Intraoperative checking of the first ray rotation and sesamoid position through sonographic assistance.

INTRODUCTION: Hallux valgus (HV) deformity affects the orientation of the metatarsophalangeal (MTP) joint in three planes. Displacement in the coronal plane results in axial rotation of the first metatarsal, with progressive subluxation of the first MTP joint. Multiple techniques have been described to correct the malrotation itself. However, none of them have checked intraoperatively the final position of the first metatarsal head and sesamoids previous to the fixation of the Lapidus procedure or first metatarsal bone osteotomies. The aim of this article is to describe a novel technique to check the first ray rotation and sesamoids position through sonographic assistance. MATERIALS AND METHODS: Before fixation of the Lapidus procedure, with the ankle in maximal dorsiflexion, the surgeon takes the linear ultrasound probe and places it on the sole to visualize the sesamoids, which should be viewed at the same level, with the flexor hallucis longus (FHL) centered between both. Once the ideal position of the head of the first ray has been achieved, temporary fixation with K-wires is performed over the first TMT joint and M1-M2 joint for further sonographic verification of the sesamoids beneath the first metatarsal head. The height of the sesamoids relative to the second metatarsal head should be checked by sonographic control too. RESULTS: Four patients were included. Three females and one male. Their mean age was 76.4 years (R 61-72). Their mean BMI was 29 (R 27.5-32.24). The mean IMA (intermetatarsal angle) was 18.2 (R 17.2-19) degrees and the mean MPA (metatarsophalangeal angle) was 50 (R 36-63) degrees. CONCLUSIONS: Sonographic assistance, is a widely available, inexpensive, and comparative imaging technique that can guide the first ray rotation and sesamoids position in HV surgery, theoretically improving radiological outcomes.

Mapeo sonográfico de los nervios de la cara medial del tobillo y del pie / Sonographic mapping of the nerves of the medial side of the ankle and foot

El uso de los ultrasonidos en el examen, la identificación y el intervencionismo de las diferentes ramas nerviosas del tobillo y del pie son una herramienta de gran apoyo en el ámbito clínico. En la actualidad, la ecografía es un método que se ha ido universalizando en el mundo de la podología, bien por su mayor accesibilidad debido al abaratamiento de los costes, a los avances tecnológicos y a sus beneficios de inocuidad, fácil disponibilidad para el examen inmediato y su aplicación dinámica en la evaluación de las diferentes estructuras anatómicas. El presente trabajo trata de presentar a la comunidad podológica una descripción detallada del mapeo mediante ecografía de los nervios en cara medial del pie. Entendemos que esta descripción puede ayudar a los profesionales en el diagnóstico de las patologías de atrapamiento nervioso a dicho nivel, así como en procedimientos mínimamente invasivos guiados ecográficamente en dicha área anatómica.(AU)

The use of ultrasound in clinical practice is a great tool for the examination, identification and intervention of the different nerve branches in the foot and ankle. Nowadays, sonography is an exploratory method that has been universally expanded in podiatry because of lowering of costs associated to its use, technological progresses and its benefits of safety, disposal for the inmediate clinical exam and its dynamic application in the evaluation of different structures. The aim of the present paper is to present to the podiatry community a detailed description of sonographic mapping of the nerves in the medial side of the ankle. It is intended to help professionals involved in the management of foot ankle disorders regarding the diagnosis of entrapment neuropathies at this level and also to help with minimally invasive treatments sonographically guided.(AU)

Ultrasound Examination of the Ligament Complex Within the Medial Aspect of the Ankle and Foot.

To properly diagnose and treat injuries to the ankle or foot, the physician must have good anatomical knowledge of the ligaments involved. The bundles can be distinguished and identified by ultrasound examination of the medial aspect, but this may be a challenging task. In the present illustrated study, we discuss how a detailed ultrasound examination can be made of the different ligaments within the medial aspect of the ankle and foot.

Morphological Characteristics of Passive and Active Structures of the Foot Across Populations With Different Levels of Physical Activity.

BACKGROUND: Imaging diagnosis plays a fundamental role in the evaluation and management of injuries suffered in sports activities. OBJECTIVE: To analyze the differences in the thickness of the Achilles tendon, patellar tendon, plantar fascia, and posterior tibial tendon in the following levels of physical activity: persons who run regularly, persons otherwise physically active, and persons with a sedentary lifestyle. DESIGN: Cross-sectional and observational. PARTICIPANTS: The 91 volunteers recruited from students at the university and the Triathlon Club from December 2016 to June 2019. The data were obtained (age, body mass index, and visual analog scale for quality of life together with the ultrasound measurements). RESULTS: Tendon and ligament thickness was greater in the runners group than in the sedentary and active groups with the exception of the posterior tibial tendon. The thickness of the Achilles tendon was greater in the runners than in the other groups for both limbs (P = .007 and P = .005). This was also the case for the cross-sectional area (P < .01) and the plantar fascia at the heel insertion in both limbs (P = .034 and P = .026) and for patellar tendon thickness for the longitudinal measurement (P < .01). At the transversal level, however, the differences were only significant in the right limb (P = .040). CONCLUSION: The thickness of the Achilles tendon, plantar fascia, and patellar tendon is greater in runners than in persons who are otherwise active or who are sedentary.