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1.
Zhonghua Yi Xue Za Zhi ; 100(31): 2423-2428, 2020 Aug 18.
Artigo em Chinês | MEDLINE | ID: mdl-32819057

RESUMO

Objective: To evaluate the clinical effect of Z-shaped rotating osteotomy of metatarsal diaphysis in patients with moderate and severe hallux valgus with metatarsophalangeal joint incongruency. Methods: We selected 36 patients (38 feet) with moderate and severe hallux valgus with metatarsophalangeal joint incongruency who underwent Z-shaped rotating osteotomy of metatarsal diaphysis in the First Affiliated Hospital of Army Medical University of Chinese PLA from September 2010 to January 2019. There were 2 males and 34 females with an average age of (49±18) years (18-77 years). Hallux valgus angle (HVA), first-second intermetatarsal angle (IMA), distal metatarsal articular angle (DMAA), congruency index, length of first metatarsal, and functional scores were evaluated before and 6 weeks after surgery and at the last follow-up. The data were compared by one-way ANONA or t test. Results: The congruency index was significantly improved from 0.75±0.11 before surgery to 0.95±0.07 at the last follow-up (t=11.728, P<0.01). HVA and IMA improved significantly at 6 weeks after surgery, however, HVA at the last follow-up showed an increased trend compared with that at 6 weeks after the operation, while no significant improvement in IMA. Although DMAA increased slightly 6 weeks after surgery when compared with that before surgery, there was no significant difference in it between the last follow-up and the 6 weeks after surgery, and no significant difference in the length of the first metatarsal at different time points (F=0.991, P>0.05). In terms of functional scores, American Orthopaedic Foot & Ankle Society (AOFAS) score increased from 50±9 before surgery to 80±17 at the last follow-up, while visual analogue scale (VAS) decreased from 5.8±1.1 to 2.7±1.5, Manchester-Oxford Foot Questionnaire (MOXFQ) score decreased from 70±13 to 25±19 (t=12.024, 13.439, 16.880, all P<0.05). Conclusions: The treatment of moderate and severe hallux valgus with metatarsophalangeal joint incongruency by Z-shaped rotating osteotomy of metatarsal diaphysis can significantly increase the congruency index of metatarsophalangeal joint and improve the metatarsophalangeal joint matching relations. It will not significantly increase the DMAA. A certain degree of radiographic recurrence occurs during a longtime follow-up, but it doesn't influence the symptoms and function.


Assuntos
Hallux Valgus/diagnóstico por imagem , Ossos do Metatarso , Articulação Metatarsofalângica , Adulto , Idoso , Diáfises , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Osteotomia , Radiografia , Resultado do Tratamento
2.
Beijing Da Xue Xue Bao Yi Xue Ban ; 52(4): 726-729, 2020 Aug 18.
Artigo em Chinês | MEDLINE | ID: mdl-32773810

RESUMO

OBJECTIVE: Metatarsophalangeal joint is an important joint for daily weight-bearing walking. Osteoarthritis, osteochondrosis of the metatarsal head, rheumatoid arthritis can often cause the destruction of 2-5 metatarsophalangeal joint, leading to pain, limited joint movement and toe deformities, severely affecting the forefoot function. The purpose of this study is to report the results of middle-long term follow-up after performing Swanson double-stem silicon implant arthroplasty in patients with diseases of 2-5 metatarsophalangeal joint. METHODS: From January 2010 to October 2015, 21 patients with 2-5 metatarsophalangeal joint replacement were performed with Swanson double-stem silicone prosthesis. In the study, 16 cases were successfully followed up, 2 men and 14 women with an average age (66.7±5.5) years. There were 9 cases diagnosed with rheumatoid arthritis, 5 cases with severe osteoarthritis and 2 cases with osteochondrosis of the metatarsal head. The American Association of foot and ankle surgery Maryland foot scoring system and visual analogue score (VAS) were used to evaluate the walking function, metatarsophalangeal joint mobility and pain degree before and after surgery. RESULTS: The follow-up time ranged from 17 months to 5 years, with an average of 3.2 years. According to Maryland foot scoring system of the American Association of foot and ankle surgery, the preoperative score was (60.69±6.12) points and postoperative score was (88.13±5.84) points. Range of motion of metatarsophalangeal joint: preoperative: back extension 5.4°±3.1°, plantar flexion 4.4°±2.7°; postoperative: back extension 15.7°±4.5°, plantar flexion 12.2°±4.3°, the motion of 2-5 metatarsophalangeal joint after operation was significantly improved compared with that before operation (P < 0.01). The preoperative VAS was (6.8±0.9) points and the last follow-up was (2.3±0.8) points, the pain symptom of metatarsophalangeal joint was improved obviously after operation. The postoperative score was significantly higher than the preoperative score according to Maryland foot scoring system (P < 0.01), the excellent rate was 81.3%. CONCLUSIONS: With the advantages of alleviating pain, preserving the length and alignment of metatarsophalangeal joint, improving the function of walking, and correcting the deformity, Swanson double-stem silicon implant arthroplasty is a reproducible and safe option for the reconstruction of the 2-5 metatarsophalangeal joint. However, there is still some probability of adverse reactions and still room for improvement.


Assuntos
Prótese Articular , Articulação Metatarsofalângica , Idoso , Artrite Reumatoide , Artroplastia , Feminino , Seguimentos , Humanos , Masculino , Articulação Metatarsofalângica/cirurgia , Pessoa de Meia-Idade , Resultado do Tratamento
3.
Zhonghua Yi Xue Za Zhi ; 100(27): 2144-2149, 2020 Jul 21.
Artigo em Chinês | MEDLINE | ID: mdl-32689757

RESUMO

Objective: To investigate the clinical outcomes and effects of distal oblique osteotomy and the Youngswick osteotomy in the treatment of grade Ⅲ and Ⅳ hallux rigidus. Methods: Totally 29 patients (33 feet) suffered from grade Ⅲ and Ⅳ hallux rigidus who received the distal first metatarsal osteotomy in Ningbo NO.6 Hospital from May 2013 to December 2018 were analyzed retrospectively. Among them, there were 10 males and 19 females. The average age was (56±6) years. Seventeen cases (18 feet) underwent distal oblique osteotomy of the first metatarsal, 12 cases (15 feet) underwent the Youngswick osteotomy. The overall clinical evaluations were investigated before the operation and at the final follow-up, included the visual analogue scale (VAS) of the pain, American Orthopedic Foot & Ankle Society (AOFAS) scores, the motionrange of the first metatarsophalangeal joint and the first metatarsophalangeal joint space. The data before and after operation were compared by paired t test and non-parametric rank sum test. Results: The operation time were (1.1±0.2) hours and (1.3±0.1) hours, and the intraoperative bleeding was 35 (25, 36) ml and 35 (30, 40) ml in the distal oblique osteotomy and Youngswick osteotomy respectively. All patients were followed up for 12 to 46 months. No nonunion or delayed union occurred in all patients. All patients did not need to be operated again, and no complications such as transferring metatarsalgia, infection and osteonecrosis occurred. In the two groups, the pain VAS score decreased significantly (Z=-3.8, -3.5, both P<0.01), the first metatarsophalangeal joint dorsal extension activity increased (Z=-3.7, -3.4, both P<0.01), the AOFAS score increased (t=28.0, 15.4, both P<0.05) and the first metatarsophalangeal joint space also improved significantly (t=17.7, 14.6, P<0.05) after the operation. There was no significant difference in VAS score, the first metatarsophalangeal joint activity and Horton index between the two groups(Z=-1.3, -0.3, -0.4, all P>0.05), and there was no statistical difference inAOFAS score (t=0.1, P>0.05). But compared with it in the first distal oblique metatarsal osteotomy, the joint space with the Youngswick osteotomy after the operation was larger ((2.4±0.3) mm vs (2.1±0.4) mm, t=2.2, P=0.04). Conclusions: The oblique metatarsal osteotomy and Youngswick osteotomy can effectively relieve the pain of the hallux rigidus, increase the dorsal extension activity and joint space of the first metatarsophalangeal joint, sink the first metatarsal head, and improve the living conditions of the patients. The results of the distal metatarsal osteotomy and the Youngswick osteotomy in the treatment of stage Ⅲ and Ⅳ patients with rigid are similar, which can delay the progress of the disease.


Assuntos
Hallux Rigidus/diagnóstico por imagem , Hallux Valgus , Ossos do Metatarso , Articulação Metatarsofalângica , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Osteotomia , Radiografia , Estudos Retrospectivos , Resultado do Tratamento
4.
PLoS One ; 15(6): e0235251, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32584901

RESUMO

Osteoarthritis is a common cause of pain and economic loss in both humans and horses. The horse is recognized as a suitable model for human osteoarthritis, because the thickness, structure, and mechanical properties of equine articular cartilage are highly comparable to those of humans. Although a number of equine experimental osteoarthritis models have been described in the literature, these cases generally involve the induction of osteoarthritis in just one joint of each animal. This approach necessitates the involvement of large numbers of horses to obtain reliable data and thus limits the use of this animal model, for both economic and ethical reasons. This study adapts an established equine model of post-traumatic osteoarthritis to induce osteoarthritis-associated lesions in all 4 fetlock joints of the same horse in order to reduce the number of animals involved and avoid individual variability, thus obtaining a more reliable method to evaluate treatment efficacy in future studies. The objectives are to assess the feasibility of the procedure, evaluate variability of the lesions according to interindividual and operated-limb position and describe the spontaneous evolution of osteoarthritis-associated pathological changes over a twelve-week period. The procedure was well tolerated by all 8 experimental horses and successfully induced mild osteoarthritis-associated changes in the four fetlock joints of each horse. Observations were carried out using clinical, radiographic, ultrasonographic, and magnetic resonance imaging methods as well as biochemical analyses of synovial fluid and postmortem microscopic and macroscopic evaluations of the joints. No significant differences were found in the progression of osteoarthritis-associated changes between horses or between the different limbs, with the exception of higher synovial effusion in hind fetlocks compared to front fetlocks and higher radiographic scores for left fetlocks compared to the right. This model thus appears to be a reliable means to evaluate the efficacy of new treatments in horses, and may be of interest for translational studies in human medicine.


Assuntos
Articulação Metatarsofalângica/patologia , Osteoartrite/patologia , Animais , Modelos Animais de Doenças , Cavalos , Imagem por Ressonância Magnética , Ossos do Metatarso/patologia , Articulação Metatarsofalângica/diagnóstico por imagem , Articulação Metatarsofalângica/cirurgia , Osteoartrite/diagnóstico por imagem , Osteoartrite/metabolismo , Índice de Gravidade de Doença , Líquido Sinovial/química
5.
J Sports Sci ; 38(16): 1836-1843, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32362240

RESUMO

Chronic foot and ankle injuries are common in dancers; understanding how lower extremity loading changes in response to altered task goals can be beneficial for rehabilitation and injury prevention strategies. The purpose of this study was to examine mechanical demands during jump take-offs when the task goal was modified to focus on either increasing jump distance or increasing jump height. It was hypothesized that a jump strategy focused on height would result in decreased energetic demands on the foot and ankle joints. Thirty healthy, experienced female dancers performed saut de chat leaps while travelling as far as possible (FAR) or jumping as high as possible (UP). Ground reaction force (GRF) impulses and peak sagittal plane net joint moments and sagittal plane mechanical energy expenditure (MEE) of the metatarsophalangeal (MTP), ankle, knee, and hip joints were calculated. During take-off, vertical and horizontal braking GRF impulses were greater and horizontal propulsive GRF impulse was lower in the UP condition. MEE at the MTP, ankle, and hip joints was lower in UP, and MEE at the knee was higher in UP. These results suggest that a strategy focused on height may be helpful in unloading the ankle and MTP joints during dance leaps.


Assuntos
Dança/fisiologia , Extremidade Inferior/fisiologia , Adolescente , Adulto , Traumatismos do Tornozelo/fisiopatologia , Articulação do Tornozelo/fisiologia , Fenômenos Biomecânicos , Dança/lesões , Metabolismo Energético , Feminino , Traumatismos do Pé/fisiopatologia , Articulação do Quadril/fisiologia , Humanos , Articulação do Joelho/fisiologia , Articulação Metatarsofalângica/fisiologia , Estudos de Tempo e Movimento , Adulto Jovem
6.
Zhongguo Gu Shang ; 33(3): 274-7, 2020 Mar 25.
Artigo em Chinês | MEDLINE | ID: mdl-32233259

RESUMO

OBJECTIVE: To explore short-term curative effect of staging operation for large gouty stone on the first metatarsophalangeal joint. METHODS: From January 2015 to December 2016, 12 patients with giant gout stone on the first metatarsophalangeal joint were treated with staging operation, including 12 males, aged from 45 to 73 years old, 6 cases on the right side and 6 cases on the left side. After conservative treatment for more than 2 years, the size and location of ventilator stone were detected by dual energy CT. The bone destruction of the first metatarsophalangeal joint was observed on X-ray examination. All patients underwent stageⅠgout radical removal and temporary fixation with Kirschner wire, and metatarsophalangeal joint fusion and internal fixation were performed after local soft tissue conditions were stabilized. The level of blood uric acid before and after hand were compared, and correction and complications of limb deformity were observed, VAS score was applied to evaluate pain relieved degree. RESULTS: All patients were successfully completed two stages ' operation. Twelve patients were followed up for 9 to 13 months. VAS sco re and uric acid content at different time points were observed and recorded. VAS score before operation ranged from 6 to 9, and decreased to 0 to 1 at 7 weeks after operation; the level of blood uric acid ranged from 443 to 501 µmol/L before operation, and decreased to 307 to 330 µmol/L at 7 weeks after operation. The first metatarsophalangeal joint deformity of foot was corrected and the shape was recovered at 5 to 7 months after operation. One patient occurred incision infection and flap edgenecrosis, and the wound healed by debridement and dressing change. CONCLUSION: Staged operation for the treatment of giant gout stone on the first metatarsophalangeal joint of foot could correct joint deformity, restore shape of the first metatarsophalangeal joint, relieve pain of the affected foot, and beneficial for control content of serum uric acid, and has less complications.


Assuntos
Gota , Articulação Metatarsofalângica , Idoso , Artrodese , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Ácido Úrico
7.
Scand J Rheumatol ; 49(3): 181-185, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32181696

RESUMO

Objective: Morning stiffness (MS) is characteristic of rheumatoid arthritis (RA). Despite its association with functional disability, the extent to which local inflammatory processes contribute to this symptom is unknown. Magnetic resonance imaging (MRI)-detected tenosynovitis of small joints is recognized as an early feature of RA, which is also associated with functional impairments. It has been proposed that tenosynovitis contributes to MS. Therefore, we assessed the relationship between MS and MRI-detected inflammation, in particular tenosynovitis.Method: In total, 286 consecutive patients newly presenting with undifferentiated arthritis and RA underwent contrast-enhanced 1.5 T MRI of (2-5) metacarpophalangeal, wrist, and (1-5) metatarsophalangeal joints. Scans were scored for tenosynovitis according to Haavardsholm, and for synovitis by Rheumatoid Arthritis Magnetic Resonance Imaging Scoring (RAMRIS). MS was dichotomized as ≥ 60 min or not. Associations between MS and tenosynovitis/synovitis were tested with logistic regression, data were categorized (solitary or simultaneous presence of synovitis/tenosynovitis), and the presence of an additive interaction was assessed.Results: MS was present in 40% of patients. Tenosynovitis was more often present in patients with MS than without MS [80% vs 65%, odds ratio (OR) 2.11, 95% confidence interval (1.21;3.69)]. Synovitis was more often present in patients with MS [58% vs 44%, OR 1.79 (1.11;2.91)]. In categorized analyses, concurrent synovitis and tenosynovitis had the largest association [OR 2.43 (1.30;4.54)], in contrast to solitary synovitis [OR 0.85 (0.21;3.47)]. The additive interaction was non-significant. The variance explained in all analyses was small (range 4-5%).Conclusion: Tenosynovitis, combined with synovitis, at small joints is associated with MS and contributes to the pathophysiology of MS.


Assuntos
Artrite Reumatoide/diagnóstico por imagem , Articulação Metacarpofalângica/diagnóstico por imagem , Articulação Metatarsofalângica/diagnóstico por imagem , Amplitude de Movimento Articular , Sinovite/diagnóstico por imagem , Tenossinovite/diagnóstico por imagem , Articulação do Punho/diagnóstico por imagem , Adulto , Idoso , Artrite Reumatoide/fisiopatologia , Feminino , Humanos , Modelos Logísticos , Imagem por Ressonância Magnética , Masculino , Articulação Metacarpofalângica/fisiopatologia , Articulação Metatarsofalângica/fisiopatologia , Pessoa de Meia-Idade , Sinovite/fisiopatologia , Tenossinovite/fisiopatologia , Articulação do Punho/fisiopatologia
8.
J Sports Sci Med ; 19(1): 20-37, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32132824

RESUMO

Although the role of shoe constructions on running injury and performance has been widely investigated, systematic reviews on the shoe construction effects on running biomechanics were rarely reported. Therefore, this review focuses on the relevant research studies examining the biomechanical effect of running shoe constructions on reducing running-related injury and optimising performance. Searches of five databases and Footwear Science from January 1994 to September 2018 for related biomechanical studies which investigated running footwear constructions yielded a total of 1260 articles. After duplications were removed and exclusion criteria applied to the titles, abstracts and full text, 63 studies remained and categorised into following constructions: (a) shoe lace, (b) midsole, (c) heel flare, (d) heel-toe drop, (e) minimalist shoes, (f) Masai Barefoot Technologies, (g) heel cup, (h) upper, and (i) bending stiffness. Some running shoe constructions positively affect athletic performance-related and injury-related variables: 1) increasing the stiffness of running shoes at the optimal range can benefit performance-related variables; 2) softer midsoles can reduce impact forces and loading rates; 3) thicker midsoles can provide better cushioning effects and attenuate shock during impacts but may also decrease plantar sensations of a foot; 4) minimalist shoes can improve running economy and increase the cross-sectional area and stiffness of Achilles tendon but it would increase the metatarsophalangeal and ankle joint loading compared to the conventional shoes. While shoe constructions can effectively influence running biomechanics, research on some constructions including shoe lace, heel flare, heel-toe drop, Masai Barefoot Technologies, heel cup, and upper requires further investigation before a viable scientific guideline can be made. Future research is also needed to develop standard testing protocols to determine the optimal stiffness, thickness, and heel-toe drop of running shoes to optimise performance-related variables and prevent running-related injuries.


Assuntos
Desempenho Atlético/fisiologia , Corrida/lesões , Corrida/fisiologia , Sapatos , Tendão do Calcâneo/fisiologia , Articulação do Tornozelo/fisiologia , Fenômenos Biomecânicos , Desenho de Equipamento , Antepé Humano/fisiologia , Humanos , Articulação Metatarsofalângica/fisiologia , Estresse Mecânico
9.
Acta Chir Orthop Traumatol Cech ; 87(1): 58-61, 2020.
Artigo em Tcheco | MEDLINE | ID: mdl-32131973

RESUMO

Congenital cleft foot is a deformity characterised by genetic heterogeneity and a high degree of phenotypic variability. This together with its very low incidence is the reason for rather controversial opinions on the treatment. The authors present a case study of a boy with unilateral cleft foot classified as type III by Blauth-Borisch and type II by Abraham et al., who underwent a surgery at the age of 12 months. The defect was closed by rectangular soft tissue flaps, the intermetatarsal ligament connecting the first metatarsal head and the third metatarsal head was reconstructed with local fibrous tissue flap. The present hypermobility with extension position of the first ray were stabilised by the Kirschner wire inserted along the axis of the first ray from the dorsum of the talus through the middle of its head to the medial chondrogenic tarsal bones and further through the first metatarsal bone and the corrected metatarsophalangeal joint of the hallux. At the age of 6 years and 7 months, due to dynamic abductovalgus foot deformity, lengthening calcaneal osteotomy was also performed. Favourable clinical and radiographic outcomes of the used surgical technique were observed by the authors. The cleft foot as such shall be treated after a thorough evaluation of the patient and his/her necessary monitoring during the childhood. Key words: ectrodactyly, cleft foot, split hand/foot malformation.


Assuntos
Hallux Valgus , Deformidades Congênitas dos Membros , Ossos do Metatarso , Articulação Metatarsofalângica , Criança , Feminino , , Hallux Valgus/cirurgia , Humanos , Deformidades Congênitas dos Membros/cirurgia , Masculino , Ossos do Metatarso/cirurgia , Articulação Metatarsofalângica/cirurgia
10.
Radiology ; 295(1): 146-154, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32043949

RESUMO

Background Although tenosynovitis in the hands is associated with rheumatoid arthritis (RA), it is unknown whether tenosynovitis of the forefoot is associated with RA. Purpose To determine the anatomy of tendon sheaths of the forefoot and the relationship between MRI-detected tenosynovitis at metatarsophalangeal (MTP) joints and RA. Materials and Methods Fourteen forefeet of donated bodies were examined at flexor tendons and extensor tendons for the presence and course of tendon sheaths. In the prospective study between June 2013 and March 2016, newly presenting patients with RA, patients with other early arthritides, and healthy control participants all underwent MRI of unilateral MTP joints 1-5. MRI studies were scored by two independent readers for tenosynovitis, synovitis, and bone marrow edema. The association between the presence of these features and RA was examined by using logistic regression. Results Macroscopically, all extensor and flexor tendons crossing MTP joints demonstrated sheaths surrounding tendons. Microscopically, a synovial sheath was present. MRI evaluation was performed in 634 participants: 157 newly presenting patients with RA (109 women; mean age, 59 years ± 11 [standard deviation]), 284 patients with other early arthritides (158 women; mean age, 56 years ± 17), and 193 healthy control participants (136 women; mean age, 50 years ± 16). MRI-detected tenosynovitis was associated with RA, both when compared with patients with other arthritides (odds ratio [OR], 2.5; 95% confidence interval [CI]: 1.7, 3.9; P < .001) and healthy control participants (OR, 46; 95% CI: 14, 151; P < .001). The association was OR of 2.4 (95% CI: 1.5, 3.8; P < .001) for flexor tendons and OR of 3.1 (95% CI: 1.9, 5.2; P < .001) for extensor tendons. The sensitivity of tenosynovitis in RA was 65 of 157 (41%; 95% CI: 35%, 50%). The specificity for RA was 63 of 284 (78%; 95% CI: 72%, 82%) compared with other arthritides, and three of 193 (98%; 95% CI: 96%, 99%) compared with healthy control participants. Conclusion Tendons at metatarsophalangeal joints are surrounded by tenosynovium. MRI-detected tenosynovitis at metatarsophalangeal joints was specific for rheumatoid arthritis when compared with findings in patients with other arthritides and findings in healthy control participants. © RSNA, 2020 Online supplemental material is available for this article.


Assuntos
Artrite Reumatoide/diagnóstico por imagem , Antepé Humano/diagnóstico por imagem , Imagem por Ressonância Magnética , Articulação Metatarsofalângica , Tendões/diagnóstico por imagem , Tenossinovite/diagnóstico por imagem , Idoso , Artrite Reumatoide/complicações , Cadáver , Feminino , Antepé Humano/anatomia & histologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Tendões/anatomia & histologia , Tenossinovite/complicações
11.
Bone Joint J ; 102-B(2): 220-226, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32009425

RESUMO

AIMS: Arthroplasty for end-stage hallux rigidus (HR) is controversial. Arthrodesis remains the gold standard for surgical treatment, although is not without its complications, with rates of up to 10% for nonunion, 14% for reoperation and 10% for metatarsalgia. The aim of this study was to analyze the outcome of a double-stemmed silastic implant (Wright-Medical, Memphis, Tennessee, USA) for patients with end-stage HR. METHODS: We conducted a retrospective review of 108 consecutive implants in 76 patients, between January 2005 and December 2016, with a minimum follow-up of two years. The mean age of the patients at the time of surgery was 61.6 years (42 to 84). There were 104 females and four males. Clinical, radiological, patient reported outcome measures (PROMS) data, a visual analogue score (VAS) for pain, and satisfaction scores were collected. RESULTS: The survivorship at a mean follow-up of 5.3 years (2.1 to 14.1) was 97.2%. The mean Manchester Oxford Foot and Ankle Questionnaire (MOXFQ) scores improved from 78.1 to 11.0, and VAS scores for pain from 7/10 to 1.3/10. The rate of satisfaction was 90.6%. Three implants (2.8%) required revision; one for infection, one-month postoperatively, and two for stem breakage at 10.4 and 13.3 years postoperatively. There was a 1.9% reoperation rate other than revision, 23.1% of patients developed a minor complication, and 21.1% of patients had non-progressive and asymptomatic cysts on radiological review. CONCLUSION: We report a 97.2% survivorship at a mean follow-up of 5.3 years with this implant. We did not find progressive osteolysis, as has been previously reported. These results suggest that this double-stemmed silastic implant provides a predictable and reliable alternative with comparable outcomes to arthrodesis for the treatment of end-stage HR. Cite this article: Bone Joint J 2020;102-B(2):220-226.


Assuntos
Artroplastia de Substituição/métodos , Hallux Rigidus/cirurgia , Prótese Articular , Articulação Metatarsofalângica/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Materiais Biocompatíveis , Dimetilpolisiloxanos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
12.
Instr Course Lect ; 69: 363-370, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32017738

RESUMO

The management of bunion deformities in adolescent patients is often a source of consternation for orthopaedic surgeons. Reports of recurrence and surgical failure along with a multitude of procedures to choose from create a wariness to manage the problem surgically. The biggest challenge in managing this problem is a lack of understanding by orthopaedic surgeons that adolescent bunions and adult bunions frequently arise from two distinct etiologies. The main difference between the two is that unlike adult bunion deformities, the hallux metatarsophalangeal joint in the adolescent bunion is congruent as the deformity is caused by a dysplasia of the metatarsal head. This dysplasia results in a valgus orientation of the first metatarsal articular surface (ie, elevated DMAA [distal metatarsal articular angle]). The recognition of this difference has implications for the evaluation and treatment of these deformities in adolescents.


Assuntos
Joanete , Hallux Valgus , Ossos do Metatarso , Articulação Metatarsofalângica , Adolescente , Humanos , Osteotomia
13.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 34(2): 168-172, 2020 Feb 15.
Artigo em Chinês | MEDLINE | ID: mdl-32030946

RESUMO

Objective: To evaluate the effectiveness of lesion clearance combined with Ilizarov technique for the treatment of tophi in first metatarsophalangeal (MTP) joint with bone defect. Methods: Between July 2016 and June 2018, 14 cases of tophi in the first MTP joint with bone defect were treated by lesion clearance combined with Ilizarov technique. There were 12 males and 2 females. The average age was 39.3 years (range, 22-60 years). The disease duration ranged from 5 to 15 years, with an average of 11.2 years. The tophi volume ranged from 2.5 cm×2.7 cm×2.2 cm to 5.2 cm×2.9 cm×2.4 cm. The X-ray films showed that the length of the bone defect ranged from 2.0 to 4.6 cm, with an average of 3.4 cm. Preoperative visual analogue scale (VAS) score was 7.6±0.9; American Orthopaedic Foot and Ankle Society (AOFAS) score was 47.5±4.3; short-form 36 health survey scale (SF-36) score was 79.7±4.7. Results: The incision primarily healed in 13 patients after operation. The skin necrosis at the edge of the incision occurred in 1 patient and recovered after symptomatic treatment. All 14 patients were followed up 12-16 months, with an average of 13.6 months. X-ray films showed that the first metatarsal column defects were repaired. The time of bone extension ranged from 2 to 6 weeks, with an average of 3.6 weeks. The time of bone healing ranged from 9 to 16 weeks, with an average of 11.2 weeks. During follow-up, no complication such as nerve, blood vessel, or tendon injury, needle tract infection, or stress fracture occurred. At last follow-up, VAS score was 1.4±0.5, AOFAS score was 86.6±4.8, and SF-36 score was 89.1±3.3, all of which were superior to preoperative scores, with significant differences ( t=22.532, P=0.000; t=22.702, P=0.000; t=6.124, P=0.000). Conclusion: Lesion clearance combined with Ilizarov technique is a safe and effective method for the treatment of tophi in the first MTP joint with bone defect.


Assuntos
Fraturas de Estresse , Técnica de Ilizarov , Ossos do Metatarso , Articulação Metatarsofalângica , Adulto , Feminino , Humanos , Extremidade Inferior , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Adulto Jovem
14.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 34(1): 41-45, 2020 Jan 15.
Artigo em Chinês | MEDLINE | ID: mdl-31939233

RESUMO

Objective: To summarize the technique and effectiveness of double metatarsal osteotomy for treating severe hallux valgus with increased distal metatarsal articular angle (DMAA). Methods: Between June 2014 and December 2017, 64 patients (94 feet) of severe hallux valgus with an increased DMAA were treated with the double metatarsal osteotomy (distal metatarsal Reverdin osteotomy+proximal metatarsal open wedge osteotomy) combined with Akin osteotomy and soft tissue surgery to correct the deformity. There were 10 males (15 feet) and 54 females (79 feet) with an average age of 44.5 years (range, 26-66 years), including 34 of unilateral foot and 30 of bilateral feet. The Maryland metatarsophalangeal joint score of the American Orthopaedic Foot and Ankle Society (AOFAS) was 54.3±7.4 and the visual analogue scale (VAS) score was 6.0±2.0. The pre- and post-operative AOFAS score, VAS score, DMAA, hallux valgus angle (HVA), first-second intermetatarsal angle (1-2IMA), and the first metatarsal length (FML) were recorded and compared. Results: All incisions healed by first intention. All patients were followed up 12-15 months, with an average of 13.2 months. The complications occurred in 4 feet, including 1 foot of hallux stiffness, 1 foot of numbness at the edge of the wound, 1 foot of metastatic metatarsalgia, and 1 foot of metatarsal bone necrosis. At 1 year after operation, the Maryland metatarsal joint score of AOFAS was 89.2±7.4, showing significant difference compared with preoperative score ( t=18.427, P=0.000); and the effectiveness was rated as excellent in 78 feet, good in 12 feet, poor in 3 feet, and bad in 1 foot, with an excellent and good rate of 95.7%. The VAS score was 1.5±2.0, showing significant difference compared with the preoperative score ( t=10.238, P=0.000). The X-ray films showed that the osteotomies achieved bony healing at 3 months after operation. There were significant differences ( P<0.05) in HVA, 1-2IMA, and DMAA between preoperation and 6 months and 1 year after operation; but no significant difference was found in FML between preoperation and 1 year after operation ( t=0.136, P=0.863). Conclusion: For the patients with severe hallux valgus with increased DMAA, the double metatarsal osteotomy can significantly relieve the clinical symptoms and improve the imaging parameters with less postoperative complications.


Assuntos
Hallux Valgus , Ossos do Metatarso , Articulação Metatarsofalângica , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Osteotomia , Radiografia , Resultado do Tratamento
16.
J Foot Ankle Surg ; 59(1): 112-116, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31882133

RESUMO

Turf toe is hyperextension injury of the plantar plate at the first metatarsophalangeal joint. Etiologies have often included sports/activities with excessive forefoot axial loading and/or violent pivotal movements. The purpose of the systematic review was to systematically review and present an overview for the current evidence-based treatment options of turf toe. Both authors systematically reviewed the PubMed and EMBASE databases from inception to April 2016 based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The level of evidence and quality of evidence were assessed by using the Level of Evidence for Primary Research Question of the Journal of Bone and Joint Surgery, and the quality of evidence was assessed with use of the Newcastle-Ottawa scale. Data were collected and categorized into: case reports and case series. Eight studies (16 turf toes) met the aforementioned criteria and were included. Five case reports and 3 case series reported various treatment options for turf toe. Specifically, 3 studies reported solely conservative treatment (n = 5), 1 study reported solely surgical treatment (n = 1), and 4 studies involved patients in conservative and/or surgical treatments (n = 10). All studies were of level of clinical evidence 4 and quality of clinical evidence score 2 (poor quality). Conservative treatment included closed reduction and immobilization, and surgical treatment included plantar plate tenodesis. Restricted dorsiflexion was the most common complication reported. Turf toe is an underreported injury with no evidence-based treatment guideline to date. Future studies of higher level and quality of evidence with a specific classification system (Jahss or Anderson) consistently reported are warranted for the development of an optimal guideline to determine the most appropriate treatment for each specific severity in injury.


Assuntos
Traumatismos em Atletas/terapia , Traumatismos do Pé/terapia , Placa Plantar/lesões , Traumatismos em Atletas/cirurgia , Traumatismos do Pé/cirurgia , Antepé Humano/lesões , Antepé Humano/cirurgia , Humanos , Articulação Metatarsofalângica/lesões , Articulação Metatarsofalângica/cirurgia , Placa Plantar/cirurgia , Suporte de Carga
17.
J Foot Ankle Surg ; 59(1): 162-168, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31882138

RESUMO

Hallux rigidus is a common condition treated daily by surgeons worldwide. During the past decade, the standard treatment algorithm has been questioned by both patients and surgeons seeking alternatives to arthrodesis, which was previously considered the gold standard for advanced disease. Patients are living longer, and many have a more active lifestyle; thus, recreating and improving range of motion and achieving pain relief are increasingly desirable. The treatment spectrum and implant options for motion-preserving techniques in the metatarsophalangeal joint has been widened with the recent US Food and Drug Administration approval of a polyvinyl-alcohol hydrogel implant. In the controlled US Food and Drug Administration trial, the 2-year revision rate was 9.2% and all failures were revised to a first metatarsophalangeal arthrodesis. Outcomes comparison of these revisions to primary fusions showed less predictable pain relief and may warrant alternative treatment considerations, preferably those that allow for continuation of motion preservation. Revision of failed hydrogel implants to arthrodesis can be performed through various first metatarsophalangeal fusion techniques or, as introduced in this review, with a fourth-generation threaded hemiarthroplasty. Excellent 10-year results with primary hemiarthroplasty supported its use as revision procedure in 2 failed polyvinyl-alcohol implantations, preserving arthrodesis for future salvage if necessary. The purpose of this report was to outline a motion-preserving technique after failed hydrogel implants and describe preoperative, intraoperative, and postoperative considerations for optimized outcomes.


Assuntos
Hallux Rigidus/cirurgia , Hemiartroplastia/métodos , Articulação Metatarsofalângica/cirurgia , Adulto , Materiais Biocompatíveis/administração & dosagem , Materiais Biocompatíveis/efeitos adversos , Feminino , Órtoses do Pé , Hallux Rigidus/diagnóstico por imagem , Hallux Rigidus/terapia , Humanos , Hidrogéis/administração & dosagem , Hidrogéis/efeitos adversos , Prótese Articular , Articulação Metatarsofalângica/diagnóstico por imagem , Desenho de Prótese , Amplitude de Movimento Articular , Reoperação
18.
J Am Podiatr Med Assoc ; 109(6): 431-436, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31755770

RESUMO

BACKGROUND: The aim of this study was to observe the pressure changes in the felt padding used to off-load pressure from the first metatarsal head, the effects obtained by different designs, and the loss of effectiveness over time. METHOD: With a study population of 17 persons, two types of 5-mm semicompressed felt padding were tested: one was C-shaped, with an aperture cutout at the first metatarsophalangeal joint, and the other was U-shaped. Pressures on the sole of the foot were evaluated with a platform pressure measurement system at three time points: before fitting the felt padding, immediately afterward, and 3 days later. RESULTS: In terms of decreased mean pressure on the first metatarsal, significant differences were obtained in all of the participants (P < .001). For plantar pressures on the central metatarsals, the differences between all states and time points were significant for the C-shaped padding in both feet (P < .001), but with the U-shaped padding the only significant differences were between no padding and padding and at day 3 (P = .01 and P = .02). CONCLUSIONS: In healthy individuals, the U-shaped design, with a padding thickness of 5 mm, achieved a more effective and longer-lasting reduction in plantar pressure than the C-shaped design.


Assuntos
Desenho de Equipamento , Pé/fisiologia , Ossos do Metatarso/fisiologia , Articulação Metatarsofalângica/fisiologia , Pressão , Adolescente , Feminino , Órtoses do Pé , Humanos , Masculino , Pessoa de Meia-Idade , Caminhada/fisiologia , Adulto Jovem
19.
J Foot Ankle Surg ; 58(6): 1091-1094, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31679663

RESUMO

Arthrodesis is the gold standard procedure for advanced arthrosis of the first metatarsophalangeal joint. Having a strong construct is preferable for allowing immediate bearing of weight, which facilitates patient rehabilitation. Plate and screw fixation is currently in favor but can lead to prominent metalware necessitating removal. The aim of this study is to report the results of a series of 54 first metatarsophalangeal joint arthrodeses performed in 52 patients treated with an implant composed of an intraosseous post and lag screw. All of the patients had a minimum follow-up of 1 year, and the indication for the surgery was end-stage hallux rigidus in 44 (81.5%) feet, severe hallux valgus in 8 (14.8%) feet, and rheumatoid arthritis in 2 (3.7%) feet. Arthrodesis was achieved in 52 (96.3%) feet at a mean of 61 ± 16 (range 39 to 201) days with nonunion observed in 2 (3.7%) feet; neither of the 2 patients had known risk factors. Metalware impinging on soft tissues necessitating removal was observed in 3 (5.6%) feet, and there were no cases of loss of position or implant breakage. The mean Manchester-Oxford Foot Questionnaire score improved from 46.4 ± 13.3 to 18.4 ± 9.4 (p < .001) at latest follow-up. In conclusion, our results suggest the intraosseous post and lag screw device was safe and effective, and it can be considered an alternative method of stabilizing the first metatarsophalangeal joint when undertaking arthrodesis surgery.


Assuntos
Artrodese/métodos , Pinos Ortopédicos , Parafusos Ósseos , Hallux Rigidus/cirurgia , Articulação Metatarsofalângica/cirurgia , Amplitude de Movimento Articular/fisiologia , Suporte de Carga , Adulto , Idoso , Feminino , Seguimentos , Hallux Rigidus/diagnóstico , Hallux Rigidus/fisiopatologia , Humanos , Masculino , Articulação Metatarsofalângica/diagnóstico por imagem , Articulação Metatarsofalângica/fisiopatologia , Pessoa de Meia-Idade , Radiografia , Estudos Retrospectivos , Fatores de Tempo
20.
J Foot Ankle Surg ; 58(6): 1288-1292, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31679683

RESUMO

In 2016, the U.S. Food and Drug Administration approved the first and only polyvinyl alcohol hydrogel implant for the treatment of hallux rigidus. The implant functions as a bumper to maintain first metatarsophalangeal joint space to prevent contact of the phalangeal base with the first metatarsal head. Short-term and intermediate outcomes with this implant have reported positive outcomes with no radiographic outcomes of implant wear or subsidence. We performed a retrospective radiographic review of 27 consecutive patients who received the implant and measured preoperative and postoperative joint space area (JSA). We found a significant improvement in JSA (p < .001) between the preoperative JSA and JSA at the first postoperative visit at 1 to 2 weeks. We also found a significant decrease in JSA (p < .001) between the first postoperative visit and the second postoperative visit at 5 to 12 weeks. This information could have further implications for implant design as well as how we can better achieve functional improvements in the first metatarsophalangeal joint in patients with hallux rigidus.


Assuntos
Hallux Rigidus/cirurgia , Prótese Articular , Articulação Metatarsofalângica/diagnóstico por imagem , Articulação Metatarsofalângica/cirurgia , Álcool de Polivinil , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Radiografia , Estudos Retrospectivos
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