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Introduction: Sex estimation is challenging in cases where dismembered or non-intact skeletal remains are recovered. Therefore, the development of sex estimation standards using various bones that present with high recovery rates during forensic investigations, like the metatarsal bones, is needed. The usefulness of the dimensions around the metatarsal diaphyseal nutrient foramen in sex estimation has not been assessed in South African Africans (SAA), constituting the majority of the country's population. Materials and methods: Five measurements around the nutrient foramen were taken from 995 metatarsal bones (first to fifth) from 200 individual skeletons (100 males, 100 females). Measurements subjected to direct and stepwise discriminant function (DFA) and logistic regression (LRA) analyses included the total length, distance from proximal end to nutrient foramen, circumference, and mediolateral and dorsoplantar diameters at the level of the nutrient foramen. Results: The original classification accuracies for multivariable functions of the stepwise and direct DFA ranged from 75.1 to 80 % and 76–79.5 % respectively. The original classification accuracies for multivariable functions of the stepwise and direct LRA ranged from 76.3% to 79.5 % and 75%–80.5 % respectively. The cross-validation classifications showed a drop of 0–2% for DFA and 0.2–1.9 % for LRA. Overall breadth measurements showed better classification accuracies than length measurements and females were classified with higher accuracy rates than males. Conclusion: The dimensions around the nutrient foramen of the metatarsal bones show sexual dimorphism in the SAA. The generated DFA and LRA functions produced high average classification accuracies which can be appropriate for use in sex estimation in forensic settings, especially when an isolated foot is recovered.

Background: Various operative methods for the treatment of Morton's neuroma have been discussed, and osteotomy of the metatarsal bone has been reported recently. However, there has been no report of pedobarographic changes after metatarsal osteotomy. Pedobarographic changes of other metatarsal area after the surgery may cause transfer metatarsalgia, and thorough analysis of the pedobarographic data should be performed peri-operatively. The purpose of this study is to investigate the post-operative pedobarographic changes of sliding osteotomy of the 3rd metatarsal bone for treating Morton's neuroma., Methods: Forty patients (45 feet) who underwent metatarsal sliding osteotomy of the 3rd metatarsal bone for treating Morton's neuroma from November 2013 to December 2021 were retrospectively reviewed. Proximal sliding osteotomy was performed at the proximal 3rd metatarsal bone through dorsal approach. Clinical outcomes were evaluated with American Orthopaedic Foot and Ankle Society Lesser Metatarsophalangeal Interphalangeal Scale (AOFAS LMIS), Foot Function Index (FFI), and Visual Analogue Scale (VAS). Plain radiograph and pedobarogram were performed to evaluate the radiologic and pedobarographic outcomes., Results: AOFAS score was improved from 52.8 ± 9.0 (18-62) to 88.8 ± 9.8 (78-100) and FFI was improved from 61.8 ± 4.9 (50-70) to 32.2 ± 5.1 (23-42) on average. The 3rd metatarsal bone was shortened by 3.1 ± 0.8 mm and dorsally shifted by 1.5 ± 0.4 mm after the surgery. Plantar intermetatarsal distances between 2nd and 3rd and 3rd and 4th metatarsal heads were significantly increased post-operatively. Average forefoot pressure and maximum pressure of the 2nd to 4th metatarsal head were not significantly changed between pre-operatively and post-operatively., Conclusion: Proximal metatarsal sliding osteotomy of the 3rd metatarsal bone shows a satisfactory result in both clinical and pedobarographical evaluations. It could be an effective treatment of permanent indirect decompression of Morton's neuroma with avoiding recurred neuroma, adhesion of tissue, paresthesia, and transfer metatarsalgia., Competing Interests: Declaration of competing interest No potential conflict of interest relevant to this article was reported., (Copyright © 2023. Published by Elsevier B.V.)

The growth and development of chicken bones have an enormous impact on the health and production performance of chickens. However, the development pattern and genetic regulation of the chicken skeleton are poorly understood. This study aimed to evaluate metatarsal bone growth and development patterns in chickens via non-linear models, and to identify the genetic determinants of metatarsal bone traits using a genome-wide association study (GWAS) based on growth curve parameters. Data on metatarsal length (MeL) and metatarsal circumference (MeC) were obtained from 471 F 2 chickens (generated by crossing broiler sires, derived from a line selected for high abdominal fat, with Baier layer dams) at 4, 6, 8, 10, and 12 weeks of age. Four non-linear models (Gompertz, Logistic, von Bertalanffy, and Brody) were used to fit the MeL and MeC growth curves. Subsequently, the estimated growth curve parameters of the mature MeL or MeC (A), time-scale parameter (b), and maturity rate (K) from the non-linear models were utilized as substitutes for the original bone data in GWAS. The Logistic and Brody models displayed the best goodness-of-fit for MeL and MeC, respectively. Single-trait and multi-trait GWASs based on the growth curve parameters of the Logistic and Brody models revealed 4 618 significant single nucleotide polymorphisms (SNPs), annotated to 332 genes, associated with metatarsal bone traits. The majority of these significant SNPs were located on Gallus gallus chromosome (GGA) 1 (167.433-176.318 Mb), GGA2 (96.791-103.543 Mb), GGA4 (65.003-83.104 Mb) and GGA6 (64.685-95.285 Mb). Notably, we identified 12 novel GWAS loci associated with chicken metatarsal bone traits, encompassing 35 candidate genes. In summary, the combination of single-trait and multi-trait GWASs based on growth curve parameters uncovered numerous genomic regions and candidate genes associated with chicken bone traits. The findings benefit an in-depth understanding of the genetic architecture underlying metatarsal growth and development in chickens., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Background: The central polydactyly of the foot is a rare congenital disorder, and its characteristics are not well known. This study aims to investigate its disease concept., Methods: We obtained the medical records of patients who were treated surgically for central polydactyly of the foot at our hospital during a 32-year period from 1990 to 2021 retrospectively. We compared our clinical data with other case series reports to investigate the characteristics of this disorder further., Results: There were 22 patients (13 males and 9 females) included in our case series. Unilateral and bilateral involvements were observed in 19 (right side: 6 patients; left side: 13 patients) and 3 patients, respectively. The second toe is the commonest duplicated toe (observed in 19 toes). 19 patients had distally duplicated toes (with normal metatarsal bone). Proximally duplicated toes were observed in only two patients., Conclusions: The incidence of central polydactyly of the foot is almost equal among male and female, and bilateral involvements are few. As this abnormality is rarely reported, further investigations are needed to clarify the clinical presentation of central polydactyly of the foot., Competing Interests: Declaration of competing interest The authors have no conflict of interest., (Copyright © 2021 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved.)

Hammer toes are one of the common deformities of the forefoot that can lead to compensatory changes during walking in individuals with this condition. Predicting the adverse effects of tissue damage on the performance of other limbs is very important in the prevention of progressive damage. Finite element (FE) and musculoskeletal modeling can be helpful by allowing such effects to be studied in a way where the internal stresses in the tissue could be investigated. Hence, this study aims to investigate the effects of the hammer toe deformity on the lower extremity, especially on the plantar fascia functions. To compare the joint reactions of the hammer toe foot (HTF) and healthy foot (HF), two musculoskeletal models (MSM) of the feet of a healthy individual and that of a participant with hammer toe foot were developed based on gait analysis. A previously validated 3D finite element model which was constructed using Magnetic Resonance Imaging (MRI) of the diabetic participant with the hammer toe deformity was processed at five different events during the stance phase of gait. It was found that the hammer toe deformity makes dorsiflexion of the toes and the windlass mechanism less effective during walking. Specifically, the FE analysis results showed that plantar fascia (PF) in HTF compared to HF played a less dominant role in load bearing with both medial and lateral parts of PF loaded. Also, the results indicated that the stored elastic energy in PF was less in HTF than the HF, which can indicate a higher metabolic cost during walking. Internal stress distribution shows that the majority of ground reaction forces are transmitted through the lateral metatarsals in hammer toe foot, and the probability of fifth metatarsal fracture and also progressive deformity was subsequently increased. The MSM results showed that the joint reaction forces and moments in the hammer toe foot have deviated from normal, where the metatarsophalangeal joint reactions in the hammer toe were less than the values in the healthy foot. This can indicate a vicious cycle of foot deformity, leading to changes in body weight force transmission line, and deviation of joint reactions and plantar fascia function from normal. These in turn lead to increased internal stress concentration, which in turn lead to further foot deformities. This vicious cycle cause progressive damage and can lead to an increase in the risk of ulceration in the diabetic foot., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

The increase in the global diabetic population is leading to an increase in associated complications such as diabetic foot ulceration (DFU), associated amputations, morbidity, which substantial treatment costs. Early identification of DFU risk is therefore of great benefit. International guidelines recommend off-loading is the most important intervention for healing and prevention of DFU, with current research focused on pressure measurement techniques. The contribution of strain to DFU formation is not well understood due to challenges in measurement. The limited data available in the literature suggest that plantar strain is involved in ulcer formation. As a consequence, there is a need for plantar strain measurement systems to advance understanding and inform clinical treatment. A method was developed to determine plantar strain based on a Digital Image Correlation (DIC) approach. A speckle pattern is applied to the plantar aspect of the foot using a low ink transference method. A raised walkway with transparent panels is combined with a calibrated camera to capture images of the plantar aspect throughout a single stance phase. Plantar strain is then determined using 2D DIC and custom analysis summarises these data into clinically relevant metrics. A feasibility study involving six healthy participants was used to assess the efficacy of this new technique. The feasibility study successfully captured plantar surface strain characteristics continuously throughout the stance phase for all participants. Peak mean and averaged mean strains varied in location between participants when mapped into anatomical regions of plantar interest, ranging from the calcaneus to the metatarsal heads and hallux. This method provides the ability to measure plantar skin strain for use in both research and clinical environments. It has the potential to inform improved understanding of the role of strain in DFU formation. Further studies using this technique can support these ambitions and help differentiate between healthy and abnormal plantar strain regimes., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Objective: This study describes foot bone anomalies and the degenerative changes associated with locomotion adaptations., Materials: An adult male (approximately 29-46 years old) from Estremoz, Portugal (13th-15th century)., Methods: The skeletal anomalies observed in this skeleton were described and measurements were compared between both sides of the individual and with the mean of the adult males from the same collection., Results: The most anomalous bones are the right medial cuneiform and metatarsals. Degenerative changes are more severe on the left lower limb and right upper limb., Conclusions: This skeleton represents a unilateral case of talipes varus of the right foot, with the metatarsals being more affected while previously published cases show more severe anomalies of the hindfoot. The degenerative changes observed in the skeleton suggest that both legs and arms, aided by crutches, were used for locomotion., Significance: This case shows that club foot skeletal anomalies are variable and the pattern of bony changes throughout the body can reveal locomotion adaptations., Limitations: The possibility of a genetic cause cannot be assessed due to the absence of paleogenomic data., Suggestions for Further Research: Since the anomalies found in this case are different than those previously published, we recommend care when analysing foot bones., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Background: The fifth metatarsal base avulsion fracture (i.e., Pseudo-Jones fracture) is one of the most common foot fractures. The management of pseudo-Jones fractures could be carried out surgically or conservatively. This systematic review and meta-analysis aimed to provide an update about the efficacy of orthotic removable support compared to short-leg casting for individuals with pseudo-Jones fracture., Methods: We searched Embase, Medline, and Cochrane Central register of Controlled Trials (CENTRAL) for randomized controlled trials (RCTs) that compared the clinical outcomes of orthotic removable support and short-leg cast for adult individuals with a fifth metatarsal base avulsion fracture. We used 95% as a confidence level and P <0.05 as a threshold. The standardized mean difference (SMD) was used for the continuous outcomes, and the risk ratio (RR) was used for the dichotomous outcomes., Results: A total of 6 RCTs incorporating 403 individuals out were deemed eligible. There was no significant difference between orthotic removable support and short-leg casting regarding AOFAS score (standardized mean difference (SMD)= 0.31, 95% CI -0.17 to 0.8), pain on VAS score (SMD= -0.08, 95% CI -0.39 to 0.22), VAS-FA score (SMD= 0.22, 95% CI -0.19 to 0.62) EQ-5D VAS score, and non-union rate (RR=0.37, 95% CI 0.05 to 2.74)., Conclusion: The current meta-analysis reveals that there is no difference between orthotic removable support and short-leg casting for the conservative management of individuals sustaining pseudo-Jones fracture., Competing Interests: Declaration of Competing Interest The authors declare no conflict of interest., (Copyright © 2021. Published by Elsevier Ltd.)

Objective: This study provides a baseline of pathological and sub-pathological changes in the lower-limb bones of a semi-feral herd of domestic cattle. The purpose is to refine an existing method for identifying the use of cattle for traction using zooarchaeological evidence., Methods: A published recording system for identifying draught cattle was applied to a sample of 15 individuals from Chillingham Park, Northumberland. Correlations were explored between individual pathological index values, the scores obtained for individual pathological/sub-pathological changes, and three biological variables: age, sex and body size., Results: Pathological index values in the Chillingham cattle were low. Positive correlations between individual pathological index values and age, sex and body size were identified. Broadening of the distal metacarpal, proximal and distal exostoses in the metatarsal, distal exostoses of the proximal phalanx, and proximal lipping and exostoses of the distal phalanx, were strongly correlated with age., Conclusions: Pathological index scores demonstrate that adaptive remodeling of the autopodia is low in a free-ranging population of cattle, supporting the view that more pronounced changes provide useful identifiers of traction use. Application of modified pathological index formulae to nine archaeological sites from England indicated that cattle were only intensively used for traction in the Roman and later medieval periods., Significance: This study refines the methods used to identify traction in the archaeological record through the consideration of cows and a wider range of ages than has been considered previously., Limitations: Only 15 individuals from the Chillingham herd were available for analysis., Suggestions for Further Research: The refined formulae should be applied to additional archaeological datasets from different regions and time periods to explore the changing exploitation of cattle for traction., (Copyright © 2021 The Author(s). Published by Elsevier Inc. All rights reserved.)

Isolated foot vein thrombosis is an infrequently reported condition, the cause of which is still questioned. Four new cases are detailed, covering different physio-pathological situations ranging from plantar vein to Lejars' sole thrombosis. They are compared to the literature. The common vein altered in most of the cases is the first metatarsal interspace perforator, which is hypothesized as the area of the onset of many cases of foot vein thrombosis. Diagnostic workup could reveal neoplasia, inflammatory diseases, or coagulation abnormality. There is no consensus regarding plantar vein thrombosis treatment, and conservative therapy, non-steroidal anti-inflammatory drugs and anticoagulant therapy have been reported., (Copyright © 2021 Elsevier Masson SAS. All rights reserved.)

Directionality of limb and facial asymmetries in nonelite equine populations has been previously reported with results indicating strong similarities to those reported in racehorses. This investigation aimed to consider the relationship between the magnitude of the asymmetries presented within the general equine population, and their previously reported directionality. Direct measurements of 15 bilateral traits (four facial and 11 limb) were captured from a mixed population of 100 horses and ponies. The pooled (whole) population was considered further as horse (withers height >148 cm) and pony (withers height ≤148 cm) groupings. Each of the three groups was further subdivided for each trait, into individuals presenting with larger left or larger right sides. Asymmetries were compared as mean asymmetries and as percentages of the trait size at each grouping level. Asymmetry magnitudes were largely reflective of the directional asymmetries previously recorded. Both the horse and pony groups presented with significantly longer right side third metacarpal (P ≤ .001) and third metatarsal (P ≤ .05 and P ≤ .001) bones, whereas in the horse group, the left fore proximal phalanx was both longer and wider than the right (P ≤ .001 and P ≤ .05). This pattern is reflective of the biomechanical preference for left lead anticlockwise canter, previously only observed in racehorses. The proximal phalanx of the forelimb potentially compensates for the higher loading forces associated with the lead forelimb. When scaled as percentages of trait size, the asymmetry magnitudes largely reflected those reported in humans, suggesting similar measurement criteria could be applied when considering stock selection and controlling for injury predisposition in horses., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Infrared thermography has been used to help in diagnosing lameness. It is hypothesized that, if used in a routine basis, it could help in understanding musculoskeletal modifications during race training. This study aimed to evaluate thermal variation in the musculoskeletal regions of young Thoroughbred (TB) horses during their initial months of race training. Thermographic examinations were performed once every 2 weeks on 16 (10 male, 6 female) two-year-old TB racehorses, from arrival to the racetrack in June 2016, until January 2017, for a total of 16 evaluations. Thermographic imaging was performed using the appropriate protocol. Temperature (°C) was measured at the dorsal and palmar/plantar aspects of specific regions of interest (fetlock, metacarpal, metatarsal, carpal, tarsal, thoracolumbar, sacroiliac spine, and both hips). Initially, we found a thermal balance and all regions demonstrated a positive correlation with one another. However, a significant difference was noted between the left and right sides as training progressed. Four horses were withdrawn from the study after 50% of evaluations because of metacarpal conditions associated with training. Thermographic examination revealed changes before the clinical manifestation of these conditions. In conclusion, this study demonstrated that infrared thermography is an image technique that can facilitate understanding of musculoskeletal system modifications to race training and should be further investigated as a predictive tool to anticipate the occurrence of lesions., (Copyright © 2020 Elsevier Inc. All rights reserved.)

This study investigates the relationship between plantar tissue stiffness and selected parameters, including age, diabetes mellitus (DM) duration, body mass index (BMI), and HbA 1c level. 70 diabetes patients with no foot problems were recruited. The plantar soft tissue at the 2nd sub-metatarsal head (MTH) pad was examined using the novel indentation system developed. The stiffness constant, K, was used to describe the tissue stiffness. The four factors (age, DM duration, BMI, and HbA 1c level) were plotted against the plantar tissue stiffness. The scatter plots revealed that a higher plantar tissue stiffness was usually associated with (1) BMI>25  kgm -2 , (2) HbA 1c score >10% (86 mmol/mol), and (3) DM duration >10 years. The three risk criteria were further evaluated using the binary classification test. The predictions were reported to be fairly accurate and reliable in detecting stiffened tissues. The study has successfully identified the strong association of BMI, HbA 1c , and DM duration with the plantar tissue properties. Special attention should be given to the high risk group with BMI>25 kgm -2 , HbA 1c score >10% (86 mmol/mol), and DM duration >10 years. The high diagnostic odds ratio attained suggests its potential usefulness in helping clinicians to diagnose diabetic foot more efficiently., Competing Interests: Declaration of competing interest Disclaimers: No conflict of interest., (Copyright © 2019. Published by Elsevier Ltd.)

Introduction: The aims of this study were to (1) describe the use of the K-wire for the initial management of high-energy Lisfranc dislocations or fracture dislocations, (2) to evaluate whether this standalone technique allowed for adequate reduction of these injuries, (3) to evaluate whether reductions were maintained until definitive fixation was performed, (4) and to determine if it contributed to any increase in complications prior to or after definitive fixation., Patients and Methods: A retrospective review was performed on all patients who presented with tarsometatarsal injuries from January 2005 through June 2015. Dislocations of the tarso-metatarsal joints were classified as either Type A (total incongruity, homolateral complex), Type B (partial incongruity, homolateral incomplete) or Type C (divergent, total or partial displacement) patterns, with or without associated fractures. For the purposes of this paper, high-energy injuries were defined as patients presenting with either a Type A or Type C (total displacement) dislocations or fracture-dislocation patterns. A total of 176 patients presented with a tarsometatarsal injury. Eighteen patients with divergent or homolateral patterns underwent a staged approach. Fifteen patients were managed exclusively with K-wire fixation. Wound complications, infections or the unexpected need to return to surgery were recorded., Results: All patients demonstrated an improved alignment using K-wires. There were no compartment syndromes, vascular insufficiency, complications to the skin associated with traction or manipulation, or pin site infections. At definitive fixation, no patient demonstrated a loss in the alignment that had been obtained at the index procedure or had an unexpected return to surgery., Discussion and Conclusions: This study demonstrates that high-energy Lisfranc injuries are uncommon and that K-wires are a simple and adequate technique that can be used for initial staged approach of these injuries. The use of 2.0mm K-wires were sufficient to obtain and maintain the reduction until definitive fixation has been obtained, without producing any increase risk for complications., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Aim: The classification of a Lisfranc injury has conventionally been based around Myerson's system. The aims of this study were to review whether a novel classification system based on sagittal displacement of the tarsometatarsal joint and breadth of injury as determined by a columnar theory was associated with functional outcomes and thus had a greater utility., Patients: We retrospectively reviewed 54 Lisfranc injuries with a minimum follow up of two years at our Level One Trauma Centre. Each fracture was sub-classified based on our novel classification system which assessed for evidence of sagittal displacement and involvement of columns of the midfoot. Our primary outcome measures were the FFI and AOFAS midfoot scores., Results: Injuries involving all three of the columns of the midfoot were associated with significantly worse functional outcome scores (FFI p=0.004, AOFAS p=0.036). Conversely, sagittal displacement, whether dorsal or plantar, had no significance (FFI p=0.147, AOFAS p=0.312). The best predictor of outcome was the quality of anatomical reduction (FFI p=0.008, AOFAS p=0.02)., Conclusion: Column involvement and not sagittal displacement is the most significant factor in considering the severity Lisfranc injury and long term functional outcomes. This classification system has greater clinical utility than those currently proposed., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Aim of the Study: The plantar neuropathic ulcer is a classical and frequent complication of a pathology recognized as pandemic by the WHO: diabetes. Even if frequently encountered during medical practice, the neuropathic ulcer remains poorly understood in its pathophysiology. Its treatment is usually long and disappointing, resulting too often in an amputation. Paradoxically, medical literature is particularly scarce on the subject of surgical approaches to the plantar neuropathic ulcer. Beyond the cases of vascular lesions requiring above all a technique of revascularization, we have tested out an original approach enabling the surgical treatment of an overt neuropathic ulcer. Our purpose was to correct the architecture of the foot for a superior distribution of foot support points. We performed subtraction osteotomies ahead of the neuropathic ulcer in order to redress the deformed bone axis. Standing with full weight on the foot is prescribed from the following day of the intervention in almost all cases., Patients and Methods: We have evaluated the effectiveness of this innovative conservative surgical treatment on neuropathic ulcers of metatarsal heads by comparing it with the usual medical treatment. Two groups of patients have thus been analysed for this retrospective comparative study in order to determinate whether the use of this surgical technique benefits the patient. The studied criteria were healing time, recurrence rate, amputation rate and overall failure rate of the treatment, represented by the occurrence of the event "recurrence or amputation"., Results: All the differences found were in favour of the surgical technique with, in particular, significant differences in healing time, amputation rate and occurrence rate of the event "recurrence or amputation". The difference in recurrence rate was also clearly in favour of the surgery group, but it was not significant., Conclusion: The conservative surgical treatment by proximal osteotomy is therefore an innovative technique enabling a significant improvement in healing time and treatment after-effects of neuropathic ulcers in non-arteritis diabetic patients., (Copyright © 2013 Elsevier Masson SAS. All rights reserved.)

Idiopathic necrosis of the second metatarsal head is quite unusual in adults. We present a rare case of idiopathic osteonecrosis of the second metatarsal head in an adult via magnetic resonance imaging, which enabled an early diagnosis of the necrosis before osteochondral deformity could develop. This case is noteworthy due to its rarity and its successful nonoperative treatment.