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Background: When foot necrosis occurs due to lower limb blood flow disorder caused by diabetes or peripheral arterial occlusion, many patients require lower limb amputation. The functional prognosis after lower limb amputation largely depends on whether the heel can be preserved. However, there are many reports that Chopart amputation causes varus and equinus deformity, and is functionally unfavorable. We herein report a case of Chopart amputation performed with muscle balancing. Postoperatively, the foot was not deformed and the patient was able to walk independently with a foot prosthesis. Case: A 78-year-old man presented with ischemic necrosis of his right forefoot. The range of necrosis extended to the central part of the sole, so Chopart amputation was performed. In the operation, to prevent varus and equinus deformity, the Achilles tendon was lengthened, the tibialis anterior tendon was transferred through a tunnel created in the neck of talus, and the peroneus brevis tendon was transferred through a tunnel created in the anterior part of the calcaneus. At the final follow-up 7 years after the operation, no varus or equinus deformity was observed. The patient became able to stand up and walk on his heel without a prosthesis. In addition, step motion was possible by wearing a foot prosthesis.

Additional file 1: Table S1. The detailed diagnosis in players excluded from the study due to regular hospital visits for lower extremity problems.

Additional file 3: Table S3. Comparison between participants with complete data and those with missing variables.

Additional file 2: Table S2. Details of missing data.

Hiroshi Kobayashi, Koji Otani, Takuya Nikaido, Kazuyuki Watanabe, Kinshi Kato, Junichi Handa, Shoji Yabuki, Shin-Ichi Konno Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, Fukushima, JapanCorrespondence: Hiroshi Kobayashi 1-Hikarigaoka, Fukushima, 960-1295, JapanTel +8124-547-1276Fax +81 24-548-5505Email hiroshik@fmu.ac.jpPurpose: Early diagnosis of degenerative cervical spondylosis (DCM) is desirable because late treatment can lead to irreversible sequelae. No screening method has yet been established. Grip strength is commonly used in primary care settings to evaluate disease activity and diagnose sarcopenia. This single-center, cross-sectional study aimed to determine the diagnostic accuracy of grip strength for cervical myelopathy (DCM) and cutoff values for primary care DCM screening using area under the curve (AUC) and sensitivity values.Patients and Methods: The DCM group comprised 249 consecutive participants (165 males, 84 females; mean age, 65.1 years) with DCM who had undergone surgery at the affiliated hospital. The control group comprised 735 (280 males, 455 females; mean age, 65.8 years) participants undertaking a local government health checkup. Stratifying by age and sex, receiver operating characteristic (ROC) analyses were constructed for each group using minimum grip strength values for both hands. Based on ROC analysis, cut-off values were established so that the screening sensitivity would be 90% for either sex or age group, respectively.Results: According to age group and sex (males/females [M/F]), AUC values for a diagnosis of DCM in M/F were as follows: 40– 59 years, 0.92/0.87; 60– 69 years, 0.94/0.89; 70– 79 years, 0.89/0.91; and 80– 89 years, 0.97/0.97. Calculated M/F cutoff values were 41/24.5, 27/16, 27/15, and 20/10 kg, which were similar to cutoff scores for sarcopenia in M/F patients aged 60– 69 and 70– 79 years. M/F sensitivities in each age groups were 0.94/0.91, 0.92/0.90, 0.95/0.96, and 0.92/0.93. M/F specificities were 0.62/0.59, 0.84/0.83, 0.61/0.71, and 0.83/0.88.Conclusion: Grip strength had moderate-to-high diagnostic accuracy for DCM between participants in the control and DCM groups. We developed easily applicable cutoff values for primary care DCM screening with ≥ 90% sensitivity. In patients with sarcopenia, DCM should be differentially diagnosed in primary care.Keywords: degenerative cervical myelopathy, cervical spondylotic myelopathy, ossification of posterior longitudinal ligament, cervical disc herniation, primary care, early detection, sarcopenia

Purpose: In diagnosing lumbar spinal stenosis (LSS), Magnetic Resonance Imaging (MRI) is appropriate to confirm the presence of anatomical stenosis of the spinal canal or compression of the nerve roots. However, it is known that morphological LSS is often present in asymptomatic subjects. There is still controversy about the relationship between anatomical LSS and symptomatic LSS. The aim of this study was to assess the association between qualitative imaging findings on MRI of the lumbar spine and symptomatic LSS. Patients and methods: This was a cross-sectional study of 239 volunteers from an epidemiological survey that included 1,862 participants in total. MRI of the lumbar spine was evaluated in four categories: morphological grading of central stenosis and lateral recess stenosis, presence of the sedimentation sign, and severity of facet joint effusion. The relationship between these morphological evaluations and typical LSS symptoms as assessed by the self-administered, self-reported history questionnaire for lumbar spinal stenosis (LSS-SSHQ) was investigated by multiple logistic regression analysis. Results: The odds ratio of the most severe central stenosis to no stenosis was 15.5 (95%CI: 1.4-164.9). Only the most severe central stenosis was associated with typical LSS symptoms, but not all cases with typical LSS symptoms were due to severe central stenosis. Conclusion: Extreme severe central stenosis was strongly related to typical LSS symptoms. However, although subjects with severe central stenosis showed symptoms suggestive of LSS, these subjects did not always show typical LSS symptoms.