Anomalous plantar intrinsic foot muscle attaching to the medial longitudinal arch: possible mechanism for medial nerve entrapment: a case report

Abstract Background Muscular variations are potentially symptomatic and may complicate imaging interpretation. Intrinsic foot musculature and extrinsic tendon insertion variations are common. Distinct supernumerary muscles are rare. We report a novel anomalous intrinsic foot muscle on the medial longitudinal arch. Case presentation An accessory muscle was encountered on the medial arch of the right foot of a 78-year-old white male cadaver, between layers two and three of the foot intrinsics. It did not appear to be a slip or variant of a known foot muscle. This muscle consisted of two slips that ran transversely on the plantar aspect of the medial arch, crossing the medial transverse tarsal joint and attaching to the tuberosity of the navicular, the short and long plantar ligaments, and spring ligament. Conclusions The medial plantar vessels and nerve passed from deep to superficial between the two slips, and this suggests a possible location for medial nerve entrapment.

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Biomechanical Evaluation of Longitudinal Arch Stability

Foot & Ankle ◽

10.1177/107110079301400609 ◽

1993 ◽

Vol 14 (6) ◽

pp. 353-357 ◽

Cited By ~ 203

Author(s):

Ching-Kuei Huang ◽

Harold B. Kitaoka ◽

Kai-Nan An ◽

Edmund Y. S. Chao

Keyword(s):

Plantar Fascia ◽

Medial Longitudinal Arch ◽

Spring Ligament ◽

Relative Contribution ◽

Longitudinal Arch ◽

Associated Symptoms ◽

Compressive Loads ◽

Fresh Frozen ◽

Biomechanical Evaluation ◽

The Common

In spite of the common occurrence of pes planus and multiple operations that have been reported to relieve the associated symptoms, there is little published on the relative contribution of various structures to stabilization of the arch of the foot. Twelve fresh-frozen human cadaveric feet were loaded along the tibial axis with compressive loads of 230, 460, and 690 newtons with the specimens intact and after sequential sectioning of plantar fascia, plantar ligaments, and spring ligament. Structures were sectioned in six different sequences and changes in vertical and horizontal dimensions of the medial arch were measured. The highest relative contribution to arch stability was provided by the plantar fascia, followed by plantar ligaments and spring ligament. Plantar fascia was a major factor in maintenance of the medial longitudinal arch. Its division in the cadaveric feet decreased arch stiffness by 25%.

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Validity of Two-Dimensional Static Footprint in Medial Longitudinal Arch Evaluation and the Characteristics of Athletes’ Footprints

10.1101/2020.02.10.941633 ◽

2020 ◽

Author(s):

Lingli Zhang ◽

Dali Yu ◽

Le Lei ◽

Yuanwu Gao ◽

Junjie Dong ◽

...

Keyword(s):

College Students ◽

Inclination Angle ◽

Medial Longitudinal Arch ◽

Two Dimensional ◽

Important Indicator ◽

First Metatarsal ◽

Longitudinal Arch ◽

Metatarsal Angle ◽

The Right ◽

High Level

AbstractBackgroundWe aimed to explore the validity of two-dimensional static footprint analysis in medial longitudinal arch evaluation as well as the characteristics of athletes’ footprints to provide a basis for the evaluation and selection of athletes.MethodsExperiment One: Twenty-nine high level athletes (runners and jumpers) and forty normal college students were selected. Based on the X-ray photos taken of the medial foot, we measured the calcaneal inclination angle, the calcaneal–first metatarsal angle and the ratio of height to length of the medial longitudinal arch. We collected indicators of two-dimensional static footprints. Experiment Two: 106 high level athletes (runners and jumpers) and 104 normal college students were selected. We also collected indicators of two-dimensional static footprints.ResultsThe average measuring the Interclass Correlation Efficient (ICC) of calcaneal inclination angle, calcaneal–first metatarsal angle, the ratio of height to length of the medial longitudinal arch, the width of ball, arch and heel, the length of footprint and each toe, Chippaux-Smirak Index (CSI) and Staheli Index (SAI) were higher than 0.800. Regardless of athletes or college students, male or female, the correlation between CSI, SAI and calcaneal inclination angle, calcaneal–first metatarsal angle, the ratio of height to length of the medial longitudinal arch was statistically significant (P<0.05). College students’ CSI of the right foot is significantly higher than that of the left foot regardless of gender (P<0.05).ConclusionsWe prove the qualification of CSI and SAI in medial longitudinal arch evaluation and explain that the relative height of medial longitudinal arch is an important indicator in track and field.

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The effect of intrinsic foot muscle training on medial longitudinal arch and ankle stability in patients with chronic ankle sprain accompanied by foot pronation

Physical therapy rehabilitation science ◽

10.14474/ptrs.2016.5.2.78 ◽

2016 ◽

Vol 5 (2) ◽

pp. 78-83 ◽

Cited By ~ 3

Author(s):

Kyoung A Chung ◽

Eunsang Lee ◽

Seungwon Lee

Keyword(s):

Ankle Sprain ◽

Medial Longitudinal Arch ◽

Muscle Training ◽

Ankle Stability ◽

Longitudinal Arch ◽

Foot Pronation ◽

Intrinsic Foot Muscle

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Does the Application of a Semiocclusive Dressing Alter the Microflora of Healthy Intact Skin on the Foot?

Journal of the American Podiatric Medical Association ◽

10.7547/18-141 ◽

2021 ◽

Vol 111 (1) ◽

Author(s):

Rachel Forss ◽

Zoe Hugman ◽

Kelly Ridlington ◽

Marissa Radley ◽

Emma Henry-Toledo ◽

...

Keyword(s):

Healing Process ◽

Fungal Growth ◽

Coagulase Negative Staphylococcus ◽

Medial Longitudinal Arch ◽

Intact Skin ◽

Gram Staining ◽

Longitudinal Arch ◽

Human Participants ◽

The Right ◽

Semiocclusive Dressing

Background The skin on human feet presents unique environments for the proliferation of potentially pathogenic commensals. This study examined microflora changes on healthy intact skin under a semiocclusive dressing on the medial longitudinal arch of the foot to determine changes in growth, distribution, and frequency of microflora under the dressing. Methods Nine human participants wore a low-adherent, absorbent, semiocclusive dressing on the medial longitudinal arch of the left foot for 2 weeks. An identical location on the right foot was swabbed and used as a control. Each foot was swabbed at baseline, week 1, and week 2. The swabs were cultured for 48 hours. Visual identification, Gram staining, DNase test agar, and a latex slide agglutination test were used to identify genera and species. Results Microflora growth was categorized as scant (0–10 colony-forming units [CFU]), light (11–50 CFU), moderate (51–100 CFU), or heavy (>100 CFU). Scant and light growth decreased and moderate and heavy growth increased under the dressing compared with the control. Seven different genera of bacteria were identified. Coagulase-negative Staphylococcus spp appeared most frequently, followed by Corynebacterium spp. Conclusions Changes in microflora distribution, frequency, and growth were found under the dressing, supporting historical studies. Microflora changes were identified as an increase in bioburden and reduction in diversity. The application of similar methods, using more sophisticated identification and analysis techniques and a variety of dressings, could lead to a better understanding of bacterial and fungal growth under dressings, informing better dressing selection to assist the healing process of wounds and prevent infection.

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Morphometric Dimensions of the Calcaneonavicular (Spring) Ligament

Foot & Ankle International ◽

10.3113/fai.2007.0927 ◽

2007 ◽

Vol 28 (8) ◽

pp. 927-932 ◽

Cited By ~ 24

Author(s):

Vishwas Patil ◽

Nabil A. Ebraheim ◽

Alexandra Frogameni ◽

Jiayong Liu

Keyword(s):

Ankle Joint ◽

Clinical Relevance ◽

Posterior Tibial Tendon ◽

Medial Longitudinal Arch ◽

Posterior Tibial ◽

Spring Ligament ◽

Longitudinal Arch ◽

Dynamic Support ◽

Complex Methods ◽

Adult Cadaver

Background: The spring ligament complex (SLC) is a static support of the head of the talus and a major anatomical contributor to the integrity of the medial longitudinal arch, particularly if the dynamic support of the posterior tibial tendon is compromised. For this reason, we sought to further elucidate the anatomical components and dimensions of this ligamentous complex. Methods: Dissection was performed on 30 adult cadaver feet disarticulated at the ankle joint that were preserved by embalming technique. Results: The superomedial ligament (SML) averages 42.51 ± 3.93 mm and 33.44 ± 3.34 mm at the superomedial and inferolateral borders, respectively. The width at the level of sustentaculum tali and navicular tuberosity averaged 20.00 ± 2.35 mm and 10.26 ± 2.05 mm, respectively. The medioplantar oblique (MPO) ligament averaged 23.56 ± 2.15 mm and 21.20 ± 1.42 mm at the medial and the lateral borders, respectively. The widths at the navicular and calcaneal side were 2.71 ± 0.39 mm and 8.14 ± 0.56 mm, respectively. The inferoplantar longitudinal (IPL) ligament measured 4.26 ± 0.43 mm and 2.66 ± 0.42 mm at the medial and lateral borders, respectively. The width at the calcaneal and navicular insertions measured 5.21 ± 0.53 mm and 3.39 ± 0.39 mm, respectively. Conclusions: The distinction between the SML and MPO components of the spring ligament complex is difficult. This study tried to clarify the dimensions and configurations of these components of the SLC. Clinical relevance: This effort may aid surgeons who wish to repair this ligament with more precision.

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The Plantar Support of the Navicular-Cunieform Joint

Foot & Ankle Orthopaedics ◽

10.1177/2473011418s00338 ◽

2018 ◽

Vol 3 (3) ◽

pp. 2473011418S0033

Author(s):

Lyndon Mason ◽

Eric Swanton ◽

Lauren Fisher ◽

Andrew Fisher ◽

Andrew Molloy

Keyword(s):

Lower Limbs ◽

Human Anatomy ◽

Tibialis Posterior ◽

Posterior Tibial Tendon ◽

Medial Longitudinal Arch ◽

Average Width ◽

Posterior Tibial ◽

Spring Ligament ◽

Longitudinal Arch ◽

Medial Cuneiform

Category: Midfoot/Forefoot Introduction/Purpose: Weight-bearing radiographic analysis of pes planus deformities shows, with varying degree of severity, a break in Meary’s line, uncovering of the talar head and an increase in talar-first metatarsal angle. Work by Alsousou (BOFAS 2016) has shown the break in Meary’s line to occur not only at the talonavicular joint (2/3rds of cases) but also at the navicular-cuneiform joint (1/3 rd of cases), distal to the spring ligament and reported posterior tibial tendon insertion. There are currently no anatomical studies analysing the medial longitudinal arch distal to the spring ligament insertion. We aimed to examine this area and assess the anatomy supporting the distal medial longitudinal arch. Methods: We examined 11 cadaveric lower limbs that had been preserved for dissection at the Human Anatomy and Resource Centre at Liverpool University, 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 posterior tibial tendon inserted into the plantar medial aspect of the navicular with separate slips to the intermediate and lateral cuneiform. Following insertion, on the navicular, a tendon-like structure extended from this navicular insertion point to the medial cuneiform. This tendon-like structure is statically inserted between the navicular and medial cuneiform allowing the pull of tibialis posterior to act on the navicular and medial cuneiform in tandem. The average width of this ligament (15.2 mm) is much greater than that of the tibialis posterior tendon (9.5 mm). A separate smaller plantar ligament is also present between the navicular and medial cuneiform. Conclusion: The posterior tibialis tendon inserts into the navicular, and what is likely an anthropological remnant, extends onto the medial cuneiform as the navicular cuneiform ligament. This provides a static restraint between two bony insertions and increases the lever arm of the posterior tibial tendon. The major support of the distal aspect of the medial longitudinal arch (i.e. the navicular-cuneiform joint) is provided by the substantial navicular cuneiform ligament.

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Effect of Obesity Level on the Longitudinal Arch in 7- to 12-Year-Old Rural and Urban Children

Journal of the American Podiatric Medical Association ◽

10.7547/13-141.1 ◽

2015 ◽

Vol 105 (6) ◽

pp. 484-492 ◽

Cited By ~ 3

Author(s):

Renata Woźniacka ◽

Aneta Bac ◽

Stanisław Matusik

Keyword(s):

Age Groups ◽

Urban Children ◽

Medial Longitudinal Arch ◽

Obese Children ◽

Longitudinal Arch ◽

Rural And Urban ◽

Foot Arch ◽

Free Body ◽

The Right ◽

Almost All

Background We sought to evaluate the influence of obesity level on the medial longitudinal arch (MLA) of the foot in 7- to 12-year-old children. Methods The study group consisted of 925 children (450 girls and 475 boys). All of the children were subjected to podoscopic foot examination and measurement of weight, height, three skinfolds, fat weight, and fat-free body weight. Results The most common type of MLA was high-arched foot, which was observed in the left foot of 523 children (56.5%) and in the right foot in 592 children (64%). In almost all of the age groups, high-arched foot was the most common disorder. High-arched foot was more common in girls than in boys, and boys displayed a higher percentage of flatfoot. Also, sex-related differences were more prominent in urban children. There was a strongly positive correlation between obesity level and MLA in the examined group. Conclusions These results suggest that the type of foot arch is influenced by parameters such as age, sex, and obesity level. High-arched foot seemed to be the most frequent pathologic abnormality in the examined group, and flatfoot, which was predominant in boys and obese children, diminished with age. High-arched foot was a more common MLA type than flatfoot regardless of obesity level assessed on the basis of body mass index and sum of three skinfolds.

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Functional Characteristics of the Foot and Plantar Aponeurosis under Tibiotalar Loading

Foot & Ankle ◽

10.1177/107110078700800103 ◽

1987 ◽

Vol 8 (1) ◽

pp. 4-18 ◽

Cited By ~ 134

Author(s):

Shahan K. Sarrafian

Keyword(s):

Internal Rotation ◽

Sagittal Plane ◽

External Rotation ◽

Transverse Plane ◽

Medial Longitudinal Arch ◽

Plantar Aponeurosis ◽

Vertical Loading ◽

Longitudinal Arch ◽

Plantar Aspect ◽

Tensile Forces

Structurally the foot is equivalent to a twisted plate. The hindpart is located in the sagittal plane and the forepart in the transverse plane. The transition induced by the twist creates the transverse and the longitudinal arches. Under vertical loading of the foot plate by the tibiotalar column, compressive forces are created on the dorsum and tensile forces on the plantar aspect of the foot plate. The plantar aponeurosis acting as a tie-rod when under tension relieves the tensile forces from the plantar aspect of the foot plate. The increased tension in the plantar aponeurosis in the weightbearing position of the foot occurs with anterior flexion of the leg or with hyperextension of the toes. In the plantigrade position when vertical loading and external rotation are simultaneously applied by the tibiotalar column on the foot, the hindfoot and the midfoot are supinated, and the forefoot is pronated. The medial longitudinal arch is higher, the foot is shorter, and the plantar aponeurosis is relaxed. The foot is then more flexible. With vertical loading and simultaneous internal rotation, the hindfoot and the midfoot are pronated, and the forefoot is supinated. The medial longitudinal arch is lower, the foot is longer, and the plantar aponeurosis is tense. The foot is then more rigid and a better lever arm. Demonstrations are presented both in living and in anatomic dissections.

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An incidental finding of testicular seminoma in the context of acute pulmonary embolism: a case report

Journal of Medical Case Reports ◽

10.1186/s13256-021-02925-z ◽

2021 ◽

Vol 15 (1) ◽

Author(s):

Kaitlin J. Mayne ◽

Emma Lewis ◽

Lewis Vickers

Keyword(s):

Pulmonary Embolism ◽

Venous Thromboembolism ◽

Clinical Guidelines ◽

Acute Pulmonary Embolism ◽

Incidental Finding ◽

White Male ◽

Vena Cava ◽

Testicular Seminoma ◽

Computed Tomography Scanning ◽

The Right

Abstract Background Clinical guidelines do not recommend further investigation for occult malignancy in the scenario of unprovoked venous thromboembolism in the absence of additional clinical features suggestive of malignancy. We present the case of a young gentleman with pulmonary embolism who was diagnosed with testicular seminoma despite lack of symptoms or signs suggestive of malignancy. This is a unique case describing a scenario not well documented in existing literature where contravention of clinical guidelines had a potentially advantageous outcome for the patient. Case presentation A 37-year-old white male presented with seemingly unprovoked acute pulmonary embolism with right heart strain. He did not have any predisposing factors for venous thromboembolism and did not have any symptoms or signs suggestive of malignancy. Clinical guidelines do not recommend further investigation to screen for malignancy in this scenario. Despite this, our young, otherwise healthy patient proceeded to computed tomography scanning, resulting in the diagnosis of localized testicular seminoma. Testicular ultrasound described normal-sized testes (despite a discrete lesion in the right testis), suggesting this was not detectable by the patient or clinician on routine examination. The patient was anticoagulated and had an inferior vena cava filter inserted to facilitate orchidectomy followed by adjuvant radiotherapy. Conclusions This case highlights the importance of considering malignancy in seemingly unprovoked venous thromboembolism and the availability of guidelines to direct further investigation. Our patient’s treatment was not in line with clinical guidelines and was considered a “lucky find.”

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