[Effect of physiotherapy on the functional improvement after hallux valgus surgery - a prospective pedobarographic study]. / Einfluss von Physiotherapie auf die Funktionsverbesserung nach Hallux-valgus-Operationen - eine prospektive pedobarografische Studie.

AIM: Recent pedobarographic analyses have shown that in spite of acceptable clinical and radiological results after hallux valgus surgery, there is decreased function of the big toe and the first ray, respectively. The aim of this prospective study was to evaluate if physiotherapy can help to increase big toe function and to restore physiological gait patterns after hallux valgus surgery. METHODS: 33 patients (31 females, 2 males, 34 feet) with a mild to moderate hallux valgus deformity have been included in this study. 22 patients underwent Austin osteotomy and 11 patients underwent Scarf osteotomy, respectively. Postsurgically, the patients wore the Rathgeber postop shoe for 4 weeks. After this period they received physiotherapy. Pedobarographic examinations were performed with the EMED-at platform 4 weeks, 8 weeks and 6 months after surgery. The AOFAS score and ROM of the first MTP joint were evaluated prior to surgery and 6 months after surgery. Also, patient's satisfaction has been evaluated 6 months after surgery. RESULTS: In the big toe region peak pressure increased from 80.7 kPa 4 weeks after surgery to 171.9 kPa 8 weeks after surgery (p < 0.0001) and 336.1 kPa 6 months after surgery. In the same period maximum force increased from 18.6 N to 47.6 N and 90.9 N, respectively. In the first metatarsal head region peak pressure increased from 141.4 kPa 4 weeks postoperatively to 215.8 kPa 8 weeks postoperatively and 292.7 kPa 6 months after surgery (p < 0.0001). The AOFAS score increased from 60.8 presurgically to 94.0 at 6 months after surgery and ROM of the first MTP joint increased during the same period from 66 degrees to 70 degrees . CONCLUSIONS: The authors conclude that postoperative physiotherapy improves big toe function and pressure distribution in the region of the first metatarsal head. This helps to restore physiological gait patterns after hallux valgus surgery.

[Biomechanics of the arch of the foot. Pre- and postoperative radiological examination]. / Biomechanik des Fussgewölbes. Prä- und postoperative Radiometrie.

The human foot is a complex biomechanical structure. The arch of the foot is formed by the bony and articular structure of the midfoot and supported by strong ligaments and tendons. The normal arch develops in childhood. Tendon and ligament rupture and degeneration often lead to flattening of the arch. Frequent painful conditions include hallux valgus deformity and rupture of the posterior tibial tendon both leading to flat feet. Radiological examination is necessary in a standardized, full weight bearing standing position. The standing dorsoplantar view shows hallux valgus angle and intermetatarsal 1/2 angle. The side view shows Lisfranc joint instability and decrease of the talometatarsal angle. Talonavicular instability is a frequent secondary sign of spring ligament and posterior tibial tendon lesion. After failure of conservative therapy, corrective surgery with osteotomy and realignment procedure of the malpositioned bones in combination with tendon and ligament reconstruction is the state of the art procedure. In postoperative follow-up a standing X-ray of the foot is again the standard tool. Additional MRI and CT examinations help to detect bone and cartilage lesions and tendon/ligament ruptures.

Spontaneous osteonecrosis of the knee: biochemical markers of bone turnover and pathohistology.

OBJECTIVE: The aim of this study was to evaluate bone metabolism in patients with spontaneous osteonecrosis (ON) of the medial femoral condyle. METHOD: In 22 consecutive patients, undergoing total knee arthroplasty, biochemical markers of bone metabolism were measured in aspirates from cancellous bone and in samples obtained simultaneously from peripheral blood. Specimens of the medial femoral condyle were available for histologic examination and the lesion size, assessed on radiographs, was compared with the results from bone turnover measurements. Twenty patients with osteoarthritis (OA) of the knee served as a control. Bone-specific alkaline phosphatase (bone ALP), osteocalcin (OC), procollagen type I N-terminal propeptide (PINP), and C-terminal cross-linking telopeptide (ICTP) were studied. RESULTS: Mean serum levels of analytes were not different in patients with ON and OA. The serum concentrations averaged 16.2 vs 13.3 ng/mL (OC), 10.2 vs 12.1 ng/mL (bone ALP), 4.6 vs 4.1 ng/mL (ICTP), and 33.2 vs 40.4 ng/mL (PINP) in patients with ON and OA, respectively. In samples obtained from cancellous bone, mean concentrations of all markers were elevated significantly when compared to serum levels. The mean marker concentrations in samples obtained from cancellous bone were 33.8 vs 43.3 ng/mL (OC), 34.6 vs 37.3 ng/mL (bone ALP), 64.8 vs 36.1 ng/mL (ICTP, P=0.02), and 208.0 vs 176.2 ng/mL (PINP) in patients with ON and OA, respectively. The lesion size was at mean 440.5+/-275.8mm(2) in knees with ON and did not correlate with either serum or bone concentrations of all markers tested (P>0.1). CONCLUSION: The marked elevation of markers in samples obtained from cancellous bone pointed at increased turnover in both diseases when compared to healthy individuals. In line with histologic findings of necrosis of subchondral bone, focal degradation of collagen type I was more pronounced in knees with ON. Mean serum concentrations of all markers, however, were not different from healthy individuals and thus did not provide any useful clue in the diagnosis spontaneous ON.

[Snowboarding. History--injuries--risks--new materials--tournament on-site services--prevention]. / Snowboarden Geschichte -- Verletzungen -- Risiken -- Materialneuigkeiten -- Wettkampfbetreuung -- Prävention.

Since the 1998 Olympic Winter Games in Nagano, snowboarding has been established as a popular winter sport for youth and adults. The most frequently affected body region reported in many studies on snowboarding injuries are the wrists accounting for more than 50% of severe injuries, especially in beginners. Wrist braces are effective in protecting snowboarding beginners against wrist injuries. Male snowboarders up to the age of 16 and female snowboarders over the age of 25 have a higher risk of injury. Snowboarders should not use ski boots and should be careful with rented equipment. Systems providing body and limb protection and also snowboard-specific helmets can reduce the injury risk for alpine racers, freestylers, and also freeriders. Snowboard training is important to prevent injuries especially for beginners, and icy slopes should be avoided.

The first metatarsal bone under loading conditions: a finite element analysis.

An individual-based, three-dimensional finite element model of the first metatarsal (MT I) bone was created with fine CT. The three-dimensional model of the bone was fixed proximally at the metatarsocuneiform joint and load was applied on the metatarsal head. Loading conditions were simulated, including muscular forces as described for a normal metatarsophalangeal (MTP) joint during three typical phases of gait as the combination of the load in the contact areas of the sesamoid bones and the base of the proximal phalanx. The resultant strain and stress distributions within the loaded MT I were calculated and visualized with the MTP in different positions.

Hallux valgus and cartilage degeneration in the first metatarsophalangeal joint.

This study relates the extent of cartilage lesions within the first metatarsophalangeal joint to hallux valgus. We prospectively examined 265 first metatarsophalangeal joints of 196 patients with a mean age of 54.2 years at operation for the existence of cartilage lesions. Grade I lesions were found in 41 feet (15.5%), grade II in 82 (30.9%), grade III in 51 (19.3%), grade IV in 20 (7.5%). Only 71 (26.8%) showed no cartilage lesion. Cartilage lesions were found within the metatarsosesamoid and metatarsophalangeal compartments in 66 feet (34.0%), within the metatarsophalangeal compartment in 26 (13.4%) and within the metatarsosesamoid compartment in 102 (52.6%). A statistically significant correlation was found between the grade of cartilage lesion and the hallux valgus angle, both for the changes within the metatarsophalangeal and the metatarsosesamoid joints.

The SCARF osteotomy for the correction of hallux valgus deformities.

The authors report their experience with a modified SCARF osteotomy with three years follow-up. Correction of moderate to severe hallux valgus deformities was achieved using a Z step osteotomy cut to realign the first metatarsal bone. A retrospective analysis was undertaken in 89 consecutive patients (111 feet). Results were analyzed by clinical examination, a questionnaire including the AOFAS forefoot score, and plain roentgenograms. Hallux valgus and intermetatarsal angle improved at mean 19.1 degrees and 6.6 degrees, respectively. Mean forefoot score improved from 50.1 to 91 points out of 100 possible points. Satisfactory healing time was expressed by an average return back to work of 5.8 weeks and back to sport of 8.3 weeks. Persistence or recurrence of hallux valgus was seen in seven patients (6%). The complication rate was 5.4% including superficial wound infection, traumatic dislocation of the distal fragment, and hallux limitus. The presented technique provides predictable correction of moderate to severe hallux valgus deformities.

MR imaging of the knee in marathon runners before and after competition.

OBJECTIVE: To evaluate the findings in MRI-studies of the knee in recreational long-distance runners after competition and to assess the reversibility of the findings. DESIGN AND PATIENTS: Eight recreational long-distance runners underwent MRI studies of the knee before, immediately after and 6-8 weeks after taking part in the Vienna City Marathon. The studies were evaluated regarding alterations of pre-existing lesions and new pathological findings. RESULTS: In six runners without major pre-existing alterations no negative effects were experienced. In one runner with pre-existing grade III alterations of the menisci, signs of progressive osteoarthritis were experienced 2 months after the competition. In all other cases increased meniscal signal alterations and minor signal changes in the bone marrow after the race were transitory. CONCLUSION: In healthy individuals no negative long-term-effects were experienced. Pre-existing high-grade lesions of the menisci might be a predisposing risk for osteoarthritis, triggered by the stress of long-distance running.

[Functional evaluation of shoes for children based on gait analysis of children in the learning to walk stage]. / Funktionelle Beurteilung von Kinderschuhen anhand der Ganganalyse von Kindern im Lauflernalter.

RESEARCH QUESTION: Although gait patterns of children are well described in gait analysis studies for barefoot gait, loading patterns in gait with shoes have not been analysed compared to barefoot gait. METHODS: 30 children (age 1.8 to 4.8 years) were examined. Ground reaction forces were recorded using two series connected Kistler plates, taking the 3D coordinates and the time coordinate. The gait aspect was recorded using a video system. Three shoe types were tested against each other and against barefoot gait. RESULTS: 1399 gait cycles, 739 barefoot, 660 with shoes were usable for calculation. Statistic analyses comparing barefoot gait to gait with shoes showed: A significant increase in ground contact duration, a shifting of maximal load from the rear towards the midfoot area, a significant increased maximal load, a cushioning of the initial impact at primary ground contact. A comparison between the shoes showed no significant influence of a medial subtalar orthotic support. CONCLUSION: Shoes cause a significant change of loading patterns. But there are also significant differences between different shoe types. CLINICAL RELEVANCE: Shoes for children must provide a stabilisation for the hindfoot, and must not restrict motion in the areas of the ankle and the metatatrsophalangeal joints. The amount of load in the different gait phases must be considered for the construction of a dynamic shoe for children.