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

2005 ◽  
Vol 26 (9) ◽  
pp. 748-753 ◽  
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.

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

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.

Plantar Forefoot Pressure Changes After Second Metatarsal Neck Osteotomy

2005 ◽  
Vol 26 (7) ◽  
pp. 550-555 ◽  
Author(s):  
Afshin Khalafi ◽  
Adam S. Landsman ◽  
Eugene P. Lautenschlager ◽  
Armen S. Kelikian
Keyword(s):  
Kirschner Wire ◽  
Metatarsal Head ◽  
Neutral Position ◽  
Pressure Measurements ◽  
Average Decrease ◽  
First Metatarsal ◽  
The Third ◽  
Second Metatarsal ◽  
Before And After ◽  
Pressure Changes

Background: The aim of this study was to evaluate plantar pressure changes after second metatarsal neck osteotomy using the Weil technique. Methods: Six below-knee cadaver specimens were used. Each specimen was held in a custom-built apparatus and loaded to 500 N for a period of 3 seconds. Using a computerized Musgrave pedobarograph, pressure measurements were made before and after osteotomy in both neutral and 45-degree heel rise positions. All osteotomies were made at an angle of approximately 20 degrees relative to the long axis of the metatarsal shaft. The metatarsal heads were displaced proximally by 5 mm and fixed with a single Kirschner wire. Results: After osteotomy there was an average decrease in pressure beneath the second metatarsal from 70.6 to 45.1 kPa in neutral and from 813.0 to 281.4 kPa in heel rise, representing statistically significant ( p ≤ 0.05) decreases of 36% and 65%, respectively. There also were significant decreases beneath the third metatarsal in both neutral (39%) and heel rise (37%), and beneath the fourth metatarsal in neutral position (28%). A significant pressure increase occurred beneath the first metatarsal in neutral (23%). No significant pressure changes occurred under the fifth metatarsal in either position. Conclusion: Overall, our results indicated that the Weil metatarsal neck osteotomy is effective at offloading the second metatarsal head at neutral and heel rise positions.

Comparison of two pixelated insoles using in-shoe pressure sensors to determine percent offloading: case studies

2020 ◽  
Vol 29 (Sup2c) ◽  
pp. S18-S26
Author(s):  
Harry Penny ◽  
Son Tran ◽  
Laura Sansosti ◽  
Steven Pettineo ◽  
Andrew Bloom ◽  
...  
Keyword(s):  
Edge Effect ◽  
Plantar Pressure ◽  
Pressure Sensors ◽  
Metatarsal Head ◽  
Percentage Reduction ◽  
Total Contact Cast ◽  
First Metatarsal ◽  
Plantar Pressures ◽  
Significant Edge ◽  
Pressure Changes

Objective: The gold standard for offloading neuropathic forefoot and midfoot wounds is the total contact cast (TCC). However, in practice TCC is rarely used and is contraindicated in patients with fluctuating oedema, poor perfusion, lack of adequate tissue oxygenation and morbid obesity. It can also be too restrictive for patients, inevitably resulting in treatment rejection and delayed healing. This paper examines the role of shoe-based offloading devices as an alternative in reducing plantar pressure and optimising the healing of neuropathic ulcers. Method: Healthy subjects were recruited and fitted for two types of pixelated insoles: PegAssist (PA) insole system (Darco International, US) and FORS-15 (FORS) offloading insole (Saluber, Italy). An area of discreet, elevated high pressure was created by adding a 1/4-inch-thick felt pad to the plantar skin under the first metatarsal head. Subjects walked barefoot in surgical shoes with standard insoles (Condition 1), barefoot in pixelated insoles (Condition 2), barefoot with pixels removed (Condition 3). Dynamic plantar pressures were measured using F-Scan and the results were analysed to determine plantar pressure changes in each condition. Results: Using PA, the percentage reduction of plantar pressure (kPa) under the first metatarsal between Condition 1 and Condition 2 was 10.54±15.81% (p=0.022), between Condition 2 and Condition 3 was 40.13±11.11% (p<0.001), and between Condition 1 and Condition 3 was 46.67±12.95 % (p<0.001). Using FORS, the percentage reduction between Condition 1 and Condition 2 was 24.25±23.33% (p=0.0029), between Condition 2 and Condition 3 was 23.61±19.45% (p<0.001), and between Condition 1 and Condition 3 was 43.39±18.70% (p<0.001). A notable difference in the findings between the two insoles was the presence of a significant edge effect associated with PA, indicating that the offloading was not entirely successful. No edge effect was detected with FORS. Conclusion: Our current analysis shows that pixelated insoles exhibit potential for supplemental offloading in surgical shoes. These devices could provide an alternative way for physicians to offload plantar wounds and expedite closure for patients that cannot tolerate a TCC or other restrictive devices.

Effectiveness and Duration of Plantar Pressure Off-loading by Two Designs of Felt Padding: A Preliminary Study

2019 ◽  
Vol 109 (6) ◽  
pp. 431-436
Author(s):  
María Pilar Nieto-Gil ◽  
Ana Belen Ortega-Avila ◽  
Manuel Pardo-Rios ◽  
Gabriel Gijon-Nogueron
Keyword(s):  
Plantar Pressure ◽  
Metatarsophalangeal Joint ◽  
Metatarsal Head ◽  
Load Pressure ◽  
First Metatarsophalangeal Joint ◽  
Time Points ◽  
First Metatarsal ◽  
Plantar Pressures ◽  
Mean Pressure ◽  
Pressure Changes

Background: The aim of this study was to observe the pressure changes in the felt padding used to off-load pressure from the first metatarsal head, the effects obtained by different designs, and the loss of effectiveness over time. Method: With a study population of 17 persons, two types of 5-mm semicompressed felt padding were tested: one was C-shaped, with an aperture cutout at the first metatarsophalangeal joint, and the other was U-shaped. Pressures on the sole of the foot were evaluated with a platform pressure measurement system at three time points: before fitting the felt padding, immediately afterward, and 3 days later. Results: In terms of decreased mean pressure on the first metatarsal, significant differences were obtained in all of the participants (P &lt; .001). For plantar pressures on the central metatarsals, the differences between all states and time points were significant for the C-shaped padding in both feet (P &lt; .001), but with the U-shaped padding the only significant differences were between no padding and padding and at day 3 (P = .01 and P = .02). Conclusions: In healthy individuals, the U-shaped design, with a padding thickness of 5 mm, achieved a more effective and longer-lasting reduction in plantar pressure than the C-shaped design.

Effect of Proximal Dome and Distal Chevron Osteotomies on Plantar Pressures and Radiographic and Functional Outcomes in Hallux Valgus Surgery: A Retrospective Analysis

2021 ◽  
Vol 111 (3) ◽  
Author(s):  
Kadir Ilker Yildiz ◽  
Abdulhamit Misir ◽  
Turan Bilge Kizkapan ◽  
Mustafa Cukurlu ◽  
Canan Gonen Aydin
Keyword(s):  
Hallux Valgus ◽  
Inclination Angle ◽  
Plantar Pressure ◽  
Functional Outcomes ◽  
First Metatarsal ◽  
Pressure Point ◽  
Radiographic Outcomes ◽  
Metatarsal Angle ◽  
Dome Osteotomy ◽  
Pressure Changes

Background No detailed comparative studies have been performed regarding plantar pressure changes between proximal dome and distal chevron osteotomies. This study aimed to compare radiographic and plantar pressure changes after distal chevron and proximal dome osteotomies and to investigate the effect of radiographic and plantar pressure changes on clinical outcomes. Methods This study included 26 and 22 patients who underwent distal chevron and proximal dome osteotomies, respectively. Visual analog scale (VAS) and American Orthopaedic Foot & Ankle Society (AOFAS) forefoot scores were used to evaluate pain and functional outcomes. Hallux valgus angle, intermetatarsal angle, talar–first metatarsal angle, and calcaneal inclination angle were measured in the evaluation of radiographic outcomes. Preoperative and postoperative plantar pressure changes were evaluated. Results There were no statistically significant differences between the two groups in age, body mass index, or AOFAS forefoot and VAS scores. In the proximal dome group, the pressure measurement showed significant lateralization of the maximal anterior pressure point in the forefoot (P &lt; .001). In addition, the postoperative calcaneal inclination angle was significantly lower (P = .004) and the talar–first metatarsal angle was significantly higher (P &lt; .001) in the proximal dome group. Postoperative transfer metatarsalgia was observed in one patient (3.8%) in the distal chevron group and five (22.7%) in the proximal dome group (P &lt; .05). Conclusions Proximal dome osteotomy led to more lateralization of the maximum anterior pressure point, decreased calcaneal inclination angle and first metatarsal elevation, and related higher transfer metatarsalgia.

scholarly journals The effects of gait speed on plantar pressure variables in individuals with normal foot posture and flatfoot

2020 ◽  
Vol 22 (3) ◽  
Author(s):  
Muge Kirmizi ◽  
Yesim S. Sengul ◽  
Salih Angin
Keyword(s):  
Plantar Pressure ◽  
Gait Speed ◽  
Maximum Force ◽  
First Metatarsal ◽  
Fast Speed ◽  
Pressure Sensitive ◽  
Plantar Pressure Distribution ◽  
Second Metatarsal ◽  
Foot Posture ◽  
All Speeds

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.

Comparison of Postoperative Height Changes of the Second Metatarsal Among 3 Osteotomy Methods for Hallux Valgus Deformity Correction

2016 ◽  
Vol 38 (1) ◽  
pp. 20-26 ◽  
Author(s):  
Jun Young Choi ◽  
Yu Min Suh ◽  
Ji Woong Yeom ◽  
Jin Soo Suh
Keyword(s):  
Hallux Valgus ◽  
Deformity Correction ◽  
Metatarsal Head ◽  
Valgus Deformity ◽  
Metatarsal Osteotomy ◽  
Level Of Evidence ◽  
First Metatarsal ◽  
Scarf Osteotomy ◽  
Hallux Valgus Deformity ◽  
Second Metatarsal

Background: We aimed to compare the postoperative height of the second metatarsal head relative to the first metatarsal head using axial radiographs among 3 different commonly used osteotomy techniques: proximal chevron metatarsal osteotomy (PCMO), scarf osteotomy, and distal chevron metatarsal osteotomy (DCMO). Methods: We retrospectively reviewed the radiographs and clinical findings of the patients with painful callosities under the second metatarsal head, complicated by hallux valgus, who underwent isolated PCMO, scarf osteotomy, or DCMO from February 2005 to January 2015. Each osteotomy was performed with 20 degrees of plantar ward obliquity. Along with lateral translation and rotation of the distal fragment to correct the deformity, lowering of the first metatarsal head was made by virtue of the oblique metatarsal osteotomy. Results: Significant postoperative change in the second metatarsal height was observed on axial radiographs in all groups; this value was greatest in the PCMO group (vs scarf: P = .013; vs DCMO: P = .008) but did not significantly differ between the scarf and DCMO groups ( P = .785). The power for second metatarsal height correction was significantly greater in the PCMO group (vs scarf: P = .0005; vs DCMO: P = .0005) but did not significantly differ between the scarf and DCMO groups ( P = .832). Conclusions: Among the 3 osteotomy techniques commonly used to correct hallux valgus deformity, we observed that PCMO yielded the most effective height change of the second metatarsal head. Level of Evidence: Level III, retrospective comparative series.

Effect of Orthotic Therapy on Claw Toe Loading

2004 ◽  
Vol 94 (3) ◽  
pp. 246-254 ◽  
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)

scholarly journals Correlative Study Between the Sesamoid Bones under the Head of the First Metatarsal and the Development of Hallux Valgus Determined with Radiographs

2021 ◽  
Author(s):  
Xiaozhong Li ◽  
Dongxue Liu ◽  
Xufang Wang
Keyword(s):  
Hallux Valgus ◽  
Metatarsal Head ◽  
Sesamoid Bone ◽  
Hallux Valgus Angle ◽  
Intermetatarsal Angle ◽  
First Metatarsal ◽  
Valgus Angle ◽  
Second Metatarsal ◽  
Sesamoid Bones ◽  
The Absolute

Abstract Objective. To study the correlative between the sesamoid bones under the head of the first metatarsal and the development of hallux valgus determined with radiographs.Methods.The measurements were performed on the X-ray of 300 normal feet and 300 cases of hallux valgus. The following parameters were measured: hallux valgus angle(HVA); the first-second intermetatarsal angle(IMA) between the axes of the first and second metatarsal;the length of the second metatarsal（CD）;the position of tibial sesamoid(TSP ) measured the percent formed between the tibial sesamoid and the centreline of the first metatarsal;the position of fibular sesamoid(FSP) measured tangent value between fibular sesamoid bone and lateral cortex of first metatarsal bone ; the absolute distances (AB) from the centre of the tibial sesamoid to the long axis of the second metatarsal, the absolute distances (EF) from the centre of the fibular sesamoid to the long axis of the second metatarsal and the absolute distance (GH) from the centre of the tibial sesamoid to the centre of the fibular sesamoid. Then calculate the ratio of AB to CD (K1), EF to CD (K2) and GH to CD (K3). Results.HVA moderately positively correlates with TSP and moderately negatively correlates with FSP in subjects with HVA ≥ 20°. HVA and FSP are strongly negatively correlated in the hallux valgus group. Conclusion.The dislocation of sesamoid bone under the first metatarsal head is an important pathological factor leading to valgus. HVA is positively correlated with TSP and negatively correlated with FSP.

scholarly journals Impact of First Metatarsal Shortening on Forefoot Loading Pattern: A Finite Element Model Study

2019 ◽  
Author(s):  
Geng Xiang ◽  
Shi Jiaqi ◽  
Chen Wenming ◽  
Xin Ma ◽  
Wang Xu ◽  
...  
Keyword(s):  
Finite Element ◽  
Finite Element Model ◽  
Plantar Pressure ◽  
Load Ratio ◽  
Element Model ◽  
Metatarsal Head ◽  
Critical Threshold ◽  
Metatarsal Osteotomy ◽  
Loading Pattern ◽  
First Metatarsal

Abstract Backgrounds There has long been agreement that shortening of the first metatarsal during hallux valgus reconstruction could lead to postoperative transfer metatarsalgia. But appropriate shortening is sometimes beneficial for correcting severe deformities or relieving stiff joints. So this study is to investigate, from the biomechanical perspective, whether and how much shortening of the first metatarsal could be allowed. Methods A finite element model of the human foot simulating the push-off phase of the gait was established and validated by subject-specific plantar pressure data. Shortening of the first metatarsal for 2mm, 4mm, 6mm, 8mm were sequentially applied to the model, and the corresponding instant forefoot loading pattern during push-off phase, especially the loading ratio at the central rays, was respectively calculated. The effect of depressing the first metatarsal head was also observed at last. Results With increasing shortening level of first metatarsal, the plantar pressure of the first ray decreased, while the lateral rays continued to rise. When the shortening reaches 6 mm, the load ratio of the central rays exceeds a critical threshold of 55%, which was considered risky. But it could still be manipulated to normal if the distal end of the first metatarsal displaced plantarly by 3 mm. Conclusions During the first metatarsal osteotomy, a maximum of 6 mm of shortening is considered to be within the safe range. Whenever a higher level of shortening is necessary, pushing down the distal metatarsal segment could be a compensatory procedure to maintain normal plantar force distributions.

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