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PubMed1992

[The intermetatarsal transverse ligaments and their connections with the tarsometatarsal articulations].

The authors have performed 20 systematical dissections of the distal part of the foot, conserved in the Toulon's liquor and 3 dissections of fresh cadavers. The last ones have been submitted at different puttings in charge before and after the resection of the intermetatarsal transverse ligament. The intermetatarsal transverse ligament is supple, extensible, but very strong. It constitutes the area of convergence of all the neighbouring fibrous structures and of several tendons of the foot. It connects together the heads of the metatarsus. It renders them jointly liable and its action is reflected above. By its modulating of the convergence of the metatarsus and their necessary associated palmar inclination, by its limitation of their divergence in relation with their dorsal inclination, it modulates and it limits the amplitude of the tarsometatarsal joints. It is helped for that by the little intermetatarsal transverse ligaments, whose the presence has been always confirmed. The metatarsus varus, very frequently associated with the hall valgus, means the escape of the first ray from the effect of the transverse intermetatarsal ligament.

Biomechanical Phenomena↗
PubMed2006

Cross-sectional geometry of the metapodial bones in the calf and ox.

The purpose of this study was to present a detailed description of the cross-sectional geometry at three levels of the metapodial bones and to assess the bone strength from the bone geometry in calf and ox. For this purpose, 20 metapodial bones from five calves and 40 metapodial bones from ten oxen were used. Sections were made at 25, 50 and 75% of the bone length and scanned. The cortical thickness, endosteal and periosteal diameters, cortical and medullar areas as well as second moment of area and section modulus were obtained from the images with the aid of a computer program. The cortical thickness and area values were higher in the metatarsus than that those in the metacarpus. The smallest cortical area and the thinnest cortical thickness were found at the distal level of metapodial bone in both calf and ox. When compared with the calf, relative increases in cortical area were seen at the proximal and distal levels, and the increases in cortical thickness were pronounced in the medial, lateral and dorsal sides in the metacarpus of the ox. With respect to the second moment of area and the polar moment, significant differences between metacarpus and metatarsus were found at the distal half of the bones in the calf while these differences were at the proximal half in the ox. The results of the current study indicated that there were important differences between the metacarpus and metatarsus as well as between the levels of the same bone with regard to the values of the geometric and strength parameters.

Age Factors↗
PubMed1990

Pharmacokinetics of mezlocillin after intraarterial or intravenous injection in patients with peripheral arterial occlusive disease (PAOD).

In the first part of this study, which was already published in this journal, tissue- and serum concentrations of Mezlocillin were compared one hour after a single dose of 2 g injected either intraarterially or intravenously in patients with ischemic lesions, due to PAOD or moist diabetic gangrene. In nearly all tissues of the minor perfused metatarsus and in the thigh, estimated as being physiologically perfused, there was an impressive trend to higher concentrations after i.a. injection. The concentrations in the thigh were higher than in the metatarsus after both, i.a. or i.v. injection. In this second part, tissue concentrations are compared three to four hours after the end of i.a. or i.v. injection of the same dose. After this interval of time, there is no longer any striking difference between the tissue concentrations after i.a. compared to i.v. injection within the physiologically perfused thigh, the concentrations in the reduced perfused metatarsus still show a convincing tendency to higher values after i.a. injection. It is concluded, that the initial tissue concentration of an antibiotic depends on its concentration within the inflowing blood and on the amount of the blood perfusion. The decline of the tissue concentration time course is more pronounced after i.a. injection. The advantage of higher concentrations after i.a. injection is limited to the initial phase after the injection.

Arterial Occlusive Diseases↗
PubMed1994

[Open osteotomy of the first cuneiform in the treatment of tarsometatarsal varus in children].

MATERIAL AND METHODS: Open wedge osteotomy of the first cuneiform was used for correction of metatarsus varus primus. The osteotomy interested the medial, dorsal and plantar face of the first cuneiform, but lateral cortex should be carefully left intact, it is used like a hinge for opening the osteotomy. This procedure is carried out when varus of the tarsometatarsal joint is superior to 20 degree, it is reduced to its normal value, between 5 and 10 degree. Osteotomy is stabilized with bone graft. In resistant metatarsus adductus, closed wedge osteotomy of the cuboid has been added to correct the varus deformity of the fore foot, it allowed lateral swing of the forefoot: the bone excised from cuboid is used to stabilized medial osteotomy. Twelve children, aged 5 to 15 years, underwent medial open wedge osteotomy of the first cuneiform for correction of 16 feet including 8 hallux valgus, 6 serpentine feet, defined as adductus of the forefoot and valgus of the hindfoot, and 2 clubfeet. In all hallux valgus it was associated with release of all contracted lateral structures and in three cases, shortening of the proximal phalanx. In serpentine feet and clubfeet closed wedge osteotomy of cuboid has been added. RESULTS: Results have been studied with follow up ranging between 18 months and 5 years. In 8 cases of hallux valgus, one case showed recurrence; failure was related to technical deficiency, because the lateral cortex of the first cuneiform was cut accidently leading to over lengthening of the first column. In 6 resistant metatarsus varus and 2 clubfeet, we didn't find any recurrence at term of our follow up. DISCUSSION: In all cases, growth of metatarsals hasn't been disturbed at term of our follow up and tarsometatarsal joint remained well corrected, because proximal epiphyseal plate of metatarsal was normally positioned and saved from damage.

Adolescent↗
PubMedDate not supplied

Reduction of intermetatarsal angle following Keller arthroplasty.

A composite retrospective radiographic analysis of 71 patients who had undergone the Keller arthroplasty and 76 who had undergone the Keller with hemi-implant was performed. The combined mean preoperative intermetatarsal angle was 11.4 degrees, the mean postoperative intermetatarsal angle was 9.4 degrees, and the mean change in intermetatarsal angle was 2.0 degrees. Although the reduction of the metatarsus primus adductus deformity obtained was less than previous studies, the amount of correction was directly proportional to the magnitude of deformity. The authors conclude that through reverse buckling at the first metatarsophalangeal joint, adequate reduction in the positional component of metatarsus primus adductus can be obtained with the Keller arthroplasty alone or with a hemi-implant. These procedures are preferred over metatarsal osteotomies in the physiologically older patient, especially when a severe metatarsus primus adductus deformity exists.

Anthropometry↗
PubMed1978

Basal osteotomy of the first metatarsal bone in hallux valgus: experiences with the use of AO plate.

In young patients with hallux valgus, osteotomy with excision of the exostosis is frequently indicated. The basal, laterally based wedge osteotomy, is relatively seldom used. However this operation may produce a considerable reduction of the metatarsus primus varus. We modified the method by adding a small AO plate to ensure stabilization. The series consisted of 36 patients, in whom 52 feet were operated on. Pain was the most frequent indication for seeking treatment. A followup was performed an average of 1.5 years postoperatively. The subjective results were good in 41 cases, fair in nine, and poor in one. Objectively the results were good in 42 cases and fair in nine. The mean period of work was seven weeks. The metatarsus varus angle was reduced from 14.8 degrees to 9.3 degrees and the hallux valgus angle from 33.2 degrees to 17.7 degrees. The distance between the first and second metatarsal bones was reduced from 13. 7 mm to 10.2 mm. A good functional and cosmetic result was achieved in most of the cases.

Adult↗
PubMed1984

Gait problems in children. A matter of rotation.

The gait disturbances commonly seen in children are usually physiologic and correct spontaneously. Conditions that fall in this category include internal femoral torsion, internal tibial torsion, metatarsus adductus, bowlegs, and knock-knees. However, metatarsus adductus may require casting, and bowlegs, if persistent, may be Blount's disease. Rickets may cause either bowlegs or knock-knees. Clubfeet are resistant to correction and warrant early orthopedic consultation.

Child↗
PubMed1978

An analysis of residual deformity in club feet submitted to early operation.

The contributions made by metatarsus primus varus, medial subluxation of the navicular, and angulation of the neck of the talus to the residual deformity in treated club feet were assessed from radiographs. Their relation to the appearance of the feet, to the age of the patient, to the results of operations, and to the age at the time of the first operation were investigated. Lateral rotation of the ankle and flattening of the talus were also studied. Medial subluxation of the navicular was found to be the most important factor influencing both the appearance of the feet and the lateral rotation of the ankle. Relocation of the talonavicular joint correlated with the success of operative treatment; and the timing of the primary operation determined the degree of relocation which could be achieved. Metatarsus primus varus and angulation of the talus were of little importance. Increased emphasis is given to the need for early relocation of the talonavicular joint.

Adolescent↗
PubMed1975

In vivo measurement of bone strain in the horse.

Strain gauges were successfully bonded in vivo to the cranial, caudal, medial, and lateral aspects of the equine radium and tibia and to the dorsal, palmar, or plantar, medial, the lateral aspects of the metacarpus and metatarsus--all in the mid-diaphyseal region. Various activities were investigated, including walking, trotting or pacing, and standing up from anesthesia. The strain patterns showed that each stride produced a characteristic deformation cycle. The strains were measured and the axial loads were calculated as the horse performed certain activities. The tension band side of each bone was predicted from the results. The tension band sides of the metacarpus and metatarsus were the dorsomedial and dorsolateral aspects; for the radius and tibia, the tension band sides were the cranial and craniolateral aspects, respectively.

Animals↗
PubMed1986

[Treatment tactics in fractures of the midfoot].

Metatarsal fractures can occur as isolated lesions in combination with injuries of the ipsilateral tarsus, or in chain injuries of the lower extremity, or within a polytrauma. The choice of surgical or conservative therapy depends significantly on localisation and dislocation of the fracture (especially the involvement of the metatarsus I or V), as well as on the extent of the primary or expected soft part damage. From 1974 to 1984, 137 patients with metatarsal fractures were treated as in patients at the Accident Hospital in Tübingen. Three groups of diseases indicated for surgery are evident from an analysis of the courses of the disease: Metatarsal fractures in combination with an ipsilateral tarsus fracture or tarsus dislocation. Metatarsal serial fracture especially in involvement of metatarsus I and/or V. Dislocated tear fracture of the base of the fifth metatarsal bone. Preference is given to percutaneous Kirschner wiring from the head of the injured metatarsal bone. The tear fracture of the base of the metatarsal bone V is treated via traction bandage. These methods are generally technically simple and enable early functional treatment and partial weight-bearing. In particular, immediate surgical treatment may not only favour reposition and retention, but may also limit damage of the soft parts.

Bone Plates↗
PubMedDate not supplied

Considerations for the Lapidus operation.

The Lapidus operation for correction of severe hallux valgus with metatarsus primus varus has never been well accepted by foot surgeons. The main reason for this has been the poor results obtained from its misuse. Lapidus strongly advocated the operation as a virtual panacea for correction of all degrees of severity of these deformities in both young and old patients. The technique, however, is appropriate for severe metatarsus primus varus with hallux valgus, in the foot with marked first ray hypermobility and collapsed distal-medial arch. The purpose and proper indications for the Lapidus operation are discussed, and the technique is illustrated.

Abnormalities, Multiple↗
PubMedDate not supplied

Idiopathic forefoot-adduction deformity: medial capsulotomy and abductor hallucis lengthening for resistant and severe deformities.

Between February 1981 and March 1993, 18 children (29 feet) with resistant forefoot adduction underwent medial capsulotomy and abductor hallucis lengthening for correction. There were 12 feet with metatarsus adductus (two simple, 10 complex) and 17 feet with skewfoot (15 simple and two complex). The mean age at the time of operation was 3.6 years (range, 9 months-5.5 years). When seen 3.6 years (range, 1-8) after surgical correction, all of them showed an improved talofirst metatarsal angle. Two children complained of pain in the foot, and one child had persistent difficulty with shoe fitting. We conclude that medial capsulotomy and abductor hallucis lengthening is a simple procedure that is effective in improving metatarsus adductus deformity.

Child, Preschool↗
PubMed1984

Bone density in women: college athletes and older athletic women.

Bone density was studied in intercollegiate athletes and older athletic women. Single-photon densitometry was used to assess bone density parameters at a new distal radial site, the midradius, and the first metatarsus. Dual-photon densitometry assessed bone density of the lumbar spine. Eleven intercollegiate tennis players, 23 swimmers, and 86 older "athletic" women from 23 to 75 years of age were compared with age-matched nonathletic controls. "Athletic" describes adult women who exercised at least three times per week, 8 or more months of the year, for a minimum of 3 years. The radius and metatarsus bone content of intercollegiate athletes was significantly above control values. Lumbar spine density was significantly higher only in tennis players. Mean bone density values for adult "athletic" women were also significantly greater than in age-matched controls. In the oldest athletic group (55-75 years of age) bone measurement values in radius and lumbar spine were in the same range as for younger "athletic" women. In contrast, after 50 years of age, these values in the control population decreased by 0.7%/year. Therefore the largest variance (increase) from age-matched controls occurred in the oldest "athletic" group. Also, we have established a distal radial density value (using our modified site) below which we consider women "at risk" and recommend further bone health evaluation. Only two adult athletic women greater than 55 years of age fell into this category. It is concluded from this cross-sectional study that a regularly maintained athletic program for adult women may reduce the rate of "normal" bone mass loss accompanying age, particularly postmenopausally.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1992

The modified Mayo procedure combined with basal valgus osteotomy of the first metatarsal for severe hallux valgus.

The modified Mayo procedure corrects valgus deformity of the great toe secondary to osteoarthritis in the first metatarsophalangeal joint. Basal osteotomy of the first metatarsal to correct metatarsus primus varus and to maintain correction of the valgus deformity may be performed simultaneously. We retrospectively reviewed the results in 55 of 70 feet treated by this combined procedure. The average duration of follow-up was 4.2 years (range 0.5-6 years) and the average age at operation was 63 years (range 45-80 years). The results were either very good or good in 82%, moderate in 14%, and poor in 4%. Our technique of basal osteotomy of the first metatarsal is a simple and effective procedure to correct metatarsus primus varus and may restore the distal transverse arch. It should be considered as a possible method of treatment when the intermetatarsal angle is greater than 10 degrees.

Adult↗
PubMed1986

Stiffness of an arthropod leg joint.

The stiffness of the tibia-metatarsus joint of several spider-species was determined for different loading conditions. The relationship between force applied to the metatarsus tip and deflection is linear and free of hysteresis during axial loading (z'), but not under lateral (y') and dorsoventral (x') loading, where joint stiffness increases with amplitude and deflection rate. Up to lateral deflections of 2.5 degrees relaxation and nonlinearity of the joint-stiffness can be described by power functions. Considering strain induced in the spider's tibia, the viscoelastic properties of the joint result in a nonlinear amplitude transfer and a high-pass filtering of mechanical vibrations applied to the spider's leg. However, this contributes only slightly to the corresponding transfer characteristics measured for the electrical response of biological strain receptors.

Animals↗
PubMed1996

Evolution during growth of the mechanical properties of the cortical bone in equine cannon-bones.

Two specimens (70.0 x 4.5 x 1.8 mm) (proximal and distal) of cortical bone were taken from each of the cranial, caudal, lateral and medial quadrants at mid-diaphysis of the third metacarpus and metatarsus of French saddle horses (12 males and seven females) aged from 1 day to 4 years. The mechanical properties (bending strength, Young's modulus, yield stress and ultimate specific deflection) were determined by a 4-point bending test, loading at a rate of 166 x 10(-6) ms-1. During growth, the mechanical properties of the cortical bone were not significantly different (p > 0.05) between metacarpus and metatarsus, but they were slightly higher in the proximal than in the distal diaphysis. The variations in these properties were significant (p < 0.0001) between quadrants. From birth to adult age, the lateral and medial quadrants had greater average bending strength (Sb = 226 +/- 27 MPa), average Young's modulus (E = 16 +/- 2 GPa) and average yield stress (Sy = 110 +/- 23 MPa) than the cranial quadrant (Sb = 209 +/- 23 MPa, E = 15 +/- 2 GPa, Sy = 99 +/- 18 MPa) while the caudal quadrant gave the lowest values (Sb = 195 +/- 30 MPa, E = 14 +/- 2 GPa, Sy = 92 +/- 21 MPa). During the growing period, the bending strength, the Young's modulus and the yield stress were positively correlated with age (p < 0.01) and the total body weight (p < 0.001) of the horses. Conversely, the ultimate specific deflection decreased slightly during the same period. The mechanical properties of the cortex were also related (p < 0.005) to the mineral content (ash or calcium). The Young's modulus was particularly correlated to calcium content (p < 0.0001). It is also linearly related to the bending strength (r = 0.8), and its in vivo determination by the ultrasound method should provide an easy and non-invasive investigation means of the mechanical properties of the cortical bone in equine cannon-bones.

Animals↗
PubMed2006

Rear-foot, mid-foot and fore-foot motion during the stance phase of gait.

This paper proposes a new protocol designed to track a large number of foot segments during the stance phase of gait with the smallest possible number of markers, with particular clinical focus on coronal plane alignment of the rear-foot, transverse and sagittal plane alignment of the metatarsal bones, and changes at the medial longitudinal arch. The shank, calcaneus, mid-foot and metatarsus were assumed to be 3D rigid bodies. The longitudinal axis of the first, second and fifth metatarsal bones and the proximal phalanx of the hallux were also tracked independently. Skin markers were mounted on bony prominences or joint lines, avoiding the course of main tendons. Trajectories of the 14 markers were collected by an eight-camera motion capture system at 100 Hz on a population of 10 young volunteers. Three-dimensional joint rotations and planar angles were calculated according to anatomically based reference frames. The marker set was well visible throughout the stance phase of gait, even in a camera configuration typical of gait analysis of the full body. The time-histories of the joint rotations and planar angles were well repeatable among subjects and consistent with clinical and biomechanical knowledge. Several dynamic measurements were originally taken, such as elevation/drop of the medial longitudinal arch and of three metatarsal bones, rear-foot to fore-foot rotation and transverse plane deformation of the metatarsus. The information obtained from this protocol, consistent with previous clinical knowledge, enhanced our understanding of the dynamics of the human foot during stance.

Adult↗
PubMed1986

Foot deformities in infants and children.

Foot deformities may reflect a generalized disorder, especially a neurologic problem; thus, the child should have a brief general examination. Many infantile foot deformities, such as calcaneovalgus, are postural and self-correcting. Metatarsus varus is not referred for treatment until age 2 months and then only if the deformity is moderate or severe. Fixed forefoot equinus and heel varus characterize a clubfoot, which requires immediate treatment. Corrective shoes are not advised as the primary treatment for metatarsus varus or clubfoot but often are prescribed to maintain the corrected position after serial casts. Flexible flatfoot is a manifestation of a constitutional laxity affecting all ligaments and joints. The feet appear abnormal because of weight-bearing stresses. Most children with flatfoot achieve a partial correction spontaneously. Current research does not document that treatment with corrective shoes or inserts produces a result better than the partial correction that occurs naturally.

Clubfoot↗