Rare Foot Research Articles

Our employees in traditional and environmentally friendly logging: characteristics of forestry workhorses in Hungary

ABSTRACT Horse logging has many advantages over forestry machines, but it is less efficient, mainly depending on the breed and size of the horse. After reviewing the literature on the state and breeds of horses used for timber harvesting in Europe, we recorded the sex, age, height at withers (where the neck meets the back), girth size and shank circumference of the workhorses in the Hungarian state forests. Most loggers (37%) used crossbreeds of warm-blooded and cold-blooded horses, because of their pace, smaller size and easier maneuverability. Twenty-nine percent of the loggers used the Muraközi type, 14% the French cold-blooded (Percheron), and 11% the Hungarian cold-blooded. The reason for using cold-blooded types was their capacity, calmness, resistance and rare foot injuries. The disadvantages of the crossbreds were their speed and lighter size. Comparing the size of the horses assessed in the field with the literature data on the breeds, it is not possible to draw clear conclusions as to which breed would be more suitable for forestry work. Most (59%) of the horses used for logging are geldings, as they are reported to be easier to work with. Forestry use could play an important role in maintaining the population of the protected indigenous horse breeds, both Hungarian cold-blooded and Muraközi.

Rare foot metastasis from breast cancer: A case report and diagnostic challenges

Rare foot metastasis from breast cancer: A case report and diagnostic challenges

Results of treatment of congenital vertical talus by the Dobbs method

Congenital vertical talus is a rare foot deformity. The hindfoot is valgus and equinus, the midfoot is dorsiflexed and forefoot is abducted due to a fixed dorsal dislocation of the navicular on the head of the talus and the cuboid on the anterior part of the calcaneus. The epidemiology and etiology of vertical talus is unknown. Dobbs et al. (J Bone Joint Surg Am 88(6):1192–200, 2006) described a minimally invasive alternative which allowed to avoid the need for extensive soft tissue release procedures in treatment of congenital vertical talus. Eleven congenital vertical talus feet (group 5 according to Hamanishi) in eight children (four boys and four girls) constituted the study material. Upon the diagnosis, the patients’ age ranged from 5 to 26 months old (the mean – 14.6). The treatment involved serial manipulation and casting according to the reverse Ponseti method (from 4 to 7 casts) followed by a minimally invasive approach consisting in temporary stabilization of the talonavicular joint with the use of K-wire and Achilles tenotomy according to the Dobbs technique. Then patients continued the shoe and bar program for 2 years. The X-ray measurements on lateral radiographic included the talocalcaneal angle, tibiotalar angle and talar axis—first metatarsal base angle whereas AP radiographic images—the talocalcaneal angle and talar axis—first metatarsal angle. The Wilcoxon test was used to compare dependent variables. The final clinical assessment made during the last follow-up (the mean: 35.8 months, the range: 25–52) revealed that neutral position of the foot and normal range of motion were observed in ten cases and recurrence of foot deformity in one case. The last X-ray examination showed normalization all of radiological parameters, except for one case, and examined parameters were statistically significant. The minimally invasive technique described by Dobbs should be the first option in treatment of congenital vertical talus. It allows to reduce the talonavicular joint, brings good results and preserves foot mobility. The attention should be put on early diagnosis.

Understanding congenital vertical talus

Congenital vertical talus (CVT) is a rare foot deformity that presents with a rigid flat foot at birth. CVT can present as an isolated abnormality in the newborn, however in at least 50% of cases in association with other conditions. Full neuro-axial imaging is essential to detect any associated neurologic problems. Radiographs of the foot, including forced plantar and dorsiflexion laterals, are diagnostic. Gold standard modern treatment uses the Dobbs method of serial manipulation and casting with minimally-invasive stabilization of the talonavicular joint and Achilles tendon tenotomy.

Diagnostic yield of exome sequencing in congenital vertical talus

BackgroundCongenital vertical talus (CVT), also known as “rocker-bottom foot”, is a rare foot deformity associated with a dislocation of the talonavicular joint. Although genetic causes of CVT have been described in single isolated and syndromic families, whole-exome sequencing (WES) of large cohorts have not yet been reported. MethodsIn this study, 62 probands with CVT were evaluated for likely causative single nucleotide variants (SNVs) and copy number variants (CNVs) using WES. Segregation of variants within families was determined by Sanger sequencing. ResultsIn this cohort, CVT occurred as an isolated anomaly in 75.8% (47/62) and was familial in 19.3% (12/62) of cases. Analysis of WES data led to the identification of likely causative variants in known disease genes in 30.6% (19/62) of all CVT probands. More than one proband had likely causative SNVs in TSHZ1, GDF5, and LMX1B. Only two probands had likely causative CNVs: a chromosome 12q13.13 deletion of the 5’ HOXC gene cluster, and a chromosome 18q22.3q23 deletion involving TSHZ1. Familial CVT was strongly predictive of identifying a molecular diagnosis [75% (9/12) of familial cases compared to 20% (10/50) of non-familial cases (Chi-square test, P-value = 0.0002)]. There was no difference in the solved rate based on isolated or syndromic presentation, unilateral or bilateral affectation, or sex. ConclusionsCVT is genetically heterogeneous and more often caused by SNVs than CNVs. There is a high yield of WES in familial CVT cases (∼75%). Additional research is needed to identify the causes of sporadic CVT, which had much lower solved rates.

Efficacy of Triple and Talonavicular Arthrodesis for the Treatment of III-V Müller-Weiss Disease.

Müller-Weiss Disease (MWD) is a rare foot disease with unclear etiology but frequently occurred in women. Due to the resistance to conservative treatment, surgical therapy has gradually occupied a necessary position in the clinical management of MWD. Joint fusion surgery is a commonly used treatment for MWD, which could effectively alleviate pain, correct deformation, and restore function. A total of 12 MWD patients (III-V stage) were enrolled in this study. All patients showed no significant improvement in conservative treatment and further received the triple and talonavicular arthrodesis. All patients were followed up with an average follow-up of 16.8 ± 1.19 months (mean ± SD). The triple and talonavicular arthrodesis significantly ameliorated the pain and walking dysfunction in the affected foot. The American Orthopedic Foot Andankle Society (AOFAS) scores dramatically increased from 43.4 ± 16.1 to 85.3 ± 6.2. Meanwhile, the conducting of triple and talonavicular arthrodesis improved the X-ray length (15.5 ± 0.8 vs. 14.3 ± 0.9 cm) and arch height (18.6 ± 0.9 vs. 10.2 ± 0.7 mm) and reduced the Meary-Tomeno angle (1.3 ± 2.5 vs. 2.14 ± 4.8°). The triple and talonavicular arthrodesis achieved a satisfying therapeutic effect on MWD patients at the III-V stage, which improved patients' outcomes and the quality of life.

Traumatic foot drop due to tibialis anterior and extensor hallucis longus tendon rupture: A rare case report

The authors present a rare case report from the time when India was struggling with a huge surge in corona cases and the mortality due to it was touching new peaks day by day. Not only the oxygen, ventilators and ICU beds but also cremation sites were overwhelmed by masses of COVID deaths. We report a rare case of a 30 year old male woodcutter in cremation ground, whose axe accidently slipped while cutting woods and injured his leg. Wound exploration and clinical examination confirmed our diagnosis foot drop due to traumatic rupture of anterior compartment muscle & tendons and radiograph confirming unicortical fracture of the tibia. Patient was taken to emergency OT and operated under spinal anesthesia and tendons repaired using modified Kessler technique. Traumatic rupture of the tibialis anterior (TA) tendon represents a very rare foot injury. A combined injury of the tibialis anterior (TA) and the extensor hallucis longus (EHL) tendons has hardly been reported. The rarity of this case prompted us to report it.

A Very Rare Diabetic Foot Co-infection Due to Escherichia hermannii and Enterobacter aerogenes in an Elderly Patient

A Very Rare Diabetic Foot Co-infection Due to Escherichia hermannii and Enterobacter aerogenes in an Elderly Patient

Results of External Fixation and Metatarsophalangeal Joint Fixation With K-Wire in Brachymetatarsia.

Brachymetatarsia is a rare foot deformity caused by the premature closure of the metatarsal physis. It may result in functional as well as cosmetic alterations, which may require operative management. A prospective study examining outcomes of 48 cases of brachymetatarsia with gradual bone lengthening at a rate of 1 mm/d using an external fixator and metatarsophalangeal joint fixation was performed. The difference between the length before treatment and after external fixator removal was measured. The patients were assessed at 2, 4, 6, and 8 weeks postoperatively; at the end of the period of distraction; and 1 year after surgery. The total number of patients was 26, and surgery was performed in 48 metatarsals. The mean age was 17.0 ± 4.1 (range, 11-24) years, and all were female. The fourth metatarsal was the most frequently affected, representing 98% of the cases; the third metatarsal represented the other 2%. The average length gained was 18.6 ± 6.7 mm, and the average length gained as a proportion of the original metatarsal length was 38.2% ± 3.1% (range, 13%-24%). The mean healing time was 71.0 (range, 64-104) days, and the mean healing index (healing time divided by centimeters of length gained [d/cm]) was 38.4 (range, 38.2-50.1) d/cm. Gradual bone lengthening at a rate of 1 mm/d using an external fixator and intramedullary nailing was a safe and efficient method, representing a minimally invasive procedure with a low incidence of complications and satisfactory results for the patient. Level IV, retrospective case series.

Treatment for displaced sustentaculum tali fractures

BackgroundSustentaculum tali fractures are rare foot fractures accounting for 1% of all calcaneal fractures, which accounts for about 1–2% of all bone fractures. Since the importance of sustentaculum tali in maintaining the medial foot arch, its fractures should be dealt with anatomical fixation to avoid post-traumatic arthrosis. ObjectiveIs to delineate the importance of sustentacular tali fractures fixation mentioning operative technique and the post-operative outcome. MethodologyTen cases with 10 consequent closed sustentaculum tali fractures were treated by ORIF. Nine of them were male gender. Patient’s age was 27.6 (ranged 22–40). Of those 10 cases, 7 were isolated sustentaculum tali fractures, while 3 cases were associated by other fractures. All patients were followed-up with a follow-up period 52.8 months (ranged 24–84m). ResultsAll fractures were united with a union rate 100%. Union appeared radiologically between 6–8 weeks post-operatively with an average 6.8 weeks. Isolated sustentacular fractures achieved post-operative 100 score while in the case with fractured talar neck, patient had a score 80, associated distal fibular fracture achieved 90 score, overall average score was 97 ranged 80–100. There was no recorded complication regarding to the operative maneuver. ConclusionFractures of the sustentaculum tali are rare injuries associated with high energy mechanisms. These fractures have a high incidence of misdiagnosis. A high index of suspicion is, therefore, required when there is pain and hematoma directly over the sustentaculum tali. Open reduction and internal fixation of these fractures is reliable and possible through a medial approach.

IATROGENIC HALLUX VARUS: CAUSES OF DEFORMITY AND POSSIBILITIES OF PERCUTANEOUS SURGICAL CORRECTION (RETROSPECTIVE ANALYSIS OF CASE REPORTS)

Introduction. Hallux varus is a relatively rare foot deformity. Commonly, hallux varus is a complication after the hallux valgus surgery and typically is the result of the first metatarsal medial eminence over resection, first and second metatarsal excessive convergence, over release of the lateral soft tissues, overtightening of the medial soft tissues and soft tissue imbalance of the first metatarsophalangeal joint.The purpose of this study was to clarify the causes and timing of the iatrogenic hallux varus formation and to evaluate the possibility and efficiency of percutaneous techniques in its surgical treatment.Material and methods. Thirty-one feet (31 females suffering from iatrogenic hallux varus) were examined clinically and radiologically, including 14 patients who underwent surgery. The average age of the whole group was 57 years (range, 39 to 74), the subgroup of operated patients — 60 years (range from 53 to 68). The time after primary interventions before the examination varied from 2 to 44 years. The mean follow-up after surgery was 6 months (range from 1.5 to 54).Results. No infection or wound-healing issues were observed. Overall, the patients were completely satisfied with the outcomes of 12 surgeries and satisfied with reservation in 2 cases.Conclusions. The visual manifestations of hallux varus are determined not only by the hallux varus angle, but also by the value of the first intermetatarsal angle. In addition to well-known factors, hallux varus formation is determined by first metatarsal bone elongation and first metatarsophalangeal joint instability. In rare cases, only one of the factors leads to the hallux varus; as a rule, we see a combination of factors with their mutual reinforcement. Despite the demonstration of usage possibility and the efficiency of percutaneous techniques in hallux varus correcting, a small number of observations in the study does not yet allow giving recommendations on the use of specific percutaneous techniques depending on the various clinical manifestations of hallux varus.

Prenatal congenital vertical talus (rocker bottom foot): a marker for multisystem anomalies.

Congenital vertical talus is a rare foot anomaly characterized by a prominent calcaneus and rigid forefoot dorsiflexion. While congenital vertical talus has been associated with anomalies such as trisomy 18, myelomeningocele and arthrogryposis, postnatal series have reported cases of isolated congenital vertical talus. The purpose of our study was to determine the incidence of isolated congenital vertical talus prenatally and identify the most common anomalies associated with this finding. A retrospective review was performed of congenital vertical talus cases identified in our fetal center from 2006 to 2015. The prenatal US and MR imaging appearance of congenital vertical talus was evaluated and differentiation from congenital talipes equinovarus was assessed. Studies were evaluated for additional abnormalities affecting the central nervous system, face, limbs, viscera, growth and amniotic fluid. Imaging findings were recorded and correlated with outcomes when available. Twenty-four cases of congenital vertical talus were identified prenatally (gestational age: 19-36weeks). All 24 had prenatal US and 21 also underwent fetal MRI on the same day. There were no isolated cases of congenital vertical talus in this series; all 24 had additional anomalies identified prenatally. Sixteen cases had bilateral congenital vertical talus (67%). Additional anomalies were identified in the brain (15), spine (11), face (6), abdominal wall (3), heart (8) and other limbs (12). Chromosomal abnormalities were identified in 6 of 20 patients who underwent genetic testing. Overall, US held some advantage in detecting the abnormality: in 10 cases, US depicted congenital vertical talus more clearly than MRI; in 8 cases, US and MRI were equal in detection and in 3 cases, MRI was superior. In 9/15 cases with intracranial abnormalities, MRI was superior to US in demonstrating structural anomalies. Outcomes included termination (11), intrauterine fetal demise (1), stillbirth or immediate neonatal demise (5), lost to follow-up (1), and 6 survivors with postnatal follow-up. In our series, there were no cases of isolated congenital vertical talus, with additional anomalies variably affecting multiple systems including the brain, spine, face, viscera and limbs. When congenital vertical talus is identified prenatally, a thorough search for additional anomalies is indicated. Fetal MRI can be a useful adjunct in confirming the diagnosis and further delineating additional anomalies, particularly in the brain and spine.

Diabetic osteoarthropathy care in Sweden – Need for improvement: A national inventory

AimsOsteoarthropathy, a rare foot complication in patients with diabetes mellitus, calls for immediate and optimal management to prevent irreversible bone/joint destruction and risk of amputation. Awareness of the condition and adequate guidelines would minimize the consequences and the costs, both for the patient and for the society. We investigated the diabetic osteoarthropathy care in Swedish orthopedic clinics. MethodsA questionnaire was distributed to 63 Swedish hospitals with emergency department for orthopedic patients. There was a 95% response rate. ResultsMost of the respondents (79%) specified absence of established procedures including guidelines for managing patients with osteoarthropathy. The most common diagnostic method was clinical diagnosis and plain X-ray (95%). MRI or scintigraphy was used by 19% and 10.5% respectively. As treatment method, 84% used a total contact cast, while 38% used orthoses. Treatment duration <3months was reported in 4%, 3–6months in 53% and 6–12months in 28% of the clinics. Four clinics reported treatment duration >12months and two clinics provided no treatment. ConclusionOur national inventory indicates a need for improvement in knowledge as well as guidance and organization at orthopedic clinics regarding optimal care of patients with diabetic osteoarthropathy.

Physician knowledge of a rare foot condition \u2013 influence of diabetic patient population on self-described knowledge and treatment

BackgroundCharcot neuroarthopathy (CN), a rare foot and ankle condition usually complicating diabetes mellitus, leads to deformity, poor quality of life, and increased mortality and morbidity. The prevalence of this condition in the diabetic patient population is not currently known but has been reportedly misdiagnosed in up to 95% of cases.MethodsWe sought to evaluate general knowledge regarding CN in non-foot specialist clinical faculty at a large academic institution and to understand their practice habits. Our survey emphasizes the necessity of better education surrounding CN to improve outcomes in a preventative fashion. This will enable us to determine how to focus educational forums surrounding this topic in the future.ResultsSeven hundred eighty-nine faculty members were sent the survey while 400 completed the survey for a response rate of 50.7%. The respondents were representative of academic rank at the institution and were comprised of endocrinologists, internal medicine physicians and family medicine physicians. We found that 67.6% of responders had a self-described poor or complete lack of knowledge of this condition. Clinicians with self-described better knowledge of CN were more likely to provide a correct initial management of CN (p < 0.001; r = 0.3639).ConclusionsIn this large tertiary institution, a majority of providers among internal medicine, endocrinologists, and family medicine physicians demonstrated minimal or no knowledge of this rare, but potentially devastating diabetes complication. However, those providers who are knowledgeable of CN, performed better in the initial management of this condition. Also, respondents who treated more diabetic patients demonstrated an association with correct management. Education, and the development of better understanding amongst clinicians, is crucial to limit the devastating effects of this condition in the future.

Functional outcome after early mobilization in isolated subtalar dislocation: Case report and review of current evidence

Isolated subtalar dislocation (SD) is an exceptionally rare foot injury. Prompt gentle reduction, injury severity, and duration of postreduction immobilization are prognostic determinants of functional outcome. Consensus has eluded the orthopedic community regarding optimal duration of immobilization and weight-bearing protocol, following successful reduction of SDs. This case report highlights the functional outcome following early postreduction immobilization and weight-bearing in isolated SD and reviews the current evidence.

Sagittal cut injury of the foot at workplace – A rare injury pattern and its management

Extremity injuries to employees in an industrial setting are not an uncommon event in today's mechanised workspace. Cut injuries of the foot during handling of machines are common in the workplace and the management of such injuries depends upon various factors at the time of presentation. This case report describes a rare foot injury which has not previously been reported in the literature and describes its subsequent successful management.

Congenital Vertical Talus: Etiology and Management.

Congenital vertical talus is a rare foot deformity. If left untreated, it causes significant disability, including pain and functional limitations. Although the etiology of vertical talus is likely heterogeneous, recent evidence strongly supports a genetic cause linking it to genes expressed during early limb development. Traditional management for vertical talus involves extensive surgeries that are associated with significant short- and long-term complications. A minimally invasive approach that relies on serial manipulation and casting to achieve most of the correction has been shown to produce excellent short-term results with regard to clinical and radiographic correction in both isolated and nonisolated cases of vertical talus. Although long-term studies are needed, achieving correction without extensive surgery may lead to more flexible and functional feet, much as Ponseti method has done for clubfeet.

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Brachymetatarsia is a rare foot disease, defined as the abnormal shortening of the metatarsal bone. It has a 0.02-0.05% incidence and is predominantly in females, with a 25:1 ratio compared to males. There are 3 types: congenital, idiopathic and associated with acquired disorders, being congenital the most common type. The current surgical options available are progressive osseous lengthening with external fixator and osteotomies with acute lengthening, each of them have advantages and disadvantages that should be taken into consideration when choosing one over the other. The following article is a short review of the illness and the report of two cases successfully treated with progressive osseous lengthening with external fixation.

Correlation of foot posture index with plantar pressure and radiographic measurements in pediatric flatfoot.

ObjectiveTo investigate the correlation between the Foot Posture Index (FPI) (including talar head palpation, curvature at the lateral malleoli, inversion/eversion of the calcaneus, talonavicular bulging, congruence of the medical longitudinal arch, and abduction/adduction of the forefoot on the rare foot), plantar pressure distribution, and pediatric flatfoot radiographic findings.MethodsNineteen children with flatfoot (age, 9.32±2.67 years) were included as the study group. Eight segments of plantar pressure were measured with the GaitView platform pressure pad and the FPI was measured in children. The four angles were measured on foot radiographs. We analyzed the correlation between the FPI, plantar pressure characteristics, and the radiographic angles in children with flatfoot.ResultsThe ratio of hallux segment pressure and the second through fifth toe segment pressure was correlated with the FPI (r=0.385, p=0.017). The FPI was correlated with the lateral talo-first metatarsal angle (r=0.422, p=0.008) and calcaneal pitch (r=-0.411, p=0.01).ConclusionOur results show a correlation between the FPI and plantar pressure. The FPI and pediatric flatfoot radiography are useful tools to evaluate pediatric flatfoot.

Perioperative management of diabetic foot.

Perioperative management of diabetic foot.