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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. 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. 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. 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. [ABSTRACT FROM AUTHOR]

The article presents an analysis of scientific literature devoted to the study of surgical anatomy of the ligamentous apparatus and metatarsal bones of the human foot. The literature covers the issues of macroanatomy and histology of the ligaments and metatarsal bones of the foot quite fully. At the same time, issues related to the same shape and size of bones, the relative position of ligaments, their histotopographic features are contradictory, which is associated with high variability, individual and age variability in combination with a number of social factors and features of the regions of residence. The work shows that at present, the data of domestic and foreign scientific literature on the anatomy and topography of the bones and ligaments of the metatarsal bones of the human foot are presented either by sectional studies or by the results of clinical observations using diagnostic equipment. The existing studies do not provide a comprehensive picture of the surgical anatomy of the ligamentous apparatus and metatarsal bones of the human foot. The article reflects the need for widespread use in fundamental anatomical studies of ligaments and metatarsal bones using the histotopographic method of research, quantitative and qualitative assessment of morphological parameters, which open up new possibilities for diagnosing pathological processes and developing new surgical techniques.

Background: This case series reported the outcomes of severe hallux valgus treated with first-ray distal metatarsal and proximal phalangeal osteotomies without soft tissue procedure. Methods: The medical records of patients who underwent this surgery from February 2018 to December 2021 were reviewed, including patients with a hallux valgus angle (HVA) ≥40 degrees who were followed up for >2 years. The analyzed data included age, sex, height, weight, and body mass index at the surgery, HVA and intermetatarsal angle (IMA) on the weighted anteroposterior radiograph of the affected foot, the Japanese Society for the Surgery of the Foot score, visual analog scale (VAS) score, and passive plantarflexion and dorsiflexion angles of the first metatarsophalangeal joint 1 month before surgery and at final follow-up. Results: The study group included 35 feet in 29 patients (26 females) with a mean age of 67 ± 10.6 years and mean follow-up of 3.5 ± 0.8 years. Average preoperative and final follow-up measures were HVA, 46.8 to 7.7 degrees; IMA, 18.8 to 9.5 degrees; and VAS score, 61.5 ± 29.6 to 2.7 ± 4.6. Range of motion decreased on average: dorsiflexion, 83.6 ± 14.7 to 71.3 ± 12.0 degrees; and plantarflexion, 63.0 ± 14.7 to 53.0 ± 11.8. All changes were statistically significant (P <.001). Conclusion: This surgery achieved good correction and clinical outcomes for severe hallux valgus, but the postoperative range of motion decreased. Level of Evidence : Level IV, case series. [ABSTRACT FROM AUTHOR]

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.

The study aims to analyse the normal anatomical and radiographical features of the Manus of the southern Aswanian‐adapted Arabian one‐humped camel, providing crucial data for diagnosing and treating various ailments. Our study was applied to 10 cadaver forelimbs of adult male one‐humped camels (4–5 years old) for an explanation of the gross anatomy of the bones of the Manus region from under the carpal bones by using traditional techniques, including the gross anatomical, radiographic and x‐ray (at the dorsopalmar and lateral planes) of the preparation of Manus bones. Our results showed that the large fused (third and fourth) metacarpal bones, in which the fusion extended along the entire length of the bone except at the distal end, diverged to form separate articulations with cross‐ponding digits. As described in all ruminant species, especially the camel, there were two digits, and each digit consisted of three phalanges and two proximal sesamoid bones. Our radiographic x‐ray data revealed that the complete radiopaque septum that completely divided the medullary cavity into two separate parts was clear from the dorsopalmar view, while the lateral view showed the proximal sesamoid bones that were placed over each other and located palmar to the head of the large metacarpal bone. In conclusion, our study reveals the adaptations of the Arabian one‐humped camel to Egyptian conditions, aiding in the early diagnosis of lameness and digit problems and enabling veterinarians and camel owners to better address these issues, thereby improving the overall health and well‐being of these animals. [ABSTRACT FROM AUTHOR]

Purpose: Foot tuberculosis is a rare form of osteoarticular tuberculosis, accounting for less than 1% of cases. It presents unique diagnostic challenges due to its nonspecific clinical features and overlapping symptoms with other conditions. This study aimed to investigate the clinical presentation, radiographic findings, and prognosis of foot tuberculosis, with the goal of improving early recognition and appropriate intervention. Methods: A prospective study was conducted between November 2016 and July 2021, involving 39 patients diagnosed with foot tuberculosis. Clinical examinations, laboratory tests, X-rays, and MRI evaluations were performed to aid in the diagnosis. Biopsy was conducted on patients with radiological lesions. Patients were treated with an 18-month course of antitubercular therapy (ATT). Foot Function Index (FFI) scores were recorded before and after treatment. Statistical analysis was conducted to assess factors impacting prognosis. Results: Unilateral foot involvement was observed in all patients, with a male predominance (61.5%) and a mean age of 31.3 years. The most common symptoms were pain and edema, with sinus tracts present in 17.9% of patients. Radiographic findings showed cystic and sclerotic lesions, with the "spina ventosa" appearance primarily affecting the metatarsal bones. MRI played a valuable role in early detection. Histopathological examination confirmed tuberculosis in all cases, and acid-fast bacilli were found in 23% of patients. Most patients (79.4%) responded well to ATT without requiring surgery. Factors such as high initial ESR, delayed ATT initiation, multiple lesions, and tarsal involvement were associated with unfavourable outcomes. Conclusion: Foot tuberculosis presents with nonspecific symptoms, leading to misdiagnosis and delays in appropriate treatment. Clinical examination, radiographic evaluation, and biopsy are essential for accurate diagnosis. Early initiation of ATT is crucial for favourable outcomes. Factors such as high initial ESR, delayed treatment initiation, multiple lesions, and tarsal involvement negatively impact prognosis. This study highlights the importance of recognizing foot tuberculosis and provides insights into its clinical presentation, radiographic features, and treatment outcomes, facilitating timely intervention and improved patient management. [ABSTRACT FROM AUTHOR]

Les fractures de contrainte surviennent lorsque, en l'absence de véritable traumatisme, les contraintes mécaniques dépassent la résistance osseuse. On distingue les fractures de stress ou de fatigue qui se produisent par excès de sollicitation mécanique sur un os normal, comme cela arrive dans tout matériau, et les fractures par insuffisance osseuse qui surviennent pour des efforts banals sur un os lui-même fragile du fait d'une ostéopathie sous-jacente. Le pied et la cheville sont une des localisations les plus fréquentes des fractures de fatigue, moins courante que d'autres sites pour ce qui est des fractures par insuffisance osseuse. Elles peuvent survenir sur n'importe quel os de la cheville ou du pied, les plus fréquentes étant celles des métatarsiens. Le diagnostic est fortement suspecté devant une douleur assez localisée de rythme mécanique et d'installation rapidement progressive dans un contexte favorisant : milieu sportif ou militaire pour les fractures de fatigue, facteurs de risque d'ostéopathie fragilisante pour les fractures par insuffisance osseuse. La radiographie est peu sensible et le diagnostic pourra reposer sur la scintigraphie osseuse, l'échographie ou surtout l'IRM. La prévention a un rôle important en milieu sportif ou militaire en adaptant l'entraînement, le matériel, en dépistant des symptômes évocateurs de la triade de l'athlète. Le traitement de la fracture elle-même repose dans tous les cas sur la restriction d'appui. Elle sera plus importante avec parfois même un traitement chirurgical d'emblée dans les localisations à haut risque de retard de consolidation ou de pseudarthrose, qui sont la base du 5e métatarsien, le naviculaire, la malléole médiale, les sésamoïdes. Stress and insufficiency fractures occur in the absence of significant trauma when mechanical loads overcome bone resistance. Stress fractures occur on normal bone upon excessive solicitations, mainly in athletes or military recruits, whereas insufficiency fractures occur during normal occupations on a bone fragilized by an underlying condition such as osteoporosis. Foot and ankle are very common sites for stress factures and to a lesser extent for insufficiency fractures. Any foot or ankle bone may be affected, the most common location being metatarsal bones. Diagnosis should be addressed in presence of rapidly progressive and localized pain at weight-bearing in predisposed patients: high sports practice or military training for stress fractures, risk factors of fragilizing bone disease for insufficiency fractures. Plain radiographs are poorly sensitive, and diagnosis often will require bone scintigraphy, ultrasound or mainly MRI. There is a large place for prevention of stress fractures, by training or devices adaptation and screening of signs of the athlete's triad. Fracture treatment always necessitates weight-bearing restriction for several weeks. This will be even more strict and prolonged, with sometimes desirable preventive surgery in the case of high-risk fractures for delayed or non-union, namely the fifth metacarpal proximal part, navicular bone, medial malleola and sesamoids. [ABSTRACT FROM AUTHOR]

Various modifications of distal chevron metatarsal osteotomy (DCMO) have been introduced for correcting moderate hallux valgus deformity; however, the amount of correction may be limited, and complications, such as the recurrence of the deformity and avascular necrosis of the metatarsal head, have been a problem. This study aimed to present a modified 90-degree DCMO technique that overcomes the previously reported shortcomings and to report a successful short-term radiographic outcome. Sixty-eight consecutive patients who underwent the operation with our modified DCMO technique and twenty-two consecutive patients with the conventional DCMO technique (control group) were retrospectively analyzed. The radiographic measurements were evaluated preoperatively, at two months post operation, and at the final follow-up. Both groups showed a significant correction of the hallux valgus angle, first–second intermetatarsal angle, distal metatarsal articular angle, and sesamoid position at the final follow-up, while the amount of correction was significantly greater in the modified DCMO group. In both groups, there were no cases of complications such as avascular necrosis of the metatarsal head, nonunion, and surgical site infection appearing throughout the follow-up period. Therefore, the modified 90-degree DCMO technique is effective and safe, which could serve as a favorable option to treat moderate hallux valgus deformity. [ABSTRACT FROM AUTHOR]

Copyright of Die Unfallchirurgie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Purpose: Metatarsal fractures often occur around the diaphyseal nutrient foramina (NF) which vary in topography depending on population affinity. Topographical and morphometrical knowledge of the NF is crucial in understanding fracture development and fracture site healing patterns. The current study aimed to describe the topography and the morphometry of the metatarsal diaphyseal NF in South African Africans (SAA), South Africans of European descent (SAED) and South Africans of Mixed Ancestry (SAMA). Methods: The study examined 4284 dry cadaveric metatarsals from both sexes and sides of these populations for NF topography and morphometry, including the presence, number, location, position, size and direction of the NF on the metatarsal bones. Results: The NF was present in 99.4% of the metatarsals. Most (84.5%) metatarsals examined had a single NF. Most (97.4%) NF were located in the middle third of the metatarsal bones. The median foramina index (FI) of the second metatarsal exhibited population affinity and significant differences were found both on the left second metatarsal (P = 0.043), and the right second metatarsal (P = 0.046). The position of NF was predominantly lateral on the first (92.4%), second (64.9%) and third (59.1%) metatarsals, whilst the position was predominantly medial on the fifth (65.1%) metatarsals. The NF positions on the fourth metatarsals showed the greatest population variability. The first metatarsals had primarily dominant-sized and distally directed NF whilst the second through fifth had primarily secondary-sized and proximally directed NF. Conclusion: The topographical anatomy of the metatarsal diaphyseal NF appears similar across the South African populations. Metatarsal bones are highly vascularized bones presenting with multiple nutrient foramina. [ABSTRACT FROM AUTHOR]

Copyright of Revista Médica Clínica Las Condes is the property of Editorial Sanchez y Barcelo and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Study design, case-control study: Background, Morton’s extension (ME) is a kind of orthotic that has been used as a conservative treatment of painful hallux rigidus (HR) osteoarthritis, but only their effects on first metatarsophalangeal joint (MPJ) mobility and position in healthy subjects have been studied, but not on its applied pulled tension forces neither in subjects with HR. Objectives: This study sought to understand how ME’s orthotics with three different thicknesses could influence the kinematic first MPJ by measuring hallux dorsiflexion using Jack’s test and a digital algometer with a rigid strip anchored to the iron hook’s extremity and comparing subjects with healthy first MPJ mobility to those with HR. We aimed to clarify whether tension values were different between healthy and HR subjects. Methods: Fifty-eight subjects were selected, of whom thirty were included in the case group according to HR criteria and twenty-eight were included in the control group. A digital algometer (FPX®® 25, Wagner Instruments®®, Greenwich, CT, USA) was used to assess the pulled tension values (kgf) of the first MPJ during Jack’s test. Results: The pulled tension values were highly reliable (ICC > 0.963). There were no statistically significant differences between the pulled tension values for the different ME conditions in the case (p = 0.969) or control (p = 0.718) groups. However, as it’s expected, there were statistically significant differences comparing all pulled tension values between case and control group subjects (p < 0.001). Conclusions: Different ME’s thicknesses had no influence on the pulled effort applied during the dorsiflexion Jack’s test between the healthy and HR groups; therefore, it can be prescribed without joint-care danger. In addition, it is proven that there is greater resistance to performing Jack’s test in the HR group than in the healthy group, regardless of ME’s orthotics. Furthermore, it is shown that the digital algometer device is a valid tool to detect the first MPJ restriction and is more reliable than other tests.

Abstract Freiberg disease is a rare condition whose diagnosis requires a high clinical suspicion. Avascular necrosis of the metatarsal head progresses with articular collapse, leading to forefoot pain and limitation of the daily activities. Several surgical techniques have been described to address the disease, and since it is usually diagnosed in later-stages, most of them include joint-destructive procedures. The use of arthroscopy on the small joint of the foot has arisen in the last few years, but its application in Freiberg disease is still scant. Joint-preserving procedures have been advocated for cases of early-stage disease, aiming to relieve symptoms while preventing the progression of the disease. In the present report, we describe a successful treatment of a 12-year-old patient with early-stage Freiberg disease using core decompression and bone marrow graft through a minimally-invasive approach assisted by arthroscopy.

Stature estimation is one of the essential procedures for personal identification in forensic osteology. Therefore, the purposes of this study are to analyze the correlation between length and width of metatarsal measurements and stature, and to develop the regression equations for a Thai population. In this study, the samples were divided into two groups. The first group was called the "training group" for generating stature estimation equations, comprised of 200 skeletons, aged between 19-94 years. The second group was called the "test group" for evaluating the accuracy of generated equations, comprising 40 skeletons. The correlation between metatarsal parameters and stature were moderate to high, and all variables had positive significant correlation with stature. For males, the left ML2 is the length variable that showed the most correlation degree against stature (r=0.702), and the left MSW4 is the width variable that had the most correlation degree against stature (r=0.483). For females, right ML1 is the length variable that had the most correlation degree against stature (r=0.632), and right PW3 is the width stature that had the most correlation degree against stature (r=0.481). For all samples, left ML1 was the length variable that had the most correlation degree against stature (r=0.796) and right PW3 was the width variable that had the most correlation degree against stature (r=0.712). The results of generating multiple regression equations using a stepwise method reveals that the correlation coefficient (R) and standard error of estimate (SEE) were 0.761 and 4.96 cm, respectively, for males, and 0.752 and 4.93 cm for females, with 0.841 and 5.26 cm for all samples, respectively. According to these results, the mean of absolute error from the test group ranged from 3 to 5 cm. Therefore, stature estimation equations using length and width of metatarsals from our study can be applied to estimate stature in the Thai population. [ABSTRACT FROM AUTHOR]

This paper describes the morphology of the feet of a population of elite women from the Ming dynasty (1368-1644 CE) in Shaanxi province. This is a social stratum, time, and place in which foot binding was practiced. Among a group of 31 skeletons exhumed from the cemetery, eight were women with well-preserved foot bones. Macroscopic examination revealed that half these women (4/8) had clearly altered foot bones: the metatarsal bones, and the few observable phalanges, were gracile and small, while the tarsal bones exhibited a slight reduction in size but no dramatic change in morphology. The other half of the women (4/8) had apparently unmodified metatarsal bones. T-tests comparing linear measurements of the foot bones between the two groups revealed that metatarsal bones were the most affected by binding, and among the tarsal bones, the talar trochlea and calcaneal dimensions were most impacted. This small group of skeletons reveals that some elite women in Shaanxi apparently still did not practice foot binding in the late Ming dynasty, or practiced a much milder form of foot binding, and that there was considerable variation even among those who did practice it.

Study design, case-control study: Background, Morton's extension (ME) is a kind of orthotic that has been used as a conservative treatment of painful hallux rigidus (HR) osteoarthritis, but only their effects on first metatarsophalangeal joint (MPJ) mobility and position in healthy subjects have been studied, but not on its applied pulled tension forces neither in subjects with HR. Objectives: This study sought to understand how ME's orthotics with three different thicknesses could influence the kinematic first MPJ by measuring hallux dorsiflexion using Jack's test and a digital algometer with a rigid strip anchored to the iron hook's extremity and comparing subjects with healthy first MPJ mobility to those with HR. We aimed to clarify whether tension values were different between healthy and HR subjects. Methods: Fifty-eight subjects were selected, of whom thirty were included in the case group according to HR criteria and twenty-eight were included in the control group. A digital algometer (FPX®® 25, Wagner Instruments®®, Greenwich, CT, USA) was used to assess the pulled tension values (kgf) of the first MPJ during Jack's test. Results: The pulled tension values were highly reliable (ICC > 0.963). There were no statistically significant differences between the pulled tension values for the different ME conditions in the case (p = 0.969) or control (p = 0.718) groups. However, as it's expected, there were statistically significant differences comparing all pulled tension values between case and control group subjects (p < 0.001). Conclusions: Different ME's thicknesses had no influence on the pulled effort applied during the dorsiflexion Jack's test between the healthy and HR groups; therefore, it can be prescribed without joint-care danger. In addition, it is proven that there is greater resistance to performing Jack's test in the HR group than in the healthy group, regardless of ME's orthotics. Furthermore, it is shown that the digital algometer device is a valid tool to detect the first MPJ restriction and is more reliable than other tests. [ABSTRACT FROM AUTHOR]

Introduction: the objective of this anatomical investigation was to record the morphology of peroneus longus (PL), brevis (PB) and tertius (PT) muscles in human cadaveric specimens. Material and Methods: this study utilized 40 cadaveric formalin fixed lower limb specimens. The leg region was meticulously dissected to expose the muscle belly and their tendons to study the morphology. They were traced till their insertion in the foot. The morphometric data were recorded by using the digital Vernier caliper. Results: PL tendon was inserting to the first metatarsal and medial cuneiform bones in 32 specimens (80%), to the shaft of first metatarsal in 3 cases (7.5%) and in 5 specimens, tendon got inserted into the second metatarsal (12.5%). Thirty PB specimens (75%) had tubular morphology at the insertion and 10 specimens (25%) showed a fan or triangular shaped flattened insertion into the fifth metatarsal. The PT was observed in all of our specimens (100%). It presented a single tendon at the site of insertion in 28 specimens (70%), presented a flattered broad insertion (band like) in 7 specimens (17.5%). This morphology shared a slip to the PB and in 5 specimens (12.5%), the muscle got inserted into the fourth metatarsal and gave fibrous expansion to the extensor digitorum longus. Conclusion: we believe that the morphological data of the peroneal muscles presented in this study are beneficial to the plastic and reconstructive surgeries, ankle and foot surgeries during the muscle flap and correction procedures of the lower extremity. [ABSTRACT FROM AUTHOR]

Abstract Objective To describe the profile of the patients and the results obtained with the use of an external fixator for metatarsal lengthening in brachymetatarsia. Methods A retrospective analysis of the medical records of patients with brachymetatarsia treated between January 2018 and April 2020 was performed. During this period, eight feet of six patients were operated on. Frequencies were estimated according to demographic and surgical aspects. Results All patients (100%; n= 6) were female, with a mean age of 28 years old, ranging from 15 to 48 years old, and were motivated to seek the orthopedic service due to aesthetic deformity. The deformity was bilateral in two patients and unilateral in four patients. The average lengthening time was 22 days ( ± 7.15, 95% confidence interval [CI]: 19.04-26.81). The lengthening speed was 0.5 mm/day, and the average total length of the lengthening was 11.46 mm ( ± 3.57; 95%CI: 9.52-13.40). Half of the patients (50%; n= 3) had local infection of the pins and were treated with antibiotics, and the others did not report any postsurgical complications. All patients denied pain or calluses after the surgical procedure and reported satisfaction with the results. Conclusion All patients were female and sought surgery for brachymetatarsia for aesthetic reasons. Osteogenic distraction at a rate of 0.5 mm/day resulted in successful lengthening of the metatarsal, with a low frequency of complications, good clinical outcomes, and high patient satisfaction.

Objective: There is increasing interest in the performance of minimally invasive foot surgery (MIS); however, limited evidence and treatment algorithms are available to support its use and guide surgical decision-making. The aim of this prospective clinical audit was to report the efficacy of a treatment algorithm used to treat patients presenting with lesser toe deformities using MIS techniques. Methods: A prospective clinical audit of 38 patients who underwent 55 MIS procedures for complex and simple lesser toe deformities was conducted between April 2018 and June 2022. All patients were followed up for a minimum of 12 months post operatively. The audit was conducted following the National Research Ethics Service (NRES) guidelines on clinical audit. Results: Mean pre-operative Visual Analogue Pain (VAS) score was 3.95 with a median of 5.00. The mean post-operative VAS scores improved to 0.23 after six weeks and 0.43 after 12 weeks. A Mann-Whitney U test concluded that this improvement was statistically significant (p

Objective. Determine the morphometric values of the plantar metatarsal tendons and ligaments in clinically healthy animals. Materials and methods. Thirty animals were used throughout the study, the plantar metatarsal tendons and ligaments were evaluated starting from the plantaromedial aspect of the proximal region to the insertion of the suspensory branches in the sesamoids bones. The variables to be studied in each structure were cross-sectional area (cm2), lateral medial width (ALM) (cm) and dorsal palmar thickness (EDP) (cm). Results. It was found that the structure with the largest area in the proximal regions was the suspensory ligament (0.858 cm2) followed by the lateral digital flexor (0.759 cm2), in regions 1B and 2A the largest structure remained the suspensory ligament and in the region 2B, the deep digital flexor tendon was the largest structure (0.804 cm2). Conclusions. The behavior of the variables in the Colombian Creole horse is similar to that reported in the literature and finally the first reference values of morphometric measurements of the tendons and ligaments of the plantar metatarsal in this breed are presented. [ABSTRACT FROM AUTHOR]

Metatarsalgia is a frequent foot disorder. The objective was to evaluate whether the length ratio between the second and the third metatarsals after Weil osteotomy influences clinical outcomes. This retrospective study included 37 patients (53 feet). Preoperative planning consisted of keeping the second metatarsal greater than or equal to the third metatarsal after Weil osteotomy of the second metatarsal or the second and third metatarsals. Based on postoperative weightbearing and digital AP radiographs after Weil osteotomy, we divided the patients into 2 groups: group 1, the second metatarsal was longer than or equal to the third metatarsal; and group 2, the second metatarsal was shorter than the third metatarsal. We investigated whether there were differences between the groups. In 35 (66%) feet, the second metatarsal was longer than or equal to the third metatarsal (group 1), and in 18 (34%) feet, the second metatarsal was shorter than the third metatarsal (group 2). Postoperative American Orthopaedic Foot and Ankle Society scores were 86.2 and 82.7, respectively (p =.32). Postoperative Visual Analog Scale scores were 1.26 and 1.67, respectively (p =.39). The sample showed 11.3% of transfer metatarsalgia to the third metatarsal. Group 1 had 9% of transfer metatarsalgia, whereas group 2 had 17% of transfer metatarsalgia (p =.40). The presence of a second metatarsal shorter than the third metatarsal, after Weil osteotomy of the second metatarsal or the second and third metatarsals, does not influence outcomes or incidence of transfer metatarsalgia to the third metatarsal. [ABSTRACT FROM AUTHOR]

Abstract Objective To present the clinical and radiographic results of hallux valgus surgical correction using four percutaneous techniques, chosen according to a predefined radiographic classification. Methods We prospectively evaluated 112 feet in 72 patients with hallux valgus operated over the course of 1 year. Percutaneous distal soft tissue release (DSTR) and the Akin procedure (DSTR-Akin) were performed in mild cases. In mild to moderate hallux valgus with distal metatarsal joint angle > 10°, we added the Reverdin-Isham (RI) osteotomy. In moderate cases with joint incongruity, we performed the percutaneous chevron (PCH). Finally, a Ludloff-like percutaneous proximal osteotomy fixed (PPOF) with a screw was proposed in severe cases with an intermetatarsal angle (IMA) > 17°. According to these criteria, 26 DSTRs-Akin, 36 PCHs, 35 RIs, and 15 PPOFs were performed. The mean follow-up was of 17.2 months (range: 12 to 36 months). The mean age at operation was 58.8 years (range: 17 to 83 years), and 89% of the patients were female. Results The mean preoperative hallux valgus angle (HVA) and the IMA decreased from 21° to 10.2° and from 11.2° to 10.3° respectively in the DSTR-Akin. In the RI, the mean HVA decreased from 26.6° to 13.7°, and the IMA, from 11.2° to 10.3°; in the PCH, the mean HVA decreased from 31° to 14.5°, and the IMA decreased 14.9° to 10.7°; as for the PPOF, the mean HVA decreased from 39.2° to 17.7°, and the IMA, from 11.8° to 6.8°. The average ankle and hindfoot score of the American Orthopaedic Foot and Ankle Society (AOFAS) increased from 49.2 to 88.6. The rate of complications was of 11%. Conclusion Our treatment protocol does not differ much from the classic ones, with similar results as well. We have as advantages less aggression to soft tissues and better cosmetic results. Level of Evidence: level IV, prospective case series.

Objective: The aim of the study was to radiographically evaluate the result of this minimally invasive technique for the surgical treatment of metatarsalgia. Methods: Radiographic images of 195 osteotomies in 48 patients (65 feet) who were exclusively submitted to the Distal Metatalsal Metaphyseal Osteotomy (DMMO) technique in the central rays (second, third, and fourth metatarsals) with a minimum follow-up of six months were analyzed. Bone healing, metatarsal shortening, and bone healing positioning (central, lateral, or medial) were evaluated. All statistical analysis was performed using the R software, and Wilcoxon statistical tests and Student’s t-test paired for continuous variables were used. Results: The mean length of the second metatarsal reduced 7.0mm (p

Objective: Present the outcomes of oblique osteotomy and capsuloplasty based on the pre-/postoperative American Orthopaedic Foot & Ankle Society (AOFAS) scores and demonstrate the possibility of correcting all four types of bunionette through a single technique. Methods: Descriptive observational study performed through medical records assessment based on the pre-/postoperative AOFAS scores. Results: Fifty-three feet were operated on, 28 on the right side and 25 on the left, predominantly female (n=34) and one male. The mean age was 44.8 years (range 19-77). The improvement in the AOFAS score occurred in all patients, the preoperative mean was 53.7 (44-57), and the postoperative mean was 77.4 (65-80). The distal oblique osteotomy of the fifth metatarsal associated with capsuloplasty was used. Conclusion: The technique used in our study presents a significant improvement in all cases, corroborating with the outcomes in the literature. Level of Evidence IV; Descriptive Observational Study.

This work presents the objectives and indications of the three distal osteotomies of the first metatarsal most frequently used in Hallux Rigidus surgery: Weil-Barouk oblique osteotomy, Youngswick (modified Chevron) osteotomy, and Watermann dorsal closed wedge osteotomy. The surgical technique, indications, advantages, and disadvantages of each of them are described. Level of Evidence V; Therapeutic Studies; Expert Opinion.

Objective: To develop distance-mapping and coverage-mapping algorithms to assess metatarsophalangeal and metatarsal-sesamoid joint interaction in hallux valgus patients, comparing them to a control group. Methods: A total of 9 hallux valgus patients (mean age 37.1 y; 6 F/3 M) and 5 controls (mean age 39 y; 4 F/1 M) underwent weight-bearing computed tomography. Specific software was used to obtain bone segmentation images of the first and second metatarsals, the first and second proximal phalanxes, and the tibial and fibular sesamoids. Joint interaction based on distance mapping and coverage mapping of the first and second metatarsophalangeal joints and the metatarsal-sesamoid joints were calculated. The surfaces of the metatarsophalangeal joints were divided in a 2-by-2 grid using the principal axes to provide a more detailed analysis. P-values

Competing Interests: All authors have disclosed no conflicts of interest.

Objective: To assess interobserver reliability of previously described coronal plane rotation measurements of medial column bones and to assess their ability to accurately quantify changes in rotational profile. Methods: Two cadaveric below-knee specimens were implanted with pins in each bone of the medial column. Weight-bearing computed tomography (CT) scans were acquired in a simulated standing position under neutral, supinated, and pronated conditions. For each specimen and condition, 2 observers measured the coronal plane rotation of the navicular, medial cuneiform, first metatarsal base, shaft, and head, and proximal phalanx of the hallux as previously described. The rotation of each pin was measured relative to the ground in the coronal plane for each condition. These measurements were defined as benchmarks for the rotational profile of each bone. The correlation between these benchmarks and direct bone measurements was then assessed. Intraclass correlation coeficiente was used to assess interobserver reliability. Pearson’s coefficient was used to evaluate correlations. Results: The interobserver reliability of direct bone measurements ranged from 0.98 to 0.99. Correlations between pin rotation and direct measurements ranged from ρ=0.87 to 0.99 across the neutral, supinated, and pronated conditions. Conclusion: Coronal plane rotation measurements of medial column bones described in this study are reliable tools. Level of Evidence III; Case-Control Study.

Objective: To assess whether traditional hallux valgus (HV) measurements obtained with conventional radiography (CR) correspond to those obtained with weight-bearing computed tomography (WBCT). Methods: In this retrospective case-control study, 26 HV feet and 20 control feet were analyzed with CR and WBCT. Hallux valgus angle (HVA), intermetatarsal angle (IMA), interphalangeal angle (IPA), distal metatarsal articular angle (DMAA), sesamoid station (SS), and first metatarsal head shape were measured. Chi-square tests were used to compare hallux valgus and control patients. T-tests were used to compare CR and WBCT. P-values less than 0.05 were considered significant. Results: WBCT was capable of discriminating patients with HV from controls, showing higher mean values for HV patients than controls in HVA (35.29 and 9.02, p < 0.001), IMA (16.01 and 10.01, p < 0.001), and DMAA (18.90 and 4.10, p < 0.001). When comparing the two methods, differences were not significant between CR and WBCT measurements in HVA (-0.84, p = 0.79), IMA (-0.93, p = 0.39), IPA (1.53, p = 0.09), or SS (p = 0.40), but were significant for DMAA (13.43, p < .0001). CR analysis yielded varied metatarsal head shapes, while all WBCT shape classifications were round. Conclusion: Unidimensional HV measurements were similar between WBCT and CR, while more three-dimensional findings were not. CR may be used to assess the axial aspects of HV, but multidimensional aspects of the deformity may not be accurately assessed with plain radiographs. Level of Evidence III; Therapeutic Studies; Retrospective Case-Control Study.

Objective: First tarsometatarsal joint (TMTJ) arthrodesis, also known as Lapidus, is a surgical procedure used to treat severe hallux valgus, associated hypermobility of the first ray, and/or osteoarthritis of the first TMTJ. Despite the high satisfaction rate and high corrective power, this technique is not without complications. This study aimed to report the complications of first TMTJ arthrodesis. Methods: This is a case series of 16 patients treated with first TMTJ arthrodesis. Patients were evaluated based on foot radiographs, clinical alignment of the hallux, and signs and symptoms. Results: Eight patients had either major or minor complications. Three patients had recurrent deformity (1 with associated nonunion), 2 had delayed union, 2 had hardware loosening (1 with associated nonunion), and 1 had wound dehiscence. Conclusion: First TMTJ arthrodesis requires greater care in choosing the surgical technique for the treatment of hallux valgus. In addition, some points should be considered to minimize complications as much as possible. We believe that data are still scarce to provide a concrete basis. Level of Evidence IV; Therapeutic Studies; Case Series.

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.

Objective: To present initial radiographic results of surgical correction of the hallux valgus angle (HVA) and the intermetatarsal angle (IMA) using the percutaneous Bianchi system (PBS) technique. Methods: Seventeen patients with moderate to severe hallux valgus (HV) were exclusively treated with the PBS technique and assessed radiographically preoperatively and during the postoperative period, from January 2019 to January 2020. The degree of deformity correction was recorded, based on the HVA and the IMA. Stata (v. 14.0) software was used for statistical analyses. Pre-surgical and post-surgical mean HVA and IMA were compared using Student’s t test for paired samples and the McNemar test was used to compare HVA and IMA categories. Statistical significance was set at 5% and 95% confidence intervals were estimated. Results: Both HVA and IMA were reduced significantly during the assessment period. Mean radiographic correction of the HVA was 15.1° and mean radiographic correction of the IMA was 7.3. Conclusions: According to the results presented, use of the PBS technique achieved adequate correction of the radiographic parameters of the patients who underwent the treatment as proposed, although it is necessary to conduct additional studies with longer follow-up to achieve a higher recommendation level. Level of Evidence IV; Therapeutic Studies; Case Series.

• A new method of sex estimation using dimensions around the metatarsal nutrient foramen. • Multivariable DFA produced 83.1–88.3% classification accuracies. • Multivariable LRA produced 83.3–88.7% classification accuracies. • The dimensions around the metatarsal nutrient foramen are suitable for sex estimation. Sex estimation equations are population-specific, and a wider use of multiple bones to generate equations will increase the accuracy of sex estimation in forensic settings. The metatarsal bones have been used previously, however the dimensions around the diaphyseal nutrient foramen have not been utilised in sex estimation. The current study aimed to determine the utility of the dimensions around the nutrient foramen of metatarsal bones in estimating sex in the South Africans of European descent (SAED). Five measurements around the nutrient foramen were taken from a total of 876 metatarsal bones (first to fifth) from 186 individual skeletons (99 males, 87 females) obtained from the Raymond A. Dart Modern Skeletal Collection. Measurements subjected to direct and stepwise discriminant function (DFA) and logistic regression (LRA) analyses included total length, distance from proximal end to nutrient foramen, circumference, and mediolateral and dorsoplantar diameters at the level of the nutrient foramen. The original classification accuracies for multivariable functions of the stepwise and direct DFA ranged from 83.1–88.3% to 85.5–88.3%, respectively. The original classification accuracies for multivariable functions of the stepwise and direct LRA ranged from 83.3%–88.7% to 86.2%–88.3%, respectively. The cross-validation classifications showed a drop of 0–2.4% for DFA and 0.2–1.1% for LRA. The width measurements were better predictors of sex than length. The dimensions around the metatarsal bone nutrient foramen exhibit sexual dimorphism in the SAED. The generated DFA and LRA functions produced high average classification accuracies which are useful in sex estimation during forensic human identification. [ABSTRACT FROM AUTHOR]

Background: Data regarding the lesion detection ability of different radiotracers are lacking in equine bone scintigraphy., Methods: In this prospective study, hydroxymethylene diphosphonate (HMDP) and methylene diphosphonate (MDP) were compared in horses with increased radiopharmaceutical uptake either in the caudal cervical region (CS group) or in the proximal metacarpal/metatarsal region (PMR group). Region of interest analysis was used to determine normal bone-to-soft tissue ratios, lesion-to-normal bone ratios and lesion-to-soft tissue ratios. Qualitative scoring and total count rates were recorded for each image., Results: A total of 213 scintigrams were included. Within the PMR group, there were significantly higher lesion-to-normal bone ratios for MDP compared with HMDP (p = 0.02). In the CS group, normal bone-to-soft tissue ratios were significantly higher for HMDP (p = 0.01). The interobserver agreement with regard to the qualitative assessment of the scintigrams was poor., Limitation: Paired studies, comparing the different radiotracers in the same patient, were not feasible., Conclusion: This study revealed minor differences between the two radiotracers, although these have no practical implications. Both radiopharmaceuticals are well suited for detecting lesions at the investigated sites using equine bone scintigraphy., (© 2024 The Authors. Veterinary Record published by John Wiley & Sons Ltd on behalf of British Veterinary Association.)

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.)

Objective: Hallux valgus is a progressive triplanar deformity of the forefoot with an important rotational component (RC) in the first metatarsal, which has been associated with recurrence. There is controversy about using weight-bearing vs. non-weight-bearing radiographs in RC measurement. This study aims to assess interobserver reliability for RC of the first metatarsal using a non-weight-bearing sesamoid view, as well as to correlate the hallux valgus angle, intermetatarsal angle, distal metatarsal articular angle (DMAA) and sesamoid position regarding RC. Methods: An observational, cross-sectional and descriptive study was conducted with 81 feet from 48 patients (66.6% female). RC was evaluated regarding the first metatarsal proximal shaft in non-weight-bearing axial metatarsal radiographs and weight-bearing anteroposterior radiographs. Measurements were taken independently by two foot and ankle subspecialists and an orthopedic resident, all of whom were blinded. Results: Statistically significant intraclass correlations (p = 0.02) were obtained for first metatarsal RC assessment among the three observers (95%CI 0.01–0.65; Cronbach’s α =0.41) in non-weight-bearing axial metatarsal views. Significant correlations (Spearman ρ) were also found for hallux valgus angle (p = 0.04) and DMAA (p = 0.01), and non-significant correlations were found for intermetatarsal angle and sesamoid position (p > 0.05). Conclusion: The significant correlations between hallux valgus angle and DMAA for RC suggest that RC is isolated from the first metatarsal bone structure. This practical assessment method may isolate the first metatarsal head RC regarding the proximal metatarsal in the metaphyseal region and could be useful in centers where weight-bearing CT scans are not available. Level of Evidence IV; Therapeutic Studies; Case Series.

Background: Freiberg’s disease is an uncommon condition typified by bony infarction of the second metatarsal head with a vague multifactorial etiology which tends to mostly occur in women. Case Report: A 22-year-old woman presented with second metatarsal head local pain exacerbating while walking without any prominent previous trauma history; clinical and imaging workups revealed metatarsal head osteonecrosis of Freiberg’s infarction. Conclusion: It should be kept in mind that for those complaining of forefoot discomfort, especially in the region of metatarsal heads, Freiberg’s avascular necrosis (AVN) could be a potential pathology.

Introduction: The os intermetatarseum is an uncommon accessory ossicle of the foot located dorsally, between the bases of the first and second metatarsals that are usually asymptomatic. In the setting of trauma, this ossicle can clinically mimic a Lisfranc fracture–dislocation, a potentially disabling condition often requiring surgical intervention. Methods: In this study, 47 cases of os intermetatarseum were reviewed across several Western Australian (WA) Hospitals and characterised based on morphology. Any fractures were recorded, and their cases were reviewed. Results: The most common type of os intermetatarseum was freestanding at 63%, followed by the articulating type at 30%. Only 7% were of the fused type. Two acute fractures were identified on plain radiography and computed tomography (CT). Conclusion: The distribution of os intermetatarseum subtypes in the WA population is consistent with previous radiological studies. The two cases of isolated acute os intermetatarseum fracture are described, the first to our knowledge, highlighting the need for increased awareness of this ossicle in the setting of foot trauma. [ABSTRACT FROM AUTHOR]

Aim: To compare the results of conservative and surgical treatment of fractures of the proximal fifth metatarsal (V MT) bone in the athletes. These fractures represent a great diagnostic and therapeutic challenge. They are traditionaly divided into 3 zones: tuberosity (zone I), metaphysis (zone II), and proximal diaphysis (zone III). Due to the compromised circulation, these fractures are characterized by difficult and prolonged healing that ends with the development of pseudarthrosis, especially in young and physically active individuals. Patients and Methods: During the 13-year period in University Hospital Merkur 61 athletes with a total of 65 fractures of V MT bones in zone II and III were treated. All other patients were excluded from this study. The patients were divided into 2 groups: Group 1 - operatively treated and Group 2 - conservatively treated fractures.There were 50 (77%) fractures in Group 1 and 15 (23%) in Group 2. At the beginning of the study, a maleolar screw was used for osteosynthesis but due to complications it was later replaced by a stronger intramedullary screw. Treatment results were followed by radiological and clinical examination and evaluated by Modified Foot score (MFS). Results: The follow-up period averaged 12 months. In the Group 1 most fractures healed within 8 weeks. Prolonged healing were present in 7 (14%) fractures. In the later rehabilitation period 3 (6%) patients had refracture which was resolved by reopereting and installing a stronger screw.In the Group2, 7 (46%) fractures did not heal over a 6-month period and 5 (33%) of them underwent surgery. Finally, all operated fractures were healed. According to MFS, the Group1 had a significantly better result. Conclusion: Good diagnosis and classification of fractures, as well as surgical treatment of fractures of the metaphysis and proximal diaphysis, guarantee rapid fracture healing and early return to full sport activity. [ABSTRACT FROM AUTHOR]

Osteoma is a benign bone-forming tumor composed of compact or mature trabecular bone and is limited almost exclusively to craniofacial bones, especially in the paranasal sinuses and mandible. It is typically a slow growing lesion that is asymptomatic, unless its size significantly increases to cause symptoms such as pain or other neurological symptoms, that happens more often in cases involving craniofacial bones. Radiological appearance of these tumors depends on their location. In cases of juxtacortical osteoma, it is crucial to differentiate between this type of tumor and parosteal osteosarcoma, sessile osteochondroma, and matured juxtacortical focus of myositis ossificans. However, in some cases, it is difficult to differentiate juxtacortical osteoma from above mentioned lesions only with radiologic appearance. We describe a case of an osteoma that arose from the second metatarsal bone, a rare anatomical location for osteoma.