scholarly journals Dynamic Pedobarography Shows Pain Avoidance Gait of Symptomatic Severe Flatfoot Patient

2018 ◽  
Vol 3 (2) ◽  
pp. 2473011418S0001
Author(s):  
Woo-Chun Lee ◽  
Chihoon Ahn ◽  
Ji-Beom Kim ◽  
Mu Hyun Kim
Keyword(s):  
Plantar Pressure ◽  
Weight Bearing ◽  
Metatarsal Head ◽  
Assessment System ◽  
Medial Longitudinal Arch ◽  
Head Elevation ◽  
Radiographic Parameters ◽  
Longitudinal Arch ◽  
Bearing Load ◽  
The Mean

Category: Basic Sciences/Biologics, Midfoot/Forefoot Introduction/Purpose: In the flatfoot patients, collapsed medial longitudinal arch during gait induced pain and it results decreased center of progression excursion index(CPEI) in dynamic pedobarography. Although the CPEI decreased is pathologic gait of flatfoot patients, range of the CPEIs is wide even in similar severity of flatfoot patients. We hypothesized that some flatfoot patients inverted forefoot or elevated first metatarsal head during gait for avoiding the pain from collapsed medial longitudinal arch, which resulted wide range of the CPEIs in flatfoot patients. The purposes of this study were to investigate the incidence of forefoot inversion and 1st metatarsal head elevation during gait in severe symptomatic flatfoot patients, and to confirm whether forefoot inversion and 1st metatarsal head elevation increases the CPEI, by using the dynamic pedobarography. Methods: We retrospectively evaluated patients who underwent surgery for flatfoot in our clinic from January, 2017 to May, 2017. Before surgery, all patients underwent plain weight-bearing radiographs and dynamic pedobarography by using in-shoe plantar pressure assessment system (Tekscan, Inc., South Boston, MA). Radiographic parameters, talonavicular coverage angle, Meary angle and moment arm, and the CPEI in dynamic pedobarogrpahy were measured. The forefoot inversion and the 1st metatarsal head elevation were defined when sum of 3rd-4th and 5th submetatarsal plantar pressure was higher than sum of 1st and 2nd submetatarsal plantar pressure, and when 2nd submetatarsal plantar pressure was higher than 1st submetatarsal plantar pressure, respectively. Correlations between the radiographic parameters and the CPEI were investigated. Incidence of the forefoot inversion and the 1st metatarsal head elevation was investigated. The CPEIs in flatfeet with forefoot inversion or 1st metatarsal head elevation were compared with those in flatfeet without these pain avoidance gait. Results: Twenty-eight flatfeet from 28 patients were included in the present study. The average age of patients was 42.3 years (range: 19-71). Means of the three radiographic parameters and the CPEI of the 28 flatfeet were listed at table.1. There was no significant correlation between the CPEI and the three radiographic parameters.(Table.2) The incidence of forefoot inversion and 1st metatarsal head elevation were 11%(3 feet), 54%(15 feet) respectively. The mean CPEI of the flatfeet with forefoot inversion or 1st metatarsal head elevation was 8(range: -10 – 18), and the mean CPEI of the flatfeet without these two compensations was 5 (range: -3 – 12). The CPEI in the flatfeet with the two compensations was significant larger than that of the flatfeet without the two compensations. (P=0.027) Conclusion: In the present study, forefoot inversion or 1st metatarsal head elevation were happened in 65% of symptomatic flatfoot patients. These two pain avoidance gait shifts weight-bearing load laterally, which decreases collapsing medial longitudinal arch and pain on the flatfoot. Because lateral shifting of weight-bearing load increases the CPEI, flatfoot patients with these two gaits showed high the CPEI. Therefore, the degree of the CPEIs are various even in similar severity of flatfoot and are not correlated with the severity of the flatfoot. Clinicians should consider these pain avoidance gait of flatfoot patients when they interpret a dynamic pedobarography of flatfoot.

An Anatomic Study of the Naviculocuneiform Ligament and Its Possible Role Maintaining the Medial Longitudinal Arch

2018 ◽  
Vol 40 (3) ◽  
pp. 352-355 ◽  
Author(s):  
Eric Swanton ◽  
Lauren Fisher ◽  
Andrew Fisher ◽  
Andrew Molloy ◽  
Lyndon Mason
Keyword(s):  
Weight Bearing ◽  
Lower Limbs ◽  
Tibialis Posterior ◽  
Medial Longitudinal Arch ◽  
Pes Planus ◽  
Average Width ◽  
Tibialis Posterior Tendon ◽  
Longitudinal Arch ◽  
Medial Cuneiform ◽  
Distal Aspect

Background: Weight-bearing radiographic analysis of pes planus deformities show, with varying degree of severity, a break in the Meary line. The break in the Meary line occurs not only at the talonavicular joint but also distal to the spring ligament and reported tibialis posterior insertion. Our aim in this study was to investigate the distal plantar ligaments of the medial longitudinal arch, to try to identify other areas where deformity correction could be affected. Methods: We examined 11 cadaveric lower limbs that had been preserved for dissection in a solution of formaldehyde. The lower limbs were carefully dissected to identify the plantar aspect of the medial longitudinal arch. Results: In all specimens, the tibialis posterior tendon inserted into the plantar medial aspect of the navicular with separate slips to the intermediate and lateral cuneiform. The navicular cuneiform ligament extended from the navicular to medial cuneiform. This structure was statically inserted between the navicular and medial cuneiform, which would allow the pull of the tibialis posterior to act on the navicular and medial cuneiform in tandem. The average width of the naviculocuneiform ligament was 15.2 mm (range 12.4-18.0) compared to 9.5 mm (range 7.6-11.4) for the tibialis posterior tendon. Conclusion: The tibialis posterior tendon inserted into the navicular and continued onto the medial cuneiform to provide a static restraint between 2 bony insertions, thus supporting the distal aspect of the medial longitudinal arch. Clinical Relevance: We are confident that it is a structure of importance in maintaining the distal aspect of the medial longitudinal arch and may therefore have significant clinical and surgical implications when treating the pes planus deformity.

scholarly journals The Shape of the First Metatarsal Head and its Association with its Pronation Angle and the Presence of Sesamoid-Metatarsal Joint Osteoarthritis

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0037
Author(s):  
Yoshimasa Ono ◽  
Satoshi Yamaguchi ◽  
Seiji Kimura
Keyword(s):  
Hallux Valgus ◽  
Weight Bearing ◽  
Qualitative Evaluation ◽  
Metatarsal Head ◽  
First Metatarsal ◽  
Lateral Edge ◽  
Ankle Surgery ◽  
History Of ◽  
Joint Deformation ◽  
The Mean

Category: Bunion Introduction/Purpose: The rounded shape of the first metatarsal head’s lateral edge on the dorsoplantar radiograph of the foot is used as a qualitative evaluation of the first metatarsal pronation in hallux valgus feet. However, the relationship between the rounded shape and the metatarsal pronation angle of the first metatarsal has not been examined in detail. Furthermore, hallux valgus often accompanies osteoarthritis in the sesamoid-metatarsal joint. Deformation of the metatarsal head by osteophytes on the lateral edge of the lateral sesamoid facet may affect the rounded shape. The purpose of this study was to evaluate the associations of the shape of the first metatarsal head with (1) the presence of osteoarthritis in the sesamoid-metatarsal joint and (2) the pronation angle of the first metatarsal head. Methods: Patients were prospectively recruited between December 2016 and March 2017. Patients with a history of previous foot and ankle surgery or destruction of the head due to rheumatoid arthritis were excluded. A total of 121 patients, with the mean age of 61 years, underwent weight-bearing dorsoplantar, lateral, and first metatarsal axial radiographs. The shape of the first metatarsal head’s lateral edge was classified as either rounded, intermediate, or angular in shape in the dorsoplantar view. The presence of osteoarthritis in the sesamoid-metatarsal joint and the pronation angle of the first metatarsal head were assessed in the first metatarsal axial view. Other variables that could affect the first metatarsal shape, including the lateral first metatarsal inclination angle, were also assessed. Univariate and multivariate analyses were performed to determine the associations of the rounded shape of the first metatarsal with the pronation angle and sesamoid-metatarsal joint osteoarthritis. Results: Of 121 feet, 31, 41, and 49 feet had rounded, intermediate, and angular metatarsal heads, respectively. Sesamoid- metatarsal joint osteoarthritis was evident in 49 (40%) feet. The mean hallux valgus and first metatarsal pronation angle was 23° and 9°, respectively. The prevalence of sesamoid-metatarsal osteoarthritis was significantly higher (24 (77%), 11 (27%), and 14 (29%) for rounded, intermediate, and angular, respectively, P < .001) in feet with a rounded metatarsal head. Furthermore, the metatarsal pronation angle was significantly larger (14°, 8°, and 4° for rounded, intermediate, and angular, respectively, P < .001). These associations were also significant in the multiple regression analysis. Conclusion: A rounded metatarsal head was associated with a higher prevalence of osteoarthritis within the sesamoid-metatarsal joint, as well as a larger first metatarsal head pronation angle. A negative round sign can be used as a simple indicator of an effective correction to the first metatarsal pronation angle during hallux valgus surgery. However, in feet with sesamoid-metatarsal osteoarthritis, surgeons will need to be cautious as overcorrection may occur.

Effect of a Metatarsal Pad on the Forefoot During Gait

2012 ◽  
Vol 102 (1) ◽  
pp. 18-24 ◽  
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)

scholarly journals TL 18086 - Forefoot axial radiographic study for the evaluation of metatarsal head alignment in the coronal plane

2019 ◽  
Vol 13 (Supl 1) ◽  
pp. 73S
Author(s):  
Rafael Barban Sposeto ◽  
Tulio Diniz Fernandes ◽  
Marcos Hideyo Sakaki ◽  
Alexandre Leme Godoy-Santos ◽  
Rafael Trevisan Ortiz ◽  
...  
Keyword(s):  
Weight Bearing ◽  
Relative Length ◽  
Metatarsal Head ◽  
Cross Sectional Study ◽  
Axial Plane ◽  
Coronal Plane ◽  
Cross Sectional ◽  
Metatarsal Bones ◽  
Informed Consent Form ◽  
The Mean

Introduction: Many authors consider differences in the relative length of metatarsal bones in the axial plane a cause of inadequate load distribution during gait, leading to metatarsalgia. The goal of surgical treatment is to realign the metatarsal formula. However, many studies have shown a 15% metatarsalgia recurrence rate after reconstructing the advocated metatarsal formula in the axial plane, questioning the importance of the alignment of the metatarsal heads in the coronal plane.  Objective: To evaluate the alignment pattern of the metatarsal heads in the coronal plane in individuals with and without metatarsalgia. Methods: This cross-sectional study evaluated individuals aged 30 to 65 years, dividing them into 2 groups, one without foot pain, deformities or callosities and another with metatarsalgia between the 2nd, 3rd and 4th metatarsal bones. The individuals were selected according to inclusion and exclusion criteria and were included in the study after signing an informed consent form. After the selection, the subjects underwent one weight-bearing forefoot axial radiograph evaluating the coronal plane to measure the heights of the metatarsal heads and a weight-bearing anteroposterior foot radiograph to determine the length of each ray. Statistical analysis was performed to compare the measurements of the 2 groups.  Results: In total, 106 individuals were divided into 2 groups, each comprising 106 feet, and evaluated. In the group with metatarsalgia, 32% patients were men, the mean age was 49.5 years, and 33 feet had hallux valgus. In the group without metatarsalgia, 51% patients were male, and the mean age was 44.6 years. The measured anthropometric variables did not differ significantly between groups. In both groups, the metatarsal heads were distributed in a curved line in the coronal plane, following the formula M1<M2>M3>M4=M5. The distal support of the 1st ray was in a more plantar position in the group of patients with metatarsalgia (p=0.000).  Conclusion: The metatarsal heads of the individuals of both groups were aligned in the coronal plane following the formula M1<M2>M3>M4=M5. However, M1, M4 and M5 were at the same height in the group without metatarsalgia, whereas the M1 weight-bearing point was more plantar in the feet of patients with metatarsalgia.

scholarly journals Effects of various walking intensities on leg muscle fatigue and plantar pressure distributions

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Chi-Wen Lung ◽  
Ben-Yi Liau ◽  
Joseph A. Peters ◽  
Li He ◽  
Runnell Townsend ◽  
...  
Keyword(s):  
Muscle Fatigue ◽  
Plantar Pressure ◽  
Walking Speed ◽  
Weight Bearing ◽  
Metatarsal Head ◽  
Multiscale Entropy ◽  
Median Frequency ◽  
Brisk Walking ◽  
First Metatarsal ◽  
Leg Muscle

Abstract Background Physical activity may benefit health and reduce risk for chronic complications in normal and people with diabetes and peripheral vascular diseases. However, it is unclear whether leg muscle fatigue after weight-bearing physical activities, such as brisk walking, may increase risk for plantar tissue injury. In the literature, there is no evidence on the effect of muscle fatigue on plantar pressure after various walking intensities. The objectives of this study were to investigate the effects of various walking intensities on leg muscle fatigue and plantar pressure patterns. Methods A 3 × 2 factorial design, including 3 walking speeds (1.8 (slow and normal walking), 3.6 (brisk walking), and 5.4 (slow running) mph) and 2 walking durations (10 and 20 min) for a total of 6 walking intensities, was tested in 12 healthy participants in 3 consecutive weeks. The median frequency and complexity of electromyographic (EMG) signals of tibialis anterior (TA) and gastrocnemius medialis (GM) were used to quantify muscle fatigue. Fourier transform was used to compute the median frequency and multiscale entropy was used to calculate complexity of EMG signals. Peak plantar pressure (PPP) values at the 4 plantar regions (big toe, first metatarsal head, second metatarsal head, and heel) were calculated. Results Two-way ANOVA showed that the walking speed (at 1.8, 3.6, 5.4 mph) significantly affected leg muscle fatigue, and the duration factor (at 10 and 20 min) did not. The one-way ANOVA showed that there were four significant pairwise differences of the median frequency of TA, including walking speed of 1.8 and 3.6 mph (185.7 ± 6.1 vs. 164.9 ± 3.0 Hz, P = 0.006) and 1.8 and 5.4 mph (185.7 ± 6.1 vs. 164.5 ± 5.5 Hz, P = 0.006) for the 10-min duration; and walking speed of 1.8 and 3.6 mph (180.0 ± 5.9 vs. 163.1 ± 4.4 Hz, P = 0.024) and 1.8 and 5.4 mph (180.0 ± 5.9 vs. 162.8 ± 4.9 Hz, P = 0.023) for the 20-min duration. The complexity of TA showed a similar trend with the median frequency of TA. The median frequency of TA has a significant negative correlation with PPP on the big toe ( r = -0.954, P = 0.003) and the first metatarsal head ( r = -0.896, P = 0.016). Conclusions This study demonstrated that brisk walking and slow running speeds (3.6 and 5.4 mph) cause an increase in muscle fatigue of TA compared to slow walking speed (1.8 mph); and the increased muscle fatigue is significantly related to a higher PPP.

scholarly journals Rehabilitation following Surgery for Reconstruction of a Foot Defect

2008 ◽  
Vol 1 ◽  
pp. CCRep.S726
Author(s):  
Susan Faber West ◽  
Peter E. Pidcoe
Keyword(s):  
Range Of Motion ◽  
Muscle Force ◽  
Weight Bearing ◽  
Force Production ◽  
Medial Longitudinal Arch ◽  
Talocrural Joint ◽  
Longitudinal Arch ◽  
Patient Goals ◽  
Av Malformation ◽  
Muscle Force Production

Background This report illustrates the use of pressure for scar management to aid in foot re-shaping following a surgical intervention to repair an arterio-venous (AV) malformation. Methods This report describes the rehabilitation of a 13-year-old girl after surgical reconstruction of a defect in her left foot following the removal of an AV malformation. Early surgical attempts to repair the problem resulted in complications that required the amputation of toes 2, 3, and 4, and the use of a split thickness skin graft to cover the plantar surface of the medial longitudinal arch on the left foot. Following surgery, the patient had an antalgic gait pattern with decreased weight bearing on the left. The graft obliterated the left medial longitudinal arch and the patient would only weight bear on the heel. The patient had decreased metatarsal joint mobility on the affected side and no movement in the remaining toes. Left talocrural joint active range-of-motion (AROM) was within normal limits and gross ankle muscle force production was assessed to have a grade of 3/5. Results Treatment included reshaping the left foot using a pressure garment and orthotic, followed by interventions to address range-of-motion and muscle force production deficiencies. All treatment objectives were achieved and all patient goals were achieved. Conclusions Pressure was effective in re-shaping the foot to promote normal gait mechanics.

scholarly journals Measurements Used to Characterize the Foot and the Medial Longitudinal Arch: Reliability and Validity

2000 ◽  
Vol 80 (9) ◽  
pp. 864-871 ◽  
Author(s):  
Dorsey S Williams ◽  
Irene S McClay
Keyword(s):  
Weight Bearing ◽  
Intraclass Correlation ◽  
Reliability And Validity ◽  
Correlation Coefficients ◽  
Reference Database ◽  
Medial Longitudinal Arch ◽  
Predisposing Factor ◽  
Foot Length ◽  
Longitudinal Arch ◽  
Group A

Abstract Background and Purpose. Abnormality in the structure of the medial longitudinal arch of the foot is commonly thought to be a predisposing factor to injury. The purpose of this investigation was to compare the reliability and validity of several measurements used to characterize various aspects of the foot, including the medial longitudinal arch. Subjects. One hundred two feet (both feet of 51 subjects) were measured to establish a reference database. From this group, a subset of 20 feet (both feet of 10 subjects) was used to determine intertester and intratester reliability. Radiographs of a further subset of 10 feet (right feet of 10 subjects) were used to determine validity. Methods. Five foot measurements were taken in 2 stance conditions: 10% of weight bearing and 90% of weight bearing. Results. Intraclass correlation coefficients (ICCs) for intertester and intratester measurements were between .480 and .995. The most reliable method of characterizing arch type in 10% of weight bearing between testers was dividing navicular height by foot length in 10% of weight bearing. However, this measure yielded highly unreliable measurements in 90% of weight bearing. The most valid measurements were navicular height divided by truncated foot length, navicular height divided by foot length in 10% of weight bearing, and navicular height divided by foot length in 90% of weight bearing. Dorsum height at 50% of foot length divided by truncated foot length showed relatively high intertester reliability (ICC=.811 in 10% of weight bearing, ICC=.848 in 90% of weight bearing) and validity (ICC=.844 in 10% of weight bearing, ICC=.851 in 90% of weight bearing). Conclusion and Discussion. These data suggest that, of the measures tested, the most reliable and valid method of clinically assessing arch height across 10% and 90% of weight bearing was dividing the dorsum height at 50% of foot length by truncated foot length.

Biomechanical Evaluation of the Efficacy of External Stabilizers in the Conservative Treatment of Acquired Flatfoot Deformity

2002 ◽  
Vol 23 (8) ◽  
pp. 727-737 ◽  
Author(s):  
Carl W. Imhauser ◽  
Nicholas A. Abidi ◽  
David Z. Frankel ◽  
Kenneth Gavin ◽  
Sorin Siegler
Keyword(s):  
Pressure Distribution ◽  
Plantar Pressure ◽  
Center Of Pressure ◽  
Lower Limbs ◽  
Quiet Standing ◽  
Medial Longitudinal Arch ◽  
Longitudinal Arch ◽  
Plantar Pressure Distribution ◽  
Flexible Flatfoot ◽  
Fresh Frozen

This study quantified and compared the efficacy of in-shoe orthoses and ankle braces in stabilizing the hindfoot and medial longitudinal arch in a cadaveric model of acquired flexible flatfoot deformity. This was addressed by combining measurement of hindfoot and arch kinematics with plantar pressure distribution, produced in response to axial loads simulating quiet standing. Experiments were conducted on six fresh-frozen cadaveric lower limbs. Three conditions were tested: intact-unbraced; flatfoot-unbraced; and flatfoot-braced. Flatfoot deformity was created by sectioning the main support structures of the medial longitudinal arch. Six different braces were tested including two in-shoe orthoses, three ankle braces and one molded ankle-foot orthosis. Our model of flexible flatfoot deformity caused the calcaneus to evert, the talus to plantarflex and the height of the talus and medial cuneiform to decrease. Flexible flatfoot deformity caused a pattern of medial shift in plantar pressure distribution, but minimal change in the location of the center of pressure. Furthermore, in-shoe orthoses stabilized both the hindfoot and the medial longitudinal arch, while ankle braces did not. Semi-rigid foot and ankle orthoses acted to stabilize the medial longitudinal arch. Based on these results, it was concluded that treatment of flatfoot deformity should at least include use of in-shoe orthoses to partially restore the arch and stabilize the hindfoot.

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