[Surgery of the rheumatoid metatarsus and phalanges].
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Arthritis↗
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[On a new technique of surgical treatment of hallux valgus in Morton's foot. (Metatarsus primus brevis)].
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Foot Diseases↗
The geriatric bunion: correction of metatarsus primus varus and hallux valgus with the Swanson total joint implant.
The authors have evaluated the long-term results of the Keller/Mayo bunionectomy with replacement of the first metatarsophalangeal joint with a Silastic double-stemmed implant (Swanson design). Examination of 50 preoperative and postoperative radiographs revealed a decrease in the hallux abductus angle of 21.46 +/- 2.66 degrees, and the intermetatarsal angle of 6.40 +/- 0.67 degrees; both of these figures have a statistically significant probability value of 0.05 attached. The mean patient age at time of surgery was 61.31 years; the mean follow-up time was 5.01 months. A literature review of implant arthroplasty for correction of hallux abducto valgus deformity is also presented.
Aged↗
[A case of cystic lesion of aneurysmal type on a metatarsus].
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Bone Cysts, Aneurysmal↗
Metatarsus adductus and skewfoot.
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Age Factors↗
[Scarf osteotomy for the treatment of hallux valgus: a review of 123 cases with 4.8 years follow-up].
PURPOSE OF THE STUDY: Many different osteotomies can be used for the treatment of hallux valgus. The purpose of this study was to evaluate the Scarf osteotomy associated or not with phalangeal osteotomy and to search for deformation cutoff points beyond which corrections appear to be difficult to achieve. MATERIAL AND METHODS: This retrospective analysis included 87 patients (123 feet) among 130 who underwent hallux valgus surgery between October 1993 and November 2000. Mean follow-up was four years eight months. The serie included 83 women and 4 men. Mean age at surgery was 53.5 years. A Scarf diaphyseal osteotomy was performed in all patients associated or not with phalangeal osteotomy. Each patient was reviewed clinically and radiographically with anteroposterior and lateral views of the foot in the standing position. RESULTS: 84.6% of the patients were satisfied or very satisfied. There was a correlation between the index of satisfaction and clinical symptoms (metatarsalgia, stiff hallux, pain over exostosis). There was a statistically significant decrease in hallux valgus (31.2 degrees to 17.5 degrees ), of metatarsus varus (12.1 degrees to 7.5 degrees ), and articular angle of the distal metatarsus (13.3 degrees to 11.1 degrees ). Patients who had phalangeal osteotomy achieved the best hallux valgus correction (15 degrees versus 21.4 degrees ). Mean shortening of the first metatarsus was 2.2 mm with a decrease in the metatarsus-ground angle (19 degrees versus 20.1 degrees ). Cutoff limits for deformations which are difficult to correct satisfactorily were M1M2 angle > or = 15 degrees and distal metatarsal articular angle > or = 13 degrees . The overall Groulier score showed 70.7% very good and good results, 27.6% fair results and 1.7% poor results. DISCUSSION: The Scarf technique is a reliable method to achieve significant correction of hallux valgus deformation. It requires a rigorous technique with specific attention to the elevation of the first metatarsus and excessive shortening, two factors favoring metatarsalgia. Adding a phalangeal osteotomy can improve the radiological result, but it is very difficult to obtain satisfactory correction if the initial deformations are severe and associated. Rotation of the plantar fragment helps for better orientation of the articular surface of the first metatarsus but limits the correction of the metatarsus varus. Function is the basic objective of hallux valgus surgery and patient satisfaction is related solely to clinical symptoms.
Adolescent↗
The use of a circular external skeletal fixation device for the management of long bone osteotomies in large ruminants: an experimental study.
The study was undertaken to evaluate the feasibility of a simple, inexpensive model of circular external fixator (CEF) for use in large ruminants. A simple model of CEF frames consisting of four full rings (13-19 cm diameter, 4 cm wide and 4 mm thick with 18-24 holes) connected by threaded rods (8 mm diameter, 10-15 cm long) and nuts was developed using mild (low carbon) steel and were nickel-plated. In the first phase of the study, three male cow calves were utilized to study the feasibility of application of the fixators in the metatarsus, tibia and radius, in reference of adaptation and tolerance by animals. In the second phase, the fixators were tested in osteotomized bones. Six bull calves of 1.5-2 years of age weighing about 200-250 kg were utilized for this purpose. After preparing the area for aseptic surgery, under xylazine (at 0.1 mg/kg, i.m.)-ketamine (i.v. till effect) general anaesthesia, the test bone (metatarsus, radius and tibia in two animals each) was approached through the medial surface and an osteotomy was created with a saw and chisel at the mid-diaphysis. The pre-constructed 4-ring CEF was mounted on the limb around the test bone in such a way that it formed a cylinder with the axis of the limb at the centre. Each ring was then fixed to the bone with a pair of beaded wires (316 SS) of 3.5 mm diameter. During the post-operative period, the animals were observed for any change in behaviour, tolerance of the fixators, the weight bearing on the test limb, the status of the fixator, and the level of reduction of the osteotomy, alignment and healing at different intervals. The fixation of CEF was easier in the metatarsus and radius than in the tibia. The inner ring diameters found adequate for metatarsus, radius and tibia were 13-15 cm, 15-17 cm and 17-19 cm, respectively. The fixators applied to different bones were well-tolerated, and the animals could lay down, stand and walk freely with the fixator without any problems. All the animals showed good weight bearing in the immediate post-operative period. Weight bearing, however, slightly reduced in the inflammatory period and showed improvement after about 4 weeks. Wire tract infection was seen in all the animals, which was more on proximal wire tracts on lateral aspect of limbs. Circular fixators were well-tolerated by all the animals, and there was no breaking/bending of connecting rods, slotted bolts or the rings at any stage of observation. Slight bowing of some wires was noticed in cases of tibia and radius (in phase II) and bending of some wires was noticed from first week in two animals one each in radius and tibia. Bone fragments were well maintained until healing occurred (appearance of bridging periosteal callus) at 60-70 days. The functional results were good in all but one case of tibia, where a mal-union was recorded. From this study, it can be concluded that CEF are well-tolerated by large ruminants and can be used to treat long bone fractures. The fixator assembly using mild steel is sufficiently strong to maintain fracture fixation and is inexpensive. The simple design of the CEF appears to be sufficient to treat simple diaphyseal fractures of the metatarsus and radius. Improvement in the technique of fixation and design-like coupling of linear and circular fixator components into hybrid constructs may help to provide greater rigidity in treating tibial and open long bone fractures.
Animals↗
Comparison of blood pressure measurements obtained in dogs by use of indirect oscillometry in a veterinary clinic versus at home.
OBJECTIVE: To compare blood pressure and heart rate measurements performed in a veterinary clinic to similar measurements performed in a dog's home. DESIGN: Prospective study. ANIMALS: 14 client-owned, clinically normal dogs. PROCEDURE: Sequential blood pressure and heart rate measurements were recorded from the metatarsus and metacarpus of conscious dogs by indirect oscillometry. Measurements were performed in the dogs' homes and were repeated in a veterinary clinic. Blood pressures and heart rate were derived from 7 serial estimates over 8 to 10 minutes. Statistical differences between the home and clinic and between recording sites were calculated. RESULTS: Systolic, diastolic, and mean blood pressure and heart rate measurements obtained from the metatarsus and metacarpus in the dogs' homes were significantly lower than measurements from the metatarsus in the clinic, but were similar to measurements from the metacarpus in the clinic. Significant differences were not found between blood pressure measurements from the metatarsus and metacarpus in the dogs' homes, but systolic and mean blood pressure and heart rate measurements from the metacarpus in the clinic were significantly lower than measurements from the metatarsus. Whereas all dogs had normal blood pressure in their homes, 5 of 14 dogs had transient hypertension (systolic pressure > 165 mm of Hg or diastolic pressure > 95 mm of Hg) in the clinic. CLINICAL IMPLICATIONS: Blood pressure and heart rate measurements obtained in the clinic initially overestimate comparable measurements in a dog's home. The differences are best explained by transient autonomic responses to the stress of the clinic. Blood pressure must be measured by use of standardized techniques on dogs acclimated to the clinic environment.
Acclimatization↗
Influence of size and stability of the osteotomy gap on the success of fracture healing.
Flexible fixation of fractures with minimally invasive surgical techniques has become increasingly popular. Such techniques can lead to relatively large fracture gaps (larger than 5 mm) and considerable interfragmentary movements (0.2-5 mm). We investigated the influence of the size of the fracture gap, interfragmentary movement, and interfragmentary strain on the quality of fracture healing. A simple diaphyseal long-bone fracture was modeled by means of a transverse osteotomy of the right metatarsus in sheep. In 42 sheep, the metatarsus was stabilized with a custom-made external ring fixator that was adjustable for gap size and axial interfragmentary movement. The sheep were randomly divided into six groups with three different gap sizes (1, 2, or 6 mm) and small or large interfragmentary strain (approximately 7 or 31%). The movement of the fracture gap was monitored telemetrically by a displacement transducer attached to the fixator. After 9 weeks of healing, the explanted metatarsus was evaluated mechanically in a three-point bending test to determine bending stiffness and was radiographed to measure the amount of periosteal callus formation. Increased size of the gap (from 1 to 6 mm) resulted in a significant reduction in the bending stiffness of the healed bones. Larger interfragmentary movements and strains (31 compared with 7%) stimulated larger callus formation for small gaps (1-2 mm) but not for larger gaps (approximately 6 mm). The treatment of simple diaphyseal fractures with flexible fixation can be improved by careful reduction of the fracture; this prevents large interfragmentary gaps. The experimental fracture model for the metatarsus showed that the healing process was inferior when the gap was larger than 2 mm.
Animals↗
[Scarf osteotomy of hallux valgus in children and adolescents].
PURPOSE OF THE STUDY: The aim of this study was to analyze the results of surgical treatment of hallux valgus using scarf osteotomy in children and adolescents. MATERIAL AND METHOD: Twelve children and adolescents (19 feet) operated on with scarf osteotomy were reviewed retrospectively with a mean follow-up of 15 months. Clinical and radiographic results were assessed. RESULTS: We obtained 10 good results (asymptomatic cases), 9 poor with residual symptoms such as pain or cosmetic problems. Two populations could be identified considering the metatarsus varus and distal metatarsal angle. Those with metatarsus varus >/= 10 degrees or normal distal metatarsal angle had good results. Those without metatarsus varus had poor results. There was no disturbance of growth. DISCUSSION: Scarf osteotomy can be used in children without risk of hindering growth. Nevertheless, good results can be achieved only in cases of true metatarsus varus and normal distal metatarsal angle. In other cases, a different osteotomy of the first metatarsal would be preferable.
Adolescent↗
Hallux limitus and hallux rigidus. Clinical examination, radiographic findings, and natural history.
Numerous clinical features of hallux limitus/rigidus have been previously reported as isolated entities based on individual case review or myopic observations. Few attempts have been made to synthesize a comprehensive natural history which correlates the inter-relationship of these findings. Frequently unrecognized or overlooked subtle clinical findings, such as shoe-wear patterns, hyperkeratoses locations, and gait disturbances, precede significant radiographic changes or painful degenerative arthritis by months to years. Recognition of these subtle clinical features will aid in establishing an early and accurate diagnosis, and provide the physician with an opportunity to institute treatment prior to the need for surgical reconstruction. Several conclusions can be made regarding the natural history of hallux rigidus. 1. Predisposing factors (pes planovalgus, uncompensated varus) lead to spastic contracture of the hallux (hallux equinus). 2. A shift in the axis of movement occurs within the first metatarsophalangeal joint, from centrally within the metatarsal head to plantarly at the level of the sesamoidophalangeal ligament. 3. Dorsal articular impingement of the proximal phalangeal base on the metatarsal head leads to either a chronic erosion of the dorsal metatarsal head (chondritis dissecans), or fracture through the subchondral bone plate (osteochondritis dissecans). 4. Progressive degenerative arthritis within the first metatarsophalangeal joint appears as joint space narrowing, dorsal osteophyte proliferation, subchondral cyst formation and sclerosis, and articular flattening. 5. Synovial effusion produces periarticular pain, resulting in chronic splinting of the hallux. 6. Auto-fusion of the metatarsophalangeal joint represents the end-stage progression of hallux rigidus. In addition to degeneration of the metatarsophalangeal joint, sesamoid degeneration further compounds joint immobility. 1. Sesamoid immobility from chronic spasm leads to traction proliferation of the sesamoid bones (hypertrophy). 2. Disuse osteopenia of the sesamoids is an indication of sesamoid-metatarsal degeneration, and parallels degenerative changes of the first metatarsophalangeal joint. 3. Proximal sesamoid retraction reflects the degree of hallux equinus. Metatarsus primus elevatus is a co-existant feature of hallux limitus and hallux rigidus. 1. Primary metatarsus primus elevatus is encountered in patients with a more proximal level of uncompensated varus, with hallux equinus occurring secondarily in an attempt to provide medial column support. 2. Secondary metatarsus primus elevatus results from the retrograde effects of hallux equinus on the first metatarsal, and occurs in patients with pes planovalgus. 3. Flexor stabilization syndrome of the hallux occurs in patients with pes planovalgus, and is analogous to a flexor stabilization hammertoe of the lesser digits. 4. Differentiation between primary and secondary metatarsus primus elevatus is made by evaluation of weight-bearing radiographs, comparing the standard lateral radiograph to a lateral radiograph using a forefoot block test, in which the digits are suspended off of the weight-bearing surface.
Adolescent↗
Effects of aging on the plantar soft tissue properties under the metatarsal heads at different impact velocities.
The plantar soft tissue properties under the metatarsal heads at different impact velocities in different age groups were measured. Each metatarsus of the left foot in healthy young adults (n = 9, 19 to 35 years old) and in healthy older persons (n = 10, 42 to 72 years old) was examined in vivo using a self-constructed loading-unloading device at low, medium and high impact status; the impact velocities of the device were about 2.5, 5 and 10 cm/s, respectively. The device comprised a 5- to 12-MHz linear-array ultrasound transducer, a miniature load cell and a fixation frame. From low to high impact status, the elastic modulus (E) in young adults significantly increased from about 300 kPa to about 500 kPa. However, the E in the older group did not show this trend. From low to high impact status, the energy dissipation ratio (EDR) of the metatarsus significantly increased from about 30% to about 60% in the young group and significantly increased from about 40% to about 70% in the older group. Most of the metatarsus in the older subjects had significantly greater E and EDR than those in the younger persons.
Adult↗
Skewfoot (forefoot adduction with heel valgus).
Skewfoot, a malalignment of tarsal and metatarsal bones, is recognized clinically by forefoot adduction and heel valgus. Synonyms include S-shaped foot, serpentine foot, and Z-foot deformity. Skewfoot must be differentiated from metatarsus adductus, metatarsus varus, and metatarsus adductovarus. Only 50 cases have been reported, and only two primary articles have been published in the English literature. Four patients who were treated at the Mayo Clinic are described. The ages of the patients at the time of presentation ranged from 6 months to 3 years. Three patients underwent operation. Because the natural history of skewfoot is unknown and pain is infrequent, treatment alternatives must be carefully considered. If operation is undertaken, realignment of the tarsal bones should be supplemented with hindfoot bone stabilization.
Child, Preschool↗
Rotational deformities of the tibia and foot in preterm infants.
Metatarsus adductus and medial tibial torsion are common in term infants. Our study shows that metatarsus adductus is rare, whereas medial tibial torsion does not occur in preterm infants with gestational ages of less than or equal to 30 weeks. These preterm infants have lateral rotation of the legs, external tibial rotation, and everted or normal feet at birth. This posture may explain the rarity of metatarsus adductus and medial tibial torsion in preterm infants.
Bone Diseases, Developmental↗
Reconstruction of hallux limitus deformity using a first metatarsal sagittal-Z osteotomy.
A sagittal-Z osteotomy was used for reconstruction of symptomatic grade I and grade II hallux limitus deformity in 10 patients using the Regnauld classification system. This surgical method was also used in a patient to reconstruct a structurally elevated first metatarsal as an adverse sequela of previous hallux valgus surgery. All patients exhibited evidence of radiographic metatarsus primus elevatus (MPE) and/or an anatomically elongated first metatarsal (EM). Linear comparison of first and second metatarsal length was performed in the transverse plane on dorsoplantar weightbearing radiographs. A long first metatarsal (positive metatarsal protrusion distance) was considered an anatomically elongated metatarsal. Metatarsus primus elevatus was evaluated by comparing the dorsal cortical margin of the first and second metatarsals and/or comparing the first metatarsal-cuneiform joint axis with the talonavicular joint axis. Metatarsus primus elevatus was therefore defined as a position of the dorsal cortical margin of the first metatarsal 5 mm superior to that of the second. A dorsal position of the first metatarsal-cuneiform joint axis in relation to the talonavicular joint axis also established MPE. A total of 11 patients underwent a total of 13 procedures. There were eight excellent results (73%) and three good results (27%). There were no fair or poor results.
Adult↗
Residual adduction of the forefoot. A review of the Turco procedure for congenital club foot.
Forty-four feet in 28 children previously treated by a one-stage posteromedial release operation (the Turco procedure) were reviewed clinically and radiologically to determine the cause of residual adduction of the forefoot. In 21 clinically adducted feet (48%) the main cause of residual deformity was metatarsus varus alone or metatarsus varus in spite of talonavicular overcorrection; in five feet the cause was talonavicular subluxation. There was no residual adduction in 23 feet (52%) but only 12 had normal radiographic measurements. In the remaining feet, various forms of spurious correction of metatarsus varus and talonavicular subluxation or both were seen, resulting in normal-looking feet. Recession of the origin of abductor hallucis and release of the short plantar muscles and fascia at the time of posteromedial release is recommended. The forefoot adduction was satisfactorily corrected in 91% of the feet subsequently operated on using this modified procedure.
Child↗
Relationships between fetal body weight of Wistar rats at term and the extent of skeletal ossification.
We investigated the relationship between fetal body weight at term (pregnancy day 21) and the extent of ossification of sternum, metacarpus, metatarsus, phalanges (proximal, medial and distal) of fore- and hindlimbs and cervical and coccygeal vertebrae in Wistar rats. The relationships between fetal body weight and sex, intrauterine position, uterine horn, horn size, and litter size were determined using historical control data (7594 fetuses; 769 litters) of untreated rats. Relationships between body weight and degree of ossification were examined in a subset of 1484 historical control fetuses (154 litters) which were subsequently cleared and stained with alizarin red S. Fetal weight was independent of horn size, uterine horn side (left or right) or intrauterine position. Males were heavier than females and fetal weight decreased with increasing litter size. Evaluation of the skeleton showed that ossification of sternum, metacarpus and metatarsus was extensively complete and independent of fetal weight on pregnancy day 21. In contrast, the extent of ossification of fore- and hindlimb phalanges and of cervical and sacrococcygeal vertebrae was dependent on fetal body weight. The strongest correlation between body weight and degree of ossification was found for hindlimb, medial and proximal phalanges. Our data therefore suggest that, in full-term rat fetuses (day 21), reduced ossification of sternum, metacarpus and metatarsus results from a localized impairment of bone calcification (i.e., a malformation or variation) rather than from general growth retardation and that ossification of hindlimb (medial and proximal) phalanges is a good indicator of treatment-induced fetal growth retardation.
Animals↗
[Surgical therapy of hallux valgus in the young and middle-aged female].
OBJECTIVE: To correct hallux valgus in the young or middle-aged female. METHOD: Through dissecting foot specimens with hallux valgus we found that the intrinsic factor that caused hallux valgus was a "capstan" like mechanism of pressure. In order to eliminate the mechanism of the deformity, we cut off the link between the adductoris hallucis and the hallux completely. The tendon of adductoris hallucis was sutured to the fascial flap of hallucis bursa passing through a hole in the caput of the metatarsus. By this way the adductoris hallucis was fixed to the 1st metatarsus strongly, thus it pulled the 1st metatarsus directly. RESULTS: Twenty feet received this operation. 18 feet were followed up for 0.5-4 years. The rate of excellent and good results was 100%. CONCLUSION: This operation by suturing the adductoris hallucis with the fascial flap of the hallucis bursa not only can relieve pain but also restore the normal appearance of the foot.
Adult↗