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Objectives Hallux valgus is associated with tarsometatarsal arthritis; its pathophysiology remains unknown. Therefore, we aimed to elucidate the relationship between arthritis of the second and third tarsometatarsal joints and incongruity of the first tarsometatarsal joint in the sagittal plane. Methods Forty-three patients (64 feet) with hallux valgus who underwent surgery at University Hospital Kyoto Prefectural University of Medicine were included and divided into two groups: control (without second and third tarsometatarsal joint degeneration) and osteoarthritis (with second and third tarsometatarsal joint degeneration). Intergroup comparisons of the incongruity of the first tarsometatarsal joint in the sagittal plane, age, body mass index, hallux valgus angle, first–second intermetatarsal angle, metatarsus adductus angle, Meary’s angle, and calcaneal pitch angle were performed. Results The proportion of patients with incongruity of the first tarsometatarsal joint was significantly higher in the osteoarthritis group than in the control group. Logistic regression analysis identified incongruity of the first tarsometatarsal joint and metatarsus adductus angle as significant related factors for arthritis of the second and third tarsometatarsal joints. Conclusions Incongruity of the first tarsometatarsal joint in the sagittal plane was involved in the development of arthritis of the second and third tarsometatarsal joints in patients with hallux valgus.

Background: Few reports have examined the regional disparity in representative surgical procedures in orthopaedics and general surgery. This study aimed to clarify the inter-prefectural regional disparity and relationships between medical specialists, facilities, and representative surgical procedures using a nationwide database in Japan. Methods: The annual incidence rate (IR) per 100,000 population of medical specialists in orthopaedics, general surgery, and anaesthesiology (OSS, GSS, ANS, respectively); medical facilities of hospitals (HP, only per 1,000 population); and representative surgical procedures in orthopaedics and general surgery were examined by prefecture in Japan during 2015–2019. Medium-sized regional disparities were evaluated using the Gini coefficient. Correlation coefficients were calculated for the aforementioned variables and the ageing rate (A/R). We also compared the urban and rural regional disparities between them. Results: The total annual average IR and Gini coefficients were 110.6 and 0.11 for femur fracture surgery (IROF), 106.3 and 0.09 for cholecystectomy (IRCC), 14.2 and 0.11 for OSS, 17.6 and 0.09 for GSS, 5.9 and 0.13 for ANS, and 8.1 and 0.21 for HP, respectively. The correlation coefficients by IROF were 0.74 for OSS (pConclusions: Inter-prefectural regional disparity was small, although some items were unevenly distributed in the rural areas, which is contrary to our expectations. Higher prevalence was recognised in rural areas than urban areas due to the higher A/R, but supply and demand are balanced. This study provides basic data for healthcare policy in a medium-sized community. Level of Evidence: III

Foot impairment in rheumatoid arthritis (RA) may exacerbate sarcopenia from physical inactivity because of foot pain while walking. The present study aimed to investigate the prevalence of sarcopenia in patients with RA-associated foot impairment, and whether treatment with a foot orthosis improved physical activity and muscle quantity.Thirty-two patients with RA were diagnosed as sarcopenic or nonsarcopenic, and the prevalence of sarcopenia was determined. Eleven patients with sarcopenia were treated with a foot orthosis. The following parameters were compared between baseline and after 6 months of treatment: physical activity (walking, moderate-intensity activity, and vigorous-intensity activity), foot pain while walking, Health Assessment Questionnaire (HAQ) score, and body composition parameters, including muscle quantity.Sarcopenia was present in 25/32 patients (78.1%). The use of a foot orthosis improved walking activity (Patients with RA-associated foot impairment had a high rate of sarcopenia. Treatment with a foot orthosis increases light-intensity physical activity such as walking, but does not enhance moderate-to-vigorous-intensity activities or increase muscle quantity.

Patients with rheumatoid arthritis (RA)-related foot impairment have a high rate of sarcopenia. Treatment using a foot orthosis (FO) enables not only a reduction in pain while walking but also an increase in physical activity, helping to prevent further loss of muscle mass. However, the primary goal of treating RA is to maximize patients' long-term quality of life (QOL). We investigated whether FO treatment both increases physical activity and improves QOL.Among 31 patients with RA-related foot impairment, 15 with sarcopenia were treated with an FO for 6 months. Foot-specific QOL (measuring using the Self-Administered Foot Evaluation Questionnaire), foot pain, activities of daily living, and physical activity (walking-intensity activity and moderate- to vigorous-intensity activity) were compared before treatment and after 6 months of treatment.Ten patients who completed 6 months of follow-up were analyzed. Significant QOL improvements were found in the Pain and Pain-Related category and the Physical Functioning and Daily Living category (P = 0.02-0.04); however, no significant changes were found in the Social Functioning, General Health and Well-Being, or Shoe-Related categories (P = 0.09-0.21). Foot pain and activities of daily living significantly improved (P = 0.01-0.04). Physical activity significantly increased for walking-intensity activity (P = 0.04) but did not change for moderate- to vigorous-intensity activity (P = 1.00).FO treatment in patients with RA-related foot impairment and sarcopenia increased light-intensity physical activity such as walking and improved physical QOL.

Background: Teriparatide (TPTD) is a drug for osteoporosis that promotes bone formation and improves bone turnover. However, the specific effects of TPTD on cortical bone are not well understood. Sweep imaging with Fourier transform (SWIFT) has been reported as a useful tool for evaluating cortical bone, but it has yet to be used to investigate the effects of TPTD on cortical bone. This study aimed to evaluate the effects of TPTD on cortical bone turnover using SWIFT in rats. Methods: Twelve-week-old female Sprague-Dawley rats (n=36) were reared for 12 weeks after ovariectomy to create a postmenopausal osteoporosis model. They were divided into two groups: the TPTD and non-TPTD groups. Rats were euthanized at 4, 12, and 24 weeks after initiating TPTD treatment. Tibial bones were extracted and evaluated using magnetic resonance imaging (MRI) and bone histomorphometry. In MRI, proton density-weighted imaging (PDWI) and SWIFT imaging were performed. The signal-to-noise ratio (SNR) was calculated for each method. The same area evaluated by MRI was then used to calculate for the bone formation rate by bone histomorphometry . Measurements were compared using the Mann-Whitney U-test, and a P-value of Results: PDWI-SNR was not significantly different between the two groups at any time point (P = 0.589, 0.394, and 0.394 at 4, 12, and 24 weeks, respectively). Contrarily, SWIFT-SNR was significantly higher in the TPTD group than in the non-TPTD group at 4 weeks after initiating treatment, but it was not significantly different at 12 and 24 weeks (P = 0.009, 0.937, and 0.818 at 4, 12, and 24 weeks, respectively). The bone formation rate was significantly higher in the TPTD group than in the non-TPTD group at all timepoints (P < 0.05, all weeks). In particular, at 4 weeks, the bone formation rate was markedly higher in the TPTD group than in the non-TPTD group (1.98±0.33 vs. 0.09±0.05 μm3/μm2/day).Conclusions: The marked increase of the bone formation rate in the cortical bone by TPTD could be measured using SWIFT. SWIFT could be an effective tool for evaluating the effects of TPTD on cortical bone turnover as images.

Background In chronic lateral ankle instability (CLAI), the instability of the ankle joint results in repeated microtrauma to the articular cartilage. How the lesion condition or stage is affected by the presence of lateral instability in medial osteochondral lesions of the talus (OLT) is unclear. We aimed to examine whether CLAI is associated with the size and staging of medial OLT on radiographs, magnetic resonance (MR) images, and arthroscopy. Methods Forty-five patients with medial OLTs in 45 ankles were reviewed. Radiographs were assessed for damage and lesion classification. The tibio-talar tilting angle (TTA) was measured. The patients were divided into two groups: the CLAI group and the stable group. The lesion classification on radiographs, MR images, and arthroscopy, and size on MR images were statistically compared. Results The CLAI group had a mean TTA of 8.15 ± 3.41°, whereas the stable group had a mean TTA of 2.24 ± 1.64°. The CLAI group had a lower clinical score than the stable group at the initial visit to our clinic. The CLAI group presented with lesions of significantly shorter longitudinal and transverse diameters. Stages of medial OLT on radiographs, MR images, and arthroscopic evaluation were earlier in the CLAI group than those in the stable group. Conclusions Patients with CLAI presented in the early stages of OLT and had significantly smaller lesions than those without CLAI. The patients without CLAI may be selected for surgery at an early phase.

Introduction Calcaneal pitch angle and Meary’s angle are commonly used to assess longitudinal foot arches on lateral-view radiographs. However, the methods used to obtain the talar, first metatarsal, calcaneal, and plantar axes differ across multiple reports, and no study has evaluated the reproducibility of these approaches. The aim of this study was to determine the most reproducible methods for radiographically evaluating longitudinal axes. Methods Standing radiographic images of 40 feet from 21 consecutive outpatients were obtained to measure longitudinal axes of the talus, first metatarsal, calcaneus and plantar surface, which were defined using six, five, four and three different methods, respectively, selected from previous reports. Intraobserver and interobserver correlation coefficients were calculated. Results The best intraobserver and interobserver correlation coefficients for the talar, first metatarsal, and calcaneal axes were obtained using methods involving a line bisecting the angle formed by the lines tangential to the superior and inferior margins of the talus, a line connecting the centre of the first metatarsal head and the midpoint of the visualized base of the first metatarsal, and a line drawn tangential to the inferior surface of the calcaneus, respectively. For the plantar axis, a method that used the horizontal plane (as a reference axis) was regarded as the best approach, although intraobserver and interobserver correlation coefficients could not be calculated because all values were zero. Conclusions The aforementioned methods were considered to be optimal for the radiographic assessment of longitudinal foot arches. This study could contribute to more accurate assessments of foot deformities.

Secular changes in the incidence rate of hip fractures were estimated to vary by fracture type, i.e., femoral neck or trochanteric fractures, age, and sex, in urban or rural areas in Kyoto Prefecture, Japan from 2008 to 2017. PURPOSE Our survey in Kyoto Prefecture from 2008 to 2017 showed that the incidence rate of femoral neck fractures is generally increasing. We investigated the differences between urban and rural areas in the changes of the incidence rate over time of femoral neck and trochanteric fractures during the same period. METHODS Patients aged 65 years and above who sustained hip fractures between 2008 and 2017 and were treated at one of the participating 11 hospitals were included. The ratio of sick beds for acute-term care at the investigated hospitals to total number of beds in the urban area was 16.5% (1863/11,158) and 30.6% (1863/5623) in the rural area. The change in incidence rate was estimated utilizing the population according to the national census conducted in 2010 and 2015. RESULTS There were 3559 and 6474 hip fractures in the urban and rural areas, respectively. Femoral neck fractures were 1936 (54.4%) and 2813 (43.5%) in each area. The increase of the population-adjusted numbers was marked by neck fractures in males, in both areas. In women, there was a significant increase in femoral neck fractures in the urban area in those aged 85 years and over. For trochanteric fractures, a significant increase was only found in women aged 65 to 74 years in the rural area. CONCLUSION A regional difference in the secular changes in incidence rate of hip fractures was found in women, not in men, mostly because neck fractures in women increased in the over 85 group in the urban area.

Summary In Kyoto Prefecture, Japan, the number of hip fractures increased during 2013–2017 compared to 2008–2012. However, the estimated overall incidence rate increased only in femoral neck fractures in men aged ≥75 and women aged ≥85. Purpose The incidence rate of hip fractures in Japan has plateaued or decreased. We investigated the annual hip fracture occurrences in Kyoto Prefecture, Japan, from 2008 to 2017. Methods Patients aged 65 years and above who sustained hip fractures between 2008 and 2017 and were treated at one of the participating 11 hospitals were included. The total number of beds in these institutions was 3701, accounting for 21.5% of the 17,242 acute-care beds in Kyoto Prefecture. The change in incidence rate was estimated utilizing the population according to the national census conducted in 2010 and 2015. Results The total number of hip fractures was 10,060, with 47.5% femoral neck fractures and 52.5% trochanteric fractures. A decrease in number was seen only in trochanteric fractures in the group of 75- to 84-year-old women. The population-adjusted numbers of femoral neck fractures showed a significant increase in all age groups in men, whereas in women, there was an increase in femoral neck fractures in the ≥85 group and trochanteric fractures in the age group 65–74, and a decrease in trochanteric fractures in the age group 75–84. The estimated change in incidence rate showed an increase in femoral neck fractures in men aged ≥75 and women aged ≥85. Conclusion In Kyoto Prefecture, the number of hip fractures increased in the second half of the study period (2013–2017) compared to the first half (2008–2012). However, the incidence rate had not increased, except in femoral neck fractures in men aged ≥75 and women aged ≥85.

Retrospective review The degree of spinal cord compression and bony spinal canal stenosis are risk factors for the occurrence of spinal cord injury (SCI) without major fracture or dislocation, but they do not affect the severity of neurological symptoms. However, whether a relatively large spinal cord for the dural sac influences the severity of symptoms in SCI cases is unknown. The purpose of this study was to verify the influence of spinal cord size relative to dural sac on the severity of paralysis in elderly patients with cervical SCI caused by minor trauma. Subjects were 50 elderly patients with SCI caused by falls on flat ground. At 72 hours after injury, neurological assessment was performed using the Japanese Orthopaedic Association (JOA) scoring system. Bony canal anteroposterior diameters (APD) at mid C5 vertebral body were measured with computed tomography. We measured dural sac and spinal cord APD at the injured level and mid C5 with magnetic resonance imaging. Spinal cord compression ratio was calculated by dividing spinal cord at the injured level by spinal cord at mid C5. As the evaluation of spinal cord size relative to the dural sac, spinal cord/dural sac ratio was calculated at the injured level and mid C5. To clarify the factors influencing the severity of paralysis, the relationships between JOA score and those parameters were examined statistically. A significant negative correlation was observed between JOA score and spinal cord/dural sac ratio at mid C5. No clear relationship was observed between JOA score and bony canal APD or spinal cord compression ratio. In elderly patients with SCI caused by minor trauma, a relatively large spinal cord for the dural sac was shown to be a factor that influences the severity of paralysis. This result can be useful for the treatment and prevention of SCI in the elderly.

Glucocorticoids and hypoxia is considered to promote osteocyte apoptosis and necrosis, which are observed in glucocorticoid-associated osteonecrosis and osteoporosis. Heme oxygenase-1 (HO-1) induced by hemin is reported to have cytoprotective effects in ischemic diseases. The objective of this study was to evaluate the effect of HO-1 on osteocyte death caused by glucocorticoids and hypoxia. We confirmed that hemin induced HO-1 expression in MLO-Y4 mouse osteocytes. MLO-Y4 was cultured with dexamethasone (Dex) under hypoxia (DH group). Furthermore, these cells were cultured with hemin (DH-h group) or hemin and zinc protoporphyrin IX (an HO-1 inhibitor) (DH-h-PP group). The rates of apoptosis and necrosis of these groups were analyzed by flow cytometry and compared with cells cultured under normal condition. Both apoptosis and necrosis increased in the DH group. Hemin administration significantly reduced cell death caused by glucocorticoids and hypoxia in the DH-h group, and its effect was attenuated by the HO-1 inhibitor in DH-h-PP group. Capase-3 activity significantly decreased in the DH-h group. This implied that the cell death inhibition effect due to hemin is mediated by HO-1 and caspase-3. HO-1 induction may be useful in the treatment of glucocorticoid-associated osteonecrosis and osteoporosis.

Although treatment protocols are available, patients experience both acute neuropathic pain and chronic neuropathic pain, hyperalgesia, and allodynia after peripheral nerve injury. The purpose of this study was to identify the brain regions activated after peripheral nerve injury using functional magnetic resonance imaging (fMRI) sequentially and assess the relevance of the imaging results using histological findings. To model peripheral nerve injury in male Sprague-Dawley rats, the right sciatic nerve was crushed using an aneurysm clip, under general anesthesia. We used a 7.04T MRI system. T 2 * weighted image, coronal slice, repetition time, 7 ms; echo time, 3.3 ms; field of view, 30 mm × 30 mm; pixel matrix, 64 × 64 by zero-filling; slice thickness, 2 mm; numbers of slices, 9; numbers of average, 2; and flip angle, 8°. fMR images were acquired during electrical stimulation to the rat’s foot sole; after 90 min, c-Fos immunohistochemical staining of the brain was performed in rats with induced peripheral nerve injury for 3, 6, and 9 weeks. Data were pre-processed by realignment in the Statistical Parametric Mapping 8 software. A General Linear Model first level analysis was used to obtain T-values. One week after the injury, significant changes were detected in the cingulate cortex, insular cortex, amygdala, and basal ganglia; at 6 weeks, the brain regions with significant changes in signal density were contracted; at 9 weeks, the amygdala and hippocampus showed activation. Histological findings of the rat brain supported the fMRI findings. We detected sequential activation in the rat brain using fMRI after sciatic nerve injury. Many brain regions were activated during the acute stage of peripheral nerve injury. Conversely, during the chronic stage, activation of the amygdala and hippocampus may be related to chronic-stage hyperalgesia, allodynia, and chronic neuropathic pain.

BACKGROUND Diabetes decreases bone strength, possibly because of cortical bone changes. Sweep imaging with Fourier transform (SWIFT) has been reported to be useful for cortical bone evaluation. PURPOSE To evaluate cortical bone changes in diabetic rats using SWIFT, assess the usefulness of this technique through comparisons with microcomputed tomography (μCT) and conventional MRI, and clarify the mechanism underlying cortical bone changes using histomorphometry STUDY TYPE: Animal cohort. ANIMAL MODEL 8-week-old male Wistar/ST rats (N = 36) were divided into diabetes (induced by streptozotocin injection) and control groups. FIELD STRENGTH/SEQUENCE 7.04T MRI, SWIFT. ASSESSMENT Six animals from each group were sacrificed at 2, 4, and 8 weeks after injection. Tibial bones were extracted and evaluated using μCT and MRI. The cortical bone mineral density (BMD) was measured using μCT. Proton density-weighted imaging (PDWI) and SWIFT were also performed. The signal-to-noise ratio (SNR) was calculated for each acquisition. The bone formation rate was evaluated using histomorphometry. STATISTICAL TESTS Findings at each timepoint were compared using Mann-Whitney U-tests. RESULTS Cortical BMD was significantly lower in the diabetes group than in the control group only at 8 weeks (P

Psychological stress induces many diseases including post-traumatic stress disorder (PTSD); however, the causal relationship between stress and brain atrophy has not been clarified. Applying single-prolonged stress (SPS) to explore the global effect of severe stress, we performed brain magnetic resonance imaging (MRI) acquisition and Voxel-based morphometry (VBM). Significant atrophy was detected in the bilateral thalamus and right visual cortex. Fluorescent immunohistochemistry for Iba-1 as the marker of activated microglia indicates regional microglial activation as stress-reaction in these atrophic areas. These data certify the impact of severe psychological stress on the atrophy of the visual cortex and the thalamus. Unexpectedly, these results are similar to chronic neuropathic pain rather than PTSD clinical research. We believe that some sensitisation mechanism from severe stress-induced atrophy in the visual cortex and thalamus, and the functional defect of the visual system may be a potential therapeutic target for stress-related diseases.

Purpose The fixed flexion view (FFV) of the knee is considered useful for evaluating the joint space when assessing the severity of osteoarthritis (OA) of the knee. To clarify the usefulness of FFV for evaluation of the joint space and severity of knee OA, this study evaluated changes in the joint space on the FFV and standing extended view (SEV) in patients with knee OA. Materials and Methods The SEV and FFV images were acquired in 567 patients (1,102 knees) who visited the hospital with a chief complaint of knee joint pain. Medial joint space width (MJSW) and Kellgren-Lawrence (K-L) classification assessed using the SEV and FFV images were compared. Results Mean MJSW was significantly smaller when assessed on the FFV than on the SEV (3.02±1.55 mm vs. 4.31±1.30 mm; p

The circadian clock regulates behavioural and physiological processes in a 24-h cycle. The nuclear receptors REV-ERBα and REV-ERBβ are involved in the cell-autonomous circadian transcriptional/translational feedback loops as transcriptional repressors. A number of studies have also demonstrated a pivotal role of REV-ERBs in regulation of metabolic, neuronal, and inflammatory functions including bile acid metabolism, lipid metabolism, and production of inflammatory cytokines. Given the multifunctional role of REV-ERBs, it is important to elucidate the mechanism through which REV-ERBs exert their functions. To this end, we established a Rev-erbα/Rev-erbβ double-knockout mouse embryonic stem (ES) cell model and analyzed the circadian clock and clock-controlled output gene expressions. A comprehensive mRNA-seq analysis revealed that the double knockout of both Rev-erbα and Rev-erbβ does not abrogate expression rhythms of E-box-regulated core clock genes but drastically changes a diverse set of other rhythmically-expressed output genes. Of note, REV-ERBα/β deficiency does not compromise circadian expression rhythms of PER2, while REV-ERB target genes, Bmal1 and Npas2, are significantly upregulated. This study highlight the relevance of REV-ERBs as pivotal output mediators of the mammalian circadian clock.

To evaluate retrospectively any association between the degree of deformity correction by medial open-wedge high tibial osteotomy (HTO) and patellofemoral joint degeneration. We hypothesized that development of patellofemoral joint degeneration depended on the degree of intraoperative deformity correction. Fifty-seven patients who underwent medial open-wedge HTO for treatment of osteoarthritis in one knee were included in this study. Knees were classified into degeneration (D) and non-degeneration (ND) groups according to worsening of the patellar and/or femoral trochlear cartilage at the time of hardware removal (D group, 27 knees) and no degeneration or improvement (ND group, 30 knees). We compared pre- to post-surgery change in hip-knee-ankle angle (HKA) and medial-proximal-tibial angle (MPTA), open-wedge HTO correction angle, and arthroscopic findings between groups. Mean age, height, weight, and body mass index were 54.1 ± 9.9 years, 160.4 ± 8.7 cm, 66.4 ± 12.1 kg, and 25.7 ± 3.3 kg/m2, respectively. Change in both HKA and MPTA differed significantly between groups. The MPTA cut-off values to predict patellofemoral degeneration were determined to be 10°, associated with an AUC of 0.75 (95% confidence interval [CI] 0.62–0.87). This study evaluated retrospectively the effect of the correction angle during medial open-wedge HTO on patellofemoral joint degeneration. If deformity correction exceeds an MPTA of 10° during open-wedge HTO, degeneration of patellofemoral joint needs to be considered. Level of evidence: Level IV.

Discoid menisci on both the medial and lateral sides are rare, and there are very few reports on cases involving both sides. We report a case of a 52-year-old female with medial and lateral discoid menisci in both knees. Arthroscopy revealed the lateral menisci of both knees were complete discoid menisci, and partial meniscectomy was performed. The medial menisci were incomplete discoid menisci, but there were no findings of abnormal mobility or injury; therefore, the medial menisci were observed without treatment. At six months postoperatively, her pain and range of motion restrictions disappeared.

Sweep imaging with Fourier transform (SWIFT) method has been developed to image tissues with very short T2 values, such as cortical bone. The purpose of this study was to measure the T1 value of the rat cortical bone. It was approximately 120 ms on 7.04T. This result could thus be useful for studying bony tissue according to the SWIFT method in the future.

To examine the recurrence of deformity after silicone implant arthroplasty combined with resection arthroplasty for severe forefoot deformity in patients with rheumatoid arthritis.We reviewed the long-term results of this procedure for 27 feet in 15 patients. Their average age and disease duration at the time of operation were 58.6 years and 17.5 years, respectively, and the average follow-up period was 10.3 years.An improved hallux valgus angle (45.3° preoperatively, 23.6° 6 months after operation) was maintained. By contrast, deformity and dislocation of lesser toe had recurred at the final follow-up; the angle between the proximal phalanx and the metatarsal of the second toe improved 13.4° with recurrence of 22.5°, the angle between the proximal phalanx and ground surface improved 22.4° with recurrence of 34.5. Furthermore, claw toe deformity at the final follow-up was significantly worse in the group whose hallux valgus deformity was observed 6 months after operation.This procedure could maintain the alignment of the first metatarsophalangeal joint, but the recurrence of claw toe deformity is a problem and the relation between the first toe and the lesser toe is an important consideration.

Purpose This study compared the analgesic effects of local infiltration analgesia (LIA) and femoral nerve block (FNB) after total knee arthroplasty (TKA) and assessed factors associated with analgesia obtained by these two methods. Materials and methods Study subjects included 66 patients (72 knees) who underwent TKA for osteoarthritis of the knee. Pain visual analogue scale (VAS), the amount of analgesics used, number of days to achieve 90° of flexion of the knee joint, date of initiating parallel-bar walking, range of motion of the knee joint at discharge, and adverse events were investigated. Results The VAS scores did not differ significantly between two groups, whereas the amount of analgesics used was significantly lower in the LIA group. Preoperative flexion contracture was significantly more severe in the LIA group with high VAS compared with low VAS. No serious adverse event occurred in the LIA or FNB group. Conclusions The lower analgesic usage in the LIA group than the FNB group indicates that the analgesic effect of LIA was greater than that of singleshot FNB after TKA. There were no serious complications in either group. The postoperative analgesic effect of LIA was smaller in patients with severe than less severe preoperative flexion contracture.

The present study aimed to diagnose complete rupture (CR) and longitudinal rupture (LR) of the posterior tibial tendon (PTT) from the magnetic resonance imaging findings in patients with PTT dysfunction and to analyze and compare the radiographs from each group to identify radiographic indicators related to the progression of PTT injury that would allow the radiographic diagnosis of CR. We evaluated 32 feet in 27 patients with PTT dysfunction (mean age 66.5, range 49 to 82, years). Radiographs were used to acquire weightbearing anteroposterior images of the foot, which were used to measure the talonavicular coverage angle. Lateral images of the foot were also acquired with the patients in the standing position. These were used to measure the lateral talometatarsal angle, calcaneal pitch angle, and medial cuneiform–fifth metatarsal height. From the axial MRI findings, the patients were divided into a CR group and an LR group, and the radiographic attributes of the CR group were analyzed. Of the 32 feet in 27 patients, 12 feet (37.5%) in 11 patients displayed CR and 20 feet (62.5%) in 18 patients displayed LR. The talonavicular coverage angle was 48.3° ± 17.3° in the CR group and 33.6° ± 13.6° in the LR group ( p = .012), and the talometatarsal angle was −28.8° ± 22.5° in the CR group and −25.4° ± 14.4° in the LR group ( p = .596). The calcaneal pitch angle was 10.4° ± 6.7° in the CR group and 10.2° ± 8.0° in the LR group ( p = .935). Finally, the medial cuneiform–fifth metatarsal height was −4.2 ± 7.1 mm in the CR group and 2.1 ± 4.7 mm in the LR group ( p = .005). When a medial cuneiform–fifth metatarsal height of ≤0 mm or talonavicular coverage angle of ≥50° was used as the diagnostic criterion for CR on weightbearing radiographs, the sensitivity was 71.4%, specificity 88.9%, and diagnostic accuracy 81.3%; hence, we believe these to be satisfactory diagnostic criteria for CR.

Background The recent classifications for posterior tibial tendon dysfunction (PTTD) stage II are based on forefoot deformity, but there is still no consensus regarding a detailed explanation of the clinical condition. The purposes of this study were to clarify the clinical condition of flatfoot deformity using three-dimensional (3D) computed tomography (CT) imaging under loading on both healthy and flat feet and to compare 3D movement of the forefoot in response to load. Methods Ten volunteers and 10 PTTD stage II patients with symptomatic flatfoot deformity were examined. CT scans of 20 healthy and 20 flat feet were performed under non-loading and full weight-bearing conditions. Images of the tibia and foot arch bones (talus, calcaneus, navicular, and first and fifth metatarsal bones) were reconstructed into 3D models. Rotations of individual tarsal bone or metatarsal bone were described by the Eulerian angles. Results Compared with healthy feet, flat feet experienced plantarflexion of the fifth metatarsal bone relative to the first metatarsal bone under loading conditions. We defined this phenomenon as synonymous with forefoot varus on the coronal plane. Conclusions The results of this study have clarified part of the clinical condition of the forefoot in flatfoot deformity and may have applications in basic research of the staging advancement and substage classification of PTTD.

Background:Sarcopenia is a progressive systemic skeletal muscle disorder associated with an increased likelihood of adverse outcomes including physical disability, falls, and mortality. The muscle mass of patients with rheumatoid arthritis (RA) is lower than that of age-matched healthy individuals, and a high prevalence rate of sarcopenia has been reported1). In particular, foot deformities may increase the prevalence rate of sarcopenia because of inactivity due to foot pain on walking. Treatment with a foot orthosis (FO) can reportedly reduce pain2); however, whether a FO can resolve inactivity and sarcopenia is unclear.Objectives:To elucidate the effectiveness of a FO on physical activity and sarcopenia in patients with RA.Methods:Thirty patients with RA with foot deformities were enrolled from April 2017 to December 2019. Sarcopenia was diagnosed using the algorithm of the European Working Group on Sarcopenia in Older People, and the cut-off values of the Asian Working Group for Sarcopenia were applied. We also collected the clinical variables of patients with concurrent RA and sarcopenia who continued to use a FO for 6 months. The primary outcome was physical activity determined by the International Physical Activity Questionnaire. The secondary outcomes were foot pain measured with a visual analog scale; activities of daily living (ADL) measured with the Health Assessment Questionnaire; and body mass index, body fat percentage, and the skeletal muscle mass index measured with a body composition device. The clinical variables were compared between baseline and 6 months after continuous treatment with a FO.Results:The prevalence rate of sarcopenia was 76.6% (23/30), and nine patients with RA continued to use the FO for 6 months. Table 1 shows outcomes at baseline and after 6 months of treatment with a FO. The only clinical variable that showed a significant difference was foot pain. Physical activities, ADL, and body compositions were maintained after 6 months.Table 1.Outcomes of 6-month treatment with FOBaseline6 monthsp valuePhysical activityIPAQWalking, MET-min/weekModerate, MET-min/weekVigorous, MET-min/week132 (66, 594)0 (0, 0)0 (0, 0)594 (396, 2376)0 (0, 0)0 (0, 0)0.071.000.32Foot painVAS score4.6 (3.1, 7.4)2.8 (1.1, 4.7)0.02ADLHAQ1.5 (1.1, 2.3)1.1 (0.9, 1.5)0.07Body compositionBMI, kg/m2BFP, %SMI, kg/m221.4 (20.7, 22.7)31.1 (24.2, 37.6)5.2 (4.8, 5.3)20.7 (19.3, 22.1)32.9 (26.3, 36.5)5.2 (5.0, 5.2)0.890.820.61IPAQ: International Physical Activity Questionnaire, VAS: visual analog scale, ADL: activities of daily living, HAQ: Health Assessment Questionnaire, BMI: body mass index, BFP: body fat percentage, SMI: skeletal muscle mass indexData are presented as median (lower quartile, upper quartile)Conclusion:The prevalence rate of sarcopenia in patients with RA with foot deformities was much higher than previous reported1). However, 6 months of treatment with a FO not only reduced foot pain but also maintained physical activity and muscle mass. Physical therapy has recently been recommended for patients with inflammatory arthritis. physical activity and muscle mass of patients with RA and concurrent foot deformities may be increased by combining physical therapy with orthotic treatment.References:[1]Tada M, et al. Matrix metalloprotease 3 is associated with sarcopenia in rheumatoid arthritis - results from the CHIKARA study. Int J Rheum Dis. 2018; 21 (11): 1962-9.[2]Hennessy K, et al. Custom foot orthoses for rheumatoid arthritis: A systematic review. Arthritis Care Res (Hoboken). 2012; 64 (3): 311-20.Acknowledgments:This work was supported by JSPS KAKENHI Grant Numbers JP19K11420.Disclosure of Interests:None declaredDOI: 10.1136/annrheumdis-2020-eular.3143

STUDY DESIGN Case-control study. OBJECTIVE The objective of this study was to reveal the changes of leg muscle strength after lateral interbody fusion (LIF). SUMMARY OF BACKGROUND DATA Muscle trauma and damage to intermuscular nerves due to dissection of the psoas are recognized perioperative complications of LIF. Although reduced leg strength is temporary in many cases, the underlying changes have not been studied in detail. METHODS Leg muscle strength was measured quantitatively before LIF surgery and 1 week, 2 weeks, 3 weeks, 4 weeks, 8 weeks, and 12 weeks after surgery (n=38). Reduced muscle strength was defined as

Background Metatarsus primus elevatus (MPE), a dorsal elevation of the first metatarsal in relation to the lesser metatarsals on lateral-view radiographs, is an indicator of hallux rigidus. The angle between the articular surfaces of the base of the first metatarsal and the anterior part of the medial cuneiform (M1C1A) reflects the sagittal instability of the first tarsometatarsal (TMT) joint. MPE may also indicate instability of the first metatarsal. The purpose of this study was to identify the influence of hallux valgus (HV) and flatfoot (FF) deformities on measurements obtained from first metatarsal-related radiographic images. Methods Standing radiographic images of 134 feet were investigated. In dorsoplantar-view radiographs, HV and intermetatarsal angles were evaluated. The position of the medial sesamoid was classified with a grading system (Hardy score). In lateral-view radiographs, MPE, M1C1A, and Meary's angle were measured. The subjects were divided into 4 groups: the normal group (G1), HV(−)FF(−); the HV group (G2), HV(+)FF(−); the FF group (G3), HV(−)FF(+); and the dual group (G4), HV(+)FF(+). The radiographic parameters were compared among the groups. Results MPE in the HV patients (G2 and G4) was less than that in the non-HV participants (G1 and G3). MPE in G4 was less than that in G3. The odds ratios of the Hardy score were higher in G2, G3 and G4 than in G1. The ratios were higher in the FF patients (G3 and G4) than in the non-FF participants (G1 and G2) and were higher in G4 than in G2. Conclusions FF affects sesamoid dislocation, and the combination of HV and FF further increases sesamoid dislocation. Combined with M1C1A and the Hardy score, MPE may be a useful indicator of three-dimensional instability of the first TMT joint. First TMT joint-related operations may be considered for severe HV treatment in G4 patients.