Background
Morton's neuromas are abnormalities of the common digital nerve branch located between the lesser metatarsal heads. Historically, interdigital (Morton's) neuromas have been characterized as being most common in the third interspace and in females. The principal investigator observed Morton's neuromas commonly in the second and third interspaces in both sexes. To our knowledge, no literature exists to evaluate Morton's neuroma location with a focus on each sex independently. The present study evaluates Morton's neuroma interspace location and whether there is a variation by sex.
Methods
In this retrospective study, 582 deidentified magnetic resonance imaging reports with a diagnosis code for Morton's neuroma were evaluated for patients scanned from January 2, 2015, through April 19, 2016. Incomplete records and those with radiologist findings inconsistent with Morton's neuroma were eliminated. For the remaining 379 patients, data were collected on sex, laterality, history of trauma, plantar plate tear, age, and interspace location. Special focus was given to second and third interspace Morton's neuromas. Data were evaluated using the Pearson χ2 and independent-samples Mann-Whitney U tests, with P < .05 indicating statistical significance.
Results
No statistically significant distribution between sex and second and third interspace Morton's neuromas was noted. Right vs left foot, age, and history of trauma did not vary statistically significantly between sexes. There was a statistically significant difference between the presence of plantar plate tears between sexes. Male patients with Morton's neuromas were found to have a higher rate of plantar plate tears (P = .01).
Conclusions
This study found that there were no statistically significant differences between sexes and Morton's neuromas location, laterality, or age.
Background
Insertional Achilles tendinopathy is a common complaint among patients. Oftentimes, conservative treatment is inadequate, and surgical treatment is required. However, there is no published consensus regarding surgical intervention in reference to insertional Achilles tendinopathy.
Methods
The purpose of this systematic review was to evaluate the surgical management of insertional Achilles tendinopathy and report which surgical procedures provide the greatest pain reduction and improvement in functional outcome. A review of PubMed, OVID, Google Scholar, and Cochrane Controlled Trials Register was performed using a defined search strategy and inclusion criteria.
Results
Of 2,863 articles identified using the defined strategy, 20 met the inclusion criteria (three prospective and 17 retrospective). Operative interventions included Achilles tendon debridement, reattachment with suture anchors, reconstruction with flexor hallucis longus tendon autograft or bone-patellar tendon autograft, and gastrocnemius recession. All of the studies, regardless of intervention, showed generalized improvement after surgery. Wide variation in outcome scoring systems prevented direct comparison between studies and interventions.
Conclusions
This systematic review did not identify a superior treatment for insertional Achilles tendinopathy but rather found that the surgical treatment should be based on the extent of tendon injury.
Background
Charcot's arthropathy (CA) is a destructive rare complication of diabetes, and its diagnosis remains challenging for foot specialists and surgeons. We aimed to assess the clinical presentation and characteristics of CA and the frequencies of its various types.
Methods
This cross-sectional study was conducted from January 1, 2007, to December 31, 2016, and included 149 adults with diabetes diagnosed as having CA. Cases of CA were classified based on the Brodsky anatomical classification into five types according to location and involved joints.
Results
The mean ± SD age of the studied cohort was 56.7 ± 11 years, with a mean ± SD diabetes duration of 21.2 ± 7.0 years. The CA cohort had poorly controlled diabetes and a high rate of neuropathy and retinopathy. The most frequent type of CA was type 4, with multiple regions involved at a rate of 56.4%, followed by type 1, with midfoot involvement at 34.5%. A total of 47.7% of the patients had bilateral CA. Complications affected 220 limbs, of which 67.7% had foot ulceration. With respect to foot deformity, hammertoe affected all of the patients; hallux valgus, 59.5%; and flatfoot, 21.8%.
Conclusions
There is a high rate of bilateral CA, mainly type 4, which could be attributed to cultural habits in Saudi Arabia, including footwear. This finding warrants increasing awareness of the importance of maintaining proper footwear to avoid such complications. Implementation of preventive measures for CA is urgently needed.
Background
Onychomycosis is the most common infectious nail disorder. Direct mycologic examination is still the cornerstone of diagnosis; however, it may take several weeks to obtain a result. Recently some dermoscopic patterns that can be useful in the diagnosis of onychomycosis were described. However, published data on dermoscopic features of onychomycosis are still limited.
Methods
We performed a prospective dermoscopic study of patients with positive fungal culture between April and December 2016. Patients with a final diagnosis of psoriasis or lichen planus were excluded from the study. Dermoscopy (polarized and nonpolarized) was performed.
Results
Thirty-seven patients were enrolled, 24 women and 13 men (median ± SD age, 48.6 ± 16.1 years). Nail samples were culture positive for Trichophyton rubrum (89.2%), Trichophyton interdigitale (8.1%), and Candida albicans (2.7%). Distal and lateral subungual onychomycosis was the most frequent clinical subtype (59.5%). The most frequent dermoscopic features were subungual keratosis (73.0%), distal subungual longitudinal striae (70.3%), spikes of the proximal margin of an onycholytic area (59.5%), transverse superficial leukonychia (29.7%), and linear hemorrhage (13.5%). Brown chromonychia was most frequently seen with nonpolarized dermoscopy (66.6% versus 24%; P = .027).
Conclusions
Specific dermoscopic signs of onychomycosis are mostly related to the proximal invasion of the nail plate. Detection of these signs is simple and can, in some cases, help avoid mycologic testing.
Background
We investigated the role of first metatarsal head shape in the etiology of hallux valgus. By pedobarographic analysis, we evaluated whether first metatarsal head shape causes an alteration in plantar pressure values that would result in metatarsalgia.
Methods
Referrals to our clinic for metatarsalgia, plantar fasciitis, and calcaneal spur were scanned retrospectively. Patients with severe hallux valgus, pes planus, gastrocnemius stiffness, generalized joint laxity, neuromuscular disease, or a history of lower-extremity orthopedic surgery were excluded. Sixty-two patients with plantar pressure assessment and radiographic evaluation were included. These patients were invited for reassessment after 10 years. Feet were divided into three groups by metatarsal head shape: round, square, and chevron. On anteroposterior radiographs, the hallux valgus and intermetatarsal angles, relative first metatarsal length, lateral sesamoid subluxation, and presence of bipartite sesamoid were noted. Plantar pressure was assessed with pedobarography.
Results
Feet with round-shaped first metatarsal heads had a statistically significantly greater progression in hallux valgus angle than the other shapes. Plantar pressures under the first, second and third, and fourth and fifth metatarsals increased with time. This can explain the mechanism of transfer metatarsalgia and painful callosities under the first metatarsal in hallux valgus. There was no correlation between hallux valgus angle, relative metatarsal length, and lateral sesamoid subluxation.
Conclusions
We found a strong relation between round-shaped first metatarsal head and hallux valgus angle progression. No patients had a risk factor responsible for hallux valgus. In other words, this study gives approximately 10-year natural history results in nearly normal feet.
Background
Neuropathologic changes may occur in the nervous system due to long-term substance use, leading to functional disability with altering of balance. We know little about substance-related mechanisms that can cause movement disorders. This study investigated the effects of plantar foot sensation and balance on physical performance as an effect of substance use in detoxified patients.
Methods
Twenty-three users of cannabis, volatile agents, or narcotic/stimulant agents alone or in combination for at least 1 year (mean age, 27.6 years) and 20 healthy volunteers (mean age, 24.6 years) were included. Participant evaluations were implemented immediately after the detoxification process with psychiatrist approval. Depression, state-trait anxiety, and fear of movement levels were evaluated with the Beck Depression Inventory, State-Trait Anxiety Inventory, and Tampa Scale for Kinesiophobia, respectively. Plantar foot sensations were evaluated with light touch, two-point discrimination, and vibration examinations. Balance was assessed with balance software and a balance board and force platform. Balance path, balance path distance, and center of pressure were recorded. Physical performance was evaluated with the Timed Up and Go (TUG) test in the final step.
Results
There was a significant difference in two-point discrimination of patients versus controls (P < .05). Significant differences were also found in balance values, particularly in the sagittal direction (P < .05). TUG test results of patients compared with controls showed a negative influence on physical function (P < .05).
Conclusions
Detailed examination should be performed to understand movement disorders in substance users. Herein, substance users had impaired two-point discrimination and sagittal balance reciprocally. Thus, customized physiotherapy approaches to substance users should be considered to improve their movement disorders.
Background
We sought to describe the innervation patterns of the foot lumbrical muscles and their morphological properties in human fetuses and to define the communicating branches between the medial (MPN) and lateral (LPN) plantar nerves, which play a part in the innervation of those muscles.
Methods
Thirty formalin-fixed fetuses (13 male and 17 female) with a mean ± SD gestational age of 25.5 ± 3.8 weeks (range, 18–36 weeks) from the inventory of the Mersin University Faculty of Medicine Anatomy Department were bilaterally dissected. Innervation patterns of the lumbrical muscles and the communicating branches between the MPN and the LPN were detected and photographed.
Results
No variations were seen in lumbrical muscle numbers. In the 60 feet, the first lumbrical muscle started directly from the flexor digitorum longus tendon in 48 and from the flexor hallucis longus slips in addition to the flexor digitorum longus tendon in 12. Fifty-five feet had the classic innervation pattern of the lumbrical muscles, and five had variations. No communicating branches were seen in 48 feet, whereas 12 had connections.
Conclusions
This study classified innervation patterns of the foot lumbrical muscles and defined two new innervation types. During surgeries on the foot and ankle in neonatal and early childhood terms, awareness of the communicating branches between the MPN and the LPN and innervation of the intrinsic muscles of the foot, such as the lumbrical muscles, might aid in preventing possible complications.
Background
There are more than ten classification systems currently used in the staging of hallux rigidus. This results in confusion and inconsistency with radiographic interpretation and treatment. The reliability of hallux rigidus classification systems has not yet been tested. We sought to evaluate the intraobserver and interobserver reliabilities of three commonly used classifications for hallux rigidus.
Methods
Twenty-one plain radiograph sets were presented to ten American College of Foot and Ankle Surgeons board-certified foot and ankle surgeons. Each physician classified each radiograph based on clinical experience and knowledge according to the Regnauld, Roukis, and Hattrup and Johnson classification systems. The two-way mixed single-measure consistency intraclass correlation coefficient was used to calculate intrarater and interrater reliabilities.
Results
The mean ± SD intrarater reliability of individual sets for the Roukis (0.62 ± 0.19) and Hattrup and Johnson (0.62 ± 0.28) classification systems was fair to good and for the Regnauld system bordered between fair to good and poor (0.43 ± 0.24). The interrater reliability of the mean classification was excellent for all three classification systems.
Conclusions
Reliable and reproducible classification systems are essential for treatment and prognostic implications in hallux rigidus. Herein, the Roukis classification system had the best intrarater reliability. Although there are various classification systems for hallux rigidus, the present results indicate that the three classification systems evaluated show reliability and reproducibility.
Background
The medial longitudinal arch angle (LAA) of the foot has been used as an index of high and low arches. The LAA during the support phase of running (LAArun), which may be related to lower-limb injuries, is commonly predicted from the LAA at standing (LAAstand). However, it is not known whether this prediction is valid for all of the foot contact patterns. The purpose of this study was to verify whether prediction of the LAArun from the LAAstand is valid for different foot strike patterns.
Methods
The 26 participants were divided into a rearfoot strike group (n = 15) and a nonrearfoot strike group (n = 11). The LAA was obtained by measuring the angle formed between the line from the navicular bone to the medial malleolus and the line from the navicular bone to the first metatarsal head. The LAAstand and the minimum value of the LAArun, when the arch is most collapsed, were measured using a motion capture system.
Results
There were no significant differences in the LAAstand, the LAArun, and the difference (LAAstand – LAArun) between the two groups. In both groups, a very strong and significant correlation was found between the LAAstand and the LAArun. Furthermore, a nearly identical equation for predicting the LAArun from the LAAstand was derived for the two groups.
Conclusions
The LAArun can be predicted from the LAAstand for any foot strike pattern with almost the same equation.
Background
The foot of a newborn is a structure that is under formation and is susceptible to presenting pathologic disorders from the moment of birth. Evidence of the prevalence of clinodactyly in newborns is scarce. Therefore, the objective of this study was to determine that prevalence and its interrelationship with gestational and neonatal factors.
Methods
In a sample of 305 newborns (147 boys and 158 girls), the commonest podiatric medical alterations with either a genetic or a postural component present at the moment of birth were explored physically. The prevalence found in the sample was then related to different anthropometric, gestational, and racial/ethnic parameters of the newborn.
Results
The sex of the newborn was unrelated to any podiatric medical pathology found. Clinodactyly was present in approximately 90% of the fifth toes studied. Breech or transverse fetal presentation and the width of the forefoot affected the appearance of clinodactyly of the fourth and fifth toes. The anthropometric differences between the feet of boys and girls were verified.
Conclusions
The presence of clinodactyly of the fourth and fifth toes in newborns is a frequent clinical finding and should, therefore, be considered in the podopediatric examination. In the neonatal population studied, the pathologic disorders explored did not depend on sex. The prevalence of fourth and fifth toe clinodactyly was significantly influenced by breech or transverse presentation and by forefoot width, but not by the mother's race/ethnicity.