Toes In Group Research Articles

Load Transference with the Gain of Excessive Body Mass: A Two-Year Longitudinal Study

Previous studies investigating the effect of excessive weight on the foot have commonly been cross-sectional; therefore, it is still unclear how the foot function gradually changes with the increased body mass that is physiologically gained over time. This study aimed to use a load transfer method to identify the mechanism of how the foot function changed with the increased excessive body mass over two years. Taking normal weight as the baseline, fifteen children became overweight or obese (group 1), and fifteen counterparts maintained normal weight (group 0) over the two years. Barefoot walking was assessed using a Footscan® plate system. A load transfer method was used based upon the relative force–time integral (FTI) to provide an insight into plantar load transference as children increased in weight. Significantly increased FTIs were found at the big toe (BT), medial metatarsal (MM), lateral metatarsal (LM), and lateral heel (HL) in group 1, while at BT, MM, medial heel (HM), and HL in group 0. Foot load showed a posterior to anterior transferal from midfoot (2.5%) and heel (7.0%) to metatarsal and big toe in group 1. The control group, however, shifted the loading within the metatarsal level from LM to HM (4.1%), and equally relieved weight from around the midfoot (MF) (3.0%) to BT, MM, HM and HL. Earlier weight loss intervention is required to prevent further adverse effects on foot functions caused by excessive weight-bearing.

Is metatarsus primus elevatus truly observed in hallux rigidus? Radiographic study using mapping methods

BackgroundHallux rigidus and metatarsus primus elevatus (MPE) are associated, but their causal relationship remains unknown. Several surgical approaches for treating hallux rigidus are available. We evaluated morphological characteristics of hallux rigidus with different grades to determine the optimal surgical approach. The amount of degenerative change in the metatarsophalangeal joint on the preoperative roentgenograms was graded on a scale of 1–3. We analyzed the morphology of hallux rigidus using X-ray image mapping developed by our team. MethodsThis study involved weight-bearing, dorsoplantar, and lateral foot X-rays of 36 feet from 26 patients underwent surgery for hallux rigidus (Group R) at our institution, and 26 normal feet (Group N). A two-dimensional coordinate system was used to analyze the sharps of these feet by converting each dot on the radiographs into X and Y coordinates. Diagrams of the feet from each group were drawn for comparison. Feet with grades 2 (Group R2) and 3 (Group R3) hallux rigidus and normal feet were compared by Kruskal–Wallis test. ResultsMapping revealed that the tip of distal phalanges of the second, and third toes in Group R medially shifted (P < 0.05) in dorsoplantar image of the feet, and that the medial point, a part of the talus, navicular, cuneiform, and first metatarsal bone in Group R, shifted lower (P < 0.05) in lateral feet images of the feet. Multiple comparisons revealed a significant navicular bone depression in grade 3 hallux rigidus compared with normal feet. A significant difference was observed between Group N and R3 but not between Group R2 and N or R3. ConclusionsX-ray morphological analysis of the foot revealed MPE in Group R. Elevation gradually increased as hallux rigidus grade worsened. Therefore, osteotomy combined with cheilectomy, whereby the first metatarsal bone can be tilted toward the plantar side, are useful for treating a higher-grade hallux rigidus. Level of evidenceLevel III, comparative study.

Why do lesser toes deviate laterally in hallux valgus? A radiographic study.

Hallux valgus foot with laterally deviated lesser toes is a complex condition to treat. Ignoring the laterally deviated lesser toes in hallux valgus might result in unsatisfactory foot shape. Without lateral support of the lesser toes, it might increase the risk of recurrence of hallux valgus. We sought to identify associated radiographic findings in patients where lesser toes follow the great toe in hallux valgus and deviate laterally. The weight-bearing, anteroposterior foot radiographs of 24 female hallux valgus feet with laterally deviated lesser toes (group L), 34 female hallux valgus feet with normal lesser toes (group H), and 43 normal female feet (group N) were selected for the study. A 2-dimensional coordinated system was used to analyze the shapes and angles of these feet by converting each dot made on the radiographs onto X and Y coordinates. Diagrams of the feet in each group were drawn for comparison. The hallux valgus angle, lateral deviation angle of the second toe, intermetatarsal angles, toe length, metatarsal length, and metatarsus adductus were calculated according to the coordinates of the corresponding points. The mapping showed the bases of the second, third, and fourth toe in group L shifted laterally away from their corresponding metatarsal head (P < .001). The mean 2-3 intermetatarsal angles were: group L, H, N = 7.7 ± 2.6, 4.3 ± 1.9, 4.3 ± 1.3 degrees, respectively (P < .001); mean 3-4 intermetatarsal angles were, for groups L, H, N = 7.3 ± 2.3, 6.1 ± 2.1, 6.3 ± 1.4 degrees, respectively (P < .05). Larger hallux valgus angles (P < .001), more adducted first metatarsal (P < .05), and divergent lateral splaying of the lesser metatarsals (P < .001) were found in group L. Larger 2-3 and 3-4 intermetatarsal angles, larger hallux valgus angle, more adducted first metatarsal, and divergent lateral splaying of the lesser metatarsals were associated with lateral deviation of the lesser toes in hallux valgus. Level III, comparative study.

Assessment of Pulse Oximeter Perfusion Index in Pediatric Caudal Block under Basal Ketamine Anesthesia

Whether pulse oximeter perfusion index (PI) may be applied to detect the onset of caudal block in pediatric patients under ketamine intravenous basal anesthesia is investigated. 40 ASA I, 2–8-year-old boys scheduled for elective circumcision surgery were randomized into two groups. Group I: 20 patients were anesthetized by 2 mg·kg−1 ketamine intravenous injection (IV) followed by caudal block using 1 mL·kg−1 lidocaine (1%); Group II: 20 patients were anesthetized by 2 mg·kg−1 ketamine IV only. PI on the toe in Group II decreased by 33 ± 12%, 71 ± 9% and 65 ± 8% at 1 min, 15 min, and 30 min after ketamine injection. The maximum increase in MAP and HR after ketamine IV was 11 ± 6% at 3 min and 10 ± 6% at 2 min. Compared to the PI value before caudal injection of lidocaine, PI in Group I increased by 363 ± 318% and 778 ± 578% at 5 min and 20 min after caudal block, while no significant changes in MAP and HR were found compared to the baseline before caudal block. Thus, PI provides an earlier, more objective, and more sensitive indicator to assess the early onset of caudal block under basal ketamine anesthesia.