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PubMedDate not supplied

Forefoot conditions in dancers: part II.

Conditions in the dancer's forefoot can be divided into five categories. Part II of our study presents two categories: acute conditions of the forefoot and conditions which masquerade as forefoot problems. Five hundred dancers were studied. Of those, some had conditions including muscle spasm, soft tissue trauma, fractures, dislocations, and abscesses, and were treated accordingly. The general health of the dancer was an important factor in treatment as well as difficulty in diagnosing the injury. Prolonged periods of healing were expected but did not prevent the return to dance class and rehearsal. The highly motivated, goal-oriented dancer often did not complain of systemic disease or pain and this prevented diagnosis until triggering tendons or muscle paralysis made it obvious. Such a sequence gave rise to prolonged convalescence or termination of the dancer's career.

Abscess↗
PubMed2006

Arthrodesis versus Mayo resection: the management of the first metatarsophalangeal joint in reconstruction of the rheumatoid forefoot.

In a prospective randomised study 31 patients were allocated to either arthrodesis or Mayo resection of the first metatarsophalangeal joint as part of a total reconstruction of the rheumatoid forefoot. Of these, 29 were re-examined after a mean of 72 months (57 to 80), the Foot Function Index was scored and any deformity measured. Load distribution was analysed using a Fscan mat in 14 cases, and time and distance were measured in 12 of these patients using a 3D Motion system. We found excellent patient satisfaction and a significant, lasting reduction of the Foot Function Index, with no statistically significant differences between the groups. There were no significant differences in recurrence of the deformity, the need for special shoes, gait velocity, step length, plantar moment, mean pressure or the position of the centre of force under the forefoot. The cadence was higher and the stance phase shorter in the fusion group. These results suggest that a Mayo resection may be an equally good option for managing the first metatarsophalangeal joint in reconstruction of the rheumatoid forefoot.

Adult↗
PubMed1987

Scintigraphy of rheumatoid peripheral joints. Reliability of visual assessment vs. computerized methods.

99mTc-methylene diphosphonate (99mTc-MDP) scintigraphy of peripheral joints was studied by visual evaluation (Visual Assessment) of the scintigrams and by a computerized region-of-interest (ROI) method without, or with a reference region (ROI method or Corrected ROI method). Sixteen rheumatoid patients and a total of 477 peripheral joints were studied and the results compared with clinical joint activity evaluated by joint palpation. The ROI method without a reference proved to be insensitive and hence unsuitable for clinical use. The results of Visual Assessment and the Corrected ROI method correlated well with each other and with clinical joint activity. The sensitivity of the methods in detecting a clinically inflamed finger joint was: ROI 6%, Corrected ROI 71% and Visual Assessment 75%. The corresponding figures for peripheral joints of the feet were as follows: 28%, 41% and 58%. We conclude that, for clinical use, Visual Assessment of the scintigram is adequate and the method of choice.

Adult↗
PubMed1985

Management of disorders of the forefoot and toenails associated with running.

Management of forefoot problems of runners requires that one understand the basic foot types and their relation to the problems as they occur and that one evaluate the entire lower extremity. The forefoot problems have been divided into disorders of the first metatarsophalangeal joint, lesser toes, metatarsalgia, callouses, and disorders of the toenails. Specific treatment and recommendation are made for each entity. Nonoperative treatment should be used whenever possible. Minor surgical procedures are helpful, but if the deformity is so severe that major reconstruction of the forefoot is performed, the patient must realize that he or she may not be able to return to full running activity.

Athletic Injuries↗
PubMedDate not supplied

[Development and evaluation of a modified version of the Larsen method for evaluating roentgenologic changes in chronic polyarthritis].

AIM OF THE STUDY: To develop and evaluate a modification of the Larsen scoring method aimed at a clear definition of the different grades and a better correlation of the numerical scale with the amount of joint destruction. DESCRIPTION OF THE METHOD: While the original method described by Larsen is based on a comparison with standard reference films the modification defines the different grades semiquantitatively by the amount of destruction of the joint surface: grade II is a destruction (erosion) of the joint surface of up to 25%, in grade III it is 26-50%, in grade IV 51-75% and in grade V over 75%. Grade I is characterized by soft tissue swelling and in addition subchondral osteoporosis and remains unchanged compared with the original method. 32 joints of the hands, wrists and forefeet are counted summing up to a total score of 0-160. Examples for different joints are given. EVALUATION OF THE METHOD: Standard ap-x-rays of hands, wrists and forefeet of 24 patients with early erosive rheumatoid arthritis at baseline (T0) and after 36 months (T1) were graded by two investigators (G.H. and R.R.). The difference of the scoring between both observers (inter-observer-difference) was related to the difference between the two timepoints (T0 and T1) in the same patient (intra-patient-difference) by means of a hierarchical analysis of variance (ANOVA). The intra-patient variance (from T0 to T1) was 259.3, which is 8 times greater than the inter-observer-variance of 32.1. The square root of intra-patient-standard deviation (16.1) and inter-observer-standard deviation (5.7) is 2.8. These data show that the progression between T0 and T1 is real. The method was easily applicable to patients in a 2-year-DMARD-trial with x-rays at baseline after 6, 12 and 24 months, showing a slowing of radiologic progression after month 6 under treatment with parenteral gold and methotrexate. CONCLUSION: The modification of Larsen's scoring method is a reliable measure to assess radiologic progression in patients with RA. Possibilities for further improvement are discussed.

Adult↗
PubMed1999

Reliability and sensitivity to change of a simplification of the Sharp/van der Heijde radiological assessment in rheumatoid arthritis.

OBJECTIVE: To determine the reliability and sensitivity to change of a simplified radiological scoring method [simple erosion narrowing score (SENS)] for rheumatoid arthritis (RA). SENS was compared to the Sharp/van der Heijde score (SHS) as a gold standard. METHODS: Sets of seven radiographs of hands and feet were taken of 20 RA patients with a wide spectrum of radiological damage. For 14 patients, these seven radiographs were taken during a follow-up period of 5 yr, and for six patients during a follow-up of 10 yr. Each set of radiographs was scored twice by the same observer (DvdH). Erosions and joint space narrowing were scored with SHS (range 0-448) in 32 and 30 joints in the hands, respectively, and both in 12 joints in the feet. SENS gives a score of 1 if there is any erosion in a joint and also 1 if there is any narrowing in the joint (range 0-86). In each case, SENS was derived from SHS. To analyse data, generalizability theory and repeated measurements ANOVA were used. RESULTS: The overall reliability coefficient was 0.81 for SHS and 0.80 for SENS. Intra-observer reliability [intraclass correlation coefficient (ICC)] was 0.99 and 0.98 for SHS and SENS, respectively. The ICC for the sensitivity to change was 0.84 for SHS and 0.88 for SENS. The smallest detectable difference (SDD) could be determined for both methods. The presence of progression based on this SDD was very comparable between the two methods. CONCLUSION: The measurement properties of SENS are good and comparable to SHS. This makes SENS suitable for use in clinical practice and in large (epidemiological) studies, especially in the first years of disease.

Adult↗
PubMed1996

Forms of forward quadrupedal locomotion. I. A comparison of posture, hindlimb kinematics, and motor patterns for normal and crouched walking.

1. Posture, hindlimb kinematics, and activity patterns of selected hindlimb muscles were compared for normal and crouched treadmill walking (0.5-0.6 m/s) for eight cats. To elicit crouched walking in which the trunk and head were lowered, cats were encouraged to walk under a light-weight Plexiglas ceiling suspended 17-20 cm above the treadmill belt. Kinematic data were obtained from high-speed ciné film, and electromyograms (EMGs)-synchronized with the kinematic records-were taken from 11 hindlimb muscles. 2. The postures for the two forms of walking were distinctly different. During crouched walking, each cat lowered its entire body keeping its trunk horizontal to the treadmill belt. Also the head was lowered, with the top of the head in line with the dorsal surface of the trunk. Hip height, used as a measure for hindlimb crouch, was reduced by 30%, from an average height of 23 cm to an average height of 16 cm above the belt during the entire step cycle. 3. Average cycle periods (766 +/- 30 ms, mean +/- SD) and percentage of time devoted to swing (30%) and stance (70%) were similar for normal and crouched walking. The profiles of the hindlimb kinematics were also similar for the hip, knee, ankle, and metatarsophalangeal (MTP) joints during the step cycle, but the timing of some of the motion reversal, as well as the ranges of motion during various phases, were different at some joints for the two forms of walking. 4. During the swing phase, the transition between the flexion and extension (F-E1 reversal) occurred later in the normalized swing phase at the hip, knee, and ankle joints, and the range of flexion was increased at each joint. With greater flexion at these joints, the anatomic axis of the hindlimb (measured from hip joint to toe) was decreased and the hind paw advanced in the narrow space between the abdomen and treadmill belt. At contact, the position of the paw was less anterior to the perpendicular reference line (hip joint marker to belt) and all joints were more flexed for crouched than normal walking. 5. Throughout the stance phase, the knee and ankle joints remained significantly more flexed by 41-45 deg during crouched than normal walking. Although the hip and MTP joints started in a more flexed position at paw contact, both joints extended more during stance for crouched than normal walking, and at the time of peak extension (just before paw lift-off), the degree of extension at the hip and MTP joints was similar for both forms of walking. 6. Muscle patterns for crouched and normal walking were similar with some exceptions. The burst durations for three primary flexor muscles, the semitendinosus (knee flexor), extensor digitorum longus (EDL, ankle flexor), and flexor digitorum longus (digit flexor) were longer for crouched than normal walking, and this was consistent with the increased range and duration of flexion during the swing phase of crouched walking. Also, two muscles that normally showed mainly swing-related activity during normal walking, the EDL and the extensor digitorum brevis, had distinct stance-related bursts that occurred after midstance during crouched walking. 7. Crouched walking requires a postural change that typically occurs when cats stalk prey and when cats walk up and down sleep slopes. Postural set during walking appears to be determined by brain stem and diencephalic centers, and the postural orientation of the cat may require adjustments in the motor program provided by spinal centers for the cat to walk. The role of posture and locomotion and the adjustments in hindlimb kinematics and EMG activity patterns have been studied for forward and backward walking in the cat and now for crouched walking on the treadmill. These data will assist us in understanding the role of posture, especially crouched posture, during other walking behaviors.

Animals↗
PubMed1986

Dynamic post-surgical hallux varus after lateral sesamoidectomy: treatment and prevention.

Hallux varus and clawing are occasionally seen after a McBride procedure, due to the severance of the flexor hallucis brevis, when the lateral sesamoid is removed. The present study includes six patients, (involving ten feet), who developed hallux varus and great toe clawing after McBride procedures were performed by various orthopedic surgeons. Treatment utilized partial proximal phalangeal resection, with and without silicone single-stem implants, extensor hallucis longus tendon transfer to the great toe metatarsal, and interphalangeal joint arthrodesis, or tenodesis of the great toe to correct clawing. One patient eventually required a great toe metatarsophalangeal joint fusion. This reconstructive surgery is generally effective by correcting capsular malalignment, the "bowstringing" tendency of the extensor hallucis longus, and great toe clawing that develops simultaneously with hallux varus. Lateral sesamoidectomy is risky, and believed unnecessary as adductor hallucis tenotomy is effective in relieving hallux valgus. Although, it can occur with excessive excision of the medial emminence and distal advancement of the abductor hallucis. The author is unaware of hallux varus developing after adductor hallucis tenotomies.

Adult↗
PubMed2004

Hallux IPJ fusion.

Surgical arthrodesis of the hallux interphalangeal joint can be used as an isolated procedure to address painful or deformed joints or in conjunction with other procedures to create a better functioning first ray. This type of arthrodesis may be necessary in neuropathic patients to prevent ulcerations or amputations. Several etiologies exist that result in a deformity about the hallux IPJ, some can be pain-free, others may be extremely debilitating to a patient. Many different surgical approaches have been described and used when performing a hallux IPJ arthrodesis. Developing your own technique enables you to understand what works for you and your patients and allows you to determine the most effective way to achieve arthrodesis. The goal is to prevent painful nonunions and address the underlying deformity. It is also important to understand that a successful arthrodesis in a patient who has a neurological disorder is the only way to prevent recurring deformities secondary to the underlying disease process. The ability to properly work-up and surgically address deformities of the hallux interphalangeal joint is necessary for those who perform lower extremity surgery.

Arthrodesis↗
PubMedDate not supplied

Tibial sesamoid planing procedure: an appraisal of 26 feet.

The authors present their findings upon evaluation of 26 feet that had undergone a tibial sesamoid planing procedure. A preoperative method of radiographic evaluation is also presented. The subjective success rate was determined to be 88.8%, whereas the objective success rate was 76.9%, and a successful procedure was performed on feet with a first metatarsal declination angle not exceeding 8 degrees. It was also determined that the apparent postoperative changes in the hallux abductus and intermetatarsal angles were 0.73 degrees and 0.6 degrees, respectively. The authors believe this procedure does not significantly alter the biomechanics of the first metatarsophalangeal joint postoperatively.

Adolescent↗
PubMed1988

Geometry of the first metatarsophalangeal joint.

This study aimed to define the articular geometry of the metatarsophalangeal (MTP) joint of the great toe. Embedded in resin blocks, five pairs of cadaveric first MTP joints (all from men) were sequentially cut in the sagittal plane with a milling machine, removing 0.5 mm of bone in each cut. The photographed cartilaginous outline of each cut was digitized against reference markers, which enabled a computer system to superimpose each outline in three dimensions. The intersesamoidal ridge was found to be parallel to the lateral shaft. The peak of the ridge was just lateral to the midline of the MT head. The articular outline, through the ridge of each sample, was circular; however, other surface contours were noncircular. The undulating plantar aspect of the MTP head formed by the intersesamoidal ridge and related grooves was found to have symmetric relationships to the sesamoid bones and a consistent orientation to the shaft. The rounded distal dorsal aspect of the MTP head showed consistent differences to the concavity formed by the phalangeal base. The sample size is too small for the sizing of prostheses but it is adequate to study the geometry of the MTP joint. More data are needed for the accurate replication of a resurfacing prosthesis and understanding of joint kinematics.

Cartilage, Articular↗
PubMed1971

Experimental production of cartilage necrosis by cold injury: failure to cause degenerative joint disease.

A cryoprobe (-20 to -80 C) was applied for 10-60 seconds to cause necrosis of metatarsal head cartilages of 11 rabbits. Segmental loss of nuclear staining was noted at 1 week and depletion of chondroitin sulfate (toluidine blue metachromasia and staining with safranin 0) a few days later. No degenerative joint disease was evident up to 6 months later. The latter finding suggests that, in addition to chondrocyte death, externally imposed stresses are necessary to disrupt the collagenous "skeleton" and initiate the changes of degenerative joint disease.

Animals↗