Metatarsophalangeal Joint Angle Research Articles

Effects of Barefoot and Shod Conditions on the Kinematics and Kinetics of the Lower Extremities in Alternating Jump Rope Skipping-A One-Dimensional Statistical Parameter Mapping Study.

To explore the difference in the biomechanics of the lower extremity during alternating jump rope skipping (AJRS) under barefoot and shod conditions. Fourteen experienced AJRS participants were randomly assigned to wear jump rope shoes or be barefoot (BF) during the AJRS at a self-selected speed. The Qualisys motion capture system and Kistler force platform were used to synchronously collect the ground reaction forces and trajectory data of the hip, knee, ankle, and metatarsophalangeal (MTP) joints. One-dimensional statistical parameter mapping was used to analyze the kinematics and kinetics of the lower extremity under both conditions using paired t-tests. Wearing shoes resulted in a significant decrease in the ROM (p < 0.001) and peak angular velocity (p < 0.001) of the MTP joint during the landing phase. In addition, the MTP joint power (p < 0.001) was significantly larger under shod condition at 92-100% of the landing phase. Moreover, wearing shoes reduced the peak loading rate (p = 0.002). The findings suggest that wearing shoes during AJRS could provide better propulsion during push-off by increasing the MTP plantarflexion joint power. In addition, our results emphasize the significance of the ankle and MTP joint by controlling the ankle and MTP joint angle.

Association of Fusion of the First Metatarsophalangeal Joint and Pes Planus Deformity Correction.

There has been scant investigation on the relationship between the distal aspect of the medial longitudinal arch and pes planus deformity. The aim of this study was to investigate whether the reduction and stabilization of the distal aspect of the medial longitudinal arch through fusion of the first metatarsophalangeal joint (MTPJ) can subsequently improve pes planus deformity parameters. This could be useful in both further understanding the role of the distal medial longitudinal arch in patients with pes planus and planning operative intervention in patients with multifactorial medial longitudinal arch problems. A retrospective cohort study was undertaken between January 2011 and October 2021, including patients undergoing first MTPJ fusion with a pes planus deformity on weightbearing preoperative radiographs. These were compared to postoperative images, and multiple pes planus measurements were taken for comparison. A total of 511 operations were identified for further analysis, with 48 feet meeting the inclusion criteria. There was a statistically significant reduction identified between the pre- and postoperative measurements of Meary angle (3.75 degrees, 95% CI 2.9-6.47 degrees) and talonavicular coverage angle (1.48 degrees, 95% CI 1.09-3.44 degrees). There was a statistically significant increase between the pre- and postoperative measurements of calcaneal pitch angle (2.32 degrees, 95% CI 0.24-4.41 degrees) and medial cuneiform height (1.25 mm, 95% CI 0.6-1.92 mm). Reduced intermetatarsal angle was significantly associated with an increase in first MTPJ angle postfusion. Many of the measurements made were found "almost perfectly" reproducible by the Landis and Koch description. Our results demonstrate that fusion of the first MTPJ is associated with improvement of medial longitudinal arch parameters of a pes planus deformity but not to levels considered to be clinically normal. Therefore, the distal aspect of the medial longitudinal arch could, to some degree, be a feature in the pes planus deformity etiology. Level III, retrospective case control study.

The efficacy of flexor tenotomy to prevent recurrent diabetic foot ulcers (DIAFLEX trial): Study protocol for a randomized controlled trial

Foot ulcers are a frequent and costly problem in people with diabetes mellitus and can lead to amputations. Prevention of these ulcers is therefore of paramount importance. Claw/hammer toe deformities are commonly seen in people with diabetes. These deformities increase the risk of ulcer development specifically at the (tip of) the toe. Percutaneous needle tenotomy of the tendon of the m. flexor digitorum longus (tendon tenotomy) can be used to reduce the severity of claw/hammer toe deformity with the goal to prevent ulcer recurrence. The main objective of this randomized controlled trial is to assess the efficacy of flexor tenotomy to prevent recurrence of toe ulcers in people with diabetes and a history of toe (pre-)ulcers. Additionally, we aim to assess interphalangeal joints (IPJ) and metatarsophalangeal joint (MTPJ) angles in a weight-bearing and non-weight-bearing position, barefoot plantar pressure during walking, cost-effectiveness and quality of life before and after the intervention and compare intervention and control study groups. Sixty-six subjects with diabetes and claw/hammer toe deformity and a recent history of (pre-)ulceration on the tip of the toe will be included and randomized between flexor tenotomy of claw/hammer toes (intervention) versus standard of care including orthosis and shoe offloading (controls) in a mono-center randomized controlled trial. Clinicaltrials.gov registrationNCT05228340.

Effect of long-term use of kinesiotape on hallux valgus angle: A double-blinded randomized controlled trial

Hallux valgus (HV) has an impact on quality of life since it alters the mechanics of the foot and causes pain. Kinesiotape (KT) has been demonstrated to be challengeable, cost-effective tool for restoring muscle function and strength, improving range of motion, reducing discomfort, and increasing lymphatic drainage. The aim of this study was to investigate the influence of 8 weeks KT on the degree HV angle (HVA) and subsequently on pain intensity. In this double-blinded randomized controlled trial, 30 subjects with HV deformity (mean age 29.07±6.3 years) were randomly allocated to study group (A) and control group (B). Group A received KT for HV, which was replaced every 5 days for 8 weeks, along with a home regular exercise program for HV, while Group B received placebo KT replaced every 5 days and the same exercise program for HV. HVA was measured using x-ray, pain intensity was measured using visual analogue scale (VAS). Outcomes were measured before and after 8 weeks of intervention. HVA showed a significant reduction in group A (p = 0.001) for both feet in comparison to group B (p = 0.11 for right foot, p = 0.09 for left foot, while pain showed significant improvement in both groups for both feet (p = 0.001). The results revealed that KT in mobile HV is effective on improving the metatarsophalangeal joint angle, decreasing pain, and hence may has positive functional impact on subjects with HV.

Metatarsophalangeal and interphalangeal joint angle measurements on weight-bearing CT images

BackgroundThe aim of this study was to present and evaluate methods of measuring toe joint angels using joint-surface based and inertial axes approaches. MethodsNine scans of one frozen human cadaveric foot were obtained using weight-bearing CT. Two observers independently segmented bones in the forefoot and measured metatarsalphalangeal joint (MTPJ) angles, proximal and distal interphalangeal joint (PIPJ and DIPJ) angles and interphalangeal angles of the hallux (IPJ) using 1) inertial axes, representing the long anatomical axes, of the bones and 2) axes determined using centroids of articular joint surfaces. ResultsThe standard deviations (SD) of the IPJ/PIPJ and DIPJ angles were lower using joint-surface based axes (between 1.5˚ and 4.1˚) than when the inertial axes method was used (between 3.3˚ and 16.4˚), for MTPJ the SD’s were similar for both methods (between 0.5˚ and 2.6˚). For the IPJ/PIPJ and DIPJ angles, the width of the 95% CI and the range were also lower using the joint-surface axes method (95% CI: 2.0˚–4.1˚ vs 3.2˚–16.3˚; range: 3.1˚–7.4˚ vs 3.8˚–35.8˚). Intra-class correlation coefficients (ICC) representing inter- and intra-rater reliability were good to excellent regarding the MTPJ and IPJ/PIPJ angles in both techniques (between 0.85 and 0.99). For DIPJ angles, ICC’s were good for the inertial axes method (0.78 and 0.79) and moderate for the joint-surface axes method (0.60 and 0.70). ConclusionThe joint-surface axes method enables reliable and reproducible measurements of MTPJ, IPJ/PIPJ and DIPJ angles. For PIPJ and DIPJ angles this method is preferable over the use of inertial axes.

The Effect of Arch Stiffness on the Foot-Ankle Temporal Kinematics during Gait Termination: A Statistical Nonparametric Mapping Study.

This study compares foot-ankle temporal kinematics characteristics during planned and unplanned gait termination (PGT and UGT) in subjects with different arch stiffnesses (ASs) based on the statistical nonparametric mapping (SnPM) method. By measuring three-dimensional arch morphological parameters under different loading conditions, 28 healthy male subjects were classified and participated in gait termination (GT) tests to collect metatarsophalangeal (MTP) and ankle-joint kinematics data. The two-way repeated-measures ANOVA using SnPM was employed to assess the impacts of AS on foot-ankle kinematics during PGT and UGT. Our results show that joint angles (MTP and ankle joints) were altered owing to AS and GT factors. The flexible arches hahadve periods of significantly greater MTP and ankle joint angles than those of stiff arches during the stance phase of GT, whereas subjects exhibited significantly smaller ankle and MTP joint angles during UGT. These results add additional insights into the morphological arch biomechanical function, and the comprehensive compensatory adjustment of lower-limb joints during gait stopping caused by unplanned stimulation.

Radiographic evaluation of congruency of the first metatarsophalangeal joint in hallux valgus

BackgroundCongruency of the first metatarsophalangeal (MTP) joint is extremely important for the selection of surgical methods and prognosis, while radiographic evaluation methods are relatively lacking. The purpose of this article was to explore radiographic indicators for evaluating congruency of the first MTP joint.MethodsWe selected patients with hallux valgus who had a weightbearing X-ray in the outpatient system and measured their hallux valgus angle (HVA). In total, 183 cases of 245 feet with HVA greater than 15° were selected. The distal metatarsal articular angle (DMAA), metatarsophalangeal joint angle (MTPJA), congruency index (CI) and tibial sesamoid position (TSP) were measured and statistically analysed.ResultsThe higher the degree of hallux valgus was, the higher the proportion of incongruency of the first MTP joint. Significant differences were found in the DMAA, MTPJA and CI between the congruency and incongruency groups of patients with moderate-to-severe hallux valgus (P < 0.05). The areas under the curve (AUCs) of the receiver operating characteristic (ROC) curve for DMAA was 0.554 (P > 0.05). However, the MTPJA and CI were 0.906 and 0.884, the sensitivity values reached 0.791 and 0.949, the specificity values were 0.862 and 0.644, and the critical values were 10.67 and 0.765, respectively. The correlation test indicated that in the congruency group, the DMAA and HVA were positively correlated, but the MTPJA, CI and HVA had low correlation coefficients. The DMAA and HVA were not correlated in the incongruency group; however, the MTPJA and HVA were significantly positively correlated, and the CI and HVA showed a negative correlation (P < 0.05).ConclusionThe MTPJA and CI are indicators that can be used to quantitatively evaluate the congruency of the first MTP joint, taking 10° and 0.765 as the demarcation points, respectively. Clinically, congruency of the MTP joint should be considered when choosing surgical methods for different degrees of hallux valgus, and the MTPJA and CI can be used as quantitative evaluation indicators.Level of evidence: Level III, Retrospective Comparative Study.

Design and investigation of the effectiveness of a metatarsophalangeal assistive device on the muscle activities of the lower extremity.

The metatarsophalangeal (MTP) joint is not considered in most current walking assistive devices even though it plays an important role during walking. The purpose of this study was to develop a new MTP assistive device and investigate its effectiveness on the muscle activities of the lower extremities during walking while wearing the device. The MTP assistive device is designed to support MTP flexion by transmitting force through a cable that runs parallel with the plantar fascia. Eight participants were instructed to walk at a constant speed on a treadmill while wearing the device. The muscle activities of their lower extremities and MTP joint kinematics were obtained during walking under both actuated and non-actuated conditions. Paired t-tests were performed to compare the differences in each dependent variable between the two conditions. The muscle activity of the MTP flexor was significantly reduced during walking under actuated conditions (p = 0.013), whereas no differences were found in the muscle activities of other muscles or in the MTP joint angle between actuated and non-actuated conditions (p > 0.05 for all comparisons). In conclusion, the cable-driven MTP assistive device is able to properly assist the MTP flexor without interfering with the action of other muscles in the lower extremities; as such, this MTP assistive device, when integrated into existing exoskeleton designs, has the potential to offer improved walking assistance by reducing the amount of muscle activity needed from the MTP flexor.

Biomechanical and musculoskeletal changes after flexor tenotomy to reduce the risk of diabetic neuropathic toe ulcer recurrence.

ObjectiveTo assess the effect of flexor tenotomy in patients with diabetes on barefoot plantar pressure, toe joint angles and ulcer recurrence during patient follow‐up.MethodsPatients with a history of ulceration on the toe apex were included. They underwent minimally invasive needle flexor tenotomy by an experienced musculoskeletal surgeon. Dynamic barefoot plantar pressure measurements and static weight‐bearing radiographs were taken before and 2–4 weeks after the procedure.ResultsA total of 14 patients underwent flexor tenotomy on 50 toes in 19 feet. There was a mean follow‐up time of 11.4 months. No ulcer recurrence occurred during follow‐up. Mean barefoot plantar pressure was assessed on 34 toes and decreased significantly after the procedure by a mean 279 kPa (95% CI: 204–353; p < 0.001). Metatarsophalangeal, proximal interphalangeal and distal interphalangeal joint angles were assessed on nine toes and all decreased significantly (by 7° [95% CI: 4–9; p < 0.001], 19° [95% CI: 11–26; p < 0.001] and 28° [95% CI: 13–44; p = 0.003], respectively).ConclusionThese observations show a beneficial effect of flexor tenotomy on biomechanical and musculoskeletal outcomes in the toes, without ulcer recurrence.

The Role of Footwear in the Pathogenesis of Hallux Valgus: A Proof-of-Concept Finite Element Analysis in Recent Humans and Homo naledi.

Hallux valgus (HV), the bunion of the first metatarsophalangeal joint (MTPJ), bothers many adults. No consensus has been reached about the causes of HV, be it a hereditary, or acquired, or multifactorial disease. Nor has agreement been reached using MTPJ angle to assess HV based on X-ray because in most cases the assessment of MTPJ is not reliable as it depends on the posture during scanning. In this study, we assume that HV is predominately acquired and that shoe wearing per se is an important player in HV pathogenesis. To verify our hypothesis, a CT-based finite element (FE) model of the first MTPJ of fossil remains of bear-footed Homo naledi was created and compared to that of five contemporary shoe-wearing wrestlers (10 models from two scans at an interval of about 18 months) because Homo naledi's first MTPJ is an ideal model for non-shoe wearing with parallel sesamoid grooves. We developed the first MTPJ structure transformation method and created MTPJ joint capsule model for both Homo naledi and wrestlers. Constraint on the medial side of the first MTPJ capsule was set to simulate shoe-wearing conditions compared to the lack of medial constraint for barefooted conditions. Analysis of eight FE models of different angles for the first MTPJ of Homo naledi was performed by the first MTPJ transformation method and results showed that stress concentrated on the medial capsule of the first MTPJ in simulated shoe-wearing conditions, even at MTPJ angle of 0°. Increase in the first MTPJ angle further increased stress concentration on the medial side, and stress-growth relationship might reveal the causes of HV. We further developed a method to position the first MTPJ in wrestlers and created CT-based models at two time points. It was evident that the first MTPJ angle increased in all but one athlete, with a maximal increase of 4.03 degrees. This verifies our hypothesis that HV might be developed by wearing shoes. Further longitudinal studies with larger sample sizes are needed to additionally validate our results and determine the magnitude of the effects of shoe wearing on development and progression of HV.

Biomechanical effects of rocker shoes on plantar aponeurosis strain in patients with plantar fasciitis and healthy controls.

Plantar fasciitis is a frequently occurring overuse injury of the foot. Shoes with a stiff rocker profile are a commonly prescribed treatment modality used to alleviate complaints associated with plantar fasciitis. In rocker shoes the apex position was moved proximally as compared to normal shoes, limiting the progression of the ground reaction forces (GRF) and peak plantarflexion moments during gait. A stiff sole minimizes dorsiflexion of the toes. The aim of this study was to investigate whether the biomechanical effects of rocker shoes lead to minimization of plantar aponeurosis (PA) strain during gait in patients with plantar fasciitis and in healthy young adults. 8 patients with plantar fasciitis (1 male, 7 females; mean age 55.0 ± 8.4 years) and 8 healthy young adults (8 females; mean age 24.1 ± 1.6 years) participated in the study. Each participant walked for 1 minute on an instrumented treadmill while wearing consecutively in random order shoes with a normal apex position (61.2 ± 2.8% apex) with flexible insole (FN), normal apex position with stiff insole (SN), proximal apex position (56.1 ± 2.6% apex) with flexible insole (FR) and proximal apex position with stiff insole (SR). Marker position data of the foot and lower leg and GRF were recorded. An OpenSim foot model was used to compute the change in PA length based on changes in foot segment positions during gait. The changes in PA length due to increases in Achilles tendon forces were computed based on previous data of a cadaver study. PA strain computed from both methods was not statistically different between shoe conditions. Peak Achilles tendon force, peak first metatarsophalangeal (MTP1) joint angle and peak plantarflexion moment were significantly lower when walking with the rocker shoe with a proximal apex position and a stiff insole for all subjects (p<.05). Changes in Achilles tendon forces during gait accounted for 65 ± 2% of the total PA strain. Rocker shoes with a stiff insole reduce peak dorsiflexion angles of the toes and plantar flexion moments, but not PA strain because the effects of a proximal apex position and stiff insole do not occur at the same time, but independently affect PA strain at 80–90% and 90–100% of the stance phase. Rocker shoes with an apex position of ~56% are insufficient to significantly reduce peak PA strain values in patients with plantar fasciitis and healthy young adults.

Dynamic angular stiffness about the metatarsophalangeal joint increases with running speed

Altering the longitudinal bending stiffness of footwear has the potential to affect mechanics of the metatarsophalangeal (MTP) joint. Recent efforts have been put forth to identify an optimal bending stiffness of footwear to improve running performance. However, little is known about how this optimal bending stiffness may change with running speed. The purpose of this study was to investigate how dynamic angular stiffness about the MTP joint changes across running speeds. Eighteen participants ran at five speeds from 3.89 to 6.11 m/s. Metatarsophalangeal joint angles, moments, and stiffness were estimated for each speed. Two MTPJ load-displacement metrics were defined, active and critical stiffness. Instantaneous stiffness of the MTP joint was also quantified. There was a significant main effect of speed on critical stiffness (p < .001), maximum MTP moment (p < .001), MTP moment at maximum dorsiflexion (p < .001), and MTP range of motion (p = .013). There was no effect of speed on active stiffness (p = .094). These results support the notion that involvement of the MTP joint increases with running speed. Individual contributions of the foot and shoe to the MTP joint moment and stiffness suggest that the foot appears to dominate the stiffness of the foot-shoe complex and torque generation about the MTP joint. Instantaneous stiffness fluctuated throughout stance phase, suggesting that foot-shoe complex stiffness is time dependent. The ratio by which critical stiffness and MTP joint range of motion increase with running speed may provide insight for how to guide construction of performance footwear. These results suggest that when utilizing MTP joint mechanics for insights into designing a shoe for performance purposes, the effect of speed should be taken into consideration.

An investigation of the association between hindlimb conformation and suspensory desmopathy in sports horses

SummaryProximal suspensory desmopathy (PSD) is a common cause of hindlimb lameness in sports horses; anecdotally there is an association with straight hock conformation. The objective of this prospective observational study is to describe hindlimb conformation in horses with and without bilateral PSD. Horses examined over one year with a definitive diagnosis for lameness (based on clinical assessment, response to diagnostic anaesthesia, radiography, ultrasonography ± MRI or scintigraphy), were included (n = 193). Markers were placed on predefined landmarks. Lateral photographs were acquired from the left and right sides with the horse standing squarely, using standardised techniques, with each metatarsus perpendicular to the ground, aligned to the tuber ischii marker. Before data acquisition, repeatability studies for marker placement, horse positioning and angle measurements were performed. The tarsal and metatarsophalangeal angles were measured using Image Measurement. Orthopaedic diagnosis, breed, work discipline, weight, height and age were recorded. Z‐tests, Fisher's exact tests, Chi‐squared tests and multivariable logistic regression were used to determine the associations between diagnosis, tarsal angles and possible confounding variables. Mann Whitney U tests were used to evaluate the relationship between metatarsophalangeal joint angle and suspensory ligament injury. Horses with PSD had larger tarsal angles than controls (P = 0.003). The proportions of Warmblood‐type horses and dressage horses with PSD were different to those of other breeds and work disciplines (P = 0.001, 0.02 respectively). A final logistic regression model demonstrated a significant effect of mean tarsal angle on outcome when breed and weight‐height product were accounted for. There was a an 11% increase in the odds of PSD for every degree increase in tarsal angle (CI 1.006–1.223, P = 0.04). There was no association between suspensory ligament injury and metatarsophalangeal joint angle. Assessment of tarsal angles at prepurchase examinations and prior to surgical treatment of PSD may be advisable.

The effects of midsole bending stiffness on ball speed during maximum effort soccer kicks

The soccer kick is the most prominent movement in soccer. Kicking performance depends on two major factors: kicking accuracy and ball speed. During the soccer kick, momentum is transferred from the foot/cleat to the ball. This interplay between the foot/cleat and the ball can be modelled as a mixture of ‘impulse-like’ and ‘throwing-like’ components. While kicking the ball, the metatarsophalangeal (MTP) joint and the cleat experience deformation. This deformation can be reduced by increasing the bending stiffness of the cleat’s midsole. Therefore, the purpose of this study was to investigate experimentally the influence of midsole bending stiffness on ball speed during maximum effort soccer kicks. Twenty male subjects (mean ± SD; age: 29.5 ± 5.6 years, height: 175.5 ± 6.4 cm, mass: 74.3 ± 8.4 kg) performed six maximum effort soccer kicks in five stiffness conditions. Kinematic data were collected using an optical motion capture system consisting of eight high-speed cameras, and ball speed was recorded using a radar gun. There was no significant difference in the average ball speed between the five stiffness conditions when all subjects were pooled. Further, there was no significant difference in the change of the MTP joint angle from before ball contact to after ball contact between the stiffness configurations. Thirteen (of the 20) subjects showed the highest ball speed in the two stiffest cleats. The differences between the best and the worst performing stiffness configurations across all subjects ranged from 2.2 km/h to 9.2 km/h. The optimal stiffness condition that resulted in highest ball speed was subject specific, and therefore soccer cleats need to be tuned to individual players.

Influence of the windlass mechanism on arch-spring mechanics during dynamic foot arch deformation.

The function of the human foot is described dichotomously as a compliant structure during mid-stance and a stiff lever during push-off. The arch-spring and the windlass mechanisms, respectively, describe each of these behaviours; however, their interaction has not been quantified to date. We hypothesized that by engaging the windlass mechanism with metatarsophalangeal joint (MTPJ) dorsiflexion, we would observe stiffening of the arch and reduced energy absorption and dissipation during dynamic compressions of the foot. Using a custom apparatus, the MTPJ angle was fixed at 30 degrees of plantarflexion, neutral or 30 degrees of dorsiflexion for nine participants, with the shank positioned similarly to the end of mid-stance. The arch was compressed at two speeds, with the faster speed comparable to walking around 1.5 m s-1 Six cameras captured the compression and elongation of the arch, along with other kinematic variables, synchronously with the ground reaction force. Combining these measures, we computed the energy absorbed, returned and dissipated in the arch. Contrary to our hypothesis, when the windlass mechanism was engaged, the arch elongated more, and absorbed and dissipated more energy than when it was not engaged. This engagement of the windlass altered the rotational axis of the mid-foot, which probably oriented the arch-spanning structures closer to their resting length, increasing their compliance. This study provides novel evidence for an interplay between the windlass and arch-spring mechanisms that aids in regulation of energy storage within the foot.

Anatomic Reconstruction Versus Traditional Rebalancing in Lesser Metatarsophalangeal Joint Reconstruction

Traditional rebalancing techniques, such as capsulotomies and capsulorrhaphies, are commonly performed during complex hammertoe and lesser metatarsal osteotomy procedures involving metatarsophalangeal joint (MTPJ) contractures; however, floating toes, digital instability, and malalignment are concerns. We critically analyzed the outcomes after anatomic reconstruction of the plantar plate and collateral ligaments compared with those after traditional rebalancing techniques. A case-control study was conducted of 54 patients who had undergone surgical correction of lesser MTPJ imbalances due to complex hammertoe deformities (power 80%, type I error = 0.05). Cases were defined as consecutive patients treated with anatomic plantar plate and collateral ligament reconstruction. Controls had undergone traditional lesser MTPJ rebalancing and were matched to cases by age, gender, follow-up duration (minimum 12 months), and concomitant procedures of the same lesser ray. Multivariate logistic regression demonstrated that patients treated with anatomic reconstruction had greater digital stability (negative dorsal drawer and negative paper pull-out test findings) at final follow-up examination compared with the controls. American College of Foot and Ankle Surgeons (ACFAS) forefoot module scores were greater in the anatomic group in all domains (p ≤ .05). Controls had greater postoperative radiographic MTPJ angles than the cases, with no differences detected between the 2 groups in visual analog scale scores or proximal interphalangeal joint angles. The importance of restoration of the plantar plate and collateral ligament integrity as a digital stabilizer is generally accepted but has not been well studied. We found that anatomic reconstruction yielded greater digital stability, greater ACFAS Forefoot module scores, and better radiographic MTPJ alignment than controls. Additional studies are warranted to assess the long-term viability of anatomic lesser MTPJ reconstruction.

The Role of the Midfoot in Drop Landings.

The midfoot is instrumental to foot function; however, quantifying its roles in human movement has been difficult. A forceful dynamic activity like landing may help elucidate the midfoot's contribution to foot energetics and function. The main purpose of this study was to measure midtarsal joint kinematics and kinetics during a barefoot single-leg landing task. A secondary aim of this study was to explore the relationship between static foot posture and dynamic midfoot function. In a cross-sectional study design, 48 females (age = 20.4 ± 1.8 yr, body mass index = 21.6 ± 1.7 kg·m) performed drop landings from a height of 0.4 m onto split force platforms. Subjects hung from wooden rings and landed on their dominant leg. Midtarsal joint kinematic and kinetic data were recorded using a 14-camera optical motion capture system in conjunction with two in-ground force platforms and a custom kinetic three-segment foot model. Foot structure was measuring using the arch height index (AHI) and the static midtarsal joint angle from motion capture. Kinematic data revealed an average sagittal plane midtarsal joint range of motion of 27° through the landing phase. Kinetic data showed that between 7% and 22% of the total lower extremity joint, work during the landing was performed by the midtarsal joint. Both standing AHI and static midtarsal joint angle (static MA) were correlated with sagittal plane midtarsal joint range of motion (standing AHI: r = -0.320, P = 0.026; static MA: r = 0.483, P < 0.001) and with midtarsal joint work (standing AHI: r = 0.332, P = 0.021; static MA: r = -0.323, P = 0.025). The midfoot contributes substantially to landing mechanics during a barefoot single-leg landing task. Static foot posture measures have limited value in predicting midfoot kinematics and kinetics during sportlike landings.

Effect of Kinesiotaping and Joint Mobilization on The Metatarsophalangeal Joint Angle and Pain in Hallux Valgus Patients

The aim of this study was to observe the effects of kinesiotaping and joint mobilization on the metatarsophalangeal joint angle and pain in hallux valgus patients Twenty-one female hallux valgus patients in their 20s were divided into two groups, a Kinesiotaping group (KT, n=10) and another group with the addition of joint mobilization (KTJM, n=11). After undergoing 6 weeks of intervention, the change in the metatarsophalangeal joint and pain were measured. Metatarsophalangeal joint angle was significantly increased both the KT and the KTMJ group after intervention. In the change of pain, both the KT and KTJM groups on an individual basis also experienced a significant decrease in pain, though comparison between the two groups failed to represent a significant difference. These findings suggest that Kinesiotatping and joint mobilization increased the joint angle and reduced pain.

Plantar Plate Repair for Lesser Metatarsophalangeal Joint Instability.

Lesser metatarsophalangeal (MTP) joint instability is a common cause of forefoot pain. Advances in operative technique and instrumentation have made it possible to anatomically treat plantar plate tears through a dorsal approach. Our goal was to evaluate the subjective, functional, and radiographic outcomes of plantar plate repair (PPR) from a dorsal approach. A prospective case series was performed evaluating the results of PPR in 97 feet with 138 plantar plate tears. Patients underwent PPR from a dorsal approach with a Weil osteotomy. We followed patients at regular intervals for 12 months and collected data preoperatively and postoperatively with respect to visual analog scale (VAS) scores, MTP range of motion (ROM), paper pull-out test, American Orthopaedic Foot & Ankle Society (AOFAS) scores, satisfaction, and radiographic measures. Eighty percent of patients scored "good" to "excellent" satisfaction scores at 12 months. The mean VAS pain score preoperatively was 5.4/10, and postoperatively was 1.5/10. The mean AOFAS scores increased from 49 to 81 points following surgery. The mean MTP ROM preoperatively was 43 degrees and postoperatively 31 degrees. Forty-two percent of toes passed the paper pull out test prior to surgery and 54% at 12 months. Mean metatarsal shortening was 2.4/3.1/1.2 mm for the second, third, and fourth metatarsals, respectively. The mean MTP joint angles preoperatively were 2/4.9/-1.3 degrees and postoperatively were 7.4/9.6/0.2 degrees, respectively, for the second, third, and fourth MTP joints. We found that the plantar plate could be repaired through a dorsal approach with reliable outcomes. PPR was a viable option to anatomically restore the ligamentous support in the unstable lesser MTP joint. Level IV, retrospective case series.

Muscle and Joint Factors Associated With Forefoot Deformity in the Diabetic Neuropathic Foot.

Diabetic forefoot joint deformities are a known risk factor for skin breakdown and amputation, but the causes of deformity are not well understood. The purposes of this study were to determine the effects of intrinsic foot muscle deterioration and limited ankle joint mobility on the severity of metatarsophalangeal joint (MTPJ) deformity, and determine the relationships between these potential contributing factors and indicators of diabetic complications (peripheral neuropathy and advanced glycation end products). A total of 34 participants with diabetic neuropathy (average age, 59 years; range 41-73) were studied. MTPJ angle and intrinsic foot muscle deterioration were measured with computed tomography and magnetic resonance imaging, respectively. Maximum ankle dorsiflexion was measured using kinematics. Skin intrinsic fluorescence served as a proxy measure for advanced glycation end product accumulation. Total forefoot lean muscle volume (r = -0.52, P < .01) and maximum ankle dorsiflexion (r = -0.42, P < .05) were correlated with severity of MTPJ deformity. Together they explained 35% of the variance of MTPJ angle. Neuropathy was correlated with forefoot muscle deterioration (ρ = 0.53, P < .01). Skin intrinsic fluorescence was correlated to severity of neuropathy (r = 0.50, P < .01) but not maximum ankle dorsiflexion, or forefoot deterioration when controlling for neuropathy. These results suggest that the interplay of intrinsic foot muscle deterioration and limited ankle mobility may be the primary contributor to the development of MTPJ deformity. Identifying these muscle and ankle motion impairments as risk factors for MTPJ deformity supports the need for targeted interventions early in the disease process to slow, or possibly stop the progression of deformity over time and reduce the risk of amputation. Level IV, case series.