Influence of Foot Type on the Clinical Outcome of Minimally Invasive Surgery for Metatarsalgia. A Prospective Pilot Study

Background and aims: Surgical procedures for central metatarsalgia seek to harmonise the metatarsal parabola with osteotomies that can be performed by minimally invasive techniques. However, the possible relationship of the foot type and the mid-term postoperative outcome is poorly described. The objective of this prospective pilot study was therefore to determine whether the foot type (pronate, neutral, or supinate) conditions the postoperative mid-term functional outcome.Methods: A series of 28 patients (6 men, 22 women) were treated for primary central metatarsalgia by means of minimally invasive distal metaphyseal osteotomy (DMMO).Results: Their functional outcomes at 6 and 12 months were assessed by the self-reporting AOFAS scale. Pre-surgery, the patients' scores were 42.82 ± 15.60. Scores improved at 6 months to 86.50 ± 8.6 and to 92.93 ± 8.6 at 12 months (p < 0.001 in both cases). There were no differences either by sex or by foot type in these overall values, although there was only a slight limitation of interphalangeal mobility in the supinated feet (p = 0.03) at 6-month follow-up as compared to other foot types.Conclusion: Hence, DMMO provides an optimal clinical and functional outcome for the surgical treatment of metatarsalgia, regardless of the patient's foot posture. The occurrence of adverse events was minimal and clinically irrelevant.Trial registration: The study was authorised by the Research Ethics Committee of the Universidad Católica de Valencia San Vicente Mártir, with the registry UCV/2018-2019/019.

​Soil Suitability for Growing Pulses in Northern Dry Zone of Karnataka

Background: A soil suitability evaluation of Kanamadi South sub-watershed in the Northern Dry Zone of India was carried out during April 2019 to define the soil fitness for the production of pigeonpea, chickpea, greengram and cowpea the four major pulses that are widely grown in the area. Methods: A detailed soil survey of Kanamadi South sub-watershed was carried out using IRS P6 LISS-IV image and Vijayapura district toposheet. The soils of Kanamadi south sub watershed were grouped into 19 mapping units based on studied 50 profiles. The studied physical and chemical properties were evaluated using the FAO (1976) framework for land evaluation was followed in the evaluation of soil-site suitability for major crops grown in Kanamadi South sub-watershed. This classification recognized two orders of land suitability, order ‘S’ (suitable) and order ‘N’ (not suitable) which are further subdivided into land suitability classes. Result: The studied 19 mapping units were moderately (S2) to marginally suitable (S3) for pigeonpea and greengram having marginal to severe limitations of rainfall and soil physico-chemical properties and none to slight limitation of land form characteristics. The mapping units were moderately suitable (S2) to marginally suitable (S3) for chickpea and cowpea having moderate to severe limitation of temperature, rainfall, depth and pH and none to slight limitation of land form characteristics. The suitability of the study area for all the pulses were said to be moderately suitable (S2) for growing pulse crop for improving productivity and improving biological nitrogen fixation.

Clinical and Anatomical Aspects of Anterior Dislocation of the Pisiform Bone

Introduction The pisiform bone is the fourth bone of the proximal row of the carpal bones, and it is located in the tendon of the flexor carpi ulnaris muscle, being considered a sesamoid bone. Traumatic dislocation of the pisiform bone is a rare condition, which usually results from a trauma in dorsal flexion of the wrist. Its treatment can be conservative or surgical, ending or not with the removal of the pisiform bone. Objective To report a case of a child who fell from his own height and presented wrist pain, diagnosed with dislocation of the pisiform bone. We emphasize the importance of anatomy knowledge in the evaluation of wrist trauma. Case Report The anamnesis confirmed that the fall occurred with the wrist in hyperextension. The physical examination showed a slight limitation of movement due to pain. Radiographic exams and a computed tomography (CT) scan of the wrist were performed, in which an anterior deviation/luxation of the pisiform bone was evidenced. A conservative treatment with plaster immobilization for analgesia was performed for 1 week. As there were no symptoms and no signs of trauma consistent with the images, such as edema and local ecchymosis, in addition to the early complete disappearance of pain, the responsible team proposed the hypothesis of asymptomatic chronic dislocation of the pisiform bone. Conclusion Imaging exams in orthopedic traumatology are fundamental for an accurate diagnosis. Nevertheless, they must be associated with knowledge of the anatomy to correlate the image findings with the anamnesis, leading to a better understanding of silent, asymptomatic, and preexisting conditions in the clinical practice.

Bilateral Multiple Metacarpal Head Avascular Necrosis: A Case Report

Avascular necrosis of the metacarpal head is a rare disease. We herein report a case with varying degrees of lesions in the third and fourth metacarpal heads of the right hand and the third metacarpal head of the left hand. The patient was a 37-year-old male right-handed mechanical worker who presented with persistent dull pain in the right hand after labor work for more than a year. The 3 lesions in this patient were treated differently based on their clinical imaging manifestations. The neurologic function of the right hand recovered by the 18-month follow-up; only a slight limitation remained in the right middle finger. This is the first report of 1 patent who received 2 different treatment methods simultaneously and both provided a satisfactory clinical result.

Plantar Fasciitis and Its Relationship with Hallux Limitus

Background We sought to determine whether patients with plantar fasciitis have limited dorsiflexion in the first metatarsophalangeal joint and which type of foot, pronated or supinated, is most frequently associated with plantar fasciitis. Methods The 100 study participants (34 men and 66 women) were divided into two groups: patients with plantar fasciitis and controls. The Foot Posture Index and dorsiflexion of the first metatarsophalangeal joint were compared between the two groups, and a correlation analysis was conducted to study their relationship. Results In the plantar fasciitis group there was a slight limitation of dorsiflexion of the hallux that was not present in the control group (P < .001). Hallux dorsiflexion and the Foot Posture Index were inversely correlated (Spearman correlation coefficient, −0.441; P < .01). Conclusions Participants with plantar fasciitis presented less hallux dorsiflexion than those in the control group, and their most common foot type was the pronated foot.

Legg-Calvé-Perthes disease: Diagnostics and contemporary treatment

Legg-Calv?-Perthes disease represents avascular necrosis of the femoral head in a growing child. It commonly affects children aged 2-14 years, mostly boys, and has familiar pattern. The etiology of this disease is unknown. It is based on avascular necrosis due to variations of the femoral head vascular supply, trauma, coagulation of endocrine disturbances. The disease presents with limping and pain localized in the hip with projection to thigh and knee, frequently accompanied by the limitation of abduction and internal rotation, as well as slight limitation in flexion of about 20 degrees. Plain radiography is most informative additional diagnostic procedure, enabling assessment of the stage of disease, containment of the femoral head within the acetabulum, acetabular coverage and the extent of disease. Main treatment goal is obtaining the spherical congruity of the hip joint. This can be achieved by abduction bracing, varization femoral osteotomies and various innominate osteotomies (sometimes combined with femoral osteotomies). Children younger than four years of age, with minimal femoral head involvement, do not need any treatment. These children with a larger involvement, older than four years of age, with possible containment in hip abducion, should be treated by one of the following procedures: Salter innominate osteotomy, Salter innominate osteotomy with femoral shortening, or triple pelvic osteotomy. The patients with containment of the hip is not possible in abduction (related to subluxation and femoral head crush), should be treated by Chiari pelvic osteotomy.