Foot Joints

脚部关节
  • 文章类型: Journal Article
    多分段足部模型(MSFM)用于捕获足部特定区域的数据,而不是将足部表示为单个足部,刚性段。据记载,不同的MSFM不会产生相同的关节运动学数据,但是关于它们用于动力学分析的信息很少。我们比较了胫骨的瞬间和力量,tarsal中,在赤脚行走和慢跑的站立阶段,使用年轻成年跑步者的动作捕捉数据,以及四个MSFM的and趾关节。在这些模型中,三个之前得到了验证:牛津,密尔沃基,和根特脚模型。基于对现有模型的文献综述,开发了一种模型:“Vogel”模型。我们进行了统计参数映射,将每个模型的联合测量值与牛津模型的相应结果进行比较,研究最多的MSFM。我们发现牛津,密尔沃基,沃格尔,和根特脚模型不能提供相同的动力学结果。段定义的差异以改变测量的脚的运动学功能的方式影响自由度。进而影响动力学结果。这项研究的结果捕获了MSFM性能的可变性,因为它与动力学结果有关,并强调在解释结果时需要保持模型差异的意识。
    Multisegmented foot models (MSFMs) are used to capture data of specific regions of the foot instead of representing the foot as a single, rigid segment. It has been documented that different MSFMs do not yield the same joint kinematic data, but there is little information available regarding their use for kinetic analysis. We compared the moment and power at the tibiotalar, midtarsal, and metatarsophalangeal joints of four MSFMs using motion capture data of young adult runners during stance phase of barefoot walking and jogging. Of these models, three were previously validated: the Oxford, Milwaukee, and Ghent Foot Models. One model was developed based upon literature review of existing models: the \"Vogel\" model. We performed statistical parametric mapping comparing joint measurements from each model to the corresponding results from the Oxford model, the most heavily studied MSFM. We found that the Oxford, Milwaukee, Vogel, and Ghent Foot Models do not provide the same kinetic results. The differences in segment definitions impact the degrees of freedom in a manner that alters the measured kinematic function of the foot, which in turn impacts the kinetic results. The results of this study capture the variability in performance of MSFMs as it relates to kinetic outcomes and emphasize a need to remain aware of model differences when interpreting results.
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  • 文章类型: Journal Article
    背景:研究报告Lisfranc损伤比想象的更常见。已经描述了几种评估Lisfranc损伤稳定性的成像方法,但许多方法无法标准化且不够准确。
    目的:提出一种三维(3D)方法,用于分析健康个体中足中关节和Lisfranc复合体内侧部分关节的关节间隙宽度的变化。
    方法:获取11只健康足的非负重和负重锥形束计算机断层扫描(CBCT)图像,并使用3D软件进行分析。根据各个图像对的变化来计算每个关节的关节空间宽度变化的平均范围。
    结果:3D分析软件用于分析Lisfranc复合体的内侧部分。在这个健康的脚样本中,Lisfranc复合体内侧部分关节空间的变化,用三维分析软件计算,小于0.6毫米。骨骼之间的距离增加或减少,根据关节表面的哪一部分进行测量。
    结论:在这项研究中,我们提出了一种三维分析方法来评估足中关节间隙宽度的变化。我们的分析显示,在健康的脚中,负重和非负重之间的关节间隙宽度变化很小,表明the中关节的运动最小。称重CBCT数据的3D分析为在各种条件下分析小型中足关节提供了有前途的工具。
    BACKGROUND: Studies report that Lisfranc injury is more common than thought. Several imaging methods for assessing the stability of Lisfranc injury have been described but many are impossible to standardize and not accurate enough.
    OBJECTIVE: To present a three-dimensional (3D) method for analyzing the changes in the joint space width of the midfoot joint and the joints of the medial part of the Lisfranc complex in healthy individuals.
    METHODS: Non-weightbearing and weightbearing cone-beam computed tomography (CBCT) images of 11 healthy feet were acquired and analyzed with 3D software. The mean range of joint space width changes of each joint was computed from the changes in individual image pairs.
    RESULTS: 3D analysis software was used to analyze the medial part of the Lisfranc complex. In this sample of healthy feet, the changes in the joint spaces in the medial part of Lisfranc complex, calculated with 3D analysis software, was less than 0.6 mm. The distance between bones increased or decreased, depending on which part of the joint surface the measurements were taken.
    CONCLUSIONS: In this study, we present a 3D analysis method to evaluate midfoot joint space width changes. Our analysis revealed that in healthy feet there are only minimal changes in the joint space width between weightbearing and non-weightbearing indicating minimal movement of the midtarsal joints. The 3D analysis of weightbearing CBCT data provides a promising tool for analyzing the small midfoot joints in a variety of conditions.
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  • 文章类型: Journal Article
    踝足复杂关节的运动由于各种生理和物理约束而耦合。本研究通过关注关节旋转方向和肌肉收缩类型,介绍了一种分析关节协同作用及其生理基础的新方法。我们开发了具有七个自由度的踝足复合体的仿生模型,考虑骨骼结构和生理轴方向。运动捕捉实验是由8名参与者在开链状态下进行背屈和屈,以及闭链状态下的各种行走任务,跨不同的地面倾角(±10°,±5°,0°)和步行速度(3km/h和4km/h)。分层聚类分析确定了联合协同聚类和运动原语,揭示了在开链运动中,踝关节的屈,睑骨,和掌趾关节与复合体中其余关节的倒置表现出协同作用;同时,背屈与外翻对齐。在闭链运动期间,协同分组在亚距骨交换,距骨,和跖趾关节.进一步分析表明,在开链运动中,多关节肌肉交叉斜关节轴的协同作用模式有助于足部运动。在闭链运动中,这些协同模式的变化增强了质心向对侧腿的推进,并改善了足弓的顺应性,促进人类运动。我们的工作增强了对踝足复合体内协同运动的生理机制的理解。
    The movement of the ankle-foot complex joints is coupled as a result of various physiological and physical constraints. This study introduces a novel approach to the analysis of joint synergies and their physiological basis by focusing on joint rotational directions and the types of muscle contractions. We developed a biomimetic model of the ankle-foot complex with seven degrees of freedom, considering the skeletal configuration and physiological axis directions. Motion capture experiments were conducted with eight participants performing dorsiflexion and plantarflexion in open-chain states, as well as various walking tasks in closed-chain states, across different ground inclinations (±10, ±5, 0 deg) and walking speeds (3 and 4 km h-1). Hierarchical cluster analysis identified joint synergy clusters and motion primitives, revealing that in open-chain movements, plantarflexion of the ankle, tarsometatarsal and metatarsophalangeal joints exhibited synergy with the inversion of the remaining joints in the complex; meanwhile, dorsiflexion was aligned with eversion. During closed-chain movements, the synergies grouping was exchanged in the subtalar, talonavicular and metatarsophalangeal joints. Further analysis showed that in open-chain movements, synergy patterns influenced by multi-joint muscles crossing oblique joint axes contribute to foot motion. In closed-chain movements, these changes in synergistic patterns enhance the propulsion of the center of mass towards the contralateral leg and improve foot arch compliance, facilitating human motion. Our work enhances the understanding of the physiological mechanisms underlying synergistic motion within the ankle-foot complex.
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  • 文章类型: Journal Article
    本研究旨在阐明第一睑板关节结构与关节小关节变性之间的关系。总共检查了50具尸体的100英尺。第一meta骨和内侧楔形骨的关节小面根据上小面和下小面的分离分为四种类型,和下外侧小平面在外侧足底突出上的形成:I型,没有分离的单个小平面或下部外侧小平面;II-a型,具有分离但没有下侧小平面的两个小平面;II-b型,两个方面,没有分离,但具有下侧小平面;III型,三个分离面和一个下外侧面。当两种骨骼类型匹配时,它们被定义为I型,II-a型,II-B型,和III型关节,分别;不匹配的类型被归类为未配对关节。使用5点量表评估两个骨骼上关节软骨退化的严重程度。在关节类型之间比较了变性等级。与II-a型相比,III型关节表现出明显较轻的内侧楔形文字关节软骨退变,II-b,解开关节。下外侧小平面的形成以及上下小平面的分离可能对关节的稳定性至关重要。
    This study aimed to elucidate the relationship between joint structures of the first tarsometatarsal and articular facet degeneration. A total of 100 feet from 50 cadavers were examined. The articular facets of the first metatarsal and medial cuneiform were categorized into four types based on the superior and inferior facets\' separation, and the formation of the inferior lateral facet on the lateral plantar prominence: Type I, a single facet with no separation or inferior lateral facet; Type II-a, two facets with separation but no inferior lateral facet; Type II-b, two facets, no separation, but with an inferior lateral facet; Type III, three facets with separation and an inferior lateral facet. When both bone types matched, they were defined as Type I, Type II-a, Type II-b, and Type III joints, respectively; unmatched types were classified as Unpair joints. The severity of articular cartilage degeneration on both bones was assessed using a 5-point scale. The degeneration grade was compared among joint types. Type III joints exhibited significantly milder articular cartilage degeneration in medial cuneiform compared to Type II-a, II-b, Unpair joints. The formation of inferior lateral facet and separation of the superior and inferior facets might be crucial for the joint\'s stability.
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  • 文章类型: Journal Article
    包括中足的掌-meta关节和Naviculoconeiform关节是继足部第一个meta趾关节之后的第二常见关节。然而,中足关节炎(MA)的相关因素很少报道。与常规射线照片相比,使用负重计算机断层扫描(WBCT)可以更精确地评估骨骼结构和对准。因此,这项研究的目的是使用WBCT调查与病史和合并症足部畸形相关的MA的危险因素。2014年9月至2022年4月的WBCT数据来自一家转诊医院。根据是否存在MA将所有病例分为两组。25个潜在的相关因素,包括人口统计学,病因学,收集常见的同时发生的足部畸形进行比较。在2014年9月至2022年4月的连续1316例病例中,选择了66例(男性247例,女性359例)。男性39例(56.3%)和女性210例(58.5%)显示MA。在逐步多元逻辑回归分析中,5个因素仍然具有统计学意义。年龄的多变量调整后的赔率比,偏侧性,体重指数(BMI),进行性塌陷脚畸形(PCFD),和较小的脚趾畸形(LTD)分别为1.08、1.54、1.05、6.62和3.03。与病史和足部畸形相关的MA的危险因素包括年龄,偏侧性,BMI,PCFD,LDT。证据级别:三级,回顾性病例对照研究。
    Tarso-metatarsal joints and naviculocuneiform joints comprising midfoot is the second most commonly involved joints following the first metatarsophalangeal joint in the foot. However, related factors of midfoot arthritis (MA) have been rarely reported. The bony structure and alignment can be more precisely assessed using Weight-Bearing Computed Tomography (WBCT) than conventional radiographs. Therefore, the aim of this study was to investigate risk factors for MA related to medical history and comorbid foot deformities using WBCT. WBCT data from September 2014 to April 2022 were extracted from a single referral hospital. All cases were divided into two groups by the presence of MA. Twenty-five potential related factors including demographics, etiology, and common co-occurring foot deformities were collected for comparison. Six hundred six cases (247 males and 359 females) among consecutive 1316 cases between September 2014 to April 2022 were selected. One hundred thirty-nine male cases (56.3%) and 210 female cases (58.5%) showed MA. In stepwise multiple logistic regression analysis, 5 factors remained statistically significant. The multivariate-adjusted odds ratios for age, laterality, body mass index (BMI), Progressive Collapsing Foot Deformity (PCFD), and lesser toe deformities (LTD) were 1.08, 1.54, 1.05, 6.62, and 3.03 respectively. Risk factors for MA associated with medical history and foot deformities included age, laterality, BMI, PCFD, and LDT.
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  • 文章类型: Journal Article
    背景:足部畸形(例如,平面外翻和腹壁外翻)在患有痉挛型脑瘫(CP)的儿童中非常常见,中脚经常参与其中。动态足部功能可以用包括多段足部模型的3D步态分析来评估。在这样的模型中加入一个中足部分,允许量化单独的Chopart和Lisfranc关节运动学。然而,在CP中以前没有报道过中足运动学。
    目的:在包括足中关节在内的多节运动学方面,CP中常见的足畸形和典型发育的足之间有什么不同?
    方法:回顾性纳入57例痉挛型CP及相关疾病儿童的103英尺,并与15例典型发育儿童进行比较。所有儿童均使用阿姆斯特丹脚模型标记集进行临床步态分析。计算每英尺三步的多段脚运动学并进行平均。进行了k均值聚类分析,以识别CP数据中存在的足部畸形组。每个聚类表示的畸形类型基于足部姿势指数。将集群的运动学输出与静态站立试验以及步行过程中的运动范围和运动学波形的典型发展数据进行比较,分别采用常规t检验和SPM独立t检验。
    结果:中性,确定了平面圆和内翻簇。中性脚的运动学与通常的数据相似。足外翻显示踝关节外翻和肖帕特背屈增加,外翻和绑架。内翻足显示踝内翻增加,肖帕特内翻和内收增加。
    结论:这项研究首次描述了CP患儿不同足部畸形的Chopart和Lisfranc关节运动学。它表明,添加足中部段可以提供额外的临床和运动学信息。它突出了畸形之间更独特的关节角度,这可能有助于优化多段足部运动学在临床决策过程中的使用。
    Foot deformities (e.g. planovalgus and cavovarus) are very common in children with spastic cerebral palsy (CP), with the midfoot often being involved. Dynamic foot function can be assessed with 3D gait analysis including a multi-segment foot model. Incorporating a midfoot segment in such a model, allows quantification of separate Chopart and Lisfranc joint kinematics. Yet, midfoot kinematics have not previously been reported in CP.
    What is the difference in multi-segment kinematics including midfoot joints between common foot deformities in CP and typically-developing feet?
    103 feet of 57 children with spastic CP and related conditions were retrospectively included and compared with 15 typically-developing children. All children underwent clinical gait analysis with the Amsterdam Foot Model marker set. Multi-segment foot kinematics were calculated for three strides per foot and averaged. A k-means cluster analysis was performed to identify foot deformity groups that were present within CP data. The deformity type represented by each cluster was based on the foot posture index. Kinematic output of the clusters was compared to typically-developing data for a static standing trial and for the range of motion and kinematic waveforms during walking, using regular and SPM independent t-tests respectively.
    A neutral, planovalgus and varus cluster were identified. Neutral feet showed mostly similar kinematics as typically-developing data. Planovalgus feet showed increased ankle valgus and Chopart dorsiflexion, eversion and abduction. Varus feet showed increased ankle varus and Chopart inversion and adduction.
    This study is the first to describe Chopart and Lisfranc joint kinematics in different foot deformities of children with CP. It shows that adding a midfoot segment can provide additional clinical and kinematic information. It highlights joint angles that are more distinctive between deformities, which could be helpful to optimize the use of multi-segment foot kinematics in the clinical decision making process.
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  • 文章类型: Journal Article
    这项研究估计了步行站立阶段中足关节复合体(MJC)运动学对骨盆前后位置的贡献,并研究了MJC是否与下肢关节在功能上协调以保持相似的骨盆位置。臀部,膝盖,脚踝,对11名非残疾参与者在行走过程中测量了MJC矢状角。关节对骨盆位置的贡献是通过从链接段模型导出的方程计算的。当MJC对骨盆位置的贡献变化并且其他关节的总和在相反方向上变化时(在站立阶段瞬间强烈的负协变[r≤-.7]),可以识别出跨步骤的功能协调。我们观察到MJC足底屈(足弓抬高)在中姿和晚期姿势导致骨盆向后,避免过度的向前位移。MJC是对骨盆位置贡献最大的第二个关节(约占所有关节贡献的18%),在踝关节之后.MJC和踝关节是最常与其他关节协调的关节(约站立阶段持续时间的70%)。研究结果表明,MJC是确定步行过程中骨盆位置的运动链的一部分,并且在功能上与下肢关节协调。
    This study estimated the contribution of the midfoot joint complex (MJC) kinematics to the pelvis anterior-posterior positions during the stance phase of walking and investigated whether the MJC is functionally coordinated with the lower limb joints to maintain similar pelvic positions across steps. Hip, knee, ankle, and MJC sagittal angles were measured in 11 nondisabled participants during walking. The joints\' contributions to pelvic positions were computed through equations derived from a link-segment model. Functional coordination across steps was identified when the MJC contribution to pelvic position varied and the summed contributions of other joints varied in the opposite direction (strong negative covariations [r ≤ -.7] in stance phase instants). We observed that the MJC plantarflexion (arch raising) during the midstance and late stance leads the pelvis backward, avoiding excessive forward displacement. The MJC was the second joint that contributed most to the pelvis positions (around 18% of all joints\' contributions), after the ankle joint. The MJC and ankle were the joints that were most frequently coordinated with the other joints (≅70% of the stance phase duration). The findings suggest that the MJC is part of the kinematic chain that determines pelvis positions during walking and is functionally coordinated with the lower limb joints.
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  • 文章类型: Journal Article
    背景:这项研究的目的是评估银屑病关节炎中足部受累的患病率,并描述其不同的临床和放射学特征。
    方法:我们进行了一项横断面研究,包括40名银屑病关节炎患者,为期12个月。回忆,脚的临床检查,镜下检查,脚和脚后跟的X光片,对每位患者进行B型和能量多普勒模式的超声检查。
    结果:在95%的病例中发现了足部受累。在70%的病例中有症状,在20%的病例中出现了这种疾病。后足和前足是受影响最大的部位(分别为77.5%和47.5%)。中足的参与很少(25%)。17.5%的病例发现了手指炎,22.5%的病例发现了前足畸形。在17.5%的病例中发现了无能步态,并且在35%的病例中发现了足部静态疾病。在45%的病例中发现了脚的皮肤病学表现。不同风湿病表现的诊断基于临床发现和X射线上的特征性放射图像。我们证明了超声在检测和诊断包括附着性炎在内的不同足部病变中的敏感性,滑膜炎和腱鞘炎,牙龈炎,骨侵蚀和牛皮癣指甲营养不良。
    BACKGROUND: The purpose of this study was to evaluate the prevalence of foot involvement in psoriatic arthritis and to describe its different clinical and radiological features.
    METHODS: We conducted a cross sectional study including 40 patients with psoriatic arthritis over a period of 12 months. Anamnesis, clinical examination of feet, podoscopic examination, X-rays of feet and heels, and ultrasound in B mode and power Doppler mode were done for each patient.
    RESULTS: Foot involvement was found in 95% of cases. It was symptomatic in 70% and inaugural of the disease in 20% of cases. The hindfoot and the forefoot were the sites most affected (77.5% and 47.5% respectively). The involvement of the midfoot was rarer (25%). Dactylitis was found in 17.5% and deformities of forefoot were found in 22.5% of cases. Antalgic gait was noted in 17.5% and static disorders of foot at podoscopic examination were identified in 35% of cases. Feet dermatological manifestations were found in 45% of cases. Diagnosis of different rheumatological manifestations was based on clinical findings and caracteristic radiological images on X-rays. We demonstrate he sensitivity of ultrasound in the detection and the diagnosis of different foot lesions including enthesitis, synovitis and tenosynovitis, dactylitis, bone erosions and psoriatic nail dystrophy.
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  • 文章类型: Journal Article
    许多小脚关节和足底组织在步态中的作用尚不清楚。虽然运动学多段足部模型增加了我们对足部分段运动的了解,动力学与这些模型的整合可以进一步促进我们对脚部力学和能量学的理解。然而,捕获和有效利用分段地面反作用力仍然具有挑战性。这项研究的目的是(1)开发将足底压力和剪切应力与多段足部模型相结合的方法,(2)生成并简明显示来自该组合系统的关键规范数据。26名健康的年轻人赤脚(1.3m/s)穿过压力/剪切传感器,其标记与已发布的4段脚模型相匹配。开发了一种新颖的基于解剖/几何模板的掩蔽方法,该方法成功地分离了与模型分割对齐的区域。建立方向剪切力图以总结复杂的足底剪切分布,显示段之间和段内的相反剪切力。分段压力中心(CoP)在每个分段内主要是静止的,这表明健康步态的向前进展主要来自于体重在相对固定的接触点上的重新分配,而不是一段内的CoP运动.在这些CoP的背景下,提出了基于逆动力学的规范脚关节力矩和功率,以帮助解释组织应力。总的来说,这项工作代表了运动捕获与直接足底压力和剪切测量的成功整合,用于多段足部动力学。所呈现的工具足够通用,可以与其他模型和上下文一起使用,虽然提出的规范数据库可能是有用的基线比较临床工作的步态能量和效率,balance,和电机控制。我们希望这项工作将有助于MSF动力学建模的进步和可用性,增加我们对脚部力学的了解,最终改善了临床诊断,康复,和治疗。
    The role of the many small foot articulations and plantar tissues in gait is not well understood. While kinematic multi-segment foot models have increased our knowledge of foot segmental motions, the integration of kinetics with these models could further advance our understanding of foot mechanics and energetics. However, capturing and effectively utilizing segmental ground reaction forces remains challenging. The purposes of this study were to (1) develop methodology to integrate plantar pressures and shear stresses with a multi-segment foot model, and (2) generate and concisely display key normative data from this combined system. Twenty-six young healthy adults walked barefoot (1.3 m/s) across a pressure/shear sensor with markers matching a published 4-segment foot model. A novel anatomical/geometric template-based masking method was developed that successfully separated regions aligned with model segmentation. Directional shear force plots were created to summarize complex plantar shear distributions, showing opposing shear forces both between and within segments. Segment centers of pressure (CoPs) were shown to be primarily stationary within each segment, suggesting that forward progression in healthy gait arises primarily from redistributing weight across relatively fixed contact points as opposed to CoP movement within a segment. Inverse dynamics-based normative foot joint moments and power were presented in the context of these CoPs to aid in interpretation of tissue stresses. Overall, this work represents a successful integration of motion capture with direct plantar pressure and shear measurements for multi-segment foot kinetics. The presented tools are versatile enough to be used with other models and contexts, while the presented normative database may be useful as a baseline comparison for clinical work in gait energetics and efficiency, balance, and motor control. We hope that this work will aid in the advancement and availability of kinetic MSF modeling, increase our knowledge of foot mechanics, and eventually lead to improved clinical diagnosis, rehabilitation, and treatment.
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  • 文章类型: Journal Article
    在手术室度过的时间对外科医生和患者都是有价值的。当涉及足和踝关节的关节固定术时,最大的速率限制因素之一是软骨去除和关节准备。联合准备中的动力仪表提供了减少联合准备时间的途径。从而减少手术室时间和成本。包括27例患者的47个关节(n)的关节固定术。在26个关节中的强力扳手关节准备与传统骨凿和刮匙关节准备在21个关节中的时间(秒)进行比较,成本(每分钟手术室总时间成本),工会率。使用距下关节的动力钳的总平均关节准备时间为268.3秒,距骨关节212.3秒,跟骨关节142.6秒,第1次TMT107.2秒。距下关节使用传统方法的平均关节准备时间509.8秒,距骨关节393.0秒,跟骨关节400.0秒,1stTMT319.6秒。距下关节的平均关节准备费用为165.47美元,距骨关节为130.89美元,跟骨关节为87.94美元,第一次TMT为66.11美元。使用传统技术准备关节的平均成本为距下关节$314.34,距骨关节$242.35,跟骨关节$246.67,第一次TMT$197.33。总体愈合率为98%(1例无症状不愈合)。提高手术室的效率对每个外科医生的实践至关重要。强力刺关节准备是提高效率和减少手术时间的可行选择。这项研究表明,结合率没有统计学上的显著差异,与现有文献的比率相当。
    Time spent in the operating room is valuable to both surgeons and patients. One of the biggest rate-limiting factors when it comes to arthrodesis procedures of the foot and ankle is cartilage removal and joint preparation. Power instrumentation in joint preparation provides an avenue to decrease joint preparation time, thus decreasing operating room time and costs. Arthrodesis of 47 joints (n) from 27 patients were included. Power rasp joint preparation in 26 joints was compared to traditional osteotome and curette joint preparation in 21 joints in both time (seconds), cost (total operating room time cost per minute), and union rate. The overall mean joint preparation time using power rasp for the subtalar joint was 268.3 seconds, talonavicular joint 212.3 seconds, calcaneocuboid joint 142.6 seconds, 1st TMT 107.2 seconds. Mean joint preparation time using traditional method for subtalar joint 509.8 seconds, talonavicular joint 393.0 seconds, calcaneocuboid joint 400.0 seconds, 1st TMT 319.6 seconds. Mean cost of joint preparation using power rasp for subtalar joint $165.47, talonavicular joint $130.89, calcaneocuboid joint $87.94, 1st TMT $66.11. Mean cost of joint preparation using traditional techniques for subtalar joint $314.34, talonavicular joint $242.35, calcaneocuboid joint $246.67, 1st TMT $197.33. Overall union rate was 98% (1 asymptomatic non-union). Increasing efficiency in the operating room is vital to every surgeon\'s practice. Power rasp joint preparation is a viable option to increase efficiency and decrease operative time, this study shows no statistically significant differences in union rate, with comparable rates to existing literature.
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