoclax monotherapy were normalized. Mechanistic studies showed that HNG downregulated the pro-apoptotic proteins Bax and p53 in cultured metatarsals and human growth plate tissues, respectively. The study in a neuroblastoma mouse model confirmed a growth-suppressive effect of venetoclax treatment. In this short-term in vivo study, no significant bone growth-rescuing effect could be verified when testing HNG at a single dose. We conclude that humanin dose-dependently protects ex vivo cultured metatarsal bones from venetoclax-induced bone growth impairment by restoring the growth plate microstructure.

Zone 2 Fifth Metatarsal Fractures Treated Nonoperatively Have Similar Time to Healing to Those Treated Operatively.

To quantify the rate of union and time to clinical and radiographic healing in Zone 2 proximal fifth metatarsal (MT) fractures and compare these outcomes between Zone 2 fractures treated operatively and nonoperatively. Retrospective cohort study. Academic Level I Trauma Center. Patients with fifth MT fractures who presented between December 2012 and April 2022 and confirmed to have Zone 2 fractures (defined as fractures entering the proximal 4-5 MT articulation on the oblique radiographic view) were included in the study analysis in either the operative or nonoperative cohort. Nonunion, time to clinical healing by, and time to radiographic healing between operative and nonoperative treatment. Among the 499 included patients, 475 patients (95.2%) were initially treated nonoperatively and 24 patients (4.8%) were treated operatively. Both groups were similar in demographics. There was no difference in the proportion of patients with nonunions between groups (6.1% in the nonoperative group vs. 3.8% in the operative group, P = 1.000). In addition, there was no statistically significant difference between groups with respect to the time to clinical healing (9.9 ± 8.3 weeks for the nonoperative group vs. 15.4 ± 15.0 weeks for the operative group, P = 0.117) or the time to radiographic healing (18.7 ± 12 weeks for the nonoperative group vs. 18.5 ± 16.6 weeks for the operative group, P = 0.970). Zone 2 fifth MT base fractures were successfully treated with nonoperative management. There was no evidence in this study that operative treatment leads to significantly faster clinical or radiographic healing. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Insights into the Distribution Patterns of Foot and Ankle Tumours: Update on the Perspective of a University Tumour Institute.

The rarity of foot and ankle tumours, together with the numerous histological entities, presents a challenge in accumulating sufficient patients to draw reliable conclusions. Therefore, we decided to present an update of a retrospective analysis of their distribution patterns, comprising 536 cases of foot and ankle tumours presented to our tumour board between June 1997 and June 2023. Our aim was to provide a comprehensive overview of the prevalence and distribution patterns of benign and malignant bone and soft tissue tumours of the foot and ankle. A total of 277 tumours involved bone (51.7%). Of these, 242 (87.4%) were benign and 35 (12.6%) were malignant. In addition, 259 soft tissue tumours (48.3%) were found, of which 191 (73.7%) were benign and 68 (26.3%) were malignant. The most common benign bone tumours were simple bone cysts, enchondromas, osteochondromas, aneurysmal bone cysts, and lipomas of bone. Common benign soft tissue tumours included a tenosynovial giant cell tumour, haemangioma, plantar fibromatosis, schwannoma, and lipoma. The most common malignant soft tissue tumours were synovial sarcoma, malignant melanoma, and myxofibrosarcoma. In terms of anatomical location, the hindfoot was the most common site (28.7%), followed by the midfoot (25.9%), ankle (25.4%), and forefoot (20.0%). The distribution of benign entities often follows typical patterns, which may facilitate an early diagnosis even without biopsy (e.g., simple bone cyst, plantar fibromatosis). On the other hand, the distribution patterns of many rare or malignant entities are inconsistent. Individual soft tissue malignancies occur very sporadically, even over long periods of time and in specialized tumour centres. It is therefore important to recognise that any suspicious mass in the foot and ankle must be considered a possible malignancy until proven otherwise.

Unravelling novel and pleiotropic genes for cannon bone circumference and bone mineral density in Yorkshire pigs.

Leg weakness is a prevalent health condition in pig farms. The augmentation of cannon bone circumference and bone mineral density can effectively improve limb strength in pigs and alleviate leg weakness. This study measured forelimb cannon bone circumference (fCBC) and rear limb cannon bone circumference (rCBC) using an inelastic tapeline and rear limb metatarsal area bone mineral density (raBMD) using a dual-energy X-ray absorptiometry bone density scanner. The samples of Yorkshire castrated boars were genotyped using a 50K single-nucleotide polymorphism (SNP) array. The SNP-chip data were imputed to the level of whole-genome sequencing data (iWGS). This study used iWGS data to perform genome-wide association studies and identified novel significant SNPs associated with fCBC on SSC6, SSC12, and SSC13, rCBC on SSC12 and SSC14, and raBMD on SSC7. Based on the high phenotypic and genetic correlations between CBC and raBMD, multi-trait meta-analysis was performed to identify pleiotropic SNPs. A significant potential pleiotropic quantitative trait locus (QTL) regulating both CBC and raBMD was identified on SSC15. Bayes fine mapping was used to establish the confidence intervals for these novel QTLs with the most refined confidence interval narrowed down to 56kb (15.11 to 15.17Mb on SSC12 for fCBC). Furthermore, the confidence interval for the potential pleiotropic QTL on SSC15 in the meta-analysis was narrowed down to 7.45kb (137.55 to137.56Mb on SSC15). Based on the biological functions of genes, the following genes were identified as novel regulatory candidates for different phenotypes: DDX42, MYSM1, FTSJ3, and MECOM for fCBC; SMURF2, and STC1 for rCBC; RGMA for raBMD. Additionally, RAMP1, which was determined to be located 23.68kb upstream of the confidence interval of the QTL on SSC15 in the meta-analysis, was identified as a potential pleiotropic candidate gene regulating both CBC and raBMD. These findings offered valuable insights for identifying pathogenic genes and elucidating the genetic mechanisms underlying CBC and BMD.

TRADITIONAL AND NOVEL 3D MEASUREMENTS USING CONE-BEAM CT IN WEIGHT-BEARING CONDITIONS

3D accurate measurements of the skeletal structures of the foot, in physiological and impaired subjects, are now possible using Cone-Beam CT (CBCT) under real-world loading conditions. In detail, this feature allows a more realistic representation of the relative bone-bone interactions of the foot as they occur under patient-specific body weight conditions. In this context, varus/valgus of the hindfoot under altered conditions or the thinning of plantar tissues that occurs with advancing age are among the most complex and interesting to represent, and numerous measurement proposals have been proposed. This study aims to analyze and compare these measurements from CBCT in weight-bearing scans in a clinical population. Sixteen feet of diabetic patients and ten feet with severe adult flatfoot acquired before/after corrective surgery underwent CBCT scans (Carestream, USA) while standing on the leg of interest. Corresponding 3D shapes of each bone of the shank and hindfoot were reconstructed (Materialise, Belgium). Six different techniques found in the literature were used to calculate the varus/valgus deformity, i.e., the inclination of the hindfoot in the frontal plane of the shank, and the distance between the ground and the metatarsal heads was calculated along with different solutions for the identification of possible calcifications. Starting with an accurate 3D reconstruction of the skeletal structures of the foot, a wide range of measurements representing the same angle of hindfoot alignment were found, some of them very different from each other. Interesting correlations were found between metatarsal height and subject age, significant in diabetic feet for the fourth and fifth metatarsal bones. Finally, CBCT allows 3D assessment of foot deformities under loaded conditions. The observed traditional measurement differences and new measurement solutions suggest that clinicians should consider carefully the anatomical and functional concepts underlying measurement techniques when drawing clinical and surgical conclusions.

Distribution of Sesamoid Bones in the Foot and Hand Radiographs; A Descriptive Cross-Sectional Study in a Tertiary Care Center in Nepal

Objective: The aim of this study was to present data about the prevalence and distribution of sesamoid bones of the hands and feet in Nepalese population by using radiographs, to determine the number of the sesamoid bones of the foot and hand, commonest site of occurrence and to correlate the findings between gender and age. Methodology: This prospective quantitative study was performed in the Department of Radiology and Imaging, TUTH. The radiographs of foot and hand were reviewed to evaluate the presence or absence of sesamoid bones and patient demographics were also noted. Data collection was done for a period of three months and random probability sampling method was used. Results: This study resulted that in foot radiographs, the most common sites of sesamoid bones was first metatarsophalangeal joint (1st MTPJ) where two sesamoid bones were found, whereas single sesamoid bone was found in other sites. The percentage of sesamoid bones in first interphalangeal joint (1st IPJ), second metatarsophalangeal joint (2nd MTPJ), third metatarsophalangeal joint (3rd MTPJ), fourth metatarsophalangeal joint (4th MTPJ) and fifth metatarsophalangeal joint (5th MTPJ) were 7.9%, 15.4%, 0 %, 0.4%, and 26.7% respectively. The number of sesamoid bones ranged from 2- 5 in single foot with frequency of occurrence of 2 bones being highest (58.3%). The percentage of sesamoid bones in foot was found to be relatively higher in female than male. In the analysis of hand radiographs, the most common sites of sesamoid bones was 1st MCPJ ( single sesamoid bone in 80.33% and a pair of sesamoid bones in 19.67% ) .The percentage of sesamoid bones in 1st IPJ, 2nd MCPJ, 3rd MCPJ, 4th MCPJ and 5th MCPJ were 37.33%, 58.67% ,5.33% , 5.33% and 59.33% respectively. The number of sesamoid bones ranged from 1 - 6 in single hand with frequency of occurrence of 3 bones being higher (32%). The percentage of sesamoid bones in hand was relatively higher in male than female. Conclusion: The distribution and frequency of sesamoid bones differ according to sites, gender and age. This study improves the knowledge on distribution of sesamoid bones of the foot and hand and also provides anatomical data that could help clinicians in diagnosis and management of various sesamoid bone disorders in patients who present with pain and discomfort in the foot and hand.

Risk factors of metatarsal stress fracture associated with repetitive sports activities: a systematic review.

Metatarsal stress fracture is common in people engaged in repetitive weight-bearing activities, especially athletes and recruits. Identifying risk factors in these contexts is crucial for effective prevention. A systematic search on Web of Science, PubMed, EBSCO, SPORTDiscus, MEDLINE, and Cochrane Library was conducted and the date range for the retrieval was set from January 1984 to April 2024. 32 eligible studies were selected from 1,728 related research. Anatomical and biomechanical factors, such as higher foot arch, abnormal inversion/eversion of foot, and longer metatarsal length or larger angles, relatively influence stress fracture risk. However, given that there is no standardized measurement, the results remain to be examined. Soccer is associated with fifth metatarsal fractures, while long-distance running and recruit training often lead to fractures of the second or third metatarsals. High exercise intensity, non-adaptive training, and inadequate equipment heighten fracture risk. This review highlights the complex interplay of anatomical, biomechanical, and sports-related factors in the risk of metatarsal stress fractures. Relatively, high arches, specific metatarsal morphologies, and foot inversion/eversion patterns are significant risk factors, particularly among athletes. Sports type also correlates with metatarsal stress fracture locations. Despite extensive research, study heterogeneity and inherent biases necessitate cautious interpretation. Comprehensive, multifactorial approaches and personalized injury prevention strategies are essential for reducing the incidence of these injuries and improving the health and performance of athletes.

Subchondral bone sequestrum formation in the proximal intra-articular and osteochondral region of the third metatarsal bone of an Appaloosa mare treated for septic arthritis

Abstract OBJECTIVE To raise awareness of the potential for intra-articular subchondral bone sequestrum formation secondary to a traumatic or septic process to enable more rapid identification of this uncommon but possible outcome in future cases. ANIMAL A client-owned 12-year-old Appaloosa mare. CLINICAL PRESENTATION, PROGRESSION, AND PROCEDURES The mare had a wound to the lateral aspect of the fourth metatarsal bone (MT4) that communicated with the distal tarsal joints. Radiographs revealed a displaced, comminuted fracture of MT4. TREATMENT AND OUTCOME The horse underwent aggressive debridement of the wound and MT4 as well as, on 2 occasions, needle joint lavage. Systemic, regional, and IA antibiotic therapy was also performed together with a bone graft from the tuber coxae. The horse’s comfort improved, and the wound appeared to be healing. Five weeks following discharge, the horse re-presented with a non–weight-bearing lameness and radiographs revealed marked osteomyelitis of the tarsometatarsal and distal intertarsal joints. Postmortem examination of the limb identified a sequestrum within the proximal articular surface of the third metatarsal bone. CLINICAL RELEVANCE The present report highlights the importance of arthroscopic lavage to visualize the cartilage surface and the benefits of advanced imaging to detect associated changes within the bone earlier than conventional radiographs. To our knowledge, no reports exist of intra-articular subchondral bone sequestra in the tarsometatarsal joint in horses.

Acrometastasis as a first sign of lung cancer

Introduction. Bone metastases occurring distally to the elbow or knee joint are called acrometastases. Acrometastases make up only 0.1% of all bone metastases, but only 0.007% to 0.3% occur in the bones of the foot or hand. In 10% of patients, bone metastases occur as the first sign of a previously undiagnosed primary tumor. Case report. A 64-year-old male reported to the hospital due to painful swelling and redness of the fifth finger of the dominant hand. Osteolysis of the proximal phalanx of the fifth finger was diagnosed radiographically. A working diagnosis of osteomyelitis and phlegmon of the proximal phalanx was made. After incisional drainage, a tumor mass was observed intraoperatively. Amputation of the finger was performed at the level of the metacarpophalangeal joint. Pathohistological analysis revealed squamous cell carcinoma metastasis. After a computed tomography scan and bronchoscopy with biopsy, a diagnosis of squamous cell carcinoma of the bronchus was made. The patient was given chemotherapy. During the application of the second cycle, there was a fatal outcome. Conclusion. Pathohistological verification and determination of the location of the primary tumor are important when acrometastasis is found because starting novel immunotherapy and targeted therapy in a timely manner could change the median survival of these patients.

Self-treatment of freezing of gait in Parkinson’s disease patients using silicone pads to apply Thai acupressure to plantar acupoints: A randomised, controlled trial

IntroductionFreezing of gait (FOG) involves dysfunction of the motor and sensory systems. Peripheral sensory stimuli, including Thai acupressure, can improve proprioceptive function and decrease FOG episodes. Here, we sought to determine the efficacy of acupressure as a self-treatment to alleviate FOG in patients with Parkinson’s disease (PD). MethodsWe conducted an open-label, controlled trial of 60 PD patients with FOG while medicated, randomised into two groups: an active-treatment group using silicone pads to apply pressure to plantar acupoints on the head of the big toe and the base of the first metatarsal bone on each foot for 6 s using patient body weight while seated, repeated four times for each acupoint bilaterally, and a sham-treatment group using a similar protocol without the silicone pads. The primary outcome was stride length. Secondary outcomes included FOG episodes, FOG duration, percent duration of FOG to total gait time (%FOG), and gait parameters. A baseline-adjusted analysis of covariance was used to compare outcomes between the two groups. ResultsCompared with the sham treatment, the active treatment increased stride length, gait velocity, and cadence (all p < 0.001), and decreased FOG episodes and duration (both p < 0.001), %FOG (p = 0.011), and double-support time (p < 0.001). No adverse effects were noted. ConclusionsAcupressure using silicone pads to stimulate plantar acupoints for self-treatment is a noninvasive, simple, safe way to improve gait and alleviate FOG in patients with PD. Clinical Trial RegistrationWe registered the study prospectively in the Thai Clinical Trial Registry No. TCTR20200317001.

Intramedullary locking mini-plate screw system in Lindgren osteotomy: a more effective fixation technique in mild and moderate hallux valgus cases.

In the treatment of mild and moderate hallux valgus (HV) cases, the Lindgren distal osteotomy (LDO) technique has been one of the most frequently preferred methods, and screw fixation has been the most preferred material for surgery. However, considering the implant removal operations due to the reaction to the material, the risk of unsteadiness, retarded union, and malunion has limited the amount of safe application of lateralization of the distal fragment in distal osteotomy surgery and has yielded the researchers for a better alternative. This study compared the results of the LDO cases using headless cannulated screws and intramedullary plate fixation materials. The retrospective study included 31 files of patients operated for HV between January 1, 2018, and December 31, 2022, in Adana City Training and Research Hospital Orthopedics Clinic, Adana, Turkey. In the radiological evaluation, the hallux valgus angle (HVA), the intermetatarsal angle (IMA), the length of the first metatarsal (ML), and the distal metatarsal articular angle (DMAA) recorded preoperatively and postoperatively were analyzed. The functional results of the operations were evaluated by using the Visual Analog Scale (VAS), American Orthopedic Foot and Ankle Society (AOFAS), and EuroQol (EQ-5D) scores. Postop HVA, IMA, MU, and DMMA values were significantly higher in patients in Group 1 than in patients in Group 2 (p<0.001; p=0.004; p=0.004; p=0.049; p<0.001, respectively). The change in Delta (∆) HVA and EQ-5D values was significantly higher in patients in Group 2 compared to patients in Group 1 (p=0.020; p=0.016, respectively). The easily available and low-cost locking plates produced for mini-fractures may safely be used in distal osteotomy surgery of mild and moderate HV successfully combined with screws if intramedullary-placed, allowing accurate lateralization and improving overall outcome.

The Impact of Running Experience and Shoe Longitudinal Bending Stiffness on Lower Extremity Biomechanics

Purpose The impacts of shoe stiffness on running biomechanics are well-documented, while the specific effects on the performance of biomechanically distinct groups such as novice runners and experienced runners are still largely unexplored. The study aimed to evaluate the biomechanical effects of different shoe longitudinal bending stiffness (adjusted by inserting carbon plate) on the lower limb during running in novice runners and experienced runners. Methods Twelve experienced runners and ten novice runners ran at a speed of 4.47 m/s while randomly wearing shoes with either low stiffness (5.9 Nm/rad) or high stiffness (8.6 Nm/rad). An Opensim musculoskeletal model was adopted for estimating lower limb joint angles, joint angular velocities, joint moment, joint work, peak joint reaction forces during running stance phase. Results Results showed that novice runners displayed greater lower limb joint mobility and less joint moment, while experienced runners exhibited less joint mobility but greater joint moment, and higher peak joint reaction forces were observed at the knee and ankle joints. Furthermore, increased shoe longitudinal bending stiffness resulted in higher peak joint reaction forces at the metatarsophalangeal joint for novice runners while lower for experienced runners. Conclusions Novice runners may face an increased risk of metatarsal pain or stress fractures when dealing with higher shoe stiffness. This nuanced understanding of joint dynamics underscores the need for tailored training and footwear recommendations to mitigate injury risks specific to different levels of running experience.

Chondromyxoid Fibroma of the Metatarsal Head: A Rare Case Report

Chondromyxoid Fibroma (CMF) is an uncommon non malignant cartilage tumour with a greater predilection for the legs, with about a quarter of cases involving the metatarsals. It accounts for less than 0.5% of all bone tumours and mostly occurs in patients aged 10 to 30 years old. Patients typically present with complaints of pain and swelling in the affected region. Radiologically, a lytic lesion with well-defined margins is observed in the metaphysis. The present case is about an 11-year-old male who presented to the Orthopaedic Outpatient Department (OPD) with a history of pain and swelling over his left foot. Upon examination, a discrete swelling was noted over the lateral aspect of the foot, extending from the head to the shaft of the 4th metatarsal. Upon palpation, the swelling was found to be tender and firm in consistency, accompanied by restricted foot movement. Initially, a giant cell tumour of the 4th metatarsal bone in the left foot was suspected based on radiography. However, histopathological examination led to the diagnosis of CMF. The lesion was curetted, and a below-knee Plaster of Paris (POP) was applied for one month. No recurrence of the lesion has been observed after five months of follow-up.

Lečenje bolnog ravnog stopala kod dece korišćenjem minimalno invazivne hirurške procedure nakon neuspelog konzervativnog lečenja

Introduction/Aim: Flexible flatfoot (FFF) is one of the most common skeletal deformities in the pediatric population, especially in preadolescence. This retrospective observational study evaluates results of a calcaneal subtalar extra-articular arthrodesis (subtalar arthroereisis) with one cannulated screw for the treatment of painful flexible flatfoot in children, after previously failed conservative treatment. Material and Methods: Preadolescent and adolescent pediatric patients were observed at the Department of Pediatric Orthopedic Surgery. The study included 28 feet of 15 children (5 girls and 10 boys) during a 6-year period, from 2016 to 2021 (average 36 months). The average age was 11.46 years (range 8-15 years). We performed the same operative technique under fluoroscopy for all patients. Radiographic parameters were taken before, after operative treatment, and after hardware removal. The following radiological parameters were measured: talo-calcanear (TC), talo-navicular (TN), talo-first metatarsal bone (T1MT) and calcanear pitch (CP) angles, in the anteroposterior and/or lateral views. Functional outcomes (extension and eversion of the foot) before surgery and after hardware removal were compared. Results: After operative treatment, the midfoot radiographic parameters were not statistically significantly altered; however, the subtalar joint and forefoot were statistically significantly improved: both radiologically and clinically. The range of extension and eversion of the foot were remarkably reduced without disturbing the morphological and functional aspects of the talocrural and subtalar joints. Conclusion: Extra-articular arthrodesis, using a cannulated screw is a minimally invasive technique, represents an optimal method for the operative treatment of symptomatic flexible flatfoot in children. This technique is simple, efficient and does not disrupt the anatomy of the foot.

An Unusual Presentation of Low-grade Chondrosarcoma of the First Metatarsal Bone requiring extensive Resection: A Case Report

Chondrosarcoma (CS) is one of the common malignant bone tumours arising from chondrocytes with variable degrees of malignancy. It is mainly noted in flat bones like the pelvis and scapula, and sometimes in long bones like the proximal femur. This case report describes a 40-year-old female who presented with pain over her right great toe for six months and swelling for four months. An open biopsy revealed low-grade CS. Subsequently, the patient underwent amputation of the first ray till the tarsometatarsal joint with meticulous dissection of the tumour mass. At eight years of follow-up, the patient had no recurrence and no functional disability. Therefore, in cases of low-grade CS, first ray amputation along with excision of the tumour mass helps avoid recurrence and metastasis, providing a satisfactory functional outcome.

Mechanical analysis of metatarsal bone load in patients with varus foot based on finite element method

Mechanical analysis of metatarsal bone load in patients with varus foot based on finite element method

Correlation between Weight Distribution on the 5th Metatarsal of Right and Left Foot in Youngsters using Podata Postural Stabilometric Foot Plate

Background: The human foot's complex structure plays a vital role in stability and support during various activities. Understanding the weight distribution across the metatarsal bones, particularly the 5th metatarsal, is crucial for maintaining optimal foot health and functionality. Previous studies have indicated variability in weight distribution between the left and right feet, influencing gait patterns and overall foot health. Objective: This study aimed to investigate the correlation between weight distribution on the 5th metatarsal of the right and left foot in young adults, providing insights into foot biomechanics and informing clinical practices and footwear design. Methods: Employing a cross-sectional observational design, the study included 140 individuals aged between 18 and 29 years. Participants with severe musculoskeletal or neurological conditions, pregnancy, or inability to maintain a standing posture were excluded. Weight distribution was assessed using the Podata Postural Stabilometric Foot Plate. Data analysis involved descriptive statistics, t-tests, and calculation of confidence intervals, performed using SPSS Version 25. Results: The mean weight on the 5th metatarsal was 0.467 kg for the left foot (standard deviation: 0.331) and 0.995 kg for the right foot (standard deviation: 0.774). A moderate positive correlation (r = 0.45) was found between the weight distributions on the left and right 5th metatarsals, with a statistically significant p-value of 0.01. Conclusion: The study revealed a significant discrepancy in weight distribution on the 5th metatarsal between the left and right feet among young adults. These findings have critical implications for personalized podiatric care and the design of orthotic devices and footwear, emphasizing the need for further research in foot biomechanics and health.