scholarly journals Objectification of indications for surgical restoration of the plantar plate in the treatment of multiplanar static foot deformities accompanied by hammertoe deformity of the lesser toes using ultrasound

2021 ◽  
Vol 27 (2) ◽  
pp. 214-219
Author(s):  
V.N. Cherevtsov ◽  
◽  
A.N. Blazhenko ◽  
S.B. Bogdanov ◽  
A.V. Mazalov ◽  
...  
Keyword(s):  
Ultrasound Imaging ◽  
Medical Center ◽  
Metatarsophalangeal Joint ◽  
Diagnostic Algorithm ◽  
Diagnostic Error ◽  
Original Method ◽  
Foot Deformities ◽  
Flat Foot ◽  
Plantar Plate ◽  
Ultrasound Evaluation

Introduction Progressive multiplanar static deformity of the forefoot can result in hallux valgus, metatarsus primus varus, transverse flat foot and associated overload of the metatarsophalangeal joints (MTPJ) with plantar plate degeneration and rupture of MPT joints of the lesser toes leading to hammertoe deformity. Diagnostic ultrasound in the identification of plantar plate tears is easy to use at any medical center of the Russian Federation with orthopaedic services and provide a relatively inexpensive option compared with other advanced imaging modalities. The goal was to present ultrasound technology for accurate evaluation of the severity of plantar plate injury which may provide guidance for surgical treatment of hammertoe deformity of the lesser toes in patients with multiplanar static forefoot deformity. Material and methods The study recruited 88 participants with multiplanar static deformity of the forefoot, who underwent ultrasound evaluation according to the original method (RF Patent No. 2699383 "Method for determining the type of degenerative rupture of the plantar plate of the metatarsophalangeal joint due to overload metatarsalgia”) to objectify the results of a physical examination with the Hamilton-Thompson test performed for identifying the degree of instability of the MTPJ, and nonparametric analysis was produced with Pearson's Chisquare test. Results Evaluation of the severity of plantar plate injury in the study group of patients (n = 88) with the Hamilton-Thompson test and ultrasound imaging showed diagnostic error in 22.8 % of cases with the use of clinical methods that allowed reasonable reduction of surgical intervention in 2.3 % and substantial correction of the treatment approaches in 20.5 % preventing a complete plantar plate tear. Discussion The ultrasound scanning introduced in the algorithm for diagnosing the degree of plantar plate rupture facilitated an objective approach to the choice of the most appropriate treatment strategy for complicated multiplanar forefoot deformities accompanied by a non-rigid hammertoe deformity of lesser toes. Conclusion Preoperative ultrasound imaging of the plantar surface of the foot for detecting the severity of plantar plate injury should be included in the diagnostic algorithm for patients with complicated multiplanar forefoot deformities accompanied by a non-rigid hammertoe deformity of lesser toes.

Fetal Malpresentation in Pregnancy

2020 ◽  
Author(s):  
Afshin Azimirad ◽  
Errol R. Norwitz
Keyword(s):  
Vaginal Delivery ◽  
Medical Center ◽  
Breech Presentation ◽  
Obstetric Care ◽  
External Cephalic Version ◽  
Breech Delivery ◽  
Advantages And Disadvantages ◽  
Ultrasound Evaluation ◽  
Elective Repeat Cesarean ◽  
Anatomical Part

Fetal presentation refers to that anatomical part of the fetus that presents at the maternal pelvic inlet. The most common and most desirable fetal presentation is cephalic (head first). Any presentation other than cephalic is referred to as a malpresentation. Breech is the most common fetal malpresentation. The prevalence of breech presentation varies with gestational age (25% at 28 weeks and 3-5% of at term). Ultrasound evaluation is the gold standard for the diagnosis of fetal presentation. External cephalic version (ECV) refers to a series of manual manipulations designed to convert a malpresenting fetus to cephalic to promote vaginal delivery. There are two strategies around the timing of ECV; at 36-37 weeks and/or at or shortly after 39 weeks’ gestation. Each has advantages and disadvantages. Currently, most breech pregnancies at term are delivered by cesarean at 39 weeks prior to the onset of labor. Malpresentation is the second most common indication for planned cesarean (behind elective repeat cesarean). Vaginal delivery for a breech fetus at term should only be attempted if the mother is strongly motivated, if the obstetric care provider is experienced, and if the medical center has the requisite facilities to manage any and all complications. This review contains 3 figures, 2 tables, and 66 references. Keywords: fetal presentation, malpresentation, breech presentation, ultrasound evaluation, external cephalic version (ECV), cesarean delivery, vaginal breech delivery

Multiplanar Correction of the Lesser Digital Deviation and Indirect Plantar Plate Rupture Repair Using a Braided Polyethylene Nylon Suture: A Technique Guide

2017 ◽  
Vol 10 (6) ◽  
pp. 551-554 ◽  
Author(s):  
Cody D. Blazek ◽  
Roberto A. Brandão ◽  
Jeffrey M. Manway ◽  
Patrick R. Burns
Keyword(s):  
Sagittal Plane ◽  
Digital Pathology ◽  
Metatarsophalangeal Joint ◽  
Metatarsal Head ◽  
Foot And Ankle ◽  
Dorsal Approach ◽  
Plantar Plate ◽  
Direct Repair ◽  
Nylon Suture ◽  
A New Technique

Forefoot and lesser digital pathology continues to be a challenging area of surgical correction for foot and ankle surgeons. Many techniques for the correction of digital deformities secondary to plantar plate rupture, regardless of planal dominance, have been described including direct repair and metatarsal shortening osteotomies for repair. The authors present a new technique for multiplanar correction of deformed lesser digits without direct repair of the plantar plate rupture utilizing a specialty suture. The technique utilizes a braided synthetic polyethylene Nylon suture, which has been traditionally used for open or arthroscopic shoulder labrum repair, for the stabilization of the lesser metatarsophalangeal joint. This novel technique guide for the correction of transverse and sagittal plane deformities of the digit at the metatarsophalangeal joint negates the need for a plantar incisional approach for plantar plate repair or metatarsal head osteotomy from a dorsal approach with augmented stabilization. Levels of Evidence: Level V: Expert opinion

Plantar plate repair and Weil osteotomy for metatarsophalangeal joint instability

2007 ◽  
Vol 13 (3) ◽  
pp. 116-121 ◽  
Author(s):  
Julie Gregg ◽  
Morry Silberstein ◽  
Callum Clark ◽  
Tim Schneider
Keyword(s):  
Joint Instability ◽  
Metatarsophalangeal Joint ◽  
Plantar Plate

Evaluation of lesser metatarsophalangeal joint plantar plate tears with contrast-enhanced and fat-suppressed MRI

2016 ◽  
Vol 45 (5) ◽  
pp. 635-644 ◽  
Author(s):  
Vanessa Dinoá ◽  
Felipe von Ranke ◽  
Flavia Costa ◽  
Edson Marchiori
Keyword(s):  
Metatarsophalangeal Joint ◽  
Plantar Plate ◽  
Contrast Enhanced

Idiopathic Papular Dermatitis in the Spectrum of Chronic Papular Eruptions (Subacute Prurigo): Reappraisal and Diagnostic Algorithm

Dermatology ◽  
2019 ◽  
Vol 235 (3) ◽  
pp. 205-212
Author(s):  
Ayelet Ollech ◽  
Emmilia Hodak ◽  
Michael David ◽  
Akiva Trattner ◽  
Elena Didkovsky ◽  
...  
Keyword(s):  
Skin Diseases ◽  
Clinical Investigation ◽  
Morphological Changes ◽  
Medical Center ◽  
Age At Onset ◽  
Diagnostic Algorithm ◽  
Papular Eruption ◽  
Wide Range ◽  
Changes Over Time ◽  
Papular Dermatitis

Background: The clinical diagnosis of papular eruptions is common but poorly characterized in the literature and the etiology is often unknown. Objective: To characterize the entity of idiopathic papular dermatitis in the spectrum of chronic papular eruptions. Methods: The cohort consisted of patients who presented at a tertiary medical center in 2005–2014 with a papular eruption of at least 4 months’ duration. Findings on histological analysis and thorough clinical investigation, performed in all cases, were collected. The patients completed a questionnaire on disease course and outcome. Results: Sixty-five patients were included. Sixteen patients showed morphological changes over time and were excluded. Investigations in the remaining 49 patients with a consistent papular morphology yielded a well-defined diagnosis in 23 (46%). Twenty-six patients (54%; 14 male) were diagnosed with idiopathic papular dermatitis. Their mean age at onset was 61.6 ± 14.4 years and the mean duration of disease 3.11 ± 2.726 years. In 60%, the rash resolved with conservative treatment during follow-up (mean 4.35 ± 2.53 years). Conclusions: Chronic papular eruptions encompass a wide range of skin diseases. In more than half of the cases, the etiopathogenesis remains unclear. On the basis of our results, we propose a diagnostic algorithm for idiopathic papular dermatitis.

The Plantar Plate of the Lesser Toes: An Anatomical Study in Human Cadavers

1994 ◽  
Vol 15 (5) ◽  
pp. 276-282 ◽  
Author(s):  
Richard B. Johnston ◽  
Judith Smith ◽  
Timothy Daniels
Keyword(s):  
Metatarsophalangeal Joint ◽  
Anatomical Study ◽  
Volar Plate ◽  
Anatomic Structure ◽  
Joint Dislocation ◽  
Plantar Plate ◽  
Adjacent Structures ◽  
Fresh Frozen ◽  
Human Cadavers ◽  
Second Toe

The purpose of this study was to evaluate the anatomic structure and biochemical composition of the plantar plate of the lesser toes. Fresh frozen-human cadaveric feet were used to study 20 metatarsophalangeal and proximal interphalangeal plantar plates. The observations of foot dissections were compared with the finger volar plate. The plantar plate of the toe is a rectangular structure with a stout distal insertion and relatively flimsy proximal origin. The anatomic relationships to adjacent structures and composition are similar between the volar plates of the fingers and plantar plates of the toes. The plantar plate is known to experience extension forces that the volar plate does not experience. The weightbearing nature of the foot and forces imposed by toe-off may create chronic hyperextension of the metatarsophalangeal joint and predispose the plantar plate to attenuation or rupture, thus leading to instability of the metatarsophalangeal joint. These findings may explain in part the clinical condition of spontaneous metatarsophalangeal joint dislocation, most commonly found in the second toe.

Clubfoot Versus Positional Foot Deformities on Prenatal Ultrasound Imaging

2019 ◽  
Vol 39 (3) ◽  
pp. 615-623
Author(s):  
Marie Brasseur‐Daudruy ◽  
Saad Abu Amara ◽  
Valentine Ickowicz‐Onnient ◽  
Salma Touleimat ◽  
Eric Verspyck
Keyword(s):  
Ultrasound Imaging ◽  
Prenatal Ultrasound ◽  
Foot Deformities

Association of Abnormal Metatarsal Parabola With Second Metatarsophalangeal Joint Plantar Plate Pathology

2016 ◽  
Vol 38 (3) ◽  
pp. 289-297 ◽  
Author(s):  
Adam E. Fleischer ◽  
Erin E. Klein ◽  
Maheen Ahmad ◽  
Shivang Shah ◽  
Fernanda Catena ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Conditional Logistic Regression ◽  
Weight Bearing ◽  
Metatarsophalangeal Joint ◽  
Control Group ◽  
X Rays ◽  
Foot And Ankle ◽  
Plantar Plate ◽  
Second Metatarsal

Background: Plantar plate pathology is common, yet it is unclear whether, and to what extent, the length of the second metatarsal contributes to this problem. Methods: We conducted a retrospective case-control (1:2) study to examine radiographic risk factors for plantar plate tears. One hundred patients (age 55.7 ± 12.3 years) with plantar plate injuries and 200 healthy controls (age 56.3 ± 11.3 years) were included. Cases were defined as patients with nonacute, isolated, plantar plate pathology of the second metatarsophalangeal joint confirmed by intraoperative inspection at a single foot and ankle specialty practice from June 1, 2007, to January 31, 2014. Patients presenting for pain outside of the forefoot served as the control group. Controls were matched on age (±2 years), gender, and year of presentation. Weight-bearing foot x-rays were assessed for several predetermined angular relationships by a single rater. Conditional logistic regression was used to identify risk factors for plantar plate injury. Results: A long second metatarsal, defined as a metatarsal protrusion index less than −4 mm, was the only significant risk factor for plantar plate pathology in both the univariate and multivariable analyses (multivariate odds ratio 2.5 [95% confidence interval 1.8 to 3.3], P = .002). Conclusion: We found that a long second metatarsal was a risk factor for developing second metatarsophalangeal joint plantar plate tears. This knowledge may aid foot and ankle surgeons when contemplating the need for second metatarsal shortening osteotomies (eg, Weil osteotomy) during plantar plate surgery and when deciding on the amount of shortening for second metatarsal osteotomies. Level of Evidence: Level III, retrospective comparative study.

The Donor Foot in Free Toe or Joint Transfers

2000 ◽  
Vol 25 (4) ◽  
pp. 382-384 ◽  
Author(s):  
X. B. YANG ◽  
Y. D. GU
Keyword(s):  
Metatarsophalangeal Joint ◽  
Foot Deformities ◽  
Case Review ◽  
Dorsal Aspect ◽  
Mild Reduction ◽  
Second Toe

Eighty-four cases of free second toe, multiple toe or second metatarsophalangeal joint transfers were studied by case review and follow-up. The function of the donor foot had recovered completely within 6 months in 89% of patients. The wounds on the donor foot healed in 2–3 weeks in 90% of patients. Slight numbness on the dorsal aspect of the donor foot, intolerance to cold, mild reduction in push-off, scar tenderness and pain or swelling occurred in only a few patients and generally were not considered of significance. Multiple toe transfers created more donor problems in terms of healing and appearance. Some foot deformities with plantar callosities were observed at long term review. However, all patients were capable of work and normal activities.

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