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Background: Hallux valgus is a progressive foot deformity that commonly affects middle-aged women. The aim of this study was to develop a novel method using only top-view photographs to assess hallux valgus severity., Methods: A top-view digital photograph was taken of each foot of 70 female participants. Two straight lines were drawn along the medial edge of the great toe and forefoot, and the included angle (termed bunion angle) was measured using a free software program. Each foot was also assessed by a clinician using the Manchester scale as no (grade 1), mild (grade 2), moderate (grade 3), or severe (grade 4) deformity., Results: The mean bunion angles of the 140 feet were 6.7°, 13.5°, and 16.2° for Manchester grades 1, 2, and 3, respectively (no foot was in grade 4). The reliability was excellent for both intrarater (intraclass correlation coefficient [ICC] = 0.93-0.95) and interrater (ICC = 0.90) assessments. Receiver operating characteristic curves determined the optimal bunion angle cutoff value for screening hallux valgus to be 9°, which gives 89.2% sensitivity and 74.2% specificity., Conclusions: The bunion angle is a reliable, clinician-free method that can potentially be integrated into a smartphone app for easy and inexpensive self-assessment of hallux valgus., Competing Interests: Conflict of Interest: None reported.

Background: Plantar pressure assessments are useful for understanding the functions of the foot and lower limb and for predicting injury incidence rates. Musculoskeletal fatigue is likely to affect plantar pressure profiles. This study aimed to characterize college elite basketball players' plantar pressure profiles and pain profiles during static standing and walking., Methods: Fifty-one male elite basketball players and 85 male recreational basketball players participated in this study. An optical plantar pressure measurement system was used to collect the arch index (AI), regional plantar pressure distributions (PPDs), and footprint characteristics during static and dynamic activities. Elite basketball players' pain profiles were examined for evaluating their common musculoskeletal pain areas., Results: The AI values were in the reference range in recreational basketball players and considerably lower in elite basketball players. Elite basketball players' static PPDs of both feet were mainly exerted on the lateral longitudinal arch and the lateral heel and were relatively lower on the medial longitudinal arch and medial and lateral metatarsal bones. The PPDs mainly transferred to the lateral metatarsal bone and lateral longitudinal arch and decreased at the medial heel during the midstance phase of walking. The footprint characteristics of elite basketball players illustrated the features of calcaneal varus (supinated foot) of high arches and dropped cuboid foot. The lateral ankle joints and anterior cruciate ligaments were the common musculoskeletal pain areas., Conclusions: Elite basketball players' AI values indicated high arches, and their PPDs tended to parallel the features of the high-arched supinated and dropped cuboid foot. Their pain profiles resonated with the common basketball injuries and reflected the features of Jones fracture and cuboid syndrome. The potential links among high-arched supinated foot, Jones fracture, and cuboid syndrome are worth further study.

Midline metatarsal ray deficiencies, which occur in approximately half of congenital short limbs with fibular deficiency, provide the most distal and compelling manifestation of a fluid spectrum of human lower-extremity congenital long bone reductions; this spectrum syndromically affects the long bone triad of the proximal femur, fibula, and midline metatarsals. The bony deficiencies correspond to sites of rapid embryonic arterial transitioning. Long bones first begin to ossify because of vascular invasions of their respective mesenchymal/cartilage anlagen, proceeding in a proximal-to-distal sequence along the forming embryonic limb. A single-axis artery forms initially in the embryonic lower limb by means of vasculogenesis. Additional arteries evolve in overlapping transitional waves, in proximity to the various anlagen, during the sixth and seventh weeks after fertilization. An adult pattern of vessels presents by the eighth week. Arterial alterations, in the form of retained primitive embryonic vessels and/or reduced absent adult vessels, have been observed clinically at the aforementioned locations where skeletal reductions occur. Persistence of primitive vessels in association with the triad of long bone reductions allows a heuristic estimation of the time, place, and nature of such coupled vascular and bony dysgeneses. Arterial dysgenesis is postulated to have occurred when the developing arterial and skeletal structures were concurrently vulnerable to teratogenic insults because of embryonic arterial instability, a risk factor during arterial transition. It is herein hypothesized that flawed arterial transitions subject the prefigured long bone cartilage models of the rapidly growing limb to the risk of teratogenesis at one or more of the then most rapidly growing sites. Midline metatarsal deficiency forms the keystone of this developmental concept of an error of limb development, which occurs as a consequence of failed completion of the medial portion of the plantar arch. Therefore, the historical nomenclature of congenital long bone deficiencies will benefit from modification from a current reliance on empirical physical taxonomies to a developmental foundation.

Background: The medial longitudinal arch angle (LAA) of the foot has been used as an index of high and low arches. The LAA during the support phase of running (LAArun), which may be related to lower-limb injuries, is commonly predicted from the LAA at standing (LAAstand). However, it is not known whether this prediction is valid for all of the foot contact patterns. The purpose of this study was to verify whether prediction of the LAArun from the LAAstand is valid for different foot strike patterns., Methods: The 26 participants were divided into a rearfoot strike group (n = 15) and a nonrearfoot strike group (n = 11). The LAA was obtained by measuring the angle formed between the line from the navicular bone to the medial malleolus and the line from the navicular bone to the first metatarsal head. The LAAstand and the minimum value of the LAArun, when the arch is most collapsed, were measured using a motion capture system., Results: There were no significant differences in the LAAstand, the LAArun, and the difference (LAAstand - LAArun) between the two groups. In both groups, a very strong and significant correlation was found between the LAAstand and the LAArun. Furthermore, a nearly identical equation for predicting the LAArun from the LAAstand was derived for the two groups., Conclusions: The LAArun can be predicted from the LAAstand for any foot strike pattern with almost the same equation.

A 53-year-old woman presented with painful swelling of the right forefoot presenting clinically as a metatarsal stress fracture. Radiographs showed destructive changes, and diagnostic imaging revealed an aggressive neoplasm. The lesion was biopsied, and the pathologic diagnosis was metastatic melanoma. A thorough physical examination and advanced imaging did not reveal a primary tumor. Ray resection was performed with en bloc resection of the neoplasm. The patient continues to receive long-term immune stimulation chemotherapy 34 months after the ray resection.

This case report presents a rare postoperative dislocation of the fifth metatarsal base following a healed open partial fourth and fifth ray amputation of a 62-year-old male veteran with poorly controlled diabetes mellitus. The dislocated fifth metatarsal base subsequently created a chronic ulceration and an inhibition of normal gait. The patient was taken to the operating room where the fifth metatarsal base was resected with transfer of the peroneus brevis tendon to the cuboid to maintain biomechanical stability.

Chondromyxoid fibroma is a rare benign tumor that is typically found in the metaphyseal ends of long tubular bones, such as the tibia. The authors describe a case of this neoplasm occurring in the foot. Treatment included complete resection with reconstruction using an autogenous fibular bone graft. The surgical technique and the advantages of using a fibular bone graft are discussed.

Sixteen patients were evaluated following excision of recurrent intermetatarsal neuroma. Each underwent removal of a segment of nerve through an incision on the plantar aspect. The nerve stump was buried in the flexor digitorum brevis muscle. At the time of follow-up examinations, six patients were asymptomatic, seven experienced mild pain after extended activity, one suffered mild consistent pain with activity, and two suffered pain that limited activities.

Ganglia have occurred in almost all areas of the foot, but most often associated with capsular or tendinous structures. They are fluid-filled masses which often present themselves radiographically as increases in soft tissue density. Ganglia exhibit high intensity magnetic resonance imaging and must be clinically and pathologically differentiated from other masses, such as, but not limited to, neuromas, granulomas, and neurilemomas. The authors present a rare occurrence of an intermetatarsal ganglionic cyst associated with the third dorsal interossei muscle, which was large enough to cause bony deformation of the adjacent metatarsals. It is unusual for ganglia to cause alterations in bone unless they are intraosseus in nature. Bone deformation and invasion are usually associated with aggressive tumors.