Metatarsal Research Articles

Transarterial Embolization for Refractory Overuse Sports Injury: Pictorial Case Reports.

Transarterial embolization for the treatment of chronic musculoskeletal diseases is gaining increasing interest in the field of interventional radiology. Overuse sports injury is defined as an injury occurring in the absence of a single, identifiable traumatic cause. In the treatment of this condition, there is a need for reliable results and a quick return to activity. Minimally invasive treatments with short periods of missed practice are required. Intra-arterial embolization has the potential to meet this need. In this article, we describe cases of embolization for refractory overuse sports injuries including patellar tendinopathy, pes anserine, plantar fasciitis, triangular fibrocartilage complex injury, hamstring injury, infrapatellar fat pad inflammation, Achilles tendinopathy, delayed union metatarsal bone fracture, lumbar spondylolysis, and repetitive hamstrings strain.

A three-dimensional analysis of the tibialis anterior tendon: emphasizing tendon insertion patterns for effective repair and understanding hallux valgus development.

The present study aimed to evaluate the insertion site of the tibialis anterior tendon three-dimensionally. Seventy lower limbs were dissected. The tibialis anterior tendon was dissected to verify the insertion site to the medial cuneiform and the base of the first metatarsal bone. The three-dimensional (3D) territory of the tibialis anterior tendon insertion on the medial cuneiform and the first metatarsal bones was measured on a reconstructed 3D model. The insertion pattern of the tibialis anterior tendon was classified into three types, the most common being Type I: a single tibialis anterior tendon dividing into two equal-sized bands to the medial cuneiform and base of the first metatarsal bone (57.1%, 40/70 of cases). The 3D territory of the tibialis anterior tendon was larger in the plantar aspect than in the medial side of both the medial cuneiform and the base of the first metatarsal bone. The width of the tendon inserted into the medial cuneiform was wider than that inserted into the first metatarsal bone. The tibialis anterior tendon was more commonly attached to the plantar part than the medial part in both the medial cuneiform and the base of the first metatarsal bone. This anatomical information will help surgeons perform anatomical reconstruction of the tibialis anterior tendon, reduce further tendon damage in the first metatarsocuneiform joint area and also provide valuable knowledge to improve understanding of hallux valgus pathogenesis.

Comminuted fractures of the proximal third of the fourth metatarsal bone: Treatment strategies

Comminuted fractures of the proximal third of the fourth metatarsal bone: Treatment strategies

Republication of "Treatment of Hallux Valgus Deformity Using a Suture Button Device: A Preliminary Report".

Hallux valgus (HV) is commonly treated with proximal or distal first metatarsal osteotomy. Despite good correction, these procedures have inherent risks such as malunion, nonunion, metatarsal shortening, loss of fixation, and avascular necrosis. Suture button fixation has been used for HV treatment. It avoids the risks of corrective osteotomies while maintaining reduction of the intermetatarsal angle (IMA). The goal of this study was to assess the radiographic and functional outcomes of patients undergoing HV correction with a distal soft tissue procedure and proximal suture button fixation. The authors retrospectively reviewed the charts and radiographs of 22 patients who had undergone HV correction using a distal soft tissue correction and proximal fixation with a miniature suture button device (Mini TightRope; Arthrex, Inc, Naples, FL). Mean follow-up was 27.7 months. The IMA, hallux valgus angle (HVA), and sesamoid station were measured on radiographs obtained preoperatively as well as in the immediate postoperative period and at final follow-up. Preoperative and postoperative Short Form-36 (SF-36) and Foot and Ankle Ability Measure (FAAM) scores were collected. Postoperative complications, and any additional operative procedures performed were also recorded. The mean preoperative IMA and HVA were 16.9 and 32.6 degrees, respectively. The mean immediate postoperative IMA was 5.2 degrees (P < .0001) and the mean HVA was 9.8 degrees (P < .0001). At final follow-up, the mean IMA was 8.2 degrees (P < .0001) and the mean HVA was 16.7 degrees (P < .0001). The average change in HVA from preoperative to final follow-up was 16.0 degrees and the average change in IMA from preoperative to final follow-up was 8.6 degrees (P < .0001). Sesamoid station assessment at the 2-week follow-up showed that 22 patients (100%) were in the normal position group; at final follow-up, 17 patients (77%) had normal position and 5 patients (23%) had displaced position. Although there were no clinically symptomatic recurrences, asymptomatic radiographic recurrence was noted in 5 patients (23%) who had a final HVA >20 degrees. All components of the FAAM and the SF-36 showed improvement from preoperative to final follow-up, although these changes were not statistically significant. Three patients experienced complications, including an intraoperative second metatarsal fracture, a postoperative second metatarsal stress fracture, and a postoperative deep vein thrombosis. The use of a distal soft tissue procedure in conjunction with proximal suture button fixation is a safe and effective procedure for treating symptomatic HV deformity. Our results show that this technique can correct the IMA, HVA, and sesamoid station without the need for osteotomy. Level IV.

Surgical Technique Preserving the Interdigital Web for Polydactyly of the Foot

Summary: We devised a new method to transfer the web as a local flap in polydactyly. Our technique aims to preserve the web space, which is indicated for polydactyly to remove the interposed toe at the metatarsal bone level. The interdigital web flap is created on one lateral side of the toe to be removed. The extra toe and metatarsal bone are removed after elevating the flap. The flap is then sutured onto the side of the remaining toe.

Study of outcome of displaced calcaneal fractures by closed reduction and percutaneous internal fixation with multiple k wires and screws

Background: Calcaneum is the largest of the tarsal bones and the largest bone of the foot. Calcaneum fracture account for 2% of all fracture of the body and 60% of all tarsal fractures. Many calcaneal fractures are work related as they result from a fall from height, especially in male age 35-45 years. In our study we treated the displaced calcaneal fracture with closed reduction and percutaneous fixation using multiple percutaneous K-wires and screw to evaluate their functional outcome. Methods: The study was conducted as a prospective study at the department of Orthopaedics, Dr. Shankarrao chavan Government Medical College, Nanded, India during the period January 2019 to June 2020. Thirty patients of 20 to 60 years, who underwent surgical fixation for displaced calcaneal fracture using multiple K wires and screws were followed up. Functional outcomes at six month follow up were assessed. Results: In this study we selected 30 patients with displaced calcaneal fracture admitting in our institute. All patients underwent operative procedure in the form of multiple k wire and cc .screws by percutaneous approach Out of all 30 patients treated with this method had shown excellent results with minimal postoperative complications. Conclusions: The study with percutaneous K wires and screws for displaced calcaneal fractures showed very good functional outcome. Although it was not free of complications, our study has shown very good results. Technique involve in our study is less invasive, with minimum blood loss, less operative time without soft tissue stripping.

Micromechanical Loading Studies in Ex Vivo Cultured Embryonic Rat Bones Enabled by a Newly Developed Portable Loading Device.

Mechanical loading has been described as having the potential to affect bone growth. In order to experimentally study the potential clinical applications of mechanical loading as a novel treatment to locally modulate bone growth, there is a need to develop a portable mechanical loading device enabling studies in small bones. Existing devices are bulky and challenging to transfer within and between laboratories and animal facilities, and they do not offer user-friendly mechanical testing across both ex vivo cultured small bones and in vivo animal models. To address this, we developed a portable loading device comprised of a linear actuator fixed within a stainless-steel frame equipped with suitable structures and interfaces. The actuator, along with the supplied control system, can achieve high-precision force control within the desired force and frequency range, allowing various load application scenarios. To validate the functionality of this new device, proof-of-concept studies were performed in ex vivo cultured rat bones of varying sizes. First, very small fetal metatarsal bones were microdissected and exposed to 0.4 N loading applied at 0.77Hz for 30s. When bone lengths were measured after 5days in culture, loaded bones had grown less than unloaded controls (p < 0.05). Next, fetal rat femur bones were periodically exposed to 0.4 N loading at 0.77Hz while being cultured ex vivo for 12days. Interestingly, this loading regimen had the opposite effect on bone growth, i.e., loaded femur bones grew significantly more than unloaded controls (p < 0.001). These findings suggest that complex relationships between longitudinal bone growth and mechanical loading can be determined using this device. We conclude that our new portable mechanical loading device allows experimental studies in small bones of varying sizes, which may facilitate further preclinical studies exploring the potential clinical applications of mechanical loading.

Defining Operative Indications in Lisfranc Injuries: A Systematic Review.

The aim of this review was to determine operative indications for Lisfranc injuries. A systematic review using a MEDLINE literature search was performed using the index "Lisfranc Injury" from 1980 onward using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines where applicable. Inclusion criteria were all clinical studies reporting on the management of Lisfranc injuries obtained via the search index, including case reports, review articles, cohort studies, and randomized trials. Non-English-language articles, inaccessible articles, those not relevant to the management of Lisfranc injuries (biomechanical, cadaveric, and technique articles), and those that did not explicitly state operative indications (vague or absent indications) were excluded. After identifying 737 studies, the full text of 391 studies was reviewed, and 58 reports providing explicit operative indications were included in the final analysis. Fifty-one (81.1%) studies provided diastasis cutoffs varying ≥2 mm (35/58; 60.4%), ≥1 mm (13; 22.4%), and ≥3 mm (3; 5.2%); the diastasis location was most commonly unspecified (31/58; 53.5%) or varied between combinations of metatarsal, tarsal, cuboid, and cuneiform bones (20/58; 27.6%). Specific imaging criteria for surgery included an avulsion fracture or fleck sign (3/58; 5.2%), arch height loss (3/58; 5.2%), and a tear on magnetic resonance imaging (5; 8.6%). The 11 (19%) studies defining operative indications in terms of classification schemes used the Nunley and Vertullo (8/58; 13.8%), Myerson (2; 3.5%), and Buehren (1; 1.7%) systems. Twenty-one (36.2%) studies provided multiple operative indications. The most common Lisfranc operative indications among the limited reporting studies varied from a 1- to 3-mm diastasis across several locations. It is imperative for operative indications to be reported with an increased frequency and in a homogenous fashion to guide the clinical management of these subtle injuries. Level IV; systematic Review.

Bacillus Calmette–Guérin osteomyelitis of the fifth metatarsal bone in a Japanese infant: a case report

Abstract Bacillus Calmette–Guérin osteomyelitis is a rare complication following Bacillus Calmette–Guérin vaccination. Here, we describe a rare case of Bacillus Calmette–Guérin osteomyelitis of the fifth metatarsal in a 21-month-old Japanese infant. A 21-month-old Japanese female infant presented with a swollen mass on the dorsolateral aspect of the left foot. Based on physical examination, radiological and histopathologic findings and laboratory results, a diagnosis of Bacillus Calmette–Guérin osteomyelitis of the fifth metatarsal bone was made, and an oral anti-tuberculosis treatment was initiated. However, the mass recurred 10 months after the start of the anti-tuberculosis treatment, so additional surgical debridement was performed. Six months after surgery, clinical findings and plain radiograph images revealed complete improvement of the affected area, and anti-tuberculosis treatment was stopped. Bacillus Calmette–Guérin osteomyelitis of the fifth metatarsal in a 21-month-old Japanese infant was successfully treated with oral anti-tuberculosis therapy and surgical debridement.

Estimation of Stature Based on Metatarsal Bones in a Thai Population

Estimation of Stature Based on Metatarsal Bones in a Thai Population

Tuberculous Osteomyelitis of the Fifth Metatarsal Treated Using the Induced Membrane Technique: A Case Report

Tuberculous osteomyelitis of the foot, an uncommon and rare entity, accounts for &lt;0.01% of all tuberculous localizations. Osteomyelitis secondary to tuberculosis is difficult to diagnose and treat, requiring a high suspicion index. We report a case of tuberculous osteomyelitis of the fifth metatarsal bone treated with the induced membrane technique. Here, we report the case of a 40-year-old woman with a history of immunosuppressive treatment presented with a complaint of painful swelling of the left foot. Radiographs showed osteolytic lesions of the fifth metatarsal bone. Initial biopsy suggested tuberculosis. She was surgically treated with the induced membrane technique. Histology confirmed tuberculous osteomyelitis and antituberculous treatment was initiated. Full weight-bearing was allowed after 8 months. At 24 months follow-up, all symptoms were resolved. The radiographs showed an integrated graft. In conclusion, the presence of osteolytic lesions on a plain film should rise high suspicious for a possible infection requiring biopsy, and if confirmed, mandates surgical debridement and reconstruction. The induced membrane technique offers a mean to treat infectious bone defects. Level of Evidence: Level 4.

Anatomical study of the 3rd metacarpal bone of some mammals

The current study included the anatomical structure of the metatarsal bone in sheep in terms of the traditional structural description of the bone, as it was found that the metatarsal bone in the fore and hind limbs of adult sheep had no visible differences between it and animals, especially ruminants. The metacarpal \tarsal bone No. 3 was cylindrical in shape, with the presence of the metacarpal \tarsal bones 2 and 4 declines, articulated from the proximal end with the metacarpal and metatarsal bones whereas from the distal part with the fetlock joint and the first phalanx bone. The aim of the study is to determine whether the environment and its changes in Iraq have affected the animals and their bones in terms of length, thickness, and hardness.

Pharmacological inhibition of BCL-2 with the FDA-approved drug venetoclax impairs longitudinal bone growth

Treatment-related skeletal complications are common in childhood cancer patients and survivors. Venetoclax is a BCL-2 inhibitor that has shown efficacy in hematological malignancies in adults and is being investigated in pediatric cancer clinical trials as a promising therapeutic modality. Venetoclax triggers cell death in cancer cells, but whether it exerts similar effects in normal bone cells, is unknown. Chondrogenic ATDC5 cells, E20 fetal rat metatarsal bones, and human growth plate biopsies were treated with different concentrations of venetoclax. Female NMRI nu/nu mice were treated with venetoclax or vehicle for 15 days. Mice were X-rayed at baseline and at the end of the experiment to assess longitudinal bone growth and body weight was monitored throughout the study. Histomorphometric and immunohistochemical analyses were performed to evaluate treatment effects on the growth plate cartilage. Venetoclax decreased the viability of chondrocytes and impaired the growth of ex vivo cultured metatarsals while reducing the height of the resting/proliferative zone and the hypertrophic cell size. When tested in vivo, venetoclax suppressed bone growth and reduced growth plate height. Our experimental data suggest that venetoclax directly targets growth plate chondrocytes suppressing bone growth and we, therefore, encourage careful monitoring of longitudinal bone growth if treating growing children with venetoclax.

A PROSPECTIVE OBSERVATIONAL STUDY OF THE FUNCTIONAL OUTCOME OF SURGICAL MANAGEMENT OF INTRA-ARTICULAR CALCANEUM FRACTURE BY CLOSED REDUCTION WITH PERCUTANEOUS PINNINGS

The calcaneum is the greatest bone of the foot and is the major weight-bearing structure of the foot and the most common tarsal bone to fracture. Many treatment techniques are described in the literature but indications for specic techniques are undened. This study analyzes the outcome of the treatment of intra-articular tonguetype calcaneum fractures treated by Essex-leproesti technique. Methods- This prospective observational study aimed to evaluate the functional outcome of tongue-type intra-articular fracture by closed reduction with a percutaneous Steinmann pin. 16 patients with intra-articular tongue-type fracture were treated in Indra Gandhi government medical college and hospital, Nagpur from December 2020 to December 2022 with a minimum follow-up of 6 months. the functional outcome was assessed by the AOFAS Score. Most common cause for injury is fall from height. All patients were managed surgically and out of 16 patients, 4 cases(25%) had excellent, 9 cases (56%) had good and 5 cases (19%) had fair results. None of the patients in this series had poor results. As per our experience, the time for surgery is short and it can easily be performed even in the presence of swelling in the period immediately after injury also the risk of infection is very low.

Proximal segmental ostectomy under standing sedation for treatment of open comminuted axially displaced fractures of the fourth metatarsal bone in two horses

SummaryTwo cases with open, comminuted, axially displaced fractures of the proximal third of the fourth metatarsal bone were referred to the University Equine Hospital Vienna. Due to concerns regarding the risk of injury to the suspensory ligament and risk of implant infection with an open configuration, surgical treatment with proximal ostectomy of the fractured fourth metatarsal bone was performed in both cases. Based on telephone follow‐up, Case 1 was reported to be sound with no significant reaction at the surgical site 22 months following the procedure and Case 2 exhibited intermittent lameness, radiographically evident irregular new bone formation and some residual ultrasonographic changes of the proximal suspensory ligament 17 months after the procedure. Based on the results of this report, a proximal ostectomy facilitated by standing sedation and regional anaesthesia is a valid treatment option in cases of open, axially displaced fractures of the fourth metatarsal bone, minimising perioperative complications but not excluding long‐term postoperative complications.

Radiographic Evaluation of First Tarsometatarsal Joint Arthrodesis for Hallux Valgus Deformity: Does the Fusion of the First to the Second Metatarsal Base Reduce the Radiological Recurrence Rate?

Modified Lapidus arthrodesis (MLA) is a well-established treatment option for symptomatic hallux valgus deformity (HVD). However, recurrence of the deformity remains a concern. The goal of this study was to evaluate the effect of an additional intermetatarsal fusion on the radiographic recurrence rate after first tarsometatarsal (TMT-I) arthrodesis. This is a retrospective evaluation of 56 feet that underwent TMT-I arthrodesis for moderate to severe HVD. Twenty-three feet received an isolated arthrodesis of the TMT-I joint (TMT-I), whereas 33 feet received an additional fusion between the base of the first and the second metatarsal bone (TMT-I/II). Various radiological parameters were determined preoperatively, 6 weeks and at a mean of 2 years postoperatively. The intermetatarsal angle (IMA) and the hallux valgus angle (HVA) were significantly lowered at both follow-up evaluations in both groups. In the TMT-I/II group, the initial reduction of HVA was significantly higher (29.3° vs 21.1°). This difference disappeared by the second follow-up, leaving no significant differences between both techniques at final follow-up. Radiological recurrence rates of HVD were comparable in both groups. Isolated TMT-I arthrodesis provides reliable radiological results in the correction of HVD. Whether additional fusion of the first and second metatarsal base should be routinely performed remains unclear. Level 3.

Clinical Results of Nonvascularized Metatarsal Articular Bone Grafting for Osteochondral Defects of the Radiocarpal and Distal Radioulnar Joint.

Background Treatment of post-traumatic osteochondral defects in the radiocarpal and distal radioulnar joint with nonvascularized metatarsal articular bone grafting is an option to restore the joint (cartilage) surface and wrist function. Purpose To evaluate the clinical midterm results of 10 consecutive patients who were treated with a nonvascularized metatarsal bone graft for cartilage bone defects of the lunate facet, scaphoid facet, sigmoid notch, or the radial part of the ulnar head. Patients and Methods Patients with isolated osteochondral defects of the lunate facet, scaphoid facet, sigmoid notch, or radial part of the ulnar head, respectively, as a result of wrist trauma were retrospectively identified in a prospectively collected database. The patients symptoms were limited wrist motion and/or pain. Clinical results and complications were extracted from patient's medical files and two questionnaires consisting of the Patient-Rated Wrist Evaluation and additional questions regarding patient satisfaction and return to work and/or hobby. Results Minor complications occurred in three cases and required surgery. In five cases an acceptable donor site foot morbidity was seen at 1 year. One patient was not satisfied due to persistent wrist pain despite adequate range of motion. One patient could not return to its prior work. Another patient could not resume its hobby. Conclusion Retrospective evaluation of 10 cases with resurfacing of the scaphoid facet, sigmoid notch, and/or lunate facet, or radial part of the ulnar head has shown that osseointegration was possible without a vascular pedicle to the graft in all cases with a (mean) follow-up of 5 years. This technique may become an alternative treatment when implants become less available. Level of Evidence Level III.

AB155. SOH23ABS_003. Metatarsal stress fractures: an analysis of readability and quality of online health materials

AB155. SOH23ABS_003. Metatarsal stress fractures: an analysis of readability and quality of online health materials

Erratum to “Development of an elastic storage-release prosthetic foot that mimics the metatarsal bone head and midtarsal joint”

Acknowledgment was not stated in the original article.

Charcot Arthropathy and Osteomyelitis: A Case of Diabetic Foot Syndrome

Diabetes mellitus is a disease that affects millions around the globe. It also comes with a major complication, diabetic foot ulcers. Lower extremities having little to no vascularity in diabetic people leads to wounds that are unable to heal on their own. These wounds later become infected and cause osteomyelitis, a condition in which the infection in soft tissues of the lower extremities spread to the bones of the foot.Charcot arthropathy is one of the more serious foot issues that can arise from diabetic neuropathy. The soft tissues, joints, and bones of the foot or ankle are all impacted by Charcot. The joints in the foot or ankle might dislocate when the bones deteriorate and become brittle. Diabetes patients who have their soft tissues and bones infected might even have to get their extremities amputated if not managed right on time. We describe the case of a 66-year-old man with type 1 diabetes mellitus who presented to the emergency department with increasing pain in the right foot. There was a hyperemic discharge coming out of his wound which increased gradually over time. The patient’s been using Lantus and Novorapid and his blood glucose measurement at the time of admission was 466. Our patient said that he was hospitalized in the intensive care unit due to diabetic ketoacidosis 20 days before he applied to our emergency department, and his wounds, discharge, pain, and redness increased after this incident. We requested his anteroposterior and lateral radiographs of the right foot and a lower extremity CT. The scans were examined carefully and at last, amputation was recommended for the patient. The patient did decline our offer and wanted to go home with a dressing. Ampicillin/sulbactam and ciprofloxacin were started. We also recommended him see infectious diseases and plastic surgery consultants in the following daysI hope you may be interested in the results of our study in this direction.