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- Author or Editor: Christopher J. Nester x
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This study was undertaken to establish whether reduced dorsiflexion at the first metatarsophalangeal joint affects sagittal plane kinematics at the ankle, knee, and hip. Twenty individuals with symptom-free metatarsophalangeal joints were studied as they walked with and without an insole designed to restrict first metatarsophalangeal joint dorsiflexion. Sagittal plane kinematics at the ankle, knee, and hip were compared in the two conditions. When walking with the insole, the ankle was more dorsiflexed during late midstance and less plantarflexed during propulsion, the knee was more flexed during midstance, and the hip was less extended during late midstance. This evidence of a link between the first metatarsophalangeal joint and the kinematics of the proximal joints demonstrates the potential for the clinical entities of hallux rigidus and hallux limitus to influence gait and justifies more detailed study of this relationship. (J Am Podiatr Med Assoc 94(3): 269–274, 2004)
Clinical and Experimental Models of the Midtarsal Joint
Proposed Terms of Reference and Associated Terminology
Recent debate and literature have provided impetus to the growing body of thought that we should not model the midtarsal joint as having two simultaneous axes of rotation but as having a single instantaneous axis of rotation. Building on this concept, we present new reference terminology and propose that descriptions of midtarsal joint kinetics and kinematics relate to moments and motion in the cardinal body planes as defined by the x-, y-, and z-axes of the local reference system of the calcaneus. This replaces the existing terminology that describes the oblique and longitudinal axes for the midtarsal joint. The purpose of the new terms of reference and terminology is to aid in the communication of ideas and concepts regarding the biomechanics of the midtarsal joint among clinicians and between researchers and clinicians. It will also allow integration of the midtarsal joint into the emerging biomechanical model of the lower limb, promote consistency in discussions of the joint, and ease understanding of the interrelationships between the kinetics and the kinematics of the articulations in the foot and lower limb and their relationship to pathology and clinical practice. (J Am Podiatr Med Assoc 96(1): 24–31, 2006)
Current biomechanical models of the midtarsal joint describe it as having two axes of rotation, the oblique and the longitudinal. The considerable freedom of movement available at the midtarsal joint means that kinematic assessment of its function and determination of its axis of rotation must be conducted under conditions that enable the joint to function as normally as possible. The assessments on which the concepts of the longitudinal and oblique axes are based do not meet this criterion. Understanding of the motions at the midtarsal joint will improve as techniques of kinematic assessment improve. Future descriptions of the midtarsal joint should adopt the standard terms applied to the other joints in the lower limb, which will facilitate the study of the midtarsal joint in relation to the function of the rest of the lower limb. (J Am Podiatr Med Assoc 91(2): 68-73, 2001)
The characteristic bone deformities associated with advanced Paget’s disease of bone may result in abnormal gait and plantar foot pressures, which contribute to the development of pressure-related skin problems. This study aimed to characterize the foot problems and foot-care needs in this patient group and to investigate the effect of disease distribution on the occurrence of foot pathology. One hundred thirty-four patients with Paget’s disease were assessed clinically, and the Foot Structure Index was completed for each patient. Patients completed self-administered questionnaires concerning foot function (Foot Function Index) and quality of life (12-Item Short Form). The results of this study suggest that foot-health and footwear problems are common in patients with Paget’s disease. Forty percent of the patients required professional foot care in addition to those already receiving it. The site of pagetic involvement did not affect the occurrence of foot pathology. Further research is required on the impact of the extent of any femoral or tibial deformity on foot symptoms and pathology. Biomechanical studies of the forces and motion in the foot related to different degrees of femoral and tibial deformity might also help determine the impact of deformity on foot pathology. (J Am Podiatr Med Assoc 96(3): 226–231, 2006)
