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1.
Yonsei Med J ; 61(7): 635-639, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32608208

RESUMO

Cavovarus deformity is considered an anatomical risk factor for chronic lateral ankle instability (CLAI). However, subtle deformity can be difficult to detect, and its correction is controversial. The current study aimed to evaluate clinical and radiographic outcomes of a modified Broström procedure (MBP) with additional procedures for CLAI with subtle cavovarus deformity and a positive peek-a-boo heel sign. We reviewed the records of 15 patients who underwent MBP with additional procedures for CLAI with a positive peek-a-boo heel sign between August 2009 and April 2015. Consecutive physical and radiographic examinations were performed. The visual analog scale (VAS) for pain, the American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, and the Karlsson-Peterson (KP) ankle score were applied to assess clinical outcomes. Weight bearing radiographs, hindfoot alignment view, and ankle stress radiographs were also examined. The mean follow-up period was 58.5 months. Calcaneal lateral closing wedge osteotomy was performed in seven patients to correct fixed hindfoot varus, and first metatarsal dorsiflexion osteotomy was performed in 11 patients to correct plantarflexion of the first ray. Three patients underwent both procedures. Mean VAS, AOFAS, and KP ankle scores improved significantly (p=0.001), and instability did not recur. Radiographically, all stress parameters improved significantly (p=0.007). Simultaneous correction of a positive peek-a-boo heel sign and cavovarus deformity with MBP for CLAI improves clinical outcomes and prevents recurrent instability. A comprehensive evaluation and cautious approach for subtle cavovarus deformity should be followed when treating patients with CLAI. This trial is registered on Clinical Research Information Service (CRiS, KCT0003287).


Assuntos
Articulação do Tornozelo/cirurgia , Instabilidade Articular/cirurgia , Osteotomia/métodos , Adulto , Tornozelo/diagnóstico por imagem , Tornozelo/fisiopatologia , Articulação do Tornozelo/diagnóstico por imagem , Feminino , , Calcanhar/diagnóstico por imagem , Calcanhar/fisiopatologia , Humanos , Instabilidade Articular/diagnóstico , Instabilidade Articular/diagnóstico por imagem , Masculino , Ossos do Metatarso , Metatarso/diagnóstico por imagem , Metatarso/cirurgia , Pessoa de Meia-Idade , Radiografia , Procedimentos Cirúrgicos Reconstrutivos , Recuperação de Função Fisiológica , Pé Cavo/diagnóstico por imagem , Pé Cavo/cirurgia , Resultado do Tratamento , Escala Visual Analógica
2.
J Athl Train ; 55(2): 181-187, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31895592

RESUMO

CONTEXT: Researchers analyzing data from the National Collegiate Athletic Association Injury Surveillance Program have not considered the differences in foot injuries across specific sports and between males and females. OBJECTIVE: To describe the epidemiologic differences in rates of overall foot injuries and common injuries among sports and between sexes. DESIGN: Descriptive epidemiology study. SETTING: Online injury-surveillance data from 15 unique sports involving males and females that demonstrated 1967 injuries over 4 821 985 athlete-exposures. PATIENTS OR OTHER PARTICIPANTS: Male and female athletes competing in National Collegiate Athletic Association sports from the 2009-2010 through 2014-2015 seasons. MAIN OUTCOME MEASURE(S): Foot injury rates (per 10 000 athlete-exposures) and the proportion of foot injuries were calculated for each sport. The effect of sex was calculated using Poisson-derived confidence intervals for 8 paired sports. A risk analysis was performed using a 3 × 3 quantitative injury risk-assessment matrix based on both injury rate and mean days of time loss. RESULTS: Foot injury rates differed between sports, with the highest rates in female gymnastics, male and female cross-country, and male and female soccer athletes. Cross-country and track and field had the highest proportions of foot injuries for both female and male sports. The 5 most common injuries were foot/toe contusions, midfoot injuries, plantar fascia injuries, turf toe, and metatarsal fractures. Only track and field athletes demonstrated a significant sex difference in injury rates, with female athletes having the higher rate. The quantitative injury risk-assessment matrix identified the 4 highest-risk injuries, considering both rate and severity, as metatarsal fractures, plantar fascia and midfoot injuries, and foot/toe contusions. CONCLUSIONS: Important differences were present among sports in terms of injury rates, the most common foot injuries, and the risk (combination of frequency and severity) of injury. These differences warrant further study to determine the mechanisms of injury and target intervention efforts.


Assuntos
Traumatismos em Atletas/epidemiologia , Traumatismos do Pé/epidemiologia , Traumatismos do Tornozelo/epidemiologia , Contusões/epidemiologia , Fáscia/lesões , Feminino , Fraturas Ósseas/epidemiologia , Ginástica/lesões , Humanos , Incidência , Masculino , Metatarso/lesões , Estações do Ano , Distribuição por Sexo , Futebol/lesões , Atletismo/lesões , Estados Unidos/epidemiologia , Universidades , Adulto Jovem
3.
Vet Surg ; 49(1): 180-186, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31576584

RESUMO

OBJECTIVE: To evaluate the efficacy of subcutaneous iohexol injection into the metatarsal region for thoracic duct lymphangiography in dogs and to determine the minimum effective dose. STUDY DESIGN: Experimental study and clinical report. ANIMALS: Five healthy beagle dogs and one dog with chylothorax. METHODS: For the experimental study, iohexol was injected subcutaneously into the metatarsal region of five dogs at three doses (0.5, 0.75, and 1 mL/kg), and the injection sites were massaged gently. Computed tomography (CT) was performed 1, 3, 5, 7, 10, 15, and 20 minutes after iohexol injection. Subjective quality was assessed, and Hounsfield unit values were measured at several regions of interest (T1, T4, T8, T13, and L3). In the dog with chylothorax, iohexol (1.0 mL/kg) was injected into the right metatarsal region prior to CT. RESULTS: The thoracic duct was visualized and enhanced by contrast in all dogs after injection of 0.75 and 1.0 mL/kg of iohexol, and in two dogs after injection of 0.5 mL/kg at 3, 5, and 7 minutes. The thoracic duct was gradually attenuated with increasing doses of iohexol. In the dog with chylothorax, the entire thoracic duct was well enhanced and dilated, and tortuous cranial mediastinal lymphatics were detected. CONCLUSION: The thoracic duct was visualized when at least 0.75 mL/kg of iohexol was injected subcutaneously into the metatarsal region of dogs. CLINICAL SIGNIFICANCE: Subcutaneous injection of iohexol into the metatarsal region offers a simple alternative to conventional thoracic duct lymphangiography.


Assuntos
Meios de Contraste/uso terapêutico , Iohexol/uso terapêutico , Linfografia/veterinária , Metatarso/diagnóstico por imagem , Ducto Torácico/diagnóstico por imagem , Tomografia Computadorizada por Raios X/veterinária , Animais , Quilotórax/diagnóstico por imagem , Quilotórax/veterinária , Doenças do Cão/diagnóstico por imagem , Cães , Feminino , Injeções Subcutâneas/veterinária
4.
Foot Ankle Clin ; 24(4): 669-676, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31653371

RESUMO

Freiberg's infraction is an uncommon condition of the lesser metatarsophalangeal joints. Onset is usually between the 11th and 17th year of age. It is the only osteochondrosis that dominantly affects females with a reported female-to-male ratio of 5.1. The second metatarsal is most frequently involved (68%) followed by the third metatarsal (27%), and the fourth (3%). Surgical treatment options can be categorized in joint destructive and joint preserving procedures. Studies reveal complete resolution of pain and full return to activities in 70% after joint destructive procedure and more than 90% after joint preserving procedures.


Assuntos
Ossos do Metatarso/cirurgia , Articulação Metatarsofalângica/cirurgia , Metatarso/anormalidades , Osteocondrite/congênito , Osteotomia/métodos , Artroplastia , Transplante Ósseo , Desbridamento , Descompressão Cirúrgica , Humanos , Metatarso/cirurgia , Osteocondrite/cirurgia
7.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 33(5): 563-567, 2019 May 15.
Artigo em Chinês | MEDLINE | ID: mdl-31090349

RESUMO

Objective: To compare the dorsiflexion osteotomy (DO) and implant arthroplasty (IA) in terms of clinical and radiographic outcomes for patients with advaced Freiberg disease. Methods: A clinical data of 25 cases of Freiberg disease, who were admitted between July 2012 and July 2016 and met selection criteria, was retrospectively reviewed. According to the Smillie classification, all patients were classified as stage Ⅳ-Ⅴ. Among them, 13 cases were treated with DO (DO group) and 12 cases were treated with IA (IA group). No significant difference was found between the two groups in gender, age, side of the affected metatarsophalangeal (MTP) joint, location, Smillie classification, disease duration, and preoperative visual analogue scale (VAS) score, range of motion of the affected MTP joints, and the American Orthopedic Foot and Ankle Society (AOFAS) score ( P>0.05). Total costs for index admissions were compared between the two groups. Clinical outcomes were evaluated in accordance with the VAS score, AOFAS score, and the range of motion of the affected MTP joints. Results: All incisions of the two groups healed by first intention. The follow-up time was 12-30 months (mean, 17 months) in DO group and 12-24 months (mean, 16 months) in IA group. The total cost of index admission was significantly higher in IA group than that n DO group ( t=2.742, P=0.011). The AOFAS scores, VAS scores, and range of dorsiflexion and plantar flexion at last follow-up were significantly improved when compared with preoperative value in the two groups ( P<0.05). There was no significant difference in all indexes between the two groups ( P>0.05). X-ray film examination showed that the osteotomy healed within 8-12 weeks (mean, 9.5 weeks) after operation in DO group. None of the patients experienced internal fixator and implant related complications postoperatively. Conclusion: DO and IA can provide significant improvement in pain and motion of the MTP joints for advanced Freiberg disease. But the DO may be the more economical method.


Assuntos
Artroplastia , Articulação Metatarsofalângica , Osteotomia , Humanos , Metatarso , Amplitude de Movimento Articular , Estudos Retrospectivos
8.
PLoS One ; 14(2): e0211412, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30759122

RESUMO

The African terrestrial fossil record has been limited in its contribution to our understanding of both regional and global Cretaceous paleobiogeography, an interval of significant geologic and macroevolutionary change. A common component in Cretaceous African faunas, titanosaurian sauropods diversified into one of the most specious groups of dinosaurs worldwide. Here we describe the new titanosaurian Mnyamawamtuka moyowamkia gen. et sp. nov. from the Mtuka Member of the Galula Formation in southwest Tanzania. The new specimen preserves teeth, elements from all regions of the postcranial axial skeleton, parts of both appendicular girdles, and portions of both limbs including a complete metatarsus. Unique traits of M. moyowamkia include the lack of an interpostzygapophyseal lamina in posterior dorsal vertebrae, pronounced posterolateral expansion of middle caudal centra, and an unusually small sternal plate. Phylogenetic analyses consistently place M. moyowamkia as either a close relative to lithostrotian titanosaurians (e.g., parsimony, uncalibrated Bayesian analyses) or as a lithostrotian and sister taxon to Malawisaurus dixeyi from the nearby Aptian? Dinosaur Beds of Malawi (e.g., tip-dating Bayesian analyses). M. moyowamkia shares a few features with M. dixeyi, including semi-spatulate teeth and a median lamina between the neural canal and interpostzygapophyseal lamina in anterior dorsal vertebrae. Both comparative morphology and phylogenetic analyses support Mnyamawamtuka as a distinct and distant relative to Rukwatitan bisepultus and Shingopana songwensis from the younger Namba Member of the Galula Formation with these results largely congruent with newly constrained ages for the Mtuka Member (Aptian-Cenomanian) and Namba Member (Campanian). Coupled with recent discoveries from the Dahkla Oasis, Egypt (e.g., Mansourasaurus shahinae) and other parts of continental Afro-Arabia, the Tanzania titanosaurians refine perspectives on the development of African terrestrial faunas throughout the Cretaceous-a critical step in understanding non-marine paleobiogeographic patterns of Africa that have remained elusive until the past few years.


Assuntos
Osso e Ossos/anatomia & histologia , Dinossauros/classificação , Fósseis , Animais , Metatarso/anatomia & histologia , Filogenia , Coluna Vertebral/anatomia & histologia , Tanzânia , Terminologia como Assunto , Dente/anatomia & histologia
9.
Anat Histol Embryol ; 48(3): 234-243, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30663784

RESUMO

The aim of this study was to provide the detailed normal gross osteology and radiographic anatomy of the pelvic limb in adult small East African goats as a reference for clinical use, biomedical research and teaching. Radiography of the pelvic limb was performed in five adult small East African goats. Bone specimens of four skeletally mature small East African goats were used for gross osteological study. The ilial wing was wide. The ischiatic tuberosity was prominent and well developed. The acetabulum was rounded. The minor trochanter was located caudomedially, and the femoral trochlea was deep and narrow. The lateral and medial condyles of the femur were approximately of the same size. The tibial tuberosity was prominent, and the cochlea grooves were deep with a pronounced intermediate ridge. The trochlea of the talus was deep. The patella presented a prominent tuberosity on the cranial surface. The metatarsal sesamoid bone was seen in all animals. The observed gross osteology and radiographic anatomy of the pelvic limb of small East African goats was consistent with the presence of strong extensor muscles of the hip, stifle and tarsus for propulsion during terrestrial walking and trotting.


Assuntos
Cabras/anatomia & histologia , Membro Posterior/anatomia & histologia , Anestesia Geral/veterinária , Animais , Feminino , Fêmur/anatomia & histologia , Fíbula/anatomia & histologia , Membro Posterior/diagnóstico por imagem , Masculino , Metatarso/anatomia & histologia , Metatarso/diagnóstico por imagem , Patela/anatomia & histologia , Ossos Pélvicos/anatomia & histologia , Radiografia/veterinária , Ossos Sesamoides/anatomia & histologia , Ossos Sesamoides/diagnóstico por imagem , Tarso Animal/anatomia & histologia , Tarso Animal/diagnóstico por imagem , Tíbia/anatomia & histologia , Falanges dos Dedos do Pé/anatomia & histologia , Falanges dos Dedos do Pé/diagnóstico por imagem
10.
Foot Ankle Clin ; 24(1): 69-82, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30685014

RESUMO

Freiberg disease is characterized as osteochondrosis of the second metatarsal head. It is the fourth most common form of primary osteochondrosis with a significant predilection to the adolescent athletic female population, although it has been seen over a wide age range. If treated early, osteochondroses such as Freiberg disease are essentially self-limiting, often resolving with nonoperative management. When surgery is warranted, it is imperative the patient's age, activity level, and degree of articular deformity be taken into account.


Assuntos
Ossos do Metatarso/patologia , Metatarso/anormalidades , Procedimentos Ortopédicos/métodos , Osteocondrite/congênito , Osteonecrose/terapia , Humanos , Osteocondrite/complicações , Osteocondrite/diagnóstico , Osteocondrite/terapia , Osteonecrose/diagnóstico , Osteonecrose/etiologia
11.
Foot Ankle Spec ; 12(5): 439-451, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30537872

RESUMO

Chronic kidney disease (CKD) is a major concern in patients with foot disease because it is associated with high rates of neuropathy, peripheral vascular disease, and poor wound healing. The purpose of this study was to evaluate renal dysfunction as a risk factor for reamputation after initial transmetatarsal amputation (TMA). Patients who underwent a TMA were retrospectively identified in the American College of Surgeons National Surgical Quality Improvement Program database. Of 2018 patients, reamputation after TMA occurred in 4.4%. End-stage renal disease (ESRD) was associated with 100% increased odds of TMA failure (adjusted odds ratio [OR] = 2.00; 95% CI = 1.10, 3.52), 128% increased odds of major amputation (adjusted OR = 2.28; 95% CI = 1.27, 3.96), and 182% increased odds of 30-day mortality (adjusted OR = 2.82; 95% CI = 1.69, 4.64). In addition, white blood cell count >10 000/mm3 and deep infection at the time of surgery were independently associated with TMA failure. In conclusion, severe renal dysfunction is associated with TMA failure in the short-term, perioperative period. There was no incremental increase in risk of TMA failure with worsening level of renal function before ESRD. A multidisciplinary approach should be implemented in patients with CKD to prevent foot-related pathologies that may necessitate lower-extremity amputation. Levels of Evidence: Level III: Retrospective cohort study.


Assuntos
Amputação/efeitos adversos , Amputação/métodos , Testes de Função Renal , Metatarso/cirurgia , Insuficiência Renal Crônica/complicações , Insuficiência Renal Crônica/diagnóstico , Falha de Tratamento , Idoso , Progressão da Doença , Diagnóstico Precoce , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/prevenção & controle , Valor Preditivo dos Testes , Insuficiência Renal Crônica/prevenção & controle , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Fatores de Risco
12.
Orthopedics ; 42(1): e138-e143, 2019 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-30540873

RESUMO

Metatarsalgia can be viewed as more of a symptom rather than a distinct diagnosis. Timing of forefoot pain during the gait cycle and evaluation of whether the pain is from anatomic abnormalities, indirect overloading, or iatrogenic causes can suggest a specific metatarsalgia etiology. A thorough physical examination of the lower extremity, especially evaluation of the plantar foot, and weight-bearing radiographs are critical for diagnosis and treatment. Nonoperative treatment consists of physical therapy, orthotics, shoe wear modification, and injections. If conservative treatment fails, surgical options may be considered. [Orthopedics. 2019; 42(1):e138-e143.].


Assuntos
Metatarsalgia/diagnóstico , Metatarsalgia/etiologia , Artrite Reumatoide/complicações , Pé Equino/complicações , Pé/diagnóstico por imagem , Fraturas Ósseas/complicações , Gota/complicações , Humanos , Doença Iatrogênica , Ossos do Metatarso/diagnóstico por imagem , Metatarso/anormalidades , Neuroma Intermetatársico/complicações , Osteocondrite/complicações , Osteocondrite/congênito , Exame Físico , Psoríase/complicações , Sinovite/complicações , Sinovite/etiologia
13.
Foot Ankle Surg ; 25(4): 457-461, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30321965

RESUMO

BACKGROUND: Freiberg-Kohler's disease is not a common disease and although various reports have been described since 1914, treatment methods are not completely established. The purpose of the present retrospective study was to evaluate the long-term outcomes following joint debridement and microfracture procedures for the treatment of Freiberg-Kohler's disease. METHODS: Fifteen consecutive patients (16 feet) with Freiberg-Kohler's disease (Smillie's classification grade III-V) were operated between May 1996 to December 2011. All patients followed the same post-operative protocol. The objective and subjective evaluations were taken at the initial examination and at final follow-up. RESULTS: Mean follow-up was 11 years ±5.5 (range 4.2-19.7 years). The AOFAS score, VAS score and ROM of the MTP joint improved significantly after surgery (p value <0.05). The AOFAS score improved from a preoperative value of 46.7±15.5 points to 83.2±9.4 points postoperative (p<0.05). The mean preoperative joint ROM was 28°±8° and 49°±13° postoperative (p<0.05). VAS score improved from a preoperative value of 5.5±1.2 points to 1.2±1 points at last follow-up (p<0.05). At the end of follow-up 13 patients (81%) declared they were very satisfied, 3 patients (19%) satisfied and nobody unsatisfied. CONCLUSIONS: Our results suggest that joint debridement and microfracture procedure is an effective surgical treatment for late-stage Freiberg-Kohler's disease with decrease of daily pain, improved ROM, and high patient satisfaction.


Assuntos
Desbridamento , Metatarso/anormalidades , Osteocondrite/congênito , Adolescente , Adulto , Idoso , Feminino , Seguimentos , , Fraturas de Estresse/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Osteocondrite/terapia , Satisfação do Paciente , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
14.
Anat Histol Embryol ; 48(1): 3-11, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30318610

RESUMO

Semiaquatic walking has resulted in the evolution of functional and morphological changes in various hoofed mammals, such as hippopotamus and Brazilian tapir. The biomechanics of skilful walking in wetlands or at the bottom of a waterbody involve the medio-lateral opening and closing of the feet to effectively support and stabilize the body on soft ground and to reduce the water resistance during recovery stroke, respectively. We demonstrate that the opening and closing of the feet in hippopotamus and Brazilian tapir are mediated by the adduction and abduction of the most medial and lateral phalanges from the CT examination. The axial toes, metacarpals and metatarsals do not contribute to changes in the width and shape of the feet, unlike the medial and lateral toes. We suggest that this semiaquatic walking motion is derived from the original terrestrial mode of locomotion, in contrast to the highly functional swimming motion using webs or fins in morphologically modified feet and tail. From the present data we demonstrate that semiaquatic locomotion evolved due to the acquisition of adductor-abductor mobility in the phalanges of the most medial and lateral digits, as shown in hippopotamus and Brazilian tapir.


Assuntos
Artiodáctilos/anatomia & histologia , Imageamento Tridimensional/veterinária , Metatarso/anatomia & histologia , Perissodáctilos/anatomia & histologia , Dedos do Pé/anatomia & histologia , Caminhada/fisiologia , Animais , Fenômenos Biomecânicos/fisiologia , Feminino , Membro Anterior/anatomia & histologia , Membro Posterior/anatomia & histologia , Imageamento Tridimensional/métodos , Masculino , Ossos do Metatarso/anatomia & histologia , Amplitude de Movimento Articular , Tomografia Computadorizada por Raios X/métodos , Áreas Alagadas
15.
J Foot Ankle Res ; 11: 57, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30356898

RESUMO

Background: The deep plantar arch is formed by anastomosis of the lateral and deep plantar arteries. Osteotomy of the lesser metatarsals is often used to treat metatarsalgia and forefoot deformity. Although it is known that some blood vessels supplying the lesser metatarsals are prone to damage during osteotomy, there is little information on the distances between the deep plantar arch and the three lesser metatarsals. The aims of this study were to identify the distances between the deep plantar arch and the lesser metatarsals and to determine how osteotomy could damage the arch. Methods: Enhanced computed tomography scans of 20 fresh cadaveric feet (male, n = 10; female, n = 10; mean age 78.6 years at the time of death) were assessed. The specimens were injected with barium via the external iliac artery, and the distance from the deep plantar arch to each lesser metatarsal was measured on axial and sagittal images. Results: The shortest distances from the deep plantar arch to the second, third, and fourth metatarsals in the axial plane were 0.5, 2.2, and 2.8 mm, respectively. The shortest distances from the distal epiphysis to a line passing through the deep plantar arch perpendicular to the longitudinal axis of the lesser metatarsal in the sagittal plane were 47.0, 45.7, and 46.4 mm, respectively, and those from the tarsometatarsal joint were 23.0, 21.0, and 18.6 mm. The deep plantar arch ran at the level of the middle third, within the proximal portion of this third in 11/20 (55.0%), 7/20 (35.0%), and 5/16 (31.2%) specimens, respectively, and at the level of the proximal third in 9/20 (45.0%), 13/20 (65.0%), and 11/16 (68.8%). Conclusions: Overpenetration into the medial and plantar aspect of the second metatarsal or the proximal and plantar aspect of the fourth metatarsal during shaft or proximal osteotomy could easily damage the deep plantar arch. Shaft or proximal osteotomy approximately 45-47 mm proximal to the distal epiphysis or 18-23 mm distal to the tarsometatarsal joint on the plantar aspect could interrupt blood flow in the deep plantar arch.


Assuntos
Ossos do Metatarso/cirurgia , Metatarsalgia/diagnóstico , Osteotomia/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Cadáver , Feminino , Humanos , Artéria Ilíaca/diagnóstico por imagem , Masculino , Ossos do Metatarso/anatomia & histologia , Ossos do Metatarso/irrigação sanguínea , Ossos do Metatarso/diagnóstico por imagem , Metatarso/anatomia & histologia , Metatarso/irrigação sanguínea , Metatarso/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos
16.
Foot Ankle Int ; 39(11): 1290-1300, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30117326

RESUMO

BACKGROUND: Conservative treatment or debridement is generally sufficient for Freiberg's disease grades I and II but operative intervention for the late stages of the disease process (III-V) is more challenging. Debridement alone is not sufficient and various forms of arthroplasty have been put forward. We have evaluated the outcomes of patients treated with an interpositional arthroplasty technique using a pedicle graft of periosteum and fat made into a "Rollmop" spacer for severe Freiberg's disease. No results have previously been reported for this technique. METHODS: Twenty-five consecutive cases (23 patients) were performed from February 2009 to September 2016 (20 females, 5 males). Mean age at surgery was 52.6 years (range 19-70.5 years) with 92% affecting the second metatarsal. Twenty-three were primary cases and 2 were revision cases. Five cases were stage III, 12 were stage IV, and 8 were stage V. All patients underwent interpositional arthroplasty using a periosteum and fat pedicle graft from the affected metatarsal shaft as described by Myerson. Patients were evaluated using Manchester-Oxford Foot Questionnaire (MOXFQ) and American Orthopaedic Foot & Ankle Society Questionnaire (AOFAS). Mean follow-up was 3.5 years (0.6-7.6 years). Paired 2-tailed Student t tests were used to assess clinical significance. RESULTS: Surgery allowed 8 patients to return to normal footwear, 10 patients returned to fashion footwear/heels, and 5 returned to sports. Nineteen cases (17 patients) were assessed with patient-reported outcome measures and all showed a clinically and statistically significant improvement in their scores. Mean pre- and postoperative VAS pain scores were 6.2 (range 4-9) and 1.8 (range 0-6) ( P < .05). Mean perioperative AOFAS scores were 45.6 (range 15-73) and 82.7 (range 57-100) ( P < .05). Mean perioperative MOXFQ scores were 60.0 (range 23-89) and 18.1 (range 0-80) ( P < .05). CONCLUSION: This novel interpositional arthroplasty technique using a "rollmop" of periosteum and fat for severe Freiberg's disease produced significant improvements in pain, functional outcome, and patient satisfaction without donor site morbidity. Furthermore, it allowed patients to return to desired footwear and sporting activities. The functional outcome and joint range of motion was superior after a K-wire was no longer placed across the joint, and we believe it is essential to avoid this to permit early range-of-motion exercises. LEVEL OF EVIDENCE: Level IV, retrospective case series.


Assuntos
Artroplastia/métodos , Metatarso/anormalidades , Osteocondrite/congênito , Periósteo/transplante , Adulto , Idoso , Estudos de Coortes , Feminino , Humanos , Masculino , Metatarso/cirurgia , Pessoa de Meia-Idade , Osteocondrite/cirurgia , Amplitude de Movimento Articular , Recuperação de Função Fisiológica , Volta ao Esporte , Sapatos , Resultado do Tratamento , Adulto Jovem
17.
Vet Radiol Ultrasound ; 59(5): 587-596, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30027637

RESUMO

Injury of the distal tarsus and proximal metatarsus commonly causes lameness. Magnetic resonance imaging (MRI) allows concurrent assessment of both the distal tarsal joints and suspensory ligament origin, and aids identification of lesions that may otherwise go undetected by other modalities. In this retrospective observational study, the medical records of a veterinary imaging center were searched for MRI exams of the distal tarsus and proximal metatarsus for the years 2012 through 2014. Studies for 125 limbs of 103 horses were identified and retrospectively evaluated by two board-certified veterinary radiologists. Soft tissue and osseous changes were characterized and graded by degree of severity. The patients' signalment, lameness severity, and results of diagnostic analgesia were recorded. Osteoarthritic changes of the distal intertarsal and tarsometatarsal joints were the most common findings. Other findings included bone marrow lesions, degenerative changes of the small cuboidal bones, subchondral cystic lesions, and intertarsal desmopathy. Suspensory ligament desmopathy was found in 53% of limbs. Fourty-seven percent of limbs that responded to analgesia of the proximal suspensory ligament had more severe lesions in the distal tarsus. Bone marrow lesions of the third tarsal bone were the only MRI finding that correlated with grade of lameness in patients for which lameness grade was reported. The grade of lameness has a poor correlation with the severity of lesions found on MRI. The findings support the use of MRI for simultaneous evaluation of the proximal metatarsus and distal tarsus, particularly given the difficulty of lesion localization with diagnostic analgesia.


Assuntos
Analgesia/veterinária , Doenças dos Cavalos/diagnóstico por imagem , Coxeadura Animal/diagnóstico por imagem , Imagem por Ressonância Magnética/veterinária , Metatarso/patologia , Tarso Animal/patologia , Animais , Doenças dos Cavalos/patologia , Cavalos , Coxeadura Animal/patologia , Imagem por Ressonância Magnética/métodos
18.
J Foot Ankle Surg ; 57(5): 967-971, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30005966

RESUMO

Patients requiring a nontraumatic transmetatarsal amputation (TMA) typically have multiple comorbidities that place them at high risk of postoperative complications and additional surgery. The present study identified the demographic, clinical, and surgical risk factors that predict complications after a nontraumatic TMA, including the incidence of 3-year mortality, proximal limb amputation, and lack of healing. The electronic medical records of patients who had undergone TMA within a Kaiser Permanente Northern California facility from March 2007 to January 2012 (n = 375) were reviewed. We used bivariate and multivariate analyses to examine the variations in the rates of TMA complications according to sex, age, race, and comorbid conditions, including nonpalpable pedal pulses, end-stage renal disease, coronary artery disease, hypertension, smoking status, and preoperative albumin <3.5 mg/dL. After a nontraumatic TMA, 136 (36.3%) patients had died within 3 years, 138 (36.8%) had required a more proximal limb amputation, and 83 (22.1%) had healed without complications. The patients with nonpalpable pedal pulses had 3 times the odds of requiring a proximal limb amputation (adjusted odds ratio [aOR] 3.07; 95% confidence interval [CI] 1.84 to 5.11), almost twice the odds of dying within 3 years (aOR 1.70; 95% CI 0.98 to 2.93), and >2 times the odds of not healing after the TMA (aOR 2.45; 95% CI 1.40 to 4.31). The patients with end-stage renal disease had 3 times the odds of dying within 3 years (aOR 3.10; 95% CI 1.69 to 5.70). The present findings can help us identify patients with an increased risk of postoperative complications after nontraumatic TMA, including patients with nonpalpable pedal pulses or end-stage renal disease, and suggest the vulnerability of this patient population.


Assuntos
Amputação/efeitos adversos , Amputação/mortalidade , Metatarso/cirurgia , Complicações Pós-Operatórias/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Incidência , Masculino , Ossos do Metatarso/cirurgia , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida , Cicatrização
19.
Pan Afr Med J ; 29: 33, 2018.
Artigo em Francês | MEDLINE | ID: mdl-29875915

RESUMO

Freiberg's disease is an osteochondrosis of the metatarsal heads mainly affecting the second metatarsal head. This study was conducted over a 3 year period. It reports 6 cases of patients, whose average age was 19.8 years, who had undergone Gauthier's dorsal subtraction osteotomy with fixation using osteosutures. The outcome of this technique was satisfactory. Indeed, the majority of patients had no pain and recovered normal daily activity. This study highlights that fixation using osteosutures is a reliable and inexpensive method.


Assuntos
Metatarso/anormalidades , Osteocondrite/congênito , Osteotomia/métodos , Adolescente , Adulto , Humanos , Metatarso/cirurgia , Osteocondrite/cirurgia , Resultado do Tratamento , Adulto Jovem
20.
J Foot Ankle Surg ; 57(5): 880-883, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29880323

RESUMO

The transmetatarsal amputation is considered a durable procedure with respect to limb salvage when managing the consequences of diabetic foot disease. The success of the procedure is, in part, determined by the preoperative appreciation of arterial and functional status. The objectives of the present investigation were to determine the length of the remaining first metatarsal required during transmetatarsal amputation to preserve the anastomotic connection of the deep plantar perforating artery and subsequent "vascular arch" of the foot and the insertion of the tibialis anterior tendon. The primary outcome measure of our investigation was a measurement of the distance between the first metatarsal-medial cuneiform articulation and the distal extent of the deep plantar perforating artery in 85 embalmed lower limbs. As a secondary outcome measure, the insertion of the tibialis anterior tendon was evaluated relative to the deep plantar perforating artery. The most distal extent of the deep plantar perforating artery was observed at a mean ± standard deviation of 15.62 ± 3.74 (range 6.0 to 28.28) mm from the first metatarsal-medial cuneiform articulation. Most (89.41%) of the arteries were found within 20 mm of the first metatarsal-medial cuneiform articulation. The insertion of the tibialis anterior tendon was found to be proximal to the deep plantar perforating artery in all specimens (100.0%). In conclusion, 2.0 cm of remnant first metatarsal might represent an anatomic definition of how "short" a transmetatarsal amputation can safely be performed in most patients when considering the vascular and biomechanical anatomy.


Assuntos
Amputação , Salvamento de Membro , Ossos do Metatarso/cirurgia , Metatarso/irrigação sanguínea , Metatarso/cirurgia , Anastomose Cirúrgica , Cadáver , Pé Diabético/cirurgia , Humanos , Ossos do Metatarso/patologia , Metatarso/inervação , Tendões/irrigação sanguínea
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