Effects of Different Habitual Foot Strike Patterns During Running on Achilles Tendon Morphology and Mechanical Loading / 医用生物力学

Objective To investigate the effects of different foot strike patterns during running on Achilles tendon(AT)morphology and mechanical loading.Methods Fourteen habitual rearfoot strike runners and 14 habitual forefoot strike runners were recruited.Morphological characteristics(tendon length,cross-sectional area,and thickness)of the AT were collected using ultrasound imaging.The AT loading characteristics(plantar flexion moment,tendon force,load rate,impulse,and stress)of subjects wearing cushioned running shoes while running at a speed of 10 km/h were collected and calculated using a three-dimensional force measurement treadmill.Results Compared to habitual rearfoot strike runners,habitual forefoot strike runners showed a significant increase in peak plantar flexion moment of ankle joint,AT peak force,average loading rate,and peak loading rate(P<0.05).However,the differences in AT length,cross-sectional area,and thickness between the two groups were not statistically significant(P>0.05).Conclusions Long-term forefoot strike patterns can adaptively enhance the mechanical loading characteristics of the AT during repetitive stretch-shortening cycles.

Resultados del tratamiento funcional de las fracturas del metatarso en las fracturas del primer radio / Results of Functional Treatment of Metatarsal Fractures in First Radius Fractures

Introducción: Las fracturas del metatarso son las lesiones traumáticas más comunes del pie, y las del primer metatarsiano son las cuartas en frecuencia. El tratamiento funcional de las fracturas metatarsianas consiste en el apoyo efectivo y precoz, sin inmovilización del miembro. Objetivo: Comparar la efectividad del tratamiento funcional en las fracturas del primer metatarsiano con los tratamientos convencionales Métodos: Se realizó un estudio analítico, observacional, retrospectivo, de casos y controles, en 102 fracturas del primer metatarsiano durante un período de ocho años. La muestra incluyó a pacientes de ambos sexos, entre 16 y 65 años de edad. Se comparó el tratamiento funcional con los tratamientos ortopédico y quirúrgico. Las fracturas fueron clasificadas según su localización, recomendación terapéutica y tratamiento efectuado. Los resultados fueron evaluados en función de la duración de la incapacidad temporal y las complicaciones. Resultados: 48 fracturas fueron tratadas con el método funcional y 41 mediante descarga e inmovilización. Los 13 pacientes con criterio de indicación quirúrgica fueron intervenidos mediante reducción y osteosíntesis. Se obtuvo una menor duración de la incapacidad y menos complicaciones con el tratamiento funcional que con los tratamientos convencionales. Conclusiones: En los últimos años ha aumentado la tendencia a tratar las fracturas metatarsianas de manera conservadora y muchos autores recomiendan el método funcional como tratamiento de elección. Este proporciona una curación más temprana y ocasiona menos complicaciones que los tratamientos convencionales(AU)

Introduction: Metatarsal fractures are the most common traumatic injuries of the foot, and those of the first metatarsal are the fourth in frequency. The functional treatment of metatarsal fractures consists of effective and early support, without limb immobilization. Objective: To compare the effectiveness of functional treatment in fractures of the first metatarsal with conventional treatments. Methods: An analytical, observational, retrospective, case-control study was conducted on 102 first metatarsal fractures over a period of eight years. The sample included patients of both sexes, between 16 and 65 years of age. Functional treatment was compared with orthopedic and surgical treatments. The fractures were classified according to location, therapeutic recommendation and treatment. The results were evaluated according to the duration of the temporary incapacity and the complications. Results: Forty eight fractures were treated with the functional method and 41 by offloading and immobilization. The thirteen patients with surgical indication criteria were operated by reduction and osteosynthesis. A shorter duration of disability and fewer complications were achieved with functional treatment than with conventional treatments. Conclusions: In recent years, the tendency to treat metatarsal fractures conservatively has increased and many authors recommend the functional method as the treatment of choice. This provides earlier healing and causes fewer complications than conventional treatments(AU)

Repair of soft tissue defect of mid-and forefoot with anterolateral wide pedicled double dynamic flap of calf / 中华显微外科杂志

Objective:To investigate the effects of anterolateral wide pedicled double dynamic flap of the calf in repair of soft tissue defects of mid-and forefoot.Methods:From September 2015 to Septemler 2020, 15 cases with severe soft tissue defects of mid-and forefoot were repaired with the anterolateral wide pedicled double dynamic flap of the calf. There were 11 males and 4 females with an average age of 37(range, 22-53)years old. Of the 15 cases, the defects were caused by traffic accident in 6 cases and objects smash in 9 cases. Three cases were simple soft tissue defect, and 12 cases combined with fracture or dislocation and bone defect. The size of soft tissue defects ranged from 4 cm×5 cm to 7 cm×12 cm. All wounds of donor sites were repaired by skin grafting. All patients entered follow-ups at the outpatient clinic or through WeChat. The appearance of flaps and limb recovery were recorded after surgery.Results:All cases followed-up for 6-24 (mean, 16) months. Two days after surgery, 1 case had flap swelling and cyanosis, which was improved after pedicle suture removal and surface bloodletting. The pedicle of the flap was slightly bloated in 4 cases, and the texture and appearance were good in 11 cases. The ankle function of all cases recovered satisfactorily. The ranges of ankle motion were 15°-20° for dorsiflexion and 30°-40° for plantar flexion. The donor site healed well and all the skin grafts survived.Conclusion:The anterolateral wide pedicled double dynamic flap of the calf is one of the ideal flaps for repairing the soft tissue defects of the mid-and forefoot with reliable blood supply, sufficient venous return, simple operation and no require a vascular anastomosis.

Weightbearing Forefoot Axial Radiography - Technical Description and Reproducibility Evaluation / Radiografia axial do antepé com carga - Descrição da técnica e avaliação da reprodutibilidade

Abstract Objective The present study aims to describe a new weightbearing radiographic method to visualize the heads of the five metatarsals on the coronal plane, evaluating their accuracy through intraclass correlation coefficients. Methods The subjects were evaluated, with weightbearing, with the ankle at 20 degrees of plantar flexion and the metatarsophalangeal joints at 10 degrees of extension, positioned on a wooden device. Two independent foot and ankle surgeons evaluated the radiography, with one of them doing it twice, at different moments, achieving an inter and intraobserver correlation, with intraclass correlation coefficients. Results We radiographed 63 feet, achieving an interobserver correlation coefficient of the radiographic method for the metatarsal heads heights in the coronal plane of the 1st, 2nd, 3rd, 4th, and 5th metatarsals of, respectively, 0.90, 0.85, 0.86, 0.83, 0.89. The intraobserver correlation coefficient were, respectively, 0.95, 0.93, 0.93, 0.86, 0.92. Conclusion Those correlations demonstrate that the method is accurate and can be used to investigate metatarsal head misalignments in this plane.

Resumo Objetivo Este estudo tem como objetivo descrever um novo método radiográfico com carga fisiológica para visualizar as cabeças dos cinco metatarsos no plano coronal. Métodos Os indivíduos foram radiograficamente avaliados com carga, com o tornozelo a 20º de flexão plantar e as articulações metatarsofalângicas a 10º de extensão, posicionadas em um dispositivo de madeira. As medidas foram aferidas por dois avaliadores independentes, sendo que um deles mediu em dois momentos distintos, obtendo a correlação inter e intraobservador, com o coeficiente de correlação intraclasses. Resultados Examinamos 63 pés, obtendo um coeficiente de correlação interobservador do método radiográfico para as alturas das cabeças dos metatarsos no plano coronal do 1º, 2º, 3º, 4º e 5º metatarsos de, respectivamente, 0,90, 0,85, 0,86, 0,83, 0,89. O coeficiente de correlação intraobservador foi, respectivamente, 0,95, 0,93, 0,93, 0,86, 0,92. Conclusão Essas correlações demonstram que o método é preciso e pode ser usado para investigar os desalinhamentos de cabeça dos metatarsos nesse plano.

Accuracy of magnetic resonance imaging for diagnosing hallux valgus / Acurácia da ressonância magnética para o diagnóstico de hálux valgo

Abstract Objective: To assess the accuracy of magnetic resonance imaging (MRI) for the diagnosis of hallux valgus using radiography during weight bearing as the gold standard. Materials and Methods: This was a retrospective analysis of all patients undergoing MRI of the foot and radiography of the foot during weight bearing at our institution between January and June of 2015. The hallux valgus angle (HVA) was measured on MRI and radiography. The Wilcoxon signed-rank test and simple linear regression were used in order to compare measurements. Patients were divided into two groups according to the HVA determined on radiography: > 15° (hallux valgus) and ≤ 15° (control). Qualitative and quantitative assessments of MRI scans were performed. For quantitative assessment, receiver operating characteristic curves were used in order to determine the HVA cutoff with the highest accuracy. Results: A total of 66 MRI scans were included, 22 in the hallux valgus group and 44 in the control group. Wilcoxon signed-rank tests indicated a significant difference between the radiography and MRI measurements. Simple linear regression showed a nonlinear relationship between the measurements and values did not present a strong correlation. In comparison with the radiography measurements, MRI with an HVA cutoff of 16.4° exhibited the highest accuracy (86%). The accuracy of the subjective (qualitative) assessment was inferior to the objective assessment (measurement of the HVA). Conclusion: Hallux valgus can be diagnosed by measuring the HVA on MRI, satisfactory accuracy being achieved with an HVA cutoff of 16.4°.

Resumo Objetivo: Avaliar a acurácia da ressonância magnética (RM) para o diagnóstico de hálux valgo usando radiografias com carga como padrão ouro. Materiais e Métodos: Análise retrospectiva de pacientes que realizaram RM do antepé e radiografias com carga, de janeiro a junho de 2015. O ângulo metatarsofalangiano (AMF) foi medido nas RMs e nas radiografias. O teste de Wilcoxon e regressão linear foram utilizados para comparar as mensurações. Pacientes foram divididos de acordo com os valores do AMF nas radiografias: > 15° (hálux valgo) e ≤ 15° (grupo controle). Avaliações qualitativa e quantitativa foram realizadas por RM. Para análise quantitativa, uma curva ROC foi utilizada para definir o ponto de corte com maior acurácia. Resultados: Foram incluídas 66 RMs, 22 no grupo com hálux valgo e 44 no grupo controle. O teste de Wilcoxon indicou diferença significativa entre os métodos. Avaliação de regressão demonstrou relação não linear entre as medidas e e os valores não apresentaram boa correlação. Considerando os grupos hálux valgo e controle, um valor de corte 16,4° na RM demonstrou maior acurácia (86%). A avaliação subjetiva foi inferior à avaliação objetiva. Conclusão: A medida do AMF na RM pode ser utilizada para diagnóstico de hálux valgo, com um valor de corte de 16,4°.

Forefoot disorders and conservative treatment / 영남의대학술지

Forefoot disorders are often seen in clinical practice. Forefoot deformity and pain can deteriorate gait function and decrease quality of life. This review presents common forefoot disorders and conservative treatment using an insole or orthosis. Metatarsalgia is a painful foot condition affecting the metatarsal (MT) region of the foot. A MT pad, MT bar, or forefoot cushion can be used to alleviate MT pain. Hallux valgus is a deformity characterized by medial deviation of the first MT and lateral deviation of the hallux. A toe spreader, valgus splint, and bunion shield are commonly applied to patients with hallux valgus. Hallux limitus and hallux rigidus refer to painful limitations of dorsiflexion of the first metatarsophalangeal joint. A kinetic wedge foot orthosis or rocker sole can help relieve symptoms from hallux limitus or rigidus. Hammer, claw, and mallet toes are sagittal plane deformities of the lesser toes. Toe sleeve or padding can be applied over high-pressure areas in the proximal or distal interphalangeal joints or under the MT heads. An MT off-loading insole can also be used to alleviate symptoms following lesser toe deformities. Morton's neuroma is a benign neuroma of an intermetatarsal plantar nerve that leads to a painful condition affecting the MT area. The MT bar, the plantar pad, or a more cushioned insole would be useful. In addition, patients with any of the above various forefoot disorders should avoid tight-fitting or high-heeled shoes. Applying an insole or orthosis and wearing proper shoes can be beneficial for managing forefoot disorders.

Clinical application of lateral supramalleolar perforator flap with the rotation point down on the repair of forefoot soft tissue defect / 中华显微外科杂志

Objective To investigate the clinical effect of lateral supramalleolar perforator flap with the rotation point down on the repair of forefoot soft tissue defect.Methods From January,2016 to June,2017,23 cases (15 males and 8 females) of forefoot soft tissue defect were repaired by lateral supramalleolar perforator flap with the rotation point down.The age ranged from 8 to 67 (mean,42.9) years.The soft tissue defects were located far from the tarsometatarsal joint of the foot and the areas were 4.0 cm×4.0 cm-8.0 cm×12.0 cm.The areas of flap stitched directly or take blade thick skin repair on the thigh.All cases were followed-up by telephone or Internet,outpatient visit and home visit.Results Twenty-one cases survived successfully.Small area necrosis occurred at the distal end of the flap in 1 case,and healed after changing treatment.In the other cases,tension blister appeared at the distal end of the flap.After cut off some surgical stitches,the flap survived.All cases were followed-up from 6 to 12 months.The shape of flaps were not bloated and had good textures.The walking of affected limbs had no significant effect,and the functional recovery was satisfactory.Conclusion The lateral supramalleolar perforator flap is easy to cut and the perforator of flap is constant,which is a appropriate flap to repair the soft tissue defect of the forefoot.

Minimally Invasive Surgery for Hallux Valgus Deformity Using Intramedullary Low Profile Plate Fixation: A Case Report / 대한족부족관절학회지

According to a recent systemic review, hallux valgus deformity has a prevalence rate of about 23% among adults aged 18 to 65 years. To date, more than 100 operative methods have been reported for the correction of hallux valgus deformity. For young female with mild to moderate hallux valgus deformity, minimally invasive surgery can be considered for aesthetic demands. Here, we report a case of a young female patient with mild hallux valgus deformity treated by minimally invasive surgery using intramedullary low profile plate fixation. This can be the favorable method for secure fixation of the osteotomy site and prevention of medial skin irritation symptoms derived from a sharp osteotomy margin.

Effectiveness of wide fascial and doubly vascularized pedicle posterior cnemis flap in repair of soft tissue defect of forefoot / 中国修复重建外科杂志

Objective: To investigate the effectiveness of wide fascial and doubly vascularized pedicle posterior cnemis flap in repair of the soft tissue defect of forefoot. Methods: Between March 2011 and March 2017, 18 cases with severe soft tissue defects of forefeet were repaired with the wide fascial and doubly vascularized pedicle posterior cnemis flaps. There were 13 males and 5 females with an average age of 33 years (range, 11-49 years). Of 18 cases, the defects were caused by trauma in 16 cases with an average disease duration of 15 hours (range, 3-72 hours), by infection after correction of spastic clubfoot in 1 case, and by infection after open fracture fixation in 1 case. The defects were on the planta of forefoot in 11 cases and on the dorsum of forefoot in 7 cases. The size of soft tissue defects ranged from 6 cm×4 cm to 15 cm×9 cm. All defects combined with the bone, joint, and tendon exposures and 4 defects combined with fractures. The size of flaps ranged from 8 cm×5 cm to 17 cm×10 cm. All wounds of donor sites were repaired by skin grafting. Results: The operation time was 100-190 minutes (mean, 140 minutes). Seventeen flaps survived and wounds healed by first intention. One flap had partial necrosis and cured after dressing change. Seventeen cases were followed up 5-24 months (mean, 16 months). Both the color and texture of the flaps were satisfactory. But the pedicles of flaps were swollen. The functions of foot and ankle returned to normal. Conclusion: The wide fascial and doubly vascularized pedicle posterior cnemis flap has reliable blood supply and sufficient venous reflux to ensure its survive, which can be used to repair severe soft tissue defect of forefoot.

Tratamiento integral del antepié con doble braquimetatarsia bilateral en un tiempo quirúrgico. Reporte de un caso / Case report: comprehensive treatment of forefoot with double brachymetatarsia in one surgical stage

Resumen: La braquimetatarsia (acortamiento metatarsal) afecta directamente el arco transverso del pie condicionando graves deformidades como hallux valgus, divergencia digital, dedo supraaducto, metatarsalgia, todas estas alteran la biomecánica del pie y la marcha. El tratamiento se realiza mediante dos técnicas principales, elongación en un solo tiempo quirúrgico con interposición de injerto óseo o elongación por callotaxis con minifijador externo. Existen variantes de ambas técnicas con la finalidad de disminuir las desventajas de cada una de ellas. El objetivo del tratamiento debe ser devolver la armonía estructural del antepié, con lo que mejora la biomecánica, traduciéndose en una evolución satisfactoria para los pacientes. En este artículo se presenta una técnica quirúrgica para pies con fisis cerradas que busca la reestructuración de la fórmula metatarsal y el restablecimiento de la estética y función. En el caso reportado se efectuó alargamiento en un solo tiempo del metatarsiano afectado con interposición de injerto óseo, acortamiento a los metatarsianos adyacentes, corrección del hallux valgus realizando las osteotomías necesarias y el tratamiento de las deformidades de los dedos menores con los métodos requeridos para cada caso. Esta técnica quirúrgica tiene como ventaja la corrección de todo el antepié en un solo tiempo quirúrgico sin necesidad de fijador externo ni de sus cuidados postoperatorios. Sus principales desventajas son la dependencia del injerto óseo estructural y la necesidad de vendaje funcional postquirúrgico hasta la consolidación ósea. En la paciente tratada se obtuvieron resultados clínicos y radiográficos satisfactorios.

Abstract: Brachymetatarsia (shortening of the metatarsal) directly affects the transversal arch of the foot causing severe deformities, such as hallux valgus, divergent toes, overlapping toes, metatarsalgia, all of these alter the biomechanics of the foot and gait. Treatment consists of two main techniques, one-stage lengthening with bone graft or elongation through callotaxis with external fixator; there are variants of both techniques used to minimize the disadvantages of each. The objective of treatment must be to return the structural harmony to the forefoot, improving the biomechanics, resulting in a satisfactory outcome for the patients. This article presents a surgical treatment for feet with closed physis to obtain the appropriate metatarsal formula and to reestablish aesthetics and function. This case was treated by means of one-stage lengthening with bone graft to the affected metatarsal; shortening of the adjacent metatarsals; hallux valgus alignment through the necessary osteotomies and the treatment of deformities of the lesser toes as needed. This surgical technique has as one of its advantages the correction of the entire forefoot at one time, without the need of an external fixator and its required postoperative care. Its main disadvantages are its dependence on structural bone graft and the need of postoperative dressing until healing of the bone has taken place. Satisfactory clinical and radiographical outcomes were obtained in treated patient.

Cause of Metatarsalgia / 대한족부족관절학회지

Metatarsalgia is one of the most common causes of patients complaining of pain in their feet. This pain is the plantar forefoot, including the second to fourth metatarsal heads and arises from either mechanical or iatrogenic causes. On the other hand, it is frequently accompanied by a deformity of the toes as well as of the first and fifth rays. The pain has a variety of causes, and sometimes the cause is difficult to distinguish. The variability of possible causative factors necessitates an individualized approach to treatment. To determine these causes, this paper presents an overview of the gait mechanics, plantar pressure, and the classification according to the etiology.

Repair of small and medium-sized defects of dorsum pedis with medial sural artery perforator flap / 中华显微外科杂志

Objective To analyze the characteristics of medial sural artery perforator (MSAP) flap, and to ex-plore the practicality of repair of small and medium-sized defects of dorsum pedis with the flap. Methods Between March, 2012 to December, 2015, 12 patients with variable defects of 4.0 cm×3.0 cm to 4.0 cm×6.0 cm underwent MSAP flap reconstruction. There were 7 males and 5 females, aged from 19 to 49 years (mean, 32 years). The disease causes were crush injury in 6 cases, machine saw injury in 5 cases, and hot crush injury in 1 case. The size of flaps ranged from 4.0 cm × 5.0 cm to 5.0 cm×7.0 cm. All of the donor site was sutured directly. Postoperative follow up was done termly. Results All 12 flaps survived. The flap was similar to the surrounding normal skin, and all patients returned to ambulation. Eleven cases survived without a hitch, the other 1 of venous congestion was salvaged by venous thrombectomy and reanastomosis. Fol-lowed-up 5-24 months postoperative, the color of the flap was similar to the surrounding skin. All patients recovered walk-ing and shoe wearing function. The calf residual linear scar. Conclusion The MSAP flap provides thin soft tissue cover-age, enabling good functional recovery after defect reconstruction dorsum of forefoot, show the evident advantages.

Biomechanical Parameters in Plantar Fasciitis Measured by Gait Analysis System With Pressure Sensor

OBJECTIVE: To investigate the differences in biomechanical parameters measured by gait analysis systems between healthy subjects and subjects with plantar fasciitis (PF), and to compare biomechanical parameters between ‘normal, barefooted’ gait and arch building gait in the participants. METHODS: The researchers evaluated 15 subjects (30 feet) with bilateral foot pain and 15 subjects (15 feet) with unilateral foot pain who had a clinical diagnosis of PF. Additionally, 17 subjects (34 feet) who had no heel pain were recruited. Subjects were excluded if they had a traumatic event, prior surgery or fractures of the lower limbs, a leg length discrepancy of 1 cm or greater, a body mass index greater than 35 kg/m2, or had musculoskeletal disorders. The participants were asked to walk with an arch building gait on a treadmill at 2.3 km/hr for 5 minutes. Various gait parameters were measured. RESULTS: With the arch building gait, the PF group proved that gait line length and single support line were significantly decreased, and lateral symmetry of the PF group was increased compared to that of the control group. The subjects with bilateral PF displayed significantly increased maximum pressure over the heel and the forefoot during arch building gait. In addition, the subjects with unilateral PF showed significantly increased maximum pressure over the forefoot with arch building gait. CONCLUSION: The researchers show that various biomechanical differences exist between healthy subjects and those with PF. Employing an arch building gait in patients with PF could be helpful in changing gait patterns to normal biomechanics.

Morton's Neuroma / 대한정형외과학회잡지

Morton's neuroma, also known as interdigital neuroma, is a common cause of forefoot pain. It is a compressive neuropathy of the interdigital nerve, which is compressed by the overlying transverse metatarsal ligament. It is not a true tumor. The symptoms are forefoot pain that radiates into the toes, according to the involved nerve branches. Its histological findings are fibrosis around the nerve, demyelination. The clinical diagnosis can be obtained from a detailed history and physical examination, such as the compressive test. Moreover, ultrasonography and magnetic resonance imaging can also be used. Conservative treatment is the common initial treatment modality for interdigital neuroma. Surgical excision or decompression is indicated after a failure of conservative treatments.

Forefoot reconstruction in application of the reverse dorsal metatarsal artery perforator flap: 43 cases report / 中华显微外科杂志

Objective To discuss the clinical application of reverse dorsal metatarsal artery perforator flap for reconstruction of forefoot soft tissue defects.Methods Since January,2008 to March,2016,43 patients with forefoot soft tissue defect due to various causes were reconstructed with the flap based on dorsal metatarsal artery perforator.Dorsal pedis was used as a donor site with dorsal metatarsal artery perforator as the donor artery.The flap size varied from 2.0 cm × 4.0 cm to 6.0 cm × 8.0 cm.Among them,27,8,4 and 4 cases were reconstructed with flap based on first,second,third and fourth dorsal metatarsal artery perforator flap respectively.Results All the patients were followed-up which ranged from 3 months to 24 months.Six flaps suffered from post operative venous congestion.Out of 6,4 survived with early emergency management while the remaining 2 suffered epidermal necrosis which survived with regular dressing change.Eventually,all the flaps survived.They had good texture and they were elastic,good-looking and very wear-resisting.Walking function was normal.Conclusion Reverse dorsal metatarsal artery perforator flap is an ideal choice in reconstruction of small to medium sized soft tissue defects of forefoot.

Reconstruction of Postburn Contracture of the Forefoot Using the Anterolateral Thigh Flap

BACKGROUND: Severe forefoot deformities, particularly those involving the dorsum of the foot, cause inconvenience in daily activities of living including moderate pain on the dorsal aspect of the contracted foot while walking and difficulty in wearing nonsupportive shoes due to toe contractures. This paper presents clinical results of reconstruction of severe forefoot deformity using the anterolateral thigh (ALT) free flap. METHODS: Severe forefoot deformities were reconstructed using ALT flaps in 7 patients (8 cases) between March 2012 and December 2015. The mean contracture duration was 28.6 years. RESULTS: All the flaps survived completely. The size of the flaps ranged from 8 cm × 5 cm to 19 cm × 8 cm. The mean follow-up period was 10 months (range, 7 to 15 months). There was no specific complication at both the recipient and donor sites. There was one case where the toe contracture could not be completely treated after surgery. All of the patients were able to wear shoes and walk without pain. Also, the patients were highly satisfied with cosmetic results. CONCLUSIONS: The ALT flap may be considered ideal for the treatment of severe forefoot deformity.

Repair of forefoot soft tissue defects with free peroneal artery perforator flap in elderly patients / 中华显微外科杂志

Objective To investigate the surgical methods and clinical effect of repairing forefoot soft tissue defects with free peroneal artery perforator flap in elderly patients.Methods From June,2011 to April,2015,17 cases of forefoot soft tissue defects repaired with free peroneal artery perforator flap in elderly patients.There were 10 cases of male and female in 7 cases with an average age of 65.8 years old ranging from 60 to 74 years.Causes of injury:traffic accident in 7 cases,heavy crushing in 9 cases,electrical bums in 1 case.Injury part:6 cases on the left side and 11 cases on the right side.Metatarsus and phalanges fracture in 9 cases,tendon injury in 5 cases.Defect area:3.0 cm × 4.0 cm-6.3 cm × 11.2 cm.Results All flaps survived.All wounds were primary healing.Skin graft survived for the foot flap donor site,and no complicated with infection.All patients were followed up from 8 to 36 months with an average of 17.6 months.The appearance of flaps were good,slight bloated.The texture and color of the flaps were close to the recipient site.Flap feel were good.Accortling to (AOFAS)criteria system,the AOFAS score of last follow-up was (77.5±13.2).Excellent in 6 cases,good in 9 cases,fair in 2 cases.VAS score was (2.6±0.4).Conclusion The free peroneal artery perforator flap with the advantages of vascular anatomy constant,blood supply is reliable,thickness moderate,etc.It is a useful clinical method to repair forefoot soft tissue defects in elderly patients.

Arthritis of the Subtalar Joint Associated with Sustentaculum Tali Facet Configuration.

Variation in the articular facet of the sustenticulum tali have been described bymany authors.Most researchers view these differences in facet configuration as anatomical variations of no functional significance. Bruckner (1987), for the first time argued that these facet configurations affect joint stability. The purpose of this study was to determine the talar facet configuration of calcanei in India, measure the angle between the anterior and middle facet planes of these calcanei, and assess the relation between the above parameters and the degenerative changes in the subtalar joints. Study was conducted in 220 calcanei of unknown age & sex. The facet patterns observed were fused anterior andmiddle facets (Type I), three separate facets (Type II), absence of the anterior facet (Type III) and threemerged facets (Type IV). Osteoarthritic changes studied are lipping, eburnation on visual inspection and subchondral sclerosis on radiographs. Present study reveals that the talar facet configuration of calcanei and the angle between the anterior and middle facets influence the stability of the subtalar joints and development of osteoarthritis.

Clinical and functional evaluation of forefoot reconstruction in patients with rheumatoid arthritis / Avaliação clínico-funcional da reconstrução do antepé nos pacientes portadores de artrite reumatoide

OBJECTIVE: to evaluate the long-term results from reconstruction of the forefoot in patients with rheumatoid arthritis who underwent arthrodesis of the metatarsophalangeal joint of the hallux, resection arthroplasty of the heads of the lateral metatarsals and correction of the deformities of the smaller toes through arthrodesis of the proximal interphalangeal joint or closed manipulation. METHODS: seventeen patients (27 feet) who underwent forefoot reconstruction surgery by means of arthrodesis of the first metatarsophalangeal joint, resection of the heads of the lateral metatarsals and correction of the deformities of the smaller toes, were studied retrospectively. The mean follow-up was 68 months (12-148 months); the mean age was 52 years (range: 20-75 months); and four patients were male and 13 were female. RESULTS: the results were classified as excellent in 17 feet, good in two, fair in four and poor in two. The mean score on the AOFAS scale was 70 points; 21 feet (78%) were found to be asymptomatic; and six feet (22%) presented some type of symptom. Three feet presented pseudarthrosis, and one of these successfully underwent revision of the arthrodesis. There was no significant difference in scoring on the AOFAS scale or in the consolidation rate, between using a plate and screws and using Kirschner wires for fixation of the arthrodesis. CONCLUSION: arthrodesis of the first metatarsophalangeal joint with resection arthroplasty on the heads of the lateral metatarsals and correction of the deformities of the smaller toes, which was used in forefoot reconstruction in rheumatoid patients, showed good long-term results with a high satisfaction rate among the patients and clinical-functional improvement...

OBJETIVO: avaliar os resultados em longo prazo da reconstrução do antepé nos pacientes com artrite reumatoide submetidos à artrodese da articulação metatarsofalângica (MTF) do hálux, artroplastia de ressecção das cabeças dos metatarsos laterais e correção das deformidades nos dedos menores por meio de artrodese da articulação interfalângica proximal (IFP) ou manipulação fechada. MÉTODOS: foram estudados retrospectivamente 17 pacientes (27 pés) submetidos à cirurgia de reconstrução do antepé com artrodese da primeira articulação MTF, ressecção das cabeças dos metatarsos laterais e correção das deformidades nos dedos menores. O seguimento médio foi de 68 meses (12 a 148), a média de idade foi de 52 anos (20 a 75 meses) e quatro pacientes eram do sexo masculino e 13 do feminino. RESULTADOS: os resultados foram classificados como excelente em 17 pés, bom em dois, regular em quatro e ruim em dois. A pontuação média da escala Aofas (American Orthopaedic Foot and Ankle Society) foi de 70 pontos, 21 pés (78%) encontravam-se assintomáticos e seis (22%) apresentavam algum tipo de sintoma. Três pés apresentaram pseudoartrose. Um deles foi submetido à revisão da artrodese com sucesso. Não houve diferença significativa na pontuação da escala Aofas e nos índices de consolidação com o uso de placa e parafusos ou fios de Kirschner na fixação da artrodese. CONCLUSÃO: a artrodese da primeira articulação MTF com artroplastia de ressecção das cabeças dos metatarsos laterais e correção das deformidades nos dedos menores, usada na reconstrução do antepé dos pacientes reumatoides, demonstrou bons resultados em longo prazo, com elevado...

Unusual metatarsophalangeal joint deformity in an advanced rheumatoid foot

No abstract available.