Ordinary Shoes Research Articles

Surgical refinements and sensory and functional outcomes of using thinned sensate anterolateral thigh perforator flaps for foot and ankle reconstruction: A retrospective study.

To improve the use of sensate anterolateral thigh (ALT) flaps for foot and ankle reconstruction, we employed a thinned nerve-selective harvesting technique. The data of 31 patients in whom sensate ALT perforator flaps were transferred for reconstruction of soft-tissue defects in the foot and ankle were reviewed. Flaps were elevated with 2 refinements. The first is the initial selection of the "true" sensory branch in the medial incision on the suprafascial plane. The second is flap thinning by keeping a cuff of thin deep fat surrounding the point where the perforator or nerve branch inserts into the superficial fat layer. The recipient site assessment consisted of complications, monofilament touch perception, sharp-blunt discrimination, axial circumference, and American Orthopedic Foot and Ankle Society score. After a mean follow-up of 31.7 months, all flaps survived uneventfully, except for marginal necrosis in 1 patient, infection in 1 patient, ulceration in 2 patients, and secondary thinning in 3 patients. The sensation of each flap was restored. A total of 87% and 90% of the patients exhibited 5 or more positive response points in the Semmes-Weinstein monofilament touch and sharp-blunt discrimination testings, respectively. The mean axial circumference of the reconstructed foot was 27.4 cm (the unaffected side was 25.8 cm). All patients achieved mobility in ordinary shoes with a mean functional score of 74.6. The thinned nerve-selective sensate ALT perforator flap can be a favorable option for foot and ankle reconstruction. This method also offers the possibility of preserving the nerve branch at the donor thigh.

Development of orthopedic support for patients with foot pathologies

The level of development and well-being of the population of Kazakhstan is directly dependent on the health of each person. In recent years, a significant increase in patients with diabetes mellitus has been observed all over the world and in Kazakhstan, because of which the number of patients with various foot diseases is growing. The works show that one of the causes of foot disease is uncomfortable shoes, since ordinary shoes do not provide the necessary structural elements, orthopedic products made of elastic, shock-absorbing and antibacterial materials that contribute to the normal functioning of the diabetic foot. The aim of the study is to determine the structural properties of the synthesized silicone composites with the addition of MCC, used in orthopedic products. In this work, studies of MCC and silicone composites were carried out using the DelsaNano particle size analyzer. Also carried out: IR - spectroscopic, electronic and optical-microscopic studies were conducted. The scientific results obtained in this work can be used to further study the problems of providing comfortable shoes for patients with various foot diseases in with DM; in the preparation and study of nanocomposite materials with antibacterial properties. They can be useful for diabetologists, orthopedists, as well as manufacturers of orthopedic products and shoes.

The Role Of Compensation, Work Environment, And OHS To Increase Employee Productivity PTPN XII Kebun Glantangan Afd. Kali Mayang

The phenomenon at PTPN XII Kebun Glantangan XII Afd. Kali Mayang, namely production is not optimal from these conditions, research is conducted on the role of compensation, work environment, and K3 to increase employee productivity PTPN XII Kebun Glantangan Afd. Kali Mayang. The study aims to analyze the effect of compensation, work environment, and OHS (Occupational Health and Safety) on the work productivity of employees of the rubber tapping section. This type of research is explanatory research with a quantitative approach. Using observation, interview, and questionnaire methods. Using analytical tools validity test, reliability test, multiple linear regression analysis, classical assumption test, T-test, and R2 test. The results showed that compensation and work environment have a positive and significant effect on work productivity and OHS has a positive effect but does not have a significant effect on work productivity, this is because there are still some tapping employees who still do not apply work protection because employees feel that using sandals or ordinary shoes when stepping feels light. It is expected that future researchers to develop and expand other research variables so that the understanding of the factors that affect employee work productivity is even broader.

Grasping at Grace

Grasping at Grace Quincy Gray McMichael (bio) When I open the door of my father's truck, all I smell is hot banana. His Ford stays ripe with carpentry odors—sweat, sawdust—but he always has at least one brown banana on the dash, roasting in the Maine sun. I hold my breath as I scoot into the middle of the bench seat, arranging the belt across my lap, pretending to buckle my nine-year-old frame into the narrow center spot. My little brother Owen, still short and chubby at seven, steps onto the truck's [End Page 33] diamond-plate running board, grasps hold of the armrest, and hauls himself inside. My lungs beg for fresh air. "Dad, can you open the window?" I croak. My father—whom I call Choad, like his friends do—complies, cranking the window open with his left hand while roaring the engine to life with his right. The cassette in the tape deck clicks into gear, flooding the cab with bewitching syncopation, over which Paul Simon sings: "The poor boy changes clothes and puts on aftershave, to compensate for his ordinary shoes." Owen leans over, red-faced and triumphant after his ascent to the favored seat by the window, and yanks the heavy door toward him to latch. Before Simon can mention those diamond-studded soles, Choad is already harmonizing, slipping into an ooo-ooo-ooo falsetto alongside Simon for the chorus. As Choad croons, he buckles his seatbelt and looks over at us, his two unintentionally itinerant children, giving a quick glance to be sure we are belted and ready. He smiles his pumpkin grin and gives a little shake of the shoulders to signal that he is slipping into full vehicular boogie, with his flying fingers making a drum set of the dashboard and his rich voice catching every dip and flip of Simon's lyric rhythm. If the romantic incongruity in this song reminds Choad of my mother—or of that glorious lost monstrosity of a home built with his sweat and her money—he is hiding his pain like a master. I am too young to match the rich girl and the poor boy in Simon's song with the complicated landscape of wealth and want that fractured my own parents' love, and our original family. Instead, I pray for a breeze to cut the thick aroma of banana as I squeeze my knees tight to the right to avoid the gearshift. Choad breaks his percussive rhythm just long enough to nudge the truck into first and we begin to roll. [End Page 34] ____ Graceland is music for the road. Released just a year after my birth, Paul Simon's 1986 album, more than any other, has carried me from place to place. The title song urges the listener to get moving: even before the sincerity of Simon's vocals spill onto the track, the rolling drumbeat doubles as wheels on pavement, conjures the urgent rotation of guardrail spokes spinning past the window. In a recording created for the twenty-fifth anniversary edition of Graceland, Simon acknowledged this, saying: "The drums were something like—kind of a traveling rhythm in country music; I'm a big Sun Records fan, and early-'50s, mid-'50s Sun Records you hear that drum beat a lot, like a fast, Johnny Cash-type of rhythm." Rolling Stone credited Simon with crafting "a finely wrought personal reflection on lost love." Graceland soon became the soundtrack of my life. Paul Simon's songwriting skill is no secret. Rolling Stone ranks him at number eight on their "100 Greatest Songwriters of All Time" list. I would probably inch him up a few notches, given Simon's ability to build the bones of a rich story in such few words while weaving "wit and literary detail" into the seamless telling. As he expressed to Village Voice contributor Robert Christgau: "I'm a relationship writer, relationships and introspection." Nowhere is this more apparent than on Graceland, and in the song "Graceland" itself. In this song, Simon shares from the perspective of an undeniably imperfect, road-worn narrator who hauls his nine-year-old along with him...

Evaluation of the Suprafascial Thin ALT Flap in Foot and Ankle Reconstruction.

Distal lower extremity reconstruction can be challenging in terms of flap design. Bulky flaps result in limited mobility accompanied with the need of customized footwear. Raising the ALT-flap in a superficial fascial plane (thin ALT-flap) can be beneficial. This study evaluates thin ALT-flaps for lower distal extremity reconstruction. In a retrospective study, patients that underwent microvascular extremity reconstruction at the level of the ankle and dorsal foot at the University of Freiburg from 2008-2018 were reviewed. 95 patients could be included in the study (35 perforator flaps, 8 fascia flaps and 54 muscle flaps).Among the perforator flaps, 21 ALT-flaps were elevated conventionally and 14 in the superficial fascial plane (thin ALT-flap). Among the conventional ALT-flaps, there was one flap loss (5%) and one successful revision (5%). 5(24%) flaps received secondary thinning. 57%(n = 12) were able to wear conventional footwear. There were 2(15%) successful revisions of thin ALT-flaps. 100% of thin ALT-flaps survived and 85%(n = 11) of the patients wore ordinary footwear after defect coverage.Among fascial flaps, 50%(n = 4) had to be revised with 2(25%) complete and 1 (13%) partial flap loss. All patients achieved mobility in ordinary shoes (n = 8).In muscle flaps, there were 7(13%) revisions and 5(9%) flap losses. 5(9%) flaps received secondary thinning. Only 33%(n = 18) were mobile in ordinary footwear. The thin ALT-flap is a save one-stage evolution for lower distal extremity reconstruction with a favorable flap survival rate. Compared with conventional ALT-flaps it might be beneficial in reducing the need for expensive custom fitted shoes and secondary thinning procedures.

Functional shoe for the detection of walking pattern anomalies

Analysis of walking patterns can play an important role in the diagnosis of musculoskeletal disorder and detecting anomalies in walking gaits. In this work, we introduce a systematic approach to detect person’s walking patterns. A flexible resistive pressure sensor, developed from electro-conductive textile fabric, is non-intrusively integrated in an ordinary shoe together with a time of flight height sensor. The constructed shoe detects both the pressure between shoe and foot and the gap between shoe and ground. The combination of those give a trace of the walking pattern. The shoe should be functional in detecting walking pattern anomalies.

Surgical Treatment of Severe Deformities of the Toes in Rheumatoid Arthritis

The article presents the case of successful surgical treatment of a female patient with severe deformities of the toes arising from rheumatoid arthritis. After clinical and radiological examination the patient was diagnosed with a hallux valgus deviation of the first toe, with 64 degrees of valgus deviation angle, and a valgus-hammered deformity of the II, III, IV toes with a dislocation of the III and IV toes. There was a violation of the stato-dynamic function of the foot, severe pain. Two techniques of joint-preserving surgical treatment were selected. Correction of deformation of the first toe was carried out according to the author's technology, to correct the deformation of other toes, the Helal technique was used in the author's modification. The result of the treatment was the achievement of correction of the deformation of the first toe and the elimination of the deformation of the second, third, and fourth toes. The patient is satisfied with the outcome, the appearance of the left foot, its function, the ability to walk without pain and wear ordinary shoes. This clinical case of surgical treatment of severe deformities of the toes with rheumatoid arthritis shows the possibility and importance of joint-saving operations to obtain a good cosmetic and functional result. Performing osteotomy of the metatarsal bones in the proposed modifications allows to correct the hallux valgus deviation of the first toe and deformation of the other toes. As a result of using these technologies, it is possible to maintain metatarsophalangeal joints, eliminate dislocations and subluxations, restore joint function, form an arch of the transverse arch of the foot, relieve pain, thereby improving the anatomical and functional state of the entire foot.

Arming shoes of the fifteenth century

AbstractMilitary footwear for the fifteenth century includes arming shoes worn under sabatons. Written sources suggest arming shoes and footwear used for fighting were ordinary shoes adapted for the purpose. Archaeological footwear was examined for signs of such modifications. Medieval shoe technology is presented, showing the range of footwear and its uses and gait biomechanics. Based on experiences from re-enactors wearing armours, medieval shoe styles are discussed for appropriateness as arming shoes. The question of why medieval military footwear shows no purposed development is addressed.

Unstable rocker shoes promote recovery from marathon-induced muscle damage in novice runners.

We recently reported that wearing unstable rocker shoes (Masai Barefoot Technology: MBT) may enhance recovery from marathon race-induced fatigue. However, this earlier study only utilized a questionnaire. In this study, we evaluated MBT utilizing objective physiological measures of recovery from marathon-induced muscle damages. Twenty-five university student novice runners were divided into two groups. After running a full marathon, one group wore MBT shoes (MBT group), and the control group (CON) wore ordinary shoes daily for 1week following the race. We measured maximal isometric joint torque, muscle hardness (real time tissue elastography of the strain ratio) in the lower limb muscles before, immediately after, and 1, 3, and 8days following the marathon. We calculated the magnitude of recovery by observing the difference in each value between the first measurement and the latter measurements. Results showed that isometric torques in knee flexion recovered at the first day after the race in the MBT group while it did not recover even at the eighth day in the CON group. Muscle hardness in the gastrocnemius and vastus lateralis showed enhanced recovery in the MBT group in comparison with the CON group. Also for muscle hardness in the tibialis anterior and biceps femoris, the timing of recovery was delayed in the CON group. In conclusion, wearing MBT shoes enhanced recovery in lower leg and thigh muscles from muscle damage induced by marathon running.

プラスチック短下肢装具の加工修正に伴う力学的特性評価

We research about fabrication and modification of Plastic Ankle-Foot Orthosis (PAFO) which usually prescribed for reducing the aftereffects of the stroke patients. We firstly got a 3D model using a 3D scanner and performed a Finite-Element Analysis (FEA) to the model. Secondly, we got the model with both sides trimming and performed FEA to it. In addition, I compared the shoe horn brace with the Texas shoe horn which was able to get by transforming the same brace. As a result, I found that the Texas Shoe horn had a bigger quantity of displacement than the ordinary shoe horn.

Foot Pressure-Sensor System for Tracking Safety and Health

This paper presents an innovative pressure sensor systemembedded in a sock, which has a number of health care applications. One of these is the low-cost, reliable detection of the bed-departure of Alzheimer’s patients, an increasingly common problem that causes significant stress to caregivers. The system comprises a pressure sensor embedded in a sock and a coin battery-powered microcontroller containing a radiofrequency module. Once the user wanders out of bed and steps onto the floor, the sensor on the sock will immediately detect the pressure caused by his or her body weight and will wirelessly trigger an audible sound in a caregiver’s monitoring unit, which can be a Smartphone, tablet, or dedicated monitor. Furthermore, the pressure sensor and the microcontroller can be combined into one re-attachable unit, which can be stuck conveniently to the ball or heel of the user’s foot or any ordinary sock, slipper or shoe. In addition, the system can function as a highly accurate pedometer that is useful for monitoring the user’s health by tracking changes in his or her gait characteristics. In this study, a prototype sensor sock was developed that included an ultra-thin flexible pressure sensor, microcontroller, Bluetooth low energy module, and control software. The efficacy of the sensor sock in detecting and alerting patients’ wandering has been demonstrated.

Assessment of Appropriate Ankle-Foot Orthoses Models for Patients with Charcot-Marie-Tooth Disease

: The purpose of this study was to demonstrate to what extent ankle-foot orthoses improve posture and gait control in patients with Charcot-Marie-Tooth disease and to identify the most appropriate characteristics of ankle-foot orthoses for patients regarding their clinical characteristics. : Twenty-six Charcot-Marie-Tooth patients were recruited. Clinical data (such as levels of sensory and muscular deficits) and posture and gait capacities were collected in three randomized experimental conditions (wearing ordinary shoes or with plastic and elastic orthoses). Several subgroups of patients, constituted using predictive value analysis, were associated using the probabilities of enhancing posture and gait control while wearing the various models of orthoses. : Compared with ordinary shoes alone, adding plastic ankle-foot orthoses partially improved both gait and posture control, whereas wearing elastic orthoses only partially affected the more dynamic gait control. Furthermore, the choice between the two models can be clarified by taking into account distal lower limb muscle capacity. : Ankle-foot orthosis prescription appears relevant for improving balance and gait performance in Charcot-Marie-Tooth patients, particularly when the model adequately compensates for specific muscle deficits. This study also provides objective arguments for making adequate bracing.

Distally Based Adipofascial Flaps for Dorsal Foot and Ankle Soft Tissue Defects

Soft tissue defects of the dorsal foot and ankle are difficult to reconstruct because the contour of the foot must be maintained for shoe fitting. The adipofascial flap, covered with a skin graft, is a suitable method of reconstruction that fulfills this important requirement. Twelve patients with soft tissue defects of the dorsal foot and at the ankle were treated in our unit with this method. Ten (83%) were children, 2 (17%) were adults. All defects were due to road traffic accidents. Three (25%) patients were women; 9 (75%) were men. The right foot was affected in 10 (83.4%) patients, with 2 (16.6%) patients having the left foot involved. The flaps used were the peroneal artery perforator flap (distally based lateral adipofascial flap) in 9 (75%) patients, the superficial sural artery flap in 2 patients (17%), and the posterior tibial artery perforator flap (distally based medial adipofascial flap) in 1 patient (8%). All flaps were successful, providing adequate contour of the foot for wearing ordinary shoes. There were 2 partial skin graft necroses, and, in 1 patient, the tips of the donor site skin flaps were necrosed. In conclusion, the distally based adipofascial flap, covered with skin graft, is a suitable method for reconstruction of soft tissue loss of the dorsal foot and ankle and provides optimum functional and aesthetic outcome with minimum donor site morbidity.

Evaluation of a Shoe Cushioning System Using Shock Absorber by Biomechanics

This study developed and evaluated a shoe cushioning system to reduce impact force exerted during running. Load-displacement curves for the shoe cushioning system were obtained from an instrumented testing machine and the results were compared with various pockets with air, water or nano-particles. The ground reaction force, force and contact pressure between the shoe and foot were collected from five young male participants, who are trained and untrained person. This study used the three cushioning systems such as ordinary shoe, with pocket containing 5 g nano-particles, with pocket containing 7 g nano-particles. For the trained participant, there was no significant difference in the cushioning performance among Shoes at a low running speed. But at the normal speed, shoes with cushion system were better in the cushioning performance. These results showed that shoes constructed with a shock cushioning system using nano-particles have a better performance for shock absorption. The significant difference was observed at a high running speed according to the composition ratio of water and nano-particles inside the pocket of shoe.

Radial forearm fasciocutaneous free-tissue transfer in ankle and foot reconstruction: review of 17 cases.

Seventeen patients who underwent soft-tissue reconstruction of various anatomic regions of the foot and ankle, using the radial forearm fasciocutaneous free flap, are reported. The procedures were performed between January, 1992 and December, 1998. Indications for reconstruction included diabetes and/or vascular insufficiency (four patients), soft-tissue defects (six patients), and chronic osteomyelitis (seven patients). The weight-bearing surface of the foot was involved in 16 patients. Defects ranged in size from 35 to 206 cm2 (mean: 86.2 cm2). At a mean follow-up of 3.8 years, the radial forearm flap was successful in all cases (100 percent). Flap complications included superficial infection (three patients), and minor wound dehiscence at the flap-leg-skin interface (two patients). Recurrent ulceration occurred in two patients; both were diabetics with weight-bearing flaps. Donor-site complications included partial skin graft loss with tendon exposure in one patient, which healed with conservative management. Recurrent or persistent osteomyelitis was not demonstrated in any of the patients. Of the 16 patients with weight-bearing flaps, 12 were ambulatory, three had limited ambulation, and one was non-ambulatory. Three patients required modified shoes. No debulking of the transferred flaps was necessary. The radial forearm flap is one of the preferred flaps for reconstruction of moderate-sized ankle and foot defects, for weight-bearing surfaces, and in the treatment of osteomyelitic and diabetic wounds. It meets most of the anatomic prerequisites for an ideal foot coverage; it also facilitates the restoration of normal foot contour, allowing patients to wear ordinary shoes. The flap provides a durable and stable weight-bearing plantar surface during ambulation, and achieves excellent aesthetic results; when used as a neurosensory flap, it permits adequate reinnervation.

Use of computerized insole sensor system to evaluate the efficacy of a modified ankle-foot orthosis for redistributing heel pressures

Objective: Evaluation of orthosis purported to decrease pressure on the heel while walking. Design: The Multipodus System is an orthotic device, designed for this purpose, that can be worn with flat or rocker bottom boot. Ten subjects underwent four trials: first, an initial walk wearing their usual shoes, then using the orthosis on the left, with a flat bottom boot, then with a rocker bottom boot, and a final walk. Pressures exerted on the plantar surface of the hindfoot, midfoot, and forefoot were measured electronically and analyzed. Setting and Participants: Ten consecutive normal subjects were tested on a conventional tile floor in a gait laboratory. Results: Peak pressures in the initial walk averaged: heel, 9.6 ± 2.3psi; midfoot, 2.6 ± 1.7psi; and forefoot, 10.3 ± 2.6psi. Pressures on the foot were redistributed significantly when the orthosis was used. Heel pressure was reduced significantly compared to the ordinary shoes using both the flat bottom boot (5.0 ± 1.2psi, a decrease of 48% [ p = .0001]) and the rocker bottom boot (4.5 ± 1.5psi, a decrease of 53% [ p = .0001]). Pressure was increased at the midfoot with both the flat bottom boot (6.6 ± 3.2psi, an increase of 61% [ p = .0001]) and the rocker bottom boot (6.8 ± 2.9psi, an increase of 62% [ p = .0001]). Pressures at the forefoot decreased 19% (8.3psi) with the flat bottom boot and 32% (7.0psi; p = .0003) with the rocker bottom boot. Conclusions: Redistribution of pressure on the foot with orthosis is characterized by reduction at the hindfoot and forefoot and increase at the midfoot with both the flat and rocker bottom boots, thereby promoting healing of calcaneal and forefoot ulcers. The integrity of the midfoot, however, must not be compromised.

Plantar pressure distribution after resection of the metatarsal heads in rheumatoid arthritis.

Surgical correction of the forefoot in rheumatoid arthritis by resection of all metatarsal heads in combination with a resection arthroplasty of the first metatarsophalangeal joint showed excellent and good results in 20 (77%) of 26 cases and satisfactory and fair results in 6 (23%) of 26 cases. Twenty-six feet in 16 patients were operated on by a plantar approach and examined after a mean follow-up period of 50 months (range, 24-90 months). Seventy-three percent of the patients were free of pain. In 75 (58%) of all 130 investigated toes, complete absence of load distribution was noted. In the remaining 55 (42%) toes, we observed a variable extent of function, depending on the length of resection. Although toe function is better in minimal metatarsal resection, single excessive length or plantar spike formation revealed pressure peaks in the metatarsal area. Metatarsal head resection provided reduction of pain and correction of severe deformities, and permitted the patients to wear ordinary shoes in 24 (93%) of 26 cases.

Arthrodesis of the first metatarsophalangeal joint for hallux valgus in rheumatoid arthritis. 1984.

We reviewed the results of reconstruction of the fore part of the foot in rheumatoid patients by arthrodesis of the first metatarsophalangeal joint. The follow-up averaged 4.1 years (range, 2.0 to 7.25 years). Eighteen feet in eleven women were operated on. Twelve feet underwent total reconstruction of the fore part: arthrodesis of the first metatarsophalangeal joint and excision of all of the lesser metatarsophalangeal joints. Six feet underwent subtotal reconstruction, which included arthrodesis of the first metatarsophalangeal joint. The results were classified as excellent in fourteen feet, good in two, and fair in two. There were no poor results. Metatarsophalangeal bone fusion was achieved in all but one foot (fusion rate, 94 per cent). The one fibrous ankylosis was painless, with satisfactory function. Interphalangeal degenerative joint disease was a radiographic but not a clinical sequela. Arthrodesis of the first metatarsophalangeal joint provided stability that permanently corrected deformity, permitted the patients to wear ordinary shoes, and, in combination with excisional arthroplasty of involved lesser metatarsophalangeal joints, relieved disabling pain in the fore part of the foot.

An Effective Shoe for Navicular Disease

Navicular disease is one of the most enigmatic and frustrating entities in horse practice. During the mid-eighties, I was attending a symposium on Navicular Disease at a veterinary meeting in Tennessee when a colleague sitting next to me sketched the shoe illustrated in Figures 1 and 2, and asked me if I had ever tried such a shoe. It looked to me as if the shoe was simply a rolled-toe shoe fitted with elongated caulks to raise the heel and I asked what the advantage would be over ordinary heel caulks, or a tapered shoe with the heels swelled, or an ordinary shoe with a wedge pad under it. He replied that he could not explain why, but that he had consistent success with the shoe. I am grateful to that unknown colleague. During the following year, I used the shoe as a last resort on patients who had failed to respond to conventional therapy (corrective shoeing and systemic medication). All diagnoses, of course, were made based upon clinical history, physical examination, radiographic confirmation, and diagnostic nerve blocking. To my surprise, all patients responded favorably, to a greater or lesser degree. Starting in 1986, I made the shoe my first therapeutic option. In a practice where several diagnoses of navicular disease per month were made, I continued to see consistently favorq'~ ,,.,.i[ Lore

Arthrodesis of the first metatarsophalangeal joint for hallux valgus in rheumatoid arthritis.

We reviewed the results of reconstruction of the fore part of the foot in rheumatoid patients by arthrodesis of the first metatarsophalangeal joint. The follow-up averaged 4.1 years (range, 2.0 to 7.25 years). Eighteen feet in eleven women were operated on. Twelve feet underwent total reconstruction of the fore part: arthrodesis of the first metatarsophalangeal joint and excision of all of the lesser metatarsophalangeal joints. Six feet underwent subtotal reconstruction, which included arthrodesis of the first metatarsophalangeal joint. The results were classified as excellent in fourteen feet, good in two, and fair in two. There were no poor results. Metatarsophalangeal bone fusion was achieved in all but one foot (fusion rate, 94 per cent). The one fibrous ankylosis was painless, with satisfactory function. Interphalangeal degenerative joint disease was a radiographic but not a clinical sequela. Arthrodesis of the first metatarsophalangeal joint provided stability that permanently corrected deformity, permitted the patients to wear ordinary shoes, and, in combination with excisional arthroplasty of involved lesser metatarsophalangeal joints, relieved disabling pain in the fore part of the foot.