Navicular disease--in search of definition.
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Animals↗
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Navicular disease--what are we talking about?
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Animals↗
Treatment and pathogenesis of navicular disease ('syndrome') in horses.
The future directions of navicular disease research are unclear. Often researchers investigate only one of the multitude of factors likely to be important in understanding the disease. Two exceptions to this is work done by Wright in this issue of EVJ and by MacGregor (1988) who compared a number of the treatment regimens (e.g. rest, warfarin, isoxsuprine, shoeing with egg bars) and found that approximately 75% of the horses improved in their performance. Perhaps this percentage of 'recovered' horses from this disease is what can be realistically expected, as often horses with navicular disease remain undiagnosed until the disease has advanced to the stage where problems exist in the foot or to where the conformation-balance of the hoof is irrecoverable. Perhaps the key to controlling the disease is prevention by maintaining good overall hoof husbandry in a conservative and consistent manner. I would advocate that efforts be made to evaluate hoof 'balance' and the validity of the hoof wall-pastern axis being parallel, as these are clearly of importance in this debilitating disease.
Animals↗
A study of 118 cases of navicular disease: clinical features.
The clinical features are reported from 118 horses (mean age 9.2 years) which were diagnosed as suffering from navicular disease using predetermined criteria. The animals were used for a variety of purposes and had been lame for periods between 1 and 72 months. The majority of cases (84.7%) had been treated using various techniques before evaluation. The severity of lameness was related to the duration of clinical signs: 78% of horses were bilaterally affected but there was no left:right limb predominance. Broken foot/pastern axes were recorded in 75% of horses while 45% also exhibited mediolateral foot imbalance. Muscle atrophy was recognised in 77% of animals which appeared to be related to limb affliction. The cranial phase of the stride was reduced in 38% and caudal phase shortened in 16% of horses. These abnormalities were related to the degree of lameness. Flexion of the distal joints increased the severity of lameness in 64% of the animals while extension was positive in 41% of instances. Turning in the direction of the lame limb exacerbated lameness in 95% of horses. Only 11% of animals responded to the use of hoof testers and 3% to foot percussion. A range of responses to local analgesia of the palmar digital nerves was recorded but 91% (of 49) of animals exhibited a positive response to local analgesia of the distal interphalangeal joint, and 92% (of 23) of horses responded to local analgesia of the navicular bursa.
Animals↗
A study of 118 cases of navicular disease: treatment by navicular suspensory desmotomy.
The 118 horses diagnosed as suffering from navicular disease by prospective criteria were treated by desmotomy of the ligamenta sesamoidea collateralia (navicular suspensory desmotomy). Three techniques were used and a standard post-operative programme was followed with clinical and radiological evaluations at 6-monthly intervals for periods of 6-36 months after surgery. At 6 and 36 months after treatment, 76% and 42.9% of horses were sound respectively. The clinical features of age, period of lameness, severity of lameness and angular limb deformities adversely affected response to surgery. The presence of flexor cortex defects, proximal border enthesophytes, mineralisation of the flexor digitorum profundus tendon and medullary sclerosis were also associated with a diminished response. There were few (1.7%) changes in the radiological appearance of distal border synovial invaginations during the follow-up period. By contrast, the majority (67.3%) of flexor cortex defects changed. Other radiological features changed at a low frequency but there was no association between radiological change and clinical outcome.
Animals↗
Regulatory significance of procaine residues in plasma and urine samples: preliminary communication.
Plasma and urinary concentrations of procaine and the duration of response to procaine after its administration as a local anaesthetic to horses were studied. Following injection of a clinical dose of procaine HCl (80 mg), the concentration of procaine in plasma was less than the lower limit of quantitation and unsuitable for threshold determination. Therefore, the urinary concentration of procaine was determined after injection of a dose of 5 mg procaine HCl, the highest no-effect dose (HNED) of this agent. Free unconjugated procaine in equine urine reached a peak concentration of 23.7 ng/mL, while total (unconjugated plus conjugated) procaine peaked at 37.9 ng/mL (mean urine pH of 8.5). Because a basic drug may concentrate substantially in acidic urine, a threshold concentration of 25 ng/mL of unconjugated procaine is a reasonable and conservative threshold for procaine at this time. Horses were administered abaxial sesamoid blocks containing 2% procaine HCl (40, 80, 160 and 320 mg) and 2% procaine HCl (40 and 320 mg) with epinephrine (1:100,000) in local anaesthetic experiments. There was a significant local anaesthetic (LA) effect for all doses of procaine HCl with the duration of effect ranging from 30 min (40 mg) to 60 min (320 mg). The addition of epinephrine significantly increased the duration of local anaesthesia to 180 min for a 40 mg dose and 420 min for a 320 mg dose. Because epinephrine may extend the duration of local anaesthesia beyond a reasonable period of confinement for horses before the starting time of a race, the increased LA effect following the addition of epinephrine to procaine has regulatory significance.
Anesthetics, Local↗
Fusion of the distal sesamoid and distal phalanx in a yearling colt.
This paper describes a rare malformation of the distal portion of the left foredigit of a 15-month-old half-bred colt which was severely lame. Radiological, pathological and tomographic studies revealed hypoplasia of the metacarpophalangeal skeleton, absence of the distal sesamoid and deformation of the distal phalanx. Morphological analysis of the lesion and computerised measurement of the width of the articular surface of the distal phalanx suggested an early fusion between the distal sesamoid and distal phalanx.
Animals↗
Validity of the sesamoid index in the diagnosis of acromegaly.
Sesamoid indices of 100 control and 10 acromegalic subjects were determined and the results compared with previous studies. It was found that a substantial overlap of values exists between the two groups and that the range of values for both groups is substantially wider than previous studies have indicated.
Acromegaly↗
Treatment of sesamoid disorders with a rocker sole shoe modification.
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Foot Diseases↗
MP I joint giving way--a case study.
A case history of a 26 year old international class female 400 m hurdle sprinter is presented. While sprinting she felt a sudden and very intensive pain at her left hallux. After this she was unable to run and had episodes of giving way in the MP I joint elicited by minor activity. Operative investigation revealed a broad disruption of the MP I medial collateral ligament. After periosteal flap repair and early functional aftertreatment she returned to full high level sports ability.
Adult↗
The passive axial compression (PAC) test: a new adjunctive provocative maneuver for the clinical diagnosis of hallucal sesamoiditis.
The authors describe a previously unreported adjunctive passive provocative maneuver that has been found to clinically reproduce the intensity of symptoms in patients diagnosed with disorders of the sesamoids. This test is useful for the initial diagnosis as well as monitoring response to treatment.
Hallux↗
Stenosing tenosynovitis of the flexor hallucis longus tendon at the sesamoid area.
The author presents a case of stenosing tenosynovitis of the flexor hallucis longus tendon at the sesamoid area of the great toe following injury of the hallux. Although stenosing tenosynovitis of the flexor hallucis longus tendon is not rare, occurring frequently in ballet dancers, its entrapment at the sesamoid area was rarely described in the literature. Early recognition of this condition is very important for successful treatment. This patient did not respond to nonoperative treatment and surgical tenolysis was very successful for relief of the symptoms.
Constriction, Pathologic↗
New radiographic analysis of sesamoid rotation in hallux valgus: comparison with conventional evaluation methods.
The position of the hallucal sesamoids needs to be included in evaluation of hallux valgus. In order to quantify the rotational position of the hallucal sesamoids, a new weightbearing tangential radiograph was established by means of a specially designed tangential positioning device. This device has a depression, and a tangential radiograph is taken with the metatarsophalangeal joint at 45 degrees dorsiflexion. A lead marker plate is placed on the depression to show the horizontal plane, and the sesamoid rotation angle (SRA) is measured. The SRA is the angle between the tangential line of the most inferior aspect of the medial-lateral sesamoids and the lead marker line. The SRA was compared with values of the four-grade scale and seven-position scale which were measured from the antero-posterior view, with respect to the hallux valgus angle (HVA), by means of conventional methods. Measurements were made of 58 feet in 29 patients with hallux valgus and 64 feet in 32 normal subjects. The SRA showed the highest correlation among the three parameters (r=0.817). Some cases had a disparity regarding the position of the sesamoids between the tangential view and the AP view due to misclassification on the AP view. We conclude that the scale of position of the sesamoid on the AP view is not valid in some cases, whereas the SRA is useful for assessing quantitatively the rotational position of the hallucal sesamoids in cases of hallux valgus.
Adolescent↗
Return to activity after sesamoidectomy in athletically active individuals.
Sesamoidectomy of the first metatarsophalangeal joint in athletically active patients may be indicated in cases of chronic sesamoiditis resistant to nonsurgical care or symptomatic displaced fractures or nonunion. Painful scar, hallux deviation, and delayed return to activity are all potential complications. These need to be considered especially when performing surgery in the athletically active individual. Twenty-six sesamoidectomies in 24 patients (21 females and 3 males) were reviewed for type of sesamoidectomy, incision location, time to return to activity, and complications. Mean age was 35.4 years (range, 16-68 years) with mean follow-up 86.4 months. Eleven athletes (defined as professional or varsity level sports) operated on had a mean return to activity of 7.5 weeks (range, 4-10 weeks), while 13 "active" patients had a mean return to activity of 12.0 weeks. This difference was statistically significant using the t-test, (p < .02). There were 10 fibular and 16 tibial sesamoids excised. Complications included one hallux varus and two cases of postoperative scarring with neuroma-like symptoms, all associated with fibular sesamoidectomy; there was one case of hallux valgus deformity with tibial sesamoidectomy. Despite the functional importance of tibial and fibular sesamoids, athletically active individuals can return to sports after a sesamoidectomy as early as 7.5 weeks.
Adolescent↗
Effect of metatarsophalangeal joint position on the reliability of the tangential sesamoid view in determining sesamoid position.
BACKGROUND: Lateral displacement of the sesamoids of the first toe relative to the metatarsal head is a common finding in hallux valgus deformity. Several methods have been described for quantifying the amount of subluxation from anteroposterior radiographs but a tangential sesamoid radiograph has been determined to be the best view to evaluate sesamoid displacement. METHOD: We evaluated the sesamoid position at different angles of the first metatarsophalangeal (MTP) joint to determine the effect of first MTP joint dorsiflexion on sesamoid position when tangential sesamoid view radiographs are made. Sesamoid positions of 22 feet with hallux valgus were graded from the short axis computed tomography (CT) images obtained with the MTP joint in 0, 35, and 70 degrees of dorsiflexion. RESULTS: Approximation of the sesamoids to reduction was apparent as dorsiflexion of the first MTP joint increased. CONCLUSION: Different dorsiflexion degrees of the first MTP joint when tangential sesamoid radiographs are made modulate the position of the sesamoids and may lead to misclassification on grading.
Hallux Valgus↗
Evaluation of hallux alignment and functional outcome after isolated tibial sesamoidectomy.
BACKGROUND: Functional loss and clinical evidence of hallux malalignment have been reported to follow isolated tibial sesamoidectomy. METHODS: Thirty-two patients with isolated tibial sesamoidectomies were identified. Patients with a diagnosis of peripheral neuropathy, diabetes mellitus, inflammatory arthropathy or previous foot surgery were excluded as were patients who had concomitant joint realignment procedures. Twenty patients were available for followup with the Short Form-36 (SF-36), Foot Function Index (FFI) disability scale, visual analog scale (VAS), and questionnaire at an average of 62 (range 10 to 157) months after surgery. Fourteen patients returned for physical examination, radiographs, and pedographic and isokinetic examination. RESULTS: Physical examination of the 14 patients did not reveal any significant change in clinical alignment, range of motion or tenderness. Preoperative and postoperative comparison radiographs did not reveal significant differences in the intermetatarsal (IM) angle, hallux valgus (HV) angle distal metatarsal articular angle (DMAA), or sesamoid alignment (sesamoid station). Postoperative outcome measurements (VAS, SF36, and FFI) for 20 patients found significant relief of pain and improved functional outcome. Computerized dynamic pedographic measurements (Performance Orthotic) for 12 patients did not reveal any altered plantar pressures in the region of the hallux metatarsophalangeal joint. Isokinetic measurements of ankle plantar flexion push-off strength in eight patients did not reveal significant differences in side-to-side measurements. Eighteen of 20 (90%) patients indicated that they were able to resume all preoperative activities; six (30%) had extreme difficulty or an inability to stand on tip toe, but this did not impact their activities of daily living or their athletic endeavors. Two patients (14.3%) developed transfer metatarsalgia, but only one was symptomatic. CONCLUSION: Isolated tibial sesamoidectomy is a safe and effective treatment for recalcitrant tibial sesamoiditis. Hallux malalignment and deformity resulting in functional loss and change in hallux alignment can be avoided by meticulous surgical technique with repair of the soft tissues.
Adolescent↗
Amputation of the great toe.
Four patients who had undergone reimplantation of the great toe to create a thumb were studied. The follow-up period ranged from 29 to 62 months. In all cases, the great toe was disarticulated at the metatarsophalangeal joint. The patients felt their feet functioned at approximately 85% of normal, and none had any significant complaint of metatarsalgia. The one patient who participated in sports after the surgery noted that it was difficult to "push off" moving away from the involved foot. X-ray examination demonstrated retraction of the sesamoids, which accounted for the increased plantar flexion of the first metatarsal shaft. The second metatarsophalanageal joint drifted into varus an average of 8 degrees. The Harris mat demonstrated that there was an increase in weightbearing beneath the second and third metatarsal heads. It appears as though, on the basis of this study, the loss of the great toe in this manner does not significantly affect the normal everyday function of an individual's foot.
Amputation, Surgical↗