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Biomedical subjects

T E Kilmartin

Publications and source records attributed to T E Kilmartin.

11 recordsLinked to original sources
PubMed2002

The surgical management of central metatarsalgia.

Seventeen patients (20 feet) underwent Weil osteotomies of the second and third metatarsals for the treatment of central metatarsalgia and were reviewed at an average of 18 months postoperatively. Fourteen patients were completely satisfied with the results of their surgery (85%), one patient was satisfied, one patient satisfied with reservations and one patient was dissatisfied. The American Orthopaedic Foot and Ankle Society clinical rating scale improved by an average of 44 points. One patient had complete recurrence of symptoms, eight out of the 40 toes involved in surgery were floating, four toes were stiff, there were three cases of infection, and transfer metatarsalgia affected the fourth metatarsal in one case. The Weil osteotomy is an effective and safe procedure for the treatment of central metatarsalgia.

Adult↗
PubMed1994

The scientific basis for the use of biomechanical foot orthoses in the treatment of lower limb sports injuries--a review of the literature.

While it is documented that many overuse injuries of the lower limb can be relieved with the use of biomechanical foot orthoses, what remains unclear is how an orthosis can produce this effect. A review of the literature indicates that biomechanical orthoses will reduce rearfoot movement, but the effect on knee function is negligible and the clinical significance of excessive rearfoot movement is yet to be proven. While many athletes may potentially benefit from the use of biomechanical orthoses, further research is necessary to justify and, if indicated, promote the use of biomechanical foot arthoses by athletes suffering from overuse injuries.

Athletic Injuries↗
PubMed1994

Effect of pronation and supination orthosis on Morton's neuroma and lower extremity function.

Twenty-three adult patients with Morton's neuroma of one foot were randomized to receive in-shoe orthoses made from a hard, compressed, felt material that would either pronate or supinate both feet. The response of the neuroma pain was measured using subjective visual analogue scales, an objective examination, and the MACTAR patient-specific measure of maximal function. The development of any other lower limb symptoms was also recorded. The pain associated with Morton's neuroma was not significantly altered by changing the position of the foot with the compressed felt orthosis. Forcibly pronating the foot did not produce a significant incidence of lower limb symptoms in the short term.

Adult↗
PubMed1994

A controlled prospective trial of a foot orthosis for juvenile hallux valgus.

In a survey of 6000 children between 9 and 10 years of age, 122 were found to have unilateral or bilateral hallux valgus. These children were randomly assigned to no treatment or to the use of a foot orthosis. About three years later 93 again had radiography. The metatarsophalangeal joint angle had increased in both groups but more so in the treated group. During the study, hallux valgus developed in the unaffected feet of children with unilateral deformity, despite the use of the orthosis.

Child↗
PubMed1992

The significance of pes planus in juvenile hallux valgus.

Pes planus of the foot is believed to be an important etiological factor in hallux valgus. This study compares the degree of pes planus in normal and hallux valgus feet. The arch index, or ratio of the area of the middle third of the foot to the total footprint area, was calculated on 128 footprints. An unpaired t-test determined no significant difference between the arch index of 32 11-year-old children with hallux valgus and 11-year-olds with no first metatarsophalangeal joint deformity (P greater than .05). The height of the arch is not relevant to the hallux valgus deformity. Arch supports designed to raise the height of the arch can play only a palliative role in the management of the condition.

Child↗
PubMed1991

Metatarsus primus varus. A statistical study.

A survey of 6000 schoolchildren discovered 36 cases of unilateral and 60 cases of bilateral hallux valgus, defined as a metatarsophalangeal angle of more than 14.5 degrees, measured on standing radiographs. Metatarsus primus varus was found not only in the early stages of hallux valgus but in the unaffected feet of children with unilateral hallux valgus. Adduction of the first metatarsal is not due to differential growth of the cortices of the first metatarsal nor is it a consequence of malalignment of the metatarsocuneiform joint. The intermetatarsal angle did not correlate with the angle of metatarsus adductus nor with the intercuneiform angle.

Anthropometry↗
PubMed1991

Orthotic effect on metatarsophalangeal joint extension. A preliminary study.

The authors evaluated the effect of modified Root orthoses on first metatarsophalangeal joint extension. Motion within the joint was measured dynamically following the insertion of bone markers into the first metatarsal and the hallux. Extension at the joint was greatest when the subjects were barefoot, the mean angle being 62 degrees. Plimsolls restricted extension of the joint to a mean angle of 57 degrees, while orthoses further reduced the angle of metatarsophalangeal joint extension to a mean angle of 55 degrees. The marginal reduction in first metatarsophalangeal joint extension caused by functional orthoses may be of therapeutic value in the early stages of hallux rigidus, when restricting motion at the joint may slow or prevent development of subchondral sclerosis.

Acupuncture Therapy↗
PubMedDate not supplied

Revision of failed foot surgery: a critical analysis.

The purpose of this study was to consider the causes of patient dissatisfaction following foot surgery and review whether poor outcomes are more commonly associated with particular techniques. Two hundred forty-four patients who had previously undergone foot surgery were referred to a podiatric surgery service because of continued pain, disability, footwear-fitting problems, and cosmetic concerns. The majority of cases had previously undergone first ray surgery to correct hallux valgus. The most common reason for referral was transfer metatarsalgia followed by recurrence of hallux valgus and lesser digit deformity. Thirty-two patients were treated with conservative measures, including orthoses and cortisone injections. Eight patients (25%) were completely satisfied with conservative treatment, 20 patients (63%) were satisfied with reservations, and four patients (12.5%) were dissatisfied. One hundred seventy-six patients underwent revision surgery. High patient satisfaction was achieved with surgical revision with 123 patients (69%) completely satisfied at an average 5.6-month follow-up, 43 patients (24%) were satisfied with reservations, while 10 patients (6%) were dissatisfied. Complications occurred in 23 patients (13%) with nine cases developing a superficial postoperative infection. In reviewing this series of patients, it is apparent that poor surgical outcomes and the need for revision surgery could in many cases be prevented with selection of surgical techniques that avoid joint destruction, excessive shortening of single metatarsals, and digital amputation.

Adolescent↗
PubMedDate not supplied

First metatarsal head shape in juvenile hallux abducto valgus.

A round first metatarsal head has been implicated as a predisposing factor in hallux abducto valgus. The shape of one hundred first metatarsal heads was analyzed on 50 weightbearing dorsoplantar x-rays of 10-year-old children with a hallux abductus angle in excess of 15 degrees and osteophytic thickening of the first metatarsophalangeal joint. The metatarsals were subjectively described as either round or square. A measurement technique was then devised to quantify in millimeters the difference between the two types. Using chi-square analysis, a very strong statistical association (p less than 0.001) was found between the subjective assessment and the objective measurement. A weak relationship was found between the metatarsal head shape and the degree of hallux abducto valgus (HAV) (r = -0.294). While the trend of this correlation is consistent with accepted wisdom, that is, the squarer the metatarsal head the less the hallux abducto valgus, the association is not strong enough to scientifically confirm it. This finding along with the presence of so many square metatarsal heads in children with advanced HAV indicates that assessment of metatarsal head shape has little place in the scientific assessment of first metatarsophalangeal joint pathology.

Child↗