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Kobayashi T, Hirota K, Otsuki R, Onodera J, Kodesho T, Taniguchi K. Morphological and mechanical characteristics of the intrinsic and extrinsic foot muscles under loading in individuals with flat feet. Gait Posture 2024; 108:15-21. [PMID: 37976604 DOI: 10.1016/j.gaitpost.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 10/04/2023] [Accepted: 11/01/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND The intrinsic and extrinsic foot softtissue structures that apply force and support the medial longitudinal arch (MLA) have been implicated in the development of flat feet. However, the relationship between the changes in MLA height under increasing load and the morphological and mechanical properties of individual intrinsic and extrinsic foot soft tissue structures is not fully understood. RESEARCH QUESTION To examine the morphological and mechanical characteristics of the foot soft tissue structures in flat feet when subjected to loading. METHODS This study consisted of two studies focusing on the extrinsic foot muscles (10 normal feet/11 flat feet) and intrinsic foot muscles (14 normal feet/13 flat feet). Images of the extrinsic and intrinsic foot muscles and plantar fascia (PF) under 10%, 50%, and 90% body weight conditions were obtained using ultrasound-based shear-wave elastography. RESULTS The cross-sectional area (CSA) of the peroneus brevis was larger in the flat-foot group than in the normal-foot group under all loading conditions. The CSAs of the intrinsic foot muscles (abductor hallucis, flexor digitorum brevis, and quadratus plantae) and thickness of the PF in the flat-foot group decreased significantly with increasing load. As for mechanical characteristics, the stiffness of the flexor digitorum longus and abductor hallucis was higher in the flat-foot group than in the normal group under high loading conditions. In addition, flat feet with greater flexibility tended to exhibit a greater decrease in PF thickness and smaller increase in stiffness. SIGNIFICANCE Excessive stretching of the intrinsic foot muscles and PF occurs in flat feet, and excessive contraction of the flexor digitorum longus may counteract the excessive lowering of the foot arch. Therefore, it is necessary to promote the contraction of the intrinsic foot musculature in feet with greater flexibility of the MLA during loading.
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Affiliation(s)
- Takumi Kobayashi
- Department of Rehabilitation, Faculty of Health Science, Hokkaido Chitose College of Rehabilitation, Chitose, Japan; Second Division of Physical Therapy, School of Health Sciences, Sapporo Medical University, Sapporo, Japan.
| | - Kento Hirota
- Second Division of Physical Therapy, School of Health Sciences, Sapporo Medical University, Sapporo, Japan; Tokachi Physical Lab, Obihiro, Japan
| | - Ryo Otsuki
- Department of Rehabilitation, Faculty of Health Science, Hokkaido Chitose College of Rehabilitation, Chitose, Japan
| | - Juri Onodera
- Department of Rehabilitation, Faculty of Health Science, Hokkaido Chitose College of Rehabilitation, Chitose, Japan
| | - Taiki Kodesho
- Department of Sport Science and Research, Japan Institute of Sports Sciences (JISS), Tokyo, Japan
| | - Keigo Taniguchi
- Second Division of Physical Therapy, School of Health Sciences, Sapporo Medical University, Sapporo, Japan
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Kusagawa Y, Kurihara T, Maeo S, Sugiyama T, Kanehisa H, Isaka T. A classification of the plantar intrinsic foot muscles based on the physiological cross-sectional area and muscle fiber length in healthy young adult males. J Foot Ankle Res 2023; 16:75. [PMID: 37950300 PMCID: PMC10638735 DOI: 10.1186/s13047-023-00676-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 10/26/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Plantar intrinsic foot muscles (PIFMs) are composed of 10 muscles and play an essential role in achieving functional diversity in the foot. Previous studies have identified that the morphological profiles of PIFMs vary between individuals. The morphological profiles of a muscle theoretically reflect its output potentials: the physiological cross-sectional area (PCSA) of a muscle is proportional to its maximum force generation, and the muscle fiber length (FL) is its shortening velocity. This implies that the PCSA and FL may be useful variables for characterizing the functional diversity of the individual PIFM. The purpose of this study was to examine how individual PIFMs can be classified based on their PCSA and FL. METHODS In 26 healthy young adult males, the muscle volume and muscle length of seven PIFMs (abductor hallucis, ABDH; abductor digiti minimi, ABDM; adductor hallucis oblique head, ADDH-OH; ADDH transverse head, ADDH-TH; flexor digitorum brevis, FDB; flexor hallucis brevis, FHB; quadratus plantae, QP) were measured using magnetic resonance imaging. The PCSA and FL of each of the seven PIFMs were then estimated by combining the data measured from the participants and those of muscle architectural parameters documented from cadavers in previous studies. A total of 182 data samples (26 participants × 7 muscles) were classified into clusters using k-means cluster analysis. The optimal number of clusters was evaluated using the elbow method. RESULTS The data samples of PIFMs were assigned to four clusters with different morphological profiles: ADDH-OH and FHB, characterised by large PCSA and short FL (high force generation and slow shortening velocity potentials); ABDM and FDB, moderate PCSA and moderate FL (moderate force generation and moderate shortening velocity potentials); QP, moderate PCSA and long FL (moderate force generation and rapid shortening velocity potentials); ADDH-TH, small PCSA and moderate FL (low force generation and moderate shortening velocity potentials). ABDH components were assigned equivalently to the first and second clusters. CONCLUSIONS The approach adopted in this study may provide a novel perspective for interpreting the PIFMs' function based on their maximal force generation and shortening velocity potentials.
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Affiliation(s)
- Yuki Kusagawa
- Research Organization of Science and Technology, Ritsumeikan University, 1-1-1 Nojihigashi, Kusatsu, Shiga, 525-8577, Japan.
- Institute of Advanced Research for Sport and Health Science, Ritsumeikan University, Kusatsu, Shiga, Japan.
| | - Toshiyuki Kurihara
- Institute of Advanced Research for Sport and Health Science, Ritsumeikan University, Kusatsu, Shiga, Japan
- Faculty of Science, Yamaguchi University, Yamaguchi, Yamaguchi, Japan
| | - Sumiaki Maeo
- Institute of Advanced Research for Sport and Health Science, Ritsumeikan University, Kusatsu, Shiga, Japan
- Faculty of Sport and Health Science, Ritsumeikan University, Kusatsu, Shiga, Japan
| | - Takashi Sugiyama
- Research Organization of Science and Technology, Ritsumeikan University, 1-1-1 Nojihigashi, Kusatsu, Shiga, 525-8577, Japan
- Institute of Advanced Research for Sport and Health Science, Ritsumeikan University, Kusatsu, Shiga, Japan
| | - Hiroaki Kanehisa
- Institute of Advanced Research for Sport and Health Science, Ritsumeikan University, Kusatsu, Shiga, Japan
- National Institute of Fitness and Sports in Kanoya, Kanoya, Kagoshima, Japan
| | - Tadao Isaka
- Institute of Advanced Research for Sport and Health Science, Ritsumeikan University, Kusatsu, Shiga, Japan
- Faculty of Sport and Health Science, Ritsumeikan University, Kusatsu, Shiga, Japan
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Akuzawa H, Morito T, Oshikawa T, Kumai T, Kaneoka K. Functional relationship between the foot intrinsic and extrinsic muscles in walking. J Electromyogr Kinesiol 2023; 71:102781. [PMID: 37247509 DOI: 10.1016/j.jelekin.2023.102781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 05/08/2023] [Accepted: 05/17/2023] [Indexed: 05/31/2023] Open
Abstract
The intrinsic and extrinsic muscles are considered to stabilize the foot and contribute to propulsion during walking. This study aimed to clarify the functional relationship between intrinsic and extrinsic muscles during walking. Thirteen healthy men participated in this study. The muscle activities of the intrinsic muscles (quadratus plantae and abductor hallucis), and the extrinsic muscles (flexor hallucis longus, flexor digitorum longus, and tibialis posterior) were measured using fine-wire and surface electromyography during walking. The muscle onset timing after foot contact was calculated and compared among muscles using the one-way ANOVA. The stance phase was divided into early and late braking, and early and late propulsion phases. Muscle activity among phases was compared using repeated-measures ANOVA. The onset time of the abductor hallucis was significantly earlier than those of the flexor digitorum longus and tibialis posterior. The quadratus plantae demonstrated significantly earlier onset than that of the tibialis posterior. In the late propulsion phase, the activity of extrinsic muscles decreased, whereas intrinsic muscles were continuously active. Early activation of the intrinsic muscles may stabilize the foot for efficient torque production by the extrinsic muscles. Furthermore, the intrinsic muscles may contribute to the final push-off after the deactivation of extrinsic muscles.
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Affiliation(s)
- Hiroshi Akuzawa
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan; Institute for Sport Sciences, Waseda University, Nishi-Tokyo, Japan.
| | - Tsuyoshi Morito
- Faculty of Sport Sciences, Waseda University, Nishi-Tokyo, Japan
| | - Tomoki Oshikawa
- Faculty of Sport Sciences, Waseda University, Nishi-Tokyo, Japan
| | - Tsukasa Kumai
- Faculty of Sport Sciences, Waseda University, Nishi-Tokyo, Japan
| | - Koji Kaneoka
- Faculty of Sport Sciences, Waseda University, Nishi-Tokyo, Japan
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Coomar LA, Daly DT, Bauman J. A Unique Variation of Quadratus Plantae in Relation to the Tendons of the Midfoot. J Funct Morphol Kinesiol 2022; 7:jfmk7020049. [PMID: 35736020 PMCID: PMC9225273 DOI: 10.3390/jfmk7020049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 06/03/2022] [Accepted: 06/07/2022] [Indexed: 11/16/2022] Open
Abstract
A novel combination of variations involving the quadratus plantae muscle (QP) and its relationship to the flexor hallucis longus (FHL) tendon was observed unilaterally in the right foot of an 88-year-old female cadaver during routine dissection. The medial head of QP was observed inserting onto the tendon of FHL rather than the tendon of flexor digitorum longus (FDL), while also contributing to an anomalous tendinous slip to the second digit in conjunction with the tendon of FHL. The tendon of FHL also gave off a slip to the third digit. Both tendinous slips attached distally to the digital tendons of FDL. Lastly, the lateral head of QP inserted onto the tendinous slip from FHL to the third digit. Ninety-five additional feet were assessed for these variations, but none were observed. This combination of variations expands upon the proposed actions of QP in the literature. Furthermore, connections between the tendons of the midfoot are of clinical significance for harvesting tendon grafts.
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Beger O, Çalışır ES, Sevmez F, İnce R, Özdemir A, Keskinbora M. Arnold Kirkpatrick Henry (1886-1962) and his eponym (Master Knot of Henry): a narrative review. Surg Radiol Anat 2021; 44:157-168. [PMID: 34611753 DOI: 10.1007/s00276-021-02847-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 09/27/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE The aims of this review were to form a more precise description for Master Knot of Henry (MKH), and to modify classifications related to interconnections between flexor hallucis longus (FHL) and flexor digitorum longus (FDL) for showing all configurations in the literature. METHODS A literature search was performed in main databases to obtain information related to anatomical definitions and variations of MKH. The search was carried out using the following keywords: "Master Knot of Henry", "Chiasma plantare", "Flexor hallucis longus" and "Flexor digitorum longus". Information extracted from the studies was: sample size, numerical values, classifications, variation types, incidence of types, anatomical definitions of MKH, year of publication, and type of study. RESULTS This study proposes that MKH should be defined as the intersection territory where FDL crosses over FHL in the plantar foot. The postchiasmatic plantar area located at distal to MKH (the narrow space between MKH and the division of FDL) should be termed as the triangle of Henry. Moreover, the classification systems showing different configurations related to interconnections situated at Henry's triangle were updated as eight types to present all forms in the literature. CONCLUSION Our definitions may assist in determining the precise anatomical boundaries of MKH, and thus facilitate the use of MKH as a surgical landmark. In addition, our modified classification systems covering all variations in the current literature may be helpful for surgeons and anatomists to understand formations of the triangle of Henry, and the long flexor tendons of the lesser toes.
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Affiliation(s)
- Orhan Beger
- Department of Anatomy, Faculty of Medicine, Gaziantep University, 27310, Gaziantep, Turkey.
| | - Ebru Sena Çalışır
- Department of Anatomy, Faculty of Medicine, Gaziantep University, 27310, Gaziantep, Turkey
| | - Fatma Sevmez
- Department of Anatomy, Faculty of Medicine, Gaziantep University, 27310, Gaziantep, Turkey
| | - Rümeysa İnce
- Department of Medical Imaging Techniques, Health Services Vocational School, Osmaniye Korkut Ata University, Osmaniye, Turkey
| | - Ayşe Özdemir
- Department of Anatomy, Faculty of Medicine, Gaziantep University, 27310, Gaziantep, Turkey
| | - Mert Keskinbora
- Department of Orthopedics and Traumatology, Yücelen Hospital, Muğla, Turkey
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Communications between the tendons of flexor hallucis longus and flexor digitorum longus: a cadaveric study. Surg Radiol Anat 2019; 41:1411-1419. [PMID: 31541272 DOI: 10.1007/s00276-019-02311-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 08/23/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Tibialis posterior tendon insufficiency in adult acquired flat foot deformity (AAFFD) is treated by reinforcing the posterior tibial tendon (PTT) using grafts from flexor hallucis longus (FHL) and flexor digitorum longus (FDL). The communication between FHL and FDL will influence the length of the graft that can be harvested from FHL and FDL. In this study, we aim to study the patterns of communications between FHL and FDL tendons and the location of Master Knot of Henry (MKH) and point of division of FDL tendons in Indian population. MATERIALS AND METHODS In this observational descriptive study, 36 formalin-fixed cadavers were sourced from Subbaiah Institute of Medical Sciences, Shimoga, Karnataka, India, and JIPMER, Puducherry, India, during the period of 2017-19. Various parameters of the foot to locate the MKH and point of division of FDL tendons and various types of communications between FHL and FDL were observed. RESULTS Among the various types of communications between FHL and FDL tendons, type I was present in 61.76% of cases, type II in 2.94% of cases, type III in 7.35% of cases, type IV in 14.70% of cases, type V in 8.82% of cases, type VI in 0% of cases, type VII in 1.47% of cases and an unusual type in 2.94% of cases. CONCLUSION In the present study done in Indian population, we found that type I variety is present more commonly followed by type IV. FHL and FDL tendon grafts can be lengthened based on the communications between them. In type I variety, the communication can be severed at the FDL end to lengthen the tendon graft for harvest.
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