Comparison of Plantar Pressure Distribution and Functional Outcome after Scarf and Austin Osteotomy.

OBJECTIVE: To investigate the changes of plantar pressure distribution in patients who underwent either Austin or Scarf osteotomy and underwent a postoperative rehabilitation program. METHODS: Between September 2006 and December 2007, 50 participants who suffered from mild to moderate hallux valgus deformity were prospectively included in this study. An Austin osteotomy (Austin group) was performed in 25 patients and a Scarf osteotomy (Scarf group) in 25 patients. Indication for the Scarf or Austin technique was made according to the consensus of the Austrian society of foot and ankle surgery. Plantar pressure analysis was performed at 4 weeks, 8 weeks, and 6 months postoperatively. Furthermore, range of motion and the American Orthopaedic Foot and Ankle Society (AOFAS) questionnaire were evaluated. RESULTS: In the big toe and first metatarsal head region in groups, maximum force, peak pressure, and force-time integral increased significantly from 4 weeks to 6 months postoperatively (P ≤ 0.001). The mean AOFAS score increased from 60.7 preoperatively to 93.1 6 months after Austin surgery and from 56.7 preoperatively to 94.4 6 months after Scarf surgery. The Austin group had a mean range of motion (ROM) of 68.5° that increased to a mean ROM of 75.5° 6 months postoperatively, while the Scarf group had a mean ROM of 67.8° that increased to a mean ROM of 68.2° 6 months postoperatively. CONCLUSION: Despite different surgical techniques and the degree of deformity, there were no differences in plantar pressure parameters and functional outcomes between both groups.

First metatarsophalangeal joint arthrodesis versus proximal phalanx hemiarthroplasty for hallux rigidus: feasibility study for a randomised controlled trial.

BACKGROUND: Osteoarthritis of the first metatarsophalangeal joint (hallux rigidus) leads to pain and poor function and mobility. Arthrodesis is the gold standard treatment for end-stage disease. Total joint arthroplasties have been attempted, but early loosening has been attributed to dorsally directed shear forces on the metatarsal component. Metallic proximal phalangeal hemiarthroplasty theoretically avoids this. Whilst early results are promising, no comparative trials exist comparing this to arthrodesis. METHODS/DESIGN: The primary objectives are to determine the range of outcome scores between the two treatment arms (to inform a power calculation). Outcome measures will include the MOXFQ, AOFAS-Hallux and EuroQol EQ-5D-5 L. Secondary objectives are to determine the accrual rate, dropout rate and trial acceptability to both patients and surgeons. These data will allow the development of a larger trial with longer follow-up.This is a prospective randomised controlled single-centre study comparing proximal phalanx hemiarthroplasty (AnaToemic, Arthrex Ltd., Sheffield, UK) with arthrodesis (15 patients in each arm). Randomisation will be performed using a 1:1 allocation ratio in blocks of six.Patients meeting the eligibility criteria will be recruited from three foot and ankle consultant surgeon's clinics (East Lancashire Hospitals NHS Trust). If agreeable, informed consent will be obtained before patients are randomised.The outcome measure scores will be completed pre-operatively and repeated at 6 weeks, 3 months and 12 months. A radiological review will be performed at 6 weeks and 12 months to determine rates of loosening (hemiarthroplasty) and union (arthrodesis). Data on length of stay, return to work, complications and re-operation rates will also be collected.The analysis will compare the change in outcome scores between treatment groups at all follow-up time points. Scores will be compared using a Student t-test, adjusting for scores at baseline.This study will be conducted in accordance with the current revision of the Declaration of Helsinki (1996) and the ICH-GCP Guideline (International Conference on Harmonisation, Good Clinical Practice, E6(R1), 1996). This study has been approved by the sponsor, the Trust Research & Development office. Ethical approval has been received from the National Research Ethics Service (North East: 12/NE/0385 for protocol version 5.3 dated 3 June 2013). TRIAL REGISTRATION: Current Controlled Trials ISRCTN88273654.

Peak load resistance of the JuggerKnot™ soft anchor technique compared with other common fixation techniques for large mallet finger fractures.

INTRODUCTION: To identify the strongest peak load resistance among four mallet finger fracture fixation methods (Kirschner wire, pull-out wire, tension-band wiring and the JuggerKnot™ (Biomet) soft anchor fixation). METHODS: Fixation techniques were assigned among 24 specimens from six cadaveric human hands in a randomized block fashion. Peak load resistance was tested at 30°, 45° and 60° of flexion of the distal interphalangeal joint. RESULTS: The mean peak load of tension-band wiring was 67.8 N at 60° of flexion which was most superior. The JuggerKnot™ fixation had mean peak loads of 13.35 N (30°), 22.51 N (45°) and 32.96 N (60°). No complications of implant failure or fragmentation of the dorsal fragment was noted. CONCLUSIONS: Tension-band wiring was the strongest fixation method but was most prominent on the skin surface as seen in three specimens. The JuggerKnot™ soft anchor fixation had similar peak load resistance as k-wire fixation and pull-out wiring.

Stabilization of first metatarsophalangeal instability with plantar plate tenodesis.

First metatarsophalangeal instability is an uncommon condition. It is resulted from disruption of the capsular-ligamentous complex, e.g. after dislocation of the hallux metatarsophalangeal joint or after turf-toe injury. The patient will experience pain with push-off and hallux rigidus type of symptoms. We present a technique to stabilize the first metatarsophalangeal joint by anchoring the plantar plate to the extensor hallucis longus tendon.

Assessment of foot impairment in rheumatoid arthritis patients by dynamic pedobarography.

OBJECTIVES: Impaired foot function may jeopardize the mobility of patients with rheumatoid arthritis (RA). However, there are still no guidelines concerning the adequate early treatment of painful rheumatoid feet which do not yet require surgery. An assessment method for RA feet appears necessary in order to detect foot problems before functional limitations develop. Therefore, the aim of the present study was to evaluate the use of pedobarographic measurements for detecting changes in plantar loading characteristics and their relationship to foot pain in patients with RA. METHODS: One hundred and twelve patients with RA (55.0+/-11.0 years of age) were divided into three groups according to their Health Assessment Questionnaire (HAQ) Score and compared to a control group of 20 healthy adults (CG). Thirty-six patients with good physical capacity belonged to group 1 (RA1; HAQ-score: 0-1.0), 38 patients with moderate capacity to group 2 (RA2; score: 1.1-2.0) and 38 patients with low capacity to group 3 (RA3; score: 2.1-3.0). Each patient's foot pain was clinically assessed. Pedobarography was used to analyze foot loading parameters while walking barefoot. RESULTS: In the forefoot, average pressures under the lateral forefoot were higher in RA1 patients than in RA2 patients and controls (p<0.05) despite an inconspicuous clinical examination of the foot in RA1 patients. RA1 patients also demonstrated higher plantar pressures than RA2 under the second metatarsal head (p<0.05). In contrast, no significant differences in maximum force could be demonstrated between patient groups. Furthermore, in RA3 patients with lower physical capacity, foot pain was increased as compared to RA1 and RA2 patients. CONCLUSION: In RA patients, pedobarographic patterns show specific changes which characterize the level of functional capacity. In patients with foot involvement, pedobarographic measurements can be useful during the earlier stages of the disease, when clinical examination does not yet indicate the need for more aggressive treatment or orthopedic interventions.

The position of the centres of the sensors of the Parotec pressure measurement insoles system related to the anatomy centres of the metatarsal heads by means of radiological records.

This study pretend to establish the anthropometric relationship between the position of osseous prominences (metatarsal heads, proximal and distal phalanxes bones) of the feet in a group of diabetic patients, and the position of the sensors of the electronic German Parotec insoles system, located in the same areas to register the plantar pressure distribution in standing position by using RXs. The aims of this study were: a) to establish the position of the centres of the sensors of the Parotec insoles related to the centres of the metatarsal heads and distal ends of the proximal phalanges and the proximal ends of the distal phalanges phalanxes of the feet, in a group of 12 diabetic subjects wearing different type of shoes, by means of radiological records, in order to answer the following questions: (1) Can the Parotec insoles designed for registering plantar pressure distribution on diabetic German people be used for measuring pressure distribution on a group of 12 diabetic type 1 and type 2 Colombian people evaluated in this study? (2) Are those bones landing according to the Parotec sensor position? (3) Which would be the proper distribution of the Parotec sensors for this group of subjects? b) To establish if the use of different types of footwear (sports, conventional and orthopaedic footwear) with the Parotec electronic insoles can influence the position of the osseous prominences in relation to the position of the sensors that register the pressure in these areas.