Plantar plate tears: a review of the modified flexor tendon transfer repair for stabilization

Forefoot pain is one of the most common presenting problems in a foot and ankle practice. One of the most common presenting problems, yet most commonly missed problems, is a plantar plate tear. Often the problem is considered to be potential neuroma, fat pad atrophy, or a generalized diagnosis of metatarsalgia or metatarsal head overload. Unfortunately, not enough attention is placed on the plantar and medial/lateral ligamentous structures of the metatarsal-phalangeal joints. This lack of attention results in poor diagnosis, lack of care, treatment for the wrong condition, and ultimate frustration for the patients and doctor.     

正常足与(*母)外翻足跖骨头下压力与足部负重比例变化的关系

目的 :从生物力学角度探讨外翻足前足横弓跖骨头下压力的改变情况。方法 :运用本所生物力学室研制的足底压力测试系统 ,对正常足与外翻足足底压力进行测试 ,并将结果进行统计分析。结果 :随着足部负重比例的增加 ,外翻足前足中间跖骨头下压力的变化较快 ,与正常足相比具有显著差异。结论 :从生物力学角度证明 ,正常足前足具有横弓结构 ,外翻足前足存在横弓塌陷。     

Longer operative time is the risk for delayed wound healing after forefoot surgery in patients with rheumatoid arthritis

Objectives. Forefoot deformities are common in patients with rheumatoid arthritis (RA) and often require operative treatment. There is a high rate of delayed wound healing after foot surgery, especially among patients with RA. The aim of this study was to identify risk factors of delayed wound healing in RA patients who had undergone forefoot surgery.

Methods. This study was a retrospective observational study designed to analyze the outcomes of all consecutive RA patients who had undergone toe arthroplasty from April 2010 through May 2014 at a single institute. Putative risk factors for delayed wound healing were assessed using univariate logistic regression analysis. Variables with α = 0.1 were then subjected to stepwise multivariate logistic regression analysis.

Results. A total of 192 RA patients (192 feet) were included in this study. Delayed wound healing was seen in 40 feet (40/192 [20.8%]). A stepwise multivariate logistic regression analysis revealed that longer operative time was the risk factor associated with delayed wound healing in RA patients undergoing forefoot surgery (p = 0.028, odds ratio = 1.19 [per 10 min], 95% confidence interval [CI]: 1.07–1.32).

Conclusions. This finding emphasizes the importance of preventing operative complications during forefoot surgery.     

Tubercular osteomyelitis of the first metatarsal bone as a cause of forefoot pain

The reporting of isolated metatarsal tuberculosis in the available literature is sparse, herein we report a case of 26-year-old female who presented with insidious onset pain and swelling in her forefoot. Radiograph showed osteolysis of the first metatarsal. Magnetic resonance imaging showed osseous erosion with marrow oedema. Diagnosis was ascertained by fine needle aspiration cytology of the lesion. The patient received anti-tubercular therapy and showed good clinical outcome. This case is reported because of its rarity of involving isolated metatarsal bone as a cause of forefoot pain.     

Clinical and radiographic outcomes of the Kramer osteotomy in the treatment of bunionette deformity

Background

Bunionette deformity is a painful bony prominence of the 5th metatarsal. We evaluated outcomes of using a Kramer osteotomy to treat this condition.

Scarf osteotomy without internal fixation for correction of hallux valgus: A clinical and radiographic review of 148 cases

Background

Hallux valgus is a common condition with in excess of 120 procedures described in the literature for its correction. Traditionally, distal metatarsal osteotomies have been employed in the treatment of mild deformities, with proximal osteotomies being reserved for more severe presentations. The Scarf osteotomy without internal fixation allows large translations which can successfully correct severe hallux valgus deformities, without limitations related to screw placement.

Rheumatoid nodule presenting as Morton’s neuroma

Among 101 feet that presented with symptoms and signs similar to Morton’s neuroma, intermetatarsal rheumatoid nodules were found in five feet (three patients). Two patients had bilateral involvement. Histology of the excised tissue showed the presence of a rheumatoid nodule and Morton’s neuroma in four feet and a rheumatoid nodule with unremarkable nerve bundles in one. A rheumatoid nodule can coexist with Morton’s neuroma, as seen in our patients, and the presentation is often similar to that of a Morton’s neuroma. Our patients were rendered asymptomatic with surgical treatment and went on to have appropriate management of rheumatoid arthritis. Rheumatoid nodule should be considered in the differential diagnosis of Morton’s neuroma in not only rheumatoid arthritis patients but also asymptomatic patients who have never been tested for rheumatoid antibodies.     

Effects of rocker radii with two longitudinal bending stiffnesses on plantar pressure distribution in the forefoot

IntroductionOutsole parameters of the shoe can be adapted to offload regions of pain or region of high pressures. Previous studies already showed reduced plantar pressures in the forefoot due to a proximally placed apex position and higher longitudinal bending stiffness (LBS). The aim of this study was to determine the effect of changes in rocker radii and high LBS on the plantar pressure profile during gait.Method10 participants walked in seven shoe conditions of which one control shoe and six rocker shoes with small, medium and large rocker radii and low and high longitudinal bending stiffness. Pedar in-shoe plantar pressure measuring system was used to quantify plantar pressures while walking on a treadmill at self-selected walking speed. Peak plantar pressure, maximum mean pressure and force-time integral were analyzed with Generalized Estimated Equation (GEE) and Tukey post hoc correction (α = .05).ResultsSignificantly lower plantar pressures were found in the first toe, toes 2–5, distal and proximal forefoot in all rocker shoe conditions as compared to the control shoe. Plantar pressures in the first toe and toes 2–5 were significantly lower in the small radius compared to medium and large radii. For the distal forefoot both small and medium radii significantly reduced plantar pressure compared to large radii. Low LBS reduced plantar pressure at the first toe significantly compared to high LBS independent of the rocker radius. Plantar pressures in the distal forefoot and toes 2–5 were lower in high LBS compared to low LBS.ConclusionManipulation of the rocker radius and LBS can effectively reduce peak plantar pressures in the forefoot region during gait. In line with previous studies, we showed that depending on the exact target location for offloading, different combinations of rocker radius and LBS need to be adopted to maximize treatment effects.     

Does running speed affect the response of joint level mechanics in non-rearfoot strike runners to footwear of varying longitudinal bending stiffness?

BackgroundModifying the longitudinal bending stiffness (LBS) of footwear has become a popular method to improve sport performance. It has been demonstrated to influence running economy by altering lower extremity joint level mechanics. Previous studies have only examined within-participant effects at one running speed.Research questionDo joint level mechanics differ in response to varying footwear LBS at a range of running speeds?MethodsThis study utilized a cross-sectional repeated measure study design using a convenience sample. Ten well trained non-rearfoot strike male distance runners ran at 3.89, 4.70, and 5.56 m/s (14, 17, 20 km/hr) in footwear of three different LBS levels. Mechanics and energetics of the metatarsophalangeal joint (MTPJ), ankle, knee, and hip joints during stance phase were assessed using an 8-camera optical motion capture system (f_s = 200 Hz), a force instrumented treadmill (f_s = 1000 Hz) and standard inverse dynamics theory.ResultsRange of motion and negative work decreased and angular stiffness increased for the MTPJ with increasing LBS at all speeds (p < .001). Peak MTPJ moment did not change at any speed in response to increased LBS. Negative work at the ankle decreased in the stiff shoe at 17 km/hr (p = .036). Peak ankle plantar flexion velocity decreased with increasing LBS at all speeds (p < .05).SignificanceWhile changes in MTPJ mechanics were consistent across speeds, decreased negative ankle work was only observed at 17 km/hr in the stiff shoe, suggesting that perhaps tuned footwear LBS may need to focus primarily on metabolically beneficial changes in ankle plantar flexor mechanical behavior to improve performance in distance runners. Tuning footwear stiffness may also be beneficial to clinical populations, as clinicians seek to optimize their patients’ locomotion economy.     

Halving the usage of rigid-soled postoperative shoes does not affect outcomes in forefoot reconstruction surgery

BackgroundPostoperative shoes are commonly used after forefoot surgery. This study’s aim was to demonstrate that reducing rigid-soled shoe time to 3 weeks neither compromises functional outcomes nor does it produce complications.MethodsProspective cohort study: 6 weeks versus 3 weeks of rigid postoperative shoe (100 and 96 patients respectively), after forefoot surgery with stable osteotomies. Manchester-Oxford Foot Questionnaire (MOXFQ) and pain Visual Analog Scale (VAS) were studied preoperative and one year postoperative. Radiological angles were also assessed after removing the rigid shoe and at 6 months.ResultsThe MOXFQ index and pain VAS depicted similar results in each group (group A: 29.8 and 25.7; group B: 32.7 and 23.7) with no differences between them (p = .43 Vs. p = .58). Moreover, no differences were reported in their differential angles (HV differential-angle p = .44, IM differential-angle p = .18) or in their complication rate.ConclusionIn forefoot surgery with stable osteotomies, shortening the postoperative shoe time to 3 weeks, neither impairs clinical results nor the initial correction angle.