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So E, Wilson M, Chu AK, Thompson JM, Prissel MA. Incidence of Nonunion of the First Metatarsophalangeal Joint Arthrodesis After Failed Implant Arthroplasty: A Systematic Review. Foot Ankle Spec 2024; 17:78-86. [PMID: 37165627 DOI: 10.1177/19386400231169364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Joint arthroplasty of the first metatarsophalangeal (MTP) joint is an accepted surgical option for patients with hallux rigidus. However, this procedure has been reported to have a high complication rate and unpredictable survivorship. Implant arthroplasty failure is a devastating complication that results in significant osseous defect with altered biomechanics of the foot. Commonly, salvage options are limited to arthrodesis with bone grafting. However, outcomes are rarely reported. The purpose of this study is to investigate the fusion rates of first metatarsophalangeal joint arthrodesis after conversion from failed implant arthroplasty. A systematic review of electronic databases to find reports of conversion arthrodesis after failed implant arthroplasty was performed. Six studies involving a total of 76 patients with a weighted mean age of 54.9 met the inclusion criteria. Out of the 6 included articles, the nonunion rate was 16.5% at a weighted mean follow-up of 48.1 months. The nonunion rate in the current report is higher than reported nonunion rates of primary arthrodesis. More prospective studies with consistent and standard outcome measures are needed to further determine the success rate of this salvage procedure.Levels of Evidence: 4, Systematic Review of Level 4 Studies.
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Affiliation(s)
- Eric So
- Bryan Medical Center, Lincoln, Nebraska
| | | | - Anson K Chu
- G2 Orthopedics and Sports Medicine, Glen Allen, Virginia
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2
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Navarro Vergara AD, Navarro Fretes A, Medina Villate MM. Infrequent Pediatric Subungual Injury Diagnosed by Intraoperative Anatomopathological Material: A Case Report. Cureus 2024; 16:e51482. [PMID: 38169766 PMCID: PMC10758304 DOI: 10.7759/cureus.51482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/01/2024] [Indexed: 01/05/2024] Open
Abstract
Subungual lesions are very common in clinical practice. We present the clinical case of a 10-year-old female patient who presented with progressive nail deformity. The onset of the condition was approximately five years prior to presentation with an injury in the left hallux, according to the mother. She denied pain or change in the color of the area from the onset of the injury to the day of consultation. There was no previous trauma. Examination revealed subungual bone injury to the distal extremity (distal phalanx of the left hallux), and imaging tests (X-ray and soft tissue ultrasound) found bone injury. Subungual exostosis was considered as a possible diagnosis, thus prompting the indication for exeresis of the tumoral process. After surgical removal, the resected specimen was sent for pathological assessment, which found that an intraosseous hemangiolymphangioma was the origin of the tumor. A subungual exostosis is a slow-growth benign osseous tumor mainly located in the distal phalanx of the hallux that especially affects young adults, being less frequent in children. This condition results from a process of bone neoformation involving different stages, the clinical symptoms of which depend on its size and associated processes. Hemangiolymphangiomas are angiomatous lesions of the blood and lymphatic vessels that have a controversial etiology and present slow, painless, and progressive growth; these lesions are mostly benign. It is worth emphasizing that subungual injuries are not always caused by an underlying bone; therefore, potential differential diagnoses, both benign and malignant, should be considered, based on the location of the injury.
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Affiliation(s)
- Alberto Daniel Navarro Vergara
- Orthopedics and Traumatology, Hospital de Trauma "Manuel Giagni", Asunción, PRY
- Orthopedics and Traumatology, Hospital de Especialidades Quirúrgicas Ingavi del Instituto de Previsión Social, Asunción, PRY
- Orthopedics and Traumatology, Universidad del Norte, Asunción, PRY
| | - Alberto Navarro Fretes
- Orthopedics and Traumatology, Universidad del Norte, Asunción, PRY
- Orthopedics and Traumatology, Hospital de Especialidades Quirúrgicas Ingavi del Instituto de Previsión Social, Asunción, PRY
- Orthopedics and Traumatology, Hospital de Trauma "Manuel Giagni", Asunción, PRY
| | - María Mercedes Medina Villate
- Orthopedics and Traumatology, Hospital de Especialidades Quirúrgicas Ingavi del Instituto de Previsión Social, Asunción, PRY
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Ziroglu N, Birinci T, Koluman A, Şahbaz Y, Çiftçi MU, Baca E, Duramaz A. Reliability and Validity of the Turkish Version of the American Orthopaedic Foot and Ankle Society Hallux Metatarsophalangeal-Interphalangeal Joint Scale. Foot Ankle Spec 2023:19386400231214285. [PMID: 38018560 DOI: 10.1177/19386400231214285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2023]
Abstract
BACKGROUND The American Orthopaedic Foot and Ankle Society Hallux Metatarsophalangeal-Interphalangeal (AOFAS Hallux MTP-IP) scale is one of the most widely used outcome measures to evaluate hallux pathologies. This study aimed to translate the AOFAS Hallux MTP-IP scale into Turkish and investigate its psychometric properties. METHODS The psychometric properties of the Turkish version of the AOFAS Hallux MTP-IP (AOFAS Hallux MTP-IP-T) scale were tested in 66 patients with hallux pathologies (52 women; mean age, 47.64 ± 12.75 years). Cronbach's alpha was used to assess internal consistency. The intraclass correlation coefficient (ICC) was used to estimate test-retest. Construct validity was analyzed with the Turkish version of the Manchester-Oxford Foot Questionnaire (MOXFQ), Visual Analogue Scale (VAS), and 12-item Short-Form Health Survey(SF-12). RESULTS The AOFAS Hallux MTP-IP-T scale had adequate internal consistency (α = 0.71) and test-retest reliability (ICC2,1 = 0.93 for pain, ICC2,1 = 0.97 for function, and ICC2,1 = 0.97 for total score). The AOFAS Hallux MTP-IP-T total score has a moderate to strong correlation with VAS-activity and MOXFQ (ρ = -0.77, P = .001; ρ = -0.69, P = .001, respectively). The weakest correlation was found between the AOFAS Hallux MTP-IP-T and the SF-12 mental component scale (ρ = 0.31, P = .01). CONCLUSION AOFAS Hallux MTP-IP-T has sufficient reliability and validity to evaluate Turkish-speaking individuals with a variety of forefoot pathologies including the hallux. LEVELS OF EVIDENCE Level II.
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Affiliation(s)
- Nezih Ziroglu
- Department of Orthopedics and Traumatology, Atakent Hospital, Acibadem University, Istanbul, Turkey
| | - Tansu Birinci
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Istanbul Medeniyet University, Istanbul, Turkey
| | - Alican Koluman
- Department of Orthopedics and Traumatology, Bakırköy Dr. Sadi Konuk Education and Research Hospital, Istanbul, Turkey
| | - Yasemin Şahbaz
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Istanbul Beykent University, Istanbul, Turkey
| | - Mehmet Utku Çiftçi
- Department of Orthopedics and Traumatology, Bakırköy Dr. Sadi Konuk Education and Research Hospital, Istanbul, Turkey
| | - Emre Baca
- Department of Orthopedics and Traumatology, Bakırköy Dr. Sadi Konuk Education and Research Hospital, Istanbul, Turkey
| | - Altuğ Duramaz
- Department of Orthopedics and Traumatology, Bakırköy Dr. Sadi Konuk Education and Research Hospital, Istanbul, Turkey
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Raghav R, Narayanannair V, Samour J. Correction of a Hyperflexed Hallux in a Saker Falcon ( Falco cherrug) by Hemisectioning the Deep Digital Flexor Tendon. J Avian Med Surg 2023; 37:275-281. [PMID: 37962320 DOI: 10.1647/22-00062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
A 3-year-old male saker falcon (Falco cherrug) was presented with a history of hyperflexion of the first digit of the left pelvic limb with what appeared to be a hypercontracted distal end of the deep digital flexor tendon (m. flexor hallucis longus). Conservative treatment, bandaging, and splinting techniques failed to resolve the hypercontraction of the deep digital flexor tendon and improve digit function. Intraoperatively, the deep digital flexor tendon was found to have formed adhesions with the tendon sheath as well as the bone and soft tissue structures underneath it, impeding its ability to move freely within the tendon sheath. The adhesions were surgically resolved, and the tendon was lengthened by hemisectioning the deep digital flexor tendon at its distal end. Postsurgically, the digit was maintained in an extended position by bandaging. Mild physiotherapy was provided at 5-day intervals to retain function and prevent adhesions. Digit extensibility and function were restored to nearly normal levels after 4 weeks.
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Affiliation(s)
- Raj Raghav
- Bahrain Falcon Hospital, Zallaq, Kingdom of Bahrain,
| | | | - Jaime Samour
- Bahrain Falcon Hospital, Zallaq, Kingdom of Bahrain
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Nishikawa DRC, Duarte FA, Saito GH, Santos IDS, Filho VM, Mendes AAM, Cabral MG, Prado MP. Subungual Glomus Tumor of the Hallux A Report of 4 Cases. Foot Ankle Spec 2023:19386400231206285. [PMID: 37876158 DOI: 10.1177/19386400231206285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2023]
Abstract
This study reports the clinical outcomes and evolution of 4 patients with subungual glomus tumor (GT) of the hallux treated with tumor excision. Preoperatively, all patients had pain of intensity 9 or 10. Three were sensitive to cold and had stabbing pain, and one reported pulsatile pain. No patient presented nail alterations. There were no bone alterations on radiographic images and diagnostic suspicion of GT was supported by magnetic resonance images. Surgical treatment was indicated due to severe pain and functional limitation. The GT excision was performed by removing the nail through an L-shaped incision in the nail bed. After surgery, they all showed clinical improvement with return to previous activities and had no difficulty in wearing regular shoes. Three patients were pain-free and one had occasional stabbing pain of intensity 2. Half of them had nail changes. There has been no recurrence so far. Thus, we found that resection of subungual GT of the hallux was effective for the clinical improvement of patients.Level of Evidence: IV, case reports.
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Affiliation(s)
- Danilo Ryuko Cândido Nishikawa
- Department of Orthopaedics, Foot and Ankle Surgery, Hospital do Servidor Público Municipal de São Paulo (HSPM), São Paulo, Brazil
- Department of Orthopaedic Surgery, Foot and Ankle Surgery, Clínica de Ortopedia e Traumatologia Ortocity, São Paulo, Brazil
- Department of Orthopaedic Surgery, Foot and Ankle Surgery, Hospital Alemão Oswaldo Cruz, São Paulo, Brazil
| | - Fernando Aires Duarte
- Department of Orthopaedic Surgery, Foot and Ankle Surgery, Clínica de Ortopedia e Traumatologia Ortocity, São Paulo, Brazil
| | | | - Ianara da Silva Santos
- Department of Orthopaedics, Foot and Ankle Surgery, Hospital do Servidor Público Municipal de São Paulo (HSPM), São Paulo, Brazil
| | - Vicente Mazzaro Filho
- Department of Orthopaedics, Foot and Ankle Surgery, Hospital Edmundo Vasconcelos, São Paulo, Brazil
| | | | - Matheus Gomes Cabral
- Department of Orthopaedics, Foot and Ankle Surgery, Hospital do Servidor Público Municipal de São Paulo (HSPM), São Paulo, Brazil
| | - Marcelo Pires Prado
- Department of Orthopaedic Surgery, Hospital Israelita Albert Einstein, São Paulo, Brazil
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Bassil GF, Nader F, Lajmi A, Missaoui Z. Dorsal Dislocation of the First and Second Metatarsophalangeal Joint: A Case Report and Literature Review. Cureus 2023; 15:e45407. [PMID: 37854726 PMCID: PMC10579970 DOI: 10.7759/cureus.45407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/17/2023] [Indexed: 10/20/2023] Open
Abstract
Dorsal dislocation of the toes is an infrequent injury that can result in severe pain and deformity. Timely diagnosis and appropriate management are paramount for optimizing patient outcomes. This case report illustrates a 53-year-old male patient who suffered dorsal dislocation of the first and second metatarsophalangeal (MTP) joints due to a crush injury. We present the clinical manifestation, radiographic findings, and management approach for this unique isolated first and second ray MTP joint dorsal dislocation, without any associated fractures. This case report underscores several critical observations: firstly, hallux dorsal dislocation can potentially coincide with other injuries; secondly, it can stem from crushing trauma to the big toe; and thirdly, successful closed reduction, when followed by effective immobilization and early rehabilitation, can yield outstanding outcomes. Additionally, the report emphasizes the importance of pursuing another closed reduction attempt under general anesthesia, if the initial attempt in the emergency room proves unsuccessful, before contemplating open reduction.
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Affiliation(s)
- Georges F Bassil
- Orthopedic Surgery, Grand Hôpital de l'Est Francilien - Site de Meaux, Meaux, FRA
| | - Fadi Nader
- Orthopedic Surgery, Grand Hôpital de l'Est Francilien - Site de Meaux, Meaux, FRA
| | - Achraf Lajmi
- Orthopedic Surgery, Grand Hôpital de l'Est Francilien - Site de Meaux, Meaux, FRA
| | - Zied Missaoui
- Orthopedic Surgery, Grand Hôpital de l'Est Francilien - Site de Meaux, Meaux, FRA
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7
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Hile ES, Ghazi M, Chandrashekhar R, Rippetoe J, Fox A, Wang H. Development and Earliest Validation of a Portable Device for Quantification of Hallux Extension Strength (QuHalEx). Sensors (Basel) 2023; 23:4654. [PMID: 37430569 PMCID: PMC10223981 DOI: 10.3390/s23104654] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 05/05/2023] [Accepted: 05/06/2023] [Indexed: 07/12/2023]
Abstract
Hallux strength is associated with sports performance and balance across the lifespan, and independently predicts falls in older adults. In rehabilitation, Medical Research Council (MRC) Manual Muscle Testing (MMT) is the clinical standard for hallux strength assessment, but subtle weakness and longitudinal changes in strength may go undetected. To address the need for research-grade yet clinically feasible options, we designed a new load cell device and testing protocol to Quantify Hallux Extension strength (QuHalEx). We aim to describe the device, protocol and initial validation. In benchtop testing, we used eight precision weights to apply known loads from 9.81 to 78.5 N. In healthy adults, we performed three maximal isometric tests for hallux extension and flexion on the right and left sides. We calculated the Intraclass Correlation Coefficient (ICC) with 95% confidence interval and descriptively compared our isometric force-time output to published parameters. QuHalEx benchtop absolute error ranged from 0.02 to 0.41 (mean 0.14) N. Benchtop and human intrasession output was repeatable (ICC 0.90-1.00, p < 0.001). Hallux strength in our sample (n = 38, age 33.5 ± 9.6 years, 53% female, 55% white) ranged from 23.1 to 82.0 N peak extension force and 32.0 to 142.4 N peak flexion, and differences of ~10 N (15%) between toes of the same MRC grade (5) suggest that QuHalEx is able to detect subtle weakness and interlimb asymmetries that are missed by MMT. Our results support ongoing QuHalEx validation and device refinement with a longer-term goal of widespread clinical and research application.
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Affiliation(s)
- Elizabeth S. Hile
- Department of Rehabilitation Sciences, University of Oklahoma Health Sciences Center College of Allied Health, 1200 North Stonewall Ave., Oklahoma City, OK 73117, USA; (J.R.); (A.F.)
- OU Health Stephenson Cancer Center, 800 NE 10th Street, Oklahoma City, OK 73104, USA
| | - Mustafa Ghazi
- Infant Neuromotor Control Laboratory, Division of Developmental-Behavioral Pediatrics, Children’s Hospital Los Angeles, Los Angeles, CA 90027, USA;
| | - Raghuveer Chandrashekhar
- Department of Occupational Therapy, University of Florida, Gainesville, FL 32603, USA; (R.C.); (H.W.)
| | - Josiah Rippetoe
- Department of Rehabilitation Sciences, University of Oklahoma Health Sciences Center College of Allied Health, 1200 North Stonewall Ave., Oklahoma City, OK 73117, USA; (J.R.); (A.F.)
| | - Ashley Fox
- Department of Rehabilitation Sciences, University of Oklahoma Health Sciences Center College of Allied Health, 1200 North Stonewall Ave., Oklahoma City, OK 73117, USA; (J.R.); (A.F.)
| | - Hongwu Wang
- Department of Occupational Therapy, University of Florida, Gainesville, FL 32603, USA; (R.C.); (H.W.)
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8
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Muramatsu K, Tani Y, Kobayashi M, Sugimoto H, Iwanaga R, Mihara A, Sakai K. Refractory satellite ganglion cyst in the hallux and finger. Mod Rheumatol Case Rep 2023; 7:257-260. [PMID: 35522075 DOI: 10.1093/mrcr/rxac036] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 04/04/2022] [Accepted: 04/11/2022] [Indexed: 01/07/2023]
Abstract
Painful ganglion cysts that develop in the hallux and finger usually enlarge progressively to the peripheral direction. Simple resection of satellite ganglion cyst alone has been reported to cause a high rate of recurrence and treatment is often very difficult. The purpose of this study is to evaluate the appropriate surgical treatment for painful satellite ganglion cysts in the hallux and finger and discuss the origin of the ganglion cysts in cases treated surgically at our hospital. We reviewed five cases (three males and two females, ages 55-87 years), three of which occurred in the hallux and two in the finger. In all cases, the preoperative magnetic resonance image showed a large fluid of the flexor tendon sheath. And also, joint effusion was found in the metatarsophalangeal joint and the proximal interphalangeal joint. The first case of the hallux ganglion underwent simple excision of the cyst and had recurrences three times. In the other four cases, the additional synovectomy of the metatarsophalangeal joint and the proximal interphalangeal joint was performed along with ganglion cyst excision. These cases had no recurrence up to 1 year after operation. Recently, there have been reports that tendon sheath ganglions are connected to the ankle, wrist, hallux, and phalangeal joints. Although there are a few cases in our department, satellite ganglion cyst of the hallux and finger possibly originates from adjacent joints. Additional synovectomy of the affected joint should be performed for the excision of satellite ganglion cyst to prevent recurrence.
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Affiliation(s)
- Keiichi Muramatsu
- Department of Orthopedic Surgery, Nagato General Hospital, Nagato, Yamaguchi, Japan.,Department of Orthopaedic Surgery, Yamaguchi University, Ube, Yamaguchi, Japan
| | - Yasuhiro Tani
- Department of Orthopedic Surgery, Nagato General Hospital, Nagato, Yamaguchi, Japan
| | - Masato Kobayashi
- Department of Orthopedic Surgery, Nagato General Hospital, Nagato, Yamaguchi, Japan
| | - Hideaki Sugimoto
- Department of Orthopedic Surgery, Nagato General Hospital, Nagato, Yamaguchi, Japan
| | - Ryuta Iwanaga
- Department of Orthopaedic Surgery, Yamaguchi University, Ube, Yamaguchi, Japan
| | - Atsushi Mihara
- Department of Orthopaedic Surgery, Yamaguchi University, Ube, Yamaguchi, Japan
| | - Koji Sakai
- Department of Orthopaedic Surgery, Yamaguchi University, Ube, Yamaguchi, Japan
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9
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Husebye EE, Stødle AH. Arthroscopic Repair of Chronic Plantar Plate Tears of the First Metatarsophalangeal Joint: A New Surgical Technique With Patient Outcomes. Orthop J Sports Med 2022; 10:23259671221137558. [PMID: 36582934 PMCID: PMC9793050 DOI: 10.1177/23259671221137558] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 08/30/2022] [Indexed: 12/24/2022] Open
Abstract
Background Most plantar plate tears of the first metatarsophalangeal joint can be treated successfully by nonoperative means. Primary repair may be indicated to restore continuity of the plantar structures and joint stability. Inadequate or failed nonoperative treatment may cause persistent pain and disability and thereby represent a career-threatening injury to an athlete. The chronic plantar plate tears are difficult both to diagnose and to treat. When surgical treatment is indicated, traditionally a wide plantar or 2 parallel incisions are used. An arthroscopic approach allows for verification and visualization of the injury and, at the same time, repair of the injury. Purpose To describe findings of plantar plate tears, present a new arthroscopic procedure for plantar plate tear repair, and present the outcomes after surgery. Study Design Case series; Level of evidence, 4. Methods This was a retrospective study on the first 10 patients treated with the arthroscopic technique. The patients underwent surgery between June 2017 and January 2021. Patient data, clinical symptoms and findings, and operative details were obtained from the patient records. Patients were contacted via email to complete patient-reported outcome measures (Manchester Oxford Foot Questionnaire [MOxFQ] and Numeric Rating Scale [NRS] for pain). Results Four female and 6 male patients with a median age of 24 years (range, 12-44 years) were operated on at a median of 20 months (range, 2-38 months) after injury. Of the 10 patients, 8 had a hyperextension injury of the first metatarsophalangeal joint and 7 had a subtle valgus malalignment of the hallux; 8 patients were injured during sport activity. All patients reported plantar pain at pushoff. All but 1 patient returned to the same level of preinjury activity within 6 months. At a median of 29 months (range, 7-49 months) after surgery, the median MOxFQ score was 6 (range, 0-41) and the median NRS pain score was 0. Conclusion Arthroscopic plantar plate repair of chronic plantar plate tears resulted in a high rate of return to activity/sport and excellent outcome scores.
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Affiliation(s)
- Elisabeth Ellingsen Husebye
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo,
Norway.,Elisabeth Ellingsen Husebye, MD, PhD, Division of Orthopaedic
Surgery, Oslo University Hospital, Oslo, Norway (email
, )
(Twitter: @ElisabethEllin9)
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10
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Horner K, Summerhays B, Fiala K, Schweser KM. Radiographic Evaluation of Isolated Continuous Compression Staples for Akin Osteotomy Fixation. J Foot Ankle Surg 2022; 62:487-491. [PMID: 36513576 DOI: 10.1053/j.jfas.2022.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 11/01/2022] [Accepted: 11/20/2022] [Indexed: 11/26/2022]
Abstract
Continuous compression implants (nitinol staples) are gaining popularity secondary to their lower profile, less demanding technique, and less surgical dissection. Biomechanical support exists; however, clinical data is limited in the foot/ankle. This study's purpose is to determine the efficacy of nitinol staples to achieve stable, bony healing in Akin osteotomies and examine their clinical outcomes, complications, re-operations, and pain scores. We performed a retrospective chart review on 90 patients (93 osteotomies) who underwent an Akin osteotomy using a nitinol staple over a 2-year period. Radiographs were randomized and independently reviewed by 3 blinded foot and ankle surgeons. Osteotomies were deemed healed if greater than 50% of the osteotomy contained bridging bone, partially healed as less than 50% bridging bone, and nonunion as no healing, broken hardware, or loss of reduction. Visual analog scale pain scores were analyzed. Radiographic union was seen in 98.9% of Akin osteotomies (92/93), with no loss of reduction or broken staples (0/95). Only 3.2% (3/93) of patients returned to the operating room unplanned: 1 infection (1.1%), 1 symptomatic hardware removal (1.1%), and 1 traumatic disruption of fixation (1.1%). Postoperative pain scores were significantly lower than preoperative. Staples are lower profile and technically less demanding compared to headed screws, plates, and tension band constructs. They offer continuous compression of the osteotomy and are rigid enough to maintain reduction. Based on the findings of this paper, the use of staples provides robust and stable fixation for Akin osteotomies and has low complication and high healing rates.
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Affiliation(s)
- Kevin Horner
- School of Medicine, University of Missouri, Columbia, MO
| | | | - Kyle Fiala
- Department of Orthopaedic Surgery, University of Missouri, Columbia, MO
| | - Kyle M Schweser
- Department of Orthopaedic Surgery, University of Missouri, Columbia, MO.
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11
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Granatosky MC, Toussaint SLD, Young MW, Panyutina A, Youlatos D. The northern treeshrew (Scandentia: Tupaiidae: Tupaia belangeri) in the context of primate locomotor evolution: A comprehensive analysis of gait, positional, and grasping behavior. J Exp Zool A Ecol Integr Physiol 2022; 337:645-665. [PMID: 35451573 DOI: 10.1002/jez.2597] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 03/25/2022] [Accepted: 03/31/2022] [Indexed: 06/14/2023]
Abstract
The locomotor behaviors of treeshrews are often reported as scurrying "squirrel-like" movements. As such, treeshrews have received little attention beyond passing remarks in regard to primate locomotor evolution. However, scandentians vary considerably in habitat and substrate use, thus categorizing all treeshrew locomotion based on data collected from a single species is inappropriate. This study presents data on gait characteristics, positional, and grasping behavior of the northern treeshrew (Tupaia belangeri) and compares these findings to the fat-tailed dwarf lemur (Cheirogaleus medius) to assess the role of treeshrews as a model for understanding the origins of primate locomotor and grasping evolution. We found that northern treeshrews were primarily arboreal and shared their activities between quadrupedalism, climbing and leaping in rates similar to fat-tailed dwarf lemurs. During quadrupedal locomotion, they exhibited a mixture of gait characteristics consistent with primates and other small-bodied non-primate mammals and demonstrated a hallucal grasping mode consistent with primates. These data reveal that northern treeshrews show a mosaic of primitive mammalian locomotor characteristics paired with derived primate features. Further, this study raises the possibility that many of the locomotor and grasping characteristics considered to be "uniquely" primate may ultimately be features consistent with Euarchonta.
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Affiliation(s)
- Michael C Granatosky
- Department of Anatomy, New York Institute of Technology College of Osteopathic Medicine, Old Westbury, New York, USA
- Center for Biomedical Innovation, New York Institute of Technology College of Osteopathic Medicine, Old Westbury, New York, USA
| | | | - Melody W Young
- Department of Anatomy, New York Institute of Technology College of Osteopathic Medicine, Old Westbury, New York, USA
| | - Aleksandra Panyutina
- Severtsov Institute of Ecology and Evolution, Russian Academy of Sciences, Moscow, Russian Federation
| | - Dionisios Youlatos
- Department of Zoology, Aristotle University of Thessaloniki, Thessaloniki, Greece
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12
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Curran MG, Murphy EP, Murphy FM, Fenelon CG, Kearns SR. Functional Capabilities After First Metatarsal Phalangeal Joint Arthrodesis Using a Locking Plate and Compression Screw Construct. J Foot Ankle Surg 2022; 61:79-83. [PMID: 34429264 DOI: 10.1053/j.jfas.2021.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Revised: 02/01/2021] [Accepted: 06/08/2021] [Indexed: 02/03/2023]
Abstract
Arthrodesis of the first metatarsal phalangeal joint (MTPJ) is a widely utilized surgical procedure for a wide array of metatarsal pathologies. This study aims to explore the functional limitations following first MTPJ arthrodesis, overall satisfaction and patient's abilities to achieve activities of daily living (ADL). This prospective cohort study assessed functional limitations as well as footwear and lifestyle restrictions using several questionnaires. One hundred and three participants who had a first MTPJ arthrodesis under the care of a single surgeon were recruited. Pre- and postoperative patient-reported outcome measures were recorded. The American Orthopaedic Foot and Ankle Score (AOFAS) and the Manchester-Oxford Foot Questionnaire were also used to further examine functional status. Hallux valgus angle (HVA) and intermetatarsal angle (IMA) were compared using preoperative and postoperative weightbearing radiographs and successful fusion was recorded. Complications were documented and are discussed in detail. The duration of follow-up was more than 12 months. There was one nonunion in the cohort while 2 patients experienced delay to fusion. Approximately 97% of patients were very satisfied with the procedure and their ability to achieve ADLs post operatively. A further 82.5% of patients were able to return to wearing nonadaptive footwear. The mean reduction in HVA and IMA was 21.78° and 6.84°, respectively. This study demonstrates the safe and successful use of a compression screw/locking plate construct for arthrodesis of the first MTPJ. Furthermore, the study provides clear evidence of high levels of functionality after the procedure with statistically significant differences (p value <.05) in all 4 facets of the AOFAS questionnaire as well as several notable differences in activity levels and footwear restrictions pre and postoperatively.
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Affiliation(s)
- Michael G Curran
- Clinical Specialist Podiatrist, Orthopaedic Department, Bon Secours Hospital, Galway, Ireland.
| | - Evelyn P Murphy
- Specialist Registrar, Orthopaedic Department, Galway University Hospital, Galway, Ireland
| | - Fiona M Murphy
- Intern, Orthopaedic Department, Galway University Hospital, Galway, Ireland
| | - Christopher G Fenelon
- Specialist Registrar, Orthopaedic Department, Galway University Hospital, Galway, Ireland
| | - Stephen R Kearns
- Consultant Orthopaedic Surgeon, Orthopaedic Department, Galway University Hospital, Bon Secours Hospital, Galway, Ireland
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Jor A, Rahman A. Prototype Development of a Combined Padded Metatarsal Cup for High Heeled Footwear to Enhance Female Foot Musculoskeletal Safety. Kurume Med J 2021; 66:185-193. [PMID: 34690204 DOI: 10.2739/kurumemedj.ms664003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
This study investigated the feasibility of combined padded metatarsal cup on plantar pressures and stress distribution in the bone alignment of female foot with high heeled footwear during balanced standing. The aim of this study is to redistribute the plantar pressure away from the medial side of the forefoot. A combined padded metatarsal cup (CPMC) was developed from medium soft ethylene vinyl acetate (MSEVA) and very soft ethylene propylene diene monomer (VSEPDM) neoprene sponge. The participants of three categories were selected for the study. The peak plantar pressure and a radiographic assessment of foot musculoskeletal alignment were carried out. The results showed that the magnitude of load on medial forefoot area could be effectively reduced by inserting joint of soft materials on metatarsal region. Hence load on hallux could also be reduced satisfactorily which could resist the hallux valgus deformity. A comparison of conventional system and jointing materials separately with the developed prototype was made and found that the developed prototype of CPMC provides more relaxation of plantar pressure and musculoskeletal safety and confirms more comfort on hypothesis test. The concept of combined padded metatarsal cup should therefore be considered to help in designing musculoskeletal safety footwear.
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Affiliation(s)
- Abu Jor
- Department of Leather Engineering, Khulna University of Engineering & Technology
| | - Azizur Rahman
- Department of Industrial Engineering and Management, Khulna University of Engineering & Technology
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14
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Crooks SA, Lewis TL, Ray R, Gordon DJ. Symmetry of bilateral hallux valgus deformity: A radiographic study. Clin Anat 2021; 35:414-420. [PMID: 34390035 DOI: 10.1002/ca.23772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 07/21/2021] [Accepted: 08/01/2021] [Indexed: 11/09/2022]
Abstract
Hallux valgus (HV) is a common anatomical deformity leading to pain and difficulty with footwear and mobility. Bilateral HV deformity is much more common than unilateral although it remains unclear whether the severity of deformity is equal between feet. The objective was to investigate the severity and symmetry of HV in patients with bilateral symptomatic deformity presenting for surgery. Weight-bearing radiographs of patients presenting with symptomatic bilateral HV were reviewed. The hallux valgus angle (HVA) and intermetatarsal angle (IMA) were measured and classified as mild, moderate, or severe. Left-to-right comparison was undertaken to assess whether the degree of deformity was similar for each foot. The relationship between age, HVA, and IMA was also assessed. Between July 2014 and June 2020, 322 ft (161 patients with bilateral deformity) underwent corrective HV surgery. Of those, 6.8%, 64.6%, and 28.4% were classified as mild, moderate, and severe, respectively on the left side, and on the right 6.2%, 67.7%, and 26.1% were classified as mild, moderate, and severe respectively. There was no statistically significant difference between feet for either IMA (p = 0.06) or HVA (p = 0.85). There was a moderate correlation (R = 0.41, p ≤ 0.001) between HVA and IMA. There was only a 'weak' or 'very weak' correlation between age and HVA or IMA. Patients presenting for surgery with symptomatic bilateral HV have symmetrical moderate radiographic deformity at the time they present for consideration of surgical intervention.
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Affiliation(s)
- Sophie A Crooks
- King's Foot and Ankle Unit, King's College Hospital NHS Foundation Trust, London, UK
| | - Thomas L Lewis
- King's Foot and Ankle Unit, King's College Hospital NHS Foundation Trust, London, UK
| | - Robbie Ray
- King's Foot and Ankle Unit, King's College Hospital NHS Foundation Trust, London, UK
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15
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Burke JE, Shi GG, Wilke BK, Whalen JL. Allograft Interposition Bone Graft for First Metatarsal Phalangeal Arthrodesis: Salvage After Bone Loss and Shortening of the First Ray. Foot Ankle Int 2021; 42:969-975. [PMID: 33926279 DOI: 10.1177/10711007211001031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Previous studies have demonstrated success in using autogenous bone graft for arthrodesis in patients with failed surgeries of the hallux. These patients have several causes for pain and dysfunction preoperatively, including a shortened first ray, nonunion, and poor hallux alignment. METHODS In this study, a consecutive series of 36 patients (38 procedures) were treated with a patellar wedge interposition structural allograft to salvage bone loss from great toe arthrodesis malunion, painful joint replacement, failed osteotomy, or infection of the great toe metatarsophalangeal (MP) joint with shortening of the first ray. The goals of the surgery were to restore length to the first ray and provide a stable MP joint fusion to relieve pain. The 38 treated toes were evaluated for preoperative and postoperative American Orthopaedic Foot & Ankle Society (AOFAS) MP scores, subjective patient outcome scores, and clinically successful fusion of the hallux. RESULTS At a minimum 1-year follow-up (mean, 3.2 years), all but 2 feet healed with a solid fusion, and all healed patients reported good or excellent outcomes. AOFAS MP scores averaged 43.5 preoperatively and 77.2 postoperatively. Three patients with infection as cause for nonunion of the initial procedure were treated with staged procedures, including the use of a temporary antibiotic spacer and mini external fixator; all 3 healed without recurrent infection. One patient had a fracture of her allograft following her interposition arthrodesis, but it fused successfully after a second interposition arthrodesis surgery. Two patients developed a nonunion of the revision arthrodesis. CONCLUSION The use of an interposition patellar wedge allograft can restore length to the first ray and provide successful salvage of arthrodesis nonunions and bone loss from failed hemiarthroplasty and total joint implants of the great toe MP joint. LEVEL OF EVIDENCE Level IV, retrospective case series.
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Affiliation(s)
- John E Burke
- Division of Orthopedic Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - Glenn G Shi
- Division of Orthopedic Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - Benjamin K Wilke
- Division of Orthopedic Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - Joseph L Whalen
- Division of Orthopedic Surgery, Mayo Clinic, Jacksonville, FL, USA
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López-López D, Larrainzar-Garijo R, De-Bengoa-Vallejo RB, Losa-Iglesias ME, Bayod-López J. Effectiveness of the Lapidus plate system in foot surgery: A PRISMA compliant systematic review. Int Wound J 2021; 19:507-514. [PMID: 34255939 PMCID: PMC8874064 DOI: 10.1111/iwj.13649] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 06/09/2021] [Accepted: 06/21/2021] [Indexed: 12/13/2022] Open
Abstract
Lapidus arthrodesis is an established standard procedure to correct various foot surgery problems and hallux limitus, hypermobility of the first ray, hallux abductus valgus, and symptomatic lesser metatarsal. After decades, many fixation methods in the orthopaedic surgery industry have been developed for decreasing complications and improving this technique. The aim of this PRISMA compliant systematic review is to analyse the effectiveness of several lapidus plate systems in foot surgery. We have carried out the first systematic review of the relevant published literature so as to systematically evaluate the scientific knowledge available now on this association, assigning predefined eligibility criteria. Fourteen studies were selected which had an overall of 738 cases. The first tarsal metatarsal joint and hallux valgus were treated by the application of different types of Lapidus plate system. The optimal level of the fixation in these procedures is related with the type and system insertion place of the plate with or without screw in each specific foot disease. There is an insufficient number of studies about the effectiveness of the different types of Lapidus plate system in foot surgery, and there is a need to increase outcomes knowledge on the level of the fixation, sort of the system, and insert place in foot surgery.
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Affiliation(s)
- Daniel López-López
- Research, Health and Podiatry Group, Department of Health Sciences, Faculty of Nursing and Podiatry, Universidade da Coruña, Ferrol, Spain
| | - Ricardo Larrainzar-Garijo
- Orthopaedics and Trauma Department, Medicine School, Universidad Complutense, Hospital Universitario Infanta Leonor, Madrid, Spain
| | | | | | - Javier Bayod-López
- Biomedical Research Networking center in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN). Group of Applied Mechanics and Bioengineering (AMB), Aragon Institute of Engineering Research (I3A), Universidad de Zaragoza, Zaragoza, Spain
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17
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Sharma S, Dhillon MS, Singh G, Das A. Fibular Strut Arthrodesis for Salvage of Campanacci Grade III Giant Cell Tumor of the Hallucal Proximal Phalanx: A Case Report. J Foot Ankle Surg 2021; 60:861-865. [PMID: 33757685 DOI: 10.1053/j.jfas.2020.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 07/26/2020] [Accepted: 11/02/2020] [Indexed: 02/03/2023]
Abstract
Involvement of toe phalanges by giant cell tumor (GCT) is extremely rare; tumors in these locations tend to be aggressive. Whereas aggressive GCTs of the distal phalanx may be managed successfully by en-bloc resection without reconstruction or amputation, management of these lesions, when they involve the proximal phalanx, can be challenging. We present a Campannaci grade III GCT of the hallucal proximal phalanx in a 14-year old girl that had breached into the dorsal soft tissues and the metatarso-phalangeal joint. Wide local resection of the proximal phalanx along with reconstruction arthrodesis with an autologous, non-vascularized fibular strut graft was performed. There was no recurrence at 3 years of follow-up. The patient had an excellent functional outcome. To the best of our knowledge, this is the first case reporting the outcomes of fibular strut arthrodesis for salvage of GCT of the hallucal proximal phalanx.
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Affiliation(s)
- Siddhartha Sharma
- Associate Professor, Department of Orthopaedics, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
| | - Mandeep S Dhillon
- Professor and Head, Department of Orthopaedics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Gaganpreet Singh
- Assistant Professor, Department of Orthopedics, All India Institute of Medical Sciences, Bathinda, India
| | - Ashim Das
- Professor, Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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18
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David-Rivera AE, Quintero-Ariza ÁJ, Corredor-Guzmán K. [Inveterate dislocation of the first metatarsophalangeal joint]. Acta Ortop Mex 2021; 35:359-361. [PMID: 35139596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Injuries in the metatarsophalangeal joint complex of the hallux are seen with greater frequency in athletes, their importance lies in the functional limitation it generates. Early diagnosis and treatment can reduce the sequelae, however, the recognition of chronic lesions and with it the implementation of adequate therapeutic management generate improvements in quality of life. This document records a case of inveterate dislocation of the metatarsophalangeal joint of the hallux of more than one year of evolution with involvement of the intersesamoid ligament which was corrected with arthrodesis achieving immediate satisfactory results, in the medium and long term with the subsequent functional recovery and total reduction of pain.
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19
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Mahdaviazad H, Kardeh B, Vosoughi AR. American Orthopedic Foot and Ankle Society Hallux Metatarsophalangeal-Interphalangeal Joint Scale: A Cross-Cultural Adaptation and Validation Study in the Persian Language. J Foot Ankle Surg 2021; 59:729-732. [PMID: 32201126 DOI: 10.1053/j.jfas.2020.01.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 11/04/2019] [Accepted: 01/19/2020] [Indexed: 02/03/2023]
Abstract
We evaluated the reliability and validity of the Persian translation of the American Orthopedic Foot and Ankle Society hallux metatarsophalangeal-interphalangeal joint scale (AOFAS Hallux MTP-IP). The translated AOFAS Hallux MTP-IP scale form was completed for 101 patients with hallux deformities; the subjective questions were answered by the patients, whereas the orthopedic foot and ankle surgeon and his assistant answered the objective questions. The validated Persian version of the 36-Item Short Form Survey Instrument (SF-36) was used for validity assessment. Eighty-five females and 16 males with a mean age of 49 years were enrolled. Hallux valgus and hallux rigidus was the diagnosis in 73 and 28 patients, respectively. Intrarater reliability had a high level of correlation (rho >0.6) for all subscales and total score. Although the correlation between the total score of the AOFAS Hallux MTP-IP scale and role: physical subscale of SF-36 was the highest (rho = 0.47), the total score of AOFAS Hallux MTP-IP scale and the other 7 domains of SF-36 had a correlation ranging between -0.17 and 0.43. Moreover, the correlation between total score of AOFAS-Hallux MTP-IP and SF-36 physical component summary scale was 0.50, which was higher than the correlation between total score of AOFAS and SF-36 mental component summary scale (rho = 0.35). Convergent validity was approved for MTP joint motion (0.59), IP joint motion (0.51), and callus (0.56) items of AOFAS-Hallux MTP-IP. Spearman's rank correlation coefficient between all items of the functional subscale of AOFAS Hallux MTP-IP scale with its own subscales was higher than the coefficient between these items and other subscales, including pain and alignment (discriminate validity). Floor and ceiling effects were calculated as 2% and 1%, respectively. Our findings indicate that the translated Persian version of the AOFAS Hallux MTP-IP scale is a reliable instrument, but its validity is not satisfactory.
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Affiliation(s)
- Hamideh Mahdaviazad
- Assistant Professor of Community and Preventive Medicine, Bone and Joint Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Bahareh Kardeh
- General Practitioner, Department of Orthopedic Surgery, Bone and Joint Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Amir Reza Vosoughi
- Associate Professor of Orthopedic Surgery and Orthopedic Foot & Ankle Surgeon, Department of Orthopedic Surgery, Bone and Joint Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
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20
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Ferreira GF, Stéfani KC. A Global Bibliometric Analysis of Hallux Valgus Research (1999-2019). J Foot Ankle Surg 2021; 60:501-506. [PMID: 33573904 DOI: 10.1053/j.jfas.2020.09.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 09/01/2020] [Accepted: 09/30/2020] [Indexed: 02/03/2023]
Abstract
Hallux valgus (HV) is a very common deformity among foot disorders, therefore attracting strong interest from foot and ankle surgeons. We investigated publication trends on HV in the literature. The analysis was conducted through an electronic search of the Web of Science database for publications between 1999 and 2019, studying the data of origin through bibliometrics. The following search string was utilized: TI = (hallux valgus* OR hallux abductovalgus*) with filters for the English language and documents in article format. The "Bibliometrix" package of R software was used for the bibliometric analysis, and the VOSviewer was used to create graphs. A total of 789 articles were found in the electronic search, with 2,723 cited articles. The most common Web of Science category was Orthopedics (83.0%), and Coughlin M.J. was the main researcher in this field with the largest number of publications (17). The United States led in terms of the number of published articles (26.7%). An increase in the number of publications over time was noted, with 2016 being the year with the highest number of articles (78). The journal with the most articles was Foot and Ankle International, with 35.2% of the publications. The number of published studies on HV has increased rapidly since 2012. The United States ranks first in related research worldwide. The journal with the most articles was Foot and Ankle International.
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Affiliation(s)
- Gabriel Ferraz Ferreira
- Foot and Ankle Surgery Group, Orthopedics and Traumatology Department, Hospital do Servidor Público Estadual, São Paulo, SP, Brazil
| | - Kelly Cristina Stéfani
- Foot and Ankle Surgery Group, Orthopedics and Traumatology Department, Hospital do Servidor Público Estadual, São Paulo, SP, Brazil.
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21
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van Straaten A, Clockaerts S, Vanhoenacker F. Osteoid Osteoma of the Hallux: A Diagnostic Challenge. J Belg Soc Radiol 2021; 105:36. [PMID: 34164601 DOI: 10.5334/jbsr.2497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Teaching point: Unexplained bone marrow edema on MRI warrants further investigation with CT to demonstrate a nidus which is pathognomonic for an osteoid osteoma.
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22
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Tsai J, Daniel JN, McDonald EL, Pedowitz DI, Rogero RG, Shakked RJ, Nicholson KJ, Raikin SM. High Prevalence of Degenerative Changes at the Metatarsal Head Sesamoid Articulation Found During Hallux Valgus Correction Surgery. Foot Ankle Spec 2021; 14:219-225. [PMID: 32174166 DOI: 10.1177/1938640020912135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background. Despite the absence of complications and a restoration of normal hallux alignment, some patients have suboptimal outcomes from hallux valgus correction surgery. One risk factor for persistent pain may be the presence of arthritic changes at the metatarsal head articulation with the sesamoids, an area not easily assessed with standard radiographs unless dedicated sesamoid views are obtained. In this study, we prospectively evaluated the metatarsal head for degenerative changes during hallux valgus correction surgery and identified preoperative risk factors associated with these changes. Methods. We prospectively evaluated 200 feet in 196 patients who underwent hallux valgus surgery intraoperatively for the pattern and severity of arthritic changes at the metatarsal head. Mann-Whitney U testing was implemented to compare differences in arthritic scores between preoperative deformity groups. The Spearman correlation test was used to determine the association between age and preoperative deformity with the severity of degenerative changes. Results. More than half of all feet assessed had severe arthritic changes at the plantar medial aspect of the metatarsal head and 40% of feet at the plantar lateral aspect. Age and intermetatarsal angle were found to be positively correlated with arthritis in this area. Conclusion. Our prospective study has demonstrated the high prevalence of arthritic changes at the metatarsal head sesamoid articulation and the positive influence of age and severity of deformity on metatarsal head arthritic changes seen during hallux valgus correction surgery. Furthermore, these arthritic changes were found to have no significant influence on preoperative functional and pain levels.Levels of Evidence: Level IV: Case series.
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Affiliation(s)
- Justin Tsai
- Rothman Orthopaedic Institute, Philadelphia, Pennsylvania
| | | | | | | | - Ryan G Rogero
- Rothman Orthopaedic Institute, Philadelphia, Pennsylvania
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23
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Tan EW, Bolia IK, Peterson AB, Korber S, Romano R, Weber AE, Gamradt SC, Thordarson DB. Return to Sport Following Operative Treatment of Displaced Medial Sesamoid Fractures in NCAA Division I Football Players. Foot Ankle Int 2021; 42:654-657. [PMID: 33557611 DOI: 10.1177/1071100720978751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Level of Evidence: Level V.
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Affiliation(s)
- Eric W Tan
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, CA, USA
| | - Ioanna K Bolia
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, CA, USA
| | - Alexander B Peterson
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, CA, USA
| | - Shane Korber
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, CA, USA
| | - Russ Romano
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, CA, USA
| | - Alexander E Weber
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, CA, USA
| | - Seth C Gamradt
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, CA, USA
| | - David B Thordarson
- Department of Orthopaedic Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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24
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Wasilewska M, Guziński M, Gosk-Bierska I. Abnormalities of the hallux skin and nail in the course of very rare arteriovenous malformation. J Vasc Bras 2020; 19:e20200050. [PMID: 34290753 PMCID: PMC8276656 DOI: 10.1590/1677-5449.200050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 06/03/2020] [Indexed: 11/29/2022] Open
Abstract
Arteriovenous malformations (AVMs) are usually found in the pelvic area and the brain. These vascular anomalies are rarely reported in the toes. AVMs in the toes may be asymptomatic, but can also cause atypical symptoms. Congenital AVMs can expand as patients age and manifest in adulthood. They may be provoked by injury. Acquired AVM might be caused by iatrogenic factors, venous or arterial catheterization, percutaneous invasive vascular procedures, surgery, or degenerative vascular disorders. An AVM can damage surrounding tissues and can cause destruction of skin, nails and bones. The course of the disease is often unpredictable and diagnosis is usually delayed as a result.
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Affiliation(s)
- Marta Wasilewska
- Wroclaw Medical University - WMU, Department of Angiology, Hypertension and Diabetology, Wroclaw, Dolnoslaskie, Poland
| | - Maciej Guziński
- Wroclaw Medical University - WMU, Department of General Radiology, Interventional Radiology and Neuroradiology, Wroclaw, Dolnoslaskie, Poland
| | - Izabela Gosk-Bierska
- Wroclaw Medical University - WMU, Department of Angiology, Hypertension and Diabetology, Wroclaw, Dolnoslaskie, Poland
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25
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Henry JK, Kraszewski A, Volpert L, Cody E, Hillstrom H, Ellis SJ. Comparing First Metatarsophalangeal Joint Flexibility in Hallux Rigidus Patients Pre- and Postcheilectomy Using a Novel Flexibility Device. Foot Ankle Orthop 2020; 5:2473011420930000. [PMID: 35097381 PMCID: PMC8697098 DOI: 10.1177/2473011420930000] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Hallux rigidus (HR) is a common pathology of the first metatarsophalangeal (MTP) joint causing pain and stiffness. However, severity of symptoms and radiographic findings are not always concordant. A novel flexibility device, which measures the mobility of the MTP joint through its arc of motion, has been validated. This study compares flexibility in patients before and after cheilectomy (with or without proximal phalanx osteotomy) for HR. Methods This is a single-center study of adult patients with HR who were indicated for cheilectomy or cheilectomy and Moberg (dorsiflexion closing wedge) osteotomy of the proximal phalanx based on symptoms and radiographs from 2013 to 2015. Pre- and postoperatively, patients underwent testing with a validated flexibility protocol to generate flexibility curves. Parameters included early and late flexibility, laxity torque, and laxity angle. Patients completed Foot and Ankle Outcomes Scores (FAOS) pre- and postoperatively. Twelve operative patients underwent preoperative testing, with 9 completing postoperative testing (mean age, 53.0 years; 67% female; mean 2.8-year follow-up). Results Patients had significant improvements in early sitting and standing flexibility, sitting and standing laxity angles, standing laxity torque, and both sitting and standing maximum dorsiflexion after surgery (all P < .05). While preoperative early flexibility, laxity angle, and maximum dorsiflexion all differed significantly between patients and controls (P < .015), postoperative early flexibility was similar to controls (P > .279). FAOS scores for pain, symptoms, sport, and quality improved significantly after surgery. Conclusion Surgical treatment with cheilectomy was associated with significant improvements in nearly all flexibility parameters for sitting and standing positions. However, most postoperative flexibility parameters did not improve to the level of normal controls. Regardless, patients still experienced significant improvements in outcomes. This study demonstrated that surgical correction is associated with significant biomechanical and clinical results. The flexibility device can be used in further studies to assess outcomes after other HR procedures. Level of Evidence Level II, prospective comparative study.
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Affiliation(s)
- Jensen K Henry
- Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Andrew Kraszewski
- Leon Root Motion Analysis Laboratory, Hospital for Special Surgery, New York, NY, USA
| | - Lauren Volpert
- Orthopaedic Surgery, Foot & Ankle Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Elizabeth Cody
- Foot & Ankle Department, Hospital for Special Surgery, New York, NY, USA
| | - Howard Hillstrom
- Leon Root Motion Analysis Laboratory, Hospital for Special Surgery, New York, NY, USA
| | - Scott J Ellis
- Orthopaedic Surgery, Foot & Ankle Department, Hospital for Special Surgery, New York, NY, USA
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Romero LS, Park H, Shoaee N, Cohen PR. Onychomatricoma Presenting as a Dystrophic Right Great Toenail: Case Report and Review. Cureus 2020; 12:e7946. [PMID: 32499986 PMCID: PMC7268579 DOI: 10.7759/cureus.7946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Onychomatricoma is a rare, benign nail matrix tumor. It most frequently occurs on one of the first three fingers of the dominant hand or the big toe in middle-aged women. Our patient presented with a 10-year history of a progressive thickening of her right great toenail; it bled easily and was intermittently painful. She had experienced trauma to the nail prior to the onset of the dystrophy. MRI primarily showed inflammation localized to the nail bed without bony extension. Excisional biopsy, which included both the nail plate and matrix, established the diagnosis of onychomatricoma originating from the ventral nail matrix (lunula). Nail trauma or fungal infection may have a causative role in the pathogenesis of onychomatricoma. The nail plate can show splitting, increased curvature, or ridging; it can also present with yellow, red or brown, linear, pigmented bands. The clinical differential diagnosis of onychomatricoma includes fibrokeratoma, melanonychia, onychomycosis, periungual fibroma, and squamous cell carcinoma. Dermoscopic imaging shows parallel lesion edges and splinter hemorrhages; these dermoscopic features support the diagnosis of onychomatricoma over squamous cell carcinoma. Imaging such as ultrasound or MRI may suggest the diagnosis. Biopsy of the tumor is necessary to establish the diagnosis; the tumor may derive either from the ventral nail matrix (lunula) or from the ventral surface of the proximal nail fold. Histologic features vary depending not only on tumor origin but also on tissue orientation. Proximally, there is a fibroepithelial tumor consisting of fibrous stalk pierced by epithelial invaginations; the epithelium shows matrical differentiation containing basal and prekeratogenous cells. Distally, the tumor pierces the nail plate as glove-finger digitations; these digitations appear as discrete villi in the nail plate or show their negative image as multiple empty channels that have been described as “worm holes”. The channels may be epithelial lined and contain serous fluid. It is important to obtain an adequate biopsy specimen; the distinctive fibroepithelial histology might be inapparent in partial specimens lacking the epithelial invaginations. Immunohistochemical staining can distinguish onychomatricoma from tumors that can mimic its pathologic changes: fibromyxoma, neurofibroma, and perineurioma. Complete surgical excision is generally curative.
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Affiliation(s)
- Laura S Romero
- Dermatology, University of California - San Diego, San Diego, USA.,Medicine/Dermatology, Veterans Administration Medical Center, San Diego, USA
| | - Helen Park
- Dermatology, University of California San Diego School of Medicine, San Diego, USA
| | - Noushin Shoaee
- Podiatry, Carmel Valley Foot and Ankle Surgery, San Diego, USA
| | - Philip R Cohen
- Dermatology, San Diego Family Dermatology, National City, USA
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27
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Bernasconi A, De Franco C, Iorio P, Smeraglia F, Rizzo M, Balato G. Use of synthetic cartilage implant (Cartiva®) for degeneration of the first and second metatarsophalangeal joint: what is the current evidence? J BIOL REG HOMEOS AG 2020; 34:15-21. ADVANCES IN MUSCULOSKELETAL DISEASES AND INFECTIONS-SOTIMI 2019. [PMID: 32856435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Polyvinyl alcohol hydrogel implants (also known as Synthetic Cartilage Implant or Cartiva® have been described in the treatment of degeneration of the first and second metatarsophalangeal joint (MTPJ). We reviewed literature to report characteristics of devices on the market and investigate their efficacy and safety. Following the PRISMA checklist, the Medline and Scopus databases were searched, including studies reporting use of Cartiva® for treating joint degeneration of the first and second MPTJ. Studies were searched for surgical technique, postoperative protocol, clinical scores, complications and reoperations. We found that, although some studies suggest that the use of Synthetic Cartilage Implant (Cartiva® is effective in the treatment of hallux rigidus in providing symptoms relief without sacrifice of joint motion, the redundancy of cohorts reported in studies and the frequency of conflict of interest reported by authors weaken the strength of evidence available and warrant further studies. Regarding the treatment of the second MTPJ ailments, no recommendation can be formulated to date due to the lack of primary studies.
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Affiliation(s)
- A Bernasconi
- Orthopaedic Division, Department of Public Health, University of Naples Federico II, Naples, Italy
| | - C De Franco
- Orthopaedic Division, Department of Public Health, University of Naples Federico II, Naples, Italy
| | - P Iorio
- Orthopaedic Division, Department of Public Health, University of Naples Federico II, Naples, Italy
| | - F Smeraglia
- Orthopaedic Division, Department of Public Health, University of Naples Federico II, Naples, Italy
| | - M Rizzo
- Orthopaedic Division, Department of Public Health, University of Naples Federico II, Naples, Italy
| | - G Balato
- Orthopaedic Division, Department of Public Health, University of Naples Federico II, Naples, Italy
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Toussaint S, Llamosi A, Morino L, Youlatos D. The Central Role of Small Vertical Substrates for the Origin of Grasping in Early Primates. Curr Biol 2020; 30:1600-1613.e3. [PMID: 32169214 DOI: 10.1016/j.cub.2020.02.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 12/16/2019] [Accepted: 02/04/2020] [Indexed: 02/07/2023]
Abstract
The manual and pedal grasping abilities of primates, characterized by an opposable hallux, flat nails, and elongated digits, constitute a unique combination of features that likely promoted their characteristic use of arboreal habitats. These hand and foot specificities are central for understanding the origins and early evolution of primates and have long been associated with foraging in a fine-branch milieu. However, other arboreal mammals occupy similar niches, and it remains unclear how substrate type may have exerted a selective pressure on the acquisition of nails and a divergent pollex/hallux in primates or in what sequential order these traits evolved. Here, we video-recorded 14,564 grasps during arboreal locomotion in 11 primate species (6 strepsirrhines and 5 platyrrhines) and 11 non-primate arboreal species (1 scandentian, 3 rodents, 3 carnivorans, and 4 marsupials). We quantified our observations with 19 variables to analyze the effect of substrate orientation and diameter on hand and foot postural repertoire. We found that hand and foot postures correlate with phylogeny. Also, primates exhibited high repertoire diversity, with a strong capability for postural adjustment compared to the other studied groups. Surprisingly, nails do not confer an advantage in negotiating small substrates unless the animal is large, but the possession of a grasping pollex and hallux is crucial for climbing small vertical substrates. We propose that the divergent hallux and pollex may have resulted from a frequent use of vertical plants in early primate ecological scenarios, although nails may not have resulted from a fundamental adaptation to arboreal locomotion.
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Affiliation(s)
- Severine Toussaint
- Centre de Recherche en Paléontologie-Paris, UMR 7207, CNRS/MNHN/UPMC, 8 rue Buffon CP38, 75231 Paris Cedex 05, France; Centre de Recherche Interdisciplinaire, Département Frontières du vivant et de l'apprendre, 8 bis rue Charles V, 75004 Paris, France; UFR Sciences Du Vivant, Université Paris Diderot-Paris 7, Sorbonne Universités, 35 rue Hélène Brion, 75013 Paris, France.
| | - Artémis Llamosi
- Centre de Recherche Interdisciplinaire, Département Frontières du vivant et de l'apprendre, 8 bis rue Charles V, 75004 Paris, France; UFR Sciences Du Vivant, Université Paris Diderot-Paris 7, Sorbonne Universités, 35 rue Hélène Brion, 75013 Paris, France
| | - Luca Morino
- Parc Zoologique de Paris, Muséum National d'Histoire Naturelle, Sorbonne Université, 53 avenue de Saint Maurice, 75012 Paris, France
| | - Dionisios Youlatos
- Department of Zoology, School of Biology, Aristotle University of Thessaloniki, Panepistimioupoli, 54124 Thessaloniki, Greece
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29
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Stevens R, Bursnall M, Chadwick C, Davies H, Flowers M, Blundell C, Davies M. Comparison of Complication and Reoperation Rates for Minimally Invasive Versus Open Cheilectomy of the First Metatarsophalangeal Joint. Foot Ankle Int 2020; 41:31-36. [PMID: 31910054 DOI: 10.1177/1071100719873846] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Dorsal cheilectomy of the first metatarsophalangeal joint is an accepted treatment to alleviate dorsal impingement, pain, and reduced dorsiflexion in hallux rigidus. Traditionally performed via an open incision, this procedure has more recently been performed using minimally invasive techniques despite limited supportive published evidence. METHODS From December 2012 through December 2017, a retrospective analysis of all cheilectomies performed in our institution was done. The surgical technique was recorded along with any subsequent procedures performed for either persistent or recurrent pain, and complications were also noted. A comparison between open and minimally invasive outcomes was performed. In total, 171 cheilectomies were performed during this period. There were 38 open and 133 minimally invasive procedures. RESULTS At a mean 3-year follow-up, the reoperation rates of the 2 groups were different with only 1 (2.6%) of the open group requiring a fusion, while 17 (12.8%) of the minimally invasive surgical (MIS) group required further surgery (relative risk, 4.86; P = .059). In the open group, there was 1 (2.6%) complication, compared with 15 (11.3%) in the minimally invasive group (relative risk, 4.29; P = .076). CONCLUSION While patients may opt for MIS cheilectomy with a proposed faster recovery time and better cosmesis, they should be counseled about the risks and benefits of both methods, and that the technique of MIS cheilectomy utilized in this study appears to have an increased relative risk of requiring a further procedure. LEVEL OF EVIDENCE Level III, retrospective comparative series.
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Affiliation(s)
| | - Matthew Bursnall
- School of Health and Related Research, The University of Sheffield, Sheffield, UK
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30
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Shi E, Todd N, Rush S, Jennings M, Yurgelon J, Sue A, Bourke C, Baravarian B, Allen J, Shofler D. First Metatarsophalangeal Joint Space Area Decreases Within 1 Month After Implantation of a Polyvinyl Alcohol Hydrogel Implant: A Retrospective Radiographic Case Series. J Foot Ankle Surg 2019; 58:1288-1292. [PMID: 31679683 DOI: 10.1053/j.jfas.2019.04.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 03/10/2019] [Accepted: 04/04/2019] [Indexed: 02/03/2023]
Abstract
In 2016, the U.S. Food and Drug Administration approved the first and only polyvinyl alcohol hydrogel implant for the treatment of hallux rigidus. The implant functions as a bumper to maintain first metatarsophalangeal joint space to prevent contact of the phalangeal base with the first metatarsal head. Short-term and intermediate outcomes with this implant have reported positive outcomes with no radiographic outcomes of implant wear or subsidence. We performed a retrospective radiographic review of 27 consecutive patients who received the implant and measured preoperative and postoperative joint space area (JSA). We found a significant improvement in JSA (p < .001) between the preoperative JSA and JSA at the first postoperative visit at 1 to 2 weeks. We also found a significant decrease in JSA (p < .001) between the first postoperative visit and the second postoperative visit at 5 to 12 weeks. This information could have further implications for implant design as well as how we can better achieve functional improvements in the first metatarsophalangeal joint in patients with hallux rigidus.
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Affiliation(s)
- Eric Shi
- Fellow, Sutter Health Palo Alto Medical Foundation, Mountain View, CA.
| | - Nicholas Todd
- Attending Physician, Sutter Health Palo Alto Medical Foundation, Mountain View, CA
| | - Shannon Rush
- Attending Physician, Sutter Health Palo Alto Medical Foundation, Mountain View, CA
| | - Meagan Jennings
- Attending Physician, Sutter Health Palo Alto Medical Foundation, Mountain View, CA
| | - Jesse Yurgelon
- Attending Physician, Sutter Health Palo Alto Medical Foundation, Mountain View, CA
| | - Alan Sue
- Attending Physician, Sutter Health Palo Alto Medical Foundation, Mountain View, CA
| | | | - Bob Baravarian
- Assistant Clinical Professor UCLA School of Medicine, Los Angeles, CA
| | - Jamey Allen
- Fellow, University Foot and Ankle Institute, Santa Monica, CA
| | - David Shofler
- Assistant Professor, Department of Podiatric Medicine, Surgery, and Biomechanics, Western University College of Podiatric Medicine, Pomona, CA
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31
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Patel S, Garg P, Fazal MA, Ray PS. First Metatarsophalangeal Joint Arthrodesis Using an Intraosseous Post and Lag Screw With Immediate Bearing of Weight. J Foot Ankle Surg 2019; 58:1091-1094. [PMID: 31679663 DOI: 10.1053/j.jfas.2019.01.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Indexed: 02/03/2023]
Abstract
Arthrodesis is the gold standard procedure for advanced arthrosis of the first metatarsophalangeal joint. Having a strong construct is preferable for allowing immediate bearing of weight, which facilitates patient rehabilitation. Plate and screw fixation is currently in favor but can lead to prominent metalware necessitating removal. The aim of this study is to report the results of a series of 54 first metatarsophalangeal joint arthrodeses performed in 52 patients treated with an implant composed of an intraosseous post and lag screw. All of the patients had a minimum follow-up of 1 year, and the indication for the surgery was end-stage hallux rigidus in 44 (81.5%) feet, severe hallux valgus in 8 (14.8%) feet, and rheumatoid arthritis in 2 (3.7%) feet. Arthrodesis was achieved in 52 (96.3%) feet at a mean of 61 ± 16 (range 39 to 201) days with nonunion observed in 2 (3.7%) feet; neither of the 2 patients had known risk factors. Metalware impinging on soft tissues necessitating removal was observed in 3 (5.6%) feet, and there were no cases of loss of position or implant breakage. The mean Manchester-Oxford Foot Questionnaire score improved from 46.4 ± 13.3 to 18.4 ± 9.4 (p < .001) at latest follow-up. In conclusion, our results suggest the intraosseous post and lag screw device was safe and effective, and it can be considered an alternative method of stabilizing the first metatarsophalangeal joint when undertaking arthrodesis surgery.
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Affiliation(s)
- Shelain Patel
- Consultant Orthopaedic Surgeon, Royal National Orthopaedic Hospital, Stanmore, United Kingdom.
| | - Parag Garg
- Clinical Fellow, Barnet General Hospital, Barnet, United Kingdom
| | - M Ali Fazal
- Consultant Orthopaedic Surgeon, Barnet General Hospital, Barnet, United Kingdom
| | - Pinak S Ray
- Consultant Orthopaedic Surgeon, Barnet General Hospital, Barnet, United Kingdom
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32
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Kodama A, Kurose Y, Mizuseki T, Tanimoto K, Adachi N. Plantar Partial Pressure Analysis in a Patient with Reverse Extensor Digitorum Brevis Flap for the Treatment of Hallux Injury. J Orthop Case Rep 2019; 9:75-78. [PMID: 31559234 PMCID: PMC6742865 DOI: 10.13107/jocr.2250-0685.1430] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction An extensor digitorum brevis (EDB) flap can be used to cover a small soft-tissue defect and has been widely used as pedicled flap to cover defects around the ankle and foot. However, its post-operative functional recovery is unknown. Few reports have evaluated gait after foot flap surgeries, although gait assessment is considered to be necessary for functional evaluation after foot reconstruction. We performed a reverse EDB flap to treat a right hallux injury and conducted a plantar partial pressure (PPP) analysis as a postoperative functional evaluation. Case Report A 30-year-old laborer suffered an injury resulting in necrosis of the distal phalanx and soft-tissue defect of the proximal phalanx. After amputation, the proximal phalanx was covered with a reverse EDB flap. PPP analysis involved a 4-m-long platform system (P-Walk) and was conducted 3- and 12-month post-surgery. Walking velocity and the single-support phase on the affected limb had increased markedly after 12 months. After 12 months, the PPP of the first metatarsal head was greater than on the unaffected side, and the cadence and single-leg support rate were equal to the unaffected side. Conclusion A nearly normal gait was obtained by covering the basal part of the hallux with an EDB flap and preserving the metatarsophalangeal joint.
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Affiliation(s)
- Akira Kodama
- Department of Orthopaedic Surgery, Hiroshima Prefectural Rehabilitation Center, Higashi-Hiroshima, Hiroshima, Japan.,Department of Orthopaedic Surgery, Biomedical and Health Sciences, Hiroshima University, Higashi-Hiroshima, Hiroshima, Japan
| | - Yasuo Kurose
- Department of Orthopaedic Surgery, Hiroshima Prefectural Rehabilitation Center, Higashi-Hiroshima, Hiroshima, Japan
| | - Takaya Mizuseki
- Department of Orthopaedic Surgery, Hiroshima Prefectural Rehabilitation Center, Higashi-Hiroshima, Hiroshima, Japan
| | - Kaguna Tanimoto
- Department of Orthopaedic Surgery, Hiroshima Prefectural Rehabilitation Center, Higashi-Hiroshima, Hiroshima, Japan
| | - Nobuo Adachi
- Department of Orthopaedic Surgery, Biomedical and Health Sciences, Hiroshima University, Higashi-Hiroshima, Hiroshima, Japan
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33
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Shah NN, Richardson MP, Chu AK, Hyer CF. Rate of Development of Hallucal Interphalangeal Degenerative Joint Disease After First Metatarsophalangeal Joint Arthrodesis: A Retrospective Radiographic Analysis. Foot Ankle Spec 2019; 12:357-362. [PMID: 30343598 DOI: 10.1177/1938640018803767] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The development of hallux interphalangeal joint (IPJ) arthritis after an arthrodesis of the first metatarsophalangeal joint has been established in the literature. However, the significance has not been well reported. A retrospective, radiographic review of patients who had undergone a first metatarsophalangeal joint arthrodesis was performed. The Coughlin classification for degree of arthritic degeneration, hallux abductus angle, and hallux interphalangeus angle were measured in 107 radiographs of 103 patients preoperatively and postoperatively. Postoperative angles were measured immediately following surgery at approximately 6 weeks, 3 months, 6 months, 12 months, and 24 months. We found that the hallux abductus angle had decreased in the patients postoperatively; however, the hallux abductus interphalangeus angle increased on average after first metatarsophalangeal fusion. The majority of patients started with a Coughlin classification I of the hallux IPJ, which remained unchanged over the postoperative period, with no statistically significant difference in IPJ degeneration in the patients with or without fusion of the first metatarsophalangeal joint. In addition, no patients had a symptomatic hallux IPJ postoperatively within our limited study period. Further prospective studies would be beneficial with longer follow-up times to assess IPJ degeneration following first metatarsophalangeal joint fusions. Levels of Evidence: Level III: Retrospective, comparative study.
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Affiliation(s)
- Nisha N Shah
- OhioHealth Grant Medical Center, 111 South Grant Avenue, Columbus, Ohio
| | | | - Anson K Chu
- OhioHealth Grant Medical Center, 111 South Grant Avenue, Columbus, Ohio
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Pearson JM, Moraes LVM, Paul KD, Peng J, Chinnakkannu K, McKissack HM, Shah A. Is Fibular Sesamoidectomy a Viable Option for Sesamoiditis? A Retrospective Study. Cureus 2019; 11:e4939. [PMID: 31431844 PMCID: PMC6695232 DOI: 10.7759/cureus.4939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background Pathologic conditions of the sesamoids can be a source of disabling pain for patients, particularly during toe-off. Some underlying causes include osteonecrosis, inflammation, arthritis, and fracture. Nonoperative treatment is the initial standard of care, and has demonstrated satisfactory outcomes overall; however, operative management may be indicated in cases of pain refractory to conservative management. Sesamoidectomy is an uncommon procedure with risk of potential complications, but may be warranted in select cases of failed nonoperative treatment. Methods A retrospective chart review was conducted at one institution from 2009 to 2018. Twelve patients diagnosed with fibular sesamoiditis were treated with sesamoidectomy. Baseline patient demographics as well as postoperative outcomes were recorded. Results All 12 patients underwent fibular sesamoidectomy using the plantar approach following which their symptom (pain) resolved. Average follow-up for this cohort was 35 months. Of the sample, two patients experienced transient neuritis, one patient developed a superficial infection, and one had painful postoperative scarring. Hallux varus deformity was not observed in any patients. Conclusion Fibular sesamoidectomy may be a safe, viable procedure for patients with sesamoiditis who fail conservative measures.
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Affiliation(s)
- Jeffrey M Pearson
- Orthopaedic Surgery, University of Alabama School of Medicine, Birmingham, USA
| | - Leonardo V M Moraes
- Orthopedics, Instituto De Assistência Médica Ao Servidor Público Estadual (IAMPSE), São Paulo, BRA
| | - Kyle D Paul
- Orthopaedics, University of Alabama School of Medicine, Birmingham, USA
| | - Jianguang Peng
- Orthopaedic Surgery, Xuanwu Hospital Capital Medical University, Beijing, CHN
| | | | - Haley M McKissack
- Orthopaedics, University of Alabama School of Medicine, Birmingham, USA
| | - Ashish Shah
- Orthopaedics, University of Alabama School of Medicine, Birmingham, USA
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35
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Calvo-Lobo C, Painceira-Villar R, García-Paz V, Becerro-de-Bengoa-Vallejo R, Losa-Iglesias ME, Munuera-Martínez PV, López-López D. Falls rate increase and foot dorsal flexion limitations are exhibited in patients who suffer from asthma: A novel case-control study. Int J Med Sci 2019; 16:607-613. [PMID: 31171913 PMCID: PMC6535651 DOI: 10.7150/ijms.32105] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Accepted: 03/27/2019] [Indexed: 11/05/2022] Open
Abstract
Purpose: Based on the possible association between reduced foot dorsiflexion and high risk of falls, the main objective was to determine the ankle and 1º metatarsophalangeal joint (1stMTTP) dorsiflexion range of motion and falls rate in patients with asthma compared to healthy matched-paired controls. Methods: A case-control study was carried out. Eighty participants were recruited and divided into patients with asthma (case group; n=40) and matched-paired healthy participants (control group; n=40). Foot dorsal flexion range of motion (assessed by the Weight-Bearing Lunge Test [WBLT]) and falls rate (evaluated as falls number during the prior year) were considered as the primary outcomes. Indeed, ankle dorsiflexion was measured by a mobile app (º) and a tape measure (cm) as well as 1stMTTP dorsiflexion was determined by and universal goniometer (º). Results: Statistically significant differences (P<.05) showed that patients with asthma presented a greater falls rate than healthy participants and reduced bilateral ankle and 1stMTTP dorsiflexion ranges of motion than healthy participants, except for the left ankle dorsiflexion measured as degrees (P>.05). Conclusions: These study findings showed that a falls rate increase and bilateral foot dorsal flexion limitations of the ankle and 1stMTTP joints are exhibited in patients who suffer from asthma.
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Affiliation(s)
- César Calvo-Lobo
- Nursing and Physical Therapy Department, Institute of Biomedicine (IBIOMED), Faculty of Health Sciences, Universidad de León, Ponferrada, León, Spain
| | - Roi Painceira-Villar
- Research, Health and Podiatry Unit. Department of Health Sciences. Faculty of Nursing and Podiatry. Universidade da Coruña, Spain
| | - Vanesa García-Paz
- Departament of Allergology. Complexo Hospitalario Universitario de Ferrol, Ferrol. Spain
| | | | | | | | - Daniel López-López
- Research, Health and Podiatry Unit. Department of Health Sciences. Faculty of Nursing and Podiatry. Universidade da Coruña, Spain
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36
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Crowell A, Van JC, Meyr AJ. Early Weight-Bearing After Arthrodesis of the First Metatarsal-Phalangeal Joint: A Systematic Review of the Incidence of Non-Union. J Foot Ankle Surg 2018; 57:1200-1203. [PMID: 30201557 DOI: 10.1053/j.jfas.2018.05.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Indexed: 02/03/2023]
Abstract
Arthrodesis of the first metatarsal-phalangeal joint is a reliable procedure for correction of both hallux limitus/rigidus and severe hallux abducto valgus deformities. However, 1 potential contraindication to the procedure is the extended period of non-weight-bearing immobilization that is typically associated with the postoperative course. The objective of this investigation was to perform a systematic review of the incidence of non-union after early weight bearing in patients who underwent arthrodesis of the first metatarsal-phalangeal joint. We performed a review of electronic databases with the inclusion criteria of retrospective case series, retrospective clinical cohort analyses, and prospective clinical trials with n ≥ 15 feet, a mean follow-up of ≥12 months, a defined postoperative early weight-bearing protocol (defined as ≤2 weeks), a clear description of the fixation construct, a reported incidence rate of non-union, and patients who underwent primary surgery for hallux abducto valgus or hallux limitus/rigidus deformities. Seventeen studies met our inclusion criteria, with a total of 898 feet analyzed. Of these, 57 (6.35%) were described as developing a non-union. This would likely be considered an acceptable crude, heterogeneous incidence of non-union when considering this procedure. It might also indicate that arthrodesis of the first metatarsal-phalangeal joint does not always require an extended period of non-weight-bearing postoperative immobilization.
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Affiliation(s)
- Amanda Crowell
- Resident, Temple University Hospital Podiatric Surgical Residency Program, Philadelphia, PA.
| | - Jennifer C Van
- Clinical Assistant Professor, Department of Podiatric Surgery, Temple University School of Podiatric Medicine, Philadelphia, PA
| | - Andrew J Meyr
- Clinical Assistant Professor, Department of Podiatric Surgery, Temple University School of Podiatric Medicine, Philadelphia, PA
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37
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Abstract
Turf toe is a condition that describes injury to the plantar metatarsophalangeal-sesamoid complex of the great toe. It is a relatively rare and debilitating condition, particularly seen in American footballers after the introduction of harder, artificial ‘turf’ surfaces. Turf toe represents a significant injury to the hallux and requires a high index of suspicion. If unrecognized, it can lead to chronic problems including reduced push-off strength, persistent pain, progressive deformity and eventual joint degeneration. Patients with chronic injuries may have worse outcomes, and therefore early, accurate diagnosis and initiation of treatment play a vital role. A multidisciplinary team approach is key for successful return to sport.
Cite this article: EFORT Open Rev 2018;3:501-506. DOI: 10.1302/2058-5241.3.180012
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Affiliation(s)
| | | | - Matthew Welck
- Foot & Ankle Unit, Royal National Orthopaedic Hospital, UK
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38
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Abstract
BACKGROUND Hallux interphalangeal (IP) arthritis can occur after first metatarsophalangeal (MTP) arthrodesis. IP arthrodesis is a standard treatment, but in the setting of prior MTP surgery there will be increased stress on the IP joint. This may result in diminished potential for bone healing. This investigation assessed the outcomes of hallux IP arthrodesis after first MTP arthrodesis. METHODS Charts were retrospectively reviewed for patients who underwent interphalangeal arthrodesis between January 1, 2007, and April 3, 2017, and who had a minimum of 12 weeks of follow-up. We compared patients with and without prior ipsilateral first MTP arthrodesis. There were 42 patients whose median follow-up was 9 (range, 3-135) months. RESULTS Median time from previous first MTP arthrodesis until IP arthrodesis was 54 months. Six nonunions (35.3%) occurred in 17 patients with prior first MTP arthrodesis. Only 2 nonunions (8.0%) occurred in 25 patients with isolated IP arthrodesis. The multivariable risk difference of nonunion was 53.3% ( P = .001). Prior first MTP arthrodesis also was more likely to have complications (52.9% vs 24.0%, respectively). The multivariable risk difference of complications was 35.7% ( P = .082). The speed of bone healing was significantly different, with a multivariable rate ratio of 0.21 ( P = .012). Conclusion Prior first MTP arthrodesis resulted in 4.8 times slower bone healing for IP arthrodesis. It increased the risks of nonunion and any other complications. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Affiliation(s)
- Songwut Thitiboonsuwan
- 1 Duke University Medical Center, Durham, NC, USA.,2 Navamindradhiraj University, Bangkok, Thailand
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Abstract
BACKGROUND Turf toe is a term used to describe a hyperextension injury to the first metatarsophalangeal joint. Although the vast majority of turf toe injuries can be treated successfully without operative intervention, there are instances where surgery is required to allow the athlete to return to play. Although there is a plethora of literature on turf toe injuries and nonoperative management, there are currently few reports on operative outcomes in athletes. METHODS We obtained all cases of turf toe repair according to the ICD-10 procedural code. The inclusion criteria included: age greater than 16, turf toe injury requiring operative management and at least a varsity level high school football player. The charts were reviewed for age, BMI, level of competition, injury mechanism, football position, setting of injury and playing surface. In addition, we recorded the specifics of the operative procedure, a listing of all injured structures, the implants used and the great toe range of motion at final follow-up visit. The AOFAS Hallux score and VAS was used postoperatively as our outcome measures. Our patient population included 15 patients. The average follow-up time was 27.5 months. RESULTS The average patient was 19.3 years old with a body mass index of 32.3. The average playing time missed was 16.5 weeks. The average dorsiflexion range of motion at the final follow-up was 42.3 degrees. At final follow-up, the average AOFAS Hallux score was 91.3. The average VAS pain score was 0.7 at rest and 0.8 with physical activity. CONCLUSION Complete turf toe injuries are often debilitating and may require operative management to restore a pain-free, stable, and functional forefoot. This study represents the largest cohort of operatively treated grade 3 turf toe injuries in the literature and demonstrates that good clinical outcomes were achieved with operative repair. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
- Kenneth Smith
- 1 University of Alabama at Birmingham, Department of Orthopaedic Surgery, Birmingham, AL, USA
| | - Norman Waldrop
- 2 American Sports Medicine Institute, Birmingham, AL, USA
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Aprile I, Galli M, Pitocco D, Di Sipio E, Simbolotti C, Germanotta M, Bordieri C, Padua L, Ferrarin M. Does First Ray Amputation in Diabetic Patients Influence Gait and Quality of Life? J Foot Ankle Surg 2018; 57:44-51. [PMID: 29268902 DOI: 10.1053/j.jfas.2017.07.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Indexed: 02/03/2023]
Abstract
It has recently been suggested that first ray amputation in diabetic patients with serious foot complications can prolong bipedal ambulatory status, and reduce morbidity and mortality. However, no data are available on gait analysis and quality of life after this procedure. In the present case-control study (6 amputee and 6 nonamputee diabetics, 6 healthy non-diabetic), a sample of amputee diabetic patients were evaluated and compared with a sample of nonamputee diabetic patients and a group of age-matched healthy subjects. Gait biomechanics, quality of life, and pain were evaluated. Compared with the other 2 groups, amputee patients displayed a lower walking speed and greater variability and lower ankle, knee, and hip range of motion values. They also tended to have a more flexed hip profile. Pain and lower quality of life were related to worsening biomechanical data. Our study results have shown that gait biomechanics in diabetic patients with first ray amputation are abnormal, probably owing to the severity of diabetes and the absence of the push-off phase provided by the hallux. Tailored orthotics and rehabilitation programs and a specific pain management program should be considered to improve the gait and quality of life of diabetic patients with first ray amputation.
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Affiliation(s)
- Irene Aprile
- Director, Rehabilitation Department, Don Carlo Gnocchi Onlus Foundation, Milan, Italy.
| | - Marco Galli
- Orthopedic Surgeon, Institute of Clinical Orthopaedic, Catholic University, Rome, Italy
| | - Dario Pitocco
- Associate Physician, Department of Internal Medicine, Diabetes Care Unit, Catholic University, Rome, Italy
| | - Enrica Di Sipio
- Research Engineer, Don Carlo Gnocchi Onlus Foundation, Milan, Italy
| | | | - Marco Germanotta
- Research Engineer, Don Carlo Gnocchi Onlus Foundation, Milan, Italy
| | | | - Luca Padua
- Research Head, Don Carlo Gnocchi Onlus Foundation, Milan, Italy; Associate Professor, Department of Geriatrics, Neurosciences and Orthopaedics, Catholic University of the Sacred Heart, Rome, Italy
| | - Maurizio Ferrarin
- Research Head, Biomedical Technology Department, IRCCS Don Carlo Gnocchi Foundation, Milan, Italy
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Khezami M, Abdennadher A, Bellaaj H, Znagui T, Hamdi M, Nouisri L. [Turrett's exostoses: about 35 casesk]. Pan Afr Med J 2018; 29:229. [PMID: 30100982 PMCID: PMC6080961 DOI: 10.11604/pamj.2018.29.229.14165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 01/29/2018] [Indexed: 11/13/2022] Open
Abstract
Nous rapportons à travers une étude rétrospective faite de 35 cas d’exostose sous unguéale de l’hallux dite exostose de Turrett's colligée entre 1995 et 2015 au service d’Orthopédie Traumatologie de l’Hôpital Militaire Principal d’Instruction de Tunis les résultats de la prise en charge de cette pathologie faite d’adultes jeunes d’âge moyen de 29 ans avec un sexe ratio de 1,7. Le délai moyen de consultation est de 18 mois. Ce retard de consultation est expliqué par une errance diagnostique en rapport avec une ressemblance du tableau clinique avec celui d’un ongle incarné. Le diagnostic est toujours confirmé par une radiographie de face et de profil de l’orteil intéressé. Le traitement a consisté en une exérèse radicale de l’exostose soit à travers une large fenêtre unguéale soit par un abord latéro-unguéal. L’examen anatomopathologique est systématique. Il a permis de confirmer la bénignité de l’affection dans tous les cas. La guérison a été de règle dans tous les cas avec une reprise de l’activité antérieure en 2 mois en moyenne. Aucune récidive n’a été notée.
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Affiliation(s)
- Mounira Khezami
- Service d'Orthopédie Traumatologie Hôpital Militaire Principal d'Instruction de Tunis, Tunisie
| | - Achraf Abdennadher
- Service d'Orthopédie Traumatologie Hôpital Militaire Principal d'Instruction de Tunis, Tunisie
| | - Hiba Bellaaj
- Service d'Orthopédie Traumatologie Hôpital Militaire Principal d'Instruction de Tunis, Tunisie
| | - Talel Znagui
- Service d'Orthopédie Traumatologie Hôpital Militaire Principal d'Instruction de Tunis, Tunisie
| | - Mounir Hamdi
- Service d'Orthopédie Traumatologie Hôpital Militaire Principal d'Instruction de Tunis, Tunisie
| | - Lotfi Nouisri
- Service d'Orthopédie Traumatologie Hôpital Militaire Principal d'Instruction de Tunis, Tunisie
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Abstract
BACKGROUND Arthroscopy has been increasingly used to evaluate small joints in the foot and ankle. In the hallux metatarsophalangeal (MTP) joint, little data exist evaluating the efficacy of arthroscopy to visualize the articular surface. The goal of this cadaveric study was to determine how much articular surface of the MTP joint could be visualized during joint arthroscopy. METHODS Ten fresh cadaveric foot specimens were evaluated using standard arthroscopy techniques. The edges of the visualized joint surface were marked with curettes and Kirschner wires; the joints were then surgically exposed and imaged. The visualized surface area was measured using ImageJ® software. RESULTS On the distal 2-dimensional projection of the joint surface, an average 57.5% (range, 49.6%-65.3%) of the metatarsal head and 100% (range, 100%-100%) of the proximal phalanx base were visualized. From a lateral view of the metatarsal head, an average 72 degrees (range, 65-80 degrees) was visualized out of an average total articular arc of 199 degrees (range, 192-206 degrees), for an average 36.5% (range, 32.2%-40.8%) of the articular arc. CONCLUSION Complete visualization of the proximal phalanx base was obtained. Incomplete metatarsal head visualization was obtained, but this is limited by technique limitations that may not reflect clinical practice. CLINICAL RELEVANCE This information helps to validate the utility of arthrosocpy at the hallux metatarsophalangeal joint.
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Affiliation(s)
| | - John T Campbell
- 2 Institute for Foot and Ankle Reconstruction, Mercy Medical Center, Baltimore, MD, USA
| | - Clifford L Jeng
- 2 Institute for Foot and Ankle Reconstruction, Mercy Medical Center, Baltimore, MD, USA
| | - R Frank Henn
- 3 Department of Orthopaedic Surgery, University of Maryland Medical Center, Baltimore, MD, USA
| | - Rebecca A Cerrato
- 2 Institute for Foot and Ankle Reconstruction, Mercy Medical Center, Baltimore, MD, USA
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Van Dyke B, Berlet GC, Daigre JL, Hyer CF, Philbin TM. First Metatarsal Head Osteochondral Defect Treatment With Particulated Juvenile Cartilage Allograft Transplantation: A Case Series. Foot Ankle Int 2018; 39:236-241. [PMID: 29110501 DOI: 10.1177/1071100717737482] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Focal damage to articular cartilage, also called an osteochondral defect (OCD), can be a cause of pain and decreased range of motion. Recent advancements have led to transplantation techniques using particulated juvenile articular cartilage allograft. This technique has been applied to the first metatarsal head to a very limited degree, with no published results to our knowledge. The aim of this study was to review the clinical results of patients who underwent particulated juvenile cartilage allograft implantation for first metatarsal head OCDs. METHODS We performed a retrospective consecutive case series study. Nine patients, at an average age of 41 years, were treated for symptomatic focal osteochondral defects of the first metatarsal head with particulate cartilage grafting from 2010 to 2016. Patients were contacted by phone to assess interest in returning to the office for follow-up, where weightbearing radiographs of the foot were obtained and a foot examination was performed. RESULTS At an average follow-up of 3.3 years, 7 of 9 patients reported no pain with recreational activities and no patient required further operations. This patient cohort was physically active, with 6 of 9 listing running as a regular activity. The average overall American Orthopaedic Foot & Ankle Society (AOFAS) Hallux Metatarsophalangeal-Interphalangeal Scale questionnaire score was 85 (maximum 100), AOFAS pain 35.6 (maximum 40), and AOFAS function 40.1 (maximum 45). Patient satisfaction surveys correlated with the AOFAS scores and revealed that 7 of 9 patients were very satisfied with their results, 1 was satisfied, and 1 patient was very dissatisfied. CONCLUSION Particulated juvenile cartilage allograft transplantation is a promising treatment option for symptomatic first metatarsophalangeal focal articular cartilage lesions. Further study is needed to demonstrate which lesions respond better to this type of cartilage graft versus traditional marrow-stimulating procedures. LEVEL OF EVIDENCE Level IV, retrospective case series.
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Patel BA, Organ JM, Jashashvili T, Bui SH, Dunsworth HM. Ontogeny of hallucal metatarsal rigidity and shape in the rhesus monkey (Macaca mulatta) and chimpanzee (Pan troglodytes). J Anat 2018; 232:39-53. [PMID: 29098692 PMCID: PMC5735049 DOI: 10.1111/joa.12720] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2017] [Indexed: 11/28/2022] Open
Abstract
Life history variables including the timing of locomotor independence, along with changes in preferred locomotor behaviors and substrate use during development, influence how primates use their feet throughout ontogeny. Changes in foot function during development, in particular the nature of how the hallux is used in grasping, can lead to different structural changes in foot bones. To test this hypothesis, metatarsal midshaft rigidity [estimated from the polar second moment of area (J) scaled to bone length] and cross-sectional shape (calculated from the ratio of maximum and minimum second moments of area, Imax /Imin ) were examined in a cross-sectional ontogenetic sample of rhesus macaques (Macaca mulatta; n = 73) and common chimpanzees (Pan troglodytes; n = 79). Results show the hallucal metatarsal (Mt1) is relatively more rigid (with higher scaled J-values) in younger chimpanzees and macaques, with significant decreases in relative rigidity in both taxa until the age of achieving locomotor independence. Within each age group, Mt1 rigidity is always significantly higher in chimpanzees than macaques. When compared with the lateral metatarsals (Mt2-5), the Mt1 is relatively more rigid in both taxa and across all ages; however, this difference is significantly greater in chimpanzees. Length and J scale with negative allometry in all metatarsals and in both species (except the Mt2 of chimpanzees, which scales with positive allometry). Only in macaques does Mt1 midshaft shape significantly change across ontogeny, with older individuals having more elliptical cross-sections. Different patterns of development in metatarsal diaphyseal rigidity and shape likely reflect the different ways in which the foot, and in particular the hallux, functions across ontogeny in apes and monkeys.
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Affiliation(s)
- Biren A. Patel
- Department of Integrative Anatomical SciencesKeck School of MedicineUniversity of Southern CaliforniaLos AngelesCAUSA
- Human and Evolutionary Biology SectionDepartment of Biological SciencesUniversity of Southern CaliforniaLos AngelesCAUSA
| | - Jason M. Organ
- Department of Anatomy and Cell BiologyIndiana University School of MedicineIndianapolisINUSA
- Department of Biomedical EngineeringIndiana University – Purdue University IndianapolisIndianapolisINUSA
| | - Tea Jashashvili
- Molecular Imaging CenterDepartment of RadiologyKeck School of MedicineUniversity of Southern CaliforniaLos AngelesCAUSA
- Department of Geology and PaleontologyGeorgian National MuseumTbilisiGeorgia
| | - Stephanie H. Bui
- Human and Evolutionary Biology SectionDepartment of Biological SciencesUniversity of Southern CaliforniaLos AngelesCAUSA
| | - Holly M. Dunsworth
- Department of Sociology and AnthropologyUniversity of Rhode IslandKingstonRIUSA
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Sun T, Zhao H, Wang L, Wu W. Partite hallux sesamoid bones: Relationship with sesamoid bones at other metatarsophalangeal joints. Anat Rec (Hoboken) 2017; 301:34-38. [PMID: 29024479 DOI: 10.1002/ar.23696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Revised: 03/27/2017] [Accepted: 04/19/2017] [Indexed: 11/10/2022]
Abstract
Partite hallux sesamoids are clinically meaningful but their association with other sesamoids is not clear. The objective was to relate the prevalence of the partite hallux sesamoid bones to sesamoid bones at other metatarsophalangeal (MTP) joints. We conducted a retrospective review of plain radiographs of 7946 adult feet between November 2005 and September 2012 to identify partite hallux sesamoids and sesamoids at other MTP joints. Coexistence patterns of the partition and extra sesamoids were studied. Presence or absence of sesamoids at other MTP joints as well as sex and laterality were compared between the feet with and without partite hallux sesamoids using Pearson Chi-square test. Association between age and partition was evaluated using Spearman's correlation coefficient. Overall partite prevalence rate is 6.82%, and coexistence with extra MTP sesamoids was 0.42%. One pattern was partition in hallux sesamoid only, and 4 patterns were coexistence with extra sesamoids. The prevalence rates of partite hallux sesamoids were 7.17% (508/7081) and 3.93% (34/865) in feet without and with extra sesamoids, respectively. The relative risk of 1.889 (95% CI, 1.325-2.693) of partite hallux sesamoids was noted in feet without than with extra sesamoids (Χ2 = 12.759, P < 0.001). A negative correlation between age and distribution of partition was identified (r = -0.061, P < 0.001). Partition of hallux sesamoid bones is a developmental variation, it can coexist with sesamoids at other MTP joints following a certain pattern; and its prevalence rate is almost twice higher in feet without than with extra MTP sesamoids. Anat Rec, 2017. © 2017 Wiley Periodicals, Inc. Anat Rec, 301:34-38, 2018. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Tao Sun
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, 050051, China
| | - Haitao Zhao
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, 050051, China
| | - Lingxiang Wang
- Department of Gynecology, Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, 050011, China
| | - Wenjuan Wu
- Department of Radiology, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, 050051, China
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Cody EA, Kraszewski AP, Marinescu A, Kunas GC, Mani SB, Rao S, Hillstrom HH, Ellis SJ. Measuring Joint Flexibility in Hallux Rigidus Using a Novel Flexibility Jig. Foot Ankle Int 2017; 38:885-892. [PMID: 28535691 DOI: 10.1177/1071100717709538] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The flexibility of the first metatarsophalangeal (MTP) joint in patients with hallux rigidus (HR) has not been studied. Compared to measuring range of motion alone, measures of joint flexibility provide additional information that may prove useful in the assessment of HR. The purpose of this study was to assess the flexibility of the hallux MTP joint in patients with HR compared to controls using a novel flexibility device. METHODS Fifteen patients with Coughlin stage II or III HR and 20 healthy controls were recruited prospectively. Using a custom flexibility jig, each of 2 raters performed a series of seated and standing tests on each subject. Dorsiflexion angle and applied torque were plotted against each other to generate 5 different parameters of flexibility. Differences between (1) HR patients and controls and (2) the sitting and standing testing positions were assessed with t tests. Intrarater test-retest reliability, remove-replace reliability, and interrater reliability were assessed with intraclass correlation coefficients (ICCs). RESULTS Patients in the HR group were older than patients in the control group ( P < .001) and had lower maximum dorsiflexion ( P < .001). HR patients were less flexible as measured by 3 of the 5 flexibility parameters: early flexibility (first 25% of motion; P = .027), laxity angle ( P < .001), and torque angle ( P = .002). After controlling for age, only laxity angle differed significantly between HR patients and controls ( P < .001). Generally, patients were more flexible when seated compared to standing, with this effect being more marked in HR patients. All parameters had good or excellent intra- and interrater reliability (ICC ≥ 0.60). CONCLUSIONS Hallux MTP joint flexibility was reliably assessed in HR patients using a flexibility device. Patients with HR had decreased flexibility of the hallux MTP joint compared to control patients. LEVEL OF EVIDENCE Level II, prospective comparative study.
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Affiliation(s)
| | | | | | | | | | - Smita Rao
- 3 New York University Steinhardt School of Culture Education and Human Development, New York, NY, USA
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Abstract
BACKGROUND Hallux rigidus can be treated using several different methods and the best treatment option depends on the severity of degenerative changes of the metatarsophalangeal (MTP) joint. However, the ideal operative option for advanced hallux rigidus remains debatable. This prospective study was performed to evaluate the intermediate-term clinical outcomes of distal metatarsal osteotomy used as a joint-preserving method for the treatment of advanced hallux rigidus. METHODS Forty-two cases (39 patients) were followed for more than 3 years after distal metatarsal dorsiflexion osteotomy for advanced hallux rigidus of grade III-IV. Clinical evaluations included the American Orthopaedic Foot & Ankle Society (AOFAS) scores, Foot and Ankle Ability Measure (FAAM) scores, and patient subjective satisfaction scores. Range of motion (ROM) of great toe, complications, reoperation rates, width of the MTP joint space, and times to union were evaluated. RESULTS Mean AOFAS hallux and mean FAAM scores significantly improved from 56.4 and 61.2 points preoperatively to 87.6 and 88.7 points at final follow-up, respectively ( P < .001). Grade III and IV groups had significantly different AOFAS and FAAM scores at final follow-up. Mean dorsiflexion of great toe significantly improved from 14.8° preoperatively to 35.5° at final follow-up ( P < .001). Mean patient satisfaction score at final follow-up was 92.8 points. There were 4 cases (9.5%) of subsequent fusion and 2 cases (4.8%) of transfer metatarsalgia. CONCLUSIONS Distal metatarsal dorsiflexion osteotomy using bio-compression screws appears to be an effective operative option for grade III advanced hallux rigidus with viable cartilage on >50% of the first metatarsal articular surface, as it restored joint motion, provided reliable pain relief, and did not require implant removal. However, based on the unsatisfactory clinical results and the high rate of reoperation observed, the authors cannot recommend this operative method for the treatment of end-stage (grade IV) hallux rigidus. LEVEL OF EVIDENCE Level IV, prospective case series.
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Affiliation(s)
- Byung-Ki Cho
- 1 Department of Orthopaedic Surgery, College of Medicine, Chungbuk National University, Cheongju, Korea
| | - Kyoung-Jin Park
- 1 Department of Orthopaedic Surgery, College of Medicine, Chungbuk National University, Cheongju, Korea
| | - Ji-Kang Park
- 1 Department of Orthopaedic Surgery, College of Medicine, Chungbuk National University, Cheongju, Korea
| | - Nelson F SooHoo
- 2 Department of Orthopaedic Surgery, School of Medicine, University of California, Los Angeles, CA, USA
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Zrig M, Othman Y, Bellaaj Z, Koubaa M, Abid A. Dislocation of the First Metatarsophalangeal Joint: A Case Report and Suggested Classification System. J Foot Ankle Surg 2017; 56:643-647. [PMID: 28314638 DOI: 10.1053/j.jfas.2016.12.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2015] [Indexed: 02/03/2023]
Abstract
Dislocation of the first metatarsophalangeal joint is a relatively rare and still poorly known injury. The current classification includes only the dorsal variety of this lesion; thus, as further cases of other varieties are reported, a larger understanding of this entity is required. We report the case of a young male with dorsal dislocation of the first metatarsophalangeal joint treated by closed reduction. The clinical outcome at the 2-year follow-up point is reported. A review of the published data of the variations of this injury reported to date is included, and a new summarizing classification is suggested.
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Affiliation(s)
- Makram Zrig
- Professor of Orthopedic Surgery, Department of Orthopaedic and Traumatic Surgery, Fattouma Bourguiba Hospital, Monastir, Tunisia.
| | - Youssef Othman
- Orthopedic Surgeon, Department of Orthopaedic and Traumatic Surgery, Fattouma Bourguiba Hospital, Monastir, Tunisia
| | - Zied Bellaaj
- Assistant Associate Professor of Orthopedic Surgery, Department of Orthopaedic and Traumatic Surgery, Fattouma Bourguiba Hospital, Monastir, Tunisia
| | - Mustapha Koubaa
- Professor of Orthopedic Surgery, Department of Orthopaedic and Traumatic Surgery, Fattouma Bourguiba Hospital, Monastir, Tunisia
| | - Abderrazek Abid
- Professor of Orthopedic Surgery, Head of Department, Department of Orthopaedic and Traumatic Surgery, Fattouma Bourguiba Hospital, Monastir, Tunisia
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49
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Donegan RJ, Blume PA. Functional Results and Patient Satisfaction of First Metatarsophalangeal Joint Arthrodesis Using Dual Crossed Screw Fixation. J Foot Ankle Surg 2017; 56:291-297. [PMID: 28231963 DOI: 10.1053/j.jfas.2016.10.021] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Indexed: 02/03/2023]
Abstract
A total of 262 feet in 228 consecutive patients underwent first metatarsophalangeal joint (MPJ) fusion; thus, the present study is the largest single-surgeon patient series reported. The inclusion criteria included severe painful deformity of the first MPJ due to osteoarthritis, rheumatoid arthritis, or gouty arthritis and stage 3 or 4 hallux rigidus. The exclusion criteria were revision surgery of the first MPJ, fixation other than with dual crossed screws, and a postoperative follow-up period of <3 months. Fusion of the first MPJ was fixated with dual-crossed 3.0-mm screws. The office follow-up period was ≥3 months postoperatively and the survey follow-up period was ≥6 months postoperatively. The mean duration to radiographic evidence of arthrodesis was 7.00 ± 2.33 weeks, and 252 of the feet (96.18%) achieved successful arthrodesis. The mean postoperative office follow-up duration was 30.43 ± 6.59 weeks. The mean modified American College of Foot and Ankle Surgeons scale score was 51.2 ± 3.28 of maximum possible of 68 points. The mean subjective score was 37.1 ± 2.5 (maximum possible of 50 points), and the mean objective score was 14.5 ± 1.7 (maximum possible of 18 points). Furthermore, 200 patients (87.72%) reported that they had little to no pain, 187 (82.02%) reported they either mostly liked the appearance of their toe or liked it very much, and 173 (75.88%) reported that they could wear any type of shoe most or all the time after the operation. Of the respondents, 207 (90.79%) stated they would have the surgery repeated, and 197 (86.40%) would recommend the surgery to a family member or friend.
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Affiliation(s)
| | - Peter A Blume
- Assistant Professor, Yale New Haven Hospital, New Haven, CT
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50
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Stevens J, Meijer K, Bijnens W, Fuchs MCHW, van Rhijn LW, Hermus JPS, van Hoeve S, Poeze M, Witlox AM. Gait Analysis of Foot Compensation After Arthrodesis of the First Metatarsophalangeal Joint. Foot Ankle Int 2017; 38:181-191. [PMID: 27770063 DOI: 10.1177/1071100716674310] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Arthrodesis of the first metatarsophalangeal (MTP1) joint is an intervention often used in patients with severe MTP1 joint osteoarthritis and relieves pain in approximately 80% of these patients. The kinematic effects and compensatory mechanism of the foot for restoring a more normal gait pattern after this intervention are unknown. The aim of this study was to clarify this compensatory mechanism, in which it was hypothesized that the hindfoot and forefoot would be responsible for compensation after an arthrodesis of the MTP1 joint. METHODS Gait properties were evaluated in 10 feet of 8 patients with MTP1 arthrodesis and were compared with 21 feet of 12 healthy subjects. Plantar pressures and intersegmental range of motion were measured during gait by using the multisegment Oxford Foot Model. Pre- and postoperative X-rays of the foot and ankle were also evaluated. RESULTS The MTP1 arthrodesis caused decreased eversion of the hindfoot during midstance, followed by an increased internal rotation of the hindfoot during terminal stance, and ultimately more supination and less adduction of the forefoot during preswing. In addition, MTP1 arthrodesis resulted in a lower pressure time integral beneath the hallux and higher peak pressures beneath the lesser metatarsals. A mean dorsiflexion fusion angle of 30 ± 5.4 degrees was observed in postoperative radiographs. CONCLUSION This study demonstrated that the hindfoot and forefoot compensated for the loss of motion of the MTP1 joint after arthrodesis in order to restore a more normal gait pattern. This resulted in a gait in which the rigid hallux was less loaded while the lesser metatarsals endured higher peak pressures. Further studies are needed to investigate whether this observed transfer of load or a preexistent decreased compensatory mechanism of the foot can possibly explain the disappointing results in the minority of the patients who experience persistent complaints after a MTP1 arthrodesis. LEVEL OF EVIDENCE Level III, comparative series.
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Affiliation(s)
- Jasper Stevens
- 1 Department of Orthopaedics, Maastricht University Medical Centre, The Netherlands
| | - Kenneth Meijer
- 2 Department of Human Movement Sciences, Maastricht University, The Netherlands
| | - Wouter Bijnens
- 2 Department of Human Movement Sciences, Maastricht University, The Netherlands
| | - Mathijs C H W Fuchs
- 1 Department of Orthopaedics, Maastricht University Medical Centre, The Netherlands
| | - Lodewijk W van Rhijn
- 1 Department of Orthopaedics, Maastricht University Medical Centre, The Netherlands
| | - Joris P S Hermus
- 1 Department of Orthopaedics, Maastricht University Medical Centre, The Netherlands
| | - Sander van Hoeve
- 3 Department of Surgery, Division of Trauma surgery, Maastricht University Medical Centre, The Netherlands
| | - Martijn Poeze
- 3 Department of Surgery, Division of Trauma surgery, Maastricht University Medical Centre, The Netherlands
| | - Adhiambo M Witlox
- 1 Department of Orthopaedics, Maastricht University Medical Centre, The Netherlands
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