Second metatarsal osteotomies for metatarsalgia: A robotic cadaveric study of the effect of osteotomy plane and metatarsal shortening on plantar pressure

Purpose: It is not known how gait speed affects plantar pressure characteristics in flatfoot. The aim of this work was to investigate the effects of gait speed on plantar pressure variables in flatfoot by comparing it to normal foot posture. Methods: Thirty individuals with flatfoot and 30 individuals with normal foot posture were recruited. Plantar pressure variables were obtained by a pressure-sensitive mat at self-selected slow, normal, and fast speeds. All assessments were performed on the dominant foot, and three satisfactory steps were obtained for each gait speed condition. The order of gait speeds was randomized. Results: In the flatfoot group, the contact area was higher in the midfoot, third metatarsal, and hallux at all speeds, also in the second metatarsal at slow and normal speeds than the normal foot posture group (p < 0.05). The maximum force was higher in the midfoot and hallux at all speeds in the flatfoot group (p < 0.05). Also, the maximum force was lower in the first metatarsal at normal and fast speeds, and in the lateral heel at fast speed (p < 0.05). In the flatfoot group, the peak pressure was found to be higher in the hallux at slow speed, but to be lower in the first metatarsal at fast speed (p < 0.05). Further, plantar pressure distribution was affected by gait speed in both feet. Conclusions: Analysis of plantar pressure variables should be performed at different gait speeds.

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Effect of Orthotic Therapy on Claw Toe Loading

Journal of the American Podiatric Medical Association ◽

10.7547/0940246 ◽

2004 ◽

Vol 94 (3) ◽

pp. 246-254 ◽

Cited By ~ 9

Author(s):

Penny J. Claisse ◽

Jodi Binning ◽

Julia Potter

Keyword(s):

Pressure Measurement ◽

Plantar Pressure ◽

Metatarsal Head ◽

Plantar Surface ◽

Time Integral ◽

Pressure Time ◽

Second Metatarsal ◽

Plantar Pressure Measurement ◽

Access To Data ◽

Toe Deformity

This study demonstrates the effect of orthotic therapy for toe deformity on toe and metatarsal head pressures using a new analysis method facilitated by an in-shoe pressure-measurement system’s ability to export detailed data. Plantar pressure–time integrals in 11 individuals (22 feet) with claw deformity of the lesser toes were measured with and without toe props. Differences in pressure–time integrals at every individual sensor unit were then calculated for the two conditions, and significance was tested using the paired t-test. Plantar surface charts with contours of equal significant pressure–time integral change showed significant reduction under 17 second toes (77%), 22 third toes (100%), 15 fourth toes (68%), 13 second metatarsal heads (59%), 16 third metatarsal heads (73%), and 16 fourth metatarsal heads (73%). All 22 feet showed increases under the prop in the area of the third toe sulcus. This innovative approach to plantar pressure analysis could improve access to data that show significant pressure–time integral changes and, therefore, could advance the clinical application of plantar pressure measurement. (J Am Podiatr Med Assoc 94(3): 246–254, 2004)

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Effectiveness of the Fixtoe Device® in Plantar Pressure Reduction: A Preliminary Study.

10.21203/rs.3.rs-1110567/v1 ◽

2021 ◽

Author(s):

Maria Ruiz-Ramos ◽

Ángel Manuel Orejana-García ◽

Ignacio Vives-Merino ◽

Carmen Bravo-Llatas ◽

José Luis Lázaro-Martínez ◽

...

Keyword(s):

Plantar Pressure ◽

Metatarsophalangeal Joint ◽

Metatarsal Head ◽

Clinical Results ◽

Cross Sectional ◽

Time Integral ◽

Pressure Time ◽

Second Metatarsal ◽

Maximal Pressure ◽

Taping Technique

Abstract Background: Metatarsalgia is a common foot condition. The metatarsophalangeal stabilizing taping technique described by Yu et al. has shown good clinical results as a provisional treatment in propulsive metatarsalgia. 35 The Fixtoe Device®, a novel orthopedic device, intends to simulate stabilizing tape. However, to date, there is no evidence of its effectiveness.Methods: The aim of this study was to assess plantar pressure changes using the Fixtoe Device®, in comparison with the traditional method (stabilizing tape) in a young, healthy sample thorough a cross-sectional study. Maximal pressure (Kpa) and pressure-time integral (Kpa/s) in the second metatarsal head were measured in twenty-four healthy volunteers. Registers were taken in four different conditions: barefoot, traditional stabilizing tape, Fixtoe Device® without metatarsal pad, and Fixtoe Device® with metatarsal pad. Results: Mean second metatarsal head maximal pressure and mean pressure-time integral showed statistical difference among the four analyzed conditions (p < 0.0001 in both cases). The improvement in maximal pressure and pressure-time integral obtained in each intervention also showed significance (p < 0.0001 in both cases). Comparing the improvement of the Fixtoe Device® with and without metatarsal pad with that of tape condition showed a moderate to high and moderate effect size for both peak pressure and pressure-time integral reduction.Conclusions: The Fixtoe Device® reduces median maximal pressure and median pressure-time integral under the second metatarsal head in healthy young individuals. The Fixtoe Device® shows higher effectiveness than the traditional second metatarsophalangeal joint stabilizing taping technique. To our knowledge, this is the first investigation proving the effectiveness of the recently developed Fixtoe Device® in terms of plantar pressure modification, which leads the way to its use in clinics.

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Effect of a Metatarsal Pad on the Forefoot During Gait

Journal of the American Podiatric Medical Association ◽

10.7547/1020018 ◽

2012 ◽

Vol 102 (1) ◽

pp. 18-24 ◽

Cited By ~ 10

Author(s):

Koen L. M. Koenraadt ◽

Niki M. Stolwijk ◽

Dorine van den Wildenberg ◽

Jaak Duysens ◽

Noël L. W. Keijsers

Keyword(s):

Plantar Pressure ◽

Stance Phase ◽

Alternative Hypothesis ◽

Metatarsal Head ◽

Pain Reduction ◽

Motion Analysis System ◽

Extra Space ◽

Second Metatarsal ◽

The Mean ◽

Analysis System

Background: Metatarsal pads are frequently prescribed for patients with metatarsalgia to reduce pain under the distal metatarsal heads. Several studies showed reduced pain and reduced plantar pressure just distal to the metatarsal pad. However, only part of the pain reduction could be explained by the decrease in plantar pressure under the forefoot. Therefore, an alternative hypothesis is proposed that pain relief is related to a widening of the foot and the creation of extra space between the metatarsal heads. This study focused on the effect of a metatarsal pad on the geometry of the forefoot by studying forefoot width and the height of the second metatarsal head. Methods: Using a motion analysis system, 16 primary metatarsalgia feet and 12 control feet were measured when walking with and without a metatarsal pad. Results: A significant mean increase of 0.60 mm in forefoot width during the stance phase was found when a metatarsal pad was worn. During midstance, the mean increase in forefoot width was 0.74 mm. In addition, walking with a metatarsal pad revealed an increase in the height of the second metatarsal head (mean, 0.62 mm). No differences were found between patients and controls. Conclusions: The combination of increased forefoot width and the height of the second metatarsal head produced by the metatarsal pad results in an increase in space between the metatarsal heads. This extra space could play a role in pain reduction produced by a metatarsal pad. (J Am Podiatr Med Assoc 102(1): 18–24, 2012)

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Analysis of Plantar Pressure Pattern after Metatarsal Head Resection. Can Plantar Pressure Predict Diabetic Foot Reulceration?

Journal of Clinical Medicine ◽

10.3390/jcm10112260 ◽

2021 ◽

Vol 10 (11) ◽

pp. 2260

Author(s):

Marta García-Madrid ◽

Yolanda García-Álvarez ◽

Francisco Javier Álvaro-Afonso ◽

Esther García-Morales ◽

Aroa Tardáguila-García ◽

...

Keyword(s):

Plantar Pressure ◽

Metatarsal Head ◽

First Metatarsal ◽

Metatarsal Bones ◽

Second Metatarsal ◽

Patients With Diabetes ◽

Peak Plantar Pressure ◽

One Year ◽

The Moment ◽

A Minor

To evaluate the metatarsal head that was associated with the highest plantar pressure after metatarsal head resection (MHR) and the relations with reulceration at one year, a prospective was conducted with a total of sixty-five patients with diabetes who suffered from the first MHR and with an inactive ulcer at the moment of inclusion. Peak plantar pressure and pressure time integral were recorded at five specific locations in the forefoot: first, second, third, fourth, and fifth metatarsal heads. The highest value of the four remaining metatarsals was selected. After resection of the first metatarsal head, there is a displacement of the pressure beneath the second metatarsal head (p < 0.001). Following the resection of the minor metatarsal bones, there was a medial displacement of the plantar pressure. In this way, plantar pressure was displaced under the first metatarsal head following resection of the second or third head (p = 0.001) and under the central heads after resection of the fourth or fifth metatarsal head (p < 0.009 and p < 0.001 respectively). During the one-year follow-up, patients who underwent a metatarsal head resection in the first and second metatarsal heads suffered transfer lesion in the location with the highest pressure. Patients who underwent a minor metatarsal head resection (second–fifth metatarsal heads) showed a medial transference of pressure. Additionally, following the resection of the first metatarsal head there was a transference of pressure beneath the second metatarsal head. Increase of pressure was found to be a predictor of reulceration in cases of resection of the first and second metatarsal heads.

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Effect of First Metatarsal Shortening and Dorsiflexion Osteotomies on Forefoot Plantar Pressure in a Cadaver Model

Foot & Ankle International ◽

10.1177/107110070502600913 ◽

2005 ◽

Vol 26 (9) ◽

pp. 748-753 ◽

Cited By ~ 34

Author(s):

Hung-Geun Jung ◽

David I. Zaret ◽

Brent G. Parks ◽

Lew C. Schon

Keyword(s):

Plantar Pressure ◽

Dynamic Structure ◽

Metatarsal Head ◽

Wedge Osteotomy ◽

Significance Level ◽

First Metatarsal ◽

Paired Student ◽

Second Metatarsal ◽

Alpha Level ◽

Pressure Changes

Background: Metatarsalgia of the second ray is a common problem associated with disorders of the first metatarsal. It also occurs after the operative treatment of those disorders. Plantar pressure changes from alteration of the static and dynamic structure of the forefoot may be associated with this condition. This study evaluated changes in plantar forefoot pressure especially under the second metatarsal head after three operative procedures on the first ray. Methods: Each of 12 cadaver foot specimens was cyclically loaded on the servohydraulic MTS Mini Bionix test frame (MTS Systems Corp., Eden Prairie, MN) with traction on the Achilles tendon. Plantar forefoot pressure was measured by the F-scan system (Tekscan, Inc., S. Boston, MA) with the foot intact, after a first metatarsal base dorsal closing-wedge osteotomy with 5-mm base length to simulate dorsal malunion, and after 5-mm and 10-mm metatarsal shortening procedures. Paired Student t-test analysis was used to compare data for the intact foot with data after each intervention. One form of Bonferroni's correction was done to establish a new alpha level to tighten the analysis and to compensate for multiple paired Student t-tests. The significance level was calculated to be 0.016 based on an original alpha level of 0.05. Results: As compared with the intact foot, all three procedures on the first metatarsal resulted in significant decreases in plantar pressure under the first metatarsal head ( p < 0.016). Plantar pressure under the second metatarsal head increased significantly as compared with the intact foot ( p < 0.016) after all three procedures. Pressures under the third-fourth metatarsal heads increased significantly compared with the intact foot after the 5-mm and 10-mm shortenings ( p < 0.016). Plantar pressure under the fifth metatarsal did not change significantly after any of the three procedures. Conclusions: Dorsiflexion osteotomy and shortening of the first metatarsal are associated with significant forefoot plantar pressure changes in a cadaver model.

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Multistep Measurement of Plantar Pressure Alterations Using Metatarsal Pads

Foot & Ankle International ◽

10.1177/107110079401501205 ◽

1994 ◽

Vol 15 (12) ◽

pp. 654-660 ◽

Cited By ~ 55

Author(s):

An-Hsiung Chang ◽

Ziad U. Abu-Faraj ◽

Gerald F. Harris ◽

Joe Nery ◽

Michael J. Shereff

Keyword(s):

Plantar Pressure ◽

Metatarsal Head ◽

Plantar Surface ◽

Plantar Pressures ◽

Quantitative Studies ◽

Pressure Time ◽

Second Metatarsal ◽

Peak Pressures ◽

Male Subjects ◽

Multiple Step

Metatarsal pads are frequently prescribed for nonoperative management of metatarsalgia due to various etiologies. When appropriately placed, they are effective in reducing pressures under the metatarsal heads on the plantar surface of the foot. Despite the positive clinical reports that have been cited, there are no quantitative studies documenting the load redistribution effects of these pads during multiple step usage within the shoe environment. The objective of this study was to assess changes in plantar pressure metrics resulting from pad use. Ten normal adult male subjects were tested during a series of 400-step trials. Pressures were recorded from eight discrete plantar locations at the hindfoot, midfoot, and forefoot regions of the insole. Significant increases in peak pressures, contact durations, and pressure-time integrals were noted at the metatarsal shaft region with pad use ( P ≤ .05). Statistically significant changes in metric values were not seen at the other plantar locations, although metatarsal pad use resulted in mild decreases in mean peak pressures at the first and second metatarsal heads and slight increases laterally. Contact durations decreased at all metatarsal head locations, while pressure-time integrals decreased at the first, second, third, and fourth metatarsal heads. A slight increase in pressure-time integrals was seen at the fifth metatarsal head. The redistribution of plantar pressures tended to relate not only to the dimensions of the metatarsal pads, but also to foot size, anatomic foot configuration, and pad location. Knowledge of these parameters, along with careful control of pad dimensions and placement, allows use of the metatarsal pad as an effective orthotic device for redistributing forefoot plantar pressures.

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