Digital formula is conditioned by deformities and footwear characteristics in older people. A comparison between general population and population with psychiatric disorders

Forefoot morphology is determined by toe length. It is hereditary and unlikely to change during a person’s lifetime, although certain factors may lead to modifications. This study examines whether extrinsic factors such as footwear or deformities are associated with changes in the morphology of the forefoot and its pathologies. A study was made of the forefoot morphology, deformities and footwear of 331 participants divided into two populations: a control group (168 participants) and a population of people living in an institution (163 participants with psychiatric disorders). The results show that although Egyptian foot is the most common morphology in both populations, square foot was more prevalent among the women in the control population than among the women in the institution group. In addition, the type of footwear used by the women in the control population was mostly high-heeled constrictive street footwear, compared to the non-constrictive home footwear worn by the women in the institution population, p-value < 0.001. A high prevalence of square feet was observed in the control group women with hallux valgus (HV), p-value 0.008. A relationship was detected between the presence of HV and its prevalence in participants with square foot, concurrent with the use of constrictive footwear and mostly affecting women. The combination of HV and constrictive footwear could explain the high prevalence of the square foot morphology. These footwear characteristics can be considered risk factors in the alteration of the digital formula and aggravation of the deformity suffered in older women

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A radiographic review of the subacromial architecture: a South African study

The subacromial space, which is occupied by the subacromial bursa, rotator cuff complex and the long head of the biceps brachii tendon, is a well-known area of study due to its association with subacromial disease. Although it is demarcated by the coraco-acromial arch and the supraglenoid tubercle, degenerative changes in these osteological components often lead to mechanical narrowing and subsequent tendon abrasion. In addition to the morphological characteristics, the morphometry of the subacromial architecture is considered to play an important role in maintaining glenohumeral stability. Accordingly, the present study outlined the morphometry of the subacromial architecture and the acromial morphology from a radiological perspective. A total of 120 true lateral-outlet view radiographs (n = 120), representative of 58 males and 62 females of the Black (12), Coloured (10), Indian (27) and White (71) race groups, were analysed. In addition to calculation of the standard and population-specific means, the acromial classification scheme of Bigliani et al. (1986) was adopted. A trend of ascending values from Type III (16.7%) to Type II (37.5%) to Type I (45.8%) acromia was noted. Various shapes of the subacromial space were observed, viz. rhomboidal (20.0%), trapezoidal (65.8%) and triangular (14.1%). Since a statistically significant P value of 0.030 was recorded for the comparison of acromial type with the shape of the subacromial space, the shape of the subacromial space appeared to be dependent on the acromial type. While the parameters were determined with regard to the demographic representation of South Africa, this study also provided standard mean values which were not previously reported. Furthermore, the correlation of the acromio-glenoidal length with side, gender and shape of the subacromial space reflected levels of significance and highlighted this parameter as a diagnostic determinant of subacromial disease due to its tendency to change in accordance with the demographic and morphological factors

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[Extensor digitorum longus transfer in flexible overlapping fifth toe deformity]. / Transfer der Extensor-digitorum-longus-Sehne zur Behandlung des flexiblen Digitus quintus varus superductus.

OBJECTIVE: Pain relief through realignment of the fifth toe by dorsomedial capsular release at the fifth metatarsophalaneal joint and transfer of the extensor digitorum longus tendon to the aponeurosis of the abductor digiti quinti muscle. INDICATIONS: Flexible overlapping fifth toe deformity. CONTRAINDICATIONS: Fixed deformity. Angular toe deformity distal to the metatarsophalangeal joint (e.g. delta phalanx). Lateral drift of all lesser toes. SURGICAL TECHNIQUE: Dorsolateral approach to the fifth metatarsophalangeal joint. Release of the dorsomedial capsule. Tenotomy of the fifth extensor digitorum longus tendon at the dorsum of the foot. Transfer of the distally based tendon around the proximal phalanx to the aponeurosis of the abductor digiti quinti muscle. Correction of the deformity by tensioning the tendon graft appropriately. POSTOPERATIVE MANAGEMENT: Ambulation with full weightbearing in a postoperative shoe. Toe alignment dressing for 6 weeks. RESULTS: A total of 48 patients (56 feet; average age 37 years) with a flexible overlapping fifth toe deformity were followed up after soft tissue release and transfer of the extensor digitorum longus tendon; 40 patients (48 feet) were re-evaluated clinically after 11.4 months (range 9-26 months). Postoperative complications were sensory disturbance at the lateral side of the fifth toe (n = 5), superficial wound slough (n = 3). Follow-up results included broad and hypertrophic scars at the fifth metatarsophalangeal joint (n = 16), physiological alignment of the fifth toe in 37 feet (77.1%), overcorrection (interdigital space 4/5 > 3 mm) in 4 feet (8.3%), undercorrection in 7 feet (14.6%). In 4 feet the undercorrection could be attributed to a Tailor's bunion deformity, which was not treated appropriately.

Enfermedad de Charcot-Marie-Tooth: consideraciones ortopédicas / Charcot-Marie-Tooth syndrome: orthopaedic considerations

La enfermedad de Charcot-Marie-Tooth es una enfermedad heredodegenerativa del sistema nervioso periférico. La alteración es progresiva, y provoca deformidades en pies y manos. La musculatura de la pierna y el pie es la más afectada. La forma de presentación es muy diversa debido a que la afectación muscular es diferente en cada paciente. El pie cavo-varo es la forma de presentación habitual. El tratamiento conservador consiste en férulas correctoras, plantillas y rehabilitación. La indicación quirúrgica se plantea cuando fracasa el tratamiento conservador. La deformidad y el dolor son los problemas principales. En las deformidades flexibles se plantean cirugías para preservar las articulaciones. Los dedos en garra se tratarán con transferencias tendinosas o artroplastias. La deformidad en garra del dedo gordo se produce por el descenso del primer metatarsiano y la hiperactividad del músculo extensor hallucis longus. El tratamiento de esta deformidad del dedo gordo se realiza mediante la técnica de Jones. El descenso del primer metatarsiano necesitará una osteotomía dorsiflexora en la base del primer metatarsiano. Para el varo de retropié se utiliza la osteotomía valguizante de calcáneo. La retracción de la fascia plantar, gastrocnemio y Aquiles se trata con elongación de las estructuras retraídas. Cuando las deformidades son rígidas, será necesario realizar una artrodesis de las articulaciones afectadas. La artrodesis más utilizada es la triple artrodesis (AU)

Charcot-Marie-Tooth disease is a degenerative hereditary disease of the peripheral nervous system. The change is progressive and causes deformities in the feet and hands. The musculature of the leg and foot are most affected. The form of presentation is very diverse owing to the muscle involvement being different in each patient. The high-arched foot is the most common form of presentation. Conservative treatment consists of correction splints, insoles and rehabilitation. Surgery may be indicated when conservative treatment fails. The deformity and pain are the main problems. In flexion deformities surgery is indicated to conserve the joints. Claw hammer toes should be treated with tendon transfers and arthroplasty. The claw deformity in the big toe is caused by the descent of the first metatarsal and hyperactivity of the hallucis longus extensor muscle. The Jones technique is performed as treatment for this deformity of the big toe. The descent of the first metatarsal requires a dorsiflexion osteotomy in the base of the first metatarsal. For the hind foot varus a calcaneal vagus osteotomy is used. The tightening of the plantar fascia, gastrocnemius and Achilles is treated with an extension of the muscle contractures. When the deformities are rigid, it will be necessary to perform an arthrodesis of the affected joints. The arthrodesis most used is the triple arthrodesis (AU)