Foot Deformities, Acquired

足部畸形,收购
  • 文章类型: Journal Article
    背景:进行性塌陷性足部畸形(PCFD),正式称为“成人获得性扁平足畸形”(AAFFD),是一种复杂的足部畸形,由多个组成部分组成。如果需要手术,联合保存程序,如内侧移位跟骨截骨术(MDCO),经常执行。本系统综述的目的是总结MDCO对足部生物力学影响的证据。
    方法:根据系统评价和荟萃分析(PRISMA)的首选报告项目,对两个主要来源(PubMed和Scopus)进行系统文献检索,没有时间限制。仅包括报告MDCO后生物力学变化的原始研究研究。排除标准包括评论文章,案例研究,学习不是用英语写的。纳入27项研究,根据QUACS量表和改良的Coleman评分对方法学质量进行分级。
    结果:纳入的27项研究包括18具尸体,7项基于生物力学模型的研究,2项临床研究。评估了MDCO对以下五个主要参数的影响:足底筋膜(n=6),内侧纵弓(n=9),足后和中关节压力(n=10),跟腱(n=5),和步态模式参数(n=3)。研究的质量中等至良好,体外的合并平均QUACS评分为65%(范围46-92%),临床研究的合并平均Coleman评分为58分(范围56-65)。
    结论:全面了解MDCO如何影响足部功能是正确理解这种常见手术的术后效果的关键。根据证据,MDCO影响足底筋膜和跟腱的功能,内侧纵弓的完整性,后足和中足关节压力,以及因此特定的步态模式参数。
    BACKGROUND: Progressive collapsing foot deformity (PCFD), formally known as \"adult-acquired flatfoot deformity\" (AAFFD), is a complex foot deformity consisting of multiple components. If surgery is required, joint-preserving procedures, such as a medial displacement calcaneal osteotomy (MDCO), are frequently performed. The aim of this systematic review is to provide a summary of the evidence on the impact of MDCO on foot biomechanics.
    METHODS: A systematic literature search across two major sources (PubMed and Scopus) without time limitation was performed according to the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) criteria. Only original research studies reporting on biomechanical changes following a MDCO were included. Exclusion criteria consisted of review articles, case studies, and studies not written in English. 27 studies were included and the methodologic quality graded according to the QUACS scale and the modified Coleman score.
    RESULTS: The 27 included studies consisted of 18 cadaveric, 7 studies based on biomechanical models, and 2 clinical studies. The impact of MDCO on the following five major parameters were assessed: plantar fascia (n = 6), medial longitudinal arch (n = 9), hind- and midfoot joint pressures (n = 10), Achilles tendon (n = 5), and gait pattern parameters (n = 3). The quality of the studies was moderate to good with a pooled mean QUACS score of 65% (range 46-92%) for in-vitro and a pooled mean Coleman score of 58 (range 56-65) points for clinical studies.
    CONCLUSIONS: A thorough knowledge of how MDCO impacts foot function is key in properly understanding the postoperative effects of this commonly performed procedure. According to the evidence, MDCO impacts the function of the plantar fascia and Achilles tendon, the integrity of the medial longitudinal arch, hind- and midfoot joint pressures, and consequently specific gait pattern parameters.
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  • 文章类型: Journal Article
    Checkrein畸形的特征在于hallux的动态状态,其中屈曲畸形因踝背屈而加重,因踝趾屈而减轻。在大多数情况下,checkrein畸形继发于外伤或手术后。有人认为,长屈肌腱系链或包裹疤痕组织或骨折部位。一旦畸形已经根深蒂固,保守治疗很难改善,严重病例通常需要手术治疗。各种手术选择可用于纠正checkrein畸形。它包括在骨折部位简单地释放粘连;在骨折部位通过Z-成形术延长长屈肌,同时释放粘连;在中足通过Z-成形术延长长屈肌,后踝关节,或tar骨隧道区域;和指间关节固定术的长指屈肌切开术治疗复发性病例。这篇综述旨在总结总体病因,相关解剖学,诊断,以及文献中描述的checkrein畸形的治疗。
    Checkrein deformity is characterized by the dynamic status of the hallux, in which flexion deformity is aggravated by ankle dorsiflexion and relieved by ankle plantarflexion. In most cases, a checkrein deformity occurs secondary to trauma or following surgery. It has been suggested that the flexor hallucis longus tendon tethers or entraps scar tissue or fracture sites. Improvement with conservative treatment is difficult once the deformity has already become entrenched, and surgical management is usually required in severe cases. Various surgical options are available for the correction of checkrein deformities. It includes a simple release of adhesion at the fracture site; lengthening of the flexor hallucis longus by Z-plasty at the fracture site combined with the release of adhesion; lengthening of the flexor hallucis longus by Z-plasty at the midfoot, retromalleolar, or tarsal tunnel area; and flexor hallucis longus tenotomy with interphalangeal arthrodesis for recurrent cases. This review aimed to summarize the overall etiology, relevant anatomy, diagnosis, and treatment of checkrein deformities described in the literature.
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  • 文章类型: Journal Article
    BACKGROUND: Neuro-osteoarthropathy of the foot (CN) is divided into an active and inactive stage, with impact on the further treatment. The histopathological Charcot score (HCS) can be used, to grade the inflammatory activity in tissue samples.
    OBJECTIVE: This study aims to clarify whether successful bony healing after arthrodesis is related to inflammatory activity of the disease.
    METHODS: N = 80 patients underwent corrective arthrodesis of the midfoot (group 1) or hindfoot/ankle (group 2). A distinction was made between patients with/without diabetes mellitus and with/without pain perception. Intraoperative samples were taken to determine HCS. The osseous healing of the arthrodesis was determined by computed tomography 12 weeks postoperatively.
    RESULTS: There was an indirect correlation between bony consolidation and HCS. In group 2, there was a significantly worse bony healing in patients without pain sensation. There seems to be a tendency for HCS to be increased in patients without diabetes/no pain sensation.
    CONCLUSIONS: The present study confirms the assumption that corrective arthrodesis should be performed in the inactive stage of CN only. High activity levels obviously impede bony healing. HCS represents a relevant prognostic tool for surgical treatment.
    UNASSIGNED: HINTERGRUND: Die Neuroosteoarthropathie des Fußes wird in ein aktives und ein inaktives Stadium unterteilt, was Einfluss auf die weitere Therapie hat. Hierfür kann der histopathologische Charcot-Score (HCS) verwendet werden, da er ein Maß für die Entzündungsaktivität auf Basis von Gewebeproben darstellt.
    UNASSIGNED: In der vorliegenden Arbeit soll geklärt werden, ob eine erfolgreiche knöcherne Heilung nach Arthrodese abhängig von der Entzündungsaktivität der Erkrankung ist.
    UNASSIGNED: Es unterzogen sich N = 80 Patienten einer Korrekturarthrodese des Mittel- (Gruppe 1) oder Rückfußes/OSG (Gruppe 2). Unterschieden wurde zwischen Patienten mit/ohne Diabetes mellitus sowie mit/ohne Schmerzempfinden. Intraoperativ wurden Proben zur Bestimmung des HCS entnommen. Die knöcherne Heilung der Arthrodesen wurde 12 Wochen postoperativ mittels Computertomographie überprüft.
    UNASSIGNED: Es ergab sich eine indirekte, signifikante Korrelation zwischen knöcherner Konsolidierung und HCS. In Gruppe 2 bestand bei Patienten ohne Schmerzempfinden eine signifikant schlechtere knöcherne Heilung. Tendenziell schien der HCS bei Patienten ohne Diabetes/ohne Schmerzempfinden erhöht zu sein.
    CONCLUSIONS: Die vorliegende Studie bestätigt die Vermutung, dass Korrekturarthrodesen nur im inaktiven Stadium der Charcot-Erkrankung durchgeführt werden sollten. Hohe Aktivitätsniveaus behindern offensichtlich die knöcherne Heilung. Der HCS ist ein relevanter prognostischer Faktor für die Therapieplanung.
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  • 文章类型: Journal Article
    类风湿关节炎(RA)患者常发生小趾meta趾(MTP)关节的背侧脱位,并可能导致疼痛和不舒服的足底call骨和溃疡。当前的研究检查了一种新的影像学参数(MTP重叠距离[MOD])在评估MTP关节脱位严重程度中的可靠性和临床意义。当前研究的受试者是147名RA患者(276英尺;1104脚趾)。MOD,定义为meta骨头部和指骨近端的重叠距离,是在普通射线照片上测量的。分析了MOD与临床症状(前足疼痛和/或call骨形成)之间的关系,以创建严重程度分级系统。因此,有call骨的脚趾的MOD明显更大。ROC分析显示,MOD具有较高的AUC来预测无症状的足部(-0.70)和call骨(0.89)。MOD等级定义如下:等级1,0≤MOD<5mm;等级2,5≤MOD<10mm;等级3,MOD≥10mm。MOD等级的观察者内部和观察者之间的可靠性具有很高的可重复性。此外,对于较小的脚趾畸形,在保留关节手术后,MOD和MOD等级显着改善。我们的结果表明,MOD和MOD等级可能是评估RA患者小脚趾畸形和手术干预对MTP关节影响的有用工具。
    Dorsal dislocation of metatarsophalangeal (MTP) joints of the lesser toe frequently occurs in patients with rheumatoid arthritis (RA), and may cause painful and uncomfortable plantar callosities and ulceration. The current study examined the reliability and clinical relevance of a novel radiographic parameter (the MTP overlap distance [MOD]) in evaluating the severity of MTP joint dislocation. The subjects of the current study were 147 RA patients (276 feet; 1104 toes). MOD, defined as the overlap distance of the metatarsal head and the proximal end of the phalanx, was measured on plain radiographs. The relationship between the MOD and clinical complaints (forefoot pain and/or callosity formation) was analyzed to create a severity grading system. As a result, toes with callosities had a significantly larger MOD. ROC analysis revealed that the MOD had a high AUC for predicting an asymptomatic foot (-0.70) and callosities (0.89). MOD grades were defined as follows: grade 1, 0 ≤ MOD < 5 mm; grade 2, 5 ≤ MOD < 10 mm; and grade 3, MOD ≥ 10 mm. The intra- and inter-observer reliability of the MOD grade had high reproducibility. Furthermore, the MOD and MOD grade improved significantly after joint-preserving surgeries for lesser toe deformities. Our results suggest that MOD and MOD grade might be useful tools for the evaluation of deformities of the lesser toe and the effect of surgical intervention for MTP joints in patients with RA.
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  • 文章类型: Journal Article
    Flatfoot deformity consists of a loss of medial arch, hindfoot valgus, and forefoot abduction. Historically considered a posterior tendon insufficiency, multiple ligament damage and subsequent incompetence explain the different clinical presentations with varying degrees of deformity. When surgery is deemed necessary, depending on the apex of the deformity, skeletal and soft tissue procedures are considered to keep motion and restore function. Osteotomies are considered at every level where an apex of deformity is found. The recently designated tibiocalcaneonavicular ligament comprises the older superficial and deep deltoid and spring ligaments; its repair or reconstruction should be considered in most flatfoot cases.
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  • 文章类型: Journal Article
    Objective: The aim of this study was to evaluate and classify the types and incidences of foot deformities in patients with Rheumatoid Arthritis (RA). Methods: A cross-sectional study with convenience sample was obtained of 220 patients with foot pain and RA classification criteria (approved by the American College of Rheumatology and the European League against Rheumatism in 2010). A series of outcomes were assessed to measure the morphological characteristics of the feet. The Foot Posture Index (FPI), the Manchester Scale of Hallux Valgus and the Nijmegen classification of forefoot disorders were assessed. Results: The most common foot posture according to the FPI assessment are the pronated position in the left foot (32.7% of participants) and the neutral position in the right foot (34.1% of participants). The disease progression causes more developed and serious foot deformities. 1.82% of patients present a severe level of Hallux Valgus before 10 years of disease evolution whereas 4.09% of patients present a severe level of Hallux Valgus after 10 years of disease evolution. Conclusions: The most common foot type in patients with RA is the pronated foot type with deformities in the MTP joints without Hallux Valgus. However, a percentage of patients with RA presents supinated foot type. The evolution of the disease shows some morphological changes in terms of patient\'s feet. The presence of more developed foot deformities is increased, such us Hallux Valgus or MTP joints deformity (Grade 3 in the Nijmegen classification scale).
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  • 文章类型: Journal Article
    The combination of first metatarsophalangeal joint arthrodesis and resection arthroplasty of all lesser metatarsal heads has been historically considered the golden standard treatment for rheumatoid forefoot deformities. However, as recent improved management of rheumatoid arthritis have reduced progression of joint destruction, the surgical treatments for rheumatoid forefoot deformities have gradually changed from joint-sacrificing surgery, such as arthrodesis and resection arthroplasty, to joint-preserving surgery. The aim of this literature review was to provide current evidence for joint-preserving surgery for rheumatoid forefoot deformities. We focused on the indications, specific outcomes, and postsurgical complications of joint-preserving surgery in this review.
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  • 文章类型: Journal Article
    BACKGROUND: The treatment for displaced Salter-Harris II (S-H II) distal tibia fractures remains controversial. The purpose of this study was to review S-H II distal tibia fractures and evaluate the rate of premature physeal closure (PPC) treated by open reduction and internal fixation (ORIF).
    METHODS: We reviewed the charts and radiographs of S-H II fractures of the distal tibia with displacement > 3 mm between 2012 and 2019 treated by ORIF. Patients were followed up for a minimum of 6 months. CT scans of injured side or contralateral ankle radiograph were obtained if there was any evidence of PPC. Any angular deformity or shortening of the involved leg was documented. Multivariable logistic regression was performed to identify risk factors for the occurrence of PPC.
    RESULTS: A total of 65 patients with a mean age of 11.8 years were included in this study. The mean initial displacement was 8.0 mm. All patients but one were treated within 7 days after injury and the mean interval was 3.7 days. Supination-external rotation injuries occurred in 50 patients, pronation-eversion external rotation in 13, and supination-plantar flexion in two. The residual gap was less than 1 mm in all patients following ORIF and all fractures healed within 4-6 weeks. Superficial skin infection developed in one patient. Ten patients complained of the cosmetic scar. The rate of PPC was 29.2% and two patients with PPC developed a varus deformity of the ankle. Patients with associated fibular fracture had 7 times greater odds of developing PPC. Age, gender, injured side, mechanism of injury, amount of initial displacement, interval from injury to surgery, or energy of injury did not significantly affect the rate of PPC.
    CONCLUSIONS: ORIF was an effective choice of treatment for S-H II distal tibia fractures with displacement > 3 mm to obtain a satisfactory reduction. PPC is a common complication following ORIF. The presence of concomitant fibula fracture was associated with PPC.
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  • 文章类型: Journal Article
    The purpose of this study was to assess the functional results, quality of life, and complications in two groups of Charcot-Marie-Tooth (CMT) patients according to the type of surgical operations, joint preserving, or joint sacrificing surgery.
    Fifty-two feet in forty-six patients with CMT who had undergone surgical deformity correction were divided into two groups based on the main surgical procedure for the correction: Class I (joint preserving surgery) and class II (joint sacrificing surgery). Foot ankle disability index (FADI) and short form 12 version 2 (SF12V2) were documented pre-operative and 12 months post-operative. The complications of both groups were monitored with a mean follow-up time of 20.5 months (range, 13-71.5).
    After surgical treatment, FADI scores showed differences (p=0.005) between both groups. The functional improvement was 29 (20-46; p<0.001) in class I and 10 (2-36; p=0.001) in class II. The patients in both groups acquired a better quality of life as demonstrated in physical component summary of SF12 but without statistically difference. Three feet needed reintervention in class I (two for cavovarus recurrence and one for hallux flexus) at the end of follow-up. In contrast, five feet needed a new operation for cavovarus recurrence, claw toes recurrence, and ankle osteoarthritis after the progression of the condition.
    An early surgical intervention to neutralize the deforming forces in CMT patients could be a useful strategy to delay or prevent the need for extensive reconstruction and potential future complications.
    Based on the type of surgical intervention in CMT patients, the joint preserving surgery in addition to soft tissue balancing procedures obtained better functional outcomes and lower rate of complications when compared to the group of joint sacrificing surgery.
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  • 文章类型: Journal Article
    This study aimed to evaluated ischemic metabolites in subcutaneous tissue, skeletal muscle, and calcaneal cancellous bone before, during, and after tourniquet application in a simultaneous paired comparison of tourniquet-exposed and non-tourniquet-exposed legs. Ten patients scheduled for hallux valgus or hallux rigidus surgery were included. Microdialysis catheters were placed to simultaneously and continuously sample the metabolites glucose, lactate, pyruvate, and glycerol bilaterally for 12 h in subcutaneous tissue, skeletal muscle, and calcaneal cancellous bone. A tourniquet was applied on the leg planned for surgery (inflation time: 15 min, mean tourniquet duration time (range): 65 (58;77) min). During tourniquet inflation, a 2- to 3-fold increase of the mean lactate/pyruvate ratio was found for all investigated tissues in the tourniquet-exposed leg compared with the non-tourniquet-exposed leg. The lactate/pyruvate ratio recovery time after tourniquet release was within 30 min for skeletal muscle, 60 min for subcutaneous tissue, and 130 min for calcaneal cancellous bone. Only the tourniquet-exposed skeletal muscles were found to be ischemic during tourniquet inflation, defined by a significant increase of the lactate/pyruvate ratio exceeding the ischemic cutoff level of 25; however, this level decreased below 25 immediately after tourniquet release. The glycerol ratio increased instantly after inflation in the tourniquet-exposed leg in skeletal muscle and subcutaneous tissue, and recovered within 60 (skeletal muscle) and 130 min (subcutaneous tissue) after tourniquet release. These findings suggest that applying tourniquet for approximately 1 h results in limited tissue ischemia and cell damage in subcutaneous tissue, skeletal muscle, and calcaneal cancellous bone.
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