RESUMEN
INTRODUCTION: Lisfranc injuries are uncommon but frequently misdiagnosed and carry a high rate of morbidity. OBJECTIVE: This review highlights the pearls and pitfalls of Lisfranc injuries, including presentation, diagnosis, and management in the emergency department (ED) based on current evidence. DISCUSSION: Lisfranc injuries are caused by high- or low-energy trauma to the tarsometatarsal (TMT) joint complex. The severity of injury exists on a spectrum, ranging from minor subluxations to fractures and dislocations involving the TMT joint complex. They can be complicated by compartment syndrome, neurovascular compromise, and open fractures. Prompt diagnosis is critical in preventing chronic pain and mobility challenges, as even small subluxations can result in significant morbidity. Lisfranc injuries should be considered in all patients with a foot injury. Patients with Lisfranc injuries most commonly present with midfoot pain, swelling, or ecchymosis. Despite the importance of a timely diagnosis, Lisfranc injuries are commonly missed on plain radiographs due to their often subtle findings. When x-rays are negative but there is significant clinical suspicion, emergency clinicians should obtain advanced imaging such as computed tomography to aid in diagnosis. All Lisfranc injuries should be discussed with orthopedic surgery to determine definitive management. Patients who can be discharged should be made non-weightbearing and placed in a short-leg splint. CONCLUSION: The consideration of Lisfranc injuries can help emergency clinicians make a timely diagnosis to prevent future complications.
Asunto(s)
Servicio de Urgencia en Hospital , Traumatismos de los Pies , Humanos , Traumatismos de los Pies/diagnóstico por imagen , Traumatismos de los Pies/epidemiología , Fracturas Óseas/diagnóstico por imagen , Huesos Metatarsianos/lesiones , Huesos Metatarsianos/diagnóstico por imagen , Incidencia , Tomografía Computarizada por Rayos X , Luxaciones Articulares/diagnóstico por imagen , Luxaciones Articulares/epidemiología , Articulaciones del Pie/lesiones , Articulaciones del Pie/diagnóstico por imagenRESUMEN
PURPOSE: We aimed to report the union rate after only utilizing a locally obtained autologous bone graft while correcting the deformity and performing joint arthrodesis in patients with foot and ankle Charcot neuropathy (CN) and to report on the radiographic, functional, complications incidence outcomes at a minimum of two years of follow up. METHODS: We included 24 patients having a mean age of 55.4 ± 10.1 years diagnosed with CN of the foot, ankle, or both. Seven (29.2%) cases were classified as Brodsky type 1, 11 (45.8%) as type 3 A, and six (25%) were type 4. Hindfoot and Midfoot bi-columnar arthrodesis was performed in 70.8% and 29.2% of the patients, respectively. Eight (33.3%) cases had preoperative ulcers. Functional outcomes were evaluated using a modified AOFAS score. Arthrodesis site union was assessed clinically and radiographically. All patients were available for a mean follow up of 35.7 ± 9.5 (24-54) months. RESULTS: Arthrodesis site union was achieved in 23 (95.8%) cases after a mean of 4 ± 1.7 (2-7.5) months. The mean modified AOFAS score was 72.4 ± 10.41 (46-83) points; 79.2% achieved excellent and good scores. Ulcers healed in 87.5% of the patients. Twenty-two (91.7%) patients were satisfied with their functional results. Infection incidence was 12.5%, and no patients required revision or amputation. CONCLUSION: Foot and ankle Charcot neuroarthropathy deformity correction by arthrodesis of the affected joint as a salvage management option resulted in acceptable clinical and radiological outcomes. To enhance the local environment for arthrodesis consolidation, locally obtained autografts led to higher union rates and avoided the drawbacks of using other graft types.
Asunto(s)
Artrodesis , Artropatía Neurógena , Trasplante Óseo , Trasplante Autólogo , Humanos , Artrodesis/métodos , Persona de Mediana Edad , Artropatía Neurógena/cirugía , Femenino , Masculino , Trasplante Óseo/métodos , Anciano , Adulto , Trasplante Autólogo/métodos , Resultado del Tratamiento , Estudios de Seguimiento , Articulación del Tobillo/cirugía , Articulación del Tobillo/diagnóstico por imagen , Factores de Tiempo , Articulaciones del Pie/cirugía , Articulaciones del Pie/diagnóstico por imagen , Estudios Retrospectivos , Pueblo NorteafricanoRESUMEN
Multisegmented foot models (MSFMs) are used to capture data of specific regions of the foot instead of representing the foot as a single, rigid segment. It has been documented that different MSFMs do not yield the same joint kinematic data, but there is little information available regarding their use for kinetic analysis. We compared the moment and power at the tibiotalar, midtarsal, and metatarsophalangeal joints of four MSFMs using motion capture data of young adult runners during stance phase of barefoot walking and jogging. Of these models, three were previously validated: the Oxford, Milwaukee, and Ghent Foot Models. One model was developed based upon literature review of existing models: the "Vogel" model. We performed statistical parametric mapping comparing joint measurements from each model to the corresponding results from the Oxford model, the most heavily studied MSFM. We found that the Oxford, Milwaukee, Vogel, and Ghent Foot Models do not provide the same kinetic results. The differences in segment definitions impact the degrees of freedom in a manner that alters the measured kinematic function of the foot, which in turn impacts the kinetic results. The results of this study capture the variability in performance of MSFMs as it relates to kinetic outcomes and emphasize a need to remain aware of model differences when interpreting results.
Asunto(s)
Pie , Modelos Biológicos , Humanos , Fenómenos Biomecánicos/fisiología , Pie/fisiología , Masculino , Femenino , Adulto , Caminata/fisiología , Cinética , Articulaciones del Pie/fisiología , Carrera/fisiología , Adulto Joven , Marcha/fisiologíaRESUMEN
Nitinol staple use in orthopedic surgery has increased in recent years. Biomechanical studies provide useful data for use in foot/ankle; however, clinical data is limited. This study's purpose is to determine the efficacy of nitinol staples to achieve stable, bony arthrodesis in midfoot and Chopart joints, and examine their clinical outcomes and pain scores. A retrospective chart review was performed on 127 midfoot/Chopart joint arthrodeses (71 patients) using nitinol staples in isolation. The primary outcome variable was radiographic evidence of healing. Radiographs were blinded, randomized, and independently reviewed by 3 board certified foot and ankle surgeons. Complete/partial union was seen in 89% of all joints (113/127), increasing to 93% when including only midfoot joints (98/106). Chopart joints had significantly lower healing rates (15/21; 71%) compared to all midfoot joints (p = .01) and isolated tarsometatarsal joints (86/91; 95%) (p = .006). Neuropathy and smoking did not affect arthrodesis, but diabetes did (p = .004). Joints requiring bone grafting had worse rates of arthrodesis (38/49; 76%) (p = .002). For all joints, postoperative visual analog scale scores were significantly lower than preoperative (p < .001). Preoperative midfoot and Chopart pain scores were similar (p = .30). Midfoot joints had significantly lower pain scores postoperatively than preoperatively (p < .001). No such significance existed in Chopart joints (p = .07). Isolated nitinol staples are a viable option for midfoot arthrodesis, especially tarsometatarsal joints, and offer significant pain improvement. Chopart joints may require more rigid fixation than nitinol staples, given the lower healing rate.
Asunto(s)
Aleaciones , Artrodesis , Radiografía , Suturas , Humanos , Artrodesis/instrumentación , Artrodesis/métodos , Estudios Retrospectivos , Masculino , Femenino , Persona de Mediana Edad , Anciano , Resultado del Tratamiento , Adulto , Grapado Quirúrgico , Dimensión del Dolor , Articulaciones del Pie/cirugía , Articulaciones del Pie/diagnóstico por imagen , Anciano de 80 o más AñosRESUMEN
BACKGROUND: Studies report that Lisfranc injury is more common than thought. Several imaging methods for assessing the stability of Lisfranc injury have been described but many are impossible to standardize and not accurate enough. PURPOSE: To present a three-dimensional (3D) method for analyzing the changes in the joint space width of the midfoot joint and the joints of the medial part of the Lisfranc complex in healthy individuals. MATERIAL AND METHODS: Non-weightbearing and weightbearing cone-beam computed tomography (CBCT) images of 11 healthy feet were acquired and analyzed with 3D software. The mean range of joint space width changes of each joint was computed from the changes in individual image pairs. RESULTS: 3D analysis software was used to analyze the medial part of the Lisfranc complex. In this sample of healthy feet, the changes in the joint spaces in the medial part of Lisfranc complex, calculated with 3D analysis software, was less than 0.6â mm. The distance between bones increased or decreased, depending on which part of the joint surface the measurements were taken. CONCLUSION: In this study, we present a 3D analysis method to evaluate midfoot joint space width changes. Our analysis revealed that in healthy feet there are only minimal changes in the joint space width between weightbearing and non-weightbearing indicating minimal movement of the midtarsal joints. The 3D analysis of weightbearing CBCT data provides a promising tool for analyzing the small midfoot joints in a variety of conditions.
Asunto(s)
Tomografía Computarizada de Haz Cónico , Articulaciones del Pie , Imagenología Tridimensional , Soporte de Peso , Humanos , Soporte de Peso/fisiología , Tomografía Computarizada de Haz Cónico/métodos , Imagenología Tridimensional/métodos , Masculino , Femenino , Adulto , Articulaciones del Pie/diagnóstico por imagen , Articulaciones del Pie/fisiología , Adulto Joven , Valores de Referencia , Persona de Mediana Edad , Voluntarios SanosRESUMEN
The movement of the ankle-foot complex joints is coupled as a result of various physiological and physical constraints. This study introduces a novel approach to the analysis of joint synergies and their physiological basis by focusing on joint rotational directions and the types of muscle contractions. We developed a biomimetic model of the ankle-foot complex with seven degrees of freedom, considering the skeletal configuration and physiological axis directions. Motion capture experiments were conducted with eight participants performing dorsiflexion and plantarflexion in open-chain states, as well as various walking tasks in closed-chain states, across different ground inclinations (±10, ±5, 0 deg) and walking speeds (3 and 4â kmâ h-1). Hierarchical cluster analysis identified joint synergy clusters and motion primitives, revealing that in open-chain movements, plantarflexion of the ankle, tarsometatarsal and metatarsophalangeal joints exhibited synergy with the inversion of the remaining joints in the complex; meanwhile, dorsiflexion was aligned with eversion. During closed-chain movements, the synergies grouping was exchanged in the subtalar, talonavicular and metatarsophalangeal joints. Further analysis showed that in open-chain movements, synergy patterns influenced by multi-joint muscles crossing oblique joint axes contribute to foot motion. In closed-chain movements, these changes in synergistic patterns enhance the propulsion of the center of mass towards the contralateral leg and improve foot arch compliance, facilitating human motion. Our work enhances the understanding of the physiological mechanisms underlying synergistic motion within the ankle-foot complex.
Asunto(s)
Articulación del Tobillo , Músculo Esquelético , Humanos , Articulación del Tobillo/fisiología , Músculo Esquelético/fisiología , Fenómenos Biomecánicos , Masculino , Adulto , Adulto Joven , Caminata/fisiología , Pie/fisiología , Articulaciones del Pie/fisiología , Femenino , Contracción Muscular/fisiologíaRESUMEN
BACKGROUND: Early detection of Lisfranc injury is critical for improving clinical outcomes, but diagnosing subtle injury can be difficult. Weightbearing computed tomography (WBCT) allows evaluation of such injuries in 3 dimensions (3D) under physiologic load. This study aimed to assess the utility of 1-, 2-, and 3-dimensional measurements on WBCT to diagnose subtle injury in isolated ligamentous Lisfranc injuries. METHODS: Ten cadaveric specimens underwent WBCT evaluation of the Lisfranc joint complex in the intact state and subsequently with sequential sectioning of the dorsal Lisfranc ligament and interosseous Lisfranc ligament (IOL) to create subtle Lisfranc injury, and finally after transectioning of plantar Lisfranc ligament (PLL) to create the injury conditions for complete ligamentous Lisfranc injury. Measurements under static vertical tibial load of 80 kg were performed on WBCT images including (1) Lisfranc joint (medial cuneiform-base of second metatarsal) volume, (2) Lisfranc joint area, (3) C1-C2 intercuneiform area, (4) C1-M2 distance, (5) C1-C2 distance, (6) M1-M2 intermetatarsal distance, (7) first tarsometatarsal (TMT1) alignment, (8) second tarsometatarsal (TMT2) alignment, (9) TMT1 dorsal step-off distance, and (10) TMT2 dorsal step-off distance. RESULTS: In the subtle Lisfranc injury state, Lisfranc joint volume and area, C1-M2 distance, and M1-M2 distance measurements on WBCT significantly increased, when compared with the intact state (P values .001 to .014). Additionally, Lisfranc joint volume and area, C1-M2 distance, M1-M2 distance, TMT2 alignment, and TMT2 dorsal step-off measurements were increased in the complete Lisfranc injury state. Of all measurements, C1-M2 distance had the largest area under the curve (AUC) of 0.96 (sensitivity = 90%; specificity = 90%), followed by Lisfranc volume (AUC = 0.90; sensitivity = 80%; specificity = 80%) and Lisfranc area (AUC = 0.89; sensitivity = 80%; specificity = 100%). CONCLUSION: In a cadaveric model we found that WBCT scan can increase the diagnostic accuracy for subtle Lisfranc injury. Among the measurements, C1-M2 distance exhibited the highest level of accuracy. The 2D joint area and 3D joint volume also proved to be accurate, with 3D volume measurements of the Lisfranc joint displaying the most significant absolute difference between the intact state and increasing severity of Lisfranc injury. These findings suggest that 2D joint area and 3D joint volume may have potential as supplementary measurements to more accurately diagnose subtle Lisfranc injuries. CLINICAL RELEVANCE: WBCT may help surgeons detect subtle Lisfranc injuries.
Asunto(s)
Cadáver , Ligamentos Articulares , Tomografía Computarizada por Rayos X , Soporte de Peso , Humanos , Tomografía Computarizada por Rayos X/métodos , Ligamentos Articulares/lesiones , Ligamentos Articulares/diagnóstico por imagen , Traumatismos de los Pies/diagnóstico por imagen , Articulaciones del Pie/diagnóstico por imagen , Articulaciones del Pie/lesiones , Huesos Metatarsianos/diagnóstico por imagen , Huesos Metatarsianos/lesiones , MasculinoRESUMEN
INTRODUCTION: The aim of this study was to examine the incidence and progression of foot osteoarthritis (OA), as well as associated factors, in a community-based cohort. METHODS: Baseline (2013-2015) and follow-up (2016-2018) foot radiographs were available for 541 participants (71% women, mean age 69 years; 35% black, 53% with obesity). The LaTrobe Foot Atlas was used to examine osteophytes (OPs, score 0-3) and joint space narrowing (JSN, score 0-3) at 5 joint sites. Incident foot radiographic OA (rOA) was a baseline score <2 OP and JSN in all 5 joints with ≥2 OP or JSN at follow-up in any of the joints. Progression was a worsening OP or JSN score in a joint with baseline foot rOA. At baseline and follow-up, participants reported the presence/absence of foot symptoms and completed the Foot and Ankle Outcome Score (FAOS) for each foot. Joint-based logistic regression models with generalized estimating equations were used to examine associations (adjusted odds ratio [aOR], 95% confidence interval [CI]) of foot rOA incidence and progression and with covariates. RESULTS: Among 928 feet without baseline rOA, 4% developed incident foot rOA (2% of those developed symptoms). Among 154 feet with baseline foot rOA, 55% had radiographic progression (16% of those had symptoms). Women and those with higher body mass index (BMI) were more likely to have incident foot rOA (aOR [95% CI] = 4.10 [1.22, 13.8] and 1.60 [1.31, 1.97], respectively); history of gout was associated with incidence or progression of foot rOA (2.75 [1.24, 6.07]). BMI was associated with worse scores on all FAOS subscales (aORs range 1.21-1.40). CONCLUSION: Progression of foot rOA is common but not necessarily related to worsening symptoms. BMI may be a modifiable risk factor for foot OA.
Asunto(s)
Progresión de la Enfermedad , Osteoartritis , Humanos , Femenino , Masculino , Anciano , Osteoartritis/epidemiología , Osteoartritis/diagnóstico por imagen , Incidencia , Estudios Longitudinales , Persona de Mediana Edad , Factores de Riesgo , Radiografía , Articulaciones del Pie/diagnóstico por imagenRESUMEN
This study aimed to elucidate the relationship between joint structures of the first tarsometatarsal and articular facet degeneration. A total of 100 feet from 50 cadavers were examined. The articular facets of the first metatarsal and medial cuneiform were categorized into four types based on the superior and inferior facets' separation, and the formation of the inferior lateral facet on the lateral plantar prominence: Type I, a single facet with no separation or inferior lateral facet; Type II-a, two facets with separation but no inferior lateral facet; Type II-b, two facets, no separation, but with an inferior lateral facet; Type III, three facets with separation and an inferior lateral facet. When both bone types matched, they were defined as Type I, Type II-a, Type II-b, and Type III joints, respectively; unmatched types were classified as Unpair joints. The severity of articular cartilage degeneration on both bones was assessed using a 5-point scale. The degeneration grade was compared among joint types. Type III joints exhibited significantly milder articular cartilage degeneration in medial cuneiform compared to Type II-a, II-b, Unpair joints. The formation of inferior lateral facet and separation of the superior and inferior facets might be crucial for the joint's stability.
Asunto(s)
Cadáver , Humanos , Femenino , Masculino , Anciano , Persona de Mediana Edad , Anciano de 80 o más Años , Cartílago Articular/patología , Huesos Metatarsianos/patología , Huesos Metatarsianos/anatomía & histología , Articulaciones Tarsianas/patología , Articulaciones Tarsianas/anatomía & histología , Articulaciones del Pie/patologíaRESUMEN
Tarso-metatarsal joints and naviculocuneiform joints comprising midfoot is the second most commonly involved joints following the first metatarsophalangeal joint in the foot. However, related factors of midfoot arthritis (MA) have been rarely reported. The bony structure and alignment can be more precisely assessed using Weight-Bearing Computed Tomography (WBCT) than conventional radiographs. Therefore, the aim of this study was to investigate risk factors for MA related to medical history and comorbid foot deformities using WBCT. WBCT data from September 2014 to April 2022 were extracted from a single referral hospital. All cases were divided into two groups by the presence of MA. Twenty-five potential related factors including demographics, etiology, and common co-occurring foot deformities were collected for comparison. Six hundred six cases (247 males and 359 females) among consecutive 1316 cases between September 2014 to April 2022 were selected. One hundred thirty-nine male cases (56.3%) and 210 female cases (58.5%) showed MA. In stepwise multiple logistic regression analysis, 5 factors remained statistically significant. The multivariate-adjusted odds ratios for age, laterality, body mass index (BMI), Progressive Collapsing Foot Deformity (PCFD), and lesser toe deformities (LTD) were 1.08, 1.54, 1.05, 6.62, and 3.03 respectively. Risk factors for MA associated with medical history and foot deformities included age, laterality, BMI, PCFD, and LDT.
Asunto(s)
Tomografía Computarizada por Rayos X , Soporte de Peso , Humanos , Masculino , Femenino , Persona de Mediana Edad , Factores de Riesgo , Anciano , Adulto , Estudios Retrospectivos , Artritis/diagnóstico por imagen , Articulaciones del Pie/diagnóstico por imagen , Deformidades del Pie/diagnóstico por imagenRESUMEN
This study explored the relationship between the morphological characteristics of the first tarsometatarsal ligaments and fibularis longus (FL) and the severity of articular cartilage degeneration in the first tarsometatarsal joint. Sixty legs from 30 cadavers were examined. The plantar, dorsal, and medial first tarsometatarsal ligaments were classified by fiber bundle number, and their morphological characteristics (fiber bundle length, width, thickness) were measured. The FL was categorized by its continuity with the plantar first tarsometatarsal ligament (PTML): Type A, connection with the PTML only on the first metatarsal; Type B, connection along the entire PTML; and Type C, no connection with the PTML. The severity of articular cartilage degeneration was assessed in four stages. No significant differences in cartilage degeneration among ligament types were found. Negative correlations were observed between the fiber bundle width and thickness of the PTML and the severity of cartilage degeneration. FL was classified as Type A in 68%, Type B in 27%, and Type C in 5% of feet. The fiber bundle thickness of the PTML in Type B was greater than in other types. Our findings suggest that smaller fiber bundle width and thickness in the PTML may be associated with severe cartilage degeneration. The FL had continuity with the PTML in 95% of feet and could enhance the mechanical strength of the PTML in Type B feet.
Asunto(s)
Ligamentos Articulares , Humanos , Femenino , Masculino , Anciano , Ligamentos Articulares/patología , Ligamentos Articulares/anatomía & histología , Anciano de 80 o más Años , Persona de Mediana Edad , Articulaciones del Pie/patología , Cadáver , Cartílago Articular/patología , Huesos Metatarsianos/patología , Huesos Metatarsianos/anatomía & histología , Articulaciones Tarsianas/patología , Articulaciones Tarsianas/anatomía & histologíaRESUMEN
BACKGROUND: Foot deformities (e.g. planovalgus and cavovarus) are very common in children with spastic cerebral palsy (CP), with the midfoot often being involved. Dynamic foot function can be assessed with 3D gait analysis including a multi-segment foot model. Incorporating a midfoot segment in such a model, allows quantification of separate Chopart and Lisfranc joint kinematics. Yet, midfoot kinematics have not previously been reported in CP. RESEARCH QUESTIONS: What is the difference in multi-segment kinematics including midfoot joints between common foot deformities in CP and typically-developing feet? METHODS: 103 feet of 57 children with spastic CP and related conditions were retrospectively included and compared with 15 typically-developing children. All children underwent clinical gait analysis with the Amsterdam Foot Model marker set. Multi-segment foot kinematics were calculated for three strides per foot and averaged. A k-means cluster analysis was performed to identify foot deformity groups that were present within CP data. The deformity type represented by each cluster was based on the foot posture index. Kinematic output of the clusters was compared to typically-developing data for a static standing trial and for the range of motion and kinematic waveforms during walking, using regular and SPM independent t-tests respectively. RESULTS: A neutral, planovalgus and varus cluster were identified. Neutral feet showed mostly similar kinematics as typically-developing data. Planovalgus feet showed increased ankle valgus and Chopart dorsiflexion, eversion and abduction. Varus feet showed increased ankle varus and Chopart inversion and adduction. SIGNIFICANCE: This study is the first to describe Chopart and Lisfranc joint kinematics in different foot deformities of children with CP. It shows that adding a midfoot segment can provide additional clinical and kinematic information. It highlights joint angles that are more distinctive between deformities, which could be helpful to optimize the use of multi-segment foot kinematics in the clinical decision making process.
Asunto(s)
Parálisis Cerebral , Humanos , Parálisis Cerebral/fisiopatología , Niño , Fenómenos Biomecánicos , Masculino , Femenino , Estudios Retrospectivos , Pie/fisiopatología , Rango del Movimiento Articular/fisiología , Análisis de la Marcha , Marcha/fisiología , Trastornos Neurológicos de la Marcha/fisiopatología , Trastornos Neurológicos de la Marcha/etiología , Deformidades del Pie/fisiopatología , Articulaciones del Pie/fisiopatología , Preescolar , AdolescenteRESUMEN
This study estimated the contribution of the midfoot joint complex (MJC) kinematics to the pelvis anterior-posterior positions during the stance phase of walking and investigated whether the MJC is functionally coordinated with the lower limb joints to maintain similar pelvic positions across steps. Hip, knee, ankle, and MJC sagittal angles were measured in 11 nondisabled participants during walking. The joints' contributions to pelvic positions were computed through equations derived from a link-segment model. Functional coordination across steps was identified when the MJC contribution to pelvic position varied and the summed contributions of other joints varied in the opposite direction (strong negative covariations [r ≤ -.7] in stance phase instants). We observed that the MJC plantarflexion (arch raising) during the midstance and late stance leads the pelvis backward, avoiding excessive forward displacement. The MJC was the second joint that contributed most to the pelvis positions (around 18% of all joints' contributions), after the ankle joint. The MJC and ankle were the joints that were most frequently coordinated with the other joints (â 70% of the stance phase duration). The findings suggest that the MJC is part of the kinematic chain that determines pelvis positions during walking and is functionally coordinated with the lower limb joints.
Asunto(s)
Caminata , Humanos , Masculino , Caminata/fisiología , Fenómenos Biomecánicos , Femenino , Adulto , Extremidad Inferior/fisiología , Articulación del Tobillo/fisiología , Articulaciones del Pie/fisiología , Pie/fisiología , Pelvis/fisiología , Articulación de la Cadera/fisiologíaRESUMEN
Time spent in the operating room is valuable to both surgeons and patients. One of the biggest rate-limiting factors when it comes to arthrodesis procedures of the foot and ankle is cartilage removal and joint preparation. Power instrumentation in joint preparation provides an avenue to decrease joint preparation time, thus decreasing operating room time and costs. Arthrodesis of 47 joints (n) from 27 patients were included. Power rasp joint preparation in 26 joints was compared to traditional osteotome and curette joint preparation in 21 joints in both time (seconds), cost (total operating room time cost per minute), and union rate. The overall mean joint preparation time using power rasp for the subtalar joint was 268.3 seconds, talonavicular joint 212.3 seconds, calcaneocuboid joint 142.6 seconds, 1st TMT 107.2 seconds. Mean joint preparation time using traditional method for subtalar joint 509.8 seconds, talonavicular joint 393.0 seconds, calcaneocuboid joint 400.0 seconds, 1st TMT 319.6 seconds. Mean cost of joint preparation using power rasp for subtalar joint $165.47, talonavicular joint $130.89, calcaneocuboid joint $87.94, 1st TMT $66.11. Mean cost of joint preparation using traditional techniques for subtalar joint $314.34, talonavicular joint $242.35, calcaneocuboid joint $246.67, 1st TMT $197.33. Overall union rate was 98% (1 asymptomatic non-union). Increasing efficiency in the operating room is vital to every surgeon's practice. Power rasp joint preparation is a viable option to increase efficiency and decrease operative time, this study shows no statistically significant differences in union rate, with comparable rates to existing literature.
Asunto(s)
Artrodesis , Tempo Operativo , Humanos , Artrodesis/economía , Artrodesis/métodos , Masculino , Femenino , Persona de Mediana Edad , Articulaciones del Pie/cirugía , Adulto , Estudios Retrospectivos , Anciano , Osteotomía/economía , Osteotomía/métodosRESUMEN
The role of the many small foot articulations and plantar tissues in gait is not well understood. While kinematic multi-segment foot models have increased our knowledge of foot segmental motions, the integration of kinetics with these models could further advance our understanding of foot mechanics and energetics. However, capturing and effectively utilizing segmental ground reaction forces remains challenging. The purposes of this study were to (1) develop methodology to integrate plantar pressures and shear stresses with a multi-segment foot model, and (2) generate and concisely display key normative data from this combined system. Twenty-six young healthy adults walked barefoot (1.3 m/s) across a pressure/shear sensor with markers matching a published 4-segment foot model. A novel anatomical/geometric template-based masking method was developed that successfully separated regions aligned with model segmentation. Directional shear force plots were created to summarize complex plantar shear distributions, showing opposing shear forces both between and within segments. Segment centers of pressure (CoPs) were shown to be primarily stationary within each segment, suggesting that forward progression in healthy gait arises primarily from redistributing weight across relatively fixed contact points as opposed to CoP movement within a segment. Inverse dynamics-based normative foot joint moments and power were presented in the context of these CoPs to aid in interpretation of tissue stresses. Overall, this work represents a successful integration of motion capture with direct plantar pressure and shear measurements for multi-segment foot kinetics. The presented tools are versatile enough to be used with other models and contexts, while the presented normative database may be useful as a baseline comparison for clinical work in gait energetics and efficiency, balance, and motor control. We hope that this work will aid in the advancement and availability of kinetic MSF modeling, increase our knowledge of foot mechanics, and eventually lead to improved clinical diagnosis, rehabilitation, and treatment.
Asunto(s)
Pie , Modelos Biológicos , Humanos , Pie/fisiología , Adulto , Masculino , Femenino , Marcha/fisiología , Presión , Estrés Mecánico , Fenómenos Biomecánicos , Cinética , Articulaciones del Pie/fisiologíaRESUMEN
BACKGROUND: The purpose of this study was to evaluate the prevalence of foot involvement in psoriatic arthritis and to describe its different clinical and radiological features. PATIENTS AND METHODS: We conducted a cross sectional study including 40 patients with psoriatic arthritis over a period of 12 months. Anamnesis, clinical examination of feet, podoscopic examination, X-rays of feet and heels, and ultrasound in B mode and power Doppler mode were done for each patient. RESULTS: Foot involvement was found in 95% of cases. It was symptomatic in 70% and inaugural of the disease in 20% of cases. The hindfoot and the forefoot were the sites most affected (77.5% and 47.5% respectively). The involvement of the midfoot was rarer (25%). Dactylitis was found in 17.5% and deformities of forefoot were found in 22.5% of cases. Antalgic gait was noted in 17.5% and static disorders of foot at podoscopic examination were identified in 35% of cases. Feet dermatological manifestations were found in 45% of cases. Diagnosis of different rheumatological manifestations was based on clinical findings and caracteristic radiological images on X-rays. We demonstrate he sensitivity of ultrasound in the detection and the diagnosis of different foot lesions including enthesitis, synovitis and tenosynovitis, dactylitis, bone erosions and psoriatic nail dystrophy.
Asunto(s)
Artritis Psoriásica , Radiografía , Humanos , Artritis Psoriásica/diagnóstico por imagen , Artritis Psoriásica/complicaciones , Artritis Psoriásica/epidemiología , Masculino , Estudios Transversales , Femenino , Persona de Mediana Edad , Adulto , Prevalencia , Anciano , Enfermedades del Pie/diagnóstico por imagen , Enfermedades del Pie/epidemiología , Articulaciones del Pie/diagnóstico por imagen , Pie/diagnóstico por imagenRESUMEN
Injury to the tarsometatarsal joint (TMT) results in instability throughout the midfoot that does not often improve with conservative management. If instability is identified, surgical intervention is frequently recommended, either open reduction and internal fixation (ORIF) or primary arthrodesis (PA). These 2 treatment options have been compared in the literature multiple times, often reporting similar outcomes. Due to this, as well as the need for subsequent hardware removal after ORIF has led many surgeons towards PA at the index surgery. Concern for nonunion is a leading concern with surgeons who advocate instead for ORIF. The purpose of this study is to review patients who underwent PA and observe nonunion rates. Nonunion at the TMT has been previously studied, but only in the chronic setting. We performed a retrospective study of 34 patients who had PA in the management of an acute Lisfranc injury. The average age in our study was 43.9 years old (range 19-72, SD 17.4) with an average follow-up of 9.4 months (range 4-33, SD 6.2). Radiographs were evaluated for signs of nonunion at regular postoperative intervals. Within the patients included in the study, a total of 71 TMT joints were fused. Overall successful fusion rate was 95.8% at an average of 7.9 weeks (range 6-12, SD 1.4) postoperatively. Individual nonunion rates at the first, second, and third TMT were 0%, 1.4% and 2.8% respectively. Our study demonstrates that primary arthrodesis provides a predictable outcome with low nonunion rates in the management of acute Lisfranc injury.
Asunto(s)
Artrodesis , Fracturas no Consolidadas , Humanos , Artrodesis/métodos , Estudios Retrospectivos , Adulto , Persona de Mediana Edad , Masculino , Femenino , Anciano , Fracturas no Consolidadas/cirugía , Fracturas no Consolidadas/diagnóstico por imagen , Adulto Joven , Fijación Interna de Fracturas/métodos , Huesos Metatarsianos/lesiones , Huesos Metatarsianos/cirugía , Articulaciones Tarsianas/cirugía , Articulaciones Tarsianas/lesiones , Resultado del Tratamiento , Traumatismos de los Pies/cirugía , Traumatismos de los Pies/diagnóstico por imagen , Estudios de Seguimiento , Articulaciones del Pie/cirugía , Articulaciones del Pie/lesiones , Articulaciones del Pie/diagnóstico por imagen , RadiografíaRESUMEN
The primary purpose of this study was to compare the ankle joint mechanics, during the stance phase of running, computed with a multi-segment foot model (MULTI; three segments) with a traditional single segment foot model (SINGLE). Traditional ankle joint models define all bones between the ankle and metatarsophalangeal joints as a single rigid segment (SINGLE). However, this contrasts with the more complex structure and mobility of the human foot, recent studies of walking using more multiple-segment models of the human foot have highlighted the errors arising in ankle kinematics and kinetics by using an oversimplified model of the foot. This study sought to compare whether ankle joint kinematics and kinetics during running are similar when using a single segment foot model (SINGLE) and a multi-segment foot model (MULTI). Seven participants ran at 3.1 m/s while the positions of markers on the shank and foot were tracked and ground reaction forces were measured. Ankle joint kinematics, resultant joint moments, joint work, and instantaneous joint power were determined using both the SINGLE and MULTI models. Differences between the two models across the entire stance phase were tested using statistical parametric mapping. During the stance phase, MULTI produced ankle joint angles that were typically closer to neutral and angular velocities that were reduced compared with SINGLE. Instantaneous joint power (p<0.001) and joint work (p<0.001) during late stance were also reduced in MULTI compared with SINGLE demonstrating the importance of foot model topology in analyses of the ankle joint during running. This study has highlighted that considering the foot as a rigid segment from ankle to MTP joint produces poor estimates of the ankle joint kinematics and kinetics, which has important implications for understanding the role of the ankle joint in running.
Asunto(s)
Articulación del Tobillo , Carrera , Humanos , Tobillo , Caminata , Pierna , Fenómenos Biomecánicos , Articulaciones del Pie , MarchaRESUMEN
OBJECTIVES: Hallux valgus is associated with tarsometatarsal arthritis; its pathophysiology remains unknown. Therefore, we aimed to elucidate the relationship between arthritis of the second and third tarsometatarsal joints and incongruity of the first tarsometatarsal joint in the sagittal plane. METHODS: Forty-three patients (64 feet) with hallux valgus who underwent surgery at University Hospital Kyoto Prefectural University of Medicine were included and divided into two groups: control (without second and third tarsometatarsal joint degeneration) and osteoarthritis (with second and third tarsometatarsal joint degeneration). Intergroup comparisons of the incongruity of the first tarsometatarsal joint in the sagittal plane, age, body mass index, hallux valgus angle, first-second intermetatarsal angle, metatarsus adductus angle, Meary's angle, and calcaneal pitch angle were performed. RESULTS: The proportion of patients with incongruity of the first tarsometatarsal joint was significantly higher in the osteoarthritis group than in the control group. Logistic regression analysis identified incongruity of the first tarsometatarsal joint and metatarsus adductus angle as significant related factors for arthritis of the second and third tarsometatarsal joints. CONCLUSIONS: Incongruity of the first tarsometatarsal joint in the sagittal plane was involved in the development of arthritis of the second and third tarsometatarsal joints in patients with hallux valgus.
Asunto(s)
Hallux Valgus , Huesos Metatarsianos , Metatarso Varo , Osteoartritis , Humanos , Hallux Valgus/complicaciones , Hallux Valgus/diagnóstico por imagen , Hallux Valgus/cirugía , Metatarso Varo/complicaciones , Articulaciones del Pie , Huesos Metatarsianos/diagnóstico por imagen , Huesos Metatarsianos/cirugía , Osteoartritis/complicaciones , Osteoartritis/diagnóstico por imagen , Osteoartritis/cirugíaRESUMEN
OBJECTIVE: This study compared radiographic measures of foot structure between people with and without symptomatic radiographic midfoot osteoarthritis (OA). METHODS: This was a cross-sectional study of adults aged 50 years and older registered with four UK general practices who reported foot pain in the past year. Bilateral weightbearing dorsoplantar and lateral radiographs were obtained. Symptomatic radiographic midfoot OA was defined as midfoot pain in the last 4 weeks, combined with radiographic OA in one or more midfoot joints (first cuneometatarsal, second cuneometatarsal, navicular-first cuneiform, and talonavicular). Midfoot OA cases were matched 1:1 for sex and age to controls with a 5-year age tolerance. Eleven radiographic measures were extracted and compared between the groups using independent sample t-tests and effect sizes (Cohen's d). RESULTS: We identified 63 midfoot OA cases (mean ± SD age was 66.8 ± 8.0 years, with 32 male and 31 female participants) and matched these to 63 controls (mean ± SD age was 65.9 ± 7.8 years). There were no differences in metatarsal lengths between the groups. However, those with midfoot OA had a higher calcaneal-first metatarsal angle (d = 0.43, small effect size, P = 0.018) and lower calcaneal inclination angle (d = 0.46, small effect size, P = 0.011) compared with controls. CONCLUSIONS: People with midfoot OA have a flatter foot posture compared with controls. Although caution is required when inferring causation from cross-sectional data, these findings are consistent with a pathomechanical pathway linking foot structure to the development of midfoot OA. Prospective studies are required to determine the temporal relationships between foot structure, function, and the development of this common and disabling condition.