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Sample records for valgus joint angles

  1. Radiographic Shape of Foot With Second Metatarsophalangeal Joint Dislocation Associated With Hallux Valgus.

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    Kokubo, Tetsuro; Hashimoto, Takeshi; Suda, Yasunori; Waseda, Akeo; Ikezawa, Hiroko

    2017-12-01

    Second metatarsophalangeal (MTP) joint dislocation is associated with hallux valgus, and the treatment of complete dislocation can be difficult. The purpose of this study was to radiographically clarify the characteristic foot shape in the presence of second MTP joint dislocation. Weight-bearing foot radiographs of the 268 patients (358 feet) with hallux valgus were examined. They were divided into 2 groups: those with second MTP joint dislocation (study group = 179 feet) and those without dislocation (control group = 179 feet). Parameters measured included the hallux valgus angle (HVA), first-second intermetatarsal angle (IMA), second MTP joint angle, hallux interphalangeal angle (IPA), second metatarsal protrusion distance (MPD), metatarsus adductus angle (MAA), and the second metatarsal declination angle (2MDA). Furthermore, the dislocation group was divided into 3 subgroups according to second toe deviation direction: group M (medial type), group N (neutral type), and group L (lateral type). The IPA and the 2MDA were significantly greater in the study group than in the control group. By multiple comparison analysis, the IMA was greatest in group M and smallest in group L. The IPA was smaller and 2MDA greater in group N than in group L. The HVA and MAA in group L were greatest, and MPD in group L was smallest. The patients with second MTP joint dislocation associated with hallux valgus had greater hallux interphalangeal joint varus and a second metatarsal more inclined than with hallux valgus alone. The second toe deviated in a different direction according to the foot shape. Level III, retrospective comparative study.

  2. Radiographic Relevance of the Distal Medial Cuneiform Angle in Hallux Valgus Assessment.

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    Hatch, Daniel J; Smith, Abigail; Fowler, Troy

    2016-01-01

    The angle formed by the distal articular facet of the medial cuneiform has been evaluated and discussed by various investigators. However, no consistent method has been available to radiograph and measure this entity. The wide variability of the angle is not conducive to comparative analysis. Additionally, investigators have noted that the angles observed (obliquity) vary greatly because of changes in radiographic angle, foot position, rotation of the first ray, and declination of the first metatarsal. Recognizing that these variables exist, we propose a reproducible assessment using digital radiography and application of deformity of correction principles. Our results have indicated a mean distal medial cuneiform angle of 20.69° in normal feet, 23.51° with moderate hallux valgus, and 20.41° with severe hallux valgus deformity. The radiograph beam was kept at 15° from the coronal plane. An inverse relationship was found between the distal medial cuneiform angle and bunion severity. This was in contrast to our expected hypothesis. The overall angle of the first metatarsal-medial cuneiform did, however, correlate with the severity of the bunion deformity (p hallux valgus. A better indicator appears to be the first metatarsal-medial cuneiform angle. This pathologic entity is a 3-dimensional one that incorporates the joint morphology of the first ray, triplane osseous positioning, and soft tissue imbalances. Perhaps, 3-dimensional computed tomography imaging will provide better insight into this entity. Copyright © 2016 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  3. Hallux valgus angle as main predictor for correction of hallux valgus

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    Malefijt Maarten

    2008-05-01

    Full Text Available Abstract Background It is recognized that different types of hallux valgus exist. Classification occurs with radiographic and clinical parameters. Severity of different parameters is used in algorithms to choose between different surgical procedures. Because there is no consensus about each parameter nor their cut-off point we conducted this study to analyze the influence of these variables on the postoperative hallux valgus angle. Methods After informed consent 115 patients (136 feet were included. Bunionectomy, osteotomy, lateralization of the distal fragment, lateral release and medial capsulorraphy were performed in all patients. Data were collected on preoperative and postoperative HVA, IMA and DMAA measurements. Forty cases were included since our findings in a previous article 1, therefore, current data concern an expanded study group with longer follow-up and were not published before. At least two-year follow-up data were evaluated with logistic regression and independent t-tests. Results Preoperative HVA was significant for prediction of postoperative HVA in logistic regression. IMA and DMAA were not significant for prediction of postoperative HVA in logistic regression, although they were significantly increased in larger deformities. In patients with preoperative HVA of 37 degrees or more, satisfactory correction could be obtained in 65 percent. The other nine of these 26 patients developed subluxation. Conclusion The preoperative HVA was the main radiological predictor for correction of hallux valgus, correction rate declined from preoperative HVA of 37. IMA and DMAA did have a minor role in patients with preoperative HVA lower than 37 degrees, however, likely contributed to preoperative HVA of 37 degrees or more.

  4. Correlation between generalized joint hypermobility and hallux valgus

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    A. A. Kardanov

    2015-01-01

    Full Text Available Purpose: to evaluate correlation between generalized joint hypermobility, forefoot deformities and elasticity of the first ray of the foot. Material and methods. We examined 138 patients with complaints related with deformities at the forefoot level. During this study the medical history was obtained, the elasticity type of the feet was defined and the degree of motion of the medial metatarsal-cuneiform joint was evaluated. Forefoot elasticity was identified by bringing together the heads I and V metatarsal bones with fingers. If convergence occurred with little resistance, those feet were called hyperelastic. The convergence of the heads I and V metatarsal bones of the foot with an average type of elasticity occurred with resistance. It was impossible to converge the heads of I and V metatarsal bones. Due to the results of weight-bearing and non-weight bearing X-ray, analysis of the main radiographic angles of the foot was performed: between I and V metatarsal bones, between the first and second metatarsal bones and between the first metatarsal bone and proximal phalanx of the great toe. Calculation formula of the forefoot flatness index, showing the average ratios of basic radiographic angles of the foot on the x-ray images (weight-bearing and non-weight bearing was created. An assessment of total joint hypermobility using Beighton scale and evaluation of first ray deformity using DuPont scale were performed. Statistical analysis of obtained data was performed, as a result of which significantly strong correlation between total joint hypermobility, forefoot elasticity and valgus deviation of the great toe were revealed. Results. 11% of the feet were hyperelastic. Calculation of the index of forefoot flatness showed that forefoot flatness wasn’t significant for a rigid foot - 5.6 %, for the feet with an average degree of mobility it was 6.0% and it was expressed for hypemobile feet - 12.3 %. Strong correlation relation between the forefeet

  5. Mild hallux valgus angle affects single-limb postural stability in asymptomatic subjects.

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    Çınar-Medeni, Özge; Atalay Guzel, Nevin; Basar, Selda

    2016-01-01

    Single-limb postural stability is a key component of lower extremity functional status. Factors affecting postural stability should be well defined to prevent injuries. The aim of this study was to investigate the effect of the hallux valgus angle on postural stability in asymptomatic subjects. A total of 19 subjects were included in the study. The hallux valgus angle and postural stability were assessed. Participants were assigned to two groups according to whether the hallux valgus angle was pathological or not. A hallux valgus angle greater than 15 degrees was accepted as pathological. The relationship between the hallux valgus angle and postural stability, and the differences in postural stability scores between the two groups were analyzed. Postural stability was assessed with a stabilometer. The test was performed with the eyes open. We found a significant correlation between the hallux valgus angle and mediolateral and overall stability index (r= 0.484, p= 0.036; r = 0.463, p= 0.046 respectively). Subjects with a pathological mild hallux valgus angle had greater stability index scores than normal subjects (phallux valgus angle has negative effects on postural stability as a forefoot deformity. This deformity should be taken into account for injury prevention strategies in pain-free younger adults.

  6. The Effect of Incorrect Foot Placement on the Accuracy of Radiographic Measurements of the Hallux Valgus and Inter-Metatarsal Angles for Treating Hallux Valgus.

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    Kuyucu, E; Ceylan, H H; Surucu, S; Erdil, I; Kara, A; Gulenc, B G; Bulbul, M; Erdil, M

    2017-01-01

    PURPOSE OF THE STUDY Accurate radiographic measurements are crucial in treating hallux valgus (HV). This three-dimensional deformity should not be evaluated from one joint on one plane. However, in practice, surgeons measure the deformity only on transverse dorsoplantar radiographs. We determined the amount of error associated with positioning the foot incorrectly on radiographs. MATERIAL AND METHODS To simulate incorrect positions of the foot in radiographic evaluation, we designed an angled device that can move in transverse and frontal plane. In four patients with symptomatic HV, we took weight-bearing radiographs of the involved foot in seven different positions. These 28 radiographs were given identifying but meaningless labels. On each radiograph, six surgeons blinded to the position of the radiograph measured the HV angle (HVA) and the inter-metatarsal angle (IMA) and state the treatment plan according to five treatment options were given to participants. RESULTS Inter-observer agreement was high for measurements of HVA and IMA in all positions (interclass correlation coefficients, 0.96 and 0.88, respectively). However, intra-observer agreement was poor for HVA (intra-observer agreement, 0.17) but good for IMA (intra-observer agreement, 0.64). According to the measurements in different positions, intra-observer treatment choices revealed moderate results (ICC: 0.524). Clinical Relevance Radiographic measurements are very important on the treatment decisions of hallux valgus. The foot position can influence the measurement accuracy and can cause incorrect decisions. In this study, we evaluated the impact of foot positions on measurements of hallux valgus angle and inter-metatarsal angle. Additionally, we evaluated the incorrect foot positioning on treatment decisions. Moreover, we analyzed intra-observer and inter-observer agreements of these angles in various positions. CONCLUSIONS We recommend that measurements of IMA are more reliable than those of HVA for

  7. Short-Term Effects of Kinesiotaping on Pain and Joint Alignment in Conservative Treatment of Hallux Valgus.

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    Karabicak, Gul Oznur; Bek, Nilgun; Tiftikci, Ugur

    2015-10-01

    The main aim of this study was to measure short-term effects of kinesiotaping on pain and joint alignment in the conservative treatment of hallux valgus. Twenty-one female patients diagnosed with a total of 34 feet with hallux valgus (13 bilateral, 6 right, and 2 left) participated in this study. Kinesiotaping was implemented after the first assessment and renewed in days 3, 7, and 10. The main outcome measures were pain, as assessed using visual analog scale, and hallux adduction angle, as measured by goniometry. Secondary outcome measure was patients' functional status, as measured by Foot Function Index and the hallux valgus scale of the American Orthopaedic Foot and Ankle Society (AOFAS). The radiographic results were also measured before and after 1 month of treatment. The Wilcoxon test was used to compare the differences between initial and final scores of AOFAS, as well as FFI scales and hallux valgus angle assessment scores. There was a significant reduction in goniometric measurement of hallux valgus angle (P = .001). There was a significant reduction in pain intensity (P = .001) and AOFAS and Foot Function Index scores at the end of the treatment (P = .001 and P = .001, respectively). There was a significant difference between radiographic results in 1-month control (P = .009). For this group of female patients, pain and joint alignment were improved after a 10-day kinesiotape implementation in patients with hallux valgus. The findings showed short-term decreased pain and disability in hallux valgus deformity. Copyright © 2015 National University of Health Sciences. Published by Elsevier Inc. All rights reserved.

  8. Reliability of Two Smartphone Applications for Radiographic Measurements of Hallux Valgus Angles.

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    Mattos E Dinato, Mauro Cesar; Freitas, Marcio de Faria; Milano, Cristiano; Valloto, Elcio; Ninomiya, André Felipe; Pagnano, Rodrigo Gonçalves

    The objective of the present study was to assess the reliability of 2 smartphone applications compared with the traditional goniometer technique for measurement of radiographic angles in hallux valgus and the time required for analysis with the different methods. The radiographs of 31 patients (52 feet) with a diagnosis of hallux valgus were analyzed. Four observers, 2 with >10 years' experience in foot and ankle surgery and 2 in-training surgeons, measured the hallux valgus angle and intermetatarsal angle using a manual goniometer technique and 2 smartphone applications (Hallux Angles and iPinPoint). The interobserver and intermethod reliability were estimated using intraclass correlation coefficients (ICCs), and the time required for measurement of the angles among the 3 methods was compared using the Friedman test. A very good or good interobserver reliability was found among the 4 observers measuring the hallux valgus angle and intermetatarsal angle using the goniometer (ICC 0.913 and 0.821, respectively) and iPinPoint (ICC 0.866 and 0.638, respectively). Using the Hallux Angles application, a very good interobserver reliability was found for measurements of the hallux valgus angle (ICC 0.962) and intermetatarsal angle (ICC 0.935) only among the more experienced observers. The time required for the measurements was significantly shorter for the measurements using both smartphone applications compared with the goniometer method. One smartphone application (iPinPoint) was reliable for measurements of the hallux valgus angles by either experienced or nonexperienced observers. The use of these tools might save time in the evaluation of radiographic angles in the hallux valgus. Copyright © 2016 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  9. Effect of toe-spread-out exercise on hallux valgus angle and cross-sectional area of abductor hallucis muscle in subjects with hallux valgus.

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    Kim, Moon-Hwan; Yi, Chung-Hwi; Weon, Jong-Hyuck; Cynn, Heon-Seock; Jung, Do-Young; Kwon, Oh-Yun

    2015-04-01

    [Purpose] This study investigated whether the toe-spread-out exercise affects the hallux valgus angle, the cross-sectional area of the abductor hallucis muscle, and the hallux valgus angle during active abduction. [Subjects and Methods] Twenty-four subjects with hallux valgus were randomly assigned to orthosis and orthosis plus toe-spread-out exercise groups. The orthosis group wore the orthosis for 8 weeks, while the orthosis plus toe-spread-out group also performed the toe-spread-out exercise. The hallux valgus angle, the cross-sectional area of the abductor hallucis muscle, and the hallux valgus angle during active abduction were measured initially and after 8 weeks by radiography and ultrasonography. [Results] While there were no significant changes in the three parameters in the orthosis group, there were significant differences in the orthosis plus toe-spread-out exercise group after 8 weeks. In addition there were significant differences in the three measures between the two groups. [Conclusion] The toe-spread-out exercise reduces the hallux valgus angle and hallux valgus angle during active abduction, and increases the cross-sectional area of the abductor hallucis muscle. The toe-spread-out exercise is recommended for patients with mild to moderate hallux valgus.

  10. Approach for measuring the angle of hallux valgus

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    Jin Zhou

    2013-01-01

    Materials and Methods: Fifteen age, body weight, and height matched male students were included and those with foot disorders, deformities, or injuries were excluded from the study. The dorsal protrusions of the first metatarsal and the hallux were marked by palpating from three experienced observers; then their barefoot model in standing was collected by a three dimensional laser scanning system. The AoH was defined in the X-Y plane by the angle between the line joining the marks of centre of head and centre of base of metatarsal shaft and the one connecting the marks of the centre of metatarsal head and the hallux. The same procedure was repeated a week later. Besides, other measures based on the footprint, outline, and the radiography were also available for comparisons. Paired t-test, linear regression, and reliability analysis were applied for statistical analysis with significant level of 0.05 and 95% confidence interval. Results: There were no significant differences recorded between the new method and the radiographic method ( P = 0.069. The AoH was superior to the methods of footprint and outline and it displayed a relative higher correlation with the radiographic method (r = 0.94, r2 = 0.89. Moreover both the inter and intraobserver reliabilities of this method were proved to be good. Conclusion: This new method can be used for hallux valgus inspection and evaluation.

  11. Comparison of Intercuneiform 1-2 Joint Mobility Between Hallux Valgus and Normal Feet Using Weightbearing Computed Tomography and 3-Dimensional Analysis.

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    Kimura, Tadashi; Kubota, Makoto; Suzuki, Naoki; Hattori, Asaki; Marumo, Keishi

    2018-03-01

    An association has been reported between hallux valgus and hypermobility of the first ray, but subluxation of the intercuneiform 1-2 joint was also suspected in some cases. However, dynamics of the intercuneiform 1-2 joint has seldom been investigated. This study used weightbearing computed tomography (CT) and a 3-dimensional (3D) analysis system to evaluate displacement of the intercuneiform 1-2 joint, intercuneiform 2-3 joint, and second cuneonavicular joint due to weightbearing in hallux valgus and normal feet. Patients were 11 women with hallux valgus (mean age, 56 years; mean hallux valgus angle, 43 degrees; mean first-second intermetatarsal angle, 22 degrees) and 11 women with normal feet (mean age, 57 years; mean hallux valgus angle, 14 degrees; mean first-second intermetatarsal angle, 9 degrees). Each patient was placed supine with the lower limbs extended, and CT was performed under nonweightbearing and weightbearing conditions (load equivalent to body weight). 3D models reconstructed from CT images were used to compare displacement of the intermediate cuneiform relative to the medial cuneiform under nonweightbearing and weightbearing conditions. Relative to the medial cuneiform, the middle cuneiform was displaced by 0.1 and 0.8 degrees due to dorsiflexion, 0.2 and 1.0 degrees due to inversion, and 0.7 and 0.7 degrees due to abduction in normal feet and feet with hallux valgus, respectively, with the latter having significantly greater dorsiflexion ( P = .0067) and inversion ( P = .0019). There was no significant intergroup difference at the intercuneiform 2-3 joint and second cuneonavicular joint. This study clarified the detailed load-induced displacement of the cuneiform 3-dimensionally. Compared with normal feet, hallux valgus feet had significantly greater mobility of the intercuneiform 1-2 joint, suggesting hypermobility of this joint. Level III, case-control study.

  12. Hallux valgus angle as main predictor for correction of hallux valgus.

    NARCIS (Netherlands)

    Deenik, A.R.; Visser, E. de; Louwerens, J.W.; Waal Malefijt, M.C. de; Draijer, F.; Bie, R.A. de

    2008-01-01

    BACKGROUND: It is recognized that different types of hallux valgus exist. Classification occurs with radiographic and clinical parameters. Severity of different parameters is used in algorithms to choose between different surgical procedures. Because there is no consensus about each parameter nor

  13. Radiographic angles in hallux valgus: differences between measurements made manually and with a computerized program.

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    Piqué-Vidal, Carlos; Maled-García, Ignaci; Arabi-Moreno, Juanjo; Vila, Joan

    2006-03-01

    The objective of this study was to compare angular measurements in the evaluation of hallux valgus deformities using a goniometer and a computerized program to assess degree of concordance between the two methods and determine the reliability of manual measurements. Angles measured included the hallux valgus angle (HVA), the intermetatarsal angle (IMA), the distal metatarsal articular angle (DMAA), and the proximal phalangeal articular angle (PPAA), also called the hallux valgus interphalangeus angle or interphalangeal angle. Measurements were made on preoperative weightbearing radiographs in 176 patients with symptomatic hallux valgus. Manual measurements were made with a goniometer by an orthopaedic surgeon. An independent experienced technician used digitized images to perform angular measurements with the Autocad software program (Autodesk Inc., San Rafael, CA). HVA values obtained with the two techniques were similar. However, significantly higher mean values were obtained with the Autocad for the IMA and PPAA measurements, and higher mean values were obtained for the DMAA measurement with the manual technique. Whereas differences were more or less randomly distributed for the HVA, in the remaining patients, measurements were clearly related to the measurement technique, i.e., for the DMAA, the manual technique had a tendency to show higher values, and for the IMA and PPAA the manual technique showed lower values than the computer. Correlations between both techniques for the different angular measurements were as follows: HVA, -0.179 (p = 0.018); DMMA, -0.294 (p Autocad angular measurements was excellent for the HVA (ICC = 0.89) and DMAA (ICC = 0.80) and very poor for the PPAA (ICC = 0.11) and IMA (ICC = 0.42). Angular measurements made on weightbearing radiographs with the Autocad in patients with hallux valgus deformities were more reliable than those made with a goniometer. Although for large angles, such as HVA and DMAA, results obtained with both

  14. A comparison of hallux valgus angles assessed with computerised plantar pressure measurements, clinical examination and radiography in patients with diabetes

    NARCIS (Netherlands)

    Janssen, D.M.; Sanders, A.P.; Guldemond, N.A.; Hermus, J.; Walenkamp, G.H.; Van Rhijn, L.W.

    2014-01-01

    Background Hallux valgus deformity is a common musculoskeletal foot disorder with a prevalence of 3.5% in adolescents to 35.7% in adults aged over 65 years. Radiographic measurements of hallux valgus angles (HVA) are considered to be the most reproducible and accurate assessment of HVA. However, in

  15. Hallux Valgus and the First Tarsometatarsal Joint: Clinical and Biomechanical Aspects

    NARCIS (Netherlands)

    F.W.M. Faber (Frank)

    2003-01-01

    textabstractThis thesis describes a series of cadaver, experimental, radiographic and clinical studies on the relation between a hallux valgus deformity and mobility of the first tarsometatarsal joint. Hypermobility of stiffnes of the joint was determined by Doppler imaging of vibrations and by

  16. "Angle to Be Corrected" in Preoperative Evaluation for Hallux Valgus Surgery: Analysis of a New Angular Measurement.

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    Ortiz, Cristian; Wagner, Pablo; Vela, Omar; Fischman, Daniel; Cavada, Gabriel; Wagner, Emilio

    2016-02-01

    The most common methods for assessing severity of hallux valgus deformity and the effects of an operative procedure are the angular measurements in weightbearing radiographs, specifically the hallux valgus angle and intermetatarsal angle (IMA). Our objective was to analyze the interobserver variability in hallux valgus patients of a new angle called the "angle to be corrected" (ATC), and to compare its capacity to differentiate between different deformities against IMA. We included 28 symptomatic hallux valgus patients with 48 weightbearing foot x-rays. Three trained observers measured the 1 to 2 IMA and the ATC. We then identified retrospectively 45 hallux valgus patients, which were divided into 3 operative technique groups having used the ATC as reference, and analyzed the capacity of the IMA to differentiate between them. The IMA average value was 13.6 degrees, and there was a significant difference between observer 3 and observer 1 (P = .001). The average value for the ATC was 8.9 degrees, and there was no difference between observers. Both angles showed a high intraclass correlation. Regarding the capacity to differentiate between operative technique groups, the ATC was different between the 3 operative technique groups analyzed, but the IMA showed differences only between 2. The ATC was at least as reliable as the intermetatarsal angle for hallux valgus angular measurements, showing a high intraclass correlation with no interobserver difference. It can be suggested that the ATC was better than the IMA to stratify hallux valgus patients when deciding between different operative treatments. Level III, comparative study. © The Author(s) 2015.

  17. Physeal growth retardation leads to correction of intracarpal angular deviations as well as physeal valgus deformity

    International Nuclear Information System (INIS)

    Brauer, T.S.; Booth, T.S.; Riedesel, E.

    1999-01-01

    Retrospective analysis of the radiographs of horses with carpal valgus, presented to the Iowa State University Veterinary Teaching Hospital from 1987-1996, were used to compare 2 methods of geometric analysis for finding the total angle of deviation. The pivot point angle method and the individual joint angle method were found to be comparable for determining the total angle of deviation. The individual joint angle method was used to analyse individual carpal joint angles and physis angle in joints with carpal valgus, as well as the changes that occurred in response to surgical correction. Multiple joint involvement was common with carpal valgus; and surgical manipulation caused a change in angle at all joints. Use of the individual joint angle method for evaluating carpal valgus may aid the surgeon in making a more accurate prognosis

  18. Technique tip: Simultaneous first metatarsal lengthening and metatarsophalangeal joint fusion for failed hallux valgus surgery with transfer metatarsalgia.

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    Chowdhary, Ashwin; Drittenbass, Lisca; Stern, Richard; Assal, Mathieu

    2017-03-01

    Failed hallux valgus surgery may result in residual or recurrent hallux valgus, and as well transfer metatarsalgia. The present technical tip concerns the combination of fusion of the first metatarsophalangeal (MTP) joint and lengthening of the first metatarsal (MT) through a scarf osteotomy. Six patients underwent the presented technique, all for the indication of failed hallux valgus surgery with shortening of the first MT and degenerative changes in the 1st MTP joint. Follow-up at six months revealed all patients had complete healing of the osteotomy and arthrodesis sites. They were all asymptomatic and fully active, completely satisfied with the outcome. Combined fusion of the first MTP joint and lengthening of the first MT through a scarf osteotomy results in an excellent outcome in patients with failed hallux valgus surgery with shortening of the first MT and degenerative changes in the 1st MTP joint. Copyright © 2016 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.

  19. Operative treatment of hallux valgus – the effect of three osteotomy types on the first metatarsal, hallux valgus and metatarsal distal articulation angles

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    Andrej Prlja

    2007-11-01

    Full Text Available Background: Modern approach to hallux valgus deformations enables not only the stage treatment considering the magnitude of the deformity but also the objective evaluation of the results.We investigated the influence of the three most commonly used osteotomies on three most common demonstrative factors, especially proximal osteotomy on the distal metatasal articulation angle.Methods: Three groups were created regarding the magnitude of the deformation. X rays of 15 corrections in each group were reviewed (45 cases, 34 women, 2 men. Each group was treated with only one of the three osteotomies: distal chevron osteotomy (Ch, distal chevron osteotomy with medial edge (ChM and proximal osteotomy (POT. The effect on the three most comonly used demonstrative factors were noted: first intermetatarsal angle (IM, hallux valgus angle (HV, distal metatarsal articulation angle (DMAA. The age and the demonstrative factors were compared pre- and postoperative, in and between the groups.Results: The correct, graded selection of the patients for the treatment was confirmed and false negative results excluded. Preoperative values of HV and DMAA are significantely different between three groups (p < 0.001 while IM are not (p = 0.118. Postoperative values of the HV and IM are significantely lower in all three groups (p < 0.001. DMAA is statisticaly different (positive postoperatively in the ChM group (p < 0.001 but not in the Ch and POT groups (P = 0.398; p = 0.456.Conclusions: Modern approach on hallux valgus deformations enables stage treatment and objective evaluation of the results what is demonstrated by the effect of the osteotomies on the demonstrative factors. Further investigations of the factors not yet considered or even unknown are also possible as shown on the example of the difference between the expected and measured effect of POT on DMAA.

  20. [PERSONALIZED DISTAL FEMORAL VALGUS RESECTION ANGLE IN PRIMARY TOTAL KNEE ARTHROPLASTY].

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    Wang, Xilong; Shang, Xifu; Ll, Guoyuan; He, Rui; Zheng, Jie

    2015-01-01

    To investigate the feasibility and effectiveness of a personalized distal femoral valgus resection angle for improving postoperative coronal alignment of lower limb in total knee arthroplasty (TKA). A retrospective analysis was made on the clinical data of 50 patients who received primary TKA between January 2013 and February 2013. There were 11 male and 39 female patients with degenerative knee osteoarthritis. The patients were divided into 2 groups. In test group (n=25), the resection angle was adjusted to the femoral mechanical anatomical angle (FMA); in control group (n=25), a fixed distal valgus resection angle of 5° was used. There was no significant difference in gender, age, body mass index, disease duration, sides, grade, preoperative FMA, mechanical femorotibial angle (MFT), and preoperative Knee Society Score (KSS) between 2 groups (P > 0.05). Whole long X-ray film was taken to measure FMA and MFT at 3 days after operation, postoperative KSS was used to evaluate the knee function after 6 and 15 months. MFT was (-0.20 ± 1.87)° in test group and was (1.71 ± 3.67)° in control group, showing significant difference between 2 groups (t = 2.32, P = 0.02). The ideal MFT angle (0 ± 3)° was achieved in 22 patients (88%) of test group and in 16 patients (64%) of control group, showing significant difference between 2 groups (χ2 = 2.32, P = 0.02). Primary healing of incision was obtained in all patients of 2 groups. No deep venous thrombosis occurred. The patients of 2 groups were followed up 15 months after operation. There was significant difference in KSS between test and control groups at 6 months (88.23 ± 2.57 vs. 82.92 ± 2.59) (t = 7.26, P = 0.00) and at 15 months (90.76 ± 2.77 vs. 88.65 ± 1.77) (t = 3.20, P = 0.02). No sign of prosthesis loosening was observed by X-ray examination. Compared with using of a fixed distal femoral resection angle, an individual FMA can significantly improve the postoperative MFT and promote early recovery of the knee

  1. Can Double Osteotomy Be a Solution for Adult Hallux Valgus Deformity With an Increased Distal Metatarsal Articular Angle?

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    Park, Chul Hyun; Cho, Jae Ho; Moon, Jeong Jae; Lee, Woo Chun

    2016-01-01

    No previous study has reported the results of double metatarsal osteotomy for adult hallux valgus deformity with an increased distal metatarsal articular angle (DMAA). The purpose of the present study was to evaluate the results after double metatarsal osteotomy in adult patients with incongruent hallux valgus deformity. We retrospectively reviewed 16 cases of consecutive first metatarsal double metatarsal osteotomy without lateral soft tissue release in 14 patients with symptomatic hallux valgus associated with an increased DMAA (≥15° after proximal chevron osteotomy on intraoperative radiographs). Clinical results were assessed using the American Orthopaedic Foot and Ankle Society scale and the visual analog scale. The radiographic results were assessed over time, and changes in the DMAA and the relative length of the first metatarsal were assessed by measuring each value preoperatively and at the last follow-up visit. The American Orthopaedic Foot and Ankle Society and visual analog scale scores were significantly improved after surgery. The hallux valgus angle and intermetatarsal angle were stabilized >3 months after surgery. The sesamoid position did not increase significantly beyond the immediate postoperative period. The mean DMAA was corrected from 21.6° (range 15° to 29°) preoperatively to 11.1° (range -2° to 17°) at the last follow-up visit. The mean amount of shortening of the first metatarsal after surgery was 5.5 (range 4 to 7) mm. In conclusion, double metatarsal osteotomy without lateral soft tissue release in adult hallux valgus deformity results in high postoperative recurrence and complication rates. Copyright © 2016 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  2. The effect of repetitive baseball pitching on medial elbow joint space gapping associated with 2 elbow valgus stressors in high school baseball players.

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    Hattori, Hiroshi; Akasaka, Kiyokazu; Otsudo, Takahiro; Hall, Toby; Amemiya, Katsuya; Mori, Yoshihisa

    2018-04-01

    To prevent elbow injury in baseball players, various methods have been used to measure medial elbow joint stability with valgus stress. However, no studies have investigated higher levels of elbow valgus stress. This study investigated medial elbow joint space gapping measured ultrasonically resulting from a 30 N valgus stress vs. gravitational valgus stress after a repetitive throwing task. The study included 25 high school baseball players. Each subject pitched 100 times. The ulnohumeral joint space was measured ultrasonographically, before pitching and after each successive block of 20 pitches, with gravity stress or 30 N valgus stress. Two-way repeated measures analysis of variance and Pearson correlation coefficient analysis were used. The 30 N valgus stress produced significantly greater ulnohumeral joint space gapping than gravity stress before pitching and at each successive 20-pitch block (P space gapping increased significantly from baseline after 60 pitches (P space gapping (r = 0.727-0.859, P space gapping before pitching; however, 30 N valgus stress appears to induce greater mechanical stress, which may be preferable when assessing joint instability but also has the potential to be more aggressive. The present results may indicate that constraining factors to medial elbow joint valgus stress matched typical viscoelastic properties of cyclic creep. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  3. Medial Elbow Joint Space Increases With Valgus Stress and Decreases When Cued to Perform A Maximal Grip Contraction.

    Science.gov (United States)

    Pexa, Brett S; Ryan, Eric D; Myers, Joseph B

    2018-04-01

    Previous research indicates that the amount of valgus torque placed on the elbow joint during overhead throwing is higher than the medial ulnar collateral ligament (UCL) can tolerate. Wrist and finger flexor muscle activity is hypothesized to make up for this difference, and in vitro studies that simulated activity of upper extremity musculature, specifically the flexor digitorum superficialis and flexor carpi ulnaris, support this hypothesis. To assess the medial elbow joint space at rest, under valgus stress, and under valgus stress with finger and forearm flexor contraction by use of ultrasonography in vivo. Controlled laboratory study. Participants were 22 healthy males with no history of elbow dislocation or UCL injury (age, 21.25 ± 1.58 years; height, 1.80 ± 0.08 m; weight, 79.43 ± 18.50 kg). Medial elbow joint space was measured by use of ultrasonography during 3 separate conditions: at rest (unloaded), under valgus load (loaded), and with a maximal grip contraction under a valgus load (loaded-contracted) in both limbs. Participants lay supine with their arm abducted 90° and elbow flexed 30° with the forearm in full supination. A handgrip dynamometer was placed in the participants' hand to grip against during the contracted condition. Images were reduced in ImageJ to assess medial elbow joint space. A 2-way (condition × limb) repeated-measures analysis of variance and Cohen's d effect sizes were used to assess changes in medial elbow joint space. Post hoc testing was performed with a Bonferroni adjustment to assess changes within limb and condition. The medial elbow joint space was significantly larger in the loaded condition (4.91 ± 1.16 mm) compared with the unloaded condition (4.26 ± 1.23 mm, P space increases under a valgus load and then decreases when a maximal grip contraction is performed. This indicates that wrist and finger flexor muscle contraction may assist in limiting medial elbow joint space, a result similar to findings of previous

  4. Radiographic correlates of hallux valgus severity in older people

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    D'Arcangelo Paul R

    2010-09-01

    Full Text Available Abstract Background The severity of hallux valgus is easily appreciated by its clinical appearance, however x-ray measurements are also frequently used to evaluate the condition, particularly if surgery is being considered. There have been few large studies that have assessed the validity of these x-ray observations across a wide spectrum of the deformity. In addition, no studies have specifically focused on older people where the progression of the disorder has largely ceased. Therefore, this study aimed to explore relationships between relevant x-ray observations with respect to hallux valgus severity in older people. Methods This study utilised 402 x-rays of 201 participants (74 men and 127 women aged 65 to 94 years. All participants were graded using the Manchester Scale - a simple, validated system to grade the severity of hallux valgus - prior to radiographic assessment. A total of 19 hallux valgus-related x-ray observations were performed on each set of x-rays. These measurements were then correlated with the Manchester Scale scores. Results Strong, positive correlations were identified between the severity of hallux valgus and the hallux abductus angle, the proximal articular set angle, the sesamoid position and congruency of the first metatarsophalangeal joint. As hallux valgus severity increased, so did the frequency of radiographic osteoarthritis of the first metatarsophalangeal joint and a round first metatarsal head. A strong linear relationship between increased relative length of the first metatarsal and increased severity of hallux valgus was also observed. Conclusions Strong associations are evident between the clinical appearance of hallux valgus and a number of hallux valgus-related x-ray observations indicative of structural deformity and joint degeneration. As it is unlikely that metatarsal length increases as a result of hallux valgus deformity, increased length of the first metatarsal relative to the second metatarsal may

  5. Q-angle in patellofemoral pain: relationship with dynamic knee valgus, hip abductor torque, pain and function

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    Gabriel Peixoto Leão Almeida

    2016-04-01

    Full Text Available OBJECTIVE: To investigate the relationship between the q-angle and anterior knee pain severity, functional capacity, dynamic knee valgus and hip abductor torque in women with patellofemoral pain syndrome (PFPS. METHODS: This study included 22 women with PFPS. The q-angle was assessed using goniometry: the participants were positioned in dorsal decubitus with the knee and hip extended, and the hip and foot in neutral rotation. Anterior knee pain severity was assessed using a visual analog scale, and functional capacity was assessed using the anterior knee pain scale. Dynamic valgus was evaluated using the frontal plane projection angle (FPPA of the knee, which was recorded using a digital camera during step down, and hip abductor peak torque was recorded using a handheld dynamometer. RESULTS: The q-angle did not present any significant correlation with severity of knee pain (r = -0.29; p = 0.19, functional capacity (r = -0.08; p = 0.72, FPPA (r = -0.28; p = 0.19 or isometric peak torque of the abductor muscles (r = -0.21; p = 0.35. CONCLUSION: The q-angle did not present any relationship with pain intensity, functional capacity, FPPA, or hip abductor peak torque in the patients with PFPS.

  6. Ankle joint pressure changes in a pes cavovarus model: supramalleolar valgus osteotomy versus lateralizing calcaneal osteotomy.

    Science.gov (United States)

    Schmid, Timo; Zurbriggen, Sebastian; Zderic, Ivan; Gueorguiev, Boyko; Weber, Martin; Krause, Fabian G

    2013-09-01

    A fixed cavovarus foot deformity can be associated with anteromedial ankle arthrosis due to elevated medial joint contact stresses. Supramalleolar valgus osteotomies (SMOT) and lateralizing calcaneal osteotomies (LCOT) are commonly used to treat symptoms by redistributing joint contact forces. In a cavovarus model, the effects of SMOT and LCOT on the lateralization of the center of force (COF) and reduction of the peak pressure in the ankle joint were compared. A previously published cavovarus model with fixed hindfoot varus was simulated in 10 cadaver specimens. Closing wedge supramalleolar valgus osteotomies 3 cm above the ankle joint level (6 and 11 degrees) and lateral sliding calcaneal osteotomies (5 and 10 mm displacement) were analyzed at 300 N axial static load (half body weight). The COF migration and peak pressure decrease in the ankle were recorded using high-resolution TekScan pressure sensors. A significant lateral COF shift was observed for each osteotomy: 2.1 mm for the 6 degrees (P = .014) and 2.3 mm for the 11 degrees SMOT (P = .010). The 5 mm LCOT led to a lateral shift of 2.0 mm (P = .042) and the 10 mm LCOT to a shift of 3.0 mm (P = .006). Comparing the different osteotomies among themselves no significant differences were recorded. No significant anteroposterior COF shift was seen. A significant peak pressure reduction was recorded for each osteotomy: The SMOT led to a reduction of 29% (P = .033) for the 6 degrees and 47% (P = .003) for the 11 degrees osteotomy, and the LCOT to a reduction of 41% (P = .003) for the 5 mm and 49% (P = .002) for the 10 mm osteotomy. Similar to the COF lateralization no significant differences between the osteotomies were seen. LCOT and SMOT significantly reduced anteromedial ankle joint contact stresses in this cavovarus model. The unloading effects of both osteotomies were equivalent. More correction did not lead to significantly more lateralization of the COF or more reduction of peak pressure but a trend was

  7. First Metatarsophalangeal Joint Arthrodesis in Hallux Valgus Versus Hallux Rigidus Using Cup and Cone Preparation Compression Screw and Dorsal Plate Fixation.

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    Chien, Calvin; Alfred, Terrence; Freihaut, Richard; Pit, Sabrina

    2017-10-19

    Various techniques have been described for first metatarsophalangeal (MTP) joint arthrodesis. The purpose of this study was to determine if cup and cone preparation by a single surgeon with an interfragmentary screw and dorsal plate fixation provides a comparable union rate in hallux valgus versus hallux rigidus. Our study included all patients who underwent first MTP joint fusions using cup and cone preparation with an interfragmentary compression screw and dorsal plate fixation from 2010 to 2015. We compared union rates in 65 patients with hallux rigidus with 47 who had hallux valgus. One of 65 hallux rigidus cases developed non-union and underwent revision surgery. One of 47 patients in the hallux valgus group developed a painless non-union. All other patients achieved union based on post operative radiographs. Our rate of painful non-union was 1.5% for hallux rigidus and 0% for hallux valgus, which is lower than recent published literature of 7% for hallux valgus and 3.7% for hallux rigidus. We found no difference between the two groups suggesting this method may provide stronger fixation and may be preferable when dealing with hallux valgus. First metatarsophalangeal joint fusion in patients with severe hallux valgus and hallux rigidus, using spherical reamers, compression screw and dorsal plate fixation is equally successful at achieving clinical and radiographic fusion in both hallux valgus and hallux rigidus.

  8. Tendon shift in hallux valgus: observations at MR imaging

    Energy Technology Data Exchange (ETDEWEB)

    Eustace, S. [Department of Radiology, Boston University Medical Center Hospital, 88 East Newton Street, Atrium - 2, Boston, MA 02118 (United States); Williamson, D. [Department of Radiology, Brigham and Womens Hospital, Boston, Massachusetts (United States); Wilson, M. [Department of Orthopedics, Brigham and Womens Hospital, Boston, Massachusetts (United States); O`Byrne, J. [Department of Radiology, Boston University Medical Center Hospital, 88 East Newton Street, Atrium - 2, Boston, MA 02118 (United States); Bussolari, L. [Department of Radiology, Brigham and Womens Hospital, Boston, Massachusetts (United States); Thomas, M. [Department of Radiology, Brigham and Womens Hospital, Boston, Massachusetts (United States); Stephens, M. [Department of Radiology, Boston University Medical Center Hospital, 88 East Newton Street, Atrium - 2, Boston, MA 02118 (United States); Stack, J. [Department of Radiology, Boston University Medical Center Hospital, 88 East Newton Street, Atrium - 2, Boston, MA 02118 (United States); Weissman, B. [Department of Radiology, Brigham and Womens Hospital, Boston, Massachusetts (United States)

    1996-08-01

    Objective. This study was undertaken to demonstrate a shift in tendon alignment at the first metatarsophalangeal joint in patients with hallux valgus by means of magnetic resonance imaging. Design. Ten normal feet and 20 feet with the hallux valgus deformity conforming to conventional clinical and radiographic criteria were prospectively studied using magnetic resonance imaging. Correlation was made between tendon position at the first metatarsophalangeal joint and the severity of the hallux valgus deformity. Results. There is a significant shift in tendon position at the first metatarsophalangeal joint of patients with hallux valgus. The insertion of the abductor hallucis tendon is markedly plantarward and the flexor and extensor tendons bowstring at the first metatarsophalangeal joint compared with patients without the deformity. The severity of the tendon shift correlates with the hallux valgus angle and clinical severity of the hallux valgus deformity in each case. Conclusion. Patients with hallux valgus have a significant tendon shift at the first metatarsophalangeal joint which appears to contribute to development of the deformity. (orig.). With 4 figs., 1 tab.

  9. Tendon shift in hallux valgus: observations at MR imaging

    International Nuclear Information System (INIS)

    Eustace, S.; Williamson, D.; Wilson, M.; O'Byrne, J.; Bussolari, L.; Thomas, M.; Stephens, M.; Stack, J.; Weissman, B.

    1996-01-01

    Objective. This study was undertaken to demonstrate a shift in tendon alignment at the first metatarsophalangeal joint in patients with hallux valgus by means of magnetic resonance imaging. Design. Ten normal feet and 20 feet with the hallux valgus deformity conforming to conventional clinical and radiographic criteria were prospectively studied using magnetic resonance imaging. Correlation was made between tendon position at the first metatarsophalangeal joint and the severity of the hallux valgus deformity. Results. There is a significant shift in tendon position at the first metatarsophalangeal joint of patients with hallux valgus. The insertion of the abductor hallucis tendon is markedly plantarward and the flexor and extensor tendons bowstring at the first metatarsophalangeal joint compared with patients without the deformity. The severity of the tendon shift correlates with the hallux valgus angle and clinical severity of the hallux valgus deformity in each case. Conclusion. Patients with hallux valgus have a significant tendon shift at the first metatarsophalangeal joint which appears to contribute to development of the deformity. (orig.). With 4 figs., 1 tab

  10. A comparison of men's and women's strength to body mass ratio and varus/valgus knee angle during jump landings.

    Science.gov (United States)

    Haines, Tracie L; McBride, Jeffrey M; Triplett, N Travis; Skinner, Jared W; Fairbrother, Kimberly R; Kirby, Tyler J

    2011-10-01

    The purpose of this investigation was to compare valgus/varus knee angles during various jumps and lower body strength between males and females relative to body mass. Seventeen recreationally active females (age: 21.94 ± 2.59 years; height: 1.67 ± 0.05 m; mass: 64.42 ± 8.39 kg; percent body fat: 26.89 ± 6.26%; squat one-repetition maximum: 66.18 ± 19.47 kg; squat to body mass ratio: 1.03 ± 0.28) and 13 recreationally active males (age: 21.69 ± 1.65 years; height: 1.77 ± 0.07 m; mass: 72.39 ± 9.23 kg; percent body fat: 13.15 ± 5.18%; squat one-repetition maximum: 115.77 ± 30.40 kg; squat to body mass ratio: 1.59 ± 0.31) performed a one-repetition maximum in the squat and three of each of the following jumps: countermovement jump, 30 cm drop jump, 45 cm drop jump, and 60 cm drop jump. Knee angles were analysed using videography and body composition was analysed by dual-energy X-ray absorptiometry to allow for squat to body mass ratio and squat to fat free mass ratio to be calculated. Significant differences (P ≤ 0.05) were found between male and female one-repetition maximum, male and female squat to body mass ratio, and male and female squat to fat free mass ratio. Significant differences were found between male and female varus/valgus knee positions during maximum flexion of the right and left leg in the countermovement jump, drop jump from 30 cm, drop jump from 45 cm, and drop jump from 60 cm. Correlations between varus/valgus knee angles and squat to body mass ratio for all jumps displayed moderate, non-significant relationships (countermovement jump: r = 0.445; drop jump from 30 cm: r = 0.448; drop jump from 45 cm: r = 0.449; drop jump from 60 cm: r = 0.439). In conclusion, males and females have significantly different lower body strength and varus/valgus knee position when landing from jumps.

  11. Association of knee confidence with pain, knee instability, muscle strength, and dynamic varus-valgus joint motion in knee osteoarthritis.

    Science.gov (United States)

    Skou, Søren T; Wrigley, Tim V; Metcalf, Ben R; Hinman, Rana S; Bennell, Kim L

    2014-05-01

    To investigate associations between self-reported knee confidence and pain, self-reported knee instability, muscle strength, and dynamic varus-valgus joint motion during walking. We performed a cross-sectional analysis of baseline data from 100 participants with symptomatic and radiographic medial tibiofemoral compartment osteoarthritis (OA) and varus malalignment recruited for a randomized controlled trial. The extent of knee confidence, assessed using a 5-point Likert scale item from the Knee Injury and Osteoarthritis Outcome Score, was set as the dependent variable in univariable and multivariable ordinal regression, with pain during walking, self-reported knee instability, quadriceps strength, and dynamic varus-valgus joint motion during walking as independent variables. One percent of the participants were not troubled with lack of knee confidence, 17% were mildly troubled, 50% were moderately troubled, 26% were severely troubled, and 6% were extremely troubled. Significant associations were found between worse knee confidence and higher pain intensity, worse self-reported knee instability, lower quadriceps strength, and greater dynamic varus-valgus joint motion. The multivariable model consisting of the same variables significantly accounted for 24% of the variance in knee confidence (P knee confidence is associated with higher pain, worse self-reported knee instability, lower quadriceps muscle strength, and greater dynamic varus-valgus joint motion during walking. Since previous research has shown that worse knee confidence is predictive of functional decline in knee OA, addressing lack of knee confidence by treating these modifiable impairments could represent a new therapeutic target. Copyright © 2014 by the American College of Rheumatology.

  12. [Mass sports improves proprioception and reduces valgus stress on the female knee joint].

    Science.gov (United States)

    Lippross, S; Prange, G; Oehlert, K; Katharina, O; Furkmann, O; Seekamp, A; Hassenpflug, J; Varoga, D

    2010-03-01

    ACL rupture is more common in females than in males. The injury can result in chondral and meniscal damage or chronic instability. Most often ACL rupture occurs during landing after throwing and jumping in ball sports. Many studies have reported on incidence, mechanism of injury and predisposing factors in professional athletes. In contrast, we have investigated the impact of mass sports on predisposing factors for the female ACL rupture. In an empirical analytical study leg-axis dynamics, proprioception and foot load of 44 women participating either in regular mass sports or in no sports were investigated by video analysis and on the Biodex-Stability Platform. Our study demonstrates that mass sports improves proprioception of the knee joint. Non-sportive subjects had an increased valgus leg axis during landing in comparison with mass sport participants. Here, we show to the best of our knowledge for the first time that moderate sports activity has a positive effect on predisposing factors of the female ACL rupture. We conclude that prevention programmes focussed on jumping and proprioception can lower the incidence of female ACL ruptures.

  13. Avaliação do ângulo intermetatarsal após a artrodese da primeira articulação metatarsofalangeana para tratamento do hálux valgo Evaluation of the intermetatarsal angle after the arthrodesis of the first metatarsophalangeal joint for treatment of the hallux valgus

    Directory of Open Access Journals (Sweden)

    Marco Túlio Costa

    2012-01-01

    Full Text Available OBJETIVO: Avaliar a correção do ângulo intermetatarsal após a artrodese da articulação metatarsofalangeana do hálux. Acreditamos que a deformidade em varo do primeiro metatarso pode ser corrigida após a artrodese da primeira articulação metatarsofalangeana, sem a necessidade da osteotomia proximal. MÉTODO: Foram analisados, retrospectivamente, 43 pés de pacientes submetidos à artrodese da primeira articulação metatarsofalangeana no período de maio de 1997 a outubro de 2009 utilizando radiografias. O tempo médio de seguimento foi de 58 meses. A mensuração dos ângulos metatarsofalangeano, intermetatarsal e a luxação dos sesamoides foram realizadas nas radiografias no pré-operatório, pós-operatório imediato e pós-operatório tardio. RESULTADOS: O ângulo médio metatarsofalangeano foi de 37,6 graus no pré-operatório, 12,8 graus no pós-operatório imediato e 16,4 graus no pósoperatório tardio. O ângulo médio intermetatarsal foi de 16 graus no pré-operatório, 10 graus no pós-operatório imediato e 10,2 graus no pós-operatório tardio. Quanto à luxação dos sesamoides, nas radiografias pré-operatórias a maioria dos pés foram classificados como G3, no pós-operatório imediato foi classificada como G2 e no pós-operatório tardio como G1. CONCLUSÃO: O ângulo intermetatarsal e a luxação dos sesamoides melhoram com a artrodese da primeira articulação metatarsofalangeana sem a necessidade de uma osteotomia na base do primeiro metatarso.OBJECTIVE: To evaluate the correction of the intermetatarsal angle after arthrodesis of the metatarsophalangeal joint of the hallux. We believe that varus deformity of the first metatarsal can be corrected after arthrodesis of the first metatarsophalangeal joint, without the need for proximal osteotomy. METHODS: Forty-three feet of patients who had undergone arthrodesis of the first metatarsophalangeal joint between May 1997 and October 2009 were retrospectively analyzed by

  14. A DYNAMIC VALGUS INDEX THAT COMBINES HIP AND KNEE ANGLES: ASSESSMENT OF UTILITY IN FEMALES WITH PATELLOFEMORAL PAIN.

    Science.gov (United States)

    Scholtes, Sara A; Salsich, Gretchen B

    2017-06-01

    Two=dimensional motion analysis of lower=extremity movement typically focuses on the knee frontal plane projection angle, which considers the position of the femur and the tibia. A measure that includes the pelvis may provide a more comprehensive and accurate indicator of lower=extremity movement. Hypothesis/Purpose: The purpose of the study was to describe the utility of a two=dimensional dynamic valgus index (DVI) in females with patellofemoral pain. The hypothesis was that the DVI would be more reliable and valid than the knee frontal plane projection angle, be greater in females with patellofemoral pain during a single=limb squat than in females without patellofemoral pain, and decrease in females with patellofemoral pain following instruction. Study Design: Controlled Laboratory Study. Data were captured while participants performed single limb squats under two conditions: usual and corrected. Two=dimensional hip and knee angles and a DVI that combined the hip and knee angles were calculated. Three=dimensional sagittal, frontal, and transverse plane angles of the hip and knee and a DVI combining the frontal and transverse plane angles were calculated. The two=dimensional DVI demonstrated moderate reliability (ICC=0.74). The correlation between the two=dimensional and three=dimensional DVI's was 0.635 (ppatellofemoral pain demonstrated a greater two=dimensional DVI (31.14 °±13.36 °) than females without patellofemoral pain (18.30 °±14.97 °; p=0.010). Females with patellofemoral pain demonstrated a decreased DVI in the corrected (19.04 °±13.70 °) versus usual (31.14 °±13.36 °) condition (p=0.001). The DVI is a reliable and valid measure that may provide a more comprehensive assessment of lower=extremity movement patterns than the knee frontal plane projection angle in individuals with lower=extremity musculoskeletal pain problems. 2b.

  15. ARTHRODESIS OF THE FIRST METATARSOPHALANGEAL JOINT IN PATIENTS WITH RHEUMATOID ARTHRITIS AND HALLUX VALGUS: CHOICE OF TECHNIQUE OF ARTHRODESIS FIXATION, COMPLICATIONS AND LONG-TERM RESULTS

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    V. P. Pavlov

    2014-01-01

    Full Text Available Objective: to study results of arthrodesis of the first metatarsophalangeal joint (I MPT joint in patients with rheumatoidarthritis (RA and hallux valgus, assess methods of arthrodesis fixation, reveal complications and analyze longterm results.Subjects and methods. Authors observed 86 patients with RA, female : male ratio 3.2:1, mean age was 53.8±9.5 years (from 18 to 75 years; 80 from them had seropositive and 6 – seronegative RA. 72 patients had low, and 14 –moderate activity of the disease. II stage of RA was revealed in 31.4%, III – in 62.8%, IV – in 5.8%; 52.3% of  patients had I and 47.7% – II functional class. All patients  ad hallux valgus as a component of typical deformation of the forefoot – digitis V rheumaticus (DVR. Standard global reconstructive operation (SGRO and its modification (MGRO were used. Both techniques included arthrodesis of the I MTP joint where fusion of bones was fixed with Kirschner wire and compression clamps in groups A and B respectively. Results of surgical treatmentwere assessed separately for I and II–V toes. The present work provides solely the results of the I MTP joint arthrodesis.Results. Assessment of the I MTP joint with hallux valgus before and 2.3±1.5 years after operation based on AOFAS comprised 35.51±8.16/82.32±6.09 in the group A and 39.93±6.65/82.26±5,59 in the group B. Inefficiency of arthrodesis of the I MTP joint was observed in 3 patients from the group B (2.15%. Before operation, 3 from 141 feet had hallux valgus of the II stage (21–40°; III (41–60° and IV (>60° stages of hallux valgus were recorded in 90 and48 feet respectively. Following 2.3 years after arthrodesis normal I MTP joints (10–11° were observed in 131 feet whereas, that of the II stage of hallux valgus (12–20° – in 10 feet.Conclusion. High efficacy of arthrodesis of the I MTP joint in patients with RA and hallux valgus and, subsequently, low failure rate (2.15% were achieved as

  16. Rubber hand illusion affects joint angle perception.

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    Martin V Butz

    Full Text Available The Rubber Hand Illusion (RHI is a well-established experimental paradigm. It has been shown that the RHI can affect hand location estimates, arm and hand motion towards goals, the subjective visual appearance of the own hand, and the feeling of body ownership. Several studies also indicate that the peri-hand space is partially remapped around the rubber hand. Nonetheless, the question remains if and to what extent the RHI can affect the perception of other body parts. In this study we ask if the RHI can alter the perception of the elbow joint. Participants had to adjust an angular representation on a screen according to their proprioceptive perception of their own elbow joint angle. The results show that the RHI does indeed alter the elbow joint estimation, increasing the agreement with the position and orientation of the artificial hand. Thus, the results show that the brain does not only adjust the perception of the hand in body-relative space, but it also modifies the perception of other body parts. In conclusion, we propose that the brain continuously strives to maintain a consistent internal body image and that this image can be influenced by the available sensory information sources, which are mediated and mapped onto each other by means of a postural, kinematic body model.

  17. Factors affecting femoral rotational angle based on the posterior condylar axis in gap-based navigation-assisted total knee arthroplasty for valgus knee.

    Science.gov (United States)

    Lee, Sung-Sahn; Lee, Yong-In; Kim, Dong-Uk; Lee, Dae-Hee; Moon, Young-Wan

    2018-01-01

    Achieving proper rotational alignment of the femoral component in total knee arthroplasty (TKA) for valgus knee is challenging because of lateral condylar hypoplasia and lateral cartilage erosion. Gap-based navigation-assisted TKA enables surgeons to determine the angle of femoral component rotation (FCR) based on the posterior condylar axis. This study evaluated the possible factors that affect the rotational alignment of the femoral component based on the posterior condylar axis. Between 2008 and 2016, 28 knees were enrolled. The dependent variable for this study was FCR based on the posterior condylar axis, which was obtained from the navigation system archives. Multiple regression analysis was conducted to identify factors that might predict FCR, including body mass index (BMI), Kellgren-Lawrence grade (K-L grade), lateral distal femoral angles obtained from the navigation system and radiographs (NaviLDFA, XrayLDFA), hip-knee-ankle (HKA) axis, lateral gap under varus stress (LGVS), medial gap under valgus stress (MGVS), and side-to-side difference (STSD, MGVS - LGVS). The mean FCR was 6.1° ± 2.0°. Of all the potentially predictive factors evaluated in this study, only NaviLDFA (β = -0.668) and XrayLDFA (β = -0.714) predicted significantly FCR. The LDFAs, as determined using radiographs and the navigation system, were both predictive of the rotational alignment of the femoral component based on the posterior condylar axis in gap-based TKA for valgus knee. A 1° increment with NaviLDFA led to a 0.668° decrement in FCR, and a 1° increment with XrayLDFA led to a 0.714° decrement. This suggests that symmetrical lateral condylar hypoplasia of the posterior and distal side occurs in lateral compartment end-stage osteoarthritis with valgus deformity.

  18. Relationship of frontal plane rotation of first metatarsal to proximal articular set angle and hallux alignment in patients undergoing tarsometatarsal arthrodesis for hallux abducto valgus: a case series and critical review of the literature.

    Science.gov (United States)

    Dayton, Paul; Feilmeier, Mindi; Kauwe, Merrell; Hirschi, Jordan

    2013-01-01

    Rotation of the first metatarsal, as a component of hallux abducto valgus, is rarely discussed and is not addressed as a component of most hallux valgus corrective procedures. We believe frontal plane rotation of the first metatarsal to be an integral component of hallux abducto valgus deformity (the "third plane of deformity") and believe de-rotation is necessary for complete deformity correction. We observed the change in angular measurements commonly used in the evaluation of hallux valgus deformity in patients who underwent a modified lapidus procedure. We measured the intermetatarsal angle, hallux abductus angle, proximal articular set angle, and tibial sesamoid position on weightbearing radiographs of 25 feet in 24 patients who had undergone tarsal metatarsal corrective arthrodesis and lateral capsular release. Specific attention was given to reduction of the frontal plane rotation of the first metatarsal during correction. Our results showed a change in the angular measurements observed by 4 investigators as follows. The mean change in the intermetatarsal angle was 10.1° (p hallux abductus angle was 17.8° (p valgus, or everted position of the first metatarsal, was noted as a component of the hallux abducto valgus deformity in our patient population and was corrected by varus rotation or inversion of the metatarsal. We also reviewed the current literature related to anatomic changes in the first ray in the patient with hallux valgus deformity and reviewed our hypothesis regarding the reduction in the proximal articular set angle, which we believe to be related to frontal plane rotation of the first metatarsal, resulting in a radiographic artifact. Copyright © 2013. Published by Elsevier Inc.

  19. Comparison of Designed Slippers Splints with the Splints Available on the Market in the Treatment of Hallux Valgus

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    Yadollah Pournia

    2012-02-01

    Full Text Available Hallux valgus or the lateral deviation of the great toe is a complex disease. If it is not treated, it will cause the deviation of other toes. Hallux valgus is three times more common in females and may cause uncomfortable deformity of the foot, problems in putting on unsuitable and narrow toe box shoes, and pain on the medial side of the first metatarsophalangeal joint; therefore, patients seek medical services. Untreated hallux valgus may cause the hammer toe deformity of the second toe. In this cohort study, 30 patients referring to the Orthopedic Clinic of Shohada Ashayer Hospital of Khorramabad, Iran, with a complaint of hallux valgus were randomly divided into two groups. The splints designed by the researches (slippers splints were given to the case group, and the splints on the market including night splints and interdigital pads were given to the control group. The patients were followed every three months for a year and every time the weight bearing anteroposterior radiography of both feet were taken and hallux valgus and inter-metatarsal angles were measured. The data was analyzed by the SPSS software using repeated measure tests. In the case group that used the designed splints regularly, hallux valgus angles decreased more dramatically than in the control group (P<0.001. This study showed that, despite controversies over the nonoperative treatment of hallux valgus, if hallux valgus angle in patient is mild to moderate, the splint can be used as a nonoperative treatment.

  20. [Distal soft-tissue procedure in hallux valgus deformity].

    Science.gov (United States)

    Arbab, D; Wingenfeld, C; Frank, D; Bouillon, B; König, D P

    2016-04-01

    Distal, lateral soft tissue release to restore mediolateral balance of the first metatarsophalangeal (MTP) joint in hallux valgus deformity. Incision of the adductor hallucis tendon from the fibular sesamoid, the lateral capsule, the lateral collateral ligament, and the lateral metatarsosesamoid ligament. Hallux valgus deformities or recurrent hallux valgus deformities with an incongruent MTP joint. General medical contraindications to surgical interventions. Painful stiffness of the MTP joint, osteonecrosis, congruent joint. Relative contraindications: connective tissue diseases (Marfan syndrome, Ehler-Danlos syndrome). Longitudinal, dorsal incision in the first intermetatarsal web space between the first and second MTP joint. Blunt dissection and identification of the adductor hallucis tendon. Release of the adductor tendon from the fibular sesamoid. Incision of the lateral capsule, the lateral collateral ligament, and the lateral metatarsosesamoid ligament. Postoperative management depends on bony correction. In joint-preserving procedures, dressing for 3 weeks in corrected position. Subsequently hallux valgus orthosis at night and a toe spreader for a further 3 months. Passive mobilization of the first MTP joint. Postoperative weight-bearing according to the osteotomy. A total of 31 patients with isolated hallux valgus deformity underwent surgery with a Chevron and Akin osteotomy and a distal medial and lateral soft tissue balancing. The mean preoperative intermetatarsal (IMA) angle was 12.3° (range 11-15°); the hallux valgus (HV) angle was 28.2° (25-36°). The mean follow-up was 16.4 months (range 12-22 months). The mean postoperative IMA correction ranged between 2 and 7° (mean 5.2°); the mean HV correction was 15.5° (range 9-21°). In all, 29 patients (93%) were satisfied or very satisfied with the postoperative outcome, while 2 patients (7%) were not satisfied due to one delayed wound healing and one recurrent hallux valgus deformity. There were no

  1. Radiological Characteristics and Anatomical Risk Factors in the Evaluation of Hallux Valgus in Chinese Adults

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    Xu, Hailin; Jin, Kaiji; Fu, Zhongguo; Ma, Mingtai; Liu, Zhongdi; An, Shuai; Jiang, Baoguo

    2015-01-01

    Background: There are no unified theories as to the anatomical changes that occur with hallux valgus, we investigated the radiological characteristics and anatomical risk factors for hallux valgus deformity in Chinese adults. Methods: We reviewed 141 patients with hallux valgus (206 feet; 15 males, 126 females; mean age, 58.5 years). These patients attended Peking University People's Hospital from April 2008 to March 2014. All feet had intact radiological data, obtained using the Centricity RIS/PACS system. We measured hallux valgus angle (HVA), 1–2 intermetatarsal angle (IMA), proximal articular set angle (PASA), distal articular set angle, hallux interphalangeal angle, metatarsocuneiform angle, size of the medial eminence of the distal first metatarsal, tibial sesamoid position, and joint congruity of the first metatarsophalangeal joint (MTPJ). Results: We found positive correlations between the HVA and IMA (r = 0.279, P 0.05). Feet were divided into three groups based on HVA severity. IMA (P 0.05). Feet were then grouped based on the shape of the first metatarsal head. Using this grouping, HVA was significant higher in the rounded shape (19.92°) than in a flat shape (17.66°). The size of the medial eminence of the distal first metatarsal was positively correlated with HVA (r = 0.185, P hallux valgus formation, and decompensation leads to subdislocation in the first MTPJ. A rounded first metatarsal head would thus predispose a foot to hallux valgus. Furthermore, bone proliferation at the medial eminence may also lead to early hallux valgus development. PMID:25563313

  2. Radiological Characteristics and Anatomical Risk Factors in the Evaluation of Hallux Valgus in Chinese Adults

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    Hailin Xu

    2015-01-01

    Full Text Available Background: There are no unified theories as to the anatomical changes that occur with hallux valgus, we investigated the radiological characteristics and anatomical risk factors for hallux valgus deformity in Chinese adults. Methods: We reviewed 141 patients with hallux valgus (206 feet; 15 males, 126 females; mean age, 58.5 years. These patients attended Peking University People′s Hospital from April 2008 to March 2014. All feet had intact radiological data, obtained using the Centricity RIS/PACS system. We measured hallux valgus angle (HVA, 1-2 intermetatarsal angle (IMA, proximal articular set angle (PASA, distal articular set angle, hallux interphalangeal angle, metatarsocuneiform angle, size of the medial eminence of the distal first metatarsal, tibial sesamoid position, and joint congruity of the first metatarsophalangeal joint (MTPJ. Results: We found positive correlations between the HVA and IMA (r = 0.279, P 0.05. Feet were divided into three groups based on HVA severity. IMA (P 0.05. Feet were then grouped based on the shape of the first metatarsal head. Using this grouping, HVA was significant higher in the rounded shape (19.92° than in a flat shape (17.66°. The size of the medial eminence of the distal first metatarsal was positively correlated with HVA (r = 0.185, P < 0.01. The medial eminence in the moderate and severe groups was significantly larger than that in the mild group; moderate and severe groups were not significantly different. Conclusions: PASA enlargement is an adaptive change during early hallux valgus formation, and decompensation leads to subdislocation in the first MTPJ. A rounded first metatarsal head would thus predispose a foot to hallux valgus. Furthermore, bone proliferation at the medial eminence may also lead to early hallux valgus development.

  3. [Lack of correlation between plantar arthrosis of the first metatarsal joint and sesamoids and pain in patients after hallux valgus surgery].

    Science.gov (United States)

    Villas, C; Escribano, R J; Alfonso, M

    2012-01-01

    To determine the relationship between osteoarthritis in the plantar region of the first metatarsophalangeal joint of the foot and patient pain after hallux valgus surgery. A total of 28 patients undergoing hallux valgus surgery were examined. The patients were examined for pain in the plantar region of the metatarsophalangeal joint (sesamoid bones area), by looking into their medical records and by means of palpation during the physical exam. X-rays were taken to look for metatarsophalangeal arthritis, and PASA and sesamoid displacement were measured. During the surgical procedure, the metatarsal head was macroscopically assessed for arthritis according to the ICRS Score. Of the 28 patients, 18 had no pain, 7 had mild pain (VAS 1-3) and 3 had moderate pain (VAS 4-6). Macroscopically, all the patients had some degree of plantar osteoarthritis. Only 5 patients had radiological signs of metatarsophalangeal arthritis. There was no correlation (P=.44) between pain and plantar osteoarthritis. There was a mild but non-significant correlation between PASA and osteoarthritis (P=.06). There was a weak but significant correlation between patient age and arthritis (P=.04). Osteoarthritis in the plantar aspect of the first metatarsal head does not correlate with patient symptoms or with pain intensity in patients undergoing hallux valgus surgery. Copyright © 2011 SECOT. Published by Elsevier Espana. All rights reserved.

  4. Reliability and relationship of radiographic measurements in hallux valgus.

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    Lee, Kyoung Min; Ahn, Soyeon; Chung, Chin Youb; Sung, Ki Hyuk; Park, Moon Seok

    2012-09-01

    Although various radiographic measurements have been developed and used for evaluating hallux valgus, not all are universally believed to be necessary and their relationships have not been clearly established. Determining which are related could provide some insight into which might be useful and which would not. We investigated the reliability of eight radiographic measurements used to evaluate hallux valgus, and determined which were correlated and which predicted the hallux valgus angle. We determined eight radiographic indices for 732 patients (mean age, 51 years; SD, 17 years; 107 males and 625 females) with hallux valgus: hallux valgus angle, intermetatarsal angle, hallux interphalangeal angle, distal metatarsal articular angle, proximal phalangeal articular angle, simplified metatarsus adductus angle, first metatarsal protrusion distance, and sesamoid rotation angle. Intraobserver and interobserver reliabilities of each radiographic measurement were analyzed on 36 feet from 36 randomly selected patients. Correlations among the radiographic measurements were analyzed. Radiographic measurements predicting hallux valgus angle were evaluated using multiple regression analysis. Hallux valgus angle had the highest reliability, whereas the distal metatarsal articular angle and simplified metatarsus adductus angle had the lowest. Distal metatarsal articular angle, intermetatarsal angle, and sesamoid rotation angle had the highest correlations with hallux valgus angle. Distal metatarsal articular angle correlated with sesamoid rotation angle. The intermetatarsal angle, interphalangeal angle, distal metatarsal articular angle, first metatarsal protrusion distance, sesamoid rotation angle, and metatarsus adductus angle predicted the hallux valgus angle. We suggest using hallux valgus angle, intermetatarsal angle, interphalangeal angle, sesamoid rotation angle, and first metatarsal protrusion distance considering their reliability and prediction of the deformity.

  5. Radiographic Measurements Associated With the Natural Progression of the Hallux Valgus During at Least 2 Years of Follow-up.

    Science.gov (United States)

    Lee, Seung Yeol; Chung, Chin Youb; Park, Moon Seok; Sung, Ki Hyuk; Ahmed, Sonya; Koo, Seungbum; Kang, Dong-Wan; Lee, Kyoung Min

    2018-04-01

    This study aimed to investigate the radiographic measurements associated with the progression of hallux valgus during at least 2 years of follow-up. Seventy adult patients with hallux valgus who were followed for at least 2 years and underwent weightbearing foot radiography were included. Radiographic measurements included the hallux valgus angle (HVA), hallux interphalangeal angle, intermetatarsal angle (IMA), metatarsus adductus angle, distal metatarsal articular angle (DMAA), tibial sesamoid position, anteroposterior (AP) talo-first metatarsal angle, and lateral talo-first metatarsal angle. Patients were divided into progressive and nonprogressive groups. Binary logistic regression analysis was performed to identify factors that significantly affected the progression of hallux valgus deformity. The correlation between change in HVA and changes in other radiographic indices during follow-up was analyzed. The DMAA ( P = .027) and AP talo-first metatarsal angle ( P = .034) at initial presentation were found to be significant factors affecting the progression of hallux valgus deformity. Change in the HVA during follow-up was significantly correlated with changes in the IMA ( r = 0.423; P = .001) and DMAA ( r = 0.541; P < .001). The change in the HVA was found to be significantly correlated with changes in the IMA and DMAA. A future study is required to elucidate whether this correlation can be explained by the progressive instability of the first tarsometatarsal joint. We believe special attention needs to be paid to patients with pes planus and increased DMAA. Level III, comparative study.

  6. Surgical correction of hallux valgus complicated with adult-type pes plano-valgus.

    Science.gov (United States)

    Choi, Jun Young; Yoon, Hyeong Hwa; Suh, Yu Min; Suh, Jin Soo

    2017-01-01

    To investigate the efficiency of simultaneous correction of moderate to severe hallux valgus deformity and adult-type pes planus. Twenty cases of moderate to severe hallux valgus complicated with adult-type pes planus in 19 consecutive patients (15 (79%) women, 4 (11%) men; mean age: 44.50 ± 17.13 years, mean follow-up duration: 31.30 ± 17.02 months) were included. Medial calcaneal sliding osteotomy was performed to correct hindfoot valgus, whereas treatments of hallux valgus were case dependent. The mean postoperative hallux valgus angle, intermetatarsal angle, hindfoot alignment angle, and hindfoot alignment ratio were 8.40 ± 5.29°, 4.20 ± 2.54°, 3.09 ± 2.92º and 0.41 ± 0.17, respectively. Although a hallux varus deformity occurred as a postoperative complication in one case (5%), there were no cases of postoperative recurrence. Simultaneous correction of hallux valgus and pes plano-valgus using medial calcaneal sliding osteotomy is an effective technique that reduces recurrence of hallux valgus and increases satisfaction in patients with moderate to severe hallux valgus deformity complicated with adult-type pes planus accompanying hindfoot valgus.

  7. Effect of Forefoot Strike on Lower Extremity Muscle Activity and Knee Joint Angle During Cutting in Female Team Handball Players.

    Science.gov (United States)

    Yoshida, Naruto; Kunugi, Shun; Mashimo, Sonoko; Okuma, Yoshihiro; Masunari, Akihiko; Miyazaki, Shogo; Hisajima, Tatsuya; Miyakawa, Shumpei

    2015-06-01

    The purpose of this study is to examine the effects of different strike forms, during cutting, on knee joint angle and lower limb muscle activity. Surface electromyography was used to measure muscle activity in individuals performing cutting manoeuvres involving either rearfoot strikes (RFS) or forefoot strikes (FFS). Three-dimensional motion analysis was used to calculate changes in knee angles, during cutting, and to determine the relationship between muscle activity and knee joint angle. Force plates were synchronized with electromyography measurements to compare muscle activity immediately before and after foot strike. The valgus angle tends to be smaller during FFS cutting than during RFS cutting. Just prior to ground contact, biceps femoris, semitendinosus, and lateral head of the gastrocnemius muscle activities were significantly greater during FFS cutting than during RFS cutting; tibialis anterior muscle activity was greater during RFS cutting. Immediately after ground contact, biceps femoris and lateral head of the gastrocnemius muscle activities were significantly greater during FFS cutting than during RFS cutting; tibialis anterior muscle activity was significantly lower during FFS cutting. The results of the present study suggest that the hamstrings demonstrate greater activity, immediately after foot strike, during FFS cutting than during RFS cutting. Thus, FFS cutting may involve a lower risk of anterior cruciate ligament injury than does RFS cutting.

  8. Relationship of Radiographic and Clinical Parameters With Hallux Valgus and Second Ray Pathology.

    Science.gov (United States)

    Gribbin, Caitlin K; Ellis, Scott J; Nguyen, Joseph; Williamson, Emilie; Cody, Elizabeth A

    2017-01-01

    Hallux valgus is frequently associated with additional forefoot pathologies, including hammertoes and midfoot osteoarthritis (OA). However, the pathogenesis of these concurrent pathologies remains to be elucidated. We sought to determine whether there is a relationship between demographic and radiographic parameters and the incidence of secondary pathologies in the setting of a bunion, with an emphasis on second tarsometatarsal (TMT) OA and hammertoes. A total of 153 patients (172 feet) who underwent reconstruction for hallux valgus were divided into 3 groups: (1) bunion only (61 patients), (2) bunion with hammertoe without second TMT joint OA (78 patients), and (3) bunion with second TMT joint OA (14 patients). Preoperative age, sex, and body mass index (BMI) as well as hallux valgus angle (HVA), intermetatarsal angle (IMA), metatarsus adductus angle (MAA), ratio of second to first metatarsal length, and Meary's angle were recorded. One-way analysis of variance (normality demonstrated) and Kruskal-Wallis (normality not demonstrated) tests were used to assess differences in continuous variables. Post hoc tests were conducted with the Bonferroni technique. Associations between discrete variables and the study groups were analyzed using χ 2 tests. Following the univariate analysis, multinomial logistic regression models were built to determine potential risk factors for hammertoe or TMT OA group placement. Patients in the hammertoe and TMT OA groups were significantly older than patients in the bunion only group ( P hallux valgus who are at greater risk for developing secondary pathologies. Level III, retrospective comparative series.

  9. Treatment of hallux valgus deformity.

    Science.gov (United States)

    Fraissler, Lukas; Konrads, Christian; Hoberg, Maik; Rudert, Maximilian; Walcher, Matthias

    2016-08-01

    Hallux valgus deformity is a very common pathological condition which commonly produces painful disability. It is characterised as a combined deformity with a malpositioning of the first metatarsophalangeal joint caused by a lateral deviation of the great toe and a medial deviation of the first metatarsal bone.Taking the patient's history and a thorough physical examination are important steps. Anteroposterior and lateral weight-bearing radiographs of the entire foot are crucial for adequate assessment in the treatment of hallux valgus.Non-operative treatment of the hallux valgus cannot correct the deformity. However, insoles and physiotherapy in combination with good footwear can help to control the symptoms.There are many operative techniques for hallux valgus correction. The decision on which surgical technique is used depends on the degree of deformity, the extent of degenerative changes of the first metatarsophalangeal joint and the shape and size of the metatarsal bone and phalangeal deviation. The role of stability of the first tarsometatarsal joint is controversial.Surgical techniques include the modified McBride procedure, distal metatarsal osteotomies, metatarsal shaft osteotomies, the Akin osteotomy, proximal metatarsal osteotomies, the modified Lapidus fusion and the hallux joint fusion. Recently, minimally invasive percutaneous techniques have gained importance and are currently being evaluated more scientifically.Hallux valgus correction is followed by corrective dressings of the great toe post-operatively. Depending on the procedure, partial or full weight-bearing in a post-operative shoe or cast immobilisation is advised. Post-operative radiographs are taken in regular intervals until osseous healing is achieved. Cite this article: Fraissler L, Konrads C, Hoberg M, Rudert M, Walcher M. Treatment of hallux valgus deformity. EFORT Open Rev 2016;1:295-302. DOI: 10.1302/2058-5241.1.000005.

  10. The Effect of an Isometric Hip Muscle Strength Training Protocol on Valgus Angle During a Drop Vertical Jump in Competitive Female Volleyball Players

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    Kaitlin M. Jackson

    2017-10-01

    Full Text Available Background: Hip muscle weakness is associated with higher peak knee valgus angles (VA during drop vertical jumps (DVJ and linked to ACL injury risk. Objective: To determine if isometric strengthening (IST of the hip extensor, abductor, and external rotator muscle groups would reduce VA exhibited during a DVJ. Methodology:  Fourteen female volleyball players (7 training (TG, 7 control (CG, VA≥9˚ during DVJ participated. Pre- and post-test gluteal, quadriceps and hamstring strength were measured with a digital force gauge. Three-dimensional kinematics were collected during 15 DVJ trials. TG participated in a 6-week IST program that targeted the hip extensor, abductor, and external rotator muscle groups. Two-way mixed ANOVAs compared mean differences of VA and strength. Single-participant analyses examined if athlete-specific adaptations went undetected in the analyses of aggregated data. Results: TG hip extension, abduction, and knee flexion strength increased, respectively, by 20.5%, 27.5% and 23.5% (P<0.05. No group-level changes in VA were detected. Unilateral VA decreased for 5 TG participants, and bilateral VA decreased in 2 TG participants. Conclusions: IST increased isometric hip muscle strength, but its effect on VA is inconclusive based on group-level analyses. Using single-participant designs, future studies should assess IST and/or dynamic resistance/neuromuscular training in a larger sample to determine its effect on ACL injury risk factors.

  11. IMU-Based Joint Angle Measurement for Gait Analysis

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    Thomas Seel

    2014-04-01

    Full Text Available This contribution is concerned with joint angle calculation based on inertial measurement data in the context of human motion analysis. Unlike most robotic devices, the human body lacks even surfaces and right angles. Therefore, we focus on methods that avoid assuming certain orientations in which the sensors are mounted with respect to the body segments. After a review of available methods that may cope with this challenge, we present a set of new methods for: (1 joint axis and position identification; and (2 flexion/extension joint angle measurement. In particular, we propose methods that use only gyroscopes and accelerometers and, therefore, do not rely on a homogeneous magnetic field. We provide results from gait trials of a transfemoral amputee in which we compare the inertial measurement unit (IMU-based methods to an optical 3D motion capture system. Unlike most authors, we place the optical markers on anatomical landmarks instead of attaching them to the IMUs. Root mean square errors of the knee flexion/extension angles are found to be less than 1° on the prosthesis and about 3° on the human leg. For the plantar/dorsiflexion of the ankle, both deviations are about 1°.

  12. Geometry of the Valgus Knee: Contradicting the Dogma of a Femoral-Based Deformity.

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    Eberbach, Helge; Mehl, Julian; Feucht, Matthias J; Bode, Gerrit; Südkamp, Norbert P; Niemeyer, Philipp

    2017-03-01

    Realignment osteotomies of valgus knee deformities are usually performed at the distal femur, as valgus alignment is considered to be a femoral-based deformity. This dogma, however, has not been proven in a large patient population. Valgus malalignment may also be caused by a tibial deformity or a combined tibial and femoral deformity. The purposes of this study were (1) to analyze the coronal geometry of patients with valgus malalignment and identify the location of the underlying deformity and (2) to investigate the proportion of cases that require realignment osteotomy at the tibia, the femur, or both locations to avoid an oblique joint line. Cross-sectional study; Level of evidence, 3. The analysis included 420 standing full-leg radiographs of patients with valgus malalignment (mechanical femorotibial angle [mFTA], ≥4°). A systematic analysis of the coronal leg geometry was performed including the mFTA, mechanical lateral distal femoral angle (mLDFA), mechanical medial proximal tibial angle (mMPTA), and joint-line convergence angle (JLCA). The localization of the deformity was determined according to the malalignment test described by Paley, and patients were assigned to 1 of 4 groups: femoral-based valgus deformity, tibial-based valgus deformity, femoral- and tibial-based valgus deformity, or intra-articular/ligamentary-based valgus deformity. Subsequently, the ideal osteotomy site was identified with the goal of a postoperative change of the joint line of two different maximum values, ±2° and ±4°, from its physiological varus position of 3°. Measurements of the coronal alignment revealed a mean (±SD) mFTA of 7.4° ± 4.3° (range, 4°-28.2°). The mean mLDFA and mean mMPTA were 84.8° ± 2.4° and 90.9° ± 2.6°, respectively. The mean JLCA was 1.2° ± 3.1°. The majority (41.0%) of valgus deformities were tibial based, 23.6% were femoral based, 26.9% were femoral and tibial based, and 8.6% were intra-articular/ligamentary based. To achieve a

  13. [A cadaveric study of a new capsulorrhaphy for the surgical treatment of hallux valgus].

    Science.gov (United States)

    Orozco-Villaseñor, S L; Monzó-Planella, M; Martín-Oliva, X; Vázquez-Escamilla, J; Mayagoitia-Vázquez, J J; Frías-Chimal, J E

    2017-01-01

    There are many surgical options for the treatment of hallux valgus in combination with capsular repairs for the correction of hallux valgus. This report corresponds to a descriptive study where a new capsulorrhaphy technique in hallux valgus is proposed. Six dissections were performed on cadavers with hallux valgus deformity using the following surgical technique: medial approach on the first toe longitudinally, dissecting by planes and locating the metatarsophalangeal joint capsule; it was incised longitudinally. The capsule was separated and an exostectomy of the first metatarsal head was done, the edges were regularized and a release of the abductor hallucis was performed. Later, the capsular remnant was resected and repaired. Six cadaveric feet with hallux valgus were studied, five with mild deformity, one with moderate deformity, one foot with the 2nd finger on supraductus. Many capsular repairs have been reported in the literature, including «L», triangular, «V-Y», rectangular, with satisfactory results, along with osteotomy of the first metatarsal. In this report, a new capsular repair was described. Applying this new capsular repair, we reduced the metatarsophalangeal and intermetatarsal angles and achieved a capsular closure with suitable tension; the metatarsophalangeal joint mobility was preserved.

  14. Mitchell′s osteotomy in the management of hallux valgus: An Indian perspective

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    Baba Asif

    2009-01-01

    Full Text Available Background: Hallux valgus is a common condition that affects the forefoot. A large number of procedures are described for managing this condition. Mitchell′s osteotomy and its modifications are being widely used for treating hallux valgus. However, most of the studies describe the results from the developed world. We present results of the classic Mitchell′s osteotomy in hallux valgus in Indian subcontinent. Materials and Methods: Forty eight adult patients (including 12 bilateral ones in the age range of 18-60 years with hallux valgus were managed with the classic Mitchell′s osteotomy. Pain over the bunion was the reason for surgery in 53 of 60 feet and cosmesis in the remaining 7 feet. Patients with hallux valgus angle more than 20° degrees and not responding to a trial of conservative treatment were included. Patients having metatarsophalangeal (MTP joint osteoarthritis (Grade II and higher, hallux rigidus, rheumatoid arthritis, and with subluxation of MTP joint were excluded from the study. Further, patients with first metatarsal more than 3 mm shorter than second metatarsal were also excluded. Results: The average follow-up period is 3 yrs (range 18months - 6yrs. About 55 feet (83% were painless after surgery. Forty-two (70% patients were happy with the cosmetic results of the surgery. Metatarsalgia was the reason for dissatisfaction with the procedure in five patients. The average correction of hallux valgus and the intermetatarsal angles achieved was 19.7° and 6.9°, respectively. Using the Broughton and Winson scoring system, 37 (61.7% feet had excellent results, 18 (30% had good, and five (8.3% feet had a poor results. Conclusion: The classic Mitchell′s procedure is a simple procedure and gives good cosmetic and radiological results.

  15. SURGICAL CORRECTION OF HALLUX VALGUS IN PATIENTS WITH TRANSVERSE FLATFOOT AND DEFORMING ARTHROSIS OF THE FIRST METATARSOPHALANGEAL JOINT

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    V. M. Mashkov

    2013-01-01

    Full Text Available Objective: to determine the opportunity of usage of Schede-Brandes procedure in the treatment of patients with hallux valgus. Material and methods. The results of Shede-Brandeis operation were studied in 119 patients (198 feet. The study included patients who were followed up long-term results of treatment for up to 10 years. The results of the surgical treatment were assessed by the AOFAS scale and total criteria proposed I.A. Pakhomov. According to these scales the following results were obtained: the good - in 59,59% of patients, satisfactory - in 22,73%, poor - in 17,68%. Conclusion. These results allow to recommend Schede-Brandes procedure for use in elderly patients with osteoporosis, concomitant vascular diseases of lower extremities and with rheumatoid arthritis.

  16. Measurements of normal joint angles by goniometry in calves.

    Science.gov (United States)

    Sengöz Şirin, O; Timuçin Celik, M; Ozmen, A; Avki, S

    2014-01-01

    The aim of this study was to establish normal reference values of the forelimb and hindlimb joint angles in normal Holstein calves. Thirty clinically normal Holstein calves that were free of any detectable musculoskeletal abnormalities were included in the study. A standard transparent plastic goniometer was used to measure maximum flexion, maximum extension, and range-of-motion of the shoulder, elbow, carpal, hip, stifle, and tarsal joints. The goniometric measurements were done on awake calves that were positioned in lateral recumbency. The goniometric values were measured and recorded by two independent investigators. As a result of the study it was concluded that goniometric values obtained from awake calves in lateral recumbency were found to be highly consistent and accurate between investigators (p <0.05). The data of this study acquired objective and useful information on the normal forelimb and hindlimb joint angles in normal Holstein calves. Further studies can be done to predict detailed goniometric values from different diseases and compare them.

  17. Variability and Similarity of Gait as Evaluated by Joint Angles

    DEFF Research Database (Denmark)

    Yang, Sylvia X M; Larsen, Peter Kastmand; Alkjær, Tine

    2014-01-01

    . Six sets from 12 men were collected. For each man, a variability range VR (mean ± 1SD) of a specific joint angle at a specific time point (a gait cycle was 100 time points) was calculated. In turn, each individual was compared with the 11 others, and whenever 1 of these 11 had a value within...... this individual’s VR, it counted as positive. By adding the positives throughout the gait cycle, we created simple bar graphs; tall bars indicated a small discriminatory power, short bars indicated a larger one. The highest discriminatory power was at time points 60–80 in the gait cycle. We show how our data can...

  18. Tibial condylar valgus osteotomy (TCVO) for osteoarthritis of the knee: 5-year clinical and radiological results.

    Science.gov (United States)

    Chiba, Ko; Yonekura, Akihiko; Miyamoto, Takashi; Osaki, Makoto; Chiba, Goji

    2017-03-01

    Tibial condylar valgus osteotomy (TCVO) is a type of opening-wedge high tibial osteotomy for advanced medial knee osteoarthritis (OA) with subluxated lateral joint. We report the concept, the current surgical technique with a locking plate, and the short-term clinical and radiological results of this procedure. 11 knees with medial OA and a widened lateral joint were treated by TCVO (KL stage III: 6, IV: 5). In this procedure, by the L-shaped osteotomy from the medial side of the proximal tibia to the intercondylar eminence and the valgus correction, lateralization of the mechanical axis and reduction of the subluxated lateral joint are obtained with early postoperative weight-bearing. Before, 6 months, 1, and 5 years after the operation, a visual analog scale (VAS), the Western Ontario and McMaster Universities Arthritis Index (WOMAC), alignment of the lower extremity, and congruency and stability of the femorotibial joint were investigated. The VAS improved from an average of 73 mm to 13 mm, and the total WOMAC score from 52 to 14 before to 5 years after the operation, respectively. The mechanical axis changed from 1 to 60%, and the FTA changed from 186° to 171°. The joint line convergence angle (JLCA) changed from 6° to 1°, and the angle difference of JLCA between varus and valgus stress improved from 8° to 4° after the procedure. Improvements in pain and activities of daily living were observed by TCVO along with valgus correction of the lower extremity and stabilization of the femorotibial joint.

  19. Quality of Life in Patients With Untreated and Symptomatic Hallux Valgus.

    Science.gov (United States)

    Yamamoto, Yohei; Yamaguchi, Satoshi; Muramatsu, Yuta; Terakado, Atsushi; Sasho, Takahisa; Akagi, Ryuichiro; Endo, Jun; Sato, Yasunori; Takahashi, Kazuhisa

    2016-11-01

    The purposes of this study were to compare the quality of life (QOL) of subjects who had untreated symptomatic hallux valgus with the QOL of the general population and to investigate factors associated with the QOL of the subjects. One hundred sixteen subjects with previously untreated and symptomatic hallux valgus were surveyed. QOL was assessed using the 36-item Short Form Health Survey (SF-36). Additionally, clinical evaluations (the visual analog scale for pain, Japanese Society for Surgery of the Foot Scale, lesser toe pain, and pain in other parts of the body) and radiographic evaluations (hallux valgus angle, intermetatarsal angle between the first and second metatarsals, and dislocation of the second metatarsophalangeal joint) were performed. Differences in the SF-36 between the subjects and the general population were tested using independent t tests. Correlations between the QOL measurements, clinical evaluations, and radiographic evaluations were assessed using Spearman rank correlation coefficient. All SF-36 subscales and physical component summary scores for the subjects were significantly lower than those of the general population. Notably, the standardized physical function subscale (38.2 ± 15.8, P hallux valgus subjects was lower than that of the general population. All QOL and clinical evaluation parameters were not significantly or negligibly correlated with the severity of toe deformities. Surgical decision making should not be based on the severity of the deformity alone, but rather patient QOL should also be carefully assessed. Level III, comparative series. © The Author(s) 2016.

  20. Z-osteotomy in hallux valgus: clinical and radiological outcome after Scarf osteotomy

    Directory of Open Access Journals (Sweden)

    Marcus Jaeger

    2009-05-01

    Full Text Available Correction osteotomies of the first metatarsal are common surgical approaches in treating hallux valgus deformities whereas the Scarf osteotomy has gained popularity. The purpose of this study was to analyze short- and mid-term results in hallux valgus patients who underwent a Scarf osteotomy. The subjective and radiological outcome of 131 Scarf osteotomies (106 hallux valgus patients, mean age: 57.5 years, range: 22-90 years were retrospectively analyzed. Mean follow-up was 22.4 months (range: 6 months-5 years. Surgical indications were: intermetatarsal angle (IMA of 12-23°; increased proximal articular angle (PAA>8°, and range of motion of the metatarsophalangeal joint in flexion and extension >40°. Exclusion criteria were severe osteoporosis and/or osteoarthritis. The mean subjective range of motion (ROM of the great toe post-surgery was 0.8±1.73 points (0: full ROM, 10: total stiffness. The mean subjective cosmetic result was 2.7±2.7 points (0: excellent, 10: poor. The overall post-operative patient satisfaction with the result was high (2.1±2.5 points (0: excellent, 10: poor. The mean hallux valgus angle improvement was 16.6° (pre-operative mean value: 37.5° which was statistically significant (p<0.01. The IMA improved by an average of 5.96° from a pre-operative mean value of 15.4° (p<0.01. Neither osteonecrosis of the distal fragment nor peri-operative fractures were noted during the follow-up. In keeping with our follow-up results, the Scarf osteotomy approach shows potential in the therapy of hallux valgus. 筻

  1. Radiographic evaluation of hallux valgus

    International Nuclear Information System (INIS)

    Richardson, M.L.; Hansen, S.T.; Kilcoyne, R.F.

    1987-01-01

    This paper presents the common preoperative and postoperative findings in hallux valgus, a common foot disorder of multiple etiologies, which can lead to significant foot pain and deformity. Little has been published in radiologic literature about the proper initial radiographic workup and the postoperative follow-up of this very common and very treatable cause of foot pain. Besides the primary findings of varus angulation of the first metatarsal and valgus angulation of the great toe, one may also see dorsal slaying of the first metatarsal head. As increased weight is borne by the central metatarsals, they may develop hyperostosis and stress fractures. Angular deformities of the hallux sesamoid joint and lesser toes may also be seen

  2. The comparison of designed slipper splints with the splints available on the market in the treatment of hallux valgus

    Directory of Open Access Journals (Sweden)

    babak Mirzashahi

    2011-08-01

    Conclusion: This study showed that despite the contraversies in nonoperative treatment of Hallux valgus, if the Hallux valgus angle of patients are mild to moderate, this splints can be used to treat it.

  3. Joint Angle and Frequency Estimation Using Multiple-Delay Output Based on ESPRIT

    Science.gov (United States)

    Xudong, Wang

    2010-12-01

    This paper presents a novel ESPRIT algorithm-based joint angle and frequency estimation using multiple-delay output (MDJAFE). The algorithm can estimate the joint angles and frequencies, since the use of multiple output makes the estimation accuracy greatly improved when compared with a conventional algorithm. The useful behavior of the proposed algorithm is verified by simulations.

  4. IMPACTS OF DIFFERENT JOINT ANGLES AND ADHESIVES ON DIAGONAL TENSION PERFORMANCES OF BOX-TYPE FURNITURE

    Directory of Open Access Journals (Sweden)

    Musa Atar

    2010-02-01

    Full Text Available The goal of this study was to determine the effects of different joint angles and adhesives on diagonal tension performances of the box-type furniture made from solid wood and medium density fiberboard (MDF. After drilling joints of 75º, 78º, 81º, 84º, and 87º degrees on Oriental beech, European oak, Scotch pine, and MDF samples, a diagonal tensile test was applied on corners glued with polyvinyl acetate (PVAc and polyurethane (D-VTKA = Desmodur-Vinyl Trieketonol Acetate according to ASTM D 1037 standard. With reference to the obtained results, the highest tensile strength was obtained in European oak with PVAc glue and joint angle of 84º, while the lowest value was obtained in MDF with D-VTKA glue and joint angle of 75º. Considering the interaction of wood, adhesive, and joint angle, the highest tensile strength was obtained in European oak with joint angle of 81º and D-VTKA glue (1.089 N.mm-2, whereas the lowest tensile strength was determined in MDF with joint angle of 75º and PVAc glue (0.163 N.mm-2. Therefore, PVAc as glue and 81º as joint angle could be suggested to obtain some advantageous on the dovetail joint process for box-type furniture made from both solid wood and MDF.

  5. Why do lesser toes deviate laterally in hallux valgus? A radiographic study.

    Science.gov (United States)

    Roan, Li-Yi; Tanaka, Yasuhito; Taniguchi, Akira; Tomiwa, Kiyonori; Kumai, Tsukasa; Cheng, Yuh-Min

    2015-06-01

    Hallux valgus foot with laterally deviated lesser toes is a complex condition to treat. Ignoring the laterally deviated lesser toes in hallux valgus might result in unsatisfactory foot shape. Without lateral support of the lesser toes, it might increase the risk of recurrence of hallux valgus. We sought to identify associated radiographic findings in patients where lesser toes follow the great toe in hallux valgus and deviate laterally. The weight-bearing, anteroposterior foot radiographs of 24 female hallux valgus feet with laterally deviated lesser toes (group L), 34 female hallux valgus feet with normal lesser toes (group H), and 43 normal female feet (group N) were selected for the study. A 2-dimensional coordinated system was used to analyze the shapes and angles of these feet by converting each dot made on the radiographs onto X and Y coordinates. Diagrams of the feet in each group were drawn for comparison. The hallux valgus angle, lateral deviation angle of the second toe, intermetatarsal angles, toe length, metatarsal length, and metatarsus adductus were calculated according to the coordinates of the corresponding points. The mapping showed the bases of the second, third, and fourth toe in group L shifted laterally away from their corresponding metatarsal head (P hallux valgus angles (P hallux valgus angle, more adducted first metatarsal, and divergent lateral splaying of the lesser metatarsals were associated with lateral deviation of the lesser toes in hallux valgus. Level III, comparative study. © The Author(s) 2015.

  6. NORMAL AXIAL ANGLES OF THE KNEE JOINT IN ADULT ...

    African Journals Online (AJOL)

    hi-tech

    2003-08-01

    Aug 1, 2003 ... Conclusion: Our study has demonstrated comparative variations in means and ranges of normal axial angles .... population was significantly different from the mean ... case, however, the angle also exhibits racial variations.

  7. Interdependence of torque, joint angle, angular velocity and muscle action during human multi-joint leg extension.

    Science.gov (United States)

    Hahn, Daniel; Herzog, Walter; Schwirtz, Ansgar

    2014-08-01

    Force and torque production of human muscles depends upon their lengths and contraction velocity. However, these factors are widely assumed to be independent of each other and the few studies that dealt with interactions of torque, angle and angular velocity are based on isolated single-joint movements. Thus, the purpose of this study was to determine force/torque-angle and force/torque-angular velocity properties for multi-joint leg extensions. Human leg extension was investigated (n = 18) on a motor-driven leg press dynamometer while measuring external reaction forces at the feet. Extensor torque in the knee joint was calculated using inverse dynamics. Isometric contractions were performed at eight joint angle configurations of the lower limb corresponding to increments of 10° at the knee from 30 to 100° of knee flexion. Concentric and eccentric contractions were performed over the same range of motion at mean angular velocities of the knee from 30 to 240° s(-1). For contractions of increasing velocity, optimum knee angle shifted from 52 ± 7 to 64 ± 4° knee flexion. Furthermore, the curvature of the concentric force/torque-angular velocity relations varied with joint angles and maximum angular velocities increased from 866 ± 79 to 1,238 ± 132° s(-1) for 90-50° knee flexion. Normalised eccentric forces/torques ranged from 0.85 ± 0.12 to 1.32 ± 0.16 of their isometric reference, only showing significant increases above isometric and an effect of angular velocity for joint angles greater than optimum knee angle. The findings reveal that force/torque production during multi-joint leg extension depends on the combined effects of angle and angular velocity. This finding should be accounted for in modelling and optimisation of human movement.

  8. Tibial valgus aperture osteotomy

    International Nuclear Information System (INIS)

    De los Rios G, Adolfo Leon; Saavedra Abadia, Adolfo Leon; Palacios, Julio

    2005-01-01

    This study is based on work carried out a The knee clinic at the arthroscopic surgery unit of the Institute of osteo-articular diseases, Imbanaco Medical Centre, The University Hospital of the Valle (Cali-Colombia) and The Fractures Clinic Ltd. (Palmira-Valle). This is a descriptive study, which demonstrates very positive outcomes for aperture osteotomy, without detracting from the importance of, and the progress made in uni-compartmental and total joint articular replacements of the knee. 10 patients were treated with a highs tibial open osteotomy between November 1988 and December 2002: 3 had post-traumatic deformities, without arthrosic alterations; 1 had pseudo-arthrosis caused by a failed corrective procedure; 1 had complex instability of the knee with osseous varus; 6 had a degenerative lesion of the medial meniscus with medial condral alterations. Follow-up was form 12 to 54 months. Treatment involved a tibial valgus aperture osteotomy and osteo-synthesis. Evaluation was carried out using the International Knee Documentation Committee (IKDC) scale, the For Special Surgery and The Knee Society Score

  9. Recurrence of Hallux Valgus Can Be Predicted from Immediate Postoperative Non-Weight-Bearing Radiographs.

    Science.gov (United States)

    Park, Chul Hyun; Lee, Woo-Chun

    2017-07-19

    The aims of this study were to identify risk factors for the recurrence of hallux valgus deformity and to clarify whether recurrence after surgery to treat hallux valgus can be predicted using radiographic parameters assessed on immediate postoperative non-weight-bearing radiographs. A proximal chevron osteotomy combined with a distal soft-tissue procedure was performed by a single surgeon to treat moderate to severe hallux valgus deformity in 93 patients (117 feet). The feet were grouped according to nonrecurrence or recurrence. Changes in the hallux valgus angle, the intermetatarsal angle, and sesamoid position over time were analyzed by comparing values measured during each postoperative period. The relative risks of recurrence as indicated by preoperative and postoperative radiographic parameters were determined. Twenty (17.1%) of the 117 feet showed hallux valgus recurrence at the time of the last follow-up. The hallux valgus angle and the intermetatarsal angle stabilized at 6 months after surgery in the nonrecurrence group. An immediate postoperative hallux valgus angle of ≥8°, an immediate postoperative sesamoid position of grade 4 or greater, a preoperative metatarsus adductus angle of ≥23°, and a preoperative hallux valgus angle of ≥40° were significantly associated with recurrence. Recurrence of hallux valgus after a proximal chevron osteotomy can be reliably predicted from immediate postoperative non-weight-bearing radiographs. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

  10. Comparison of dorsal and dorsomedial displacement in evaluation of first ray hypermobility in feet with and without hallux valgus.

    Science.gov (United States)

    Singh, Dishan; Biz, Carlo; Corradin, Marco; Favero, Laura

    2016-06-01

    Hypermobility of the first ray, a probable primary cause of hallux valgus, has traditionally been evaluated in the dorsal direction only although the first tarso-metatarsal joint allows movement in a dorso-medial direction. 600 feet, divided according to the presence or absence of hallux valgus, were evaluated for both dorsal and dorso-medial displacement using a Klaue device. In the control group, the mean first ray displacement was 7.2mm (4.2-11.3) in the dorsal direction (sagittal plane) and 8.3mm (4.0-12.6) in the 45° dorso-medial direction. In the hallux valgus group, the mean first ray mobility was 9.8mm (5.2-14.1) in the dorsal direction compared to a mean of 11.0mm (5.9-16.2) in the 45° dorso-medial direction. It is a paradox that hypermobility of the first ray is measured in only a dorsal (vertical) direction whereas a hallux valgus angle and an intermetatarsal angle are only measured in a transverse plane. Furthermore, the weightbearing foot pronates during gait and the first metatarsal is displaced in a dorsomedial direction rather than a pure dorsal direction. It is suggested that measurement hypermobility of the first ray at a 45° dorso-medial direction is more appropriate. Copyright © 2015 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.

  11. Effect of knee joint angle on neuromuscular activation of the vastus intermedius muscle during isometric contraction.

    Science.gov (United States)

    Watanabe, K; Akima, H

    2011-12-01

    The purpose of this study was to compare the relationship between surface electromyography (EMG) and knee joint angle of the vastus intermedius muscle (VI) with the synergistic muscles in the quadriceps femoris (QF) muscle group. Fourteen healthy men performed maximal voluntary contractions during isometric knee extension at four knee joint angles from 90°, 115°, 140°, and 165° (180° being full extension). During the contractions, surface EMG was recorded at four muscle components of the QF muscle group: the VI, vastus lateralis (VL), vastus medialis (VM), and rectus femoris (RF) muscles. The root mean square of the surface EMG at each knee joint angle was calculated and normalized by that at a knee joint angle of 90° for individual muscles. The normalized RMS of the VI muscle was significantly lower than those of the VL and RF muscles at the knee joint angles of 115° and 165° and those of the VL, VM, and RF muscles at the knee joint angle of 140° (Pneuromuscular activation of the VI muscle is regulated in a manner different from the alteration of the knee joint angle compared with other muscle components of the QF muscle group. © 2011 John Wiley & Sons A/S.

  12. Neinvazivní obrazová analýza hallux valgus

    OpenAIRE

    Setínková, Jana

    2014-01-01

    6 Abstract Title: Noninvasive image analysis of hallux valgus. Objectives: Propose a simple, cheap, fast and non-invasive method for diagnostics and monitoring the effect of therapy of hallux valgus deformity. Methods: Evaluation the parameters in X-ray and photography which were taken before and after therapy of hallux valgus. I measured angles on foot in programme AutoCAD and confront the correlation of angles in X-ray and photography. I also looked for an angle similar to the hallux valgus...

  13. Correction of Hallux Valgus Interphalangeus With an Osteotomy of the Distal End of the Proximal Phalanx (Distal Akin Osteotomy).

    Science.gov (United States)

    Vander Griend, Robert

    2017-02-01

    Operative correction of a symptomatic hallux valgus interphalangeus (HVI) deformity is often achieved with an osteotomy at the proximal end of the proximal phalanx (Akin osteotomy). However, the apex of the typical HVI deformity (center of rotation angle) is at the interphalangeal joint of the hallux. This study was done to evaluate the results of performing a medial closing wedge osteotomy at the distal end of the proximal phalanx. Thirty-three patients (33 feet) underwent an osteotomy at the distal end of the proximal phalanx for correction of HVI. All of the patients had other forefoot deformities which were corrected at the same time. Eight of these were revision procedures of prior forefoot operations. The length of follow-up was determined by the associated procedures with a minimum follow-up of 4 months. The preoperative hallux valgus interphalangeus angle averaged 16 degrees of valgus (range 7-32 degrees) and was corrected to an average of 2 degrees of valgus (range 5 degrees valgus to 5 degrees varus). All of the patients were satisfied with the postoperative appearance and function of the first toe. Because of simultaneous correction of numerous other forefoot problems, it was not possible to specifically isolate or evaluate the effects and benefits of this osteotomy using outcomes measures. There was one intraoperative complication resulting in a fracture extending into the adjacent IP joint. Correction of an HVI deformity can be achieved with an osteotomy at the distal end of the proximal phalanx. This was a safe technique with few complications and with good results in terms of both correction and patient satisfaction. Level IV, retrospective case series.

  14. Measurement of first ray of foot with reference to hallux valgus.

    Science.gov (United States)

    Howale, Deepak S; Iyer, Kanaklata V; Shah, Jigesh V

    2012-06-01

    A study was carried out on 58 healthy volunteers. None of the volunteeres had any foot complaints. This was done to study Indian feet, as foot is an important part of human anatomy and its certain deformities eg, hallux valgus, can be very disabling. We have studied anatomical angles between 1st and 2nd rays of foot eg, angle of hallux valgus and angle of slant of distal facet of medial cuneiform and have shown significant correlation between them and development of hallux valgus. The coefficient of correlation (r) calculated between these two angles is significant, showing that this angle influences the angle of hallux valgus and hence development of hallux valgus. These are anatomical angles and indicate shapes of medial cuneiform and 1st metatarsal. Hence these seem to be inherited, making the feet anatomically predisposed to develop hallux valgus. This view is supported by Gray's Anatomy. The extrinsic factors such as narrow toes, closed, footwear worn for an extended period do increase the angle of hallux valgus. So, in predisposed feet, this is one of the extrinsic factor which can lead to development of hallux valgus. On studying these two angles, orthopaedicians should be on alert and should advise such individuals on wearing foot- friendly foot-wear.

  15. Fusimotor control of spindle sensitivity regulates central and peripheral coding of joint angles.

    Science.gov (United States)

    Lan, Ning; He, Xin

    2012-01-01

    Proprioceptive afferents from muscle spindles encode information about peripheral joint movements for the central nervous system (CNS). The sensitivity of muscle spindle is nonlinearly dependent on the activation of gamma (γ) motoneurons in the spinal cord that receives inputs from the motor cortex. How fusimotor control of spindle sensitivity affects proprioceptive coding of joint position is not clear. Furthermore, what information is carried in the fusimotor signal from the motor cortex to the muscle spindle is largely unknown. In this study, we addressed the issue of communication between the central and peripheral sensorimotor systems using a computational approach based on the virtual arm (VA) model. In simulation experiments within the operational range of joint movements, the gamma static commands (γ(s)) to the spindles of both mono-articular and bi-articular muscles were hypothesized (1) to remain constant, (2) to be modulated with joint angles linearly, and (3) to be modulated with joint angles nonlinearly. Simulation results revealed a nonlinear landscape of Ia afferent with respect to both γ(s) activation and joint angle. Among the three hypotheses, the constant and linear strategies did not yield Ia responses that matched the experimental data, and therefore, were rejected as plausible strategies of spindle sensitivity control. However, if γ(s) commands were quadratically modulated with joint angles, a robust linear relation between Ia afferents and joint angles could be obtained in both mono-articular and bi-articular muscles. With the quadratic strategy of spindle sensitivity control, γ(s) commands may serve as the CNS outputs that inform the periphery of central coding of joint angles. The results suggest that the information of joint angles may be communicated between the CNS and muscles via the descending γ(s) efferent and Ia afferent signals.

  16. [Double Osteotomy of the First Metatarsal for Treatment of Juvenile Hallux Valgus Deformity - Our Experience].

    Science.gov (United States)

    Jochymek, J; Peterková, T

    2016-01-01

    The aim of the study was to evaluate the mid-term results in a group of selected patients undergoing corrective surgery for juvenile hallux valgus, using double osteotomy of the first metatarsal. The group included eight patients, seven girls and one boy, with a more severe form of this deformity treated by double osteotomy of the first metatarsal between 2010 and 2013. The indication for corrective surgery was serious pain when walking; all patients had previously undergone conservative treatment with no effect. All patients had pre-operative clinical examination, the affected foot was X-rayed with the patient standing and radiographic assessments of the intermetatarsal and hallux valgus angles were made. The evaluation of treatment outcomes was based on the scoring system of the American Orthopaedic Foot and Ankle Society (AOFAS) and X-ray images of the foot. The average follow-up was 37 months. Post-operatively, none of the patients reported pain while walking, only two of them experienced pain during sports activities. The average post-operative AOFAS score was 92 points. Both the intermetatarsal angle and the hallux valgus angle improved after surgery in all patients, with two reporting only mild hallux valgus deformity. One patient showed postoperative restriction of motion at the first metatarsophalangeal joint. This was the only complication recorded in association with the surgery. Almost all authors dealing with the treatment of hallux valgus deformity primarily prefer conservative therapy. However, this treatment is usually not very effective in severe forms of the disorder. Surgical management is indicated in symptomatic patients or in those with severe juvenile hallux valgus deformity. In paediatric patients it is necessary to respect the presence of an epiphyseal growth plate in the first proximal metatarsal and therefore it is often preferred to use distal first metatarsal osteotomy. At our department, Mitchell's osteotomy for hallux valgus deformity

  17. Joint angle sensors for closed-loop control

    Science.gov (United States)

    Ko, Wen H.; Miao, Chih-Lei

    In order to substitute braces that have built-in goniometers and to provide feedback signals for closed loop control of lower extremity Functional Neuromuscular System in paraplegics, a stretchable capacitive sensor was developed to accurately detect angular movement in joints. Promising clinical evaluations on the knee joints of a paraplegic and a volunteer were done. The evaluations show great promise for the possibility of implantation applications.

  18. Valgus-varus motion of the knee in normal level walking and stair climbing.

    Science.gov (United States)

    Yu, B; Stuart, M J; Kienbacher, T; Growney, E S; An, K-N

    1997-07-01

    OBJECTIVE: The knee valgus-varus moment and the knee angles were compared between normal level walking and stair climbing. DESIGN: Ten healthy subjects were tested for ascent, descent, and level walking. BACKGROUND: An understanding of the normal valgus-varus motion of the knee during stair climbing is needed to apply biomechanical analysis of stair climbing as a evaluation tool for knee osteoarthritis patients. METHODS: A motion analysis system, three force plates, and a flight of stairs were used to collect kinematic and kinetic data. The knee angles and moments were calculated from the collected kinematic and kinetic data. RESULTS: The knee varus angle for the maximum knee valgus moments in stair climbing was significantly greater than that in level walking. The knee valgus moment was significantly correlated to ground reaction forces and knee valgus-varus angle during stair climbing and level walking. CONCLUSIONS: There is a coupling between the knee valgus-varus motion and flexion-extension motion. Ground reaction forces are the major contributors to the within-subject variation in the knee valgus-varus moment during stair climbing and level walking. The knee valgus-varus angle is a major contributor to the between-subject variation in the knee valgus moment during stair climbing and level walking.

  19. Nonlinear joint angle control for artificially stimulated muscle

    NARCIS (Netherlands)

    Veltink, Petrus H.; Chizeck, Howard J.; Crago, Patrick E.; El-Bialy, Ahmed

    1992-01-01

    Designs of both open- and closed-loop controllers of electrically stimulated muscle that explicitly depend on a nonlinear mathematical model of muscle input-output properties are presented and evaluated. The muscle model consists of three factors: a muscle activation dynamics factor, an angle-torque

  20. Effect of Bipartite Hallucal Sesamoid on Hallux Valgus Surgery.

    Science.gov (United States)

    Park, Young Hwan; Jeong, Chan Dong; Choi, Gi Won; Kim, Hak Jun

    2017-06-01

    Bipartite hallucal sesamoids are often found in patients with hallux valgus. However, it is unknown whether bipartite hallucal sesamoids affect the results of hallux valgus surgery or not. The purpose of the present study was to evaluate the outcomes of chevron osteotomy for hallux valgus with and without bipartite hallucal sesamoid. A total of 152 patients (168 feet) treated with distal or proximal chevron osteotomy for hallux valgus constituted the study cohort. The 168 feet were divided into 2 groups: bipartite hallucal sesamoid (31 feet) and without bipartite hallucal sesamoid (137 feet). Hallux valgus angle (HVA), intermetatarsal angle (IMA), distal metatarsal articular angle (DMAA), tibial sesamoid position, and first metatarsal length were measured for radiographic outcomes and the American Orthopaedic Foot & Ankle Society (AOFAS) hallux metatarsophalangeal-interphalangeal (MTP-IP) score was measured for clinical outcomes. All radiographic measurements and the AOFAS score showed significant ( P .05) were found between the 2 groups in terms of HVA, IMA, DMAA, tibial sesamoid position, metatarsal shortening, and AOFAS score on final follow-up. This study suggests that bipartite hallucal sesamoids do not affect the results of hallux valgus surgery. Level III, retrospective comparative study.

  1. A modified Austin/chevron osteotomy for treatment of hallux valgus and hallux rigidus.

    Science.gov (United States)

    Vasso, Michele; Del Regno, Chiara; D'Amelio, Antonio; Schiavone Panni, Alfredo

    2016-03-01

    The purpose of this brief paper is to present the preliminary results of a modified Austin/chevron osteotomy for treatment of hallux valgus and hallux rigidus. In this procedure, the dorsal arm of the osteotomy is performed orthogonal to the horizontal plane of the first metatarsal, the main advantage being that this allows much easier and more accurate multiplanar correction of first metatarsal deformities. From 2010 to 2013, 184 consecutive patients with symptomatic hallux valgus and 48 patients with hallux rigidus without severe metatarsophalangeal joint degeneration underwent such modified chevron osteotomy. Mean patient age was 54.9 (range 21-70) years, and mean follow-up duration was 41.7 (range 24-56) months. Ninety-three percent of patients were satisfied with the surgery. Mean American Orthopaedic Foot and Ankle Society (AOFAS) score improved from 56.6 preoperatively to 90.6 at last follow-up, and mean visual analog scale (VAS) pain score decreased from 5.7 preoperatively to 1.6 at final follow-up (p hallux valgus, mean hallux valgus angle decreased from 34.1° preoperatively to 6.2° at final follow-up, and mean intermetatarsal angle decreased from 18.5° preoperatively to 4.1° at final follow-up (p < 0.05). One patient developed postoperative transfer metatarsalgia, treated successfully with second-time percutaneous osteotomy of the minor metatarsals, whilst one patient had wound infection that resolved with systemic antibiotics. Level IV.

  2. Minimally Invasive and Open Distal Chevron Osteotomy for Mild to Moderate Hallux Valgus.

    Science.gov (United States)

    Brogan, Kit; Lindisfarne, Edward; Akehurst, Harold; Farook, Usama; Shrier, Will; Palmer, Simon

    2016-11-01

    Minimally invasive surgical (MIS) techniques are increasingly being used in foot and ankle surgery but it is important that they are adopted only once they have been shown to be equivalent or superior to open techniques. We believe that the main advantages of MIS are found in the early postoperative period, but in order to adopt it as a technique longer-term studies are required. The aim of this study was to compare the 2-year outcomes of a third-generation MIS distal chevron osteotomy with a comparable traditional open distal chevron osteotomy for mild-moderate hallux valgus. Our null hypothesis was that the 2 techniques would yield equivalent clinical and radiographic results at 2 years. This was a retrospective cohort study. Eighty-one consecutive feet (49 MIS and 32 open distal chevron osteotomies) were followed up for a minimum 24 months (range 24-58). All patients were clinically assessed using the Manchester-Oxford Foot Questionnaire. Radiographic measures included hallux valgus angle, the intermetatarsal angle, hallux interphalangeal angle, metatarsal phalangeal joint angle, distal metatarsal articular angle, tibial sesamoid position, shape of the first metatarsal head, and plantar offset. Statistical analysis was done using Student t test or Wilcoxon rank-sum test for continuous data and Pearson chi-square test for categorical data. Clinical and radiologic postoperative scores in all domains were substantially improved in both groups (P .05). There were no significant differences in complications between the 2 groups ( > .5). The midterm results of this third-generation technique show that it was a safe procedure with good clinical outcomes and comparable to traditional open techniques for symptomatic mild-moderate hallux valgus. Level III, retrospective comparative study. © The Author(s) 2016.

  3. Associations between alpha angle and herniation pit on MRI revisited in 185 asympomatic hip joints

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Eun Chae; Choi, Jung Ah [Dept. of Radiology, Seoul National University Bundang Hospital, Seongnam (Korea, Republic of)

    2015-12-15

    To evaluate the association between alpha angle and herniation pit on MRI in asymptomatic hip joints and their associations with demographic variables.Hip MRI of 185 asymptomatic hip joints of 105 adults (age 18 to 80 years) from September 2011 through December 2012 were retrospectively studied. Alpha angles were measured on oblique axial MR images by 2 observers. Herniation pit was determined by 1 observer. Size measures, prevalence, and statistical analyses were conducted regarding its association with age, gender, laterality (right or left hip). Intra- and inter-observer agreements were determined by intra-class correlation coefficient. The prevalence of herniation pit in asymptomatic hips was 21.6%. The range of alpha angle was 27.6-65.0 degrees. Seventeen and 16 out of 185 (9.1% and 8.6%) hip joints showed alpha angle of ≥ 55 degrees in first and second measurement sessions, respectively. There was no association between alpha angle ≥ 55 and presence of herniation pit. There was no association between alpha angle ≥ 55 and the size of herniation pit. Inter-observer agreement of alpha angle was 0.485 between first measurements of first vs. second observer, respectively. Intra-observer agreement of alpha angle was 0.654, respectively. Forty (21.6%) of 185 hip joints (35 of 105 patients, 33.3%) had herniation pit, with no difference according to age, gender, or laterality of hip joint. There is no association between alpha angle ≥ 55 degrees and presence of herniation pit or demographic variables.

  4. Unilateral hallux valgus: is it true unilaterality, or does it progress to bilateral deformity?

    Science.gov (United States)

    Young, Ki Won; Park, Young Uk; Kim, Jin Su; Jegal, Hyuk; Lee, Kyung Tai

    2013-04-01

    This study was undertaken to determine whether unilateral hallux valgus progresses unilaterally and to evaluate the demographics, etiologies, and radiographic findings associated with symptomatic unilateral hallux valgus deformities. Patients treated for hallux valgus between January 2004 and December 2008 were identified, and of these, 33 patients with unilateral deformities were enrolled. Progression of deformities in normal feet were evaluated at last follow-up visit, and the clinical information and radiographic measurements of those with a deformed normal foot or an unchanged normal foot were compared. Thirty-three patients (3.4%) had a unilateral hallux valgus deformity on preoperative radiographs. The mean length of follow up was 4.7 years (range, 2.4-11). Twenty-four cases had no deformity of the normal foot at last follow-up (the unchanged group), but 15 cases had developed hallux valgus deformity (the deformed group). No significant intergroup differences were found in terms of metatarsus adductus angle (P = .412), Meary angle (P = .771), talocalcaneal angle (P = 1.000), or calcaneal pitch angle (P = .267). However, members of the deformed group were significantly younger at disease onset (P = .045), exhibited a curved first metatarsal head (P = .046), and had a larger initial hallux valgus angle (P hallux valgus was found to be over 97.3%, and significant differences were found between the deformed and unchanged groups in terms of age of onset, metatarsal head shape, and hallux valgus angle.

  5. Neuromuscular adaptations associated with knee joint angle-specific force change.

    Science.gov (United States)

    Noorkõiv, Marika; Nosaka, Kazunori; Blazevich, Anthony J

    2014-08-01

    Neuromuscular adaptations to joint angle-specific force increases after isometric training have not yet been fully elucidated. This study examined angle-specific neuromuscular adaptations in response to isometric knee extension training at short (SL, joint angle 38.1° ± 3.7°) versus long (LL, 87.5° ± 6.0°) muscle lengths. Sixteen men trained three times a week for 6 wk either at SL (n = 8) or LL (n = 8). Voluntary maximal isometric knee extensor (MVC) force, doublet twitch force, EMG amplitudes (EMG/Mmax), and voluntary activation during MVC force (VA%) were measured at eight knee joint angles (30°-100°) at weeks 0, 3, and 6. Muscle volume and cross-sectional area (CSA) were measured from magnetic resonance imaging scans, and fascicle length (Lf) was assessed using ultrasonography before and after training. Clear joint angle specificity of force increase was seen in SL but not in LL. The 13.4% ± 9.7% (P = 0.01) force increase around the training angle in SL was related to changes in vastus lateralis and vastus medialis EMG/Mmax around the training angle (r = 0.84-0.88, P < 0.05), without changes in the doublet twitch force-angle relation or muscle size. In LL, muscle volume and CSA increased and the changes in CSA at specific muscle regions were correlated with changes in MVC force. A 5.4% ± 4.9% (P = 0.001) increase in Lf found in both groups was not associated with angle-specific force changes. There were no angle-specific changes in VA%. The EMG/Mmax, although not VA%, results suggest that neural adaptations underpinned training-related changes at short quadriceps lengths, but hypertrophic changes predominated after training at long lengths. The findings of this study should contribute to the development of more effective and evidence-based rehabilitation and strength training protocols.

  6. Neural network committees for finger joint angle estimation from surface EMG signals

    Directory of Open Access Journals (Sweden)

    Reddy Narender P

    2009-01-01

    Full Text Available Abstract Background In virtual reality (VR systems, the user's finger and hand positions are sensed and used to control the virtual environments. Direct biocontrol of VR environments using surface electromyography (SEMG signals may be more synergistic and unconstraining to the user. The purpose of the present investigation was to develop a technique to predict the finger joint angle from the surface EMG measurements of the extensor muscle using neural network models. Methodology SEMG together with the actual joint angle measurements were obtained while the subject was performing flexion-extension rotation of the index finger at three speeds. Several neural networks were trained to predict the joint angle from the parameters extracted from the SEMG signals. The best networks were selected to form six committees. The neural network committees were evaluated using data from new subjects. Results There was hysteresis in the measured SMEG signals during the flexion-extension cycle. However, neural network committees were able to predict the joint angle with reasonable accuracy. RMS errors ranged from 0.085 ± 0.036 for fast speed finger-extension to 0.147 ± 0.026 for slow speed finger extension, and from 0.098 ± 0.023 for the fast speed finger flexion to 0.163 ± 0.054 for slow speed finger flexion. Conclusion Although hysteresis was observed in the measured SEMG signals, the committees of neural networks were able to predict the finger joint angle from SEMG signals.

  7. Knee joint angle affects EMG-force relationship in the vastus intermedius muscle.

    Science.gov (United States)

    Saito, Akira; Akima, Hiroshi

    2013-12-01

    It is not understood how the knee joint angle affects the relationship between electromyography (EMG) and force of four individual quadriceps femoris (QF) muscles. The purpose of this study was to examine the effect of the knee joint angle on the EMG-force relationship of the four individual QF muscles, particularly the vastus intermedius (VI), during isometric knee extensions. Eleven healthy men performed 20-100% of maximal voluntary contraction (MVC) at knee joint angles of 90°, 120° and 150°. Surface EMG of the four QF synergists was recorded and normalized by the root mean square during MVC. The normalized EMG of the four QF synergists at a knee joint angle of 150° was significantly lower than that at 90° and 120° (P knee joint angle of 150°. Furthermore, the neuromuscular activation of the VI was the most sensitive to change in muscle length among the four QF synergistic muscles. Copyright © 2013 Elsevier Ltd. All rights reserved.

  8. Treatment of moderate hallux valgus by percutaneous, extra-articular reverse-L Chevron (PERC) osteotomy.

    Science.gov (United States)

    Lucas y Hernandez, J; Golanó, P; Roshan-Zamir, S; Darcel, V; Chauveaux, D; Laffenêtre, O

    2016-03-01

    The aim of this study was to report a single surgeon series of consecutive patients with moderate hallux valgus managed with a percutaneous extra-articular reverse-L chevron (PERC) osteotomy. A total of 38 patients underwent 45 procedures. There were 35 women and three men. The mean age of the patients was 48 years (17 to 69). An additional percutaneous Akin osteotomy was performed in 37 feet and percutaneous lateral capsular release was performed in 22 feet. Clinical and radiological assessments included the type of forefoot, range of movement, the American Orthopedic Foot and Ankle (AOFAS) score, a subjective rating and radiological parameters. The mean follow-up was 59.1 months (45.9 to 75.2). No patients were lost to follow-up. The mean AOFAS score increased from 62.5 (30 to 80) pre-operatively to 97.1 (75 to 100) post-operatively. A total of 37 patients (97%) were satisfied. At the last follow up there was a statistically significant decrease in the hallux valgus angle, the intermetatarsal angle and the proximal articular set angle. The range of movement of the first metatarsophalangeal joint improved significantly.. There was more improvement in the range of movement in patients who had fixation of the osteotomy of the proximal phalanx. Preliminary results of this percutaneous approach are promising. This technique is reliable and reproducible. Its main asset is that it maintains an excellent range of movement. The PERC osteotomy procedure is an effective approach for surgical management of moderate hallux valgus which combines the benefits of percutaneous surgery with the versatility of the chevron osteotomy whilst maintaining excellent first MTPJ range of motion. ©2016 The British Editorial Society of Bone & Joint Surgery.

  9. Influence of joint dip angle on seismic behaviors of rock foundation

    International Nuclear Information System (INIS)

    Yang, Lei; Gao, Yang; Jiang, Yujing; Li, Bo; Li Shucai

    2012-01-01

    The seismic response of rock foundation to seismic loads is an important issue to the stability and safety of nuclear power plants. Due to the fact that the discontinuities like joints existing in the rock mass govern principally the deformation and failure behaviors of the rock mass, the influence of discontinuities on the seismic behaviors of rock mass remains as one of the fundamental problems in the safety assessment of nuclear power plants. In this study, the distinct element method (DEM) and finite element method (FEM) were adopted to investigate the seismic responses of rock foundation to a real seismic wave, taking into account the effect of joint dip angle on the deformation and dynamic behaviors of rock foundation. In the DEM simulations, the intact rock has an amplification effect on the amplitudes of seismic waves, while the joints exhibit an attenuation effect on the seismic waves. In the FEM simulations, however, the attenuation effect of joints is not obvious. The dip angle of joints has strong effects on the deformation and dynamic behaviors of rock foundation, in terms that different dip angles lead to obviously different deformation and horizontal stress in the rock foundation when subjected to seismic load. When the dip angle of joints is around 60deg, the seismic velocity, displacement and stress reach the maximums. Therefore, attentions need to be paid on this factor during the seismic design of nuclear power plants. (author)

  10. Algorithm for Severe Hallux Valgus Associated With Metatarsus Adductus.

    Science.gov (United States)

    Sharma, Jyoti; Aydogan, Umur

    2015-12-01

    Radiographic angles, such as the intermetatarsal angle, hallux valgus angle, and distal metatarsal articular angle, are commonly used to help guide operative planning for soft tissue and osseous treatment options for hallux valgus. Hallux valgus treatment in the setting of associated metatarsus adductus is less common and not well described. The presence of metatarsus adductus reduces the gap between the first and second metatarsals. Consequently, it complicates the measurement of the first-second intermetatarsal angle and can limit the area available for transposition of the first metatarsal head. A compensatory pronation is also created, which must be compensated for. We present 4 cases of patients that had hallux valgus with severe metatarsus adductus treated operatively, as well as a treatment algorithm. For concomitant correction of both the metatarsus adductus and the hallux valgus, a thorough surgical treatment algorithm was implemented to address the hallux, lesser toe deformities, and pes planus deformity. Postoperatively, the patients were kept non-weight bearing for 6 weeks, followed by gradual weight bearing in a protective boot. Physical therapy was instituted at the start of weight bearing to encourage a return to activities of daily living. At follow-up, patients reported significant relief of their pain symptoms with a narrower and improved appearance of the foot. No recurrence was noted. One patient used a medial arch support but was otherwise symptom free. Radiographic measurements improved on postoperative radiographs. For the treatment of hallux valgus with metatarsus adductus, the second and third metatarsals may need to be addressed for the first metatarsal to be laterally transposed adequately. Overall, this comprehensive approach addresses the hindfoot, midfoot, and forefoot for patients with hallux valgus associated with metatarsus adductus, with successful results. © The Author(s) 2015.

  11. Evaluation of Hallux Valgus Correction With Versus Without Akin Proximal Phalanx Osteotomy.

    Science.gov (United States)

    Shibuya, Naohiro; Thorud, Jakob C; Martin, Lanster R; Plemmons, Britton S; Jupiter, Daniel C

    2016-01-01

    Although the efficacy of Akin proximal phalanx closing wedge osteotomy as a sole procedure for correction of hallux valgus deformity is questionable, when used in combination with other osseous corrective procedures, the procedure has been believed to be efficacious. However, a limited number of comparative studies have confirmed the value of this additional procedure. We identified patients who had undergone osseous hallux valgus correction with first metatarsal osteotomy or first tarsometatarsal joint arthrodesis with (n = 73) and without (n = 81) Akin osteotomy and evaluated their radiographic measurements at 3 points (preoperatively, within 3 months after surgery, and ≥6 months after surgery). We found that those people who had undergone the Akin procedure tended to have a larger hallux abduction angle and a more laterally deviated tibial sesamoid position preoperatively. Although the radiographic correction of the deformity was promising immediately after corrective surgery with the Akin osteotomy, maintenance of the correction was questionable in our cohort. The value of additional Akin osteotomy for correction of hallux valgus deformity is uncertain. Published by Elsevier Inc.

  12. Joint angles of the ankle, knee, and hip and loading conditions during split squats.

    Science.gov (United States)

    Schütz, Pascal; List, Renate; Zemp, Roland; Schellenberg, Florian; Taylor, William R; Lorenzetti, Silvio

    2014-06-01

    The aim of this study was to quantify how step length and the front tibia angle influence joint angles and loading conditions during the split squat exercise. Eleven subjects performed split squats with an additional load of 25% body weight applied using a barbell. Each subject's movements were recorded using a motion capture system, and the ground reaction force was measured under each foot. The joint angles and loading conditions were calculated using a cluster-based kinematic approach and inverse dynamics modeling respectively. Increases in the tibia angle resulted in a smaller range of motion (ROM) of the front knee and a larger ROM of the rear knee and hip. The external flexion moment in the front knee/hip and the external extension moment in the rear hip decreased as the tibia angle increased. The flexion moment in the rear knee increased as the tibia angle increased. The load distribution between the legs changed squat execution was varied. Our results describing the changes in joint angles and the resulting differences in the moments of the knee and hip will allow coaches and therapists to adapt the split squat exercise to the individual motion and load demands of athletes.

  13. Consequences of Avulsion Fracture of the Proximal Phalanx Caused by a Technical Failure of Hallux Valgus Surgery.

    Science.gov (United States)

    Park, Young Uk; Lee, Kyung Tai; Jegal, Hyuk; Kim, Ki Chun; Choo, Ho Sik; Kweon, Heon Ju

    2016-01-01

    Several cases of avulsion fracture of the proximal phalanx of the big toe during the lateral capsular release procedure were observed. However, these fractures have not been reported as a complication of hallux valgus surgery. The purpose of the present study was to report the proximal phalanx base fracture as an unrecognized complication and to evaluate the clinical and radiographic consequences of this complication. We retrospectively reviewed 225 feet that had undergone hallux valgus surgery involving proximal chevron osteotomy and distal soft tissue release from May 2009 to December 2012. Of these 225 feet (198 patients), 12 (5.3%) developed proximal phalanx base fracture postoperatively. These patients were assigned to the fracture group. The remaining patients were assigned to the nonfracture group. Patients were followed to observe whether the fractures united and whether degenerative changes developed at the first metatarsophalangeal joint because of this fracture. The mean follow-up period was 36 (range 12 to 72) months. All the subjects in the fracture and nonfracture groups underwent weightbearing anteroposterior and lateral radiographs of the foot at the initial presentation and final follow-up point. The 2 groups were compared with respect to the hallux valgus angle, intermetatarsal angle, range of motion, American Orthopaedic Foot and Ankle Society score, satisfaction, and degenerative changes. No significant differences were found in age, follow-up period, hallux valgus angle, intermetatarsal angle, range of motion of the first metatarsophalangeal joint, American Orthopaedic Foot and Ankle Society score, satisfaction, and degenerative changes between the 2 groups. Ten (83.3%) of the 12 fractures healed, 2 (16.7% of the fractures, 0.89% of the operated feet) progressed to asymptomatic nonunion, and 3 (1.33%) developed first metatarsophalangeal joint degeneration. Avulsion fracture of the proximal phalanx of the big toe is an uncommon complication of

  14. The Effect of Gap Angle on Tensile Strength of Preceramic Base Metal Solder Joints.

    Science.gov (United States)

    Fattahi, Farnaz; Hashemi Ardakani, Zahra; Hashemi Ardakani, Maryam

    2015-12-01

    Soldering is a process commonly used in fabricating dental prosthesis. Since most soldered prosthesis fail at the solder joints; the joint strength is of utmost importance. The purpose of this study was to evaluate the effect of gap angle on the tensile strength of base metal solder joints. A total number of 40 Ni-Cr samples were fabricated according to ADA/ISO 9693 specifications for tensile test. Samples were cut at the midpoint of the bar, and were placed at the considered angles by employing an explicitly designed device. They were divided into 4 groups regarding the gap angle; Group C (control group) with parallel gap on steady distance of 0.2mm, Group 1: 10°, Group 2: 20°, and Group3: 30° gap angles. When soldered, the specimens were all tested for tensile strength using a universal testing machine at a cross-head speed of 0.5 mm/min with a preload of 10N. Kruskal-Wallis H test was used to compare tensile strength among the groups (ptensile strength values obtained from the study groups were respectively 307.84, 391.50, 365.18, and 368.86 MPa. The tensile strength was not statistically different among the four groups in general (p≤ 0.490). Making the gap angular at the solder joints and the subsequent unsteady increase of the gap distance would not change the tensile strength of the joint.

  15. [Minimally invasive therapy for hallux valgus with deformity of little toe varus].

    Science.gov (United States)

    Gu, Shi-Wei; Yang, Ke; Zhao, Si-Qiao; Gao, Zhan-Ao; Ma, Shun-Qian; Zhang, Wen-Qing

    2018-03-25

    To explore clinical effect of minimally corrective osteotomy for the treatment of hallux valgus with deformity of little toe varus through small incision. From January 2013 to June 2016, 168 hallux valgus patients with deformity of little toe varus were treated by minimally corrective osteotomy through small incision. Among them, 7 males and 161 females were aged from 22 to 75 years old with an average of(59.3±3.5) years old. Preoperative clinical manifestation mainly focus on red and swollen of bunion, pain around with metatarsal bones, and diagnosed as hallux valgus with deformity of little toe varus through small incision. Operative time, postoperative complications, pre and post-operative IMA(angle between the first and the second metatarsal bones), HVA (hallux valgus angle), LDA(valgus angle of the fifth metatarsal bones), MPA(valgus angle of little toe), IM4-5 (angle between the forth and the fifth metatarsal bones) and PASA(fixed angle of proximal joint), postoperative AOFAS score were used to evaluate foot function. One hundred and sixty-eight patients were followed up for 6 to 48 months with an average of (28.6±3.2) months. All wounds were healed well without infection, sinus tract and other complications. Operative time ranged from 16 to 28 min with an average of (18.3±2.1) min. IMA, HVA, LDA, MPA and IM A 4-5 were (10.1±2.1)°, (32.6±4.2)°, (6.9±2.3)°, (18.5±5.2)°, (15.1±2.9)°preoperatively, improved to (8.3±2.2)°, (10.9±2.9)°, (2.7±0.4)°, (6.5±1.6)°, (8.9±1.8)° postoperatively, and had significant differences before and after operation. While there was no difference in PASA before (9.1±2.1)°and after operation(8.7±1.9)°. AOFAS score were improved from (31.6±3.9) before operation to(83.7±5.2) after operation, but no significant difference( P >0.05). According to AOFAS score, 147 patients obtained excellent results, 13 good, 6 moderate and 2 poor. Minimally corrective osteotomy for the treatment of hallux valgus with deformity

  16. Treatment of Hallux Valgus with Hyaluronic Acid: A Pilot Study

    Directory of Open Access Journals (Sweden)

    Ižlhan Sezer

    2017-05-01

    Full Text Available Aim: Hallux valgus is the deformity of the first metatarsophalangeal (MTP joint with abduction and valgus rotation of the great toe, combined with a medially prominent first metatarsal head. Hyaluronic acid injection has been used in the treatment of degenerative disorders of several joints successfully. In this research, we aimed to investigate the effectiveness of hyaluronic acid injection in patients with hallux valgus. Material and Method: Eleven female and two male patients with hallux valgus were included in this pilot study. Only patients with mild and moderate hallux valgus were included in the study. 1 cc hyaluronic acid was injected into the affected MTF joint three times, at one-week intervals. Visual analogue scale(VAS score, walking time without pain, walking distance, and daily analgesic needs of the patients were recorded. All clinical outcomes were assessed before, and then one and three months after the first injection. Results:The mean VAS score was 83.08±4.58. One month after the first injection, VAS scores of patients had decreased significantly (30±4.38, P: 0.001. Also, increased walking time and distance and decreased daily analgesic need were observed at the first month of postinjection follow-up (P: 0.001. After 3 months, the positive outcomes remained significant compared to preinjection evaluations. Discussion: According to our preliminary results, we suggest thathyaluronic acid injectionsmay be effective in reducing pain and increasing walking time and distance in patients with hallux valgus.Future studies are needed to clarify the beneficial effects of hyaluronic acid injection in patients with hallux valgus.

  17. KINEMATIC ANALYSIS OF KNEE VALGUS DURING DROP VERTICAL JUMP AND FORWARD STEP-UP IN YOUNG BASKETBALL PLAYERS.

    Science.gov (United States)

    Paz, Gabriel Andrade; Maia, Marianna de Freitas; Farias, Déborah; Santana, Haroldo; Miranda, Humberto; Lima, Vicente; Herrington, Lee

    2016-04-01

    Lower limb asymmetry between dominant and nondominant limbs is often associated with injuries. However, there is a lack of evidence about frontal plane projection angle (FPPA) of the knee joint (knee valgus) during drop vertical jump (DVJ) and forward step-up tasks (FSUP) in young basketball players. Therefore, the purpose of this study was to assess the FPPA (i.e., dynamic knee valgus) via 2D video analysis during DVJ and FSUP tasks in the dominant and nondominant limbs of young male basketball players. Twenty seven young male basketball players (age 14.5 ± 1.3 y, height 161.1 ± 4.1 cm, weight 64.2 ± 10.2 kg) participated in this study. The participants were asked to perform a bilateral DVJ and unilateral FSUP tasks. Kinematic analysis of FPPA was completed via a two-dimensional (2D) examination in order to evaluate the knee valgus alignment during the beginning of the concentric phase of each task. Knee valgus alignment was computed considering the angle between the line formed between the markers at the anterior superior iliac spine and middle of the tibiofemoral joint and the line formed from the markers on the middle of the tibiofemoral joint to the middle of the ankle mortise. Paired t-tests were used to evaluate differences in tasks. Standard error of measurement (SEM) was calculated to establish random error scores. There was no difference in knee valgus angle during the DVJ task between dominant (20.2 ± 4.4 º) and nondominant legs (20 ± 4.1 º; p = 0.067). However, a significant difference was noted during FSUP between the non-dominant limb (18.7 ± 3.4 º) when compared to the dominant (21.7 ± 3.5 º; p = 0.001) limb. Two dimensional kinematic analysis of knee FPPA may help coaches and other professionals to detect asymmetries between dominant and nondominant limbs, and to develop training programs with the goal of reducing overall lower extremity injury risk. 2b.

  18. History of surgical treatments for hallux valgus.

    Science.gov (United States)

    Galois, Laurent

    2018-05-31

    In the nineteenth century, the prevalent understanding of the hallux valgus was that it was purely an enlargement of the soft tissue, first metatarsal head, or both, most commonly caused by ill-fitting footwear. Thus, treatment had varying results, with controversy over whether to remove the overlying bursa alone or in combination with an exostectomy of the medial head. Since 1871, when the surgical technique was first described, many surgical treatments for the correction of hallux valgus have been proposed. A number of these techniques have come into fashion, and others have fallen into oblivion. Progress in biomechanical knowledge, and improvements in materials and supports have allowed new techniques to be developed over the years. We have developed techniques that sacrifice the metatarsophalangeal joint (arthrodesis, arthroplasties), as well as conservative procedures, and one can distinguish those which only involve the soft tissues from those that are linked with a first ray osteotomy.

  19. An evaluation of the carrying angle of the elbow joint in adolescents

    African Journals Online (AJOL)

    McRoy

    Department of Anatomy and Orthopedics, Sri Lakshmi Narayana Institute of Medical Sciences,. Pondicherry - 605 502 ... forearm deviates laterally from the long axis of the humerus, with the arm extended and the palm ... for elbow reconstruction. Key words: Carrying angle, elbow joint, adolescent, forearm, humerus, ulna ...

  20. Fatigue affects peak joint torque angle in hamstrings but not in quadriceps.

    Science.gov (United States)

    Coratella, Giuseppe; Bellin, Giuseppe; Beato, Marco; Schena, Federico

    2015-01-01

    Primary aim of this study was to investigate peak joint torque angle (i.e. the angle of peak torque) changes recorded during an isokinetic test before and after a fatiguing soccer match simulation. Secondarily we want to investigate functional Hecc:Qconc and conventional Hconc:Qconc ratio changes due to fatigue. Before and after a standardised soccer match simulation, twenty-two healthy male amateur soccer players performed maximal isokinetic strength tests both for hamstrings and for quadriceps muscles at 1.05 rad · s(‒1), 3.14 rad · s(‒1) and 5.24 rad · s(‒1). Peak joint torque angle, peak torque and both functional Hecc:Qconc and conventional Hconc:Qconc ratios were examined. Both dominant and non-dominant limbs were tested. Peak joint torque angle significantly increased only in knee flexors. Both eccentric and concentric contractions resulted in such increment, which occurred in both limbs. No changes were found in quadriceps peak joint torque angle. Participants experienced a significant decrease in torque both in hamstrings and in quadriceps. Functional Hecc:Qconc ratio was lower only in dominant limb at higher velocities, while Hconc:Qconc did not change. This study showed after specific fatiguing task changes in hamstrings only torque/angle relationship. Hamstrings injury risk could depend on altered torque when knee is close to extension, coupled with a greater peak torque decrement compared to quadriceps. These results suggest the use eccentric based training to prevent hamstrings shift towards shorter length.

  1. Assessment of novel digital and smartphone goniometers for measurement of canine stifle joint angles.

    Science.gov (United States)

    Freund, Kristin A; Kieves, Nina R; Hart, Juliette L; Foster, Sasha A; Jeffery, Unity; Duerr, Felix M

    2016-07-01

    OBJECTIVE To evaluate accuracy and reliability of 3 novel goniometers for measurement of canine stifle joint angles and compare the results with those obtained with a universal goniometer (UG). SAMPLE 8 pelvic limbs from 4 canine cadavers. PROCEDURES Each limb was secured to a wooden platform at 3 arbitrarily selected fixed stifle joint angles. Goniometry was performed with 2 smartphone-based applications (novel goniometers A and B), a digital goniometer (novel goniometer C), and a UG; 3 evaluators performed measurements in triplicate for each angle with each device. Results were compared with stifle joint angle measurements on radiographs (used as a gold standard). Accuracy was determined by calculation of bias and total error, coefficients of variation were calculated to estimate reliability, and strength of linear association between radiographic and goniometer measurements was assessed by calculation of correlation coefficients. RESULTS Mean coefficient of variation was lowest for the UG (4.88%), followed by novel goniometers B (7.37%), A (7.57%), and C (12.71%). Correlation with radiographic measurements was highest for the UG (r = 0.97), followed by novel goniometers B (0.93), A (0.90), and C (0.78). Constant bias was present for all devices except novel goniometer B. The UG and novel goniometer A had positive constant bias; novel goniometer C had negative constant bias. Total error at 50° and 100° angles was > 5% for all devices. CONCLUSIONS AND CLINICAL RELEVANCE None of the devices accurately represented radiographically measured stifle joint angles. Additional veterinary studies are indicated prior to the use of novel goniometers in dogs.

  2. Combined rotation scarf and Akin osteotomies for hallux valgus: a patient focussed 9 year follow up of 50 patients

    Directory of Open Access Journals (Sweden)

    Kilmartin Timothy E

    2010-02-01

    Full Text Available Abstract Background The Cochrane review of hallux valgus surgery has disputed the scientific validity of hallux valgus research. Scoring systems and surrogate measures such as x-ray angles are commonly reported at just one year post operatively but these are of dubious relevance to the patient. In this study we extended the follow up to a minimum of 8 years and sought to address patient specific concerns with hallux valgus surgery. The long term follow up also allowed a comprehensive review of the complications associated with the combined rotation scarf and Akin osteotomies. Methods Between 1996 and 1999, 101 patients underwent rotation scarf and Akin osteotomies for the treatment of hallux valgus. All patients were contacted and asked to participate in this study. 50 female participants were available allowing review of 73 procedures. The average follow up was over 9 years and the average age at the time of surgery was 57. The participants were physically examined and interviewed. Results Post-operatively, in 86% of the participants there were no footwear restrictions. Stiffness of the first metatarsophalangeal joint was reported in 8% (6 feet; 10% were unhappy with the cosmetic appearance of their feet, 3 feet had hallux varus, and 2 feet had recurrent hallux valgus. There were no foot-related activity restrictions in 92% of the group. Metatarsalgia occurred in 4% (3 feet. 96% were better than before surgery and 88% were completely satisfied with their post-operative result. Hallux varus was the greatest single cause of dissatisfaction. The most common adverse event in the study was internal fixation irritation. Hallux valgus surgery is not without risk and these findings could be useful in the informed consent process. Conclusions When combined the rotation scarf and Akin osteotomies are an effective treatment for hallux valgus that achieves good long-term correction with a low incidence of recurrence, footwear restriction or metatarsalgia

  3. Validation of functional calibration and strap-down joint drift correction for computing 3D joint angles of knee, hip, and trunk in alpine skiing

    OpenAIRE

    Fasel, Benedikt; Spörri, Jörg; Schütz, Pascal; Lorenzetti, Silvio; Aminian, Kamiar

    2017-01-01

    To obtain valid 3D joint angles with inertial sensors careful sensor-to-segment calibration (i.e. functional or anatomical calibration) is required and measured angular velocity at each sensor needs to be integrated to obtain segment and joint orientation (i.e. joint angles). Existing functional and anatomical calibration procedures were optimized for gait analysis and calibration movements were impractical to perform in outdoor settings. Thus, the aims of this study were 1) to propose and va...

  4. No evidence hip joint angle modulates intrinsically produced stretch reflex in human hopping.

    Science.gov (United States)

    Gibson, W; Campbell, A; Allison, G

    2013-09-01

    Motor output in activities such as walking and hopping is suggested to be mediated neurally by purported stretch reflex augmentation of muscle output. Reflex EMG activity during these tasks has been frequently investigated in the soleus muscle; with alterations in reflex amplitude being associated with changes in hip joint angle/phase of the gait cycle. Previous work has focussed on reflex activity induced by an artificial perturbation or by induction of H-reflexes. As such, it is currently unknown if stretch reflex activity induced intrinsically (as part of the task) is modulated by changes in hip joint angle. This study investigated whether hip joint angle modulated reflex EMG 'burst' activity during a hopping task performed on a custom-built partially reclined sleigh. Ten subjects participated; EMG and kinematic data (VICON motor capture system) was collected for each hop cycle. Participants completed 5 sets of 30s of self-paced hopping in (1) hip neutral and (2) hip 60° flexion conditions. There was no difference in EMG 'burst' activity or in sagittal plane kinematics (knee/ankle) in the hopping task between the two conditions. The results indicate that during a functional task such as hopping, changes in hip angle do not alter the stretch reflex-like activity associated with landing. Copyright © 2013 Elsevier B.V. All rights reserved.

  5. Proximal supination osteotomy of the first metatarsal for hallux valgus.

    Science.gov (United States)

    Yasuda, Toshito; Okuda, Ryuzo; Jotoku, Tsuyoshi; Shima, Hiroaki; Hida, Takashi; Neo, Masashi

    2015-06-01

    Risk factors for hallux valgus recurrence include postoperative round-shaped lateral edge of the first metatarsal head and postoperative incomplete reduction of the sesamoids. To prevent the occurrence of such conditions, we developed a proximal supination osteotomy of the first metatarsal. Our aim was to describe this novel technique and report the outcomes in this report. Sixty-six patients (83 feet) underwent a distal soft tissue procedure combined with a proximal supination osteotomy. After the proximal crescentic osteotomy, the proximal fragment was pushed medially, and the distal fragment was abducted, and then the distal fragment of the first metatarsal was manually supinated. Outcomes were assessed using the American Orthopaedic Foot & Ankle Society (AOFAS) score and radiographic examinations. The average follow-up duration was 34 (range, 25 to 52) months. The mean AOFAS score improved significantly from 58.0 points preoperatively to 93.8 points postoperatively (P hallux valgus and intermetatarsal angle decreased significantly from 38.6 and 18.0 degrees preoperatively to 11.0 and 7.9 degrees postoperatively, respectively (both, P hallux valgus, defined as a hallux valgus angle ≥ 25 degrees. The rates of occurrence of a positive round sign and incomplete reduction of the sesamoids significantly decreased postoperatively, which may have contributed to the low hallux valgus recurrence rates. We conclude that a proximal supination osteotomy was an effective procedure for correction of hallux valgus and can achieve a low rate of hallux valgus recurrence. Level IV, retrospective case series. © The Author(s) 2015.

  6. Mobile Phone-Based Joint Angle Measurement for Functional Assessment and Rehabilitation of Proprioception

    Directory of Open Access Journals (Sweden)

    Quentin Mourcou

    2015-01-01

    Full Text Available Assessment of joint functional and proprioceptive abilities is essential for balance, posture, and motor control rehabilitation. Joint functional ability refers to the capacity of movement of the joint. It may be evaluated thereby measuring the joint range of motion (ROM. Proprioception can be defined as the perception of the position and of the movement of various body parts in space. Its role is essential in sensorimotor control for movement acuity, joint stability, coordination, and balance. Its clinical evaluation is commonly based on the assessment of the joint position sense (JPS. Both ROM and JPS measurements require estimating angles through goniometer, scoliometer, laser-pointer, and bubble or digital inclinometer. With the arrival of Smartphones, these costly clinical tools tend to be replaced. Beyond evaluation, maintaining and/or improving joint functional and proprioceptive abilities by training with physical therapy is important for long-term management. This review aims to report Smartphone applications used for measuring and improving functional and proprioceptive abilities. It identifies that Smartphone applications are reliable for clinical measurements and are mainly used to assess ROM and JPS. However, there is lack of studies on Smartphone applications which can be used in an autonomous way to provide physical therapy exercises at home.

  7. The results of Scarf osteotomy combined with distal soft tissue procedure are mostly satisfactory in surgical management of moderate to severe hallux valgus.

    Science.gov (United States)

    Şaylı, Uğur; Akman, Budak; Tanrıöver, Altuğ; Kaspar, Çiğdem; Güven, Melih; Özler, Turhan

    2017-05-29

    Intrinsically stable diaphyseal osteotomy gained popularity in recent years for symptomatic hallux valgus deformities. In this study, Scarf osteotomy results, in surgical management of moderate to severe hallux valgus, are presented. Study group consisted of 40 feet of 32 (28 females, four males) patients surgically managed by Scarf osteotomy between September 2009 and 2011, with a mean age of 52,98 (range, 31-75) years at the time of surgery. Patient satisfaction and VAS were used for subjective evaluation while for objective measures AOFAS score, first metatarsophalangeal joint ROM and radiological measurements (intermetatarsal, hallux valgus and distal metatarsal articular angles) were evaluated. Mean follow-up period was 38 (range, 24-60) months. Sixteen feet (40%) were reported as very satisfied, 19 (47,5%) as satisfied and the remaining five (12,5%) as unsatisfied resulting with a total of 35 (87,5%) satisfaction. The mean preoperative VAS and AOFAS forefoot scores improved from 8,13±0,791 to 2,68±1,228 (p=0,0001) and from 58,25±6,15 to 78,25±8,13 (p=0,0001) on the final follow-up, respectively. The postoperative change of first metatarsophalangeal joint ROM was not statistically significant (p=0,281). On the radiological evaluation; intermetatarsal and hallux valgus angles improved from a mean value of 14,77±1,76 to 8,13±1,52° (p=0,0001) and from 35,28±5,86 to 20,10±5,55° (p=0,0001), respectively. Distal metatarsal articular angle did not show any statistically significant change (p=0,195). Scarf osteotomy combined with distal soft tissue procedure is a technically demanding procedure. The osteotomy is intrinsically stable and the correction power is high and the results are mostly satisfactory. Copyright © 2017. Published by Elsevier Ltd.

  8. Pain Resolution After Hallux Valgus Surgery.

    Science.gov (United States)

    Chen, Jerry Yongqiang; Ang, Benjamin Fu Hong; Jiang, Lei; Yeo, Nicholas Eng Meng; Koo, Kevin; Singh Rikhraj, Inderjeet

    2016-10-01

    Although more than 1500 publications on hallux valgus can be found in the current literature, none of them have reported on the course of pain resolution after hallux valgus surgery. Thus, this study aimed to investigate pain resolution after hallux valgus surgery and to identify predictive factors associated with residual pain at 6 months after surgery. We prospectively followed up 308 patients who underwent hallux valgus surgery at a tertiary hospital at 6 months and 2 years after surgery. Multivariate logistic regression analysis was performed to evaluate the risk factors associated with residual pain after surgery. Ninety-four patients (31%) had some degree of residual pain at 6 months after surgery. After excluding 4 patients who developed osteoarthritis of the first metatarsophalangeal joint over the next 18 months, 73 of the remaining 90 (81%) experienced improvement in visual analog scale (VAS) by the 2-years follow-up. Their median VAS improved from 4 (interquartile range [IQR] 3, 5) at 6 months to 0 (IQR 0, 3) at 2 years (P < .001). A higher preoperative VAS increased the risk of having persistent pain at 6 months after sugery (odds ratio [OR] 1.388, 95% confidence interval [CI] 1.092, 1.764, P = .007), whereas a higher preoperative Mental Component Score of SF-36 (MCS) reduced this risk (OR 0.952, 95% CI 0.919, 0.987, P = .007). As much as 31% of patients will have residual pain at 6 months after surgery. Preoperative VAS and MCS are predictors for residual pain. However, these patients will continue to improve over the next 18 months, with 71% of them being pain free at 2 years after surgery. Level II, prospective comparative study. © The Author(s) 2016.

  9. Relationship between pedographic analysis and the Manchester scale in hallux valgus.

    Science.gov (United States)

    Iliou, Kalliopi; Paraskevas, George; Kanavaros, Panagiotis; Gekas, Christos; Barbouti, Alexandra; Kitsoulis, Panagiotis

    2015-01-01

    The aim of this study was to evaluate the correlation between the Manchester scale and foot pressure distribution in patients with hallux valgus deformity. The study included 152 feet of 87 patients with hallux valgus and a control group of 391 feet of 241 individuals without hallux valgus deformity. The severity of hallux valgus was determined using the Manchester scale grading system. Plantar loading patterns in 10 foot areas were determined for all participants. According to the Manchester scale, 72% of the participants had no, 12.9% mild, 10.7% moderate and 4.4% severe deformity. The Manchester scale grade was highly correlated with both hallux valgus angle and first intermetatarsal angle (p=0.00). Significant differences between the four grades were present for mean pressure under the hallux and the first and second metatarsal heads only (p=0.00). The load distribution under these areas was higher as the hallux valgus progressed from mild to more severe. In all groups, the highest pressure was observed under the second metatarsal head. The Manchester scale was strongly associated with both the hallux valgus angle and the first intermetatarsal angle. The progression from mild to moderate and severe deformation is associated with peak pressure raise at the hallux, first and second metatarsal heads. The Manchester scale appears to be a useful tool to provide information for the degree of deformity and the pressure under painful foot areas.

  10. Effect of Knee Joint Angle and Contraction Intensity on Hamstrings Coactivation.

    Science.gov (United States)

    Wu, Rui; Delahunt, Eamonn; Ditroilo, Massimiliano; Lowery, Madeleine M; DE Vito, Giuseppe

    2017-08-01

    This study investigated the effect of knee joint angle and contraction intensity on the coactivation of the hamstring muscles (when acting as antagonists to the quadriceps) in young and older individuals of both sexes. A total of 25 young (24 ± 2.6 yr) and 26 older (70 ± 2.5 yr) healthy men and women participated. Maximal voluntary isometric contraction of the knee extensors and flexors was assessed at two knee joint angles (90° and 60°, 0° = full extension). At each angle, participants performed submaximal contractions of the knee extensors (20%, 50%, and 80% maximal voluntary isometric contraction), whereas surface EMG was simultaneously acquired from the vastus lateralis and biceps femoris muscles to assess the level (EMG root-mean-square) of agonist activation and antagonist coactivation. Subcutaneous adipose tissue in the areas corresponding to surface EMG electrode placements was measured via ultrasonography. The contractions performed at 90° knee flexion demonstrated higher levels of antagonist coactivation (all P < 0.01) and agonist activation (all P < 0.01) as a function of contraction intensity compared with the 60° knee flexion. Furthermore, after controlling for subcutaneous adipose tissue, older participants exhibited a higher level of antagonist coactivation at 60° knee flexion compared with young participants (P < 0.05). The results of the present study suggest that 1) the antagonist coactivation is dependent on knee joint angle and contraction intensity and 2) subcutaneous adipose tissue may affect the measured coactivation level likely because of a cross-talk effect. Antagonist coactivation may play a protective role in stabilizing the knee joint and maintaining constant motor output.

  11. Joint angle affects volitional and magnetically-evoked neuromuscular performance differentially.

    Science.gov (United States)

    Minshull, C; Rees, D; Gleeson, N P

    2011-08-01

    This study examined the volitional and magnetically-evoked neuromuscular performance of the quadriceps femoris at functional knee joint angles adjacent to full extension. Indices of volitional and magnetically-evoked neuromuscular performance (N=15 healthy males, 23.5 ± 2.9 years, 71.5 ± 5.4 kg, 176.5 ± 5.5 cm) were obtained at 25°, 35° and 45° of knee flexion. Results showed that volitional and magnetically-evoked peak force (PF(V) and P(T)F(E), respectively) and electromechanical delay (EMD(V) and EMD(E), respectively) were enhanced by increased knee flexion. However, greater relative improvements in volitional compared to evoked indices of neuromuscular performance were observed with increasing flexion from 25° to 45° (e.g. EMD(V), EMD(E): 36% vs. 11% improvement, respectively; F([2,14])=6.8, pjoint positions. These findings suggest that the extent of the relative differential between volitional and evoked neuromuscular performance capabilities is joint angle-specific and not correlated with performance capabilities at adjacent angles, but tends to be smaller with increased flexion. As such, effective prediction of volitional from evoked performance capabilities at both analogous and adjacent knee joint positions would lack robustness. Copyright © 2011 Elsevier Ltd. All rights reserved.

  12. A controlled intervention study assessing the relation between hip abductor strength and knee valgus

    OpenAIRE

    Grytdal, Are

    2015-01-01

    Background: Anterior cruciate ligament (ACL) injury is a common and severe lower limb injury. Knee abduction moment has been associated with risk of non-contact ACL injury, and knee valgus angle has been reported as part of the non-contact ACL injury mechanism. Fatigued and weak hip abductors have been correlated with increased knee abduction moment and knee valgus angle. Strengthening the hip abductor muscles might play an important role in ACL injury prevention. Purpose: T...

  13. Validation of functional calibration and strap-down joint drift correction for computing 3D joint angles of knee, hip, and trunk in alpine skiing.

    Science.gov (United States)

    Fasel, Benedikt; Spörri, Jörg; Schütz, Pascal; Lorenzetti, Silvio; Aminian, Kamiar

    2017-01-01

    To obtain valid 3D joint angles with inertial sensors careful sensor-to-segment calibration (i.e. functional or anatomical calibration) is required and measured angular velocity at each sensor needs to be integrated to obtain segment and joint orientation (i.e. joint angles). Existing functional and anatomical calibration procedures were optimized for gait analysis and calibration movements were impractical to perform in outdoor settings. Thus, the aims of this study were 1) to propose and validate a set of calibration movements that were optimized for alpine skiing and could be performed outdoors and 2) to validate the 3D joint angles of the knee, hip, and trunk during alpine skiing. The proposed functional calibration movements consisted of squats, trunk rotations, hip ad/abductions, and upright standing. The joint drift correction previously proposed for alpine ski racing was improved by adding a second step to reduce separately azimuth drift. The system was validated indoors on a skiing carpet at the maximum belt speed of 21 km/h and for measurement durations of 120 seconds. Calibration repeatability was on average boots. Joint angle precision was <4.9° for all angles and accuracy ranged from -10.7° to 4.2° where the presence of an athlete-specific bias was observed especially for the flexion angle. The improved joint drift correction reduced azimuth drift from over 25° to less than 5°. In conclusion, the system was valid for measuring 3D joint angles during alpine skiing and could be used outdoors. Errors were similar to the values reported in other studies for gait. The system may be well suited for within-athlete analysis but care should be taken for between-athlete analysis because of a possible athlete-specific joint angle bias.

  14. Proximal Intermetatarsal Divergence in Distal Chevron Osteotomy for Hallux Valgus: An Overlooked Finding.

    Science.gov (United States)

    Akpinar, Evren; Buyuk, Abdul Fettah; Cetinkaya, Engin; Gursu, Sarper; Ucpunar, Hanifi; Albayrak, Akif

    2016-01-01

    The goal of distal chevron osteotomy for hallux valgus is to restore proper first-toe joint alignment by performing lateral translation of the distal first metatarsal fragment (the metatarsal head). We hypothesized that in some patients this procedure might also result in involuntary medial translation of the proximal first metatarsal fragment, which we called proximal intermetatarsal divergence. The aim of the present study was to compare the pre- and postoperative radiographs of patients with hallux valgus to determine whether we could identify proximal intermetatarsal divergence. We retrospectively compared the pre- and postoperative radiographs of 29 feet in 28 patients treated with distal chevron osteotomy. Two different methods were used to measure the intermetatarsal angles: the anatomic intermetatarsal angle (aIMA) and the mechanical intermetatarsal angle (mIMA). The maximum intermetatarsal distance (MID) was also measured. We defined proximal intermetatarsal divergence as a postoperative increase in the aIMA or MID, coupled with a decrease in the mIMA. For data analysis, we divided the patients into low-angle (mild deformity) and high-angle (severe deformity) groups, according to their preoperative mIMA. The mean ± standard deviation patient age was 41 ± 14 years. In the low-angle group, the mean mIMA decreased (from 10.91° to 7.00°), the mean aIMA increased (from 11.80° to 13.55°), and the mean MID increased (from 17.97 mm to 20.60 mm; p = .001, for all). In the high-angle group, the mean mIMA decreased (from 14.30° to 6.90°; p = .001), the mean aIMA decreased (from 14.77° to 13.54°; p = .06), and the mean MID decreased (from 20.74 mm to 20.37 mm; p = .64). The results of our study suggest that proximal intermetatarsal divergence might occur after distal chevron osteotomy for hallux valgus, primarily in patients with a low preoperative mIMA. Copyright © 2016 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All

  15. Knee joint contact mechanics during downhill gait and its relationship with varus/valgus motion and muscle strength in patients with knee osteoarthritis.

    Science.gov (United States)

    Farrokhi, Shawn; Voycheck, Carrie A; Gustafson, Jonathan A; Fitzgerald, G Kelley; Tashman, Scott

    2016-01-01

    The objective of this exploratory study was to evaluate tibiofemoral joint contact point excursions and velocities during downhill gait and assess the relationship between tibiofemoral joint contact mechanics with frontal-plane knee joint motion and lower extremity muscle weakness in patients with knee osteoarthritis (OA). Dynamic stereo X-ray was used to quantify tibiofemoral joint contact mechanics and frontal-plane motion during the loading response phase of downhill gait in 11 patients with knee OA and 11 control volunteers. Quantitative testing of the quadriceps and the hip abductor muscles was also performed. Patients with knee OA demonstrated larger medial/lateral joint contact point excursions (p knee OA compared to their control counterparts (p = 0.02). Additionally, patients with knee OA demonstrated significantly increased frontal-plane varus motion excursions (p knee OA were linearly associated with greater frontal-plane varus motion excursions (p knee OA may be related to compromised frontal-plane joint stability but not with deficits in muscle strength.

  16. Muscle and reflex changes with varying joint angle in hemiparetic stroke

    Directory of Open Access Journals (Sweden)

    Alibiglou Laila

    2008-02-01

    Full Text Available Abstract Background Despite intensive investigation, the origins of the neuromuscular abnormalities associated with spasticity are not well understood. In particular, the mechanical properties induced by stretch reflex activity have been especially difficult to study because of a lack of accurate tools separating reflex torque from torque generated by musculo-tendinous structures. The present study addresses this deficit by characterizing the contribution of neural and muscular components to the abnormally high stiffness of the spastic joint. Methods Using system identification techniques, we characterized the neuromuscular abnormalities associated with spasticity of ankle muscles in chronic hemiparetic stroke survivors. In particular, we systematically tracked changes in muscle mechanical properties and in stretch reflex activity during changes in ankle joint angle. Modulation of mechanical properties was assessed by applying perturbations at different initial angles, over the entire range of motion (ROM. Experiments were performed on both paretic and non-paretic sides of stroke survivors, and in healthy controls. Results Both reflex and intrinsic muscle stiffnesses were significantly greater in the spastic/paretic ankle than on the non-paretic side, and these changes were strongly position dependent. The major reflex contributions were observed over the central portion of the angular range, while the intrinsic contributions were most pronounced with the ankle in the dorsiflexed position. Conclusion In spastic ankle muscles, the abnormalities in intrinsic and reflex components of joint torque varied systematically with changing position over the full angular range of motion, indicating that clinical perceptions of increased tone may have quite different origins depending upon the angle where the tests are initiated. Furthermore, reflex stiffness was considerably larger in the non-paretic limb of stroke patients than in healthy control subjects

  17. Effects of counteracting external valgus moment on lateral tibial cartilage contact conditions and tibial rotation.

    Science.gov (United States)

    Shriram, Duraisamy; Parween, Rizuwana; Lee, Yee Han Dave; Subburaj, Karupppasamy

    2017-07-01

    Knee osteoarthritis that prevalently occurs at the medial compartment is a progressive chronic disorder affecting the articular cartilage of the knee joint, and lead to loss of joint functionality. Valgus braces have been used as a treatment procedure to unload the medial compartment for patients with medial osteoarthritis. Valgus braces through the application of counteracting external valgus moment shift the load from medial compartment towards the lateral compartment. Previous biomechanical studies focused only on the changes in varus moments before and after wearing the brace. The objective of this study was to investigate the influence of opposing external valgus moment applied by knee braces on the lateral tibial cartilage contact conditions using a 3D finite element model of the knee joint. Finite element simulations were performed on the knee joint model without and with the application of opposing valgus moment to mimic the unbraced and braced conditions. Lateral tibial cartilage contact pressures and contact area, and tibial rotation (varus-valgus and internal-external) were estimated for the complete walking gait cycle. The opposing valgus moment increased the maximum contact pressure and contact area on the lateral tibial cartilage compared to the normal gait moment. A peak contact pressure of 8.2 MPa and maximum cartilage loaded area of 28% (loaded cartilage nodes) on the lateral cartilage with the application of external valgus moment were induced at 50% of the gait cycle. The results show that the use of opposing valgus moment may significantly increase the maximum contact pressures and contact area on the lateral tibial cartilage and increases the risk of articular cartilage damage on the lateral compartment.

  18. Biomechanical analysis of clavicle hook plate implantation with different hook angles in the acromioclavicular joint.

    Science.gov (United States)

    Hung, Li-Kun; Su, Kuo-Chih; Lu, Wen-Hsien; Lee, Cheng-Hung

    2017-08-01

    A clavicle hook plate is a simple and effective method for treating acromioclavicular dislocation and distal clavicle fractures. However, subacromial osteolysis and peri-implant fractures are complicated for surgeons to manage. This study uses finite element analysis (FEA) to investigate the post-implantation biomechanics of clavicle hook plates with different hook angles. This FEA study constructed a model with a clavicle, acromion, clavicle hook plate, and screws to simulate the implantation of clavicle hook plates at different hook angles (90°, 95°, 100°, 105°, and 110°) for treating acromioclavicular joint dislocations. This study investigated the biomechanics of the acromion, clavicle, hook plate, and screws. A smaller hook angle increases the stress on the middle third of the clavicle. A larger hook angle increases the force exerted by the clavicle hook plate on the acromion. The screw at the most medial position on the plate generated the highest stress. The highest stress on the implanted clavicle hook plate was on the turning corner of the hook. A clavicle hook plate with different hook angles may induce different biomechanical behaviors in the clavicle and acromion. Orthopedic surgeons must select a suitable clavicle hook plate based on the anatomical structure of each patient.

  19. Multisegmental Foot and Ankle Motion Analysis After Hallux Valgus Surgery

    Science.gov (United States)

    Canseco, Karl; Long, Jason; Smedberg, Thomas; Tarima, Sergey; Marks, Richard M.; Harris, Gerald F.

    2015-01-01

    Background Gait changes in patients with hallux valgus, including altered kinematic and temporal-spatial parameters, have been documented in the literature. Although operative treatment can yield favorable clinical and radiographic results, restoration of normal gait in this population remains unclear. Segmental kinematic changes within the foot and ankle during ambulation after operative correction of hallux valgus have not been reported. The aim of this study was to analyze changes in multisegmental foot and ankle kinematics in patients who underwent operative correction of hallux valgus. Methods A 15-camera Vicon Motion Analysis System was used to evaluate 24 feet in 19 patients with hallux valgus preoperatively and postoperatively. The Milwaukee Foot Model was used to characterize segmental kinematics and temporal-spatial parameters (TSPs). Preoperative and postoperative kinematics and TSPs were compared using paired nonparametric methods; comparisons with normative data were performed using unpaired nonparametric methods. Outcomes were evaluated using the SF-36 assessment tool. Results Preoperatively, patients with hallux valgus showed significantly altered temporal-spatial and kinematic parameters. Postoperatively, kinematic analysis demonstrated restoration of hallux position to normal. Hallux valgus angles and intermetatarsal angles were significantly improved, and outcomes showed a significant increase in performance of physical activities. Temporal-spatial parameters and kinematics in the more proximal segments were not significantly changed postoperatively. Conclusion Postoperative results demonstrated significant improvement in foot geometry and hallux kinematics in the coronal and transverse planes. However, the analysis did not identify restoration of proximal kinematics. Clinical Relevance Further investigation is necessary to explore possible causes/clinical relevance and appropriate treatment interventions for the persistently altered kinematics

  20. PREVALENCE OF HALLUX ABDUCTO VALGUS AMONG VARIOUS GROUPS IN ANAMBRA STATE OF NIGERIA; Predominio de hallux abducto valgus entre varios grupos en el estado de anambra de Nigeria

    Directory of Open Access Journals (Sweden)

    Chijioke Mmadueke Okeke

    2017-08-01

    Full Text Available Hallux Abducto Valgus is characterized by lateral deviation of the proximal phalanx of the hallux, medial deviation of the first metatarsal bone, and subluxation of the first metartasophalangeal joint. The objective of this study was to determine the prevalence of hallux abducto valgus among residents of Anambra State of Nigeria. The study was a cross sectional descriptive study, using a structured questionnaire. It was conducted among male and female subjects in the following occupational groups: Farmers, Traders, Medical student, Nursing student, Road Safety Corps, Police and the Military. A total of 1033 subjects within the age range of 15 to 74 years were studied. Hallux abducto valgus was identified by inspection of the foot. Prevalence of hallux abducto valgus in the study population was 12.9%. Hallux abducto valgus was more prevalent in males (14.3% than in females (11.2%. Bilateral affectation of hallux abducto valgus (5.5% was more prevalent than unilateral affectation (Right – 2.6%, left – 4.7%. Prevalence of hallux abducto valgus increased with increment in age. The prevalence of hallux abducto valgus among various occupational groups include: Police (18.0%, Road Safety Corps (16.7%, Nursing students (10%, Military (20%, Medical students (9.9%, Traders (8.3% and farmers (17.0%. The prevalence of hallux abducto valgus in our study was 12.9%. The prevalence increased with increasing age and hallux abducto valgus was more prevalent in males than in females. Hallux Abducto Valgus es caracterizado por la desviación lateral del falange próximo del hallux, la desviación intermedia del primer hueso metatarsal, y el subluxation del primer empalme metartasophalangeal. El objetivo de este estudio era determinar el predominio del valgus del abducto del hallux entre residentes del estado de Anambra de Nigeria. El estudio era un estudio descriptivo representativo, usando un cuestionario estructurado. Fue conducido entre los temas masculinos

  1. Saare Jazz toob valguse augustipimedusse

    Index Scriptorium Estoniae

    2009-01-01

    22. augustil Saaremaal Pidula Forelli puhkekülas toimuvast esimesest Saare Jazzist alapealkirjaga "Valgus pimeduses", peaesinejaks laulja Sofia Rubina koos ansambliga Club Eclectic, soojendusesinejaks laulja Teele Viira ja erikülaliseks Soome trompetist Kalevi Louhivuori, esinejatest

  2. The study of surface electromyography used for the assessment of abductor hallucis muscle activity in patients with hallux valgus.

    Science.gov (United States)

    Mortka, Kamila; Lisiński, Przemysław; Wiertel-Krawczuk, Agnieszka

    2018-01-26

    Hallux valgus is a common foot disorder. In patients with hallux valgus, the anatomy and biomechanics of foot is subject to alterations. The aim of this clinical and neurophysiological study is to compare the activity of abductor hallucis (AbdH) muscle between the group of patients with hallux valgus and control group of healthy people, with the use of surface electromyography. The study involved 44 feet with diagnosed hallux valgus (research group) and 42 feet without deformation (control group). The X-ray images, measurements of range of motion in the first metatarsophalangeal joint and in hallux interphalangeal joint, and the surface electromyography study recorded from AbdH muscle were performed. Considering the amplitude of motor unit action potential, study participants with hallux valgus demonstrate significantly less activity of AbdH muscle than people without hallux valgus deformity. This activity is not dependent on the severity of valgus, age, or range of motion. It is speculated that the changes of the AbdH function may occur in the period before clinical appearance of hallux valgus deformity, or at the onset of distortion development. Further studies are needed for a comprehensive assessment of AbdH muscle in patients with hallux valgus.

  3. WITHDRAWN: Interventions for treating hallux valgus (abductovalgus) and bunions.

    Science.gov (United States)

    Ferrari, Jill; Higgins, Julian Pt; Prior, Trevor D

    2009-04-15

    . In general, there was no advantage or disadvantage using Keller's over the other techniques. When the distal osteotomy was compared to Keller's arthroplasty, the osteotomy showed evidence of improving the intermetatarsal angle and preserving joint range of motion. The arthroplasty was found to have less of an impact on walking ability compared to the arthrodesis.Six trials involving 309 participants compared chevron (and chevron-type) osteotomy with other techniques. The chevron osteotomy offered no advantages in these trials. For some outcomes, other techniques gave better results. Two of these trials (94 participants) compared a type of proximal osteotomy to a proximal chevron osteotomy and found no evidence of a difference in outcomes between techniques.Three trials involving 157 participants compared outcomes between original operations and surgeon's adaptations. There was no advantage found for any of the adaptations.Three trials involving 71 people with hallux valgus compared new methods of fixation to traditional methods. There was no evidence that the new methods of fixation were detrimental to the outcome of the patients.Four trials involving 162 participants evaluated methods of post-operative rehabilitation. The use of continuous passive motion appeared to give an improved range of motion and earlier recovery following surgery. Early weightbearing or the use of a crepe bandage were not found to be detrimental to final outcome. Only a few studies had considered conservative treatments. The evidence from these suggested that orthoses and night splints did not appear to be any more beneficial in improving outcomes than no treatment. Surgery (chevron osteotomy) was shown to be beneficial compared to orthoses or no treatment, but when compared to other osteotomies, no technique was shown to be superior to any other. Only one trial had compared an osteotomy to an arthroplasty. There was limited evidence to suggest that the osteotomy gave the better outcomes. It

  4. Correction of moderate to severe hallux valgus with combined proximal opening wedge and distal chevron osteotomies: a reliable technique.

    Science.gov (United States)

    Jeyaseelan, L; Chandrashekar, S; Mulligan, A; Bosman, H A; Watson, A J S

    2016-09-01

    The mainstay of surgical correction of hallux valgus is first metatarsal osteotomy, either proximally or distally. We present a technique of combining a distal chevron osteotomy with a proximal opening wedge osteotomy, for the correction of moderate to severe hallux valgus. We reviewed 45 patients (49 feet) who had undergone double osteotomy. Outcome was assessed using the American Orthopaedic Foot and Ankle Society (AOFAS) and the Short Form (SF) -36 Health Survey scores. Radiological measurements were undertaken to assess the correction. The mean age of the patients was 60.8 years (44.2 to 75.3). The mean follow-up was 35.4 months (24 to 51). The mean AOFAS score improved from 54.7 to 92.3 (p hallux valgus and intermetatarsal angles were improved from 41.6(o) to 12.8(o) (p < 0.001) and from 22.1(o) to 7.1(o), respectively (p < 0.001). The mean distal metatarsal articular angle improved from 23(o) to 9.7(o). The mean sesamoid position, as described by Hardy and Clapham, improved from 6.8 to 3.5. The mean length of the first metatarsal was unchanged. The overall rate of complications was 4.1% (two patients). These results suggest that a double osteotomy of the first metatarsal is a reliable, safe technique which, when compared with other metatarsal osteotomies, provides strong angular correction and excellent outcomes with a low rate of complications. Cite this article: Bone Joint J 2016;98-B:1202-7. ©2016 The British Editorial Society of Bone & Joint Surgery.

  5. Detecting elementary arm movements by tracking upper limb joint angles with MARG sensors

    OpenAIRE

    Mazomenos, Evangelos B.; Biswas, Dwaipayan; Cranny, Andy; Rajan, Amal; Maharatna, Koushik; Achner, Josy; Klemke, Jasmin; Jobges, Michael; Ortmann, Steffen; Langendorfer, Peter

    2015-01-01

    This paper reports an algorithm for the detection of three elementary upper limb movements, i.e., reach and retrieve, bend the arm at the elbow and rotation of the arm about the long axis. We employ two MARG sensors, attached at the elbow and wrist, from which the kinematic properties (joint angles, position) of the upper arm and forearm are calculated through data fusion using a quaternion-based gradient-descent method and a two-link model of the upper limb. By studying the kinematic pattern...

  6. Sex-related differences in outcomes after hallux valgus surgery.

    Science.gov (United States)

    Choi, Gi Won; Kim, Hak Jun; Kim, Tae Wan; Lee, Ji Wun; Park, Sung Bum; Kim, Jin Kak

    2015-03-01

    With differences between the sexes in foot bone anatomy and ligamentous laxity, there is the possibility that the results of hallux valgus surgery may also differ between the sexes. We aimed to compare the results of hallux valgus surgery between the sexes. The authors retrospectively reviewed 60 males (66 feet) and 70 females (82 feet) who underwent distal or proximal chevron osteotomy for the treatment of hallux valgus deformity between June 2005 and December 2011. We compared the clinical and radiologic outcomes between the sexes. There were no statistically significant differences in demographics between the sexes. The mean American Orthopedic Foot and Ankle Society score, visual analogue scale for pain, and patient satisfaction at the last follow-up did not differ significantly between the sexes. The mean preoperative hallux valgus angle (HVA) and inter-metatarsal angle (IMA) were not significantly different between the sexes. At the last follow-up, the mean HVA was significantly greater in females (p=0.003) than in males; mean IMA was not significantly different between the sexes. The mean correction of HVA in males was significantly greater than that in females (p=0.014). There were no significant differences between the sexes regarding clinical outcomes after distal and proximal chevron osteotomy. However, male patients achieved greater correction of HVA than female patients. There is a possibility that sexual dimorphism of the foot may affect postoperative HVA.

  7. Joint Moment-Angle Properties of the Hip Extensors in Subjects With and Without Patellofemoral Pain.

    Science.gov (United States)

    Kindel, Curtis; Challis, John

    2018-04-01

    Strength deficits of hip extension in individuals with patellofemoral syndrome are commonly reported in literature. No literature to date has examined these deficits with variable positions of the knee and hip; altering knee angle alters the length and therefore potentially the force produced by the biarticular muscles. Beyond strength, neuromuscular control can also be assessed through the analysis of isometric joint moment steadiness. Subjects consisted of a group of individuals with patellofemoral syndrome (n = 9), and a group of age- and size-matched controls with no symptoms (n = 9). Maximum isometric joint moments for hip extension were measured at 4 points within the joint's range of motion, at 2 different knee positions (0° and 90°) for each group. The joint moment signals were analyzed by computing signal Coefficient of Variation (CV). The results indicate that no significant differences were found between the groups of subjects for the hip extension moments when the knee was extended. However, there was a significant difference between the groups for the joint moments of hip extension with the knee flexed at all 4 hip positions. Results also showed hip extension CV values to be significantly higher in the patellofemoral group compared with the control group, indicating greater signal noise and therefore poorer neuromuscular control of the hip extensor musculature. This study demonstrated that individuals with patellofemoral syndrome have reduced hip extension strength and reduced neuromuscular control with the knee flexed compared with a control group. These results have implications for the etiology of patellofemoral syndrome and its rehabilitation.

  8. Shortening Scarf osteotomy for correction of severe hallux valgus. Does shortening affect the outcome?

    Science.gov (United States)

    Karpe, Prasad; Killen, Marie C; Pollock, Raymond D; Limaye, Rajiv

    2016-12-01

    Translation and shortening of Scarf osteotomy allows correction of severe hallux valgus deformity. Shortening may result in transfer metatarsalgia. To evaluate outcome of patients undergoing shortening Scarf osteotomy for severe hallux valgus deformities. Fifteen patients (20feet, mean age 58 years) underwent shortening Scarf osteotomy for severe hallux valgus deformities. Outcomes were pre and postoperative AOFAS scores, IM and HV angles, patient satisfaction. Mean follow-up was 25 months (range 22-30). The IM angle improved from a median of 18.60 (range 13.4-26.20) preoperatively to 9.70 (range 8.0-13.70) postoperatively (8.9; 95% CI=7.6-10.3; phallux valgus deformities with no transfer metatarsalgia. Copyright © 2016 Elsevier Ltd. All rights reserved.

  9. [Clinical effect of total knee arthroplasty on patients with knee osteoarthritis combined with mild to moderate valgus knee deformity].

    Science.gov (United States)

    Chen, Peng; Zeng, Min; Xie, Jie; Wang, Long; Su, Weiping; Hu, Yihe

    2016-09-28

    To investigate the clinical effect of total knee arthroplasty on patients with knee osteoarthritis combined with mild to moderate valgus knee deformity.
 A total of 15 patients received total knee arthroplasty for correcting mild (10°-15°) to moderate (15°-30°) valgus knee between January 2011 and February 2014 in Xiangya Hospital of Central South University. We adopted a stable prosthesis surgery through patellar medial approach, osteophytes cleaning, conventional osteotomy, a selective soft tissue release and balance technical correcting of knee valgus deformity. Then conventional anticoagulation and symptomatic rehabilitation was utilized. Preoperative and postoperative X-ray was conducted in patients with measuring femor-tibial angle (FTA) and inspecting the prosthesis position. FTA, visual analog scale (VAS) standard, and parallel knee scoring system (KSS) were used to evaluate the clinical effect.
 Fifteen patients were followed up for 14 to 36 (22.40±11.88) months. The hospitalization time was 7-13 (7.73±1.58) d; operative time was 58-110 (81.8±16.85) min, the dominant blood loss was 140-600 (337.30±143.65) mL. Two cases had knee extension hysteresis, and the knee activity recovered after exercise. Leg power lines were normal. Three postoperative cases suffered anterior knee pain. They were subjected to celecoxib analgesic treatment and the pain gradually eased after 3 months. One postoperative case showed incision discharge and swelling, which was healed after change of dressing. During follow-up, review of X-ray film does not show prosthesis loose, subsidence and other complications. The knee valgus angle (8.1±1.8)°, knee motion range (107.33±9.61)°, KSS knee score (74.7±14.5, 75.3±2.7) and pain score (2.5±0.9) were significantly better than the preoperative (Pclinical and function KSS scores showed that the improvement rate was 80%. 
 Total knee arthroplasty is an effective way to treat patients with knee osteoarthritis combined with

  10. Interventions for treating hallux valgus (abductovalgus) and bunions.

    Science.gov (United States)

    Ferrari, J; Higgins, J P T; Prior, T D

    2004-01-01

    general, there was no advantage or disadvantage using Keller's over the other techniques. When the distal osteotomy was compared to Keller's arthroplasty, the osteotomy showed evidence of improving the intermetatarsal angle and preserving joint range of motion. The arthroplasty was found to have less of an impact on walking ability compared to the arthrodesis. Six trials involving 309 participants compared chevron (and chevron-type) osteotomy with other techniques. The chevron osteotomy offered no advantages in these trials. For some outcomes, other techniques gave better results. Two of these trials (94 participants) compared a type of proximal osteotomy to a proximal chevron osteotomy and found no evidence of a difference in outcomes between techniques. Three trials involving 157 participants compared outcomes between original operations and surgeon's adaptations. There was no advantage found for any of the adaptations. Three trials involving 71 people with hallux valgus compared new methods of fixation to traditional methods. There was no evidence that the new methods of fixation were detrimental to the outcome of the patients. Four trials involving 162 participants evaluated methods of post-operative rehabilitation. The use of continuous passive motion appeared to give an improved range of motion and earlier recovery following surgery. Early weightbearing or the use of a crepe bandage were not found to be detrimental to final outcome. Only a few studies had considered conservative treatments. The evidence from these suggested that orthoses and night splints did not appear to be any more beneficial in improving outcomes than no treatment. Surgery (chevron osteotomy) was shown to be beneficial compared to orthoses or no treatment, but when compared to other osteotomies, no technique was shown to be superior to any other. Only one trial had compared an osteotomy to an arthroplasty. There was limited evidence to suggest that the osteotomy gat the osteotomy gave the better

  11. EFFECT OF ISOMETRIC QUADRICEPS STRENGTHENING EXERCISE AT MULTIPLE ANGLES IN KNEE JOINT AMONG NORMAL ADULTS

    Directory of Open Access Journals (Sweden)

    JibiPaul

    2014-04-01

    Full Text Available Introduction: Strengthening exercises have been routinely used in persons with orthopaedic problems and athletes to increase force production or minimize muscle imbalance and joint injuries.Many studies have reported that isometric contractions can rapidly increases strength in quadriceps muscle. Objective: Objective of the study was to find out the effect of isometric strengthening exercise on strength of quadriceps at 45 and 90 degree of knee joint and also to compare the effect of strengthening exercise on strength of quadriceps at multiple angles of knee joint among control and experimental group. Methodology: This was a ccomparative experimental study with forty female healthy subjects from physiotherapy department of KPJ Healthcare University College, Malaysia. Convenient sampling method used to select the samples. The subjects were selected by inclusion criteria and randomly divided equally in to two with 20 subjects in each group. Isometric strengthening exercise and squatting exercise were given as intervention program for eight weeks respectively for experimental and control group. Pre and post data of quadriceps muscle strength measured were collected separately at 45 and 90 degree of knee joint using goniometry during resisted extension of knee in multi gym. Result: In experimental group Pre –Post statistical analysis found significant effect in increase of quadriceps strength at 45 and 90 degree with P<0.0001.****In control group quadriceps pre-post statistical analysis found no significant effect in increase of quadriceps strength at 45 and 90 degree with P<0.083NS and P<0.055 NS respectively. Comparative study between experimental and control groups for quadriceps strength at 90 degree of knee joint found significant effect in increase of quadriceps strength with P< 0.001.*** Comparative study between experimental and control groups for quadriceps strength at 45 degree of knee joint found significant effect in increase of

  12. Multifractal fluctuations in joint angles during infant spontaneous kicking reveal multiplicativity-driven coordination

    International Nuclear Information System (INIS)

    Stephen, Damian G.; Hsu, Wen-Hao; Young, Diana; Saltzman, Elliot L.; Holt, Kenneth G.; Newman, Dava J.; Weinberg, Marc; Wood, Robert J.; Nagpal, Radhika; Goldfield, Eugene C.

    2012-01-01

    Previous research has considered infant spontaneous kicking as a form of exploration. According to this view, spontaneous kicking provides information about motor degrees of freedom and may shape multijoint coordinations for more complex movement patterns such as gait. Recent work has demonstrated that multifractal, multiplicative fluctuations in exploratory movements index energy flows underlying perceptual-motor information. If infant spontaneous kicking is exploratory and occasions an upstream flow of information from the motor periphery, we expected not only that multiplicativity of fluctuations at the hip should promote multiplicativity of fluctuations at more distal joints (i.e., reflecting downstream effects of neural control) but also that multiplicativity at more distal joints should promote multiplicativity at the hip. Multifractal analysis demonstrated that infant spontaneous kicking in four typically developing infants for evidence of multiplicative fluctuations in multiple joint angles along the leg (i.e., hip, knee, and ankle) exhibited multiplicativity. Vector autoregressive modeling demonstrated that only one leg exhibited downstream effects but that both legs exhibited upstream effects. These results confirm the exploratory aspect of infant spontaneous kicking and suggest chaotic dynamics in motor coordination. They also resonate with existing models of chaos-controlled robotics and noise-based interventions for rehabilitating motor coordination in atypically developing patients.

  13. Mobility of the First Ray in Patients With or Without Hallux Valgus Deformity: Systematic Review and Meta-Analysis.

    Science.gov (United States)

    Shibuya, Naohiro; Roukis, Thomas S; Jupiter, Daniel C

    The hypermobility theory of the first ray is the reason for the popularization of procedures such as the modified Lapidus procedure involving arthrodesis of the first tarsal-metatarsal joint for correction of hallux valgus deformity. Although many studies have involved motion of the first ray in hallux valgus patients, the presence and clinical significance of hypermobility in the first ray remains controversial. We performed a systematic review and meta-analysis to evaluate the difference in the first ray range of motion between patients with or without hallux valgus deformity. The databases used for the present review included Ovid EMBASE, Ovid MEDLINE, CINAHL, and the Cochrane Database. We searched for comparative studies that had evaluated the motion of the first ray in patients with or without hallux valgus. After screening for inclusion and exclusion criteria, we identified 3 studies that were relevant to our study question. All 3 studies showed more first ray motion in the hallux valgus group. Our quantitative synthesis showed a mean difference in the range of motion of the first ray of 3.62 mm (95% confidence interval 2.26 to 4.98) between those with and without hallux valgus deformity. Thus, we found statistically significantly increased first ray motion in patients with hallux valgus deformity compared with those without hallux valgus deformity. However, the clinical significance of this small amount of increased sagittal plane motion as a response to or a cause of hallux valgus remains unanswered. Published by Elsevier Inc.

  14. Staple fixation for akin proximal phalangeal osteotomy in the treatment of hallux valgus interphalangeus.

    Science.gov (United States)

    Neumann, Julie A; Reay, Kathleen D; Bradley, Kendall E; Parekh, Selene G

    2015-04-01

    The Akin proximal phalangeal osteotomy is commonly used in conjunction with metatarsal osteotomies to treat hallux valgus. Multiple fixation methods including suture, wire, screw, and staple fixation have been described. The aims of this study were to assess the intraoperative and postoperative complications and to evaluate short-term postoperative outcomes in patients who underwent Akin osteotomy with staple fixation. Forty-four patients (51 feet) with painful hallux valgus were retrospectively reviewed at an average of 40.4 ± 15.8 (range, 25.9 to 79.9) weeks following an Akin osteotomy with staple fixation. Patient reported preoperative and postoperative Visual Analog Score (VAS) (0 to 10, 0 = no pain) was recorded. Level of activity was reported postoperatively. Hallux valgus angles (HVAs), intermetatarsal angles (IMAs), and hallux valgus interphalangeus angles (IPAs) were evaluated on preoperative as well as final postoperative radiographs. Postoperative clinical and radiographic examinations were used to evaluate for complications. Mean VAS improved from 4.4 ± 2.6 to 1.0 ± 1.2 (P hallux valgus correction with improvement in pain and hallux valgus deformity with a low risk for complications. Level IV, case series. © The Author(s) 2014.

  15. Increased knee valgus alignment and moment during single-leg landing after overhead stroke as a potential risk factor of anterior cruciate ligament injury in badminton.

    Science.gov (United States)

    Kimura, Yuka; Ishibashi, Yasuyuki; Tsuda, Eiichi; Yamamoto, Yuji; Hayashi, Yoshimitsu; Sato, Shuichi

    2012-03-01

    In badminton, knees opposite to the racket-hand side received anterior cruciate ligament (ACL) injuries during single-leg landing after overhead stroke. Most of them occurred in the backhand-side of the rear court. Comparing lower limb biomechanics during single-leg landing after overhead stroke between the forehand-side and backhand-side court may help explain the different injury rates depending on court position. The knee kinematics and kinetics during single-leg landing after overhead stroke following back-stepping were different between the forehand-side and backhand-side court. Controlled laboratory study. Hip, knee and ankle joint kinematic and knee kinetic data were collected for 17 right-handed female college badminton players using a 3-dimensional motion analysis system. Subjects performed single-left-legged landing after an overhead stroke following left and right back-stepping. The kinematic and kinetic data of the left lower extremities during landing were measured and compared between left and right back-steps. Hip flexion and abduction and knee valgus at the initial contact, hip and knee flexion and knee valgus at the maximum knee flexion and the maximum knee valgus moment were significantly larger for the left back-step than the right back-step (p<0.05). Significant differences in joint kinematics and kinetics of the lower extremity during single-leg landing after overhead stroke were observed between different back-step directions. Increased knee valgus angle and moment following back-stepping to the backhand-side might be related to the higher incidence of ACL injury during single-leg landing after overhead stroke.

  16. A Comprehensive Evaluation of Joint Range and Angle Estimation in Indoor Ultrawideband Location Systems

    Directory of Open Access Journals (Sweden)

    Gentile Camillo

    2008-01-01

    Full Text Available Abstract Fine time resolution enables ultrawideband (UWB ranging systems to extract the first multipath arrival corresponding to the range between a transmitter and receiver, even when attenuated in strength compared to later arrivals. Bearing systems alone lack any notion of time and in general select the strongest arrival which is rarely the first one in nonline-of-sight conditions. Complementing UWB ranging systems with bearing capabilities allows indexing the arrivals as a function of both time and angle in order to isolate the first, providing precision range and angle. However, that precision degrades with the increasing presence of walls and other objects which distort the properties of the first arrival. In order to gauge the physical limits of the joint UWB system, we design and assemble a spatial-temporal channel sounder using a vector network analyzer coupled to a virtual antenna array, and conduct 200 experiments to measure the time- and angle-of-flight. The experiments are carried out in both line-of-sight and nonline-of-sight conditions up to an unprecedented 45 meters throughout four separate buildings with dominant wall material varying from sheet rock to steel. In addition, we report performance for varying bandwidth and center frequency of the system. We find that operating at a bandwidth of 4 GHz suffices in resolving multipath in most buildings and in excess shows virtually no improvement. While the range error decreases at lower center frequencies, the higher frequencies offer better angular resolution and so smaller angle error.

  17. A comparison of proximal and distal Chevron osteotomy, both with lateral soft-tissue release, for moderate to severe hallux valgus in patients undergoing simultaneous bilateral correction: a prospective randomised controlled trial.

    Science.gov (United States)

    Lee, K B; Cho, N Y; Park, H W; Seon, J K; Lee, S H

    2015-02-01

    Moderate to severe hallux valgus is conventionally treated by proximal metatarsal osteotomy. Several recent studies have shown that the indications for distal metatarsal osteotomy with a distal soft-tissue procedure could be extended to include moderate to severe hallux valgus. The purpose of this prospective randomised controlled trial was to compare the outcome of proximal and distal Chevron osteotomy in patients undergoing simultaneous bilateral correction of moderate to severe hallux valgus. The original study cohort consisted of 50 female patients (100 feet). Of these, four (8 feet) were excluded for lack of adequate follow-up, leaving 46 female patients (92 feet) in the study. The mean age of the patients was 53.8 years (30.1 to 62.1) and the mean duration of follow-up 40.2 months (24.1 to 80.5). After randomisation, patients underwent a proximal Chevron osteotomy on one foot and a distal Chevron osteotomy on the other. At follow-up, the American Orthopedic Foot and Ankle Society (AOFAS) hallux metatarsophalangeal interphalangeal (MTP-IP) score, patient satisfaction, post-operative complications, hallux valgus angle, first-second intermetatarsal angle, and tibial sesamoid position were similar in each group. Both procedures gave similar good clinical and radiological outcomes. This study suggests that distal Chevron osteotomy with a distal soft-tissue procedure is as effective and reliable a means of correcting moderate to severe hallux valgus as proximal Chevron osteotomy with a distal soft-tissue procedure. ©2015 The British Editorial Society of Bone & Joint Surgery.

  18. Elbow arthroscopy: valgus extension overload.

    Science.gov (United States)

    Ahmad, Christopher S; Conway, John E

    2011-01-01

    Valgus torque combined with deceleration produces high compression and shear forces acting on the posteromedial olecranon and the posteromedial trochlea. This valgus extension overload process may cause posteromedial trochlea chondromalacia, chondral flap formation, osteochondrosis, subchondral erosion, a subchondral insufficiency fracture, and marginal exostosis formation. Olecranon pathologies include proximal stress reaction, a posteromedial tip stress fracture, a transverse proximal process stress fracture, exostosis formation, exostosis fragmentation, and intra-articular loose bodies. Symptoms include posteromedial elbow pain during the deceleration phase of the throwing motion. The extension impingement test reproduces posterior or posteromedial pain similar to that experienced while throwing. Special radiographic techniques and CT scans can show loose bodies and osteophyte fragmentation. Surgical treatment is indicated when symptoms persist despite nonsurgical management. Based on clinical and basic science research, all patients with valgus extension overload should be comprehensively evaluated for medial ulnar collateral ligament insufficiency. Surgical treatment is limited to the resection of osteophytes only; normal olecranon should not be resected.

  19. [Correlation of medial compartmental joint line elevation with femorotibial angle correction and clinical function after unicompartmental arthroplasty].

    Science.gov (United States)

    Zhang, Zhan-Feng; Wang, Dan; Min, Ji-Kang

    2017-04-25

    To study the correlation of postoperative femorotibial angle with medial compartmental joint line elevation after unicompartmental arthroplasty(UKA), as well as the correlation of joint line elevation with the clinical function by measuring radiological joint line. A retrospective study of 56 patients from July 2012 to August 2015 was performed. The mean body mass index (BMI) was 23.5 (ranged, 18.3 to 30.1). The standing anteroposterior radiographs of these patients were assessed both pre-and post-operatively, and the knee function was evaluated according to HSS grading. The correlation between postoperative femorotibial angle(FTA) and joint line elevation was analyzed as well as the correlation between joint line elevation and the clinical function. The mean medial joint line elevation was (2.2±2.0) mm(ranged, -3.3 to 7.0 mm), and the mean FTA correction was (2.3±3.0)°(ranged, -4.5° to 9.6°). The mean follow-up period was 12.2 months. There was a significant correlation between in joint line elevation and FTA correction( P clinical function( P >0.05). There was a significant correlation between medial compartmental joint line elevation and FTA correction after UKA, and the proximal tibial osteotomy was critical during the procedure. There was no significant correlation between joint line elevation and the clinical function, which may be related to the design of UKA prosthesis.

  20. First metatarsophalangeal arthroscopy in patients with post-traumatic hallux valgus.

    Science.gov (United States)

    Lui, T H

    2015-12-01

    Post-traumatic hallux valgus is relatively rare and has been reported after rupture of the medial collateral ligament of the first metatarsophalangeal (MTP-1) joint; Lisfranc joint injury; turf toe injury; medial plantar nerve entrapment secondary to tibial fracture or first metatarsal fracture. Post-traumatic hallux valgus after medial collateral ligament injury has a high incidence of MTP-1 pathology. Detailed history and clinical examination can facilitate differentiation of the source(s) of the patient's symptoms and assist accurate formulation of the surgical plan. First, MTP arthroscopy is a feasible diagnostic and therapeutic tool to manage the MTP-1 joint pain in hallux valgus following injury to the MTP-1 joint. Copyright © 2015 Elsevier Ltd. All rights reserved.

  1. Design and characterization of a wearable macrobending fiber optic sensor for human joint angle determination

    Science.gov (United States)

    Silva, Ana S.; Catarino, André; Correia, Miguel V.; Frazão, Orlando

    2013-12-01

    The work presented here describes the development and characterization of intensity fiber optic sensor integrated in a specifically designed piece of garment to measure elbow flexion. The sensing head is based on macrobending incorporated in the garment, and the increase of curvature number was studied in order to investigate which scheme provided a good result in terms of sensitivity and repeatability. Results showed the configuration that assured a higher sensitivity (0.644 dBm/deg) and better repeatability was the one with four loops. Ultimately, this sensor can be used for rehabilitation purposes to monitor human joint angles, namely, elbow flexion on stroke survivors while performing the reach functional task, which is the most common upper-limb human gesture.

  2. Open wedge metatarsal osteotomy versus crescentic osteotomy to correct severe hallux valgus deformity

    DEFF Research Database (Denmark)

    Wester, Jens Ulrik; Hamborg-Petersen, Ellen; Herold, Niels

    2016-01-01

    BACKGROUND: Different techniques of proximal osteotomies have been introduced to correct severe hallux valgus. The open wedge osteotomy is a newly introduced method for proximal osteotomy. The aim of this prospective randomized study was to compare the radiological and clinical results after...... operation for severe hallux valgus, comparing the open wedge osteotomy to the crescentic osteotomy which is our traditional treatment. METHODS: Forty-five patients with severe hallux valgus (hallux valgus angle >35̊, and intermetatarsal angle >15̊) were included in this study. The treatment was proximal...... and 12 months after the operation. RESULTS: In group 1 the hallux valgus angle decreased from 39.0̊ to 24.1̊ after 4 months and 27.9̊ after 12 months. In group 2 the angle decreased from 38.3̊ to 21.4̊ after 4 months and 27.0̊ after 12 months. The intermetatarsal angle in group 1 was 19.0̊ preoperatively...

  3. Limited-angle multi-energy CT using joint clustering prior and sparsity regularization

    Science.gov (United States)

    Zhang, Huayu; Xing, Yuxiang

    2016-03-01

    In this article, we present an easy-to-implement Multi-energy CT scanning strategy and a corresponding reconstruction method, which facilitate spectral CT imaging by improving the data efficiency the number-of-energy- channel fold without introducing visible limited-angle artifacts caused by reducing projection views. Leveraging the structure coherence at different energies, we first pre-reconstruct a prior structure information image using projection data from all energy channels. Then, we perform a k-means clustering on the prior image to generate a sparse dictionary representation for the image, which severs as a structure information constraint. We com- bine this constraint with conventional compressed sensing method and proposed a new model which we referred as Joint Clustering Prior and Sparsity Regularization (CPSR). CPSR is a convex problem and we solve it by Alternating Direction Method of Multipliers (ADMM). We verify our CPSR reconstruction method with a numerical simulation experiment. A dental phantom with complicate structures of teeth and soft tissues is used. X-ray beams from three spectra of different peak energies (120kVp, 90kVp, 60kVp) irradiate the phantom to form tri-energy projections. Projection data covering only 75◦ from each energy spectrum are collected for reconstruction. Independent reconstruction for each energy will cause severe limited-angle artifacts even with the help of compressed sensing approaches. Our CPSR provides us with images free of the limited-angle artifact. All edge details are well preserved in our experimental study.

  4. Influence of Joint Angle on EMG-Torque Model During Constant-Posture, Torque-Varying Contractions.

    Science.gov (United States)

    Liu, Pu; Liu, Lukai; Clancy, Edward A

    2015-11-01

    Relating the electromyogram (EMG) to joint torque is useful in various application areas, including prosthesis control, ergonomics and clinical biomechanics. Limited study has related EMG to torque across varied joint angles, particularly when subjects performed force-varying contractions or when optimized modeling methods were utilized. We related the biceps-triceps surface EMG of 22 subjects to elbow torque at six joint angles (spanning 60° to 135°) during constant-posture, torque-varying contractions. Three nonlinear EMG σ -torque models, advanced EMG amplitude (EMG σ ) estimation processors (i.e., whitened, multiple-channel) and the duration of data used to train models were investigated. When EMG-torque models were formed separately for each of the six distinct joint angles, a minimum "gold standard" error of 4.01±1.2% MVC(F90) resulted (i.e., error relative to maximum voluntary contraction at 90° flexion). This model structure, however, did not directly facilitate interpolation across angles. The best model which did so achieved a statistically equivalent error of 4.06±1.2% MVC(F90). Results demonstrated that advanced EMG σ processors lead to improved joint torque estimation as do longer model training durations.

  5. The "moving valgus stress test" for medial collateral ligament tears of the elbow.

    Science.gov (United States)

    O'Driscoll, Shawn W M; Lawton, Richard L; Smith, Adam M

    2005-02-01

    The diagnosis of a painful partial tear of the medial collateral ligament in overhead-throwing athletes is challenging, even for experienced elbow surgeons and despite the use of sophisticated imaging techniques. The "moving valgus stress test" is an accurate physical examination technique for diagnosis of medial collateral ligament attenuation in the elbow. Cohort study (diagnosis); Level of evidence, 2. Twenty-one patients underwent surgical intervention for medial elbow pain due to medial collateral ligament insufficiency or other abnormality of chronic valgus overload, and they were assessed preoperatively with an examination called the moving valgus stress test. To perform the moving valgus stress test, the examiner applies and maintains a constant moderate valgus torque to the fully flexed elbow and then quickly extends the elbow. The test is positive if the medial elbow pain is reproduced at the medial collateral ligament and is at maximum between 120 degrees and 70 degrees. The moving valgus stress test was highly sensitive (100%, 17 of 17 patients) and specific (75%, 3 of 4 patients) when compared to assessment of the medial collateral ligament by surgical exploration or arthroscopic valgus stress testing. The mean shear range (ie, the arc within which pain was produced with the moving valgus stress test) was 120 degrees to 70 degrees. The mean angle at which pain was at a maximum was 90 degrees of elbow flexion. The moving valgus stress test is an accurate physical examination technique that, when performed and interpreted correctly, is highly sensitive for medial elbow pain arising from the medial collateral ligament.

  6. The results of Grice Green subtalar arthrodesis of valgus foot in spina bifida

    Directory of Open Access Journals (Sweden)

    Fatih Küçükdurmaz

    2012-01-01

    Full Text Available Background: Valgus foot is a common foot deformity in spina bifida. The most popular operation for the valgus deformity has been the Grice talocalcaneal blocking. It has not been studied primarily in children with spina bifida. We report a prospective series, we present the results of hind foot valgus deformity of children with spina bifida, using Grice talocalcaneal arthrodesis with a tricortical iliac bone graft. Materials and Methods: Between May 2000 and December 2003, 21 patients with bilateral (42 feet valgus deformity of feet underwent surgery. There were 7 males and 14 females. The mean age of patients was 67.7 months (range 50-108 months. Results: The total number of feet that had nonunion was 11, in 7 of them the grafts were completely reabsorbed and the outcome of all these feet was unsatisfactory. Four feet had partial union of which three had unsatisfactory and one had satisfactory outcome. Sixteen feet had residual valgus deformity at the last followup visit, 10 patients had nonunion, and 6 had inadequate correction. Mean preoperative talocalcaneal and calcaneal pitch angles were 48.5΀ and 31.9΀, respectively, which decreased to 38.5΀ and 29.1΀, respectively, postoperatively. The decrease in talocalcaneal angle and calcaneal pitch was significant between preoperative and postoperative measurements (P<0.05. Conclusion: Grice subtalar arthrodesis technique is still a valuable option for valgus foot in patients with spina bifida. In this study, we found more encouraging results in older patients.

  7. A radiographic analysis of the contribution of hallux valgus interphalangeus to the total valgus deformity of the hallux.

    Science.gov (United States)

    Strydom, Andrew; Saragas, Nikiforos Pandelis; Ferrao, Paulo Norberto Faria

    2017-03-01

    The hallux valgus interphalangeus (HVI) deformity is described as rare, but improved outcomes in hallux valgus (HV) surgery is associated with its surgical correction via an Akin osteotomy. The hypothesis of this study is that HVI is common and makes a significant contribution to the total valgus deformity of the hallux (TVDH). 285 pre-operative foot radiographs (193 with HV, 92 non-HV), utilising standardised radiographic and measurement techniques, were analysed retrospectively. The hallux valgus angle (HVA), intermetatarsal angle (IMA), interphalangeal angle (IPA) and distal metatarsal articular angle (DMAA) were measured. The TVDH was calculated as the sum of the HVA and IPA. 163 (57.2%) of the study population were Caucasian, 119 (41.8%) African and 3 Indian (1.0%). 236 (82.8%) of the population was female. There was a statistically significant difference in the proportion of abnormal IPA in the Caucasian population 112 (68.7%) compared to the proportion of abnormal IPA in the African population 64 (53.8%), p=0.01. The average contribution of the IPA to the TVDH across the whole study population was a mean (SD) of 37.9% (21.2). The average contribution of IPA to TVDH was greater in feet without HV (58.0%) when compared to feet with HV (28.3%). HVI is common, particularly in Caucasians (p=0.01) and makes a significant contribution to the TVDH (p<0.01). The contribution to the TVDH is more significant in mild HV. There is an inverse relationship between the IPA and other angular measurements in the foot. HVI is a common entity. The significant contribution of the IPA to the TVDH dictates that HVI must be incorporated in management algorithms. The TVDH should replace the isolated concepts of HV and HVI. Level III, retrospective cohort. Copyright © 2016 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.

  8. The progression of hallux valgus in the oriental Chinese population in Hong Kong.

    Science.gov (United States)

    Koo, Kenneth Kin-Hoo; Tse, Lung Fung; Cheng, Hi Shan; Ho, Kevin Ki Wai

    2017-08-01

    Hallux valgus is the lateral deviation of the great toe at the MTPJ that has many attributing aetiologies. This study will aim to identify whether hallux valgus progresses over time in the oriental Chinese population in Hong Kong. Patients with acquired symptomatic hallux valgus who presented to clinic between 2008 and 2013 were included. The deformities were analysed radiologically at presentation and pre-operative and angles were measured. These angles were analysed in relation to the waiting time from presentation to surgery. A sample of 43 cases from 38 patients (Mean age 63 years, range 48-80 years) were included. Forty-one cases had a hallux valgus angle (HVA) >24° at presentation (Mean 40.4°) and all had an intermetatarsal angle (IMA) >9°. A significant difference is seen with HVA (p=0.040, t=-2.128) at presentation and pre-op but not IMA (p=0.281, t=-1.095). The average wait for surgery was 705.7days which had shown significant correlation with progression in HVA (p=0.031). No significant difference was seen between IMA and waiting time to surgery (p=0.195). The findings suggests severe hallux valgus deformity does progress over time in Hong Kong. Shorter waiting times for surgery could be beneficial to this population. Level III, retrospective comparative series. Crown Copyright © 2017. Published by Elsevier Ltd. All rights reserved.

  9. Posterior Radioscaphoid Angle as a Predictor of Wrist Degenerative Joint Disease in Patients With Scapholunate Ligament Tears.

    Science.gov (United States)

    Gondim Teixeira, Pedro Augusto; De Verbizier, Jacques; Aptel, Sabine; Wack, Maxime; Dap, François; Dautel, Gilles; Blum, Alain

    2016-01-01

    The purpose of this study is to determine whether the posterior radioscaphoid angle, a marker of posterior displacement of the scaphoid, is associated with degenerative joint disease in patients with scapholunate ligament tears. Images from 150 patients with wrist pain who underwent CT arthrography and radiography were retrospectively evaluated. Patients with and without scapholunate ligament ruptures were divided into two groups according to CT arthrography findings. The presence of degenerative changes (scapholunate advanced collapse [SLAC] wrist) was evaluated and graded on conventional radiographs. Images were evaluated by two readers independently, and an adjudicator analyzed the discordant cases. Posterior radioscaphoid angle values were correlated with CT arthrography and radiographic findings. The association between posterior radioscaphoid angle and degenerative joint disease was evaluated. Scapholunate and radiolunate angles were considered in the analysis. The posterior radioscaphoid angle was measurable in all patients, with substantial interobserver agreement (intraclass correlation coefficient, 0.75). The posterior radioscaphoid angle performed better than did the scapholunate and radiolunate angles in the differentiation of patients with and without SLAC wrist (p degenerative wrist disease, with potential prognostic implications in patients with wrist trauma and scapholunate ligament ruptures.

  10. Point-Connecting Measurements of the Hallux Valgus Deformity: A New Measurement and Its Clinical Application

    Science.gov (United States)

    Seo, Jeong-Ho; Boedijono, Dimas

    2016-01-01

    Purpose The aim of this study was to investigate new point-connecting measurements for the hallux valgus angle (HVA) and the first intermetatarsal angle (IMA), which can reflect the degree of subluxation of the first metatarsophalangeal joint (MTPJ). Also, this study attempted to compare the validity of midline measurements and the new point-connecting measurements for the determination of HVA and IMA values. Materials and Methods Sixty feet of hallux valgus patients who underwent surgery between 2007 and 2011 were classified in terms of the severity of HVA, congruency of the first MTPJ, and type of chevron metatarsal osteotomy. On weight-bearing dorsal-plantar radiographs, HVA and IMA values were measured and compared preoperatively and postoperatively using both the conventional and new methods. Results Compared with midline measurements, point-connecting measurements showed higher inter- and intra-observer reliability for preoperative HVA/IMA and similar or higher inter- and intra-observer reliability for postoperative HVA/IMA. Patients who underwent distal chevron metatarsal osteotomy (DCMO) had higher intraclass correlation coefficient for inter- and intra-observer reliability for pre- and post-operative HVA and IMA measured by the point-connecting method compared with the midline method. All differences in the preoperative HVAs and IMAs determined by both the midline method and point-connecting methods were significant between the deviated group and subluxated groups (p=0.001). Conclusion The point-connecting method for measuring HVA and IMA in the subluxated first MTPJ may better reflect the severity of a HV deformity with higher reliability than the midline method, and is more useful in patients with DCMO than in patients with proximal chevron metatarsal osteotomy. PMID:26996576

  11. Correlation between Manchester Grading Scale and American Orthopaedic Foot and Ankle Society Score in Patients with Hallux Valgus

    Science.gov (United States)

    Iliou, Kalliopi; Paraskevas, George; Kanavaros, Panagiotis; Barbouti, Alexandra; Vrettakos, Aristidis; Gekas, Christos; Kitsoulis, Panagiotis

    2015-01-01

    Objective To evaluate the correlation between the Manchester Grading Scale and the American Orthopaedic Foot and Ankle Society (AOFAS) score in patients with a hallux valgus deformity. Subjects and Methods The study sample included 181 feet of 122 patients with hallux valgus and 424 feet of 212 individuals without hallux valgus deformity as the control group. The severity of hallux valgus, utilizing a relative nonmetric scale, the Manchester Grading Scale, and the metric AOFAS score, was determined for all individuals in the hallux valgus and control groups. SPSS version 18 (Chicago, Ill., USA) was used for data analysis. Results According to the Manchester Grading Scale, the 424 feet of the normal group were classified as ‘no deformity−. In the hallux valgus group, 85 feet were classified as ‘mild deformity−, 67 as ‘moderate deformity' and 29 as ‘severe deformity−. The AOFAS total score in the control group was 99.14. In the hallux valgus group, patients with mild or moderate deformity had total scores of 86.20 and 68.19, respectively. For those with severe hallux valgus, the total score was 44.69 and the differences were statistically significant (p = 0.000). Using the Pearson correlation, strong negative correlations were found between the AOFAS score and the hallux valgus angle (HVA; r = −0.899, p = 0.000). Strong negative correlations were demonstrated between the AOFAS score and the first intermetatarsal angle (IMA) as well (r = −0.748, p = 0.000). Conclusions The AOFAS score was negatively associated with the Manchester Grading Scale, HVA and first IMA. As the severity of hallux valgus increased, the AOFAS score seemed to decrease. PMID:26335050

  12. Lateral sesamoid position in hallux valgus: correlation with the conventional radiological assessment.

    Science.gov (United States)

    Agrawal, Yuvraj; Desai, Aravind; Mehta, Jaysheel

    2011-12-01

    We aimed to quantify the severity of the hallux valgus based on the lateral sesamoid position and to establish a correlation of our simple assessment method with the conventional radiological assessments. We reviewed one hundred and twenty two dorso-plantar weight bearing radiographs of feet. The intermetatarsal and hallux valgus angles were measured by the conventional methods; and the position of lateral sesamoid in relation to first metatarsal neck was assessed by our new and simple method. Significant correlation was noted between intermetatarsal angle and lateral sesamoid position (Rho 0.74, p lateral sesamoid position and hallux valgus angle (Rho 0.56, p lateral sesamoid position is simple, less time consuming and has statistically significant correlation with that of the established conventional radiological measurements. Copyright © 2011 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.

  13. The Mechanical Axis of the First Ray: A Radiographic Assessment in Hallux Abducto Valgus Evaluation.

    Science.gov (United States)

    LaPorta, Guido A; Nasser, Ellianne M; Mulhern, Jennifer L; Malay, D Scot

    2016-01-01

    The present report describes a new method of hallux abducto valgus deformity correction planning using the mechanical axis of the medial column (mechanical axis planning). This method of radiographic evaluation identifies an ideal position for the first metatarsal after correction and is useful regardless of the surgical procedure chosen. We retrospectively reviewed 200 radiographs to identify a "normal" value for the mechanical axis angle. We reviewed 100 radiographs of patients with hallux abducto valgus deformity (deformity group) and 100 radiographs of patients without hallux abducto valgus deformity (control group). The deformity group revealed an M1-M2 anatomic axis angle of 13.5° ± 2.83° and an M1-M2 mechanical axis angle of 11.58° ± 1°. The control group revealed an M1-M2 anatomic axis angle of 7.5° ± 1.76° and an M1-M2 mechanical axis angle of 11.19° ± 0.9°. The differences in the M1-M2 anatomic axis angle and M1-M2 mechanical axis angle were statistically significant between the control and deformity groups. We sought to provide a reliable method for planning hallux abducto valgus deformity correction by aligning the mechanical axis of the medial column and the mechanical axis of the first ray to the "normal" value of 11° to reduce the deformity. Copyright © 2016 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  14. POD evaluation for joint angles from inertial and optical motion capturing system

    International Nuclear Information System (INIS)

    Shimizu, Kai; Kobayashi, Futoshi; Nakamoto, Hiroyuki; Kojima, Fumio

    2016-01-01

    It has been recognized that advances in preventive maintenance can improve the sustainment of systems, facilities, and infrastructure. Robot technologies have also received attention for maintenance applications. In order to operate delicate tasks, multi-fingered robot hands have been proposed in cases where human capability is deficient. This paper deals with motion capturing systems for controlling the hand/arm robot remotely. Several types of motion capturing systems have been developed so far. However, it is difficult for individual motion capturing systems to measure precise joint angles of a human arm. Therefore, in this paper, we integrate the inertial motion capturing system with the optical motion capturing system to capture a human arm posture. By evaluating the reliability of each motion capturing system, the integration is carried out. The probability of detection (POD) is applied to evaluate and compare the reliability of datasets measured by each motion capturing system. POD is one of the widely used statistical techniques to determine reliability. We apply the â analysis to determine the POD(a) function from the data set. Based on the POD evaluation, two motion capturing systems are integrated. (author)

  15. Joint-Angle Specific Strength Adaptations Influence Improvements in Power in Highly Trained Athletes

    Directory of Open Access Journals (Sweden)

    Rhea Matthew R.

    2016-03-01

    Full Text Available Purpose. The purpose of this study was to examine the influence of training at different ranges of motion during the squat exercise on joint-angle specific strength adaptations. Methods. Twenty eight men were randomly assigned to one of three training groups, differing only in the depth of squats (quarter squat, half squat, and full squat performed in 16-week training intervention. Strength measures were conducted in the back squat pre-, mid-, and post-training at all three depths. Vertical jump and 40-yard sprint time were also measured. Results. Individuals in the quarter and full squat training groups improved significantly more at the specific depth at which they trained when compared to the other two groups (p < 0.05. Jump height and sprint speed improved in all groups (p < 0.05; however, the quarter squat had the greatest transfer to both outcomes. Conclusions. Consistently including quarter squats in workouts aimed at maximizing speed and jumping power can result in greater improvements.

  16. Joint small-angle X-ray and neutron scattering data analysis of asymmetric lipid vesicles

    International Nuclear Information System (INIS)

    Eicher, Barbara; Heberle, Frederick A.; Marquardt, Drew T.

    2017-01-01

    Low- and high-resolution models describing the internal transbilayer structure of asymmetric lipid vesicles have been developed. These models can be used for the joint analysis of small-angle neutron and X-ray scattering data. The models describe the underlying scattering length density/electron density profiles either in terms of slabs or through the so-called scattering density profile, previously applied to symmetric lipid vesicles. Both models yield structural details of asymmetric membranes, such as the individual area per lipid, and the hydrocarbon thickness of the inner and outer bilayer leaflets. The scattering density profile model, however, comes at a cost of increased computational effort but results in greater structural resolution, showing a slightly lower packing of lipids in the outer bilayer leaflet of ~120 nm diameter palmitoyloleoyl phosphatidylcholine (POPC) vesicles, compared to the inner leaflet. Here, analysis of asymmetric dipalmitoyl phosphatidylcholine/POPC vesicles did not reveal evidence of transbilayer coupling between the inner and outer leaflets at 323 K,i.e.above the melting transition temperature of the two lipids.

  17. High Rate of Recurrence Following Proximal Medial Opening Wedge Osteotomy for Correction of Moderate Hallux Valgus.

    Science.gov (United States)

    Iyer, Sravisht; Demetracopoulos, Constantine A; Sofka, Carolyn M; Ellis, Scott J

    2015-07-01

    The proximal medial opening wedge (PMOW) osteotomy has become more popular to treat moderate to severe hallux valgus with the recent development of specifically designed, low-profile modular plates. Despite the promising results previously reported in the literature, we have noted a high incidence of recurrence in patients treated with a PMOW. The purpose of this study was to report the clinical and radiographic outcomes of an initial cohort of patients treated with a PMOW osteotomy for moderate hallux valgus. We retrospectively analyzed prospectively gathered data on a cohort of 17 consecutive patients who were treated by the senior author using a PMOW osteotomy for moderate hallux valgus deformity. Average time to follow-up was 2.4 years (range, 1.0-3.5 years). The intermetatarsal angle (IMA), the hallux valgus angle (HVA), and the distal metatarsal articular angle (DMAA) were assessed on standard weightbearing radiographs of the foot preoperatively and at all follow-up visits. The Foot and Ankle Outcome Score (FAOS) was collected on all patients preoperatively and at final follow-up. Despite demonstrating good correction of their deformity initially, 11 of the 17 patients (64.7%) had evidence of recurrence of their hallux valgus deformity at final follow-up. Patients who recurred had a greater preoperative HVA (P = .023) and DMAA (P = .049) than patients who maintained their correction. Improvement in the quality-of-life subscale of the FAOS was noted at final follow-up for all patients (P = .05). There was no significant improvement in any of the other FAOS subscales. There was a high rate of recurrence of the hallux valgus deformity in this cohort of patients. Recurrence was associated with greater preoperative deformity and an increased preoperative DMAA. The PMOW without a concomitant distal metatarsal osteotomy may be best reserved for patients with mild hallux valgus deformity without an increased DMAA. Level IV, retrospective case series. © The Author

  18. Estimation of ground reaction forces and joint moments on the basis on plantar pressure insoles and wearable sensors for joint angle measurement.

    Science.gov (United States)

    Ostaszewski, Michal; Pauk, Jolanta

    2018-05-16

    Gait analysis is a useful tool medical staff use to support clinical decision making. There is still an urgent need to develop low-cost and unobtrusive mobile health monitoring systems. The goal of this study was twofold. Firstly, a wearable sensor system composed of plantar pressure insoles and wearable sensors for joint angle measurement was developed. Secondly, the accuracy of the system in the measurement of ground reaction forces and joint moments was examined. The measurements included joint angles and plantar pressure distribution. To validate the wearable sensor system and examine the effectiveness of the proposed method for gait analysis, an experimental study on ten volunteer subjects was conducted. The accuracy of measurement of ground reaction forces and joint moments was validated against the results obtained from a reference motion capture system. Ground reaction forces and joint moments measured by the wearable sensor system showed a root mean square error of 1% for min. GRF and 27.3% for knee extension moment. The correlation coefficient was over 0.9, in comparison with the stationary motion capture system. The study suggests that the wearable sensor system could be recommended both for research and clinical applications outside a typical gait laboratory.

  19. Computed tomographic method for measurement of inclination angles and motion of the sacroiliac joints in German Shepherd Dogs and Greyhounds.

    Science.gov (United States)

    Saunders, Fritha C; Cave, Nick J; Hartman, Karl M; Gee, Erica K; Worth, Andrew J; Bridges, Janis P; Hartman, Angela C

    2013-09-01

    To develop an in vivo CT method to measure inclination angles and motion of the sacroiliac joints in dogs of performance breeds. 10 German Shepherd Dogs and 12 Greyhounds without signs of lumbosacral region pain or neurologic problems. CT of the ilium and sacrum was performed in flexed, neutral, and extended hind limb positions. Lines were drawn on volume-rendered images acquired in the flexed and extended positions to measure motion of the ilia relative to the sacra. Inclination angles of the synovial and ligamentous components of the sacroiliac joints were measured on transverse-plane CT images acquired at cranial and caudal locations. Coefficients of variance of measurements were calculated to determine intraobserver variability. Coefficients of variance of measurements ranged from 0.17% to 2.45%. A significantly higher amount of sacroiliac joint rotational motion was detected for German Shepherd Dogs versus Greyhounds. The cranial synovial joint component had a significantly more sagittal orientation in German Shepherd Dogs versus Greyhounds. No significant differences were detected between breeds for x- or y-axis translational motion or caudal synovial or ligamentous joint component inclination angles. The small amounts of sacroiliac joint motion detected in this study may buffer high-frequency vibrations during movement of dogs. Differences detected between breeds may be associated with the predisposition of German Shepherd Dogs to develop lumbosacral region signs of pain, although the biological importance of this finding was not determined. Future studies are warranted to compare sacroiliac joint variables between German Shepherd Dogs with and without lumbosacral region signs of pain.

  20. Minimally Invasive Distal Metatarsal Osteotomy for Mild-to-Moderate Hallux Valgus Deformity

    Directory of Open Access Journals (Sweden)

    Yu-Chuan Lin

    2009-08-01

    Full Text Available Minimally invasive surgery has recently been introduced for foot and ankle surgery, and hallux valgus surgery is no exception. The purpose of our study was to analyze the early results and to present our experience of minimally invasive distal metatarsal osteotomy in correcting mild-to-moderate hallux valgus deformities. Between September 2005 and December 2006, 31 consecutive patients (47 feet with mild-to-moderate hallux valgus deformities underwent minimally invasive distal metatarsal osteotomies. The clinical and radiographic outcomes were assessed. The satisfaction rate was 90.32%. The mean total American Orthopedic Foot and Ankle Society halluxmetatarsophalangeal-interphalangeal scale was 92.7 points. Complications included two (4.26% episodes of stiffness, six (12.77% episodes of pin tract infection, and one (2.13% deep infection. There were no cases with nonunion, malunion, overcorrection, transfer metatarsalgia or osteonecrosis. On weight-bearing anteroposterior foot radiographs, the mean hallux valgus angle and first intermetatarsal angle corrections were 11.8° and 6.3°, respectively, which is a statistically significant difference (p < 0.001 between the preoperative and postoperative status. Here, minimally invasive distal metatarsal osteotomy was associated with good satisfaction, functional improvement and low complication rates. This technique offers an effective, safe and simple way to treat hallux valgus with a first intermetatarsal angle less than 15°.

  1. Distal Metatarsal Osteotomy in Hallux Valgus Surgery: Chevron Osteotomy

    Directory of Open Access Journals (Sweden)

    Fatih Dogar

    2016-04-01

    Full Text Available Aim: Hallux valgus is a complex foot deformity resulting from medial deviation of first metatarsal and lateral deviation of toe. Radiographic and functional outcomes of chevron type distal metatarsal osteotomy applied to symptomatic hallux valgus patients with moderate deformity were assessed in the present study. Chevron osteotomy was applied to 27 feet (13 left, 14 right of 22 patients (12 women and 10 men; mean age: 45±16.7 years. Mean follow-up was 15.4± 4.71 months (range, 10%u201324. Material and Method: The average preoperative AOFAS score of 39.1 ± 8.55 (range, 32%u201357 improved (p < 0.0001 to 87.8 ± 4.7 (range, 82%u201397. The average preoperative hallux valgus angle (HVA of 37.4 ± 5.8 (range, 29%u201350 improved (p < 0.0001 to 14.8 ± 3.1 (range, 10%u201320 , and the average preoperative intermetatarsal 1-2 angle (IMA of 13.1 ± 1.5 (range, 11%u201317 improved (p < 0.0001 to 7.1 ± 1.4 (range, 5%u20139 . The average sesamoid position improved from 2.9 ± 0.2 (range, 2-3 preoperatively to 1.2 ± 0.4 (range, 1-2 (p < 0.0001. Toe hypoesthesia was developed in one patient as a complication. At the end of follow-up, patient satisfaction was found to be excellent in 16 feet (59.2% and good in 11 feet (40.8%. Results: The results of the study that chevron osteotomy yields good radiological result, high degree of postoperative patient satisfaction with minimal complications. Chevron ostoetomy is most effective method in the treatment of moderate hallux valgus.

  2. Comparison of reliability of five patellar position indices at various stifle joint angles in pelvic limbs obtained from cadavers of red foxes (Vulpes vulpes)

    DEFF Research Database (Denmark)

    Miles, James E; Nielsen, Dorte H; Jensen, Bente Rona

    2012-01-01

    To compare 5 patellar position indices at various stifle joint angles in cadavers of red foxes, determine measurement reliability, and assess the suitability of these indices for clinical use.......To compare 5 patellar position indices at various stifle joint angles in cadavers of red foxes, determine measurement reliability, and assess the suitability of these indices for clinical use....

  3. Severe Degeneration of the Medial Collateral Ligament in Hallux Valgus: A Histopathologic Study in 12 Consecutive Patients

    Science.gov (United States)

    Prasitdumrong, Ittipol; Rungprai, Chamnanni; Reeboonlarb, Nitit; Poonpracha, Tara; Phisitkul, Phinit

    2013-01-01

    Objective To determine the degree and location of degenerative changes of the medial collateral ligament of the first metatarsophalangeal joint, using the lateral collateral ligament as a control, in patients undergoing hallux valgus correction. Materials and Methods A strip of medial and lateral collateral ligaments were biopsied from 12 consecutive patients (age 45 ± 4.8 years) with symptomatic hallux valgus. A blinded analysis of histopathology was performed by an experienced pathologist. Results The medial collateral ligament was significantly more degenerated compared to the lateral collateral ligament (x2 = 23.41, DF = 2, p hallux valgus correction. The Authors received no financial support for this study. PMID:24027461

  4. Consideration of Shoulder Joint's Image with the Changed Tube Angle of the Shoulder Oblique Projection in Supine Position

    International Nuclear Information System (INIS)

    Seo, Jae Hyun; Choi, Nam Gil

    2008-01-01

    There is a standard shoulder oblique method (Grashey method) available to view the shoulder joint. This method projects AP view of the shoulder joint so that the Humerus head's subuxation or joint degeneration can be easily visualized. However, in this view, the patients, with supine or sitting or erect position, have to keep their body obliquely. Whereas, the patients who are not well or operated, usually feel very uncomfortable to keep their body in this position and hence, we need other persons' help and much efforts will be needed to get the good quality shoulder joint view. Therefore, we thought of examining a method which shows the joint well by angling the tube to Medio-Lateral direction and without keeping the patients' one side upward in supine position. For this study, total 15 subjects with no history of neurological or psychiatric illness, were recruited for examinations. They consisted of 9 males and 6 females. Statistic group analysis was performed with ANOVA test. Scores of the evaluation of the experts were 1.01±0.54 at 25 degrees, 2.50±0.50 at 30 degrees, 2.85±0.36 at 35 degrees and 2.33±0.47 at 40 degrees, respectively, and they were significant(p<0.05, Table 1). Joint space of the Humerus head and Scapula were well distinguished at 35 degrees, 30 degrees and 40 degrees with the almost same score. However, the degree of distortion at 40 degrees was more severe than that at 30 degrees. Ultimately, 30-35 degrees views were shown to yield good quality shoulder oblique images. In conclusion, this method may be very useful for the patients who are uncomfortable and for the emergency patients. In order to get similar or comparable view, the same X-tube angle is recommended to be used before and after the operation. Therefore, we hope that this new angled method seems to be efficient.

  5. Our Experience with Double Metatarsal Osteotomy in the Treatment of Hallux Valgus

    Directory of Open Access Journals (Sweden)

    Pradeep George Mathew

    2012-01-01

    Full Text Available Adolescent hallux valgus (HV is a progressive deformity of adolescent age consisting of metatarsus primus varus and hallux valgus. It has a high recurrence rate after conventional surgical correction. Ten feet in nine patients (two males, seven females were treated surgically with the Peterson Newman bunion procedure, with a minimum follow‑up of one year. During the final follow‑up all these patients had no complaints of pain, joint stiffness or limping. Even though the patients had some mild loss of range of movements at the MTP joints 4–6° compared to preoperative value, it did not cause any functional impairment and all were satisfied with the final outcome. The double ostetomy for treatment of hallux valgus is technically precise procedure, provides excellent correction and stability and has low rate of recurrence of deformity. We had an excellent outcome in 10 feet in our study without residual deformity or complications.

  6. Estimation of distal arm joint angles from EMG and shoulder orientation for transhumeral prostheses.

    Science.gov (United States)

    Akhtar, Aadeel; Aghasadeghi, Navid; Hargrove, Levi; Bretl, Timothy

    2017-08-01

    In this paper, we quantify the extent to which shoulder orientation, upper-arm electromyography (EMG), and forearm EMG are predictors of distal arm joint angles during reaching in eight subjects without disability as well as three subjects with a unilateral transhumeral amputation and targeted reinnervation. Prior studies have shown that shoulder orientation and upper-arm EMG, taken separately, are predictors of both elbow flexion/extension and forearm pronation/supination. We show that, for eight subjects without disability, shoulder orientation and upper-arm EMG together are a significantly better predictor of both elbow flexion/extension during unilateral (R 2 =0.72) and mirrored bilateral (R 2 =0.72) reaches and of forearm pronation/supination during unilateral (R 2 =0.77) and mirrored bilateral (R 2 =0.70) reaches. We also show that adding forearm EMG further improves the prediction of forearm pronation/supination during unilateral (R 2 =0.82) and mirrored bilateral (R 2 =0.75) reaches. In principle, these results provide the basis for choosing inputs for control of transhumeral prostheses, both by subjects with targeted motor reinnervation (when forearm EMG is available) and by subjects without target motor reinnervation (when forearm EMG is not available). In particular, we confirm that shoulder orientation and upper-arm EMG together best predict elbow flexion/extension (R 2 =0.72) for three subjects with unilateral transhumeral amputations and targeted motor reinnervation. However, shoulder orientation alone best predicts forearm pronation/supination (R 2 =0.88) for these subjects, a contradictory result that merits further study. Copyright © 2017 Elsevier Ltd. All rights reserved.

  7. Short-Term Radiographic Outcome After Distal Chevron Osteotomy for Hallux Valgus Using Intramedullary Plates With an Amended Algorithm for the Surgical Management of Hallux Valgus.

    Science.gov (United States)

    Matsumoto, Takumi; Gross, Christopher E; Parekh, Selene G

    2018-03-01

    Distal Chevron osteotomy is a well-established surgical procedure for mild to moderate hallux valgus deformity. Many methods have been described for fixation of osteotomy site; secure fixation, enabling large displacement of the metatarsal head, is one of the essentials of this procedure. The purpose of the present study was to evaluate the short-term radiographic outcome of a distal Chevron osteotomy using an intramedullary plate for the correction of hallux valgus deformity. The present study evaluated 37 patients (40 feet) who underwent distal Chevron osteotomy using an intramedullary plate by periodic radiographs obtained preoperatively and at 4 weeks, 8 weeks, 3 months, and 6 months postoperatively. Correction of the hallux valgus angle averaged 17.8°, intermetatarsal angle 7.4°, distal metatarsal articular angle 2.7°, and sesamoid position 1.4 stages at 3 months postoperatively. The average lateral shift of the capital fragment was 6.5 mm. All patients achieved bone union, and there were no cases of dislocation, displacement, or avascular necrosis of the metatarsal head fragment. In conclusion, a distal Chevron osteotomy using an intramedullary plate was a favorable method for the correction of mild to moderate hallux valgus deformity. Level IV: Case series.

  8. A geometric analysis of hallux valgus: correlation with clinical assessment of severity

    Science.gov (United States)

    Piqué-Vidal, Carlos; Vila, Joan

    2009-01-01

    Background Application of plane geometry to the study of bunion deformity may represent an interesting and novel approach in the research field of hallux valgus. For the purpose of contributing to development of a different perspective in the assessment of hallux valgus, this study was conducted with three objectives: a) to determine the position on the intersection point of the perpendicular bisectors of the longitudinal axes of the first metatarsal and proximal phalanx (IP), b) to correlate the location of this point with hallux valgus deformity according to angular measurements and according to visual assessment of the severity carried out by three independent observers, and c) to assess whether this IP correlated with the radius of the first metatarsophalangeal arc circumference. Methods Measurements evaluated were intermetatarsal angle (IMA), hallux valgus angle (HVA), and proximal phalangeal articular angle (PPAA). The Autocad® program computed the location of the IP inside or outside of the foot. Three independent observers rated the severity of hallux valgus in photographs using a 100-mm visual analogue scale (VAS). Results Measurements of all angles except PPAA showed significantly lower values when the IP was located out of the foot more distantly and vice versa, significantly higher values for severe deformities in which the IP was found inside the foot (p < 0.001). The IP correlated significantly with VAS scores and with the length of the radius of the circle that included the first metatarsophalangeal arc circumference (p < 0.001) Conclusion The IP is a useful indicator of hallux valgus deformity because correlated significantly with IMA and HVA measurements, VAS scores obtained by visual inspection of the degree of deformity, and location of the center of the first metatarsophalangeal arc circumference. PMID:19442286

  9. A geometric analysis of hallux valgus: correlation with clinical assessment of severity

    Directory of Open Access Journals (Sweden)

    Vila Joan

    2009-05-01

    Full Text Available Abstract Background Application of plane geometry to the study of bunion deformity may represent an interesting and novel approach in the research field of hallux valgus. For the purpose of contributing to development of a different perspective in the assessment of hallux valgus, this study was conducted with three objectives: a to determine the position on the intersection point of the perpendicular bisectors of the longitudinal axes of the first metatarsal and proximal phalanx (IP, b to correlate the location of this point with hallux valgus deformity according to angular measurements and according to visual assessment of the severity carried out by three independent observers, and c to assess whether this IP correlated with the radius of the first metatarsophalangeal arc circumference. Methods Measurements evaluated were intermetatarsal angle (IMA, hallux valgus angle (HVA, and proximal phalangeal articular angle (PPAA. The Autocad® program computed the location of the IP inside or outside of the foot. Three independent observers rated the severity of hallux valgus in photographs using a 100-mm visual analogue scale (VAS. Results Measurements of all angles except PPAA showed significantly lower values when the IP was located out of the foot more distantly and vice versa, significantly higher values for severe deformities in which the IP was found inside the foot (p p Conclusion The IP is a useful indicator of hallux valgus deformity because correlated significantly with IMA and HVA measurements, VAS scores obtained by visual inspection of the degree of deformity, and location of the center of the first metatarsophalangeal arc circumference.

  10. Effectiveness of Percutaneous Proximal Closing Wedge Osteotomy With Akin Osteotomy to Correct Severe Hallux Valgus Determined by Radiographic Parameters.

    Science.gov (United States)

    Kurashige, Toshinori; Suzuki, Seiichi

    2017-04-01

    Some authors reported the results from percutaneous distal metatarsal osteotomy for hallux valgus recently. On the other hand, there are few reports of percutaneous proximal metatarsal osteotomy. The purpose of the present study was to evaluate the radiographic results of percutaneous proximal closing wedge osteotomy with Akin osteotomy for correction of severe hallux valgus and increasing longitudinal arch height. Consecutive 17 feet (mean age = 70.8 years) were investigated. The mean follow-up was 22 months. Excision of medial eminence, distal soft tissue release, and Akin osteotomy were all performed percutaneously and concurrently. Weight-bearing anteroposterior and lateral radiographs of the feet were acquired preoperatively and at final follow-up. On the anteroposterior radiographs, hallux valgus angle, intermetatarsal angle, and first metatarsal shortening were measured. On the lateral radiographs, talometatarsal angle, calcaneal pitch angle, and first metatarsal dorsiflexion were measured. The average improvements in hallux valgus angle and intermetatarsal angle were 27.6° and 9.9°, respectively. The average first metatarsal shortening was 2.7 mm. The first metatarsal dorsiflexion improved by 2.2°; however, other parameters did not improve significantly. In conclusion, percutaneous proximal closing wedge osteotomy with Akin osteotomy corrects severe hallux valgus; however, the procedure does not increase the medial longitudinal arch. Therapeutic, Level IV: Case series.

  11. Correlation between hindfoot joint three-dimensional kinematics and the changes of the medial arch angle in stage II posterior tibial tendon dysfunction flatfoot.

    Science.gov (United States)

    Zhang, Yi-Jun; Xu, Jian; Wang, Yue; Lin, Xiang-Jin; Ma, Xin

    2015-02-01

    The aim of this study was to explore the correlation between the kinematics of the hindfoot joint and the medial arch angle change in stage II posterior tibial tendon dysfunction flatfoot three-dimensionally under loading. Computed tomography (CT) scans of 12 healthy feet and 12 feet with stage II posterior tibial tendon dysfunction flatfoot were taken both in non- and full-body-weight-bearing condition. The CT images of the hindfoot bones were reconstructed into three-dimensional models with Mimics and Geomagic reverse engineering software. The three-dimensional changes of the hindfoot joint were calculated to determine their correlation to the medial longitudinal arch angle. The medial arch angle change was larger in stage II posterior tibial tendon dysfunction flatfoot compared to that in healthy foot under loading. The rotation and translation of the talocalcaneal joint, the talonavicular joint and the calcanocuboid joint had little influence on the change of the medial arch angle in healthy foot. However, the eversion of the talocalcaneal joint, the proximal translation of the calcaneus relative to the talus and the dorsiflexion of talonavicular joint could increase the medial arch angle in stage II posterior tibial tendon dysfunction flatfoot under loading. Joint instability occurred in patients with stage II posterior tibial tendon dysfunction flatfoot under loading. Limitation of over movement of the talocalcaneal joint and the talonavicular joint may help correct the medial longitudinal arch in stage II posterior tibial tendon dysfunction flatfoot. Copyright © 2014 Elsevier Ltd. All rights reserved.

  12. The Effect of Foot Progression Angle on Knee Joint Compression Force during Walking

    DEFF Research Database (Denmark)

    Baldvinsson, Henrik Koblauch; Heilskov-Hansen, Thomas; Alkjær, Tine

    2013-01-01

    males walked at a fixed speed of 4.5 km/h under three conditions: Normal walking, internally rotated and externally rotated. All gait-trials were recorded by six infrared cameras. Net joint moments were calculated by 3D inverse dynamics. The results revealed that the medial knee joint compartment......It is unclear how rotations of the lower limb affect the knee joint compression forces during walking. Increases in the frontal plane knee moment have been reported when walking with internally rotated feet and a decrease when walking with externally rotated feet. The aim of this study...... was to investigate the knee joint compressive forces during walking with internal, external and normal foot rotation and to determine if the frontal plane knee joint moment is an adequate surrogate for the compression forces in the medial and lateral knee joint compartments under such gait modifications. Ten healthy...

  13. Posterior Tibial Slope Angle Correlates With Peak Sagittal and Frontal Plane Knee Joint Loading During Robotic Simulations of Athletic Tasks

    Science.gov (United States)

    Bates, Nathaniel A.; Nesbitt, Rebecca J.; Shearn, Jason T.; Myer, Gregory D.; Hewett, Timothy E.

    2017-01-01

    Background Tibial slope angle is a nonmodifiable risk factor for anterior cruciate ligament (ACL) injury. However, the mechanical role of varying tibial slopes during athletic tasks has yet to be clinically quantified. Purpose To examine the influence of posterior tibial slope on knee joint loading during controlled, in vitro simulation of the knee joint articulations during athletic tasks. Study Design Descriptive laboratory study. Methods A 6 degree of freedom robotic manipulator positionally maneuvered cadaveric knee joints from 12 unique specimens with varying tibial slopes (range, −7.7° to 7.7°) through drop vertical jump and sidestep cutting tasks that were derived from 3-dimensional in vivo motion recordings. Internal knee joint torques and forces were recorded throughout simulation and were linearly correlated with tibial slope. Results The mean (6SD) posterior tibial slope angle was 2.2° ± 4.3° in the lateral compartment and 2.3° ± 3.3° in the medial compartment. For simulated drop vertical jumps, lateral compartment tibial slope angle expressed moderate, direct correlations with peak internally generated knee adduction (r = 0.60–0.65), flexion (r = 0.64–0.66), lateral (r = 0.57–0.69), and external rotation torques (r = 0.47–0.72) as well as inverse correlations with peak abduction (r = −0.42 to −0.61) and internal rotation torques (r = −0.39 to −0.79). Only frontal plane torques were correlated during sidestep cutting simulations. For simulated drop vertical jumps, medial compartment tibial slope angle expressed moderate, direct correlations with peak internally generated knee flexion torque (r = 0.64–0.69) and lateral knee force (r = 0.55–0.74) as well as inverse correlations with peak external torque (r = −0.34 to 20.67) and medial knee force (r = −0.58 to −0.59). These moderate correlations were also present during simulated sidestep cutting. Conclusion The investigation supported the theory that increased posterior

  14. MR imaging of the temporomandibular joint. Part 2. Effect of flip angle on MR imaging with FLASH sequence

    International Nuclear Information System (INIS)

    Sakamoto, Maya; Sasano, Takashi; Higano, Shuichi; Takahashi, Shoki; Kurihara, Noriko

    1998-01-01

    In our previous study on MR imaging of the temporomandibular joint (TMJ), fast low angle shot (FLASH) showed the highest image contrast between disc and surrounding TMJ tissues compared with those of 4 other sequences (i,e., fast imaging with steady precession (FISP), conventional T1-weighted spin echo (SE) and fast spin echo (FSE, TR/TE/ETL: 1100/12/3, 3000/15/7)). Furthermore, FLASH also received a high score on visual evaluation including the position and contour of the disc, and the border between the disc and surrounding tissues. Therefore, we concluded that FLASH was the most suitable sequence for evaluating the TMJ disc. However, the image contrast and signal intensity on MR imaging with gradient echo pulse sequence are affected by flip angle. Consequently, in this report, to find the most suitable flip angle for MR scanning of the TMJ using a FLASH sequence (TR/TE: 450/11), ten TMJs of 5 volunteers were experimentally imaged with various flip angles from 10 degrees to 70 degrees at an interval of 10 degrees between 10 to 70. The image contrast and contrast-to-noise ratio (CNR) between the disc and surrounding tissues were compared. In addition, signal-to-noise ratio (SNR) of phantoms was also calculated using the same imaging parameters. Visual evaluation including position and contour of the disc, and the border between the disc and surrounding tissues, was also performed by 4 radiologists. As the flip angle increased, imaging contrast decreased while SNR increased. Images with flip angles between 30 and 60 degrees demonstrated high CNR. On visual evaluation, images using flip angles between 30 and 50 degrees received high scores. In conclusion, FLASH sequence with a flip angle between 30 and 50 degrees was considered most suitable for evaluating the TMJ disc based on the results of visual assessment and analysis of three major components of image diagnostic quality: image contrast, CNR and SNR. (author)

  15. Hallux abductus interphalangeus in normal feet, early-stage hallux limitus, and hallux valgus.

    Science.gov (United States)

    Castillo-Lopez, Jose M; Ramos-Ortega, Javier; Reina-Bueno, Maria; Domínguez-Maldonado, Gabriel; Palomo-Toucedo, Inmaculada C; Munuera, Pedro V

    2014-03-01

    Excessive deviation of the distal phalanx in abduction frequently occurs in advanced stages of hallux rigidus but not in hallux valgus. Therefore, theoretically there should be no significant differences in the hallux interphalangeal angle (HIPA) between individuals with normal feet, those with hallux valgus, and those with mild hallux limitus. The objective of the present study was thus to determine if significant differences in HIPA exist in the early stages of hallux valgus or hallux limitus deformities. The hallux interphalangeal angle was measured in three groups of participants: a control group with normal feet (45 participants), a hallux valgus group (49 participants), and a hallux limitus group (48 participants). Both of the pathologies were at an early stage. A dorsoplantar radiograph under weightbearing conditions was taken for each individual, and measurements (HIPA and hallux abductus angle [HAA]) were taken using AutoCAD (Autodesk Inc, San Rafael, California) software. Intergroup comparisons of HIPA, and correlations between HIPA, HAA, and hallux dorsiflexion were calculated. The comparisons revealed no significant differences in the values of HIPA between any of the groups (15.2 ± 5.9 degrees in the control group, 15.5 ± 3.9 degrees in the hallux valgus group, and 16.15 ± 4.3 in the hallux limitus group; P  =  0.634). The Pearson correlation coefficients in particular showed no correlation between hallux dorsiflexion, HAA, and HIPA. For the study participants, there were similar deviations of the distal phalanx of the hallux with respect to the proximal phalanx in normal feet and in feet with the early stages of the hallux limitus and hallux valgus deformities.

  16. The influence of muscle pennation angle and cross-sectional area on contact forces in the ankle joint.

    Science.gov (United States)

    Sopher, Ran S; Amis, Andrew A; Davies, D Ceri; Jeffers, Jonathan Rt

    2017-01-01

    Data about a muscle's fibre pennation angle and physiological cross-sectional area are used in musculoskeletal modelling to estimate muscle forces, which are used to calculate joint contact forces. For the leg, muscle architecture data are derived from studies that measured pennation angle at the muscle surface, but not deep within it. Musculoskeletal models developed to estimate joint contact loads have usually been based on the mean values of pennation angle and physiological cross-sectional area. Therefore, the first aim of this study was to investigate differences between superficial and deep pennation angles within each muscle acting over the ankle and predict how differences may influence muscle forces calculated in musculoskeletal modelling. The second aim was to investigate how inter-subject variability in physiological cross-sectional area and pennation angle affects calculated ankle contact forces. Eight cadaveric legs were dissected to excise the muscles acting over the ankle. The mean surface and deep pennation angles, fibre length and physiological cross-sectional area were measured. Cluster analysis was applied to group the muscles according to their architectural characteristics. A previously validated OpenSim model was used to estimate ankle muscle forces and contact loads using architecture data from all eight limbs. The mean surface pennation angle for soleus was significantly greater (54%) than the mean deep pennation angle. Cluster analysis revealed three groups of muscles with similar architecture and function: deep plantarflexors and peroneals, superficial plantarflexors and dorsiflexors. Peak ankle contact force was predicted to occur before toe-off, with magnitude greater than five times bodyweight. Inter-specimen variability in contact force was smallest at peak force. These findings will help improve the development of experimental and computational musculoskeletal models by providing data to estimate force based on both surface and deep

  17. Surgery for the correction of hallux valgus: minimum five-year results with a validated patient-reported outcome tool and regression analysis.

    Science.gov (United States)

    Chong, A; Nazarian, N; Chandrananth, J; Tacey, M; Shepherd, D; Tran, P

    2015-02-01

    This study sought to determine the medium-term patient-reported and radiographic outcomes in patients undergoing surgery for hallux valgus. A total of 118 patients (162 feet) underwent surgery for hallux valgus between January 2008 and June 2009. The Manchester-Oxford Foot Questionnaire (MOXFQ), a validated tool for the assessment of outcome after surgery for hallux valgus, was used and patient satisfaction was sought. The medical records and radiographs were reviewed retrospectively. At a mean of 5.2 years (4.7 to 6.0) post-operatively, the median combined MOXFQ score was 7.8 (IQR:0 to 32.8). The median domain scores for pain, walking/standing, and social interaction were 10 (IQR: 0 to 45), 0 (IQR: 0 to 32.1) and 6.3 (IQR: 0 to 25) respectively. A total of 119 procedures (73.9%, in 90 patients) were reported as satisfactory but only 53 feet (32.7%, in 43 patients) were completely asymptomatic. The mean (SD) correction of hallux valgus, intermetatarsal, and distal metatarsal articular angles was 18.5° (8.8°), 5.7° (3.3°), and 16.6° (8.8°), respectively. Multivariable regression analysis identified that an American Association of Anesthesiologists grade of >1 (Incident Rate Ratio (IRR) = 1.67, p-value = 0.011) and recurrent deformity (IRR = 1.77, p-value = 0.003) were associated with significantly worse MOXFQ scores. No correlation was found between the severity of deformity, the type, or degree of surgical correction and the outcome. When using a validated outcome score for the assessment of outcome after surgery for hallux valgus, the long-term results are worse than expected when compared with the short- and mid-term outcomes, with 25.9% of patients dissatisfied at a mean follow-up of 5.2 years. ©2015 The British Editorial Society of Bone & Joint Surgery.

  18. Relationship between degenerative joint disease and hip joint laxity by use of distraction index and Norberg angle measurement in a group of cats

    International Nuclear Information System (INIS)

    Langenbach, A.; Giger, U.; Green, P.; Rhodes, H.; Gregor, T.P.; Lafond, E.; Smith, G.

    1998-01-01

    Objective: To determine the relationship between degenerative joint disease (DJD) and passive laxity of the hip joint in a group of cats. Design: Prospective study. Animals: A select (nonrandomized) group of 78 cats. Procedure: Standard hip-extended radiographic views and compression and distraction views of the pelvis were obtained from cats during sedation. Radiographs were evaluated, using an Orthopedic Foundation for Animals (OFA)-like scoring system for dogs. Passive joint laxity was measured, using Norberg angle (NA) and distraction index (DI). Hip laxity in cats with DJD was compared with hip laxity in cats without DJD. Results: Hip dysplasia (HD) was subjectively diagnosed radiographically in 25 of 78 (32%) cats using the OFA-like scoring system. Nineteen cats had mild HD 4 had moderate HD, and 2 had severe HD. Fifteen of the 25 cats with HD had DJD. The NA ranged from 56 to 105. The mean NA in cats with DJD was (84 degrees) significantly lower than in cats without DJD (95 degrees). The DI ranged from 0.2 to 0.84. The mean DI for cats with DJD was (0.6) significantly higher than that for cats without DJD (0.49). Cats with a DI < 0.4 did not have DJD. Cats had an increased likelihood of having DJD with increased laxity in the coxofemoral joint, as measured by NA or DI. Clinical Implications: The mean NA for radiographically normal cats (92.4 degrees) was lower than that in radiographically normal dogs (103 degrees). The overall mean DI for cats in this group (0.51) is similar to dogs of breeds with high joint laxity, such as the Labrador Retriever (0.5). As in dogs, there is a relationship between DJD and laxity in the hip joint of cats

  19. Olecranon orientation as an indicator of elbow joint angle in the stance phase, and estimation of forelimb posture in extinct quadruped animals.

    Science.gov (United States)

    Fujiwara, Shin-Ichi

    2009-09-01

    Reconstruction of limb posture is a challenging task in assessing functional morphology and biomechanics of extinct tetrapods, mainly because of the wide range of motions possible at each limb joint and because of our poor knowledge of the relationship between posture and musculoskeletal structure, even in the extant taxa. This is especially true for extinct mammals such as the desmostylian taxa Desmostylus and Paleoparadoxia. This study presents a procedure that how the elbow joint angles of extinct quadruped mammals can be inferred from osteological characteristics. A survey of 67 dried skeletons and 113 step cycles of 32 extant genera, representing 25 families and 13 orders, showed that the olecranon of the ulna and the shaft of the humerus were oriented approximately perpendicular to each other during the stance phase. At this angle, the major extensor muscles maximize their torque at the elbow joint. Based on this survey, I suggest that olecranon orientation can be used for inferring the elbow joint angles of quadruped mammals with prominent olecranons, regardless of taxon, body size, and locomotor guild. By estimating the elbow joint angle, it is inferred that Desmostylus would have had more upright forelimbs than Paleoparadoxia, because their elbow joint angles during the stance phase were approximately 165 degrees and 130 degrees , respectively. Difference in elbow joint angles between these two genera suggests possible differences in stance and gait of these two mammals. Copyright 2009 Wiley-Liss, Inc.

  20. Radiographic evaluation of perching-joint angles in cockatiels (Nymphicus hollandicus), Hispaniolan Amazon parrots (Amazona ventralis), and barred owls (Strix varia).

    Science.gov (United States)

    Bonin, Glen; Lauer, Susanne K; Guzman, David Sanchez-Migallon; Nevarez, Javier; Tully, Thomas N; Hosgood, Giselle; Gaschen, Lorrie

    2009-06-01

    Information on perching-joint angles in birds is limited. Joint immobilization in a physiologic perching angle has the potential to result more often in complete restoration of limb function. We evaluated perching-joint angles in 10 healthy cockatiels (Nymphicus hollandicus), 10 Hispaniolan Amazons (Amazona ventralis), and 9 barred owls (Strix varia) and determined intra- and interobserver variability for goniometric measurements in 2 different radiographic projections. Intra- and interobserver variation was less than 7% for all stifle and intertarsal joint measurements but frequently exceeded 10% for the hip-joint measurements. Hip, stifle, and intertarsal perching angles differed significantly among cockatiels, Hispaniolan Amazon parrots, and barred owls. The accuracy of measurements performed on straight lateral radiographic projections with superimposed limbs was not consistently superior to measurements on oblique projections with a slightly rotated pelvis. Stifle and intertarsal joint angles can be measured on radiographs by different observers with acceptable variability, but intra- and interobserver variability for hip-joint-angle measurements is higher.

  1. New modified technique of osteotomy for hallux valgus.

    Science.gov (United States)

    Oh, I S; Kim, M K; Lee, S H

    2004-12-01

    To improve the technique of osteotomy for hallux valgus (bunion). 38 cases of a new modified osteotomy procedure for hallux valgus were performed for 22 patients (21 women and one man). During a 3-year (range, 2-5 years) follow-up, the patients underwent physical examination; and their American Orthopedic Foot and Ankle Society hallux-metatarso-phalangeal-interphalangeal scale scores and standard foot radiographic measurements were recorded. 20 of the 22 patients (38 cases) had no pain, achieved good cosmesis, and were completely satisfied with the results of the operation. The remaining 2 patients had occasional mild discomfort. The mean hallux-metatarso-phalangeal-interphalangeal scale score was 93 points (range, 78-100 points). The mean preoperative and postoperative metatarsophalangeal angles were 34 degrees and 11 degrees, respectively. The mean postoperative reduction of the intermetatarsal angle and metatarsophalangeal angle were 6 degrees and 23 degrees, respectively. The new technique of osteotomy achieved even greater stability and accurate correction of the deformity in our 38 cases. Furthermore, it was more effective than conventional 'chevron' osteotomy in terms of correction of the deformity. Therefore, it should be used more widely.

  2. Effect of hoof angle on joint contact area in the equine metacarpophalangeal joint following simulated impact loading ex vivo.

    Science.gov (United States)

    McCarty, C A; Thomason, J J; Gordon, K; Hurtig, M; Bignell, W

    2015-11-01

    To add to the existing data on impact loading of the metacarpophalangeal (MCP) joint as a precursor to assessing the potential role of impact in joint disease. To examine the effect of impact loading on contact areas of the first phalanx (P1) and proximal sesamoids (PS) with the third metacarpal (McIII) under 3 hoof-strike conditions (toe-first, flat, heel-first). Randomised, repeated controlled experiment using cadaver material. Eight cadaver limbs were subjected to randomised, repeated controlled trials where the hoof was struck by a pendulum impact machine (impact velocity 3.55 m/s) under 3 strike conditions. Data from pressure sensitive film placed over medial and lateral McIII condyles and lateromedially across the dorsal aspect of McIII were quantified: total areas of P1 and PS contact (cm(2) ) at maximum recorded pressure; centroid locations of contact areas relative to the sagittal ridge (cm) and transverse ridge (cm) and dispersion of pixels (cm(4) ) for each McIII condyle (medial/lateral). The effect of the strike conditions on each variable were statistically tested using repeated-measures ANOVA (α = 0.05). Contact area between P1 and McIII condyles fell in well-defined areas bounded by the sagittal and transverse ridge, contact areas from PS were smaller and widely dispersed across McIII palmar border. Ratio of contact area of P1 to PS was 2.83 (Pcontact area (P>0.54) CONCLUSIONS: Contact at impact (primarily from P1 and distally situated on McIII), contrasts with contact areas at midstance from both P1 and PS, symmetrically placed. Under impact, the greatest contact area was on the dorsal aspect of the medial condyle and coincides with the area subjected to the greatest increase in subchondral bone stiffening in joint disease. © 2014 EVJ Ltd.

  3. Evaluation of First-Ray Mobility in Patients with Hallux Valgus Using Weight-Bearing CT and a 3-D Analysis System: A Comparison with Normal Feet.

    Science.gov (United States)

    Kimura, Tadashi; Kubota, Makoto; Taguchi, Tetsuya; Suzuki, Naoki; Hattori, Asaki; Marumo, Keishi

    2017-02-01

    Some physicians report that patients with hallux valgus have hypermobility at the tarsometatarsal (TMT) joint of the first ray and 3-dimensional (3-D) deformity. With use of non-weight-bearing and weight-bearing computed tomography (CT), we evaluated the 3-D mobility of each joint of the first ray in feet with hallux valgus compared with normal feet. Ten feet of 10 patients with hallux valgus and 10 feet of 10 healthy volunteers with no foot disorders were examined. All participants were women. Weight-bearing (a load equivalent to body weight) and non-weight-bearing CT scans were made with use of a device that we developed. Orthogonal coordinate axes were set and a 3-D model was reconstructed. Each joint of the first ray was aligned with the respective proximal bone, and 3-D displacement of the distal bone relative to the proximal bone under loading was quantified. At the talonavicular joint, significantly greater dorsiflexion of the navicular relative to the talus was observed in the hallux valgus group compared with the control group. At the medial cuneonavicular joint, the hallux valgus group showed significantly greater eversion and abduction of the medial cuneiform relative to the navicular. At the first TMT joint, the hallux valgus group showed significantly greater dorsiflexion, inversion, and adduction of the first metatarsal relative to the medial cuneiform. At the first metatarsophalangeal joint, the hallux valgus group showed significantly greater eversion and abduction of the first proximal phalanx relative to the first metatarsal (all p hallux valgus.

  4. Preliminary Results and Learning Curve of the Minimally Invasive Chevron Akin Operation for Hallux Valgus.

    Science.gov (United States)

    Jowett, Charlie R J; Bedi, Harvinder S

    Minimally invasive surgery is increasing in popularity. It is relevant in hallux valgus surgery owing to the potential for reduced disruption of the soft tissues and improved wound healing. We present our results and assess the learning curve of the minimally invasive Chevron Akin operation for hallux valgus. A total of 120 consecutive feet underwent minimally invasive Chevron Akin for symptomatic hallux valgus, of which 14 were excluded. They were followed up for a mean of 25 (range 18 to 38) months. The patients were clinically assessed using the American Orthopaedic Foot and Ankle Society score. Complications and patient satisfaction were recorded. The radiographs were analyzed and measurements recorded for hallux valgus and intermetatarsal angle correction. The mean age of the patients undergoing surgery was 55 (range 25 to 81) years. Of the 78 patients, 76 (97.4%) were female and 2 (2.6%) were male; 28 (35.9%) cases were bilateral. The mean American Orthopaedic Foot and Ankle Society score improved from 56 (range 23 to 76) preoperatively to 87 (range 50 to 100) postoperatively (p technique. They display a steep associated learning curve. However, the results are promising, and the learning curve is comparable to that for open hallux valgus surgery. Copyright © 2017 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  5. Triple osteotomy for the correction of severe hallux valgus deformity: Patient reported outcomes and radiological evaluation.

    Science.gov (United States)

    Booth, Sean; Bhosale, Abhijit; Mustafa, Abubakar; Shenoy, Ravi; Pillai, Anand

    2016-08-01

    Symptomatic Hallux valgus can be treated with metatarsal osteotomy combined with proximal phalangeal osteotomy, however this might not be sufficient to treat severe HV deformities. Fifteen feet in eleven female patients treated with double first metatarsal and proximal phalanx osteotomies without lateral release were prospectively studied and outcome measures including radiological angles and validated patient reported outcome scores collected. Mean radiological follow up was 15 months and PROMs data 17 months. Mean hallux valgus and intermetatarsal angles were corrected from 45 to 24.7° and 18.7 to 7.4° respectively. There was an eight degree recurrence of hallux valgus angle. There was no wound problems, non-unions or evidence of avascular necrosis. The EQ-5D descriptive index showed a non-statistically significant improvement. All three elements of the MOxFQ score showed a statistically significant improvement: Forefoot pain (59-26.8), Walking and Stability (49.9-29.6) and Social Interaction (56.4-33.1) CONCLUSION: Triple osteotomy, without a lateral soft tissue release, leads to good radiological and functional outcomes in those with severe hallux valgus deformity. Patients need to be warned of the recovery time and potential for future metalwork removal. The risk of early recurrence suggests that a lateral release should be included in order to maintain a long lasting correction. Copyright © 2016 Elsevier Ltd. All rights reserved.

  6. Dynamic strength of rock with single planar joint under various loading rates at various angles of loads applied

    Directory of Open Access Journals (Sweden)

    Pei-Yun Shu

    2018-06-01

    Full Text Available Intact rock-like specimens and specimens that include a single, smooth planar joint at various angles are prepared for split Hopkinson pressure bar (SHPB testing. A buffer pad between the striker bar and the incident bar of an SHPB apparatus is used to absorb some of the shock energy. This can generate loading rates of 20.2–4627.3 GPa/s, enabling dynamic peak stresses/strengths and associated failure patterns of the specimens to be investigated. The effects of the loading rate and angle of load applied on the dynamic peak stresses/strengths of the specimens are examined. Relevant experimental results demonstrate that the failure pattern of each specimen can be classified as four types: Type A, integrated with or without tiny flake-off; Type B, slide failure; Type C, fracture failure; and Type D, crushing failure. The dynamic peak stresses/strengths of the specimens that have similar failure patterns increase linearly with the loading rate, yielding high correlations that are evident on semi-logarithmic plots. The slope of the failure envelope is the smallest for slide failure, followed by crushing failure, and that of fracture failure is the largest. The magnitude of the plot slope of the dynamic peak stress against the loading rate for the specimens that are still integrated after testing is between that of slide failure and crushing failure. The angle of application has a limited effect on the dynamic peak stresses/strengths of the specimens regardless of the failure pattern, but it affects the bounds of the loading rates that yield each failure pattern, and thus influences the dynamic responses of the single jointed specimen. Slide failure occurs at the lowest loading rate of any failure, but can only occur in single jointed specimen that allows sliding. Crushing failure is typically associated with the largest loading rate, and fracture failure may occur when the loading rate is between the boundaries for slide failure and crushing

  7. Provocative mechanical tests of the peripheral nervous system affect the joint torque-angle during passive knee motion.

    Science.gov (United States)

    Andrade, R J; Freitas, S R; Vaz, J R; Bruno, P M; Pezarat-Correia, P

    2015-06-01

    This study aimed to determine the influence of the head, upper trunk, and foot position on the passive knee extension (PKE) torque-angle response. PKE tests were performed in 10 healthy subjects using an isokinetic dynamometer at 2°/s. Subjects lay in the supine position with their hips flexed to 90°. The knee angle, passive torque, surface electromyography (EMG) of the semitendinosus and quadriceps vastus medialis, and stretch discomfort were recorded in six body positions during PKE. The different maximal active positions of the cervical spine (neutral; flexion; extension), thoracic spine (neutral; flexion), and ankle (neutral; dorsiflexion) were passively combined for the tests. Visual analog scale scores and EMG were unaffected by body segment positioning. An effect of the ankle joint was verified on the peak torque and knee maximum angle when the ankle was in the dorsiflexion position (P torque (P torque when the cervical and thoracic spines were flexed (P torque-angle response since different positions of head, upper trunk, and foot induce dissimilar knee mechanical responses during passive extension. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  8. Joint angle and Doppler frequency estimation of coherent targets in monostatic MIMO radar

    Science.gov (United States)

    Cao, Renzheng; Zhang, Xiaofei

    2015-05-01

    This paper discusses the problem of joint direction of arrival (DOA) and Doppler frequency estimation of coherent targets in a monostatic multiple-input multiple-output radar. In the proposed algorithm, we perform a reduced dimension (RD) transformation on the received signal first and then use forward spatial smoothing (FSS) technique to decorrelate the coherence and obtain joint estimation of DOA and Doppler frequency by exploiting the estimation of signal parameters via rotational invariance techniques (ESPRIT) algorithm. The joint estimated parameters of the proposed RD-FSS-ESPRIT are automatically paired. Compared with the conventional FSS-ESPRIT algorithm, our RD-FSS-ESPRIT algorithm has much lower complexity and better estimation performance of both DOA and frequency. The variance of the estimation error and the Cramer-Rao Bound of the DOA and frequency estimation are derived. Simulation results show the effectiveness and improvement of our algorithm.

  9. Valgus ümber kodu / Madis Tross

    Index Scriptorium Estoniae

    Tross, Madis

    2003-01-01

    Thorn Lighting Eesti filiaali juhataja Aivar Simmermann ja firma Moodne Valgustus projektijuht Ahto Kallas aia kujundamisest valguse abil. Soovitusi välisvalgustite valikuks ja ökonoomseks kasutamiseks

  10. First Metatarsophalangeal Contact Properties Following Proximal Opening Wedge and Scarf Osteotomies for Hallux Valgus Correction: A Biomechanical Study.

    Science.gov (United States)

    Kia, Cameron; Yoshida, Ryu; Cote, Mark; DiVenere, Jessica; Geaney, Lauren E

    2017-04-01

    Proximal opening wedge osteotomy (POWO) is an established procedure for moderate to severe hallux valgus. A common concern of this procedure is that it results in lengthening of the first metatarsal, which could cause increased intra-articular pressure of the first metatarsophalangeal joint (MTP) and may ultimately lead to arthritis because of these altered mechanics. The purpose of this study was to use a cadaveric model to compare intra-articular pressures and articulating contact properties of the MTP joint following either scarf osteotomy or POWO. Fresh-frozen cadaveric below-knee specimens with pre-existing hallux valgus (n = 12) and specimens without hallux valgus (n = 6, control group) were used. The hallux valgus specimens were stratified into 2 groups (n = 6 each): POWO or scarf osteotomy. The groups were matched based on the degree of deformity. Peak intra-articular pressure, force, and area were measured in all normal, preoperative, and postoperative specimens with a simulated weightbearing model. These measurements were made with a pressure transducer placed within the first MTP joint. Postoperatively POWO group had slightly higher contact forces and pressures compared to the scarf group and lower contact forces and pressures than those of the normal group but were not statistically significant ( P > .05). Normal specimens had higher intra-articular force, pressure, and area than postoperative specimens but the difference was not found to be significant. First metatarsal lengthening was found in both the scarf and POWO specimens; however, neither increase was found to be significant ( P > .05). The results from this study show that after operative correction, contact properties of the fist MTP joint among normal, POWO, and scarf osteotomy groups revealed no significant differences. First MTP joints in those with hallux valgus had significantly lower contact force and pressure compared to those without hallux valgus. With little long-term outcomes of

  11. [Surgical technique and clinical results of total knee arthroplasty in treating endstage gonarthrosis combined with valgus knee deformity].

    Science.gov (United States)

    Wang, Xingshan; Weng, Xisheng; Lin, Jin; Jin, Jin; Qian, Wenwei

    2012-05-01

    To investigate the surgical technique and the clinical results of total knee arthroplasty (TKA) in treating end-stage gonarthrosis combined with valgus knee deformity. Between November 1998 and October 2010, 64 patients (72 knees) with end-stage gonarthrosis combined with valgus knee deformity underwent TKA by a medial parapatellar approach. Of the 64 patients, 18 were male and 46 were female with an average age of 62.5 years (range, 23-82 years), including 44 cases (49 knees) of osteoarthritis, 17 cases (20 knees) of rheumatoid arthritis, 2 cases (2 knees) of haemophilic arthritis, and 1 case (1 knee) of post-traumatic arthritis. Bilateral knees were involved in 8 cases, and single knee in 56 cases. The flexion and extension range of motion (ROM) of the knee joint was (82.2 +/- 28.7) degrees; the femur-tibia angle (FTA) was (18.0 +/- 5.8) degrees; according to Knee Society Score (KSS) criterion, the preoperative clinical score was 31.2 +/- 10.1 and functional score was 37.3 +/- 9.0. According to Krackow's classification, there were 65 knees of type I and 7 knees of type II. By medial parapatellar approach, conventional osteotomy and Ranawat soft tissue release were performed in all cases. Prosthesis of preserved posterior cruciate ligament were used in 7 cases (7 knees), posterior stabilize prosthesis in 54 cases (60 knees), constrained prosthesis in 4 cases (5 knees). Incisions healed by first intention in all cases. Peroneal nerve palsy occurred in 1 patient with haemophilic arthritis, severe valgus deformity (FTA was 41 degrees), and flexion contracture (20 degrees), which was cured after 1 year of conservative treatment. Revison surgery was performed in 1 case of deep infection at 2 years after surgery. All the patients were followed up 4.9 years on average (range, 1-13 years). At last follow-up, the FTA was (7.0 +/- 2.5) degrees, showing significant difference when compared with preoperative value (t = 15.502, P = 0.000). The KSS clinical score was 83.0 +/- 6

  12. Continuous Estimation of Human Multi-Joint Angles From sEMG Using a State-Space Model.

    Science.gov (United States)

    Ding, Qichuan; Han, Jianda; Zhao, Xingang

    2017-09-01

    Due to the couplings among joint-relative muscles, it is a challenge to accurately estimate continuous multi-joint movements from multi-channel sEMG signals. Traditional approaches always build a nonlinear regression model, such as artificial neural network, to predict the multi-joint movement variables using sEMG as inputs. However, the redundant sEMG-data are always not distinguished; the prediction errors cannot be evaluated and corrected online as well. In this work, a correlation-based redundancy-segmentation method is proposed to segment the sEMG-vector including redundancy into irredundant and redundant subvectors. Then, a general state-space framework is developed to build the motion model by regarding the irredundant subvector as input and the redundant one as measurement output. With the built state-space motion model, a closed-loop prediction-correction algorithm, i.e., the unscented Kalman filter (UKF), can be employed to estimate the multi-joint angles from sEMG, where the redundant sEMG-data are used to reject model uncertainties. After having fully employed the redundancy, the proposed method can provide accurate and smooth estimation results. Comprehensive experiments are conducted on the multi-joint movements of the upper limb. The maximum RMSE of the estimations obtained by the proposed method is 0.16±0.03, which is significantly less than 0.25±0.06 and 0.27±0.07 (p < 0.05) obtained by common neural networks.

  13. The impact of office chair features on lumbar lordosis, intervertebral joint and sacral tilt angles: a radiographic assessment.

    Science.gov (United States)

    De Carvalho, Diana; Grondin, Diane; Callaghan, Jack

    2017-10-01

    The purpose of this study was to determine which office chair feature is better at improving spine posture in sitting. Participants (n = 28) were radiographed in standing, maximum flexion and seated in four chair conditions: control, lumbar support, seat pan tilt and backrest with scapular relief. Measures of lumbar lordosis, intervertebral joint angles and sacral tilt were compared between conditions and sex. Sitting consisted of approximately 70% of maximum range of spine flexion. No differences in lumbar flexion were found between the chair features or control. Significantly more anterior pelvic rotation was found with the lumbar support (p = 0.0028) and seat pan tilt (p < 0.0001). Males had significantly more anterior pelvic rotation and extended intervertebral joint angles through L1-L3 in all conditions (p < 0.0001). No one feature was statistically superior with respect to minimising spine flexion, however, seat pan tilt resulted in significantly improved pelvic posture. Practitioner Summary: Seat pan tilt, and to some extent lumbar supports, appear to improve seated postures. However, sitting, regardless of chair features used, still involves near end range flexion of the spine. This will increase stresses to the spine and could be a potential injury generator during prolonged seated exposures.

  14. Relationship Between Displacement and Degenerative Changes of the Sesamoids in Hallux Valgus.

    Science.gov (United States)

    Katsui, Ryuhei; Samoto, Norihiro; Taniguchi, Akira; Akahane, Manabu; Isomoto, Shinji; Sugimoto, Kazuya; Tanaka, Yasuhito

    2016-12-01

    Although the tangential sesamoid view is used to visualize the sesamoid position relative to the first metatarsal head, correctly evaluating patients with severe varus of the first metatarsal is difficult. Computed tomography (CT) can be helpful due to its cross-sectional images in any plane. The purposes of this study were to evaluate the alignment of the tibial sesamoid and investigate the relationship between malalignment and degenerative change in the sesamoid metatarsal joint (SMJ) using simulated weight-bearing CT imaging in patients with hallux valgus. In total, 269 feet from 142 patients with hallux valgus were included. The mean age was 63.7 years (range, 33-87 years). An anteroposterior weight-bearing radiograph was assessed for sesamoid position into 3 grades: grade 1, the tibial sesamoid was medial to the axis of the first metatarsal; grade 2, the tibial sesamoid was located below the first metatarsal axis; and grade 3, the tibial sesamoid was lateral to the first metatarsal axis. The hallux valgus and intermetatarsal angles (HVA and IMA, respectively) were measured. The lateral shift of the tibial sesamoid relative to the first metatarsal was classified into 3 grades on simulated weight-bearing CT classification: grade 1, tibial sesamoid was entirely medial to the intersesamoid ridge; grade 2, tibial sesamoid was subluxated laterally but located below the intersesamoid ridge; and grade 3, tibial sesamoid was located entirely lateral to the intersesamoid ridge. The differences of HVA and IMA in each grade were confirmed by using 1-way analysis of variance with Bonferroni post hoc corrections. Furthermore, multiple linear regression analysis was used to predict the degenerative change in the SMJ for age, sex, sesamoid position determined by CT or plain radiography, HVA, and IMA. The χ 2 test was used for descriptive statistics to analyze the agreement between radiography or CT classifications of sesamoid position against degenerative change in the SMJ

  15. Effectiveness of the custom-mold room temperature vulcanizing silicone toe separator on hallux valgus: A prospective, randomized single-blinded controlled trial.

    Science.gov (United States)

    Chadchavalpanichaya, Navaporn; Prakotmongkol, Voraluck; Polhan, Nattapong; Rayothee, Pitchaya; Seng-Iad, Sirirat

    2018-04-01

    Silicone toe separator is considered as a conservative treatment for hallux valgus. The prefabricated toe separator does not fit all. However, effectiveness in prescription of the custom-mold toe separator is still unknown. To investigate the effect of using a custom-mold room temperature vulcanizing silicone toe separator to decrease hallux valgus angle and hallux pain. The compliances, complications, and satisfactions of toe separator were also explored. A prospective, randomized single-blinded controlled trial. A total of 90 patients with a moderate degree of hallux valgus were enrolled in a study at the Foot Clinic, Siriraj Hospital, Thailand. Patients were randomized into two groups; the study group was prescribed a custom-mold room temperature vulcanizing silicone toe separator for 6 h per night for 12 months. Patients in both groups received proper foot care and shoes and were permitted to continue drug treatment. In total, 40 patients in the study group and 39 patients in the control group completed the study. The hallux valgus angle was obtained through radiographic measurement. At month 12, both groups had significant differences in mean hallux valgus angle with a decrease of 3.3° ± 2.4° for the study group and increase of 1.9° ± 1.9° for the control group. There were statistically significant differences of hallux valgus angle between the two groups ( p Hallux pain was decreased in the study group. A custom-mold room temperature vulcanizing silicone toe separator can decrease hallux valgus angle and pain with no serious complications. Clinical relevance The custom-mold room temperature vulcanizing silicone toe separator for treatment of hallux valgus reduces deformity and hallux pain.

  16. Elbow joint instability

    DEFF Research Database (Denmark)

    Olsen, Bo Sanderhoff; Henriksen, M G; Søjbjerg, Jens Ole

    1994-01-01

    The effect of simultaneous ulnar and radial collateral ligament division on the kinematics of the elbow joint is studied in a cadaveric model. Severance of the anterior part of the ulnar collateral ligament and the annular ligament led to significant elbow joint instability in valgus and varus...

  17. Velocities and joint angles during double backward stretched salto performed with stable landing and in combination with tempo salto

    Directory of Open Access Journals (Sweden)

    J Sadowski

    2009-07-01

    Full Text Available The aim of the study was to compare the values of velocity an joint angles obtained during performance of double salto backward stretched with a stable landing and its combination with salto tempo. Seven top level acrobats (track jumpers participated in study. Mean values of body height, mass and age had a value of: 170 cm ± 4.0 cm, 72.4 kg ± 3.6 kg, 20.4±1.7 years, respectively. The studies were conducted on a standard acrobatic path (type PTS 2000. Two digital video cameras (240 Hz and APAS 2000 (Ariel Dynamics Inc. were used during studies. Markers were placed in ankle, knee, hip, arm, elbow and wrist joints. All marker positions were tracked and reconstructed using the APAS system. Two sequences with the following elements were analysed: round-off - double salto backward stretched (A and round-off - double salto backward stretched - tempo salto (B. The highest differences between the key components describing performance of presented exercises exist for joint angles during launching and landing position, and resultant velocities during touchdown. In version A the athlete created prerequisites for “gliding” double salto backward stretched by means of the body segments motions, whereas in version B he executes faster motions of the body segments accentuating his actions upon backward rotation of the body. During the final phase of double salto backward stretched in combination with tempo salto the athlete performed courbette “under himself” (almost straight feet are placed in front of vertical line, pushes directly back and in 0,1 s executes stable arm swing upward-backward to tempo salto.

  18. In-vivo imaging of the sentinel vein using the near-infrared vascular imaging system in hallux valgus patients.

    Science.gov (United States)

    Nakasa, Tomoyuki; Ishikawa, Masakazu; Ikuta, Yasunari; Yoshikawa, Masahiro; Sawa, Mikiya; Tsuyuguchi, Yusuke; Adachi, Nobuo

    2017-11-01

    A high incidence of dorsomedial cutaneous nerve (DMCN) damage in hallux valgus surgery has been reported. Identification of the vein around 1st metatarsal head is reported to be helpful to reduce the DMCN damage during surgery. The near-infrared (NIR) vascular imaging system, the VeinViewer ® Flex, projects the vein onto the skin. The purpose of this study was to investigate the difference of the vein course between normal and hallux valgus foot using the VeinViewer ® Flex, and to validate that the DMCN was accompanied with its vein. Twenty-seven feet with the hallux valgus and 27 feet in healthy subjects were included. The vein was projected onto the skin at the metatarsal head by the VeinViewer ® Flex. The distance between the vein and the mid-line of the metatarsal head was measured. The correlation of the distance and hallux valgus angle or 1-2 intermetatarsal angle (IMA) was analyzed. The vein depicted by the VeinViewer ® Flex and operative findings was compared in 4 patients during surgery. The vein in the hallux valgus patients shifted toward the dorsolateral side on the metatarsal bone head compared to that in healthy subjects. The distance from the midline of the 1st metatarsal bone to the vein in the hallux valgus (12.1 mm) was significantly higher than that in healthy subjects (2.7 mm) (p hallux valgus patients shifted toward the dorsolateral on the metatarsal bone and it could be a landmark to identify DMCN. The NIR vascular imaging system would be useful to reduce the risk of nerve damage in great toe surgery. Copyright © 2017 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved.

  19. Effect of the sagittal ankle angle at initial contact on energy dissipation in the lower extremity joints during a single-leg landing.

    Science.gov (United States)

    Lee, Jinkyu; Song, Yongnam; Shin, Choongsoo S

    2018-05-01

    During landing, the ankle angle at initial contact (IC) exhibits relatively wide individual variation compared to the knee and hip angles. However, little is known about the effect of different IC ankle angles on energy dissipation. The purpose of this study was to investigate the relationship between individual ankle angles at IC and energy dissipation in the lower extremity joints. Twenty-seven adults performed single-leg landings from a 0.3-m height. Kinetics and kinematics of the lower extremity joints were measured. The relationship between ankle angles at IC and negative work, range of motion, the time to peak ground reaction force, and peak loading rate were analyzed. The ankle angle at IC was positively correlated with ankle negative work (r = 0.80, R 2  = 0.64, p angle was negatively correlated with hip negative work (r = -0.46, R 2  = 0.21, p = 0.01) and the contribution of the hip to total negative work (r = -0.61, R 2  = 0.37, p angle at IC. The ankle angle at IC was positively correlated with total negative work (r = 0.50, R 2  = 0.25, p angle at IC increased, such that the ankle energy dissipation increased and redistributed the energy dissipation in the ankle and hip joints. Further, these results suggest that increased ankle energy dissipation with a higher IC plantar flexion angle may be a potential landing technique for reducing the risk of injury to the anterior cruciate ligament and hip musculature. Copyright © 2018 Elsevier B.V. All rights reserved.

  20. SURGICAL TREATMENT OF HALLUX VALGUS AND ITS POSSIBLE COMPLICATIONS (REVIEW

    Directory of Open Access Journals (Sweden)

    E. P. Sorokin

    2011-01-01

    Full Text Available Hallux valgus surgery remains the most important direction of modern orthopedics. In this article authors analyzed the history of Hallux valgus surgical treatment development observing the details of different types of methods directing on various pathogenic parts of pathology as well as complications occurring with different types of methods. Main tendencies of development and improvements of hallux valgus surgery are described.

  1. EFFICACY OF BILATERAL SIMULTANEOUS HALLUX VALGUS CORRECTION COMPARED TO UNILATERAL

    Directory of Open Access Journals (Sweden)

    A. V. Boychenko

    2014-01-01

    Full Text Available The aim - to compare the results of simultaneous bilateral and unilateral surgical correction of hallux valgus and to create recommendations for treatment of the patients with this pathology. Material and methods. The authorse analyzed the data of 40 patients (60 feet who carried out an operative treatment of hallux valgus in SPb multiprofile city hospital N 2 since 2011 to 2013. Functional (AOFAS score and X-ray results were compared between groups with bilateral and unilateral correction. Mean AOFAS score in these 2 groups after 12 months after surgery was 85,6±6,2 and 85,5±6,9 (p>0,05, mean intermetatarsal angle - 8,4±0,5° and 8,8±0,8° (p>0,05 respectively. No statistically significant difference between these two groups was found. Conclusion. A bigger surgical trauma in case of simultaneous bilateral correction neither worsens functional and x-ray results nor increases a complication rate.

  2. Minimally invasive distal first metatarsal osteotomy can be an option for recurrent hallux valgus.

    Science.gov (United States)

    Magnan, Bruno; Negri, Stefano; Maluta, Tommaso; Dall'Oca, Carlo; Samaila, Elena

    2018-01-12

    Recurrence rate of surgical treatment of hallux valgus ranges in the literature from 2.7% to 16%, regardless of used procedure. In this study, long-term results of a minimally invasive distal osteotomy of the first metatarsal bone for treatment of recurrent hallux valgus are described. 32 consecutive percutaneous distal osteotomies of the first metatarsal were performed in 26 patients for treatment of recurrent hallux valgus. Primary surgery had been soft tissue procedures in 8 cases (25%), first metatarsal or phalangeal osteotomies in 19 cases (59.4%) and Keller procedures in 5 cases (15.6%). Patients were assessed with a mean follow-up of 9.8±4.3 years. All patients reported the disappearance or reduction of the pain. The mean overall AOFAS score improved from 46.9±17.8 points to 85.2±14.9 at final follow-up. The mean hallux valgus angle decreased from 26.1±9.1 to 9.7±5.4°, the intermetatarsal angle decreased from 11.5±4.5 to 6.7±4.0°. No major complications were recorded with a re-recurrence rate of 3.1% (1 case). Percutaneous distal osteotomy of the first metatarsal can be a reliable and safe surgical option in the recurrent hallux valgus with low complication rate and the advantages of a minimally invasive surgery. IV, Retrospective Case Series. Copyright © 2018 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.

  3. [Hallux valgus : Etiology, diagnosis, and therapeutic principles].

    Science.gov (United States)

    Zirngibl, B; Grifka, J; Baier, C; Götz, J

    2017-03-01

    Hallux valgus-the most common forefoot deformity-can cause both pain and decreased mobility. The development and progress of the hallux valgus is a multifactorial process. Different intrinsic and extrinsic causes are responsible. Various conservative and operative treatment options exist and have to been chosen regarding the stage of the disease. Conservative orthopedic measures may prevent a deterioration of hallux valgus only at an early stage of the disease. Concerning operative techniques, more than 150 different surgical procedures are described in the literature, which can be reduced to some common procedures. These are dependent on the manifestation of the bunion as well as on associated foot and ankle pathologies. Patients should be informed that postoperative follow-up treatment until complete recovery is time-consuming.

  4. The effect of ball impact location on racket and forearm joint angle changes for one-handed tennis backhand groundstrokes.

    Science.gov (United States)

    King, Mark; Hau, Agnes; Blenkinsop, Glen

    2017-07-01

    Recreational tennis players tend to have higher incidence of tennis elbow, and this has been hypothesised to be related to one-handed backhand technique and off-centre ball impacts on the racket face. This study aimed to investigate for a range of participants the effect of off-longitudinal axis and off-lateral axis ball-racket impact locations on racket and forearm joint angle changes immediately following impact in one-handed tennis backhand groundstrokes. Three-dimensional racket and wrist angular kinematic data were recorded for 14 university tennis players each performing 30 "flat" one-handed backhand groundstrokes. Off-longitudinal axis ball-racket impact locations explained over 70% of the variation in racket rotation about the longitudinal axis and wrist flexion/extension angles during the 30 ms immediately following impact. Off-lateral axis ball-racket impact locations had a less clear cut influence on racket and forearm rotations. Specifically off-longitudinal impacts below the longitudinal axis forced the wrist into flexion for all participants with there being between 11° and 32° of forced wrist flexion for an off-longitudinal axis impact that was 1 ball diameter away from the midline. This study has confirmed that off-longitudinal impacts below the longitudinal axis contribute to forced wrist flexion and eccentric stretch of the wrist extensors and there can be large differences in the amount of forced wrist flexion from individual to individual and between strokes with different impact locations.

  5. OpenSim Model Improvements to Support High Joint Angle Resistive Exercising

    Science.gov (United States)

    Gallo, Christopher; Thompson, William; Lewandowski, Beth; Humphreys, Brad

    2016-01-01

    Long duration space travel to Mars or to an asteroid will expose astronauts to extended periods of reduced gravity. Since gravity is not present to aid loading, astronauts will use resistive and aerobic exercise regimes for the duration of the space flight to minimize the loss of bone density, muscle mass and aerobic capacity that occurs during exposure to a reduced gravity environment. Unlike the International Space Station (ISS), the area available for an exercise device in the next generation of spacecraft is limited. Therefore, compact resistance exercise device prototypes are being developed. The Advanced Resistive Exercise Device (ARED) currently on the ISS is being used as a benchmark for the functional performance of these new devices. Rigorous testing of these proposed devices in space flight is difficult so computational modeling provides an estimation of the muscle forces and joint loads during exercise to gain insight on the efficacy to protect the musculoskeletal health of astronauts. The NASA Digital Astronaut Project (DAP) is supporting the Advanced Exercise Concepts (AEC) Project, Exercise Physiology and Countermeasures (ExPC) project and the National Space Biomedical Research Institute (NSBRI) funded researchers by developing computational models of exercising with these new advanced exercise device concepts

  6. A unitary ESPRIT scheme of joint angle estimation for MOTS MIMO radar.

    Science.gov (United States)

    Wen, Chao; Shi, Guangming

    2014-08-07

    The transmit array of multi-overlapped-transmit-subarray configured bistatic multiple-input multiple-output (MOTS MIMO) radar is partitioned into a number of overlapped subarrays, which is different from the traditional bistatic MIMO radar. In this paper, a new unitary ESPRIT scheme for joint estimation of the direction of departure (DOD) and the direction of arrival (DOA) for MOTS MIMO radar is proposed. In our method, each overlapped-transmit-subarray (OTS) with the identical effective aperture is regarded as a transmit element and the characteristics that the phase delays between the two OTSs is utilized. First, the measurements corresponding to all the OTSs are partitioned into two groups which have a rotational invariance relationship with each other. Then, the properties of centro-Hermitian matrices and real-valued rotational invariance factors are exploited to double the measurement samples and reduce computational complexity. Finally, the close-formed solution of automatically paired DOAs and DODs of targets is derived in a new manner. The proposed scheme provides increased estimation accuracy with the combination of inherent advantages of MOTS MIMO radar with unitary ESPRIT. Simulation results are presented to demonstrate the effectiveness and advantage of the proposed scheme.

  7. Passive stiffness of monoarticular lower leg muscles is influenced by knee joint angle.

    Science.gov (United States)

    Ateş, Filiz; Andrade, Ricardo J; Freitas, Sandro R; Hug, François; Lacourpaille, Lilian; Gross, Raphael; Yucesoy, Can A; Nordez, Antoine

    2018-03-01

    While several studies demonstrated the occurrence of intermuscular mechanical interactions, the physiological significance of these interactions remains a matter of debate. The purpose of this study was to quantify the localized changes in the shear modulus of the gastrocnemius lateralis (GL), monoarticular dorsi- and plantar-flexor muscles induced by a change in knee angle. Participants underwent slow passive ankle rotations at the following two knee positions: knee flexed at 90° and knee fully extended. Ultrasound shear wave elastography was used to assess the muscle shear modulus of the GL, soleus [both proximally (SOL-proximal) and distally (SOL distal)], peroneus longus (PERL), and tibialis anterior (TA). This was performed during two experimental sessions (experiment I: n = 11; experiment II: n = 10). The shear modulus of each muscle was compared between the two knee positions. The shear modulus was significantly higher when the knee was fully extended than when the knee was flexed (P passive muscle force, these results provide evidence of a non-negligible intermuscular mechanical interaction between the human lower leg muscles during passive ankle rotations. The role of these interactions in the production of coordinated movements requires further investigation.

  8. Foot pain and functional limitation in healthy adults with hallux valgus: a cross-sectional study

    Directory of Open Access Journals (Sweden)

    Nix Sheree E

    2012-10-01

    Full Text Available Abstract Background Hallux valgus (HV is a very common deformity of the first metatarsophalangeal joint that often requires surgical correction. However, the association between structural HV deformity and related foot pain and disability is unclear. Furthermore, no previous studies have investigated concerns about appearance and difficulty with footwear in a population with HV not seeking surgical correction. The aim of this cross-sectional study was to investigate foot pain, functional limitation, concern about appearance and difficulty with footwear in otherwise healthy adults with HV compared to controls. Methods Thirty volunteers with HV (radiographic HV angle >15 degrees and 30 matched controls were recruited for this study (50 women, 10 men; mean age 44.4 years, range 20 to 76 years. Differences between groups were examined for self-reported foot pain and disability, satisfaction with appearance, footwear difficulty, and pressure-pain threshold at the first metatarsophalangeal joint. Functional measures included balance tests, walking performance, and hallux muscle strength (abduction and plantarflexion. Mean differences (MD and 95% confidence intervals (CI were calculated. Results All self-report measures showed that HV was associated with higher levels of foot pain and disability and significant concerns about appearance and footwear (p Conclusions These findings show that HV negatively impacts on self-reported foot pain and function, and concerns about foot appearance and footwear in otherwise healthy adults. There was also evidence of impaired hallux muscle strength and increased postural sway in HV subjects compared to controls, although general physical functioning and participation in physical activity were not adversely affected.

  9. No midterm benefit from low intensity pulsed ultrasound after chevron osteotomy for hallux valgus.

    Science.gov (United States)

    Zacherl, Max; Gruber, Gerald; Radl, Roman; Rehak, Peter H; Windhager, Reinhard

    2009-08-01

    Chevron osteotomy is a widely accepted method for correction of symptomatic hallux valgus deformity. Full weight bearing in regular shoes is not recommended before 6 weeks after surgery. Low intensity pulsed ultrasound is known to stimulate bone formation leading to more stable callus and faster bony fusion. We performed a randomized, placebo-controlled, double-blinded study on 44 participants (52 feet) who underwent chevron osteotomy to evaluate the influence of daily transcutaneous low intensity pulsed ultrasound (LIPUS) treatment at the site of osteotomy. Follow-up at 6 weeks and 1 year included plain dorsoplantar radiographs, hallux-metatarsophalangeal-interphalangeal scale and a questionnaire on patient satisfaction. There was no statistical difference in any pre- or postoperative clinical features, patient satisfaction or radiographic measurements (hallux valgus angle, intermetatarsal angle, sesamoid index and metatarsal index) except for the first distal metatarsal articular angle (DMAA). The DMAA showed statistically significant (p = 0.046) relapse in the placebo group upon comparison of intraoperative radiographs after correction and fixation (5.2 degrees) and at the 6-week follow-up (10.6 degrees). Despite potential impact of LIPUS on bone formation, we found no evidence of an influence on outcome 6 weeks and 1 year after chevron osteotomy for correction of hallux valgus deformity.

  10. Results of Lindgren-Turan Operation in Hallux Valgus

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    İstemi YÜCEL,

    2010-05-01

    Full Text Available Purpose: We evaluated the results of the Lindgren-Turan operation in the treatment of halluxvalgus.Methods: 24 feet of 18 patients were operated by the Lindgren-Turan osteotomy. Radiological,functional and pain assessments were applied to all patients.Results: Treatment produced a statistically highly significant difference in the hallux valgusangle and 1.-2.intermetatarsal angle (p0.001. Themean subjective evaluations of the patients were 8.43±0.72.Conclusion: We conclude that Lindgren-Turan osteotomy which revealed successful results onpain, deformity correction and bone healing and also provided high personal satisfaction, is areliable technique in the surgical correction of hallux valgus

  11. Valguse ja varjupooled Endla Teatrigaleriis / Rica Semjonova

    Index Scriptorium Estoniae

    Semjonova, Rica

    2004-01-01

    3. mail avati Pärnu Endla Teatrigaleriis Nerva näitus "Valguse varjus", peale näituse avamist oli kõigil võimalus Küüni saalis vaadata Priit Valkna dokumentaalfilmi "Hunt", mis valminud ETV sarjale "Eesti lood"

  12. Radiographic Outcomes of Postoperative Taping Following Hallux Valgus Correction.

    Science.gov (United States)

    Ponzio, Danielle Y; Pedowitz, David I; Verma, Kushagra; Maltenfort, Mitchell G; Winters, Brian S; Raikin, Steven M

    2015-07-01

    Traditionally, hallux valgus operative correction has been accompanied by serial spica taping of the great toe during the postoperative period. We retrospectively reviewed 187 adult patients who underwent proximal first metatarsal osteotomy with a modified McBride procedure in 2008-2009 (n = 83) and 2011-2012 (n = 104). Postoperatively, to maintain the corrected position of the hallux, patients from 2008 through 2009 underwent weekly spica taping, while patients from 2011 through 2012 utilized a toe separator. The hallux valgus angle (HVA) and intermetatarsal angle (IMA) were measured using anteroposterior weight-bearing preoperative, 2-week postoperative non-weight-bearing, and 3-month weight-bearing final follow-up radiographs. A mixed-effects linear regression model identified differences between the treatment groups over time, and a t test compared actual radiographic differences at final follow-up. The mixed-effects model revealed no significant difference in the HVA over time when comparing patients taped to those not taped at the preoperative (33 ± 6 vs 33 ± 6), 2-week postoperative (10 ± 7 vs 9 ± 6), and 3-month follow-up (14 ± 6 vs 11 ± 7) visits (P = .08). At final follow-up, the HVA was lower for the group that was not taped, but the difference (2.5 degrees) was below the minimal clinically important difference (MCID) (P = .015, 95% CI 0.5-4.5). For IMA, there was improved maintenance of correction over time in the patients that were not taped compared to those taped at the preoperative (15 ± 3 vs 15 ± 3), 2-week postoperative (2 ± 2 vs 3 ± 3), and 3-month follow-up (5 ± 4 vs 7 ± 4) visits (P = .002). At final follow-up, the IMA was lower for the group that was not taped, but the difference (1.7 degrees) was below the MCID (P = .004, 95% CI 0.7-2.9). We report no radiographic benefit of postoperative taping after hallux valgus correction. The present study challenges the previous dogma of postoperative spica taping as the protocol is cost and

  13. First Metatarsal Head and Medial Eminence Widths with and Without Hallux Valgus.

    Science.gov (United States)

    Lenz, Robin C; Nagesh, Darshan; Park, Hannah K; Grady, John

    2016-09-02

    Resection of the medial eminence in hallux valgus surgery is common. True hypertrophy of the medial eminence in hallux valgus is debated. No studies have compared metatarsal head width in patients with hallux valgus and control patients. We reviewed 43 radiographs with hallux valgus and 27 without hallux valgus. We measured medial eminence width, first metatarsal head width, and first metatarsal shaft width in patients with and without radiographic hallux valgus. Medial eminence width was 1.12 mm larger in patients with hallux valgus (P hallux valgus (P hallux valgus. However, frontal plane rotation of the first metatarsal likely accounts for this difference.

  14. Lateral Sesamoid Position Relative to the Second Metatarsal in Feet With and Without Hallux Valgus: A Prospective Study.

    Science.gov (United States)

    Geng, Xiang; Zhang, Chao; Ma, Xin; Wang, Xu; Huang, Jiazhang; Xu, Jian; Wang, Chen

    2016-01-01

    We sought to determine whether hallux valgus displaces the sesamoid bones laterally away from a stationary first metatarsal or whether the first metatarsal head is displaced medially from the stationary sesamoids, which remain in position relative to the rest of the forefoot. We reviewed weightbearing radiographs in the dorsal plantar view of 128 consecutive patients (149 feet) seen over 2 months in 2014. Of these, 82 feet (55%) had a hallux valgus angle of >15° (hallux valgus group) and 67 feet (45%) had an angle of no more than 15° (control group). We measured the absolute distances from the center of the lateral sesamoid and the first metatarsal head to the long axis of the second metatarsal. Next, the relative distances, defined as the ratio of these 2 absolute distances to the length of the second metatarsal, were calculated to adjust for foot size. Both the absolute and the relative distances from the center of the first metatarsal head to the second metatarsal differed significantly between the 2 groups and correlated positively with the hallux valgus angle and first intermetatarsal angle. However, neither the absolute nor the relative distance to the lateral sesamoid bone differed significantly between the groups, nor did they correlate with either of the 2 angles. Thus, despite medial shifting of the first metatarsal in hallux valgus, the lateral sesamoid retains its relationship to the second metatarsal in transverse plane. Its apparent lateral movement is a radiographic misinterpretation. Awareness of this misinterpretation should improve the success of corrective surgery. Copyright © 2016 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  15. Surgical treatment of hallux valgus associated with flexible flatfoot during growing age.

    Science.gov (United States)

    Faldini, Cesare; Nanni, Matteo; Traina, Francesco; Fabbri, Daniele; Borghi, Raffaele; Giannini, Sandro

    2016-04-01

    During growth, hallux valgus could present associated with flatfoot. Considering the current disagreement about correction of hallux valgus during growth and the lack of reports about simultaneous correction of hallux valgus associated with flexible flatfoot, we present simultaneous treatment of both deformities during growth combining subtalar arthroeresis and SERI first metatarsal osteotomy, reporting results at an average five-year follow-up. Thirty-two children (64 feet, age range 8-12 years) affected by hallux valgus associated with flexible flatfoot underwent surgical treatment combining SERI first metatarsal osteotomy and subtalar arthroereisis with bioabsorbable endorthotic implant. Clinical evaluation was summarized with AOFAS score, and standard standing radiographs were performed. AOFAS score ranged from 86 ± 2 to 98 ± 2 (hindfoot) and from 80 ± 4 to 98 ± 2 (forefoot). HVA ranged from 21° ± 2 to 5° ± 2, IMA from 14° ± 2 to 7° ± 2, DMAA from 18° ± 2 to 2° ± 2, and Meary's angle from 162° ± 11 to 175° ± 4. Complications included one case of delayed wound healing, inflammatory skin reaction around the outlet of the percutaneous Kirschner wire in two cases, displacement of the endorthotic implant in one case, and a second surgery to replace the implant. SERI osteotomy and subtalar arthroereisis resulted in an effective, technically simple and easily combined approach, with a high rate of good results and low rate of complications at mid-term follow-up. These techniques performed simultaneously represent a viable option in case of hallux valgus associated with flexible flatfoot during growth. Nevertheless, considering the limitations of this study, we believe that a larger case series and a longer follow-up should be desirable.

  16. The early functional outcome of Mau osteotomy for the correction of moderate-severe hallux valgus

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    Tanujan Thangarajah

    2013-11-01

    Full Text Available Hallux valgus is one of the commonest conditions of the foot and has been reported to affect nearly half of the adult population. It is most effectively treated by a corrective osteotomy of which there a numerous subtypes. The Mau osteotomy confers the greatest structural stability but is not thought to provide adequate correction of moderate-severe deformities. Accordingly, complications such as under correction and non-union are common. The aim of this study was to determine the functional outcome in patients with moderate-severe hallux valgus following a Mau osteotomy. A retrospective review of 23 patients with moderate-severe hallux valgus treated by Mau osteotomy was conducted. Patients were assessed clinically by the American Orthopedic Foot and Ankle Society (AOFAS scoring system and radiologically by measuring the first intermetatarsal (IM and hallux abductovalgus angles (HAV. The mean AOFAS score had improved from 47 preoperatively to 92 postoperatively (P<0.01. Additionally, preoperative HAV and IM angles improved from 39° and 15° respectively to 15° and 9° respectively (P<0.01. There were no cases of undercorrection or non-union. In this series, the Mau osteotomy was able to achieve good correction of the IM and HAV angles in patients with moderate-severe hallux valgus. This was reflected in a significantly higher postoperative AOFAS score. Contrary to other studies there were no cases of undercorrection and despite allowing patients to fully weight-bear postoperatively there were no cases of non-union.

  17. Comparison of the Modified McBride Procedure and the Distal Chevron Osteotomy for Mild to Moderate Hallux Valgus.

    Science.gov (United States)

    Choi, Gi Won; Kim, Hak Jun; Kim, Taik Seon; Chun, Sung Kwang; Kim, Tae Wan; Lee, Yong In; Kim, Kyoung Ho

    2016-01-01

    Distal metatarsal osteotomy and the modified McBride procedure have each been used for the treatment of mild to moderate hallux valgus. However, few studies have compared the results of these 2 procedures for mild to moderate hallux valgus. The purpose of the present study was to compare the results of distal chevron osteotomy and the modified McBride procedure for treatment of mild to moderate hallux valgus according to the severity of the deformity. We analyzed the data from 45 patients (49.5%; 48 feet [49.0%]), who had undergone an isolated modified McBride procedure (McBride group), and 46 patients (50.5%; 50 feet [51.0%]), who had a distal chevron osteotomy (chevron group). We subdivided each group into those with mild and moderate deformity and compared the clinical and radiologic outcomes between the groups in relation to the severity of the deformity. The improvements in the American Orthopaedic Foot and Ankle Society scale score and the visual analog scale for pain were significantly better for the chevron group for both mild and moderate deformity. The chevron group experienced significantly greater correction in the hallux valgus angle and intermetatarsal angle for both mild and moderate deformity. The chevron group experienced a significantly greater decrease in the grade of sesamoid displacement for patients with moderate deformity. The McBride group had a greater risk of recurrence than did the chevron group for moderate deformity (odds ratio 14.00, 95% confidence interval 3.91 to 50.06, p hallux valgus recurrence than did the distal chevron group. Therefore, we recommend distal chevron osteotomy rather than a modified McBride procedure for the treatment of mild and moderate hallux valgus. Copyright © 2016 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  18. Combined versus individual effects of a valgus knee brace and lateral wedge foot orthotic during stair use in patients with knee osteoarthritis.

    Science.gov (United States)

    Moyer, Rebecca; Birmingham, Trevor; Dombroski, Colin; Walsh, Robert; Giffin, J Robert

    2017-05-01

    The aim of this study was to investigate the combined and individual biomechanical effects of a valgus knee brace and a lateral wedge foot orthotic during stair ascent and descent in patients with knee osteoarthritis (OA). Thirty-five patients with varus alignment and medial knee OA were prescribed a custom valgus knee brace and lateral wedge foot orthotic. Knee angles and moments in the frontal and sagittal planes were determined from 3D gait analysis completed under four randomized conditions: (1) control (no knee brace or foot orthotic), (2) knee brace, (3) foot orthotic, and (4) combined knee brace and foot orthotic. Additional measures included the vertical ground reaction force, trunk lean, toe out and gait speed. During the combined use of a knee brace and foot orthotic, significant decreases in the knee adduction angle (2.17, 95%CI: 0.50-3.84, p=0.013) and 2nd peak EKAM (0.35, 95%CI: 0.17-0.52, pstair descent; and significant increases in the EKFM were observed during stair ascent (0.54, 95%CI: 0.30-0.78, pstair descent compared to ascent, except for toe out. Findings suggest greater effects on gait when both knee brace and foot orthotic are used together, resulting in a more normal gait pattern. However, whether or not a true change in knee joint load can be inferred when using these orthoses remains unclear. Further research is required to determine the clinical importance of the observed changes. Copyright © 2017. Published by Elsevier B.V.

  19. Reliability of the standard goniometry and diagrammatic recording of finger joint angles: a comparative study with healthy subjects and non-professional raters.

    Science.gov (United States)

    Macionis, Valdas

    2013-01-09

    Diagrammatic recording of finger joint angles by using two criss-crossed paper strips can be a quick substitute to the standard goniometry. As a preliminary step toward clinical validation of the diagrammatic technique, the current study employed healthy subjects and non-professional raters to explore whether reliability estimates of the diagrammatic goniometry are comparable with those of the standard procedure. The study included two procedurally different parts, which were replicated by assigning 24 medical students to act interchangeably as 12 subjects and 12 raters. A larger component of the study was designed to compare goniometers side-by-side in measurement of finger joint angles varying from subject to subject. In the rest of the study, the instruments were compared by parallel evaluations of joint angles similar for all subjects in a situation of simulated change of joint range of motion over time. The subjects used special guides to position the joints of their left ring finger at varying angles of flexion and extension. The obtained diagrams of joint angles were converted to numerical values by computerized measurements. The statistical approaches included calculation of appropriate intraclass correlation coefficients, standard errors of measurements, proportions of measurement differences of 5 or less degrees, and significant differences between paired observations. Reliability estimates were similar for both goniometers. Intra-rater and inter-rater intraclass correlation coefficients ranged from 0.69 to 0.93. The corresponding standard errors of measurements ranged from 2.4 to 4.9 degrees. Repeated measurements of a considerable number of raters fell within clinically non-meaningful 5 degrees of each other in proportions comparable with a criterion value of 0.95. Data collected with both instruments could be similarly interpreted in a simulated situation of change of joint range of motion over time. The paper goniometer and the standard goniometer can

  20. The reliability and validity of radiographic measurements for determining the three-dimensional position of the talus in varus and valgus osteoarthritic ankles

    Energy Technology Data Exchange (ETDEWEB)

    Nosewicz, Tomasz L. [Kantonsspital Liestal, Department of Orthopaedic Surgery and Traumatology, Liestal (Switzerland); Academic Medical Center, Department of Orthopaedic Surgery, Meibergdreef 9, AZ, Amsterdam (Netherlands); Knupp, Markus; Bolliger, Lilianna; Hintermann, Beat [Kantonsspital Liestal, Department of Orthopaedic Surgery and Traumatology, Liestal (Switzerland)

    2012-12-15

    To assess the most accurate radiographic method to determine talar three-dimensional position in varus and valgus osteoarthritic ankles, we evaluated the reliability and validity of different radiographic measurements. Nine radiographic measurements were performed blindly on weight-bearing mortise, sagittal, and horizontal radiographs of 33 varus and 33 valgus feet (63 patients). Intra- and interobserver reliability was determined with the intraclass coefficient (ICC). Discriminant validity of measurements between varus and valgus feet was assessed with effect size (ES). Convergent validity (Pearson's r) was evaluated by correlating measurements to the dichotomized varus and valgus groups. Obtained measurements in both groups were finally compared with each other and with 30 control feet. Reliability was excellent (ICC > 0.80) in all but two measurements. Whereas frontal plane validity was excellent (ES and r > 0.80), horizontal and sagittal measurements showed poor to moderate validity (ES and r between 0.00 and 0.60). Four measurements were significantly different among all groups (p < 0.05). Talar positional tendency was found towards dorsiflexion or endorotation in the varus group and towards plantarflexion or exorotation in the valgus group. The frontal tibiotalar surface angle, sagittal talocalcaneal inclination angle, and horizontal talometatarsal I angle showed the best reliability, validity, and difference among the groups. The frontal tibiotalar surface angle, sagittal talocalcaneal inclination angle, and horizontal talometatarsal I angle accurately determine talar three-dimensional radiographic position in weight-bearing varus and valgus osteoarthritic ankles. Careful radiographic evaluation is important, as these deformities affect talar position in all three planes. (orig.)

  1. The reliability and validity of radiographic measurements for determining the three-dimensional position of the talus in varus and valgus osteoarthritic ankles

    International Nuclear Information System (INIS)

    Nosewicz, Tomasz L.; Knupp, Markus; Bolliger, Lilianna; Hintermann, Beat

    2012-01-01

    To assess the most accurate radiographic method to determine talar three-dimensional position in varus and valgus osteoarthritic ankles, we evaluated the reliability and validity of different radiographic measurements. Nine radiographic measurements were performed blindly on weight-bearing mortise, sagittal, and horizontal radiographs of 33 varus and 33 valgus feet (63 patients). Intra- and interobserver reliability was determined with the intraclass coefficient (ICC). Discriminant validity of measurements between varus and valgus feet was assessed with effect size (ES). Convergent validity (Pearson's r) was evaluated by correlating measurements to the dichotomized varus and valgus groups. Obtained measurements in both groups were finally compared with each other and with 30 control feet. Reliability was excellent (ICC > 0.80) in all but two measurements. Whereas frontal plane validity was excellent (ES and r > 0.80), horizontal and sagittal measurements showed poor to moderate validity (ES and r between 0.00 and 0.60). Four measurements were significantly different among all groups (p < 0.05). Talar positional tendency was found towards dorsiflexion or endorotation in the varus group and towards plantarflexion or exorotation in the valgus group. The frontal tibiotalar surface angle, sagittal talocalcaneal inclination angle, and horizontal talometatarsal I angle showed the best reliability, validity, and difference among the groups. The frontal tibiotalar surface angle, sagittal talocalcaneal inclination angle, and horizontal talometatarsal I angle accurately determine talar three-dimensional radiographic position in weight-bearing varus and valgus osteoarthritic ankles. Careful radiographic evaluation is important, as these deformities affect talar position in all three planes. (orig.)

  2. Effect of shoes containing nanosilica particles on knee valgus in active females during landing

    Directory of Open Access Journals (Sweden)

    Zahra Bassiri

    2015-01-01

    Full Text Available Objective(s: The effect of silica nanoparticles (SNPs in sport shoes outsoles on the  parameters related to anterior cruciate ligament (ACL Injury has not been investigated. The aim of this study was to investigate the effect of shoes outsole containing a composite of thermoplastic elastomer based on styrene-butadiene and silica nanoparticles (TPEN shoe on Knee Valgus Angle (KVA as a risk factor of ACL injuries during landing Materials and Methods: Fourteen active healthy women without knee injuries and disorders performed bilateral drop jump (DJ and single leg drop landing (SLL tasks in barefoot, wearing shoes fabricated with polyvinyl chloride outsole (PVC shoe and TPEN shoes conditions , randomly. The knee valgus angle values of right and left legs were calculated in the landing conditions. Two factors repeated measures ANOVA were used to investigate the effect of landing and footwear conditions on KVA of right and left legs.  Results: For both left and right limbs, the KVA was at maximum and minimum values during landing with barefoot and TPEN shoes, respectively. PVC shoe significantly reduced the knee valgus by 3.84% in left and 4.18% in right knee (P

  3. Outcomes in chevron osteotomy for Hallux Valgus in a large cohort.

    Science.gov (United States)

    van Groningen, Bart; van der Steen, M C Marieke; Reijman, Max; Bos, Janneke; Hendriks, Johannes G E

    2016-12-01

    Clinical and radiological related outcomes have been reported for Chevron osteotomy as correction for mild to moderate hallux valgus, but only for relatively small patient series. Moreover, evaluation of the patient's point of view has mostly been conducted by means of more physician-based outcome measures. The goal of this study was to evaluate the effect of the Chevron osteotomy for hallux valgus on patients' daily lives using the Foot and Ankle Outcome Score (FAOS) as a validated and a hallux valgus specific patient reported outcome measure (PROM). Secondary outcome measures were radiological correction, complication rate, and re-operations. All 438 Chevron procedures (336 patients), at two surgical hospital sites in the period between January 2010 and October 2014, were retrospectively evaluated with a follow-up of at least 6 months. Patients were invited to fill in a cross-sectional online FAOS. For the FAOS, a total response of 60% was achieved. The FAOS ranged between 71 and 88 with a follow-up of on average 36 months. Patients with an undercorrection of their hallux valgus (11.6% of the procedures) scored significantly lower on three subscales of the FAOS (range between 61 and 77 versus 72-84). Patients who had a reoperation (12.6% of the procedures) also scored significantly lower on four subscales: 58-100 versus 73-89. Postoperative radiological measurements improved significantly with a mean difference of 6.1 (5.9; 6.4) degrees for the intermetatarsal angle and 13.7 (13.0; 14.5) degrees for the hallux valgus angle. In this large study cohort, Chevron osteotomy for hallux valgus offers good PROM scores on FAOS. These scores were significantly lower in patients with radiological undercorrection or with a reoperation. Results of the FAOS appear to modulate with physician based outcomes and therapeutic incidents. Improvement of outcome may therefore well be possible by increased attention on these surgical details. Copyright © 2016 Elsevier Ltd. All rights

  4. Correlation in the Coronal Angle between Knee and Hindfoot Was Observed in Patients with Rheumatoid Arthritis Unless Talocrural Joint Was Destroyed

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    Kohei Nishitani

    2017-01-01

    Full Text Available The purpose of this study is to investigate the compensatory correlation between knee and hindfoot in patients with rheumatoid arthritis (RA. This cross-sectional study included 218 patients (407 lower extremities. Radiographs of the hindfoot and full-length posteroanterior hip-to-calcaneus standing radiographs were evaluated. The destruction of the hindfoot was evaluated using the Larsen grading system. The coronal angular deformity of the knee and hindfoot was evaluated by the femorotibial angle (FTA and the angle between the tibial shaft and the entire hindfoot (tibiohindfoot angle, THFA. The correlation between FTA and THFA was determined by Pearson’s coefficient. For all patients, FTA correlated to THFA (R = 0.28, p<0.001. The correlation was observed as long as the talocrural joint was preserved (Larsen grade ≤ 2, even if the subtalar joint had been destroyed (Larsen grade ≥ 3. However, the correlation was not observed when the talocrural joint was destroyed (Larsen grade ≥ 3, R = −0.02, p=0.94. The pain in the hindfoot did not correlate with FTA or THFA. In conclusion, a compensatory deformity of the hindfoot against the deformity of the knee was observed in RA, and the correlation was lost when talocrural joint was destroyed.

  5. Bipartite hallucal sesamoid bones: relationship with hallux valgus and metatarsal index

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    Munuera, Pedro V.; Dominguez, Gabriel [University of Seville, Department of Podiatrics, Seville (Spain); Centro Docente de Fisioterapia y Podologia, Departamento de Podologia, Seville (Spain); Reina, Maria; Trujillo, Piedad [Centro Docente de Fisioterapia y Podologia, Departamento de Podologia, Seville (Spain)

    2007-11-15

    The objective was to relate the incidence of the partition of the hallucal sesamoid bones to the size of the first metatarsal and the hallux valgus deformity. In a sample of 474 radiographs, the frequency of appearance of bipartite sesamoids was studied. The length and relative protrusion of the first metatarsal, and the hallux abductus angle, were measured and compared between the feet with and without sesamoid partition. The results showed that 14.6% of the feet studied had at least one partite sesamoid, that the sesamoid most frequently divided was the medial, and that unilateral partition was the most common. No difference was found in the incidence of partite sesamoids between men and women, or between left and right feet. Protrusion and length of the first metatarsal are greater in feet with partite sesamoids than in feet without this condition. A significantly higher incidence of bipartite medial sesamoid was obtained in feet with hallux valgus compared with normal feet. (orig.)

  6. Bipartite hallucal sesamoid bones: relationship with hallux valgus and metatarsal index

    International Nuclear Information System (INIS)

    Munuera, Pedro V.; Dominguez, Gabriel; Reina, Maria; Trujillo, Piedad

    2007-01-01

    The objective was to relate the incidence of the partition of the hallucal sesamoid bones to the size of the first metatarsal and the hallux valgus deformity. In a sample of 474 radiographs, the frequency of appearance of bipartite sesamoids was studied. The length and relative protrusion of the first metatarsal, and the hallux abductus angle, were measured and compared between the feet with and without sesamoid partition. The results showed that 14.6% of the feet studied had at least one partite sesamoid, that the sesamoid most frequently divided was the medial, and that unilateral partition was the most common. No difference was found in the incidence of partite sesamoids between men and women, or between left and right feet. Protrusion and length of the first metatarsal are greater in feet with partite sesamoids than in feet without this condition. A significantly higher incidence of bipartite medial sesamoid was obtained in feet with hallux valgus compared with normal feet. (orig.)

  7. Incidence of hallux valgus deformity among Iranian university students

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    Abbas Rahimi

    2012-07-01

    Full Text Available Background and Aim: The dramatically increased incidence of hallux valgus (HV deformity is more related to the cultural rather than genetic parameters. Due to the lack of reliable information about the rate of this disorder in Iraninan societies, the researchers of the current study aimed to find out the incidence of this disorder in Iranian university students as a sample of Iranian youngsters. Materials and Methods: This descriptive study was carried out using a self-constructed and the American Orthopaedic Foot and Ankle Society (AOFAS questionnaires among 290 university students with the mean age of 21±2 years old. The HV angles (HVA was described as normal for up to 20º, mild for angles between 21º and 25º, moderate for angles between 26º and 40º, and severe for angles higher than 40 º. Then, the HVA of the subjects of this study was compared with the data from other societies.Results: The results of this study showed a 34.1% involvement of the participants (30% females and 41% males. 58% of the subjects showed a bilateral hallux valgus involvement. No significant differences were found between the males and females in terms of the severity of the deformity and the right or left side involvement (P>0.05. 71% of the involved subjects showed a mild degree and 29% showed a moderate degree of deformity. No severe deformity (above 40º was found in this study. In terms of the associated deformities, in subjects with mild deformity, 25% showed flat foot and 69% showed bunion disorder; While these were 21% and 82% in subjects with moderate deformity, respectively. In terms of inheritance correlation, while this deformity was shown in only 7% of normal subjects’ first degree relatives (father, mother, brothers or sisters, it increased to 21.1% in mild degree and 46.4% in moderate degree groups. Conclusion: This study revealed a very high incidence of HV deformity in Iranian university students as a sample of Iranian youngsters, which is

  8. The reliability and validity of radiographic measurements for determining the three-dimensional position of the talus in varus and valgus osteoarthritic ankles.

    Science.gov (United States)

    Nosewicz, Tomasz L; Knupp, Markus; Bolliger, Lilianna; Hintermann, Beat

    2012-12-01

    To assess the most accurate radiographic method to determine talar three-dimensional position in varus and valgus osteoarthritic ankles, we evaluated the reliability and validity of different radiographic measurements. Nine radiographic measurements were performed blindly on weight-bearing mortise, sagittal, and horizontal radiographs of 33 varus and 33 valgus feet (63 patients). Intra- and interobserver reliability was determined with the intraclass coefficient (ICC). Discriminant validity of measurements between varus and valgus feet was assessed with effect size (ES). Convergent validity (Pearson's r) was evaluated by correlating measurements to the dichotomized varus and valgus groups. Obtained measurements in both groups were finally compared with each other and with 30 control feet. Reliability was excellent (ICC > 0.80) in all but two measurements. Whereas frontal plane validity was excellent (ES and r > 0.80), horizontal and sagittal measurements showed poor to moderate validity (ES and r between 0.00 and 0.60). Four measurements were significantly different among all groups (p reliability, validity, and difference among the groups. The frontal tibiotalar surface angle, sagittal talocalcaneal inclination angle, and horizontal talometatarsal I angle accurately determine talar three-dimensional radiographic position in weight-bearing varus and valgus osteoarthritic ankles. Careful radiographic evaluation is important, as these deformities affect talar position in all three planes.

  9. Comparison of Clinical Outcomes of Scarf and Chevron Osteotomies and the McBride Procedure in the Treatment of Hallux Valgus Deformity

    Science.gov (United States)

    Fakoor, Mohammad; Sarafan, Naser; Mohammadhoseini, Payam; Khorami, Mohsen; Arti, Hamidreza; Mosavi, SeyedShahnam; Aghaeeaghdam, Amir

    2014-01-01

    Background: Hallux valgus deformity is a common chronic problem with a reported prevalence of 28.4% and its chief complaint is pain. Thus far, different surgical procedures with their proposed indications have been introduced. This study compared three current procedures, namely the chevron and scarf osteotomies and the McBride procedure. Methods: This retrospective cohort was conducted at the Ahvaz University of Medical Sciences on 44 patients with moderate hallux valgus deformity from 2010 and 2013. All of the patients underwent one of the three procedures (chevron, scarf or McBride). Preoperative and follow up radiographies were evaluated in terms of hallux valgus and intermetatarsal angle correction. The Foot and Ankle Disability Index was filled out to assess the functional outcome and the Visual Analogue Scale was used to evaluate pain. Also, satisfaction, aesthetics and the rate of recurrence was evaluated. Results: Hallux valgus angle and intermetatarsal angle correction were significantly higher in scarf, but not in chevron and McBride. However, from amongst the three procedures, there was no significant difference in terms of the Foot and Ankle Disability Index score, aesthetics, satisfaction level, pain score and recurrence rate. Conclusions: Considering that scarf osteotomy had better results in this study, we think that scarf osteotomy can be considered as a first choice for the treatment of moderate hallux valgus deformity. PMID:25207310

  10. [Correlative analysis on metatarsalgia and the X-ray measurement indexes under weight-bearing and non-weight-bearing of hallux valgus].

    Science.gov (United States)

    Gong, Hao; Sang, Zhi-Cheng; Wen, Jian-Min; Sun, Wei-Dong; Hu, Hai-Wei; Zhang, Yong-Chao; Zuo, Jian-Gang; Wang, Hai-Xiong

    2014-04-01

    To study changes in the radiographic appearance during weight-bearing and non-weigh-bearing in hallux valgus, and to analyse the correlation between the elasticity of plantar soft tissue of hallux valgus and the pain under the metatarsal head. From May 2012 to October 2012, 240 feet of 120 patients with hallux valgus were enrolled in the study. The degrees of the pian under the metatarsal head of all the patients were observed. AP and lateral X-ray films of feet were taken on the condition of weight-bearing and non-weight-bearing. So the hallux valgus angle (HVA), the inter-metatarsal angle between the first and second metatarsals (IM1-2), the inter-metatarsal angle between the first and fifth metatarsals (IM1-5), top angle of the medial longitudinal arch (TAOTMLA),and anterior angle of the medial longitudinal arch (AAOTMLA) were measured on the X-ray films. The differences of HVA, IM1-2, IM1-5, TAOTMLA and AAOTMLA between two groups were compared, and the correlation between the changes of IM1-2, IM 1-5, TAOTMLA, AAOTMLA and the degree of the pain under the metatarsal head were analysed. One hundred and forty-eight feet had the pain under the metatarsal head. The IM1-2, IM1-5 and TAOTMLA increased on weight-bearing position compared with those on non-weight-bearing position, but the HVA and AAOTMLA decreased on weight-bearing position compared with those on non-weight-bearing position. There was a moderate relationship between the changes of IM 1-2,IM1-5 and the degree of the hallux valgus deformity, as well as the relationship between the different of IM1-5 and the degree of the pian under the metatarsal head. The degree of the collapse of the arch of foot with hallux valgus becomes serious with its deformity increasing. The pain under the metatarsal head of hallux valgus increases with the increased changes of IM 1-2,IM 1-5 and TAOTMLA. Analysis of the X-ray observation indexes of hallux valgus on weight-bearing position and non-weight-bearing position has

  11. Impaired Varus-Valgus Proprioception and Neuromuscular Stabilization in Medial Knee Osteoarthritis

    Science.gov (United States)

    Chang, Alison H.; Lee, Song Joo; Zhao, Heng; Ren, Yupeng; Zhang, Li-Qun

    2014-01-01

    Impaired proprioception and poor muscular stabilization in the frontal plane may lead to knee instability during functional activities, a common complaint in persons with knee osteoarthritis (KOA). Understanding these frontal plane neuromechanical properties in KOA will help elucidate the factors contributing to knee instability and aid in the development of targeted intervention strategies. The study objectives were to compare knee varus-valgus proprioception, isometric muscle strength, and active muscular contribution to stability between persons with medial KOA and healthy controls. We evaluated knee frontal plane neuromechanical parameters in 14 participants with medial KOA and 14 age- and gender-matched controls, using a joint driving device (JDD) with a customized motor and a 6-axis force sensor. Analysis of covariance with BMI as a covariate was used to test the differences in varus-valgus neuromechanical parameters between these two groups. The KOA group had impaired varus proprioception acuity (1.08 ± 0.59° vs. 0.69 ± 0.49°, p < 0.05), decreased normalized varus muscle strength (1.31 ± 0.75% vs. 1.79 ± 0.84% body weight, p < 0.05), a trend toward decreased valgus strength (1.29 ± 0.67% vs. 1.88 ± 0.99%, p = 0.054), and impaired ability to actively stabilize the knee in the frontal plane during external perturbation (4.67 ± 2.86 vs. 8.26 ± 5.95 Nm/degree, p < 0.05). The knee frontal plane sensorimotor control system is compromised in persons with medial KOA. Our findings suggest varus-valgus control deficits in both the afferent input (proprioceptive acuity) and muscular effectors (muscle strength and capacity to stabilize the joint). PMID:24321442

  12. Consideration of Shoulder Joint's Image with the Changed Tube Angle of the Shoulder Oblique Projection in Supine Position

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    Seo, Jae Hyun; Choi, Nam Gil [Dept. of Radiology, Chonnam National University Hospital, Kwangju (Korea, Republic of)

    2008-06-15

    There is a standard shoulder oblique method (Grashey method) available to view the shoulder joint. This method projects AP view of the shoulder joint so that the Humerus head's subuxation or joint degeneration can be easily visualized. However, in this view, the patients, with supine or sitting or erect position, have to keep their body obliquely. Whereas, the patients who are not well or operated, usually feel very uncomfortable to keep their body in this position and hence, we need other persons' help and much efforts will be needed to get the good quality shoulder joint view. Therefore, we thought of examining a method which shows the joint well by angling the tube to Medio-Lateral direction and without keeping the patients' one side upward in supine position. For this study, total 15 subjects with no history of neurological or psychiatric illness, were recruited for examinations. They consisted of 9 males and 6 females. Statistic group analysis was performed with ANOVA test. Scores of the evaluation of the experts were 1.01{+-}0.54 at 25 degrees, 2.50{+-}0.50 at 30 degrees, 2.85{+-}0.36 at 35 degrees and 2.33{+-}0.47 at 40 degrees, respectively, and they were significant(p<0.05, Table 1). Joint space of the Humerus head and Scapula were well distinguished at 35 degrees, 30 degrees and 40 degrees with the almost same score. However, the degree of distortion at 40 degrees was more severe than that at 30 degrees. Ultimately, 30-35 degrees views were shown to yield good quality shoulder oblique images. In conclusion, this method may be very useful for the patients who are uncomfortable and for the emergency patients. In order to get similar or comparable view, the same X-tube angle is recommended to be used before and after the operation. Therefore, we hope that this new angled method seems to be efficient.

  13. A parametric model of muscle moment arm as a function of joint angle: application to the dorsiflexor muscle group in mice.

    Science.gov (United States)

    Miller, S W; Dennis, R G

    1996-12-01

    A parametric model was developed to describe the relationship between muscle moment arm and joint angle. The model was applied to the dorsiflexor muscle group in mice, for which the moment arm was determined as a function of ankle angle. The moment arm was calculated from the torque measured about the ankle upon application of a known force along the line of action of the dorsiflexor muscle group. The dependence of the dorsiflexor moment arm on ankle angle was modeled as r = R sin(a + delta), where r is the moment arm calculated from the measured torque and a is the joint angle. A least-squares curve fit yielded values for R, the maximum moment arm, and delta, the angle at which the maximum moment arm occurs as offset from 90 degrees. Parametric models were developed for two strains of mice, and no differences were found between the moment arms determined for each strain. Values for the maximum moment arm, R, for the two different strains were 0.99 and 1.14 mm, in agreement with the limited data available from the literature. While in some cases moment arm data may be better fitted by a polynomial, use of the parametric model provides a moment arm relationship with meaningful anatomical constants, allowing for the direct comparison of moment arm characteristics between different strains and species.

  14. Predicting timing of foot strike during running, independent of striking technique, using principal component analysis of joint angles.

    Science.gov (United States)

    Osis, Sean T; Hettinga, Blayne A; Leitch, Jessica; Ferber, Reed

    2014-08-22

    As 3-dimensional (3D) motion-capture for clinical gait analysis continues to evolve, new methods must be developed to improve the detection of gait cycle events based on kinematic data. Recently, the application of principal component analysis (PCA) to gait data has shown promise in detecting important biomechanical features. Therefore, the purpose of this study was to define a new foot strike detection method for a continuum of striking techniques, by applying PCA to joint angle waveforms. In accordance with Newtonian mechanics, it was hypothesized that transient features in the sagittal-plane accelerations of the lower extremity would be linked with the impulsive application of force to the foot at foot strike. Kinematic and kinetic data from treadmill running were selected for 154 subjects, from a database of gait biomechanics. Ankle, knee and hip sagittal plane angular acceleration kinematic curves were chained together to form a row input to a PCA matrix. A linear polynomial was calculated based on PCA scores, and a 10-fold cross-validation was performed to evaluate prediction accuracy against gold-standard foot strike as determined by a 10 N rise in the vertical ground reaction force. Results show 89-94% of all predicted foot strikes were within 4 frames (20 ms) of the gold standard with the largest error being 28 ms. It is concluded that this new foot strike detection is an improvement on existing methods and can be applied regardless of whether the runner exhibits a rearfoot, midfoot, or forefoot strike pattern. Copyright © 2014 Elsevier Ltd. All rights reserved.

  15. Intramuscular Pressure of Tibialis Anterior Reflects Ankle Torque but Does Not Follow Joint Angle-Torque Relationship

    Directory of Open Access Journals (Sweden)

    Filiz Ateş

    2018-01-01

    Full Text Available Intramuscular pressure (IMP is the hydrostatic fluid pressure that is directly related to muscle force production. Electromechanical delay (EMD provides a link between mechanical and electrophysiological quantities and IMP has potential to detect local electromechanical changes. The goal of this study was to assess the relationship of IMP with the mechanical and electrical characteristics of the tibialis anterior muscle (TA activity at different ankle positions. We hypothesized that (1 the TA IMP and the surface EMG (sEMG and fine-wire EMG (fwEMG correlate to ankle joint torque, (2 the isometric force of TA increases at increased muscle lengths, which were imposed by a change in ankle angle and IMP follows the length-tension relationship characteristics, and (3 the electromechanical delay (EMD is greater than the EMD of IMP during isometric contractions. Fourteen healthy adults [7 female; mean (SD age = 26.9 (4.2 years old with 25.9 (5.5 kg/m2 body mass index] performed (i three isometric dorsiflexion (DF maximum voluntary contraction (MVC and (ii three isometric DF ramp contractions from 0 to 80% MVC at rate of 15% MVC/second at DF, Neutral, and plantarflexion (PF positions. Ankle torque, IMP, TA fwEMG, and TA sEMG were measured simultaneously. The IMP, fwEMG, and sEMG were significantly correlated to the ankle torque during ramp contractions at each ankle position tested. This suggests that IMP captures in vivo mechanical properties of active muscles. The ankle torque changed significantly at different ankle positions however, the IMP did not reflect the change. This is explained with the opposing effects of higher compartmental pressure at DF in contrast to the increased force at PF position. Additionally, the onset of IMP activity is found to be significantly earlier than the onset of force which indicates that IMP can be designed to detect muscular changes in the course of neuromuscular diseases impairing electromechanical transmission.

  16. The effects of 4 weeks of jump training on landing knee valgus and crossover hop performance in female basketball players.

    Science.gov (United States)

    Herrington, Lee

    2010-12-01

    Female basketball players would appear particularly prone to knee injuries. These injuries have been associated with the nature of the sport, but more specifically with the particular movement strategies adopted. A valgus or abducted position of the knee on landing has been reported to be associated with a number of different knee injuries. Jump-training programs have been reported to improve both landing knee valgus and functional performance. The majority of the jump-training programs have been of 6 weeks' duration, 3 sessions per week often lasting up to 1 hour. For most sports coaches, team conditioners, and athletes, this duration and program length is not acceptable. The aim of this study was to assess if an abridged jump-training program could have similar effects to those previously reported. Fifteen female basketball players had their knee valgus angles assessed during 2 landing tasks, drop jump landing, and when undertaking a jump shot and along with crossover hop distance before and after a progressive jump-training program. The jump-training program lasted 4 weeks, 3 times per week, each session lasting 15 minutes. After training, crossover hop distance showed an average percentage improvement on distance jumped of 73.6% (p = 0.001); the drop jump knee valgus angle in the left leg on average was reduced by 9.8° (p = 0.002), right leg reduced by 12.3° (p = 0.0001); during the jump shot, the knee valgus angle in the left leg showed a mean reduction of 4.5° (p = 0.035), and the right leg was reduced by 4.3° (p = 0.01). The study undertaken achieved comparable results to those previously reported with an abridged program over considerably shortened session duration and training period.

  17. Minimally invasive distal linear metatarsal osteotomy combined with selective release of lateral soft tissue for severe hallux valgus.

    Science.gov (United States)

    Seki, Hiroyuki; Suda, Yasunori; Takeshima, Kenichiro; Kokubo, Tetsuro; Ishii, Ken; Nakamura, Masaya; Matsumoto, Morio; Niki, Yasuo

    2018-03-21

    Minimally invasive techniques for hallux valgus have been widely used to treat mild to moderate hallux valgus deformities. The purpose of this study was to evaluate the clinical and radiographic outcomes of distal linear metatarsal osteotomy (DLMO), which is one of the minimally invasive techniques, for severe hallux valgus. 95 patients (141 feet) with severe hallux valgus underwent DLMOs. Lateral soft tissue release (LSTR) was performed at the same time for the cases selected by an original manual test. The satisfaction level, the Japanese Society of Surgery of the Foot (JSSF) hallux scale score, and weight-bearing radiographs of the foot were assessed preoperatively and after more than 24 months. In addition, the clinical and radiographic outcomes were compared among three groups divided by the kind of LSTR: no LSTR; manual correction; and open release through skin incision. Although the first metatarsal bone was significantly shortened, dorsiflexed, and elevated on postoperative radiographs, the rate of satisfaction was 87.2% (123/141), and the mean JSSF hallux scale score improved significantly from 60.4 (44-73) to 90.4 (65-100). The mean hallux valgus and intermetatarsal angles also improved significantly from 45.5° (40.0-60.0°) to 10.3° (-28.0-40.9°) and from 19.9° (14.0-28.7°) to 8.3° (-1.6-18.5°), respectively. Delayed union (18 feet), metatarsalgia (16 feet), recurrence (22 feet), and hallux varus (22 feet) were observed, and they were more obvious in DLMO combined with open release through a skin incision. DLMO combined selectively with LSTR is an effective procedure for correcting severe hallux valgus. However, the indication for open release with DLMO should be considered carefully. Copyright © 2018. Published by Elsevier B.V.

  18. Application of posterior pelvic tilt taping for the treatment of chronic low back pain with sacroiliac joint dysfunction and increased sacral horizontal angle.

    Science.gov (United States)

    Lee, Jung-hoon; Yoo, Won-gyu

    2012-11-01

    Kinesio Taping (KT) is a therapeutic method used by physical therapists and athletic trainers in combination with other treatment techniques for various musculoskeletal and neuromuscular problems. However, no research has evaluated the effect of KT in patients with low back pain (LBP). The purpose of this case was to describe the application of posterior pelvic tilt taping (PPTT) with Kinesio tape as a treatment for chronic LBP and to reduce the anterior pelvic tilt angle. Case report. The patien was a 20-year-old female amateur swimmer with a Cobb's angle (L1-S1) of 68°, a sacral horizontal angle of 45°, and pain in both medial buttock areas and sacroiliac joints. We performed PPTT with Kinesio tape for 2 weeks (six times per week for an average of 9 h each time). The patient’s radiographs showed that the Cobb's angle (L1-S1) had decreased from 68° to 47° and that the sacral horizontal angle had decreased from 45° to 31°. Reductions in hypomobility or motion asymmetry, as assessed by the motion palpation test, and in pain, as measured by the pain-provocation tests, were observed. On palpation for both medial buttock areas in the prone position, the patient felt no pain. The patient experienced no pain or stiffness in the low back area while performing forward flexion in the standing position with knees fully extended when washing dishes in the sink. The case study demonstrated that PPTT intervention favourably affected the pelvic inclination and sacral horizontal angle, leading to beneficial effects on sacroiliac joint dysfunction (SIJD) and medial buttock pain. Additional research on the clinical effects of this taping procedure requires greater numbers of athletes with SIJD or LBP who have inappropriate anterior pelvic tilt angles and hyperlordosis.

  19. Open wedge metatarsal osteotomy versus crescentic osteotomy to correct severe hallux valgus deformity - A prospective comparative study.

    Science.gov (United States)

    Wester, Jens Ulrik; Hamborg-Petersen, Ellen; Herold, Niels; Hansen, Palle Bo; Froekjaer, Johnny

    2016-03-01

    Different techniques of proximal osteotomies have been introduced to correct severe hallux valgus. The open wedge osteotomy is a newly introduced method for proximal osteotomy. The aim of this prospective randomized study was to compare the radiological and clinical results after operation for severe hallux valgus, comparing the open wedge osteotomy to the crescentic osteotomy which is our traditional treatment. Forty-five patients with severe hallux valgus (hallux valgus angle >35̊, and intermetatarsal angle >15̊) were included in this study. The treatment was proximal open wedge osteotomy and fixation with plate (Hemax), group 1, or operation with proximal crescentic osteotomy and fixation with a 3mm cannulated screw, group 2. The mean age was 52 years (19-71). Forty-one females and four males were included. Clinical and radiological follow-ups were performed 4 and 12 months after the operation. In group 1 the hallux valgus angle decreased from 39.0̊ to 24.1̊ after 4 months and 27.9̊ after 12 months. In group 2 the angle decreased from 38.3̊ to 21.4̊ after 4 months and 27.0̊ after 12 months. The intermetatarsal angle in group 1 was 19.0̊ preoperatively, 11.6̊ after 4 months and 12.6̊ after 12 months. In group 2 the mean intermetatarsal angle was 18.9̊ preoperatively, 12.0̊ after 4 months and 12.6̊ after 12 months. The AOFAS score improved from 59.3 to 81.5 in group 1 and from 61.8 to 84.8 in group 2 respectively measured 12 months postoperatively. The relative length of the 1 metatarsal compared to 2 metatarsal bone was 0.88 and 0.87 preoperatively and 0.88 and 0.86 for group 1 and 2 respectively measured after 12 months. Crescentic osteotomy and open wedge osteotomy improve AOFAS score and VAS scores on patients operated with severe hallux valgus. No significant difference was found in the two groups looking at the postoperative improvement of HVA and IMA measured 4 and 12 months postoperatively. The postoperative VAS score and AOFAS score were

  20. Use of a percutaneous osteotomy with plate fixation in hallux valgus correction.

    Science.gov (United States)

    Díaz Fernández, Rodrigo

    2017-09-20

    With hundreds of operative methods described for correction of hallux valgus we can state that the ideal surgical treatment is still controversial. The Bösch technique has been used as a percutaneous way of correcting hallux valgus deformities with the use of a pin fixation. The aim of this study is to evaluate a new method of fixation by using a percutaneous locking plate. Between June 2013 and January 2015, 24 consecutive percutaneous subcapital osteotomies of the first metatarsal bone were performed for the treatment of painful hallux valgus deformities in 24 patients. Additional surgical procedures included DMMO's (Distal Metatarsal Minimally-Invasive Osteotomies) in 12 of the operated feet (44.44%); minor digits were corrected in 7 cases (25.9%). An Akin procedure was performed in 81% of cases and all cases underwent an adductor hallucis tenotomy. All patients were clinically assessed using the AOFAS score. Radiographic measures included the preoperative and postoperative values of the Hallux Valgus Angle (HVA), Intermetatarsal Angle (IMA), and the Distal Metatarsal Articular Angle (DMAA). The mean correction achieved improved for AHV from 36.57±7.1 to 12.22±8.69°, for IMA from 13.8±1.59 to 7.08±2.72 and for DMAA from 13.98±7.38 to 6.07±4.99. Clinically, scores on the AOFAS scale improved from a 45.8±9.6 to 91.29±9.8. Although healing of the osteotomies was observed radiographically within 6 to 12 weeks, two cases (8.3%) exhibited delayed healing. There were no cases of nonunion. There were no superficial or deep infections or wound healing problems. Plate had to be removed in 3 cases (12.5%). This technique modification is an acceptable procedure to correct hallux valgus in patients with a moderate level of deformity. Level IV. Copyright © 2017 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.

  1. Three-dimensional analysis of tarsal bone response to axial loading in patients with hallux valgus and normal feet.

    Science.gov (United States)

    Watanabe, Kota; Ikeda, Yasutoshi; Suzuki, Daisuke; Teramoto, Atsushi; Kobayashi, Takuma; Suzuki, Tomoyuki; Yamashita, Toshihiko

    2017-02-01

    Patients with hallux valgus present a variety of symptoms that may be related to the type of deformity. Weightbearing affects the deformities, and the evaluation of the load response of tarsal bones has been mainly performed using two-dimensional plane radiography. The purpose of this study was to investigate and compare structural changes in the medial foot arch between patients with hallux valgus and normal controls using a computer image analysis technique and weightbearing computed tomography data. Eleven patients with hallux valgus and eleven normal controls were included. Computed tomograms were obtained with and without simulated weightbearing using a compression device. Computed tomography data were transferred into a personal computer, and a three-dimensional bone model was created using image analysis software. The load responses of each tarsal bone in the medial foot arch were measured three-dimensionally and statistically compared between the two groups. Displacement of each tarsal bone under two weightbearing conditions was visually observed by creating three-dimensional bone models. At the first metatarsophalangeal joint, the proximal phalanges of the hallux valgus group showed significantly different displacements in multiple directions. Moreover, opposite responses to axial loading were also observed in both translation and rotation between the two groups. Weightbearing caused deterioration of the hallux valgus deformity three-dimensionally at the first metatarsophalangeal joint. Information from the computer image analysis was useful for understanding details of the pathology of foot disorders related to the deformities or instability and may contribute to the development of effective conservative and surgical treatments. Copyright © 2017 Elsevier Ltd. All rights reserved.

  2. Long-term Follow-up of a Randomized Controlled Trial Comparing Scarf to Chevron Osteotomy in Hallux Valgus Correction.

    Science.gov (United States)

    Jeuken, Ralph M; Schotanus, Martijn G M; Kort, Nanne P; Deenik, Axel; Jong, Bob; Hendrickx, Roel P M

    2016-07-01

    Hallux valgus is one of the most common foot deformities. This long-term follow-up study compared the results of 2 widely used operative treatments for hallux valgus: the scarf and chevron osteotomy. Conventional weight bearing anteroposterior (AP) radiographs of the foot were made for evaluating the intermetatarsal angle and hallux valgus angle. For clinical evaluation, the American Orthopaedic Foot & Ankle Society (AOFAS) rating system for the hallux metatarsophalangeal-interphalangeal scale was used together with physical examination of the foot. These data were compared with the results from the original study. The Short Form 36 questionnaire, the Manchester-Oxford Foot Questionnaire (MOXFQ), and a general questionnaire including a visual analog scale (VAS) pain score were used for subjective evaluation. The primary outcome measures were the radiologic recurrence of hallux valgus and reoperation rate of the same toe. Secondary outcome measures were the results from the radiographs and subjective and clinical evaluation. The response rate was 76% at the follow-up of 14 years; in the chevron group, 37 feet were included compared with 36 feet in the scarf group. Twenty-eight feet in the chevron group and 27 in the scarf group developed recurrence of hallux valgus (P = .483). One patient in the scarf group had a reoperation of the same toe compared with none in the chevron group (P = .314). Current VAS pain scores and results from the SF-36, MOXFQ, and AOFAS did not significantly differ between groups. Both techniques showed similar results after 2 years of follow-up. At 14 years of follow-up, neither technique was superior in preventing recurrence. Level II, randomized controlled trial. © The Author(s) 2016.

  3. Plate fixation for proximal chevron osteotomy has greater risk for hallux valgus recurrence than Kirschner wire fixation.

    Science.gov (United States)

    Park, Chul-Hyun; Ahn, Ji-Yong; Kim, Yu-Mi; Lee, Woo-Chun

    2013-06-01

    The purpose of this study was to compare the results of hallux valgus surgery between feet fixed with Kirschner wires and those fixed with a plate and screws. Between December 2008 and November 2009, 53 patients (62 feet) were treated with proximal chevron osteotomy and distal soft tissue procedure for symptomatic moderate to severe hallux valgus deformity. Thirty-four patients (41 feet) were stabilised with Kirschner wires (K-wire group) and 19 patients (21 feet) were stabilised with a locking plate (plate group). Clinical results were assessed using American Orthopaedic Foot and Ankle Society (AOFAS) score. Radiographic parameters were compared between these groups. Recurrence rate at the last follow-up was compared between the K-wire and plate groups. Mean AOFAS score was lower in the plate group, however, the difference between the groups was not statistically significant in AOFAS score at the last follow-up. Hallux valgus angle and intermetatarsal angle were significantly larger in the plate group at the last follow-up. Mean 1-2 metatarsal (MT) distance on immediately postoperative radiographs was significant larger in the plate group. Four (9.8 %) of the 41 feet in the K-wire group and 7 (33.3 %) of the 21 feet in the plate group showed hallux valgus recurrence at the last follow-up. The plate group had a significantly higher risk of recurrence than the K-wire group. Fixation of proximal chevron osteotomy using a plate and screws has a greater risk of hallux valgus recurrence than fixation using Kirschner wires.

  4. The Relationship Between the Sesamoid Complex and the First Metatarsal After Hallux Valgus Surgery Without Lateral Soft-Tissue Release: A Prospective Study.

    Science.gov (United States)

    Lamo-Espinosa, José María; Flórez, Borja; Villas, Carlos; Pons-Villanueva, Juan; Bondía, José M; Aquerreta, Jesús Dámaso; Alfonso, Matias

    2015-01-01

    Some investigators have emphasized restoring the relationship between the sesamoid complex and the first metatarsal head to reduce the risk of hallux valgus recurring after surgical reconstruction. In a prospective study, we analyzed whether the first metatarsophalangeal joint could be realigned after scarf-Akin bunionectomy without lateral soft tissue release. A total of 25 feet, in 22 patients, were prospectively enrolled and analyzed using anteroposterior radiographs and coronal computed tomography scans obtained before and 3 months after surgery. The Yildirim sesamoid position decreased from a preoperative of 2 (range 1 to 3) to a postoperative position of 0 (range 0 to 1; p < .001), the mean first intermetatarsal angle decreased from 12.6° ± 2.4° to 5.8° ± 2.1° (p < .001), and the mean distance between the second metatarsal and the tibial sesamoid changed from 25.7 ± 4.6 to 25.9 ± 4.6 (p = .59). Our findings suggest that dislocation of the sesamoid complex is actually caused by displacement of the first metatarsal. In conclusion, the scarf-Akin bunionectomy adequately restores the alignment of the first metatarsophalangeal joint, including restoration of the sesamoid apparatus, without direct plantar-lateral soft tissue release. Copyright © 2015 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  5. PROXIMAL FEMURAL VALGUS SUBTROCHANTERIC OSTEOTOMY FOR NON UNION OF TROCHANTERIC FRACTURES.

    Science.gov (United States)

    Silva, Paulo; Coelho, Danilo Lopes; Curi, Calim; de Oliveira, Leandro Alves; de Moraes, Frederico Barra; do Amaral, Rogério Andrade; Rebello, Percival Rosa

    2012-01-01

    To evaluate valgus subtrochanteric osteotomy for the treatment of trochanteric non-union. A retrospective study of cases series. From 1998 September to 2009 January, seventeen (17) cases with a diagnosis of non-union of trochanteric fracture were re-operated by the hip group of the Ortophaedic And Traumatology service of the Hospital Geral de Goiania (HGG). The patients presented pain at the fracture site, a femoral varus angle of less than 120°, and non-union of the fracture in the 3(rd) months after the initial surgery. Patients with ages ranging from 30 to 73 years, with a maximum follow-up of 09 years and minimum of 09 years. The mean time from first surgery to osteotomy was six months. Bone union was observed in 16 patients, with a mean union time of 12 weeks after surgery. The mean hip varus angle was 105(0) (120(0) to 90(0)). After surgery, the mean hip valgus angle was 144(0) (155(0) to 135(0)). We had one unsuccessful case; a 78-year old patient who had osteogtomy, fixed with DHS of 150(0), with valgization to 154(0). After six months of follow-up without union of the fracture, it was decided to perform total cemented hip artroplasthy, without complications. Valgus subtrochanteric osteotomies can be indicated for the treatment of trochanteric treatment of pseudoarthroses, with good final results for bone union, avoiding the need for total hip artroplasthy and maintaining biological fixation, as well as reestablishing the mechanical and anatomical axis of the affected limb.

  6. Etiological factors in hallux valgus, a three-dimensional analysis of the first metatarsal.

    Science.gov (United States)

    Ota, Tomohiko; Nagura, Takeo; Kokubo, Tetsuro; Kitashiro, Masateru; Ogihara, Naomichi; Takeshima, Kenichiro; Seki, Hiroyuki; Suda, Yasunori; Matsumoto, Morio; Nakamura, Masaya

    2017-01-01

    It has been reported that hallux valgus (HV) is associated with axial rotation of the first metatarsal (1MT). However, the association between HV and torsion of the 1MT head with respect to the base has not been previously investigated. The present study examined whether there was a significant difference in 1MT torsion between HV and control groups. Three-dimensional (3D) computed tomography (CT) scans of 39 ft were obtained, and 3D surface models of the 1MT were generated to quantify the torsion of the head with respect to the base. The HV group consisted of 27 ft from 27 women (69.5 ± 7.5 years old). Only the feet of HV patients with an HV angle >20° on weight-bearing radiography were selected for analysis. The control group consisted of 12 ft from 12 women (67.7 ± 7.2 years old). In a virtual 3D space, two unit vectors, which describe the orientation of the 1MT head and base, were calculated. The angle formed by these two unit vectors representing 1MT torsion was compared between the control and hallux valgus groups. The mean (± standard deviation) of the torsional angle of the 1MT was 17.6 (± 7.7)° and 4.7 (± 4.0)° in the HV and control groups, respectively, and the difference was significant ( p  hallux valgus patients compared to control group patients.

  7. Comparison of 3D Joint Angles Measured With the Kinect 2.0 Skeletal Tracker Versus a Marker-Based Motion Capture System.

    Science.gov (United States)

    Guess, Trent M; Razu, Swithin; Jahandar, Amirhossein; Skubic, Marjorie; Huo, Zhiyu

    2017-04-01

    The Microsoft Kinect is becoming a widely used tool for inexpensive, portable measurement of human motion, with the potential to support clinical assessments of performance and function. In this study, the relative osteokinematic Cardan joint angles of the hip and knee were calculated using the Kinect 2.0 skeletal tracker. The pelvis segments of the default skeletal model were reoriented and 3-dimensional joint angles were compared with a marker-based system during a drop vertical jump and a hip abduction motion. Good agreement between the Kinect and marker-based system were found for knee (correlation coefficient = 0.96, cycle RMS error = 11°, peak flexion difference = 3°) and hip (correlation coefficient = 0.97, cycle RMS = 12°, peak flexion difference = 12°) flexion during the landing phase of the drop vertical jump and for hip abduction/adduction (correlation coefficient = 0.99, cycle RMS error = 7°, peak flexion difference = 8°) during isolated hip motion. Nonsagittal hip and knee angles did not correlate well for the drop vertical jump. When limited to activities in the optimal capture volume and with simple modifications to the skeletal model, the Kinect 2.0 skeletal tracker can provide limited 3-dimensional kinematic information of the lower limbs that may be useful for functional movement assessment.

  8. Coordination of intrinsic and extrinsic hand muscle activity as a function of wrist joint angle during two-digit grasping.

    Science.gov (United States)

    Johnston, Jamie A; Bobich, Lisa R; Santello, Marco

    2010-04-26

    Fingertip forces result from the activation of muscles that cross the wrist and muscles whose origins and insertions reside within the hand (extrinsic and intrinsic hand muscles, respectively). Thus, tasks that involve changes in wrist angle affect the moment arm and length, hence the force-producing capabilities, of extrinsic muscles only. If a grasping task requires the exertion of constant fingertip forces, the Central Nervous System (CNS) may respond to changes in wrist angle by modulating the neural drive to extrinsic or intrinsic muscles only or by co-activating both sets of muscles. To distinguish between these scenarios, we recorded electromyographic (EMG) activity of intrinsic and extrinsic muscles of the thumb and index finger as a function of wrist angle during a two-digit object hold task. We hypothesized that changes in wrist angle would elicit EMG amplitude modulation of the extrinsic and intrinsic hand muscles. In one experimental condition we asked subjects to exert the same digit forces at each wrist angle, whereas in a second condition subjects could choose digit forces for holding the object. EMG activity was significantly modulated in both extrinsic and intrinsic muscles as a function of wrist angle (both pextrinsic and intrinsic muscles as a muscle synergy. These findings are discussed within the theoretical frameworks of synergies and common neural input across motor nuclei of hand muscles. Copyright 2010 Elsevier Ireland Ltd. All rights reserved.

  9. Secondary Subacromial Impingement after Valgus Closing-Wedge Osteotomy for Proximal Humerus Varus

    Directory of Open Access Journals (Sweden)

    Hirotaka Sano

    2015-01-01

    Full Text Available A 31-year-old construction worker had been suffering from both the motion pain and the restriction of elevation in his right shoulder due to severe varus deformity of humeral neck, which occurred after proximal humeral fracture. The angle for shoulder flexion and abduction was restricted to 50 and 80 degrees, respectively. Valgus closing-wedge osteotomy followed by the internal fixation using a locking plate was carried out at 12 months after injury. Postoperatively, the head-shaft angle of the humerus improved from 65 to 138 degrees. Active flexion and abduction angles improved from 80 to 135 degrees and from 50 to 135 degrees, respectively. However, the patient complained from a sharp pain with a clicking sound during shoulder abduction even after removal of the locking plate. Since subacromial steroid injection temporarily relieved his shoulder pain, we assumed that the secondary subacromial impingement was provoked after osteotomy. Thus, arthroscopic subacromial decompression was carried out at 27 months after the initial operation, which finally relieved his symptoms. In the valgus closing-wedge osteotomy, surgeons should pay attention to the condition of subacromial space to avoid causing the secondary subacromial impingement.

  10. valgus instability of the knee joint: a simple surgical repair

    African Journals Online (AJOL)

    1971-03-20

    Mar 20, 1971 ... The deep part of the collateral ligament was i~ored by and large. In cases which presented so late for treatment, such repairs as were technically possible and were attempted-in 6 of the early cases-did not constitute an appreciable improvement of stability to testing. The quadriceps expansion, the part ...

  11. Valgus instability of the knee joint: a simple surgical repair ...

    African Journals Online (AJOL)

    In the procedure described, a formal medial meniscectomy is performed even in the minority of cases where the meniscus appears to be normal. The quadriceps expansion, forming the superficial (or capsular) parr of the medial ligament, is overlapped side to side under maximal tension. It forms a significant and permanent ...

  12. Mechanisms for noncontact anterior cruciate ligament injuries: knee joint kinematics in 10 injury situations from female team handball and basketball.

    Science.gov (United States)

    Koga, Hideyuki; Nakamae, Atsuo; Shima, Yosuke; Iwasa, Junji; Myklebust, Grethe; Engebretsen, Lars; Bahr, Roald; Krosshaug, Tron

    2010-11-01

    The mechanism for noncontact anterior cruciate ligament injury is still a matter of controversy. Video analysis of injury tapes is the only method available to extract biomechanical information from actual anterior cruciate ligament injury cases. This article describes 3-dimensional knee joint kinematics in anterior cruciate ligament injury situations using a model-based image-matching technique. Case series; Level of evidence, 4. Ten anterior cruciate ligament injury video sequences from women's handball and basketball were analyzed using the model-based image-matching method. The mean knee flexion angle among the 10 cases was 23° (range, 11°-30°) at initial contact (IC) and had increased by 24° (95% confidence interval [CI], 19°-29°) within the following 40 milliseconds. The mean valgus angle was neutral (range, -2° to 3°) at IC, but had increased by 12° (95% CI, 10°-13°) 40 milliseconds later. The knee was externally rotated 5° (range, -5° to 12°) at IC, but rotated internally by 8° (95% CI, 2°-14°) during the first 40 milliseconds, followed by external rotation of 17° (95% CI, 13°-22°). The mean peak vertical ground-reaction force was 3.2 times body weight (95% CI, 2.7-3.7), and occurred at 40 milliseconds after IC (range, 0-83). Based on when the sudden changes in joint angular motion and the peak vertical ground-reaction force occurred, it is likely that the anterior cruciate ligament injury occurred approximately 40 milliseconds after IC. The kinematic patterns were surprisingly consistent among the 10 cases. All players had immediate valgus motion within 40 milliseconds after IC. Moreover, the tibia rotated internally during the first 40 milliseconds and then external rotation was observed, possibly after the anterior cruciate ligament had torn. These results suggest that valgus loading is a contributing factor in the anterior cruciate ligament injury mechanism and that internal tibial rotation is coupled with valgus motion. Prevention

  13. Hallux Valgus Correction Comparing Percutaneous Chevron/Akin (PECA) and Open Scarf/Akin Osteotomies.

    Science.gov (United States)

    Lee, Moses; Walsh, James; Smith, Margaret M; Ling, Jeff; Wines, Andrew; Lam, Peter

    2017-08-01

    Minimally invasive surgery is being used increasingly, including for hallux valgus surgery. Despite the growing interest in minimally invasive procedures, there have been few publications on percutaneous chevron/akin (PECA) procedures, and no studies have been published comparing PECA to open scarf/akin osteotomies (SA). This was a prospective, randomized study of 50 patients undergoing operative correction of hallux valgus using one of 2 techniques (PECA vs open SA). Data were collected preoperatively and on 1 day, 2 weeks, 6 weeks, and 6 months postoperatively. Outcome measures include the American Orthopaedic Foot & Ankle Society Hallux-Metatarsophalangeal-Interphalangeal (AOFAS-HMI) Score, visual analog pain score, hallux valgus angle (HVA), and 1-2 intermetatarsal angle (IMA). Twenty-five patients underwent PECA procedures and 25 patients received SA procedures. Both groups showed significantly improved AOFAS-HMI scores after surgery (PECA group: 61.8 to 88.9, SA group: 57.3 to 84.1, P = .560) with comparable final scores. HVA and IMA also presented similar outcomes at final follow-up ( P = .520 and P = .270, respectively). However, the PECA group showed significantly lower pain level (VAS) in the early postoperative phase (postoperative day 1 to postoperative week 6, P < .001 and P = .004, respectively). No serious complications were observed in either group. Both groups showed comparable good to excellent clinical and radiologic outcomes at final follow-up. However, the PECA group had significantly less pain in the first 6 weeks following surgery. Level of Evidence Level II, prospective comparative study.

  14. Posterolateral elbow joint instability

    DEFF Research Database (Denmark)

    Olsen, Bo Sanderhoff; Søjbjerg, Jens Ole; Nielsen, K K

    1998-01-01

    Thirty-five osteoligamentous elbows were included in a study on the kinematics of posterolateral elbow joint instability during the pivot shift test (PST) before and after separate ligament cuttings in the lateral collateral ligament complex (LCLC). Division of the annular ligament or the lateral...... ulnar collateral ligament caused no laxity during the PST. Division of the lateral collateral ligament caused maximal laxity of 4 degrees and 23 degrees during forced PST in valgus and external rotation (supination), respectively. Cutting of the LCLC at the ulnar or the humeral insertion was necessary...... for any PST stressed elbow joint laxity to occur. Total division of the LCLC induced a maximal laxity of 7.9 degrees and 37 degrees during forced PST in valgus and external rotation (supination), respectively. This study suggests the lateral collateral ligament to be the primary soft tissue constraint...

  15. A cadaveric investigation into the demographic and bony alignment properties associated with osteoarthritis of the patellofemoral joint.

    Science.gov (United States)

    Weinberg, Douglas S; Tucker, Braden J; Drain, Joseph P; Wang, David M; Gilmore, Allison; Liu, Raymond W

    2016-06-01

    Patellofemoral joint osteoarthritis is common, although circumstances dictating its evolution and pathogenesis remain unclear. Advances in surgical technique have improved the ability to modify long-bone alignment in the coronal, sagittal, and axial planes. However, to our knowledge, there is no significant long-term data available in regard to the relationship between anatomic alignment parameters most amenable to surgical modification and patellofemoral joint osteoarthritis. Five-hundred and seventy-one cadaveric skeletons were obtained from the Hamann-Todd osteological collection. Mechanical lateral distal femoral angle, medial proximal tibial angle, tibial slope, femoral version, tibial torsion, the position of the tibial tubercle relative to the width of the tibial plateau, trochlear depth, and patellar size were measured using validated techniques. A previously published grading system for patellofemoral joint arthritis was used to quantify macroscopic signs of degenerative joint disease. Increasing age (standardized beta 0.532, ppatellofemoral joint osteoarthritis. A relatively more laterally positioned tibial tubercle trended towards predicting patellofemoral joint osteoarthritis (standardized beta 0.080, p=0.089). These findings confirm that patellofemoral joint osteoarthritis is strongly associated with increasing age and female gender. Valgus alignment of the distal femur, a relatively more lateral location of the tibial tubercle, and a shallower trochlear grove appear to have modest effects on the development of patellofemoral joint osteoarthritis. Copyright © 2016 Elsevier B.V. All rights reserved.

  16. [Hindfoot valgus. Diagnosis and therapy of flatfoot].

    Science.gov (United States)

    Radl, R; Fuhrmann, G; Maafe, M; Krifter, R-M

    2012-04-01

    The clinical finding of flatfoot is characterized by a flattening of the medial longitudinal arch and valgus deformity of the hindfoot. The differential diagnosis of flatfoot is the physiological, flexible, contracted flatfoot, which occurs as a congenital or acquired deformity. Congenital flatfoot deformity requires early intensive therapy, while a flexible flatfoot in children has a good prognosis and conservative treatment usually leads to a stable and sufficient load-bearing foot. Severe flatfoot in children can be corrected successfully by simple, minimally invasive procedures. In adults with symptomatic flatfoot, which usually occurs due to an insufficiency of the tendon of the tibialis posterior, conservative therapy with insoles, shoe modifications and physiotherapeutic measures can lead to significant improvement, otherwise surgical correction is recommended. Early, stage-appropriate therapy helps to prevent an impending decompensation of the hindfoot.

  17. Improper trunk rotation sequence is associated with increased maximal shoulder external rotation angle and shoulder joint force in high school baseball pitchers.

    Science.gov (United States)

    Oyama, Sakiko; Yu, Bing; Blackburn, J Troy; Padua, Darin A; Li, Li; Myers, Joseph B

    2014-09-01

    In a properly coordinated throwing motion, peak pelvic rotation velocity is reached before peak upper torso rotation velocity, so that angular momentum can be transferred effectively from the proximal (pelvis) to distal (upper torso) segment. However, the effects of trunk rotation sequence on pitching biomechanics and performance have not been investigated. The aim of this study was to investigate the effects of trunk rotation sequence on ball speed and on upper extremity biomechanics that are linked to injuries in high school baseball pitchers. The hypothesis was that pitchers with improper trunk rotation sequence would demonstrate lower ball velocity and greater stress to the joint. Descriptive laboratory study. Three-dimensional pitching kinematics data were captured from 72 high school pitchers. Subjects were considered to have proper or improper trunk rotation sequences when the peak pelvic rotation velocity was reached either before or after the peak upper torso rotation velocity beyond the margin of error (±3.7% of the time from stride-foot contact to ball release). Maximal shoulder external rotation angle, elbow extension angle at ball release, peak shoulder proximal force, shoulder internal rotation moment, and elbow varus moment were compared between groups using independent t tests (α ways that may influence injury risk. As such, exercises that reinforce the use of a proper trunk rotation sequence during the pitching motion may reduce the stress placed on the structures around the shoulder joint and lead to the prevention of injuries. © 2014 The Author(s).

  18. Dynamic knee valgus alignment influences impact attenuation in the lower extremity during the deceleration phase of a single-leg landing.

    Directory of Open Access Journals (Sweden)

    Akihiro Tamura

    Full Text Available Dynamic knee valgus during landings is associated with an increased risk of non-contact anterior cruciate ligament (ACL injury. In addition, the impact on the body during landings must be attenuated in the lower extremity joints. The purpose of this study was to investigate landing biomechanics during landing with dynamic knee valgus by measuring the vertical ground reaction force (vGRF and angular impulses in the lower extremity during a single-leg landing. The study included 34 female college students, who performed the single-leg drop vertical jump. Lower extremity kinetic and kinematic data were obtained from a 3D motion analysis system. Participants were divided into valgus (N = 19 and varus (N = 15 groups according to the knee angular displacement during landings. The vGRF and angular impulses of the hip, knee, and ankle were calculated by integrating the vGRF-time curve and each joint's moment-time curve. vGRF impulses did not differ between two groups. Hip angular impulse in the valgus group was significantly smaller than that in the varus group (0.019 ± 0.033 vs. 0.067 ± 0.029 Nms/kgm, p<0.01, whereas knee angular impulse was significantly greater (0.093 ± 0.032 vs. 0.045 ± 0.040 Nms/kgm, p<0.01. There was no difference in ankle angular impulse between the groups. Our results indicate that dynamic knee valgus increases the impact the knee joint needs to attenuate during landing; conversely, the knee varus participants were able to absorb more of the landing impact with the hip joint.

  19. The alignment of the knee joint in relationship to age and osteoarthritis: the Copenhagen Osteoarthritis Study.

    Science.gov (United States)

    Laxafoss, Erling; Jacobsen, Steffen; Gosvig, Kasper K; Sonne-Holm, Stig

    2013-04-01

    The aim of the present study was to describe the changes in the axis of the knee joint in both radiologically osteoarthritic and non-osteoarthritic knees, on the basis of angles measurable in standardized clinical short knee radiographs, in a cross sectional study of an epidemiological cohort. From the third inclusion of the Copenhagen City Heart Study, 4,151 subjects were selected for standardized radiography of the knees. After censuring the inclusion, the resulting cohort was comprised of 3,488 individuals. Images were analyzed for radiological knee joint osteoarthritis (OA) and the anatomical femorotibial axis of the knee joint was measured. The prevalence of knee joint OA in males was 27.9% and 27.5%, for the left and right knees respectively. In females this was 32.8% and 36.4%. The mean knee joint angles were 4.11° in males; and 5.45° in females. A difference of 1.3° was found between the genders. In non-osteoarthritic knees the increase in valgus orientation in relationship to increasing age was found to be 0.03° and 0.04° per year, respectively, for males and females. Likewise, Kellgren and Lawrence found that OA was seen to influence a shift towards varus of 0.55°-0.76° per level of OA. Stratification in accordance with morphological severity of OA documented a clear tendency for the axis of the diseased knees to depart from the mean, primarily in the direction of varus. In knees exhibiting no signs of radiographic osteoarthritis we found a significant relationship between increasing age and a shift in the anatomical axis in the direction of valgus.

  20. Hallux valgus surgery affects kinematic parameters during gait.

    Science.gov (United States)

    Klugarova, Jitka; Janura, Miroslav; Svoboda, Zdenek; Sos, Zdenek; Stergiou, Nicholas; Klugar, Miloslav

    2016-12-01

    The aim of our study was to compare spatiotemporal parameters and lower limb and pelvis kinematics during the walking in patients with hallux valgus before and after surgery and in relation to a control group. Seventeen females with hallux valgus, who underwent first metatarsal osteotomy, constituted our experimental group. The control group consisted of thirteen females. Kinematic data during walking were obtained using the Vicon MX system. Our results showed that hallux valgus before surgery affects spatiotemporal parameters and lower limb and pelvis kinematics during walking. Hallux valgus surgery further increased the differences that were present before surgery. Specifically after hallux valgus surgery, the walking speed decreased even more (p=0.09, η 2 =0.19) while step time increased (p=0.002, η 2 =0.44) on both legs. The maximum ankle plantar flexion of the operated leg during toe-off decreased to a greater extend (p=0.03, η 2 =0.26). The asymmetry in the hip and the pelvis movements in the frontal plane (present preoperatively) persisted after surgery. Hallux valgus is not an isolated problem of the first ray, which could be just surgically addressed by correcting the foot's alignment. It is a long-term progressive malfunction of the foot affecting the entire kinematic chain of the lower extremity. Copyright © 2016 Elsevier Ltd. All rights reserved.

  1. [Treatment of moderate and severe hallux valgus by performing percutaneous double osteotomy of the first metatarsal bone].

    Science.gov (United States)

    Díaz Fernández, R

    2015-01-01

    To evaluate the clinical and radiological results in the surgical treatment of moderate and severe hallux valgus by performing percutaneous double osteotomy. A retrospective study was conducted on 45 feet of 42 patients diagnosed with moderate-severe hallux valgus, operated on in a single centre and by the same surgeon from May 2009 to March 2013. Two patients were lost to follow-up. Clinical and radiological results were recorded. An improvement from 48.14 ± 4.79 points to 91.28 ± 8.73 points was registered using the American Orthopedic Foot and Ankle Society (AOFAS) scale. A radiological decrease from 16.88 ± 2.01 to 8.18 ± 3.23 was observed in the intermetatarsal angle, and from 40.02 ± 6.50 to 10.51 ± 6.55 in hallux valgus angle. There was one case of hallux varus, one case of non-union, a regional pain syndrome type I, an infection that resolved with antibiotics, and a case of loosening of the osteosynthesis that required an open surgical refixation. Percutaneous distal osteotomy of the first metatarsal when performed as an isolated procedure, show limitations when dealing with cases of moderate and severe hallux valgus. The described technique adds the advantages of minimally invasive surgery by expanding applications to severe deformities. Percutaneous double osteotomy is a reproducible technique for correcting severe deformities, with good clinical and radiological results with a complication rate similar to other techniques with the advantages of shorter surgical times and less soft tissue damage. Copyright © 2014 SECOT. Published by Elsevier Espana. All rights reserved.

  2. Knee joint passive stiffness and moment in sagittal and frontal planes markedly increase with compression.

    Science.gov (United States)

    Marouane, H; Shirazi-Adl, A; Adouni, M

    2015-01-01

    Knee joints are subject to large compression forces in daily activities. Due to artefact moments and instability under large compression loads, biomechanical studies impose additional constraints to circumvent the compression position-dependency in response. To quantify the effect of compression on passive knee moment resistance and stiffness, two validated finite element models of the tibiofemoral (TF) joint, one refined with depth-dependent fibril-reinforced cartilage and the other less refined with homogeneous isotropic cartilage, are used. The unconstrained TF joint response in sagittal and frontal planes is investigated at different flexion angles (0°, 15°, 30° and 45°) up to 1800 N compression preloads. The compression is applied at a novel joint mechanical balance point (MBP) identified as a point at which the compression does not cause any coupled rotations in sagittal and frontal planes. The MBP of the unconstrained joint is located at the lateral plateau in small compressions and shifts medially towards the inter-compartmental area at larger compression forces. The compression force substantially increases the joint moment-bearing capacities and instantaneous angular rigidities in both frontal and sagittal planes. The varus-valgus laxities diminish with compression preloads despite concomitant substantial reductions in collateral ligament forces. While the angular rigidity would enhance the joint stability, the augmented passive moment resistance under compression preloads plays a role in supporting external moments and should as such be considered in the knee joint musculoskeletal models.

  3. Hallux Valgus Deformity and Treatment: A Three-Dimensional Approach: Modified Technique for Lapidus Procedure.

    Science.gov (United States)

    Santrock, Robert D; Smith, Bret

    2018-06-01

    In a hallux valgus deformity, the problem is deviation of the hallux at the metatarsophalangeal joint and of the first metatarsal at the tarsometatarsal joint. Although anterior-posterior radiograph findings have been prioritized, deviation in the other planes can substantially change visible cues. The modified technique for Lapidus procedure procedure, uses all 3 planes to evaluate and correct the deformity, making radiographic measurements less useful. Using a triplane framework and focusing on the apex of the deformity, all bunions become the same modified technique for Lapidus procedure can be performed regardless of the degree of deformity, always includes triplane correction, and deformity size becomes irrelevant. Copyright © 2018 Elsevier Inc. All rights reserved.

  4. Management of pain on hallux valgus with percutaneous intra-articular Pulse-Dose Radiofrequency.

    Science.gov (United States)

    Masala, Salvatore; Fiori, Roberto; Calabria, Eros; Raguso, Mario; de Vivo, Dominique; Cuzzolino, Alessandro; Simonetti, Giovanni

    2017-01-01

    The purpose of our study was to investigate the role of intra-articular pulse-dose radiofrequency in management of painful hallux valgus refractory to conservative therapies. Between November 2010 and April 2012, 51 patients (15 male, 36 female) with a median age of 71.4 years were included in our clinical trial. Under fluoroscopic guidance we introduced a 22 gauge 10 cm length cannula by a percutaneous access in the first metatarsophalangeal joint and its tip was placed intra-articularly. After removing the spindle, a radiofrequency needle with a 5 mm active tip was introduced. The following parameters were used: 1200 pulses at high voltage (45 V) with 20 msec duration followed by 480 msec silent phases. A great reduction in pain intensity was documented at 1 week, 1 month and 3 months after procedures. Pain intensity increased between 5 and 8 months after treatments, so we performed a second procedure in all patients between 7 months and 9 months since the first treatment. Also in this case we obtained a great reduction of pain intensity in the first 3 months after the procedure. Pain intensity returned at preprocedural values after 9 months after second procedure. No complications were observed. Our experience shows pulse-dose radiofrequency is a safe, repeatable and effective technique for managing patients with symptomatic hallux valgus in the short and medium term. Pulse-dose radiofrequency may improve pain control and quality of life in patients with hallux valgus refractory to conservative therapies. © 2014 Asia Pacific League of Associations for Rheumatology and Wiley Publishing Asia Pty Ltd.

  5. Bilateral Hallux Valgus: A Utility Outcome Score Assessment.

    Science.gov (United States)

    Makhdom, Asim M; Sinno, Hani; Aldebeyan, Sultan; Cota, Adam; Hamdy, Reggie Charles; Alzahrani, Mohammad; Janelle, Chantal

    2016-01-01

    Hallux valgus is the most common forefoot problem in adults. Although it can cause considerable disability and affect the quality of life of those affected, many patients seek medical attention because of cosmetic concerns. Our aim was to objectively measure the perceived health burden of living with bilateral hallux valgus. Previously validated utility outcome measures, including the visual analog scale, time trade-off, and standard gamble tests, were used to quantify the health burden for single-eye blindness, double-eye blindness, and bilateral hallux valgus in 103 healthy subjects using an online survey. The Student t test and linear regression analysis were used for statistical analysis. The mean visual analog scale, time trade-off, and standard gamble scores for bilateral hallux valgus were 0.86 ± 1.6, 0.95 ± 0.5, and 0.95 ± 0.14, respectively. These were significantly greater than the utility scores for single-eye and double-eye blindness (p hallux valgus. In conclusion, we have objectively demonstrated the effect of living with bilateral hallux valgus deformities. Our sample population reported being willing to undergo a procedure with a 5% mortality rate and sacrifice 1.8 years of life to attain perfect health and avoid the bilateral hallux valgus health state. Our findings will guide us in counseling our patients and understanding how they perceive their foot deformity. Copyright © 2016 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  6. Use of Minimally Invasive Distal Metatarsal Osteotomy for Correction of Hallux Valgus

    Directory of Open Access Journals (Sweden)

    Chun-Kit Tong

    2012-06-01

    Conclusion: Good clinical and radiographic results have been achieved with minimally invasive techniques for treatment of hallux valgus. This is an acceptable alternative operation for mild-to-moderate hallux valgus.

  7. Reliability of sagittal plane hip, knee, and ankle joint angles from a single frame of video data using the GAITRite camera system.

    Science.gov (United States)

    Ross, Sandy A; Rice, Clinton; Von Behren, Kristyn; Meyer, April; Alexander, Rachel; Murfin, Scott

    2015-01-01

    The purpose of this study was to establish intra-rater, intra-session, and inter-rater, reliability of sagittal plane hip, knee, and ankle angles with and without reflective markers using the GAITRite walkway and single video camera between student physical therapists and an experienced physical therapist. This study included thirty-two healthy participants age 20-59, stratified by age and gender. Participants performed three successful walks with and without markers applied to anatomical landmarks. GAITRite software was used to digitize sagittal hip, knee, and ankle angles at two phases of gait: (1) initial contact; and (2) mid-stance. Intra-rater reliability was more consistent for the experienced physical therapist, regardless of joint or phase of gait. Intra-session reliability was variable, the experienced physical therapist showed moderate to high reliability (intra-class correlation coefficient (ICC) = 0.50-0.89) and the student physical therapist showed very poor to high reliability (ICC = 0.07-0.85). Inter-rater reliability was highest during mid-stance at the knee with markers (ICC = 0.86) and lowest during mid-stance at the hip without markers (ICC = 0.25). Reliability of a single camera system, especially at the knee joint shows promise. Depending on the specific type of reliability, error can be attributed to the testers (e.g. lack of digitization practice and marker placement), participants (e.g. loose fitting clothing) and camera systems (e.g. frame rate and resolution). However, until the camera technology can be upgraded to a higher frame rate and resolution, and the software can be linked to the GAITRite walkway, the clinical utility for pre/post measures is limited.

  8. Effect of Feedback Corrective Exercise on Knee Valgus and Electromyographic Activity of Lower Limb Muscles in Single Leg Squat

    Directory of Open Access Journals (Sweden)

    Negar Koorosh-fard

    2015-07-01

    Full Text Available Objective: The aim of this study was assessing the effect of feedback correcting exercise in front of mirror during running on frontal plane knee and pelvic kinematic and electromyography activity of some lower extremity muscles in single leg squat (SLS. Materials & Methods: This study was quasi experimental. 23 active female subjects participated in two experimental and control groups with mean age (21.86± 2.43 years .experimental group contains subjects with knee valgus and pelvic drop angle more than a mean plus one standard deviation of the population in functional SLS. Muscular activity (RMS of gluteus maximus, Gluteus medius, rectus femoris, vastus medialis, vastus lateralis, biceps femoris and semitendinosus, angle of knee valgus and pelvic drop were register in end of SLS Pre and post of 8 training sessions. Comparing Variable has done with independent t statistical test between 2 groups and pair sample t test within each groups with significant level of 0.05. Results: Statistical analysis Before training showed no significant differences in pelvic drop between two groups (P&ge0.05, but knee valgus angle was significantly more than control group (P&le0.05. In spit that most muscle activities (% MVC except biceps femoris (P&le0.05, were greater in experimental group, no significant difference (P&ge0.05 has seen in two groups. Comparing pre and post test has showed no significant difference in knee valgus of experimental group, however it decreased around 2 degrees and although %MVC decreased in all muscles, just rectuse femoris has shown significant difference (P&le0.05. No significant difference has seen in control group in all variables (P&ge0.05. Conclusion: Findings showed poor neuromuscular control in experimental group which improved to some extent after training because lower muscle activity and energy consumption in specific movement with similar kinematic indicate improvement of motor control or cause learning. It seems that

  9. First inter metatarsal (IM) angles in Nigerians and their relationship ...

    African Journals Online (AJOL)

    Background: No age is immune to the deformity known as Hallux valgus as it has been proven that 50% of adults developed it during adolescence, while 40% of juveniles developed it before the age of 10.5 years. Aim: To determine from radiographs the normal value of the first inter metatarsal (IM) angle and to establish if ...

  10. Morgan line and its relationship with distraction index, angle of inclination and degenerative joint disease in the diagnosis of canine hip dysplasia

    Directory of Open Access Journals (Sweden)

    F.G. Miranda

    2016-08-01

    Full Text Available ABSTRACT We evaluated 160 hip joint radiographs of 40 dogs of different large breeds (25 females and 15 males from the metropolitan area of Belo Horizonte, Minas Gerais, Brazil. The radiographs of each dog were obtained at two different stages: stage 1 (mean 7.23 months and stage 2 (mean 14.25. The conventional radiographic method (CRM and the radiographic distraction method (RDM were used, carried out in both stages. CRM measured the Norberg angle (NA, the angle of inclination (AI and evaluated the presence of degenerative joint disease (DJD. The MRD was performed to establish the distraction index (DI. The aims were to evaluate the presence of the Morgan line and other signs of DJD and correlate them with the degree of canine hip dysplasia (CHD and also check if the DI greater than 0.3 (first stage was associated with the presence of ML (second stage. It was found that DI, AI and changes of femoral neck and the formation of osteophytes were associated with the presence of ML. It was observed that if the DI is greater than 0.3 at the first stage, the chance of a positive outcome of ML in the second stage increases by 7.2 times. Thus, 49 joints showed DI > 0.3 at the first stage, in which 31 (63.3 % presented ML at the second stage. Of the 31 animals that showed DI ≤ 0.3 at first, six (19.4% had LM at the second stage. There has been a significant association between the presence of ML and the degree of CHD. The more severe the CHD, the higher the percentage of positive ML results. Thus, among the 24 (60 % animals that showed ML, 11 (45.83 % were classified as severe dysplastics, 5 (20.83% as moderate and 8 (33.33 % as mild. None of the animals classified as normal or borderline presented ML. Among the 8 animals classified as mild dysplastics, 5 showed only ML as DJD.

  11. Knee joint changes in patients with neglected developmental hip dysplasia: a prospective case-control study.

    Science.gov (United States)

    Li, Qiwei; Kadhim, Muayad; Zhang, Lijun; Cheng, Xiangjun; Zhao, Qun; Li, Lianyong

    2014-12-01

    Few reports are available describing knee changes in neglected developmental dysplasia of the hip (DDH). The purpose of this study was to assess the radiographic morphology of knee joints in adults with neglected DDH. Thirty-seven patients (35 females and two males) with neglected DDH were prospectively recruited with an average age of 32.6 years. Twenty-three patients had unilateral and 14 patients had bilateral neglected DDH. Thirty-seven healthy individuals were recruited to form a matched control group. Three groups of knee joints were examined: affected knees (on the same side of the neglected DDH), unaffected knees (contralateral to the neglected DDH in patients with unilateral involvement), and control knees. A series of radiographic parameters of the knee joint were measured in the coronal and sagittal plane, and they were compared between patients and normal controls. In the coronal plane, the affected knees had increased valgus angulation related to increased height of the medial femoral condyle, decreased height of the lateral femoral condyle and decreased lateral distal femoral angle compared to control knees. In the sagittal plane, both distal femoral and proximal tibial joints of the affected knees developed a decrease in posterior angles. Additionally, the unaffected knees also developed radiographic changes compared to control knees. Patients with neglected DDH may develop changes in both knee joints. These changes should be considered during surgery to the hip, femur and knee to prevent potential complications. Level 2. Copyright © 2014 Elsevier B.V. All rights reserved.

  12. Radiographic assessment of knee-ankle alignment after total knee arthroplasty for varus and valgus knee osteoarthritis.

    Science.gov (United States)

    Gao, Fuqiang; Ma, Jinhui; Sun, Wei; Guo, Wanshou; Li, Zirong; Wang, Weiguo

    2017-01-01

    There are unanswered questions about knee-ankle alignment after total knee arthroplasty (TKA) for varus and valgus osteoarthritis (OA) of the knee. The aim of this retrospective study was to assess knee-ankle alignment after TKA. The study consisted of 149 patients who had undergone TKA due to varus and valgus knee OA. The alignment and angles in the selected knees and ankles were measured on full-length standing anteroposterior radiographs, both pre-operatively and post-operatively. The paired t-test and Pearson's correlation tests were used for statistical analysis. The results showed that ankle alignment correlated with knee alignment both pre-operatively and postoperatively (Pknee was corrected (Pknee-ankle alignment on the non-operative side (P>0.05). These findings indicated that routine TKA could correct the varus or valgus deformity of a knee, and improve the tilt of the ankle. Ankle alignment correlated with knee alignment both pre-operatively and postoperatively. Both pre-operative knee and ankle malalignment can be simultaneously corrected following TKA. Level III. Copyright © 2016 Elsevier B.V. All rights reserved.

  13. The Gibson and Piggott osteotomy for adult hallux valgus.

    Science.gov (United States)

    Rangrez, Arshad Bashir; Dar, Tahir Ahmed; Badoo, Abdul Rashid; Wani, Sharief Ahmed; Dhar, Shabir Ahmed; Mumtaz, Imran; Ahmed, Muzzaffar

    2012-01-01

    The Gibson and Piggott procedure for hallux valgus is based on sound surgical principles addressing the basic pathologies of this disorder. However, this procedure has not been studied extensively in the literature in comparison to the Mitchell and Chevron osteotomies. We report a prospective study conducted on 50 adult feet with hallux valgus. The Gibson and Piggot osteotomy was done on all the feet. We obtained 76% excellent and 18% good results with this procedure. The results bear out the fact that this procedure is a useful procedure for the management of this disorder.

  14. Revisional Surgery for Hallux Valgus with Serial Osteotomies at Two Levels

    Directory of Open Access Journals (Sweden)

    Jason B. T. Lim

    2011-01-01

    Full Text Available The aetiology and form of hallux valgus (HV is varied with many corrective procedures described. We report a 39-year-old woman, previously treated with a Chevron osteotomy, who presented with recurrent right HV, metatarsus primus varus, and associated bunion. Osteotomies were performed at two levels as a revisional procedure. This report highlights (1 limitations of the Chevron osteotomy and (2 the revisional procedure of the two level osteotomies: (i proximal opening-wedge basal osteotomy and (ii distal short Scarf with medial closing wedges. If a Chevron osteotomy is used inappropriately, for example, in an attempt to correct too large a deformity, it may angulate laterally causing a malunion with an increased distal metatarsal articular angle. Secondly, it is feasible to correct this combined deformity using a combination of proximal opening-wedge and distal short Scarf osteotomies.

  15. Treatment of Pseudoarthrosis After Minimally Invasive Hallux Valgus ...

    African Journals Online (AJOL)

    access techniques enable correction of 80-90% of hallux valgus deformities solely via hallux manipulation without removal of the eminence or open lateral release yielding more than 90% excellent and good results.[2,4,5] Nonunion is rarely reported. We describe our operative technique for nonunion following minimally ...

  16. Perisciatic infusion of ropivacaine and analgesia after hallux valgus repair

    DEFF Research Database (Denmark)

    Zaric, D; Jørgensen, B G; Laigaard, F

    2010-01-01

    Moderate to severe pain after hallux valgus repair can be successfully treated with a continuous popliteal sciatic nerve block in ambulatory patients. Different anesthesiologists use various infusion rates for this purpose. The aim of this study was to compare the analgesic efficacy of two infusi...... rates of ropivacaine 2 mg/ml: 5 and 8 ml/h....

  17. Perisciatic infusion of ropivacaine and analgesia after hallux valgus repair

    DEFF Research Database (Denmark)

    Zaric, D; Jørgensen, B G; Laigaard, F

    2010-01-01

    Moderate to severe pain after hallux valgus repair can be successfully treated with a continuous popliteal sciatic nerve block in ambulatory patients. Different anesthesiologists use various infusion rates for this purpose. The aim of this study was to compare the analgesic efficacy of two infusion...

  18. Valgus Slipped Capital Femoral Epiphysis in Patient with Hypopituitarism

    Directory of Open Access Journals (Sweden)

    Yoshihiro Kotoura

    2017-01-01

    Full Text Available Slipped capital femoral epiphysis (SCFE is a common disease of adolescent and the epiphysis is positioned more posteromedially in relation to the femoral neck shaft with varus SCFE; however, posterolateral displacement of the capital epiphysis, valgus SCFE, occurs less frequently. We report a case of valgus SCFE in a 17-year-old boy with hypopituitarism. After falling down, he experienced difficulty in walking. The radiographs were inconclusive; however three-dimensional computed tomography images showed lateral displacement of the epiphysis on the right femoral head. Valgus SCFE was diagnosed. The patient underwent in situ pinning of both sides. In situ pinning on the left side was performed as a prophylactic pinning because of endocrine abnormalities. At the 1-year follow-up, he could walk without any difficulty and there were no signs of pain. The epiphysis is commonly positioned more posteromedially in relation to the femoral neck shaft with most SCFE, but, in this case, the epiphysis slipped laterally. Differential diagnosis included femoral neck fracture (Delbet-Colonna type 1; however, this was less likely due to the absence of other clinical signs. Therefore, we diagnosed the patient as SCFE. When children complain of leg pain and limp, valgus SCFE that may not be visualized on anteroposterior radiographs needs to be considered.

  19. The Influence of Oblique Angle Forced Exercise in Surgically Destabilized Stifle Joints Is Synergistic with Bone, but Antagonistic with Cartilage in an Ovine Model of Osteoarthritis

    Directory of Open Access Journals (Sweden)

    Rachel J. Hill

    2017-01-01

    Full Text Available Large animal models of osteoarthritis are a necessary testing ground for FDA approval of human medicine applications. Sheep models have advantages over other available large animals, but development and progression of osteoarthritis in sheep is exceedingly slow, which handicaps progress in development of potential treatments. We combined oblique angle forced exercise to increase stress on the stifle, with surgical destabilization to hasten the development of osteoarthritis in ewes. Methods for early detection of clinical signs included radiography, urine, and serum biomarker assays and gait analysis and ex vivo we used microcomputed tomography and macroscopic joint analysis. Our model was able to produce clinically detectable signs of osteoarthritis in a relatively short period (14 weeks. Changes in bone were highly correlated between microcomputed tomography and radiographic analysis and changes in cartilage correlated well between urinary glycosaminoglycan levels and serum aggrecanase analyses. Exercise improved the negative effects of destabilization in bone but exacerbated the negative effects of destabilization in cartilage. These observations suggest that we may need to consider treatments for bone and cartilage separately. These results represent an improved large animal model of osteoarthritis with rapid onset of disease and superior detection of bone and soft tissue changes.

  20. Radiographic features that enable assessment of first metatarsal rotation: the role of pronation in hallux valgus

    Energy Technology Data Exchange (ETDEWEB)

    Eustace, S. (Dept. of Radiology, Mater Misericordiae Hospital, Dublin (Ireland)); O' Byrne, J. (Dept. of Orthopaedics, Mater Misericordiae Hospital, Dublin (Ireland)); Stack, J. (Dept. of Radiology, Mater Misericordiae Hospital, Dublin (Ireland)); Stephens, M.M. (Dept. of Orthopaedics, Mater Misericordiae Hospital, Dublin (Ireland))

    1993-04-01

    This study describes a method of detecting first metatarsal pronation on the basis of the movement of the inferior tuberosity of the base of 20 cadaveric first metatarsals at 0 , 10 , 20 and 30 pronation. On pronation, the inferior tuberosity of the base of the first metatarsal moved lateral to the mid-line axis. At 10 , the tuberosity pointed to the junction of the inner third and outer two-thirds of a line between the midpoint and lateral tubercle of the base. At 20 , it pointed to the junction of the inner two-thirds and outer third of that line. At 30 , it pointed to the outer marting of the lateral third. Using these features, the amount of first metatarsal pronation in 100 consecutive weigth-bearing views of feet was recorded and plotted against the corresponding intermetatarsal angles in those feet. Four of 43 patients with an intermetatarsal angle of less than 9 had pronation greater than 10 , 48 of 57 patients with an intermetatarsal angle greater than 9 had pronation greater than 10 (P<0.001). As intermetatarsal angles increase, the amount of first metatarsal pronation increases (r=0.69). Pronation and varus deviation of the first metatarsal are linked; both alter the tendon balance maintaining proximal phalanx alignment and lead to the development of hallux valgus. (orig.)

  1. Radiographic features that enable assessment of first metatarsal rotation: the role of pronation in hallux valgus

    International Nuclear Information System (INIS)

    Eustace, S.; O'Byrne, J.; Stack, J.; Stephens, M.M.

    1993-01-01

    This study describes a method of detecting first metatarsal pronation on the basis of the movement of the inferior tuberosity of the base of 20 cadaveric first metatarsals at 0 , 10 , 20 and 30 pronation. On pronation, the inferior tuberosity of the base of the first metatarsal moved lateral to the mid-line axis. At 10 , the tuberosity pointed to the junction of the inner third and outer two-thirds of a line between the midpoint and lateral tubercle of the base. At 20 , it pointed to the junction of the inner two-thirds and outer third of that line. At 30 , it pointed to the outer marting of the lateral third. Using these features, the amount of first metatarsal pronation in 100 consecutive weigth-bearing views of feet was recorded and plotted against the corresponding intermetatarsal angles in those feet. Four of 43 patients with an intermetatarsal angle of less than 9 had pronation greater than 10 , 48 of 57 patients with an intermetatarsal angle greater than 9 had pronation greater than 10 (P<0.001). As intermetatarsal angles increase, the amount of first metatarsal pronation increases (r=0.69). Pronation and varus deviation of the first metatarsal are linked; both alter the tendon balance maintaining proximal phalanx alignment and lead to the development of hallux valgus. (orig.)

  2. Comparison of 2D-3D Measurements of Hallux and First Ray Sagittal Motion in Patients With and Without Hallux Valgus.

    Science.gov (United States)

    Swanson, Jessica E; Stoltman, Matthew G; Oyen, Cheyenne R; Mohrbacher, Jessica A; Orandi, Atefeh; Olson, Jeff M; Glasoe, Ward M

    2016-02-01

    Clinicians base treatment decisions on measures of hallux and first ray motion in the management of first metatarsophalangeal joint disorders. Women account for a majority of the patients. This study assessed the reliability of a 2D approach for the measurements of sagittal motion, and compared the result to a Cardan (3D) angle criterion standard and evaluated how hallux valgus (bunion) deformity affected the comparisons. Twenty-nine women (controls n = 10; bunion n = 19) were examined using a retrospective repeated measures design. Weightbearing magnetic resonance (MR) images were acquired to replicate the position of the foot during the stance phase of gait. The images were reconstructed into virtual bone models using computer processes, whereby measures of hallux and first ray motion were represented by 2D and 3D methods of measurement. An examiner measured 2D motion on the image data sets using a goniometer, and reliability was assessed. The 3D Cardan angle result was derived from a matrix calculation. The 2D-3D comparison of measurements was evaluated with an analysis of variance (ANOVA) model across gait conditions, run separate for groups. The 2D measurement was reliable (ICC ≥ 0.98, SEM ≤ 0.89 degrees). There was no method-by-condition interaction (F ≤ 1.37, P ≥ .25) between variables. No significant difference was detected between the 2D-3D measurements in the control group (F ≤ 1.24, P ≥ .30), but the measurements were statistically different (F ≥ 4.46, P ≤ .049) in the bunion group. This study described a reliable 2D approach for measuring hallux and first ray sagittal motion from weightbearing images. The 2D measurements were comparable to a Cardan angle component motion result in controls, but not in women with bunion. Joint motion measurements may augment clinical decision making. These results suggest that a 2D image-based approach may be adequate to estimate hallux and first ray sagittal motion, although bunion deformity creates out

  3. A Prospective Study of Distal Metatarsal Chevron Osteotomies with K-Wire Fixations to Treat Hallux Valgus Deformities

    Science.gov (United States)

    Baig, Usman; Tariq, Ali; Din, Robert

    2017-01-01

    Introduction Hallux valgus is one of the most common forefoot deformities worldwide. Females are affected more often than males. The three most common clinical symptoms are the painful bunion, transfer metatarsalgia, and hammer or claw toes. Methods This case series consisted of 20 patients who had chevron osteotomy from January 2015 to January 2016. The clinical assessment was measured by The American Orthopedic Foot and Ankle Score (AOFAS), and radiologic assessment was determined by preoperative and postoperative hallux valgus angle (HVA) and intermetatarsal angle (IMA). Results The patients’ mean age was 56 years. Out of 20 patients, 19 were female, and one was male. The mean AOFAS improved from 51 preoperatively to 82 postoperatively. The HVA improved from 26° preoperatively to 14°. There were five complications including four Kirschner (K)-wire complications. Conclusion Distal chevron osteotomy is a reliable and time-tested procedure. The K-wire fixation has a relatively high complication rate. We planned to use other methods of fixation and then compared them with K-wires fixation results for future studies. PMID:29167752

  4. Total replace in the knee with deformity in the valgus

    International Nuclear Information System (INIS)

    Lara Cortassio, Gilberto; Pineros Ramirez, Daniel Francisco

    2006-01-01

    The total knee arthroplasty with valgus deformity is a technically demanding surgery. The bone deformities and the soft tissues make difficult to balance the soft tissues, the mechanic axis restoration and the prostheses placement. We present the results of a retrospective study, observational, descriptive type series of cases of 40 patients (42 prostheses), operated on with valgus deformity of more than 10 grades, using the I. White side technique to balance the soft tissue, with and average following up of 4.5 years. Based on the knee society scale (KSS) we found satisfactory results in more than 92% of the cases (39 prostheses). The complications were: total lost of the knee extension in 2 patients and i femoropatellar misalignment. We recommend practicing a sequential liberation of the lateral soft tissue to obtain a good clinical result and prostheses longevity

  5. Hallux valgus with Scarf Osteotomy - A revision of 82 cases

    International Nuclear Information System (INIS)

    Mendez Gonzalez, Mauricio; Gamba Sanchez, Carlos Enrique

    2005-01-01

    Descriptive observational study, type series of cases, whose objective was to describe the treatment of hallux valgus with Scarf Osteotomy; this study reviewed the clinical, radiological and subjective aspects of 82 feet, mean age of 49 years, and a mean of 14 degrades and 31 degrades to 9 degrades and 14 degrades (p<0,0001). The mean of the AOFAS scale improved from 49 points preoperatively to 92 points (p<0,0001). 61% of the patients were very satisfied, 34% were satisfied and 5% were not satisfied with the procedure. The recurrence of the deformity appeared in 3% of the patients. The rate of complications was of 6%. The SCARF osteotomy is a safe procedure. We recommended it like an effective technique for the correction of hallux valgus mild, moderate and severe

  6. Association Between Patient Factors and Outcome of Synthetic Cartilage Implant Hemiarthroplasty vs First Metatarsophalangeal Joint Arthrodesis in Advanced Hallux Rigidus.

    Science.gov (United States)

    Goldberg, Andy; Singh, Dishan; Glazebrook, Mark; Blundell, Chris M; De Vries, Gwyneth; Le, Ian L D; Nielsen, Dominic; Pedersen, M Elizabeth; Sakellariou, Anthony; Solan, Matthew; Younger, Alastair S E; Daniels, Timothy R; Baumhauer, Judith F

    2017-11-01

    We evaluated data from a clinical trial of first metatarsophalangeal joint (MTPJ1) implant hemiarthroplasty and arthrodesis to determine the association between patient factors and clinical outcomes. Patients ≥18 years with hallux rigidus grade 2, 3, or 4 were treated with synthetic cartilage implant MTPJ1 hemiarthroplasty or arthrodesis. Pain visual analog scale (VAS), Foot and Ankle Ability Measure (FAAM) sports and activities of daily living (ADL) scores, and Short Form-36 Physical Function (SF-36 PF) subscore were obtained preoperatively, and at 2, 6, 12, 24, 52, and 104 weeks postoperatively. Final outcome data, great toe active dorsiflexion motion, secondary procedures, radiographs, and safety parameters were evaluated for 129 implant hemiarthroplasties and 47 arthrodeses. The composite primary endpoint criteria for clinical success included VAS pain reduction ≥30%, maintenance/improvement in function, no radiographic complications, and no secondary surgical intervention at 24 months. Predictor variables included hallux rigidus grade; gender; age; body mass index (BMI); symptom duration; prior MTPJ1 surgery; preoperative hallux valgus angle, range of motion (ROM), and pain. Two-sided Fisher exact test was used ( P .05) when stratified by hallux rigidus grade, gender, age, BMI, symptom duration, prior MTPJ1 surgery status, and preoperative VAS pain, hallux valgus, and ROM. Synthetic cartilage implant hemiarthroplasty was appropriate for patients with grade 2, 3, or 4 hallux rigidus. Its results in those with associated mild hallux valgus (≤20 degrees) or substantial preoperative stiffness were equivalent to MTPJ1 fusion, irrespective of gender, age, BMI, hallux rigidus grade, preoperative pain or symptom duration. Level II, randomized clinical trial.

  7. Total knee arthroplasty for severe valgus knee deformity.

    Science.gov (United States)

    Zhou, Xinhua; Wang, Min; Liu, Chao; Zhang, Liang; Zhou, Yixin

    2014-01-01

    Primary total knee arthroplasty (TKA) in severe valgus knees may prove challenging, and choice of implant depends on the severity of the valgus deformity and the extent of soft-tissue release. The purpose of this study was to review 8 to 11 years (mean, 10 years) follow-up results of primary TKA for varient-III valgus knee deformity with use of different type implants. Between January 2002 and January 2005, 20 women and 12 men, aged 47 to 63 (mean, 57.19 ± 6.08) years old, with varient-III valgus knees underwent primary TKA. Of the 32 patients, 37 knees had varient-III deformities. Pie crusting was carefully performed with small, multiple inside-out incisions, bone resection balanced the knee in lieu of soft tissue releases that were not used in the series. Cruciate-retaining knees (Gemini MKII, Link Company, Germany) were used in 13 knees, Genesis II (Simth & Nephew Company, USA) in 14 knees, and hinged knee (Endo-Model Company, Germany) in 10 knees. In five patients with bilateral variant-III TKAs, three patients underwent 1-stage bilateral procedures, and two underwent 2-stage procedures. All implants were cemented and the patella was not resurfaced. The Hospital for Special Surgery (HSS) knee score was assessed. Patients were followed up from 8 to 11 years. The mean HSS knee score were improved from 50.33 ± 11.60 to 90.06 ± 3.07 (P managed with rivaroxaban and thrombo-embolic deterrent stockings. There was no incidence of pulmonary embolism. Post-operative patient satisfaction was 80.7 ± 10.4 points in the groups. Prosthetic survival rate was 100% at mean 10 years postoperative. Not only hinged implants can be successfully used in variant-III valgus knees. As our results show, if proper ligament balancing techniques are used and proper ligament balance is attained, the knee may not require the use of a more constrained components. Our results also present alternative implant choices for severe knee deformities.

  8. Characterization of gait in female patients with moderate to severe hallux valgus deformity.

    Science.gov (United States)

    Chopra, S; Moerenhout, K; Crevoisier, X

    2015-07-01

    Hallux valgus is one of the most common forefoot problems in females. Studies have looked at gait alterations due to hallux valgus deformity, assessing temporal, kinematic or plantar pressure parameters individually. The present study, however, aims to assess all listed parameters at once and to isolate the most clinically relevant gait parameters for moderate to severe hallux valgus deformity with the intent of improving post-operative patient prognosis and rehabilitation. The study included 26 feet with moderate to severe hallux valgus deformity and 30 feet with no sign of hallux valgus in female participants. Initially, weight bearing radiographs and foot and ankle clinical scores were assessed. Gait assessment was then performed utilizing pressure insoles (PEDAR) and inertial sensors (Physilog) and the two groups were compared using a non-parametric statistical hypothesis test (Wilcoxon rank sum, Phallux valgus group compared to controls and 9 gait parameters (effect size between 1.03 and 1.76) were successfully isolated to best describe the altered gait in hallux valgus deformity (r(2)=0.71) as well as showed good correlation with clinical scores. Our results, and nine listed parameters, could serve as benchmark for characterization of hallux valgus and objective evaluation of treatment efficacy. Copyright © 2015 Elsevier Ltd. All rights reserved.

  9. Inter and intra-observer reliability in assessment of the position of the lateral sesamoid in determining the severity of hallux valgus.

    Science.gov (United States)

    Panchani, Sunil; Reading, Jonathan; Mehta, Jaysheel

    2016-06-01

    The position of the lateral sesamoid on standard dorso-plantar weight bearing radiographs, with respect to the lateral cortex of the first metatarsal, has been shown to correlate well with the degree of the hallux valgus angle. This study aimed to assess the inter- and intra-observer error of this new classification system. Five orthopaedic consultants and five trainee orthopaedic surgeons were recruited to assess and document the degree of displacement of the lateral sesamoid on 144 weight-bearing dorso-plantar radiographs on two separate occasions. The severity of hallux valgus was defined as normal (0%), mild (≤50%), moderate (51-≤99%) or severe (≥100%) depending on the percentage displacement of the lateral sesamoid body from the lateral cortical border of the first metatarsal. Consultant intra-observer variability showed good agreement between repeated assessment of the radiographs (mean Kappa=0.75). Intra-observer variability for trainee orthopaedic surgeons also showed good agreement with a mean Kappa=0.73. Intraclass correlations for consultants and trainee surgeons was also high. The new classification system of assessing the severity of hallux valgus shows high inter- and intra-observer variability with good agreement and reproducibility between surgeons of consultant and trainee grades. Copyright © 2015 Elsevier Ltd. All rights reserved.

  10. Comparison of Clinical Outcomes of Scarf and Chevron Osteotomies and the McBride Procedure in the Treatment of Hallux Valgus Deformity

    Directory of Open Access Journals (Sweden)

    Mohammad Fakoor

    2014-03-01

    Full Text Available Background:   Hallux valgus deformity is a common chronic problem in middle age and elderly. Different surgical procedures have been introduced so far with their proposed indications for each. This study aimed to compare three   current procedures namely Chevron osteotomy, Scarf osteotomy and McBride technique.     Methods:   In this study, 44 patients were included from 2010 to 2013. All patients had been undergone one of the three current procedures including Chevron, Scarf or McBride techniques. Preoperative and follow-up radiographies     were evaluated in terms of hallux valgus and intermetatarsal angles. Foot Ankle Disability Index was filled to assess the functional. A Visual Analogue Scale evaluated pain. Also, satisfaction, aesthetic and the rate of recurrence were evaluated. Results:   Functional score, aesthetic and satisfaction level were higher in Scarf technique rather than Chevron and McBride techniques. Also, pain score and recurrence rate were lower in Scarf Technique rather the other two techniques.     Conclusions:   With respect to better results with Scarf osteotomy in this study, we recommend Scarf osteotomy as   a first choice for treatment of moderate hallux valgus deformity.

  11. Quality of Life Impact Related to Foot Health in a Sample of Older People with Hallux Valgus

    Science.gov (United States)

    López, Daniel López; Callejo González, Lucía; Iglesias, Marta Elena Losa; Canosa, Jesús Luis Saleta; Sanz, David Rodríguez; Lobo, Cesar Calvo; de Bengoa Vallejo, Ricardo Becerro

    2016-01-01

    Hallux Valgus (HV) is a highly prevalent forefoot deformity in older people associated with progressive subluxation and osteoarthritis of the first metatarsophalangeal (MTP) joint and it is believed to be associated with varying degrees of HV effect on the quality of life related to foot health. The aim of this study is to compare the impact of varying degrees of HV on foot health in a sample of older people. The sample consisted of 115 participants, mean age 76.7 ± 9.1, who attended an outpatient center where self-report data were recorded. The degree of HV deformity was determined in both feet using the Manchester Scale (MS) from stage 1 (mild) to 4 (very severe). Scores obtained on the Foot Health Status Questionnaire (FHSQ) were compared. This has 13 questions that assess 4 health domains of the feet, namely pain, function, general health and footwear. The stage 4 of HV shown lower scores for the footwear domain (11.23 ± 15.6); general foot health (27.62 ± 19.1); foot pain (44.65 ± 24.5); foot function (53.04 ± 27.2); vigour (42.19 ± 16.8); social capacity (44.46 ± 28.1); and general health (41.15 ± 25.5) compared with stage 1 of HV (Phallux valgus deformity which appears to be associated with the presence of greater degree of HV, regardless of gender. PMID:26816663

  12. Geometry of the Proximal Phalanx of Hallux and First Metatarsal Bone to Predict Hallux Abducto Valgus: A Radiological Study.

    Science.gov (United States)

    Perez Boal, Eduardo; Becerro de Bengoa Vallejo, Ricardo; Fuentes Rodriguez, Miguel; Lopez Lopez, Daniel; Losa Iglesias, Marta Elena

    2016-01-01

    Hallux abducto valgus (HAV) is one of the most common forefoot deformities in adulthood with a variable prevalence but has been reported as high as 48%. The study proposed that HAV development involves a skeletal parameter of the first metatarsal bone and proximal phalanx hallux (PPH) to determine if the length measurements of the metatarsal and PPH can be used to infer adult HAV. All consecutive patients over 21 years of age with HAV by roentgenographic evaluation were included in a cross-sectional study. The control group included patients without HAV. The study included 160 individuals. We identified and assessed the following radiographic measurements to evaluate HAV: the distances from the medial (LDM), central (LDC), and lateral (LDL) aspects of the base to the corresponding regions of the head of the PPH. The difference between the medial and lateral aspect of PPH was also calculated. The reliability of the variables measured in 40 radiographic films show perfect reliability ranging from 0.941 to 1 with a small error ranging from 0.762 to 0. Also, there were no systematic errors between the two measurements for any variable (P > 0.05). The LDM PPH showed the highest reliability and lowest error. It is more suitable to measure the LDM PPH instead of the LDC PPH when calculating the hallux valgus angle based on our reliability results. When the differences of the medial and lateral PPH are greater, the risk for developing HAV increases.

  13. First Metatarsal Proximal Opening Wedge Osteotomy for Correction of Hallux Valgus Deformity: Comparison of Straight versus Oblique Osteotomy

    Science.gov (United States)

    Han, Seung Hwan; Park, Eui Hyun; Jo, Joon; Koh, Yong Gon; Lee, Jin Woo; Choi, Woo Jin

    2015-01-01

    Purpose The aim of this study was to compare clinical and radiographic outcomes of proximal opening wedge osteotomy using a straight versus oblique osteotomy. Materials and Methods We retrospectively reviewed 104 consecutive first metatarsal proximal opening wedge osteotomies performed in 95 patients with hallux valgus deformity. Twenty-six feet were treated using straight metatarsal osteotomy (group A), whereas 78 feet were treated using oblique metatarsal osteotomy (group B). The hallux valgus angle (HVA), intermetatarsal angle (IMA), distal metatarsal articular angle, and distance from the first to the second metatarsal (distance) were measured for radiographic evaluation, whereas the American Orthopaedic Foot and Ankle Society (AOFAS) forefoot score was used for clinical evaluation. Results Significant corrections in the HVA, IMA, and distance from the first to the second metatarsal were obtained in both groups at the last follow-up (p<0.001). There was no difference in the mean IMA correction between the 2 groups (6.1±2.7° in group A and 6.0±2.1° in group B). However, a greater correction in the HVA and distance from the first to the second metatarsal were found in group B (HVA, 13.2±8.2°; distance, 25.1±0.2 mm) compared to group A (HVA, 20.9±7.7°; distance, 28.1±0.3 mm; p<0.001). AOFAS scores were improved in both groups. However, group B demonstrated a greater improvement relative to group A (p=0.005). Conclusion Compared with a straight first metatarsal osteotomy, an oblique first metatarsal osteotomy yielded better clinical and radiological outcomes. PMID:25837181

  14. Rehabilitation after hallux valgus surgery: importance of physical therapy to restore weight bearing of the first ray during the stance phase.

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    Schuh, Reinhard; Hofstaetter, Stefan G; Adams, Samuel B; Pichler, Florian; Kristen, Karl-Heinz; Trnka, Hans-Joerg

    2009-09-01

    Operative treatment of people with hallux valgus can yield favorable clinical and radiographic results. However, plantar pressure analysis has demonstrated that physiologic gait patterns are not restored after hallux valgus surgery. The purpose of this study was to illustrate the changes of plantar pressure distribution during the stance phase of gait in patients who underwent hallux valgus surgery and received a multimodal rehabilitation program. This was a prospective descriptive study. Thirty patients who underwent Austin (n=20) and scarf (n=10) osteotomy for correction of mild to moderate hallux valgus deformity were included in this study. Four weeks postoperatively they received a multimodal rehabilitation program once per week for 4 to 6 weeks. Plantar pressure analysis was performed preoperatively and 4 weeks, 8 weeks, and 6 months postoperatively. In addition, range of motion of the first metatarsophalangeal joint was measured, and the American Orthopaedic Foot and Ankle Society (AOFAS) forefoot questionnaire was administered preoperatively and at 6 months after surgery. The mean AOFAS score significantly increased from 60.7 points (SD=11.9) preoperatively to 94.5 points (SD=4.5) 6 months after surgery. First metatarsophalangeal joint range of motion increased at 6 months postoperatively, with a significant increase in isolated dorsiflexion. In the first metatarsal head region, maximum force increased from 117.8 N to 126.4 N and the force-time integral increased from 37.9 N.s to 55.6 N.s between the preoperative and 6-month assessments. In the great toe region, maximum force increased from 66.1 N to 87.2 N and the force-time integral increased from 18.7 N.s to 24.2 N.s between the preoperative and 6-month assessments. A limitation of the study was the absence of a control group due to the descriptive nature of the study. The results suggest that postoperative physical therapy and gait training may lead to improved function and weight bearing of the first

  15. [Clinical effect modified Chevron osteotomy combined with lateral tissue loosening in treating mild-moderate hallux valgus through internal signal approach].

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    Chen, Xue-Qiang; Wu, Qun-Feng; Dong, Wei-Qin; Yu, Li-Xin; Li, Xiong-Feng

    2018-03-25

    To explore clinical effect of modified Chevron osteotomy combined with lateral tissue loosening for the treatment of mild-moderate hallux valgus through internal signal approach. From July 2015 to June 2016, 26 patients with mild-moderate hallux valgus treated with modified Chevron osteotomy combined with lateral tissue loosening through internal signal approach, including 2 males and 24 females aged from 45 to 65 years old with an average of(54.6±4.8) years old;the courses of diseases ranged from 1 to 5 months with an average of (7.5±3.3) months. Hallux valgus angle(HVA), inter metatarsal angle(IMA) were measured at 12 months after operation, and AOFAS score was applied to evaluate clinical effect before and after operation. All incisions were healed at stage I. No incision occurred infection, metatarsal necrosis and recurrence of hallux valgus deformity. Two patients occurred skin numbness caused by musculocutaneous nerve injury. Twenty-six patients were followed up from 6 to 12 months with an average of(9.12±2.06) months. HVA, IMA were(30.01±3.71)°, (14.00±1.50)° before operation and(9.41±4.16)°, (7.00±0.60)° after operation, which had significant difference. There was statistical significance in AOFAS score before operation 54.77±9.59 and after operation 92.73±5.47, and 19 cases obtained excellent results and 7 moderate. Modified Chevron osteotomy combined with full thread headless pressure screw fixation and lateral tissue loosening for the treatment of mild-moderate hallux valgus has advantages of excellent exposure, simple operation, stable fixation, rapid recovery. Akin osteotomy with internal capsulorrhaphy were used with lateral loosening and could recover soft tissue balance between lateral and internal, and could receive satisfied clinical effects. Copyright© 2018 by the China Journal of Orthopaedics and Traumatology Press.

  16. Design and Evaluation of a New Type of Knee Orthosis to Align the Mediolateral Angle of the Knee Joint with Osteoarthritis

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    Amir Esrafilian

    2012-01-01

    Full Text Available Background. Osteoarthritis (OA is a disease which influences the performance of the knee joint. Moreover, the force and moments applied on the joint increase in contrast to normal subjects. Various types of knee orthoses have been designed to solve the mentioned problems. However, there are other problems in terms of distal migration during walking and the alignment of the orthosis which cannot be changed following the use of brace. Therefore, the main aim of the research was to design an orthosis to solve the aforementioned problems. Method. A new type of knee orthosis was designed with a modular structure. Two patients with knee OA participated in this research project. The force applied on the foot, moment transmitted through the knee joint, and spatiotemporal gait parameters were measured by use of a motion analysis system. Results. The results of the research showed that the adduction moment applied on the knee joint decreased while subjects walked with the new knee orthosis (P-value < 0.05. Conclusion. The new design of the knee brace can be used as an effective treatment to decrease the loads applied on the knee joint and to improve the alignment whilst walking.

  17. Midterm outcome after correction of hallux valgus deformity using scarf osteotomy in adult population

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    Laura Ibrahim Alolayan

    2017-01-01

    Full Text Available Context: Determining the efficacy of any surgical treatment is the key to achieve better practice and best outcomes for patients. Aims: This study is designed to address midterm outcome in adult patients with moderate-to-severe hallux valgus (HV, who underwent scarf osteotomy from 2012 to 2014. Settings and Design: This is a retrospective cohort study in which charts of all adult patients with moderate-to-severe HV who underwent scarf osteotomy from 2011 to 2014 were reviewed. Subjects and Methods: Between 2011 and 2014, 39 patients (41 feet who underwent scarf osteotomy for correction of HV deformity were retrospectively evaluated. Standard weight-bearing dorsoplantar radiographs were obtained pre- and postoperatively. HV angle (HVA, intermetatarsal angle (IMA and distal metatarsal articular angles (DMAA were measured pre- and postoperatively to evaluate the efficacy of the surgery. The complication rate was reported. The average follow-up was 13.5 months, and the patients' mean age was 37 years. Statistical Analysis Used: Data were compared using Chi-square test or Fisher's exact test whichever was appropriate. All tests were two-sided, and a P> 0.01 was considered statistically significant. Results: The average preoperative HVA and IMA were 32° and 14.3°, which improved to 11° and 7.9°, respectively. The changes were statistically significant (P 0.18. Conclusions: This study suggests that scarf osteotomy surgery is a very versatile osteotomy in correcting moderate-to-severe HV deformity. It offers a greater degree of correction and stability, lower rate of complications and good outcome. However, long-term follow-up studies are still needed.

  18. Factors Related to Prevalence of Hallux Valgus in Female University Students: A Cross-Sectional Study

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    Okuda, Hiroto; Juman, Sachiko; Ueda, Ai; Miki, Tomohiro; Shima, Masayuki

    2014-01-01

    Background We investigated the prevalence of hallux valgus (HV) and examined its association with various factors in a cross-sectional study of Japanese female university students. Methods A questionnaire survey of foot symptoms, lifestyle, and body mass index (BMI) was administered to 343 women who provided informed consent at a women’s university. Footprints were obtained and bone density was measured. Associations of HV with various factors were analyzed by logistic regression analysis. Results Big toe pain was reported in 26.5% of the women. HV (HV angle, ≥15°) was present in the left foot in 22.4%, the right foot in 20.7%, and unilaterally or bilaterally in 29.7% of women. Mild HV (HV angle, ≥15° to <20°) was noted in the left foot and right foot in 13.4% and 13.1% of women, respectively; no severe HV (HV angle, ≥40°) was observed. HV was associated with big toe pain (adjusted OR: 3.56, 95% CI: 2.01–6.32), history of HV in the mother or maternal grandmother (adjusted OR: 2.45, 95% CI: 1.19–5.02), and history of HV in other family members (adjusted OR: 3.09, 95% CI: 1.35–7.06). Moderate HV was associated with big toe pain (adjusted OR: 4.58, 95% CI: 2.17–9.66) and history of HV in the mother or maternal grandmother (adjusted OR: 3.36, 95% CI: 1.40–8.07). The proportion of women with big toe pain increased significantly with HV severity. Conclusions HV was present in about 30% of female university students. Young women with big toe pain or a family history of HV should be evaluated for HV. PMID:24705646

  19. The Effects of Shoulder- Girdle Muscles Fatigue on Ground Reaction Force, Elbow and Shoulder Joint Angle, and Accuracy of the Athletic Performance in Handball Penalty Throws

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    Mona Shiravand

    2017-09-01

    Discussion: As the subjects were professional, muscle fatigue did not have a significant effect on postural control, angles and angular velocity; but did affect the reaction force and accuracy of the throws before and after fatigue, which could ultimately affect the performance of athletes and competition results.

  20. Hallux valgus and plantar pressure loading: the Framingham foot study

    Science.gov (United States)

    2013-01-01

    Background Hallux valgus (HV), a common structural foot deformity, can cause foot pain and lead to limited mobility. The purpose of this study was to evaluate differences in plantar pressure and force during gait by HV status in a large population-based cohort of men and women. Methods A trained examiner performed a validated physical examination on participants’ feet and recorded the presence of hallux valgus and other specific foot disorders. Each foot was classified into one of four mutually exclusive groups based on the foot examination. Foot groups were: (i) HV only, (ii) HV and at least one additional foot disorder (FD), (iii) no HV but at least one other FD, and (iv) neither HV nor FD (referent). Biomechanical data for both feet were collected using Tekscan Matscan. Foot posture during quiet standing, using modified arch index (MAI), and foot function during gait, using center of pressure excursion index (CPEI), were calculated per foot. Further, walking scans were masked into eight sub-regions using Novel Automask, and peak pressure and maximum force exerted in each region were calculated. Results There were 3205 participants, contributing 6393 feet with complete foot exam data and valid biomechanical measurements. Participants with HV had lower hallucal loading and higher forces at lesser toes as well as higher MAI and lower CPEI values compared to the referent. Participants with HV and other FDs were also noted to have aberrant rearfoot forces and pressures. Conclusions These results suggest that HV alters foot loading patterns and pressure profiles. Future work should investigate how these changes affect the risk of other foot and lower extremity ailments. PMID:24138804

  1. Evaluating the Quality, Accuracy, and Readability of Online Resources Pertaining to Hallux Valgus.

    Science.gov (United States)

    Tartaglione, Jason P; Rosenbaum, Andrew J; Abousayed, Mostafa; Hushmendy, Shazaan F; DiPreta, John A

    2016-02-01

    The Internet is one of the most widely utilized resources for health-related information. Evaluation of the medical literature suggests that the quality and accuracy of these resources are poor and written at inappropriately high reading levels. The purpose of our study was to evaluate the quality, accuracy, and readability of online resources pertaining to hallux valgus. Two search terms ("hallux valgus" and "bunion") were entered into Google, Yahoo, and Bing. With the use of scoring criteria specific to hallux valgus, the quality and accuracy of online information related to hallux valgus was evaluated by 3 reviewers. The Flesch-Kincaid score was used to determine readability. Statistical analysis was performed with t tests and significance was determined by P values hallux valgus" (P = .045). Quality and accuracy were significantly higher in resources authored by physicians as compared to nonphysicians (quality, P = .04; accuracy, P hallux valgus is poor and written at inappropriate reading levels. Furthermore, the search term used, authorship, and presence of commercial bias influence the value of these materials. It is important for orthopaedic surgeons to become familiar with patient education materials, so that appropriate recommendations can be made regarding valuable resources. Level IV. © 2015 The Author(s).

  2. The influence of valgus heel position on foot loading in a child's gait

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    Eliška Martinásková

    2012-12-01

    Full Text Available BACKGROUND: Flat foot is a typical clinical sign in childhood, expressed as valgus positioning of the heel during vertical foot loading. This may lead to medial deviation of the foot axis and cause overloading of some foot areas. OBJECTIVE: To determine the influence of valgus position of the heel (both bilateral and unilateral on foot loading during gait. METHODS: An experimental group consisting of children with bilateral heel valgus deformity (16 children, age 5.3 ± 1.3 years and children with unilateral heel valgus deformity (14 children, age 5.6 ± 1.6 years. The control group comprised of 14 children (age 4.5 ± 1.2 years. For measuring foot loading during gait, the Footscan (RSScan International, Olen, Belgium pressure plate was used. Each subject went through 8 trials of gait measurement. From each trial, 8 foot areas were evaluated. Data processing with mean values for each subject was performed by non-parametric tests (Mann-Whitney and Wilcoxon tests, Spearman correlation in the STATISTICA programme (StatSoft, Inc., Tulsa, USA. RESULTS: Pressure peak and pressure impulse in the first metatarsal was greater for the bilateral valgus group (p CONCLUSION: The results show that valgus positioning of the heel influences foot loading in children during gait. The findings of this study suggest the necessity of a complex solution to the problem of preventing further progression of pathological changes.

  3. Comparison of distal soft-tissue procedures combined with a distal chevron osteotomy for moderate to severe hallux valgus: first web-space versus transarticular approach.

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    Park, Yu-Bok; Lee, Keun-Bae; Kim, Sung-Kyu; Seon, Jong-Keun; Lee, Jun-Young

    2013-11-06

    There are two surgical approaches for distal soft-tissue procedures for the correction of hallux valgus-the dorsal first web-space approach, and the medial transarticular approach. The purpose of this study was to compare the outcomes achieved after use of either of these approaches combined with a distal chevron osteotomy in patients with moderate to severe hallux valgus. One hundred and twenty-two female patients (122 feet) who underwent a distal chevron osteotomy as part of a distal soft-tissue procedure for the treatment of symptomatic unilateral moderate to severe hallux valgus constituted the study cohort. The 122 feet were randomly divided into two groups: namely, a dorsal first web-space approach (group D; sixty feet) and a medial transarticular approach (group M; sixty-two feet). The clinical and radiographic results of the two groups were compared at a mean follow-up time of thirty-eight months. The American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot scale hallux metatarsophalangeal-interphalangeal scores improved from a mean and standard deviation of 55.5 ± 12.8 points preoperatively to 93.5 ± 6.3 points at the final follow-up in group D and from 54.9 ± 12.6 points preoperatively to 93.6 ± 6.2 points at the final follow-up in group M. The mean hallux valgus angle in groups D and M was reduced from 32.2° ± 6.3° and 33.1° ± 8.4° preoperatively to 10.5° ± 5.5° and 9.9° ± 5.5°, respectively, at the time of final follow-up. The mean first intermetatarsal angle in groups D and M was reduced from 15.0° ± 2.8° and 15.3° ± 2.7° preoperatively to 6.5° ± 2.2° and 6.3° ± 2.4°, respectively, at the final follow-up. The clinical and radiographic outcomes were not significantly different between the two groups. The final clinical and radiographic outcomes between the two approaches for distal soft-tissue procedures were comparable and equally successful. Accordingly, the results of this study suggest that the medial transarticular

  4. Increases in tibial force imbalance but not changes in tibiofemoral laxities are caused by varus-valgus malalignment of the femoral component in kinematically aligned TKA.

    Science.gov (United States)

    Riley, Jeremy; Roth, Joshua D; Howell, Stephen M; Hull, Maury L

    2018-01-29

    The purposes of this study were to quantify the increase in tibial force imbalance (i.e. magnitude of difference between medial and lateral tibial forces) and changes in laxities caused by 2° and 4° of varus-valgus (V-V) malalignment of the femoral component in kinematically aligned total knee arthroplasty (TKA) and use the results to detemine sensitivities to errors in making the distal femoral resections. Because V-V malalignment would introduce the greatest changes in the alignment of the articular surfaces at 0° flexion, the hypotheses were that the greatest increases in tibial force imbalance would occur at 0° flexion, that primarily V-V laxity would significantly change at this flexion angle, and that the tibial force imbalance would increase and laxities would change in proportion to the degree of V-V malalignment. Kinematically aligned TKA was performed on ten human cadaveric knee specimens using disposable manual instruments without soft tissue release. One 3D-printed reference femoral component, with unmodified geometry, was aligned to restore the native distal and posterior femoral joint lines. Four 3D-printed femoral components, with modified geometry, introduced V-V malalignments of 2° and 4° from the reference component. Medial and lateral tibial forces were measured during passive knee flexion-extension between 0° to 120° using a custom tibial force sensor. Eight laxities were measured from 0° to 120° flexion using a six degree-of-freedom load application system. With the tibial component kinematically aligned, the increase in the tibial force imbalance from that of the reference component at 0° of flexion was sensitive to the degree of V-V malalignment of the femoral component. Sensitivities were 54 N/deg (medial tibial force increasing > lateral tibial force) (p  medial tibial force) (p imbalance to increase significantly, whereas the laxities were relatively unaffected. Because tibial force imbalance has the potential to

  5. Modified Chevron osteotomy for hallux valgus deformity in female athletes. A 2-year follow-up study.

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    Giotis, Dimitrios; Paschos, Nikolaos K; Zampeli, Franceska; Giannoulis, Dionisios; Gantsos, Apostolos; Mantellos, George

    2016-09-01

    Hallux valgus is an increasingly common deformity in young female athletes that constricts their daily athletic activities and influences foot cosmesis. The aim of this study was to evaluate the outcome of modified Chevron osteotomy for hallux valgus deformity in this specific population. Forty-two cases of modified Chevron osteotomies were carried out in 33 patients with mild to moderate hallux valgus deformity. Each participant was evaluated for AOFAS score, pain, range of motion, cosmetic and radiological outcome. Mean AOFAS score improved to 96.3 (phallux valgus deformity in young female athletes, with excellent clinical outcome. Copyright © 2015 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.

  6. Scoliosis angle

    International Nuclear Information System (INIS)

    Marklund, T.

    1978-01-01

    The most commonly used methods of assessing the scoliotic deviation measure angles that are not clearly defined in relation to the anatomy of the patient. In order to give an anatomic basis for such measurements it is proposed to define the scoliotic deviation as the deviation the vertebral column makes with the sagittal plane. Both the Cobb and the Ferguson angles may be based on this definition. The present methods of measurement are then attempts to measure these angles. If the plane of these angles is parallel to the film, the measurement will be correct. Errors in the measurements may be incurred by the projection. A hypothetical projection, called a 'rectified orthogonal projection', is presented, which correctly represents all scoliotic angles in accordance with these principles. It can be constructed in practice with the aid of a computer and by performing measurements on two projections of the vertebral column; a scoliotic curve can be represented independent of the kyphosis and lordosis. (Auth.)

  7. SURGICAL TREATMENT OF SEVERE (2-3 DEGREE DEFORMING ARTHROSIS OF FIRST METATARSOPHALANGEAL JOINT OF FOOT: TASKS, APPROACHES, TECHNIQUE

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    A. V. Mazalov

    2011-01-01

    Full Text Available Based on the experience of treating 67 patients (98 feet with deforming arthrosis of first metatarsophalangeal joint is shown that the treatment of this disease the distal decompressing osteotomy in combination with maximally radical the separation of the unions and cheilectomy possesses the significant health-improvement potential, which makes it possible to be turned to arthrodesis or arthroplasty only in the limiting cases of that the heavy cases of hallux rigidus. L-osteotomy 1-st metatarsus gives more than possibilities for the correction with the heavy deformations and the degenerate changes, the basic criterion of sufficiency of which is the volume of the intra-operating straightening of 1-st fingers reached. Optimum is reaching the straightening 1-st toes to 65° even above. An indispensable stage of complex operation is maximally radical of cheilectomy. During the formation of arthrodesis 1-st metatarsophalangeal joint in the horizontal plane the axis of 1 finger should be oriented in parallel to axis second metatarsal bones. The sagittal angle of the formation of arthrodesis depends on the manifestation of valgus of rear division. Active postoperative conducting essentially improves the distant results of the surgical treatment of deforming arthrosis of first metatarsophalangeal joint.

  8. Assessment of medial elbow laxity by gravity stress radiography: comparison of valgus stress radiography with gravity and a Telos stress device.

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    Harada, Mikio; Takahara, Masatoshi; Maruyama, Masahiro; Nemoto, Tadanobu; Koseki, Kazuhiko; Kato, Yoshihiro

    2014-04-01

    Valgus instability was reported to be higher with the elbow in 60° of flexion, rather than in 30° of flexion, although there are no studies using valgus stress radiography by gravity (gravity radiography) with the elbow in 60° of flexion. Fifty-seven patients with medial elbow pain participated. For both elbows, valgus stress radiography by use of a Telos device (Telos radiography) and gravity radiography, with the elbow in 60° of flexion, were performed for the assessment of medial elbow laxity. In both radiographs, the medial elbow joint space (MJS) on the affected side was compared with that on the opposite side, and the increase in the MJS on the affected side was assessed. For the Telos radiographs, the mean MJS was 4.7 mm on the affected side and 4.0 mm on the opposite side, with the mean increase in the MJS on the affected side being 0.7 mm. For the gravity radiographs, the mean MJS was 5.0 mm on the affected side and 4.2 mm on the opposite side, with the mean increase in the MJS on the affected side being 0.8 mm. There were significant correlations between the Telos and gravity radiographs in the MJS on the affected side, the MJS on the opposite side, and the increase in the MJS on the affected side (respectively, P gravity radiographs. Gravity radiography is useful for assessment of medial elbow laxity, similar to Telos radiography. Copyright © 2014 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.

  9. Effect of First Ray Insufficiency and Metatarsal Index on Metatarsalgia in Hallux Valgus.

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    Slullitel, Gaston; López, Valeria; Calvi, Juan Pablo; Seletti, Maximiliano; Bartolucci, Carla; Pinton, Gustavo

    2016-03-01

    Two concepts have been proposed to explain the etiology of metatarsalgia in hallux valgus patients: First, as the magnitude of hallux valgus increases, there is a mechanical overload of the lesser metatarsals. Second, increased relative lesser metatarsal length is a factor in the development of metatarsalgia. However, there is no current evidence that these structural factors lead to primary metatarsalgia. The purpose of the study was to evaluate the factors associated with metatarsalgia in hallux valgus patients. A cross-sectional study of 121 consecutive adult patients with non-arthritic hallux valgus was carried out. Binary logistic regression was performed to identify the effect of the clinical and demographic factors on the occurrence of metatarsalgia. One hundred twenty-one patients (184 feet) with hallux valgus were analyzed. The median weight was 65 kg (interquartile range 58-72). Metatarsalgia was present in 84 (45.6%) feet. The binary logistic regression showed that lesser toe deformity (OR 2.6, 95% CI 0.2-0.5), gastrocnemius shortening (OR 5.8, 95% CI 2.8-12.3), metatarsal index (OR 0.3, 95% CI 0.2-0.5), and weight (OR 2.5, 95% CI 1.2-5.3) were significantly associated. Metatarsalgia occurs in almost half of hallux valgus patients. It has a multifactorial etiology. Our findings contradict the common theory that both the magnitude of hallux valgus deformity and an increased length of the lesser metatarsals, by themselves, lead to primary metatarsalgia. Metatarsalgia was associated with Achilles shortening, excessive weight, and associated lesser toe deformity. These factors should be addressed in order to treat this disorder adequately. Level III, comparative series. © The Author(s) 2015.

  10. Ipsilateral stress fracture of the proximal fibula after total knee arthroplasty in a patient with severe valgus knee deformity on a background of Rheumatoid arthritis

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    Hirokazu Takai

    Full Text Available Introduction: Previous studies have reported a lower extremity stress fracture after total knee arthroplasty (TKA. However, a fibular fracture after TKA is quite rare. We report a case of proximal fibula fracture after TKA in a patient with rheumatoid arthritis (RA. Presentation of case: A 45 year old woman with RA had severe knee and foot pain with an antalgic gait disturbance. There was a significant joint deformity in many of lower limb joints. Interval bilateral TKAs were performed two weeks apart. Right TKA was performed using a constraint-type prosthesis, through lateral parapatellar approach. Left TKA was performed using a posterior-stabilized (PS prosthesis through the more commonly employed, medial parapatellar approach. Seven weeks after the right TKA, the patient was found to have an atraumatic proximal fibular fracture. The fracture went on to heal conservatively. Discussion: The fracture was considered to have occurred after the TKA. The callus appeared eleven weeks after the TKA. The factors that contributed to the fracture were thought to be overload of the fragile bone secondarily to disuse osteopaenia, RA or potentially the significant valgus malalignment correction. The surgical approach, the implant or implantation or the persisting joint deformity, were thought to be contributing factors to the aetiology of the stress fracture. The resultant change in clinical outcome/course is outlined in this case report. Conclusion: A stress fracture of the proximal fibula has the potential in the aetiology of may cause other stress fractures, joint other instability, and/or malalignment of the total lower extremity. Keywords: Stress fracture, Insufficiency fracture, Total knee arthroplasty, Fibula fracture, Valgus deformity, Rheumatoid arthritis

  11. Triple management of cubitus valgus deformity complicating neglected nonunion of fractures of lateral humeral condyle in children: a case series.

    Science.gov (United States)

    Abed, Yasser; Nour, Khaled; Kandil, Yasser Roshdy; El-Negery, Abed

    2018-02-01

    Long standing nonunion of the lateral humeral condyle (LHC) usually results in elbow pain and instability with progressive cubitus valgus and tardy ulnar neuritis. Surgical treatment of long standing nonunion is still a controversial issue due to the reported complications, such as stiffness, loss of elbow motion, and avascular necrosis of the LHC fragment. In this study, we reported the outcomes of treatment of cubitus valgus deformity in long standing nonunion of the LHC in children treated with combined triple management (fixation of the nonunion site, dome corrective osteotomy, and anterior transposition of ulnar nerve) through a modified para-triceptal approach. We evaluated ten patients with cubitus valgus deformity more than 20 degrees after neglected nonunion of the lateral humeral condyle more than 24 months. Only childern with post-operative follow up more than 24 months were included in this study. All patients were evaluated clinically, radio logically, and by pre- and post-operative functional evaluation using Mayo elbow performance score. For evaluation of ulnar nerve affection, the Akahori's system was used. There were six females and four males with the average age of 7.7 years at operation. The left elbow was affected in six patients and the right elbow was affected in four patients. The average time between fracture of the LHC and operation was 40.3 months with average post-operative follow up of 44.3 months. The average carrying angle of the healthy side was 5.5 degrees and pre-operative carrying angle of the affected side was 33.5 degrees. The average post-operative carrying angle of the affected side was 6.1 degrees. The improvement of the carrying angle at the last follow up was found statistically significant (p  0.05). The mean pre-operative Mayo elbow performance score was poor 55 ± 9.7, four patients had fair score, and six had poor score. The mean post-operative Mayo elbow performance score was excellent 92.5 ± 10, six

  12. Assessment of the Relationship between the Shape of the Lateral Meniscus and the Risk of Extrusion Based on MRI Examination of the Knee Joint.

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    Arkadiusz Szarmach

    Full Text Available Meniscus extrusion is a serious and relatively frequent clinical problem. For this reason the role of different risk factors for this pathology is still the subject of debate. The goal of this study was to verify the results of previous theoretical work, based on the mathematical models, regarding a relationship between the cross-section shape of the meniscus and the risk of its extrusion.Knee MRI examination was performed in 77 subjects (43 men and 34 women, mean age 34.99 years (range: 18-49 years, complaining of knee pain. Patients with osteoarthritic changes (grade 3 and 4 to Kellgren classification, varus or valgus deformity and past injuries of the knee were excluded from the study. A 3-Tesla MR device was used to study the relationship between the shape of the lateral meniscus (using slope angle, meniscus-cartilage height and meniscus-bone angle and the risk of extrusion.Analysis revealed that with values of slope angle and meniscus-bone angle increasing by one degree, the risk of meniscus extrusion raises by 1.157 and 1.078 respectively. Also, an increase in meniscus-cartilage height by 1 mm significantly elevates the risk of extrusion. At the same time it was demonstrated that for meniscus-bone angle values over 42 degrees and slope angle over 37 degrees the risk of extrusion increases significantly.This was the first study to demonstrate a tight correlation between slope angle, meniscus-bone angle and meniscus-cartilage height values in the assessment of the risk of lateral meniscus extrusion. Insertion of the above parameters to the radiological assessment of the knee joint allows identification of patients characterized by an elevated risk of development of this pathology.

  13. Assessment of the Relationship between the Shape of the Lateral Meniscus and the Risk of Extrusion Based on MRI Examination of the Knee Joint.

    Science.gov (United States)

    Szarmach, Arkadiusz; Luczkiewicz, Piotr; Skotarczak, Monika; Kaszubowski, Mariusz; Winklewski, Pawel J; Dzierzanowski, Jaroslaw; Piskunowicz, Maciej; Szurowska, Edyta; Baczkowski, Bogusław

    2016-01-01

    Meniscus extrusion is a serious and relatively frequent clinical problem. For this reason the role of different risk factors for this pathology is still the subject of debate. The goal of this study was to verify the results of previous theoretical work, based on the mathematical models, regarding a relationship between the cross-section shape of the meniscus and the risk of its extrusion. Knee MRI examination was performed in 77 subjects (43 men and 34 women), mean age 34.99 years (range: 18-49 years), complaining of knee pain. Patients with osteoarthritic changes (grade 3 and 4 to Kellgren classification), varus or valgus deformity and past injuries of the knee were excluded from the study. A 3-Tesla MR device was used to study the relationship between the shape of the lateral meniscus (using slope angle, meniscus-cartilage height and meniscus-bone angle) and the risk of extrusion. Analysis revealed that with values of slope angle and meniscus-bone angle increasing by one degree, the risk of meniscus extrusion raises by 1.157 and 1.078 respectively. Also, an increase in meniscus-cartilage height by 1 mm significantly elevates the risk of extrusion. At the same time it was demonstrated that for meniscus-bone angle values over 42 degrees and slope angle over 37 degrees the risk of extrusion increases significantly. This was the first study to demonstrate a tight correlation between slope angle, meniscus-bone angle and meniscus-cartilage height values in the assessment of the risk of lateral meniscus extrusion. Insertion of the above parameters to the radiological assessment of the knee joint allows identification of patients characterized by an elevated risk of development of this pathology.

  14. Tolko poetom hotel bõt : Rastrogannost; Dozhdlivõi den; Jaanov ogon; Setumaa I-II; Tolko poetom. Haralskije zhizneopissanija : Aire Valgus; Aare Valgus; Peeter Petrov; Vaike Metsleht; Valdur Laiapea; Hillar Aruda, ekonomist; Pärja Lumendi; Valjo Z

    Index Scriptorium Estoniae

    Traat, Mats, 1936-

    1996-01-01

    Orig.: Heldimus; Sajupäev; Jaanituli; Setumaa I-II; Ainult poeet. Harala elulood: Aire Valgus; Aare Valgus; Peeter Petrov; Vaike Metsleht; Valdur Laiapea; Hillar Aruda, ökonomist; Pärja Lumendi; Valjo Zeiger; Pavlo Moskalenko; Johannes Iva; Viljar Laanemägi; Olga Kaljusaar; Aimi Vaimets; Einard Kalm (1923-1984); Sonetid vaikimisest I; Kui

  15. Post-operative X-ray morphology: Joints

    International Nuclear Information System (INIS)

    Vogel, H.

    1987-01-01

    The description of X-ray findings after operations with the object of implanting protheses in joints makes up most of the contents of this book. The reconstruction of joints after trauma is only marginally dealt with. Among the various indications for implanting protheses, the replacement of joints destroyed by wear and trauma is the most important. Also considered were X-ray examinations after hallux-valgus operations and plastic surgery on hands and feet, as well as X-ray findings following operations on the lumbar part of the vertebral column (disc surgery). (orig./MG) [de

  16. Carpal valgus in llamas and alpacas: Retrospective evaluation of patient characteristics, radiographic features and outcomes following surgical treatment

    Science.gov (United States)

    Hunter, Barbara; Duesterdieck-Zellmer, Katja F.; Huber, Michael J.; Parker, Jill E.; Semevolos, Stacy A.

    2014-01-01

    This study evaluated outcomes of surgical treatment for carpal valgus in New World camelids and correlated successful outcome (absence of carpal valgus determined by a veterinarian) with patient characteristics and radiographic features. Univariable and multivariable analyses of retrospective case data in 19 camelids (33 limbs) treated for carpal valgus between 1987 and 2010 revealed that procedures incorporating a distal radial transphyseal bridge were more likely (P = 0.03) to result in success after a single surgical procedure. A greater degree of angulation (> 19°, P = 0.02) and younger age at surgery (< 4 months, P = 0.03) were associated with unsuccessful outcome. Overall, 74% of limbs straightened, 15% overcorrected, and 11% had persistent valgus following surgical intervention. To straighten, 22% of limbs required multiple procedures, not including implant removal. According to owners, valgus returned following implant removal in 4 limbs that had straightened after surgery. PMID:25477542

  17. Keblish's lateral surgical approach enhances patellar tilt in valgus knee arthroplasty

    Directory of Open Access Journals (Sweden)

    José Roberto Tonelli Filho

    Full Text Available ABSTRACT OBJECTIVE: To compare the clinical and radiological outcomes of conventional medial and lateral approaches for total knee replacement in the valgus osteoarthritic knee. METHODS: In this randomized controlled trial, 21 patients with valgus knee osteoarthritis were randomized to total knee replacement through medial or lateral approach. The primary outcome was radiographic patellar tilt. Secondary outcomes were visual analog scale of pain, postoperative levels of hemoglobin, and clinical aspect of the operative wound. RESULTS: There were no differences between the groups regarding other clinical variables. Mean lateral tilt of the patella was 3.1 degrees (SD ± 5.3 in the lateral approach group and 18 degrees (SD ± 10.2 in the medial approach group (p = 0.02. There were no differences regarding the secondary outcomes. CONCLUSION: Lateral approach provided better patellar tilt following total knee replacement in valgus osteoarthritic knee.

  18. Factors Associated with Hallux Valgus in a Population-Based Study of Older Women and Men: the MOBILIZE Boston Study

    Science.gov (United States)

    Nguyen, Uyen-Sa D.T.; Hillstrom, Howard J.; Li, Wenjun; Dufour, Alyssa B.; Kiel, Douglas P.; Procter-Gray, Elizabeth; Gagnon, Margaret M.; Hannan, Marian T.

    2009-01-01

    Objective To examine potential risk factors for hallux valgus in community-dwelling elders. Method Data from 600 MOBILIZE Boston Study participants (386 women and 214 men) were analyzed. Hallux valgus was defined as > 15 degrees angular deviation of the hallux with respect to the first metatarsal bone toward the lesser toes. Associations of hallux valgus with age, body mass index (BMI), race, education, pes planus, foot pain, and in women, history of high heel shoe use, were assessed using sex-specific Poisson regression with robust variance estimation for risk ratios (RR) and 95% confidence intervals (CI). Results Hallux valgus was present in 58% of women and 25% of men. Higher BMI was inversely associated with presence of hallux valgus in women (p trend = 0.001), with the strongest inverse association observed in those with BMI of 30.0 or more compared to those with normal BMI (RR=0.7, 95% CI: 0.5, 0.9). Women, who usually wore high-heeled shoes during ages 20 to 64 years compared to those who did not, had increased likelihood of hallux valgus (RR=1.2, 95% CI: 1.0, 1.5). Among men, those with BMI between 25.0 and 29.9 had increased likelihood of hallux valgus compared to those with normal BMI (RR=1.9, 95% CI: 1.0, 3.5). Men with pes planus were more likely to have hallux valgus (RR=2.1, 95% CI: 1.3, 3.3) compared to men without pes planus. Conclusion In women, hallux valgus was associated with lower BMI and high heel use during ages 20 to 64, while in men, associations were observed with higher BMI and pes planus. Our results suggest that the etiologic mechanisms for hallux valgus may differ between men and women. PMID:19747997

  19. The Q angle analysis, during resistance training, on open kinematics chain and intermidiate closed kinematics chain, through photogrametry

    Directory of Open Access Journals (Sweden)

    Ayslan Jorge Santos de Araujo

    2014-04-01

    Full Text Available To examine the Q angle, during the resistance training by "Leg Press 45" and the "extensor chair". 14 female subjects practitioners gym carried out exercises at OKC and ICKC, ranging from 0° to 90° of flexion, where images were recorded each 10°. Through SAPO v.068, the Q angles were measured; and conducted a T-test for independent samples with p<0.05. The resistance training should include muscle exercises in OKC and ICKC, with special attention to the last one, contradicting the view of some authors. The Q angle, when compared to OKC and ICKC, changed with the increase of bending the knee for both knees to normal as the valgus, validating the combination of exercises in OKC and ICKC in muscle strengthening, for possible trend to the pathologic valgus.

  20. Patellofemoral joint motion

    International Nuclear Information System (INIS)

    Stanford, W.; Phelan, J.; Albright, J.; Kathol, M.; Rooholamini, S.A.; El-Khoury, G.Y.; Palutsis, G.R.

    1988-01-01

    This paper describes the use of ultrafast computed tomography (CT) to obtain dynamic images of the patellofemoral joint during active motion. Thirty-eight patients underwent measurements of tangent offset, bisect offset, congruence angle, patellar tilt angle, lateral patellofemoral angle, sulcus angle, and sulcus depth made during leg movement. Selected parameters were compared with Merchant views. Significant correlations were obtained between Merchant views and comparable ultrafast CT views for all parameters except sulcus angle. Correlations between the other parameters were poor. Cine strips showed two patterns of movement; the patella remained centered either throughout excursion or until the last 20 0 of full extension, when it would sublux laterally

  1. Hallux Valgus, By Nature or Nurture? A Twin Study.

    Science.gov (United States)

    Munteanu, Shannon E; Menz, Hylton B; Wark, John D; Christie, Jemma J; Scurrah, Katrina J; Bui, Minh; Erbas, Bircan; Hopper, John L; Wluka, Anita E

    2017-09-01

    To evaluate the contributions of shared but unmeasured genetic and environmental factors to hallux valgus (HV). Between 2011 and 2012, 74 monozygotic (MZ) and 56 dizygotic (DZ) female twin pairs self-reported HV and putative risk factors, including footwear use across their lifespan. Estimates of casewise concordance (P C ), correlation (ρ), and odds ratios (ORs) were calculated, adjusting for age and other risk factors, and compared between MZ and DZ pairs using logistic regression, generalized estimating equations, and a maximum likelihood-based method, respectively. A total of 70 participants (27%) reported HV, with 12 MZ and 7 DZ pairs being concordant. After adjusting for age, twins were correlated (ρ = 0.27 [95% confidence interval (95% CI) 0.08, 0.46]) and concordant (P C  = 0.45 [95% CI 0.29, 0.61]; mean age 58 years), with no difference between MZ and DZ pairs (P = 0.7). HV was associated with regularly wearing footwear with a constrictive toe-box during the fourth decade (adjusted OR 2.73 [95% CI 1.12, 6.67]). This risk factor was correlated in MZ (ρ = 0.38 [95% CI 0.15, 0.60]) but not DZ (ρ = -0.20 [95% CI -0.43, 0.03]) pairs. These correlations were significantly different (P = 0.002). Twins are correlated for HV, but we found no evidence that correlation was due to shared genetic factors. We identified an environmental risk factor, footwear with a constrictive toe-box, that is not shared to the same extent by MZ and DZ pairs, contrary to the assumption of the classic twin model. Footwear, and possibly genetic factors and unknown shared environmental factors, could contribute to developing HV. © 2016, American College of Rheumatology.

  2. Helpotusta hallux valgukseen! : 8 viikon harjoitusohjelman ja kinesioteippauksen vaikutus hallux valgus virheasentoon, koettuun kipuun ja toimintakykyyn

    OpenAIRE

    Uusihaka, Noora; Hiirikoski, Joonas

    2013-01-01

    Hallux valgus eli vaivaisenluu on yleinen jalkaterän toimintahäiriö, jota esiintyy jopa 25 prosentilla ihmisistä. Usein hallux valgus on kivulias ja vaikuttaa toimintakykyyn ja elämänlaatuun negatiivisesti. Jalkaterän toimintahäiriöt, jotka aiheuttavat hallux valgusta, ovat usein seurausta jalkaterän lihasten alentuneesta lihasvoimasta ja –kontrollista. Opinnäytetyön tarkoituksena on tuottaa tietoa hallux valguksen yleisyydestä, sen etiologisista tekijöistä ja konservatiivisen hoidon mahd...

  3. The effects of neuromuscular training on knee joint motor control during sidecutting in female elite soccer and handball players.

    Science.gov (United States)

    Zebis, Mette K; Bencke, Jesper; Andersen, Lars L; Døssing, Simon; Alkjaer, Tine; Magnusson, S Peter; Kjaer, Michael; Aagaard, Per

    2008-07-01

    The project aimed to implement neuromuscular training during a full soccer and handball league season and to experimentally analyze the neuromuscular adaptation mechanisms elicited by this training during a standardized sidecutting maneuver known to be associated with non-contact anterior cruciate ligament (ACL) injury. The players were tested before and after 1 season without implementation of the prophylactic training and subsequently before and after a full season with the implementation of prophylactic training. A total of 12 female elite soccer players and 8 female elite team handball players aged 26 +/- 3 years at the start of the study. The subjects participated in a specific neuromuscular training program previously shown to reduce non-contact ACL injury. Neuromuscular activity at the knee joint, joint angles at the hip and knee, and ground reaction forces were recorded during a sidecutting maneuver. Neuromuscular activity in the prelanding phase was obtained 10 and 50 ms before foot strike on a force plate and at 10 and 50 ms after foot strike on a force plate. Neuromuscular training markedly increased before activity and landing activity electromyography (EMG) of the semitendinosus (P Neuromuscular training increased EMG activity for the medial hamstring muscles, thereby decreasing the risk of dynamic valgus. This observed neuromuscular adaptation during sidecutting could potentially reduce the risk for non-contact ACL injury.

  4. Swivel Joint For Liquid Nitrogen

    Science.gov (United States)

    Milner, James F.

    1988-01-01

    Swivel joint allows liquid-nitrogen pipe to rotate through angle of 100 degree with respect to mating pipe. Functions without cracking hard foam insulation on lines. Pipe joint rotates on disks so mechanical stress not transmitted to thick insulation on pipes. Inner disks ride on fixed outer disks. Disks help to seal pressurized liquid nitrogen flowing through joint.

  5. Ultrasonic evaluation of the abductor hallucis muscle in hallux valgus: a cross-sectional observational study

    Directory of Open Access Journals (Sweden)

    Stewart Sarah

    2013-01-01

    Full Text Available Abstract Background The aim of the study was to investigate the abductor hallucis muscle characteristics, defined as dorso-plantar (DP thickness, medio-lateral (ML width, and cross-sectional area (CSA in relation to the severity of hallux valgus using musculoskeletal ultrasound. One hundred and two feet, mean (SD age of 60.3 (20.54 years old, displaying varying severities of hallux valgus were stratified into four groups representing the four grades of the Manchester Scale (grade 0: no deformity, grade 1: mild deformity, grade 2: moderate deformity and grade 3: severe deformity. Methods The abductor hallucis muscle was imaged in each foot using a portable ultrasound system. The mean (SD DP thickness, ML width, and CSA measurements were compared across the four Manchester Scale grades using a one-way ANOVA. Results Significant differences in DP thickness were found between feet with no hallux valgus (grade 0 and feet with hallux valgus grade 2 (p = 0.001 and 3 (p  0.0125. Conclusions We speculate that morphological changes to the abductor hallucis muscle occur early in the development of the deformity.

  6. Subjective versus objective assessment in early clinical outcome of modified Lapidus procedure for hallux valgus deformity.

    Science.gov (United States)

    Chopra, S; Moerenhout, K; Crevoisier, X

    2016-02-01

    Studies have assessed the outcome of hallux valgus surgeries based on subjective questionnaires, usually the American Orthopaedic Foot and Ankle Society Score, and radiographic results reporting good to excellent outcome at 6-12 months postoperatively. However, contrasting results were reported by gait studies at 12-24 months postoperatively. In a previous study, we found nine gait parameters which can describe the altered gait in hallux valgus deformity. This study aimed, to assess the outcome of modified Lapidus at 6 months postoperatively, using gait assessment method, to determine if the nine specified gait parameters effectively relates with the clinical scores and the radiological results or add information missed by these commonly used clinical assessments. We assessed 21 participants including 11 controls and 10 patients with moderate to severe hallux valgus deformity. The patient group was followed 6 months postoperatively. The ambulatory gait assessment was performed utilizing pressure insoles and inertial sensors. Clinical assessment includes foot and ankle questionnaires along with radiographic results. Comparison was made using non parametric tests, Phallux valgus surgeries. The existing clinical assessment overestimates the functional outcome at the early postoperative phase. Copyright © 2015 Elsevier Ltd. All rights reserved.

  7. Tibial Sesamoid Position Influence on Functional Outcome and Satisfaction After Hallux Valgus Surgery.

    Science.gov (United States)

    Chen, Jerry Yongqiang; Rikhraj, Kiran; Gatot, Cheryl; Lee, Justine Yun Yu; Singh Rikhraj, Inderjeet

    2016-11-01

    During hallux valgus surgery, the abnormal position of the first metatarsal bone relative to the sesamoids is addressed. Our study aimed to investigate the influence of postoperative tibial sesamoid position (TSP) on functional outcome and patient satisfaction after hallux valgus surgery. Between February 2007 and November 2011, 250 patients who underwent hallux valgus surgery at our tertiary hospital were followed for 2 years after surgery. They were categorized into 2 groups based on Hardy and Clapham's TSP classification, recorded on postoperative weight-bearing anteroposterior (AP) radiographs: (1) normal (grades I-IV) and (2) outliers (grades V-VII). The mode TSP improved from grade VII preoperatively to grade IV postoperatively (P Hallux Metatarsophalangeal-Interphalangeal Scale was 6 (95% CI 2, 11) points higher in the normal group (P = .009). Patients in the outlier group were also more likely to be dissatisfied with the surgery performed when compared to the normal group (OR 3.881, 95% CI 1.689, 8.920, P = .001). We recommend correcting the TSP to grade of IV or less to improve functional outcome and satisfaction after hallux valgus surgery. Level III, retrospective comparative series. © The Author(s) 2016.

  8. Outcomes in chevron osteotomy for Hallux Valgus in a large cohort

    NARCIS (Netherlands)

    van Groningen, B. (Bart); M.C.M. (Marieke) van der Steen,; M. Reijman (Max); Bos, J. (Janneke); Hendriks, J.G.E. (Johannes G.E.)

    2016-01-01

    textabstractClinical and radiological related outcomes have been reported for Chevron osteotomy as correction for mild to moderate hallux valgus, but only for relatively small patient series. Moreover, evaluation of the patient's point of view has mostly been conducted by means of more

  9. Validity of self-assessment of hallux valgus using the Manchester scale

    Directory of Open Access Journals (Sweden)

    Wee Elin

    2010-09-01

    Full Text Available Abstract Background Hallux valgus (HV is a common condition involving the progressive subluxation of the first metatarsophalangeal joint due to lateral deviation of the hallux and medial deviation of the first metatarsal. The objective of this study was to evaluate the re-test reliability and validity of self-assessment of HV using a simple clinical screening tool involving four standardised photographs (the Manchester scale, in order to determine whether this tool could be used for postal surveys of the condition. Methods HV was assessed with the Manchester scale in 138 people aged 65 to 93 years of age (102 women and 36 men as part of a larger randomised controlled trial. At the six month follow-up assessment, HV was reassessed to determine re-test reliability, and participants were asked to self-assess their degree of HV independent of the examiners. Associations between (i baseline and follow-up assessments of the examiners and (ii participant and examiner assessments were performed using weighted kappa statistics. Analyses were then repeated after HV was dichotomised as present or absent using unweighted kappa, and sensitivity and specificity of self-assessment of HV was determined. Results Re-test reliability of the examiners was substantial to almost perfect (weighted kappa = 0.78 to 0.90, and there was a substantial level of agreement between observations of the participants and the examiners (weighted kappa = 0.71 to 0.80. Overall, there was a slight tendency for participants to rate their HV as less severe than the examiners. When the Manchester scale scores were dichotomised, agreement was substantial to almost perfect for both re-test comparisons (kappa = 0.80 to 0.89 and substantial for comparisons between participants and examiners (kappa = 0.64 to 0.76. The sensitivity and specificity of self-assessment of HV using the dichotomous scale were 85 and 88%, respectively. Conclusions The Manchester scale demonstrates high re

  10. How to avoid unintended valgus alignment in distal femoral derotational osteotomy for treatment of femoral torsional malalignment - a concept study.

    Science.gov (United States)

    Imhoff, Florian B; Scheiderer, Bastian; Zakko, Philip; Obopilwe, Elifho; Liska, Franz; Imhoff, Andreas B; Mazzocca, Augustus D; Arciero, Robert A; Beitzel, Knut

    2017-12-29

    Defining the optimal cutting plane for derotational osteotomy at the distal femur for correction of torsion in cases of patellofemoral instability is still challenging. This preliminary study investigates changes of frontal alignment by a simplified trigonometrical model and demonstrates a surgical guidance technique with the use of femur cadavers. The hypothesis was that regardless of midshaft bowing, a cutting plane perpendicular to the virtual anatomic shaft axis avoids unintended valgus malalignment due to derotation. A novel mathematical model, called the Pillar-Crane-Model, was developed to forecast changes on frontal alignment of the femur when a perpendicular cutting plane to the virtual anatomical shaft was chosen. As proof of concept, eight different torsion angles were assessed on two human cadaver femora (left and right). A single cut distal femoral osteotomy perpendicular to the virtual anatomical shaft was performed. Frontal plane alignment (mLDFA, aLDFA, AMA) was radiographically analyzed before and after rotation by 0°, 10°, 20°, and 30°. Measurements were compared to the model. The trigonometrical equation from the Pillar-Crane-Model provides mathematical proof that slight changes into varus occur, seen by an increase in AMA and mLDFA, when the cutting plane is perpendicular to the virtual anatomical shaft axis. A table with standardized values is provided. Exemplarily, the specimens showed a mean increase of AMA from 4.8° to 6.3° and mLDFA from 85.2° to 86.7 after derotation by 30°. Throughout the derotation procedure, aLDFA remained at 80.4° ± 0.4°SD. With the use of this model for surgical guidance and anatomic reference, unintended valgus changes on frontal malalignment can be avoided. When the cutting plane is considered to be perpendicular to the virtual anatomical shaft from a frontal and lateral view, a slight increase of mLDFA results when a derotational osteotomy of the distal femur is performed.

  11. Perioperative analgesia with a buprenorphine transdermal patch for hallux valgus surgery: a prospective, randomized, controlled study

    Directory of Open Access Journals (Sweden)

    Xu C

    2018-04-01

    Full Text Available Can Xu, Mingqing Li, Chenggong Wang, Hui Li, Hua Liu Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan Province, People’s Republic of China Purpose: Hallux valgus surgery often results in significant postoperative pain. Adequate control of pain is essential for patient satisfaction and improves the outcome of the procedure. This study aimed to investigate the perioperative analgesic effect of a buprenorphine transdermal patch in patients who underwent hallux valgus surgery.Patients and methods: A total of 90 patients were randomly divided into the following three groups based on the perioperative analgesic method: flurbiprofen axetil intravenous injection (Group F, oral celecoxib (Group C, and buprenorphine transdermal delivery system (BTDS (Group BTDS. The pain status, degree of satisfaction, adverse effects, and administration of tramadol hydrochloride for uncontrolled pain were recorded on the night before surgery, postoperative day 1, postoperative day 2, and postoperative day 3.Results: The BTDS could effectively control perioperative pain for patients undergoing ­hallux valgus surgery. The analgesic effect of the BTDS was better than that of oral celecoxib. In addition, statistically significant differences were not observed in the visual analog scale (VAS scores, adverse effects, and rescue analgesia between the patients who received the BTDS and the patients who received the flurbiprofen axetil intravenous injection. However, the degree of patient satisfaction of the BTDS group was significantly higher (P<0.05 than that of the other two groups.Conclusion: The BTDS (a preemptive analgesia regimen could exert an analgesic effect during the perioperative period for patients who had received hallux valgus surgery, and this effect is beneficial for sustaining postoperative physiological and psychological states and promoting functional rehabilitation. Keywords: hallux valgus, buprenorphine transdermal

  12. [The elbow joint - a diagnostic challenge : anatomy, biomechanics, and pathology].

    Science.gov (United States)

    Schueller-Weidekamm, C; Kainberger, F

    2008-12-01

    The elbow is one of the most commonly injured joints in sports activities. In particular, weight lifters, golfers, tennis players, and pitchers are affected. Injuries in sports involving overhead throwing are commonly based on the pathophysiologic model of valgus extension overload syndrome. The injuries are commonly complex and demand a good knowledge of the symptoms, the exact anatomy, and the biomechanics to arrive at a precise radiologic diagnosis. The characteristic patterns of injury that occur in specific sports activities are related to a combination of increased varus or valgus and extension or flexion overload that results in tensile forces and/or compression and shear stress. Acute symptoms are frequently based on chronic degeneration of the tendons and ligamentous structures due to repetitive microtrauma from overuse syndrome.

  13. Intraoperative joint gaps and mediolateral balance affect postoperative knee kinematics in posterior-stabilized total knee arthroplasty.

    Science.gov (United States)

    Watanabe, Toshifumi; Muneta, Takeshi; Sekiya, Ichiro; Banks, Scott A

    2015-12-01

    Adjusting joint gaps and establishing mediolateral (ML) soft tissue balance are considered essential interventions for better outcomes in total knee arthroplasty (TKA). However, the relationship between intraoperative laxity measurements and weightbearing knee kinematics has not been well explored. This study aimed to quantify the effect of intraoperative joint gaps and ML soft tissue balance on postoperative knee kinematics in posterior-stabilized (PS)-TKA. We investigated 44 knees in 34 patients who underwent primary PS-TKA by a single surgeon. The central joint gaps and ML tilting angles at 0°, 10°, 30°, 60°, 90°, 120° and 135° flexion were measured during surgery. At a minimum of two year follow-up, we analyzed in vivo kinematics of these knees and examined the influence of intraoperative measurements on postoperative kinematics. Gap difference of knee flexion at 135° minus 0° was correlated with the total posterior translation of lateral femoral condyle (r=0.336, p=0.042) and femoral external rotation (r=0.488, p=0.002) during squatting, anteroposterior position of lateral femoral condyle (r=-0.510, p=0.001) and maximum knee flexion (r=0.355, p=0.031) in kneeling. Similar correlations were observed between deep flexion gap differences with respect to the 90° reference and postoperative knee kinematics. Well-balanced knees showed less anterior translation of medial femoral condyle in mid- to deep flexion, consistent femoral external rotation, and the most neutral valgus/varus rotation compared with unbalanced knees. These findings indicate the importance of adequate intraoperative joint gaps in deep flexion and ML soft tissue balance throughout the range of motion. Copyright © 2015 Elsevier B.V. All rights reserved.

  14. Surgery of the hallux valgus in an ambulatory setting: a liability risk?

    Science.gov (United States)

    Galois, L; Serwier, J-M; Arashvand, A D

    2017-05-01

    The primary objective of the study is to make an inventory of malpractice in hallux valgus surgery in an ambulatory setting and to identify the patient characteristics for a higher risk of malpractice. The secondary objective is creating a methodology for analyzing the medicolegal aspects of a surgery in day case comparing with hospitalization. The database of the Branchet insurance company was used. A total of 11,000 claims for a period of 11 years (2002-2013) have been investigated. The files of the patients with hallux valgus surgery were isolated from the insurer's database using CCAM codes. The medical director, a medical officer, the legal expert and finally the judge had already analyzed all these cases. The authors reviewed the various documents with a specific questionnaire. We identified 14 cases of claims in relation with hallux valgus 1-day surgery among a total of 138 claims for hallux valgus including all techniques (10%). All patients were female. The mean age was 42.6 years (19-64) in ambulatory patients (AG group) in comparison with 49.5 years (19-73) in hospitalized patients (HG group). Percutaneous techniques were significantly more represented in the AG group (p = 0.002) and scarfs osteotomies in the HG group (p = 0.004). The use of tourniquet seemed to be lower in the AG group, but it was a not significant trend (p = 0.085). In term of anesthesia procedures, no significant differences were seen between the two groups. The comparison of the complications common to both groups showed no significant difference except for insufficient results which were more frequent in the AG group (p = 0.026). The rate of insufficient informed consent seemed to be higher in the AG group, but it was a not significant trend (p = 0.084). No specific data regarding claims in relation with hallux valgus 1-day surgery are available to our knowledge in the literature. We did not identify in our study specific complications related to ambulatory procedures

  15. Branching miter joints : principles and artwork

    NARCIS (Netherlands)

    Verhoeff, T.; Verhoeff, K.; Hart, G.W.; Sarhangi, R.

    2010-01-01

    A miter joint connects two beams, typically of the same cross section, at an angle such that the longitudinal beam edges continue across the joint. When more than two beams meet in one point, like in a tree, we call this a branching joint. In a branching miter joint, the beams’ longitudinal edges

  16. Footwear modification following hallux valgus surgery: The all-or-none phenomenon.

    Science.gov (United States)

    Robinson, Cal; Bhosale, Abhijit; Pillai, Anand

    2016-06-26

    To define footwear outcomes following hallux valgus surgery, focusing on patient return to comfortable and heeled footwear and patterns of post-operative footwear selection. Surgical intervention is indicated for symptomatic cases of hallux valgus unresponsive to conservative methods, with favourable reported outcomes. The return to various types of footwear post-operatively is reflective of the degree of correction achieved, and corresponds to patient satisfaction. Patients are expected to return to comfortable footwear post-operatively without significant residual symptoms. Many female patients will additionally attempt to return to high-heeled, narrow toe box shoes. However, minimal evidence exists to guide their expectations. Sixty-five female hallux valgus patients that had undergone primary surgery between 2011 and 2013 were retrospectively identified using our hospital surgical database. Patients were reviewed using a footwear-specific outcome questionnaire at a mean 18.5 mo follow-up. Eighty-six percent of patients were able to return to comfortable footwear post-operatively with minimal discomfort. Of those intending to resume wearing heeled footwear, 62% were able to do so, with 77% of these patients wearing these as or more frequently than pre-operatively. No significant difference was observed between pre- and post-operative heel size. Mean time to return to heeled footwear was 21.4 wk post-operation. Cosmetic outcomes were very high and did not adversely impact footwear selection. We report high rates of return to both comfortable and heeled shoes in female patients following primary hallux valgus surgery. We observed an "all-or-none phenomenon" where patients rejected a return to heeled footwear unless able to tolerate them at the same frequency and heel size as pre-operatively. A minority of patients were unable to return to comfortable footwear post-operatively, which had adverse ramifications on their quality-of-life. We recommend that the

  17. THE CORRECTION OF HALLUX VARUS DEFORMITY IN CONSEQUENCE OF SURGICAL TREATMENT FOR HALLUX VALGUS

    Directory of Open Access Journals (Sweden)

    V. M. Mashkov

    2010-01-01

    Full Text Available The analysis of treatment of 21 patients (24 feet with postoperative hallux varus deformity which have arisen after operations apropos hallux valgus is carried out. For correction of vicious position of the first finger we successfully carried out the Brandes procedure, sometimes in a combination to operations on sinews of muscles of the first finger - an adductor hallucis tendotomy and/or lengthening of the extensor hallucis longus tendon.

  18. Impact of Podiatry Resident Experience Level in Hallux Valgus Surgery on Postoperative Outcomes

    Science.gov (United States)

    Fleischer, Adam E.; Yorath, Martin C.; Joseph, Robert; Baron, Adam; Nordquist, Thomas; Moore, Braden; Robinson, Richmond; Reilly, Charles

    2018-01-01

    Background Despite modern advancements in transosseous fixation and operative technique, hallux valgus (i.e., bunion) surgery is still associated with a higher than usual amount of patient dissatisfaction, and is generally recognized as a complex and nuanced procedure requiring precise osseous and capsulotendon balancing. It stands to reason then that familiarity and skill level of trainee surgeons might impact surgical outcomes in this surgery. The aim of this study was to determine whether podiatry resident experience level influences mid-term outcomes in hallux valgus surgery. Methods Consecutive adults who underwent isolated hallux valgus surgery via distal metatarsal osteotomy at a single US metropolitan teaching hospital from January 2004 to January 2009 were contacted and asked to complete a validated outcome measure of foot health (Manchester-Oxford Foot Questionnaire) regarding their operated foot. Resident experience level was quantified using the surgical logs for the primary resident of record at the time of each case. Associations were assessed using simple, multiple and logistic regression analyses. Results A total of 102 adult patients (n=102 feet) agreed to participate with a mean age of 46.8 (SD 13.1 years, range 18-71) and average length of follow-up 6.2 years (SD 1.4, range 3.6-8.6). Level of trainee experience was not associated with postoperative outcomes in either the univariate (odds ratio 0.99 [95% CI 0.98-1.01], p = 0.827) or multivariate analyses (odds ratio 1.00 [95% CI 0.97-1.02], p = 0.907). Conclusions We conclude that podiatry resident level of experience in hallux valgus surgery does not contribute appreciably to postoperative clinical outcomes. PMID:24726058

  19. Tensile Properties of the Deep Transverse Metatarsal Ligament in Hallux Valgus: A CONSORT-Compliant Article.

    Science.gov (United States)

    Abdalbary, Sahar Ahmed; Elshaarawy, Ehab A A; Khalid, Bahaa E A

    2016-02-01

    The deep transverse metatarsal ligament (DTML) connects the neighboring2 metatarsal heads and is one of the stabilizers connecting the lateral sesamoid and second metatarsal head. In this study, we aimed to determine the tensile properties of the DTML in normal specimens and to compare these results with hallux valgus specimens. We hypothesized that the tensile properties of the DTML would be different between the 2 groups of specimens.The DTML in the first interspace was dissected from 12 fresh frozen human cadaveric specimens. Six cadavers had bilateral hallux valgus and the other 6 cadavers had normal feet. The initial length (L0) and cross-sectional area (A0) of the DTML were measured using a digital caliper, and tensile tests with load failure were performed using a material testing machine.There were significant between-groups differences in the initial length (L0) P = 0.009 and cross-sectional area (A0) of the DTML P = 0.007. There were also significant between-groups differences for maximum force (N) P = 0.004, maximum distance (mm) P = 0.005, maximum stress (N/mm) P = 0.003, and maximum strain (%) P = 0.006.The DTML is an anatomical structure for which the tensile properties differ in hallux valgus.

  20. Tensile Properties of the Deep Transverse Metatarsal Ligament in Hallux Valgus

    Science.gov (United States)

    Abdalbary, Sahar Ahmed; Elshaarawy, Ehab A.A.; Khalid, Bahaa E.A.

    2016-01-01

    Abstract The deep transverse metatarsal ligament (DTML) connects the neighboring 2 metatarsal heads and is one of the stabilizers connecting the lateral sesamoid and second metatarsal head. In this study, we aimed to determine the tensile properties of the DTML in normal specimens and to compare these results with hallux valgus specimens. We hypothesized that the tensile properties of the DTML would be different between the 2 groups of specimens. The DTML in the first interspace was dissected from 12 fresh frozen human cadaveric specimens. Six cadavers had bilateral hallux valgus and the other 6 cadavers had normal feet. The initial length (L0) and cross-sectional area (A0) of the DTML were measured using a digital caliper, and tensile tests with load failure were performed using a material testing machine. There were significant between-groups differences in the initial length (L0) P = 0.009 and cross-sectional area (A0) of the DTML P = 0.007. There were also significant between-groups differences for maximum force (N) P = 0.004, maximum distance (mm) P = 0.005, maximum stress (N/mm2) P = 0.003, and maximum strain (%) P = 0.006. The DTML is an anatomical structure for which the tensile properties differ in hallux valgus. PMID:26937914

  1. Hallux valgus interphalangeus deformity: A case series in the pediatric population.

    Science.gov (United States)

    Grawe, Brian; Parikh, Shital; Crawford, Alvin; Tamai, Junichi

    2012-03-01

    The objective of this report is to describe three cases (four feet) of hallux valgus interphalangeus deformity in the pediatric population. A retrospective review was completed to identify three patients (four feet) with a deformity consistent with hallux valgus interphalangeus. Patients were followed at regular intervals for a minimum of 6 months. Treatment modalities and clinical results were reviewed for all patients for this relatively rare entity in the skeletally immature population. All patients in this report had a deformity that was not consistent with a traumatic etiology. Case number 1 had a significantly symptomatic deformity that failed conservative treatment, and eventually necessitated full surgical correction of the deformity. Symptom free unrestricted activity was obtained post-operatively, however final follow-up radiographs have demonstrated early changes consistent with arthritis. Case numbers 2 & 3 were relatively asymptomatic throughout their course of treatment, and responded well to non-operative intervention. Based on these findings excision of the exostosis and soft-tissue realignment appears to be a reliable option for symptom relief for patients who present with a painful symptomatic hallux valgus interphalangeus deformity. However, the risk of degenerative changes following spur removal must be entertained prior to the procedure. On the contrary a pain free deformity that does not impact functionality of toe, or impair shoe ware may be treated successfully with conservative measures. Copyright © 2011 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.

  2. Chevron osteotomy for the treatment of hallux valgus.

    Science.gov (United States)

    Horne, G; Tanzer, T; Ford, M

    1984-03-01

    Seventy-six chevron osteotomies with follow-up periods ranging from six months to eight years were reviewed. The majority of patients had pain over the bunion prior to operation, and 27 also presented with second metatarsalgia. After surgery there was a marked decrease of pain in the first metatarsophalangeal joint, and in 18 feet the second metatarsalgia was either eliminated or markedly decreased. Most patients were pleased with the appearance of the feet after surgery, but almost one-third of the women complained of difficulty in wearing high heels. The surgical technique is straightforward, but careful attention to detail is necessary to obtain a consistent and satisfactory result.

  3. Joining by plating: optimization of occluded angle

    International Nuclear Information System (INIS)

    Dini, J.W.; Johnson, H.R.; Kan, Y.R.

    1978-11-01

    An empirical method has been developed for predicting the minimum angle required for maximum joint strength for materials joined by plating. This is done through a proposed power law failure function, whose coefficients are taken from ring shear and conical head tensile data for plating/substrate combinations and whose exponent is determined from one set of plated-joint data. Experimental results are presented for Al-Ni-Al (7075-T6) and AM363-Ni-AM363 joints, and the failure function is used to predict joint strengths for Al-Ni-Al (2024-T6), UTi-Ni-UTi, and Be-Ti-Be

  4. Collateral ligament strains during knee joint laxity evaluation before and after TKA.

    Science.gov (United States)

    Delport, Hendrik; Labey, Luc; De Corte, Ronny; Innocenti, Bernardo; Vander Sloten, Jos; Bellemans, Johan

    2013-08-01

    Passive knee stability is provided by the soft tissue envelope. There is consensus among orthopedic surgeons that good outcome in Total Knee Arthroplasty requires equal tension in the medial/lateral compartment of the knee joint, as well as equal tension in the flexion/extension gap. The purpose of this study was to quantify the ligament laxity in the normal non-arthritic knee before and after Posterior-Stabilized Total Knee Arthroplasty. We hypothesized that the Medial/Lateral Collateral Ligament shows minimal changes in length when measured directly by extensometers in the native human knee during varus/valgus laxity testing. We also hypothesized that due to differences in material properties and surface geometry, native laxity is difficult to reconstruct using a Posterior-Stabilized Total Knee. Six specimens were used to perform this in vitro cadaver test using extensometers to provide numerical values for laxity and varus-valgus tilting in the frontal plane. This study enabled a precise measurement of varus-valgus laxity as compared with the clinical assessment. The strains in both ligaments in the replaced knee were different from those in the native knee. Both ligaments were stretched in extension, in flexion the Medial Collateral Ligament tends to relax and the Lateral Collateral Ligament remains tight. As material properties and surface geometry of the replaced knee add stiffness to the joint, we recommend to avoid overstuffing the joint, when using this type of Posterior-Stabilized Total Knee Arthroplasty, in order to obtain varus/valgus laxity close to the native joint. Copyright © 2013 Elsevier Ltd. All rights reserved.

  5. [Application of pie-crusting the medial collateral ligament release in arthroscopic surgery for posterior horn of 
medial meniscus in knee joint].

    Science.gov (United States)

    Zhu, Weihong; Tang, Qi; Liao, Lele; Li, Ding; Yang, Yang; Chen, You

    2017-09-28

    To explore the effectiveness and safety of pie-crusting the medial collateral ligament release (MCL) in treating posterior horn of medial meniscus (PHMM) tear in tight medial tibiofemoral compartment of knee joint.
 Methods: Thirty-two consecutive patients with PHMM tear in tight medial tibiofemoral compartment of knee joint were admitted to our department from January, 2013 to December, 2014. All patients were performed pie-crusting the MCL release at its tibial insertion with 18-gauge intravenous needle. All patients were evaluated by valgus stress test and bilateral valgus stress radiograph at postoperative 1st day, 4th week and 12th week. Visual Analogue Scales (VAS), Lysholm scores, Tegner scores and International Knee Documentation Committee (IKDC) scores were recorded at the 1st, 3th, 6th month follow-up, then follow-up every 6 months.
 Results: The mean follow-up was 28 (24-36) months. All cases were negative in valgus stress test. MCL rupture, femoral fracture, articular cartilage lesion and neurovascular injury were not found at the last follow-up. The median medial joint space width of affected side and unaffected side for valgus stress radiographs were 6.8 mm and 4.3 mm (P0.05) at the 12th week, respectively. VAS scores was changed from 4.5±1.5 preoperatively to 1.7±1.0 at the final follow-up (t=16.561, Pjoint.

  6. An evidence-based review of hip-focused neuromuscular exercise interventions to address dynamic lower extremity valgus

    Directory of Open Access Journals (Sweden)

    Ford KR

    2015-08-01

    Full Text Available Kevin R Ford,1 Anh-Dung Nguyen,2 Steven L Dischiavi,1 Eric J Hegedus,1 Emma F Zuk,2 Jeffrey B Taylor11Department of Physical Therapy, High Point University, High Point, NC, USA; 2Department of Athletic Training, School of Health Sciences, High Point University, High Point, NC, USAAbstract: Deficits in proximal hip strength or neuromuscular control may lead to dynamic lower extremity valgus. Measures of dynamic lower extremity valgus have been previously shown to relate to increased risk of several knee pathologies, specifically anterior cruciate ligament ruptures and patellofemoral pain. Therefore, hip-focused interventions have gained considerable attention and been successful in addressing these knee pathologies. The purpose of the review was to identify and discuss hip-focused exercise interventions that aim to address dynamic lower extremity valgus. Previous electromyography, kinematics, and kinetics research support the use of targeted hip exercises with non-weight-bearing, controlled weight-bearing, functional exercise, and, to a lesser extent, dynamic exercises in reducing dynamic lower extremity valgus. Further studies should be developed to identify and understand the mechanistic relationship between optimized biomechanics during sports and hip-focused neuromuscular exercise interventions.Keywords: dynamic lower extremity valgus, hip neuromuscular control, ACL injury rehabilitation, patellofemoral pain, hip muscular activation

  7. Surgical treatment of subacute and chronic valgus instability in multiligament-injured knees with superficial medial collateral ligament reconstruction using Achilles allografts: a quantitative analysis with a minimum 2-year follow-up.

    Science.gov (United States)

    Liu, Xin; Feng, Hua; Zhang, Hui; Hong, Lei; Wang, Xue Song; Zhang, Jin; Shen, Jie Wei

    2013-05-01

    Symptomatic medial collateral ligament (MCL) instability is rare, and it is frequently associated with multiligament injuries. Most clinical investigations have failed to clearly define the specific objective outcome measures assessing the stability of the MCL quantitatively before and after the reconstruction procedure. To quantitatively evaluate the early clinical outcomes of patients with valgus instability of knee joints who had undergone superficial MCL reconstruction using Achilles tendon allografts. Case series; Level of evidence, 4. From August 2005 to December 2010, 19 consecutive patients with MCL injuries were included in this study. The inclusion criteria were (1) a subacute or chronic MCL injury, with a time from initial injury to surgery of longer than 3 weeks, and (2) valgus laxity graded C or D according to the International Knee Documentation Committee (IKDC). All patients underwent superficial MCL reconstruction using Achilles tendon allografts. To evaluate the laxity of the MCL preoperatively and postoperatively, valgus stress radiographs using a Telos device were used. Other assessments included the IKDC subjective functional evaluation and Lysholm score estimation. Sixteen of the 19 patients (12 men and 4 women) were available for final follow-up. The median age of the patients was 37 years (range, 19-53 years); mean body mass index (BMI) was 26.4 (range, 21.7-29.4). The mean time from injury to surgery was 15.9 months (range, 24 days to 84 months), and median follow-up period was 34 months (range, 24-67 months). The mean medial knee laxity (side-to-side difference) was 8.9 ± 3.2 mm (range, 6-15.9 mm) preoperatively and 1.1 ± 0.9 mm (range, -1.1 to 3.2 mm) postoperatively (P < .001). The preoperative mean IKDC subjective knee functional score was 49.8 ± 6.9 (range, 31-57.5), while the postoperative functional score was 84.3 ± 6.0 (range, 71.3-93.1) (P < .001). The mean Lysholm score was 69.3 ± 5.9 (range, 55-78) preoperatively and 88.6

  8. Association between hip abductor function, rear-foot dynamic alignment, and dynamic knee valgus during single-leg squats and drop landings

    Directory of Open Access Journals (Sweden)

    Yoshinori Kagaya

    2015-06-01

    Conclusion: Dynamic hip mal-alignment might be associated with both greater KID and HOD, whereas rear-foot eversion is associated only with greater KID. Hip abductor and rear-foot dysfunction are important factors for dynamic knee valgus and thus evaluating DTT and HFT will help to prevent dynamic knee valgus.

  9. Severe Hallux Valgus With Coalition of the Hallux Sesamoids Treated With Modified Lapidus Procedure: A Case Report.

    Science.gov (United States)

    Kurashige, Toshinori; Suzuki, Seiichi

    2017-12-01

    Coalition of the hallux sesamoids is an extremely rare condition. To our knowledge, only 1 case report has been published. We report a case of severe hallux valgus deformities with coalitions of the hallux sesamoids. The coalitions themselves were asymptomatic; however, this severe hallux valgus deformity needed to be surgically treated. The hallux sesamoids in both feet appeared to be fused and heart shaped on anteroposterior radiographs and dumbbell shaped on axial radiographs. It is known that postoperative incomplete reduction of the medial sesamoids can be a risk factor for the recurrence of hallux valgus. The computed tomography scan demonstrated a groove in the bottom of the center of the heart-shaped sesamoid. The flexor hallucis longus tendon was located in the groove. Therefore, a modified Lapidus procedure was performed considering the medial half of the heart-shaped sesamoid as the medial sesamoid. Although delayed union occurred, successful correction of the deformity was achieved. Level IV.

  10. [Treatment of Hallux Valgus: Current Diagnostic Testing and Surgical Treatment Performed by German Foot and Ankle Surgeons].

    Science.gov (United States)

    Arbab, Dariusch; Schneider, Lisa-Maria; Schnurr, Christoph; Bouillon, Bertil; Eysel, Peer; König, Dietmar Pierre

    2018-04-01

    Hallux valgus is one of the most prevalent foot deformities, and surgical treatment of Hallux valgus is one of the most common procedures in foot and ankle surgery. Diagnostic and treatment standards show large variation despite medical guidelines and national foot and ankle societies. The aim of this nationwide survey is a description of the current status of diagnostics and therapy of Hallux valgus in Germany. A nationwide online questionnaire survey was sent to two German foot and ankle societies. The participants were asked to answer a questionnaire of 53 questions with four subgroups (general, diagnostics, operation, preoperative management). Surgical treatment for three clinical cases demonstrating a mild, moderate and severe Hallux valgus deformity was inquired. 427 foot and ankle surgeons answered the questionnaire. 388 participants were certified foot and ankle surgeons from one or both foot and ankle societies. Medical history (78%), preoperative radiographs (100%) and preoperative radiographic management (78%) are of high or very high importance for surgical decision pathway. Outcome scores are used by less than 20% regularly. Open surgery is still the gold standard, whereas minimally invasive surgery is performed by only 7%. Our survey showed that diagnostic standards are met regularly. There is a wide variation in the type of procedures used to treat Hallux valgus deformity. TMT I arthrodesis is preferred in severe Hallux valgus, but also used to treat moderate and mild deformities. Minimally invasive surgery is still used by a minority of surgeons. It remains to be seen, to what extent minimally invasive surgery will be performed in the future. Georg Thieme Verlag KG Stuttgart · New York.

  11. "Viimne reliikvia" ja "Valgus koordis" : žanrifilmist žanrifilmini / Lauri Kärk

    Index Scriptorium Estoniae

    Kärk, Lauri, 1954-

    2010-01-01

    Žanrifilmi mõistmisest, 1960-ndate žanriuuendustest. Kahest eesti žanrifilmist: "Viimne reliikvia" (1969) ja "Valgus Koordis" (1951). Artikli järjes kõrvutatakse "Viimset reliikviat" Paul-Eerik Rummo "Tuhkatriinumänguga" (Vanemuises 1969., lavastaja E. Hermaküla). Sarnaseid jooni ka "Viimse reliikvia" ja teiste žanrifilmidega, pikemalt filmidest: Kaljo Kiisa "Hullumeelsus" (1968), Christian-Jaque'i "Tulp-Fanfanil" (Prantsusmaa, 1951), Tony Richardsoni "Tom Jones" (Inglismaa, 1963), Edmond Keosajani "Tabamatud tasujad" (Venemaa, 1966), Vytaytas Žalakeviciuse "Keegi ei tahtnud surra" (Leedu, 1965), Arthur Penni "Bonnie ja Clyde"

  12. Pronación del dedo gordo en el hallux valgus

    OpenAIRE

    Gómez Galván, Mercedes

    2015-01-01

    La pronación del dedo gordo en el hallux valgus (HV) es difícil de estudiar y cuantificar. Objetivos: evaluar la pronación del dedo gordo en el HV. Material y métodos: estudio prospectivo de 132 pacientes con HV que estaban en lista de espera quirúrgica y grupo control de 30 pacientes sin HV. Se realizó un estudio experimental con 6 falanges proximales creando un sistema de calibrado que permitía controlar su pronación a 0º, 10º, 20º, 30º, 40º, 50º y 60º. El paciente se coloca...

  13. Glaucoma, Open-Angle

    Science.gov (United States)

    ... Home » Statistics and Data » Glaucoma, Open-angle Listen Glaucoma, Open-angle Open-angle Glaucoma Defined In open-angle glaucoma, the fluid passes ... 2010 2010 U.S. Age-Specific Prevalence Rates for Glaucoma by Age and Race/Ethnicity The prevalence of ...

  14. Self-reported knee joint instability is related to passive mechanical stiffness in medial knee osteoarthritis.

    Science.gov (United States)

    Creaby, Mark W; Wrigley, Tim V; Lim, Boon-Whatt; Hinman, Rana S; Bryant, Adam L; Bennell, Kim L

    2013-11-20

    Self-reported knee joint instability compromises function in individuals with medial knee osteoarthritis and may be related to impaired joint mechanics. The purpose of this study was to evaluate the relationship between self-reported instability and the passive varus-valgus mechanical behaviour of the medial osteoarthritis knee. Passive varus-valgus angular laxity and stiffness were assessed using a modified isokinetic dynamometer in 73 participants with medial tibiofemoral osteoarthritis. All participants self-reported the absence or presence of knee instability symptoms and the degree to which instability affected daily activity on a 6-point likert scale. Forward linear regression modelling identified a significant inverse relationship between passive mid-range knee stiffness and symptoms of knee instability (r = 0.27; P 0.05). Conceivably, a stiffer passive system may contribute toward greater joint stability during functional activities. Importantly however, net joint stiffness is influenced by both active and passive stiffness, and thus the active neuromuscular system may compensate for reduced passive stiffness in order to maintain joint stability. Future work is merited to examine the role of active stiffness in symptomatic joint stability.

  15. Hindfoot Valgus following Interlocking Nail Treatment for Tibial Diaphysis Fractures: Can the Fibula Be Neglected?

    Directory of Open Access Journals (Sweden)

    Metin Uzun

    2014-01-01

    Full Text Available Purpose. We evaluated whether intramedullary nail fixation for tibial diaphysis fractures with concomitant fibula fractures (except at the distal one-third level managed conservatively with an associated fibula fracture resulted in ankle deformity and assessed the impact of the ankle deformity on lower extremity function. Methods. Sixty middle one-third tibial shaft fractures with associated fibular fractures, except the distal one-third level, were included in this study. All tibial shaft fractures were anatomically reduced and fixed with interlocking intramedullary nails. Fibular fractures were managed conservatively. Hindfoot alignment was assessed clinically. Tibia and fibular lengths were compared to contralateral measurements using radiographs. Functional results were evaluated using the Knee Injury and Osteoarthritis Outcome Score (KOOS and the Foot and Ankle Disability Index Score (FADI. Results. Anatomic union, defined as equal length in operative and contralateral tibias, was achieved in 60 fractures (100%. Fibular shortening was identified in 42 fractures (68%. Mean fibular shortening was 1.2 cm (range, 0.5–2 cm. Clinical exams showed increased hindfoot valgus in 42 fractures (68%. The mean KOOS was 88.4, and the mean FADI score was 90. Conclusion. Fibular fractures in the middle or proximal one-third may need to be stabilized at the time of tibial intramedullary nail fixation to prevent development of hindfoot valgus due to fibular shortening.

  16. Valgus osteotomy of the tibia with a Puddu plate combined with anterior cruciate ligament reconstruction

    Directory of Open Access Journals (Sweden)

    Albuquerque Roberto Freire da Mota e

    2003-01-01

    Full Text Available Anterior knee instability associated with a varus deformity is a complex condition with several treatment possibilities. Among these, anterior cruciate ligament (ACL associated to a simultaneous valgus tibial osteotomy is a increasing indication. This simultaneous procedure adds technical issues to those related to the isolated surgeries. Thus, the osteotomy plane and location of fixation hardware shouldn?t conflict with tibial tunnel and ACL graft fixation. Authors analyze the relations between a opening tibial valgus osteotomy stabilized with a Puddu plate and ACL reconstruction with a patellar tendon graft fixated with interference screws in 10 human cadaver knees. A straight oblique tibial osteotomy starting on the medial tibial cortex and oriented laterally and proximally was performed on all knees with a 10mm opening medially and stabilized with a Puddu plate on the most posterior aspect of the medial tibia, and a tibial tunnel drilled 50° to tibial plateau. With this technique there was no intersection between tibial tunnel or interference screw and the osteotomy or the plate fixation screws.

  17. Does joint alignment affect the T2 values of cartilage in patients with knee osteoarthritis?

    International Nuclear Information System (INIS)

    Friedrich, Klaus M.; Shepard, Timothy; Chang, Gregory; Wang, Ligong; Babb, James S.; Regatte, Ravinder; Schweitzer, Mark

    2010-01-01

    To assess the relationship between T2 values of femorotibial cartilage and knee alignment in patients with clinical symptoms of medial osteoarthritis (OA). Twenty-four patients (mean age ± standard deviation, 62.5 ± 9.9 years) with clinical symptoms of medial knee OA, 12 with varus and 12 with valgus alignment of the femorotibial joint, were investigated on 3T MR using a 2D multi-echo spin echo (MESE) sequence for T2 mapping. Analysis of covariance, Spearman correlation coefficients, exact Mann-Whitney tests, and Fisher's exact tests were used for statistical analysis. Overall the T2 values of cartilage in the medial compartment (median ± interquartile-range, 49.44 ± 6.58) were significantly higher (P = 0.0043) than those in the lateral compartment (47.15 ± 6.87). Patients with varus alignment (50.83 ± 6.30 ms) had significantly higher T2 values of cartilage (P < 0.0001) than patients with valgus alignment (46.20 ± 6.00 ms). No statistically significant association between the T2 values of cartilage (in either location) and the Kellgren Lawrence score was found in the varus or in the valgus group. T2 measurements were increased in medial knee OA patients with varus alignment, adding support to the theory of an association of OA and joint alignment. (orig.)

  18. Does joint alignment affect the T2 values of cartilage in patients with knee osteoarthritis?

    Energy Technology Data Exchange (ETDEWEB)

    Friedrich, Klaus M. [Medical University of Vienna, Department of Radiology, Vienna (Austria); Shepard, Timothy; Chang, Gregory; Wang, Ligong; Babb, James S.; Regatte, Ravinder [New York University Langone Medical Center, Department of Radiology, New York, NY (United States); Schweitzer, Mark [Ottawa Hospital, Diagnostic Imaging, Ottawa, ON (Canada)

    2010-06-15

    To assess the relationship between T2 values of femorotibial cartilage and knee alignment in patients with clinical symptoms of medial osteoarthritis (OA). Twenty-four patients (mean age {+-} standard deviation, 62.5 {+-} 9.9 years) with clinical symptoms of medial knee OA, 12 with varus and 12 with valgus alignment of the femorotibial joint, were investigated on 3T MR using a 2D multi-echo spin echo (MESE) sequence for T2 mapping. Analysis of covariance, Spearman correlation coefficients, exact Mann-Whitney tests, and Fisher's exact tests were used for statistical analysis. Overall the T2 values of cartilage in the medial compartment (median {+-} interquartile-range, 49.44 {+-} 6.58) were significantly higher (P = 0.0043) than those in the lateral compartment (47.15 {+-} 6.87). Patients with varus alignment (50.83 {+-} 6.30 ms) had significantly higher T2 values of cartilage (P < 0.0001) than patients with valgus alignment (46.20 {+-} 6.00 ms). No statistically significant association between the T2 values of cartilage (in either location) and the Kellgren Lawrence score was found in the varus or in the valgus group. T2 measurements were increased in medial knee OA patients with varus alignment, adding support to the theory of an association of OA and joint alignment. (orig.)

  19. Prevalence of flat foot and hallux valgus deformity among primary school female students in Kiar city of Chaharmahal and Bakhtiari

    Directory of Open Access Journals (Sweden)

    Reza Vahab Kashani

    2013-08-01

    Full Text Available Introduction: Foot deformities are common among complaints of patients referred to the orthopedic centers. Most of naturally occurring lower limb deformities in children, which are rather common, would be corrected with further normal growth. However, a small percentage of these problems remain unresolved and may cause complications in the future. The main aim of this study is determination of prevalence of flat foot and hallux valgus deformity among primary school female students in Kiar city of Chaharmahal and BakhtiariMaterial and Methods: This is a cross sectional study. Foot posture index (FPI 6 test evaluate for 345 students in age range 7- 11 years and two groups of 7 to 9 years and 11 to 10 years. Also prevalence of hallux valgus among 345 students evaluated.Results: 7.8 % of studied subjects had flat foot deformity. Among 345 students, 12 (6.6% students in range of age 7 -9 years and 15 (9.3 % students in range of 10-11 had flat foot deformity. Also prevalence of hallux valgus was 16.5%.Conclusion: These findings point to the importance of proper physical examination, early diagnosis and on-time treatment of foot deformities such as flat foot and hallux valgus deformity in children.

  20. Effect of arch support insole on plantar pressure distribution in females with mild and moderate hallux valgus

    Directory of Open Access Journals (Sweden)

    Maedeh Farzadi

    2013-10-01

    Full Text Available Objective: Hallux Valgus is one of the most foot deformities which increase plantar pressure beneath big toe and first metatarsal. The aim of this study was to assess the effect of foot orthosis on plantar pressure distribution in subjects with mild and moderate Hallux Valgus. Materials & Methods: in this quasi-experimental study, females 16 with Hallux Valgus were recruited. Plantar pressure in 8 area of foot was measured by Pedar-X insole when wearing standard shoe only shoe with foot orthosis and shoe with foot orthosis after a month of using orthosis. Data were analyzed by repeated measure analysis of variance test. Results: using foot orthosis for a month leaded to decrease pressure in the big toe (P<0/019 first metatarsal and 3-5 metatarsals (P<0.001 and also increased pressure in medial mid foot (P<0.001. Conclusion: Foot orthosis decreased peak pressure in fore foot and increased it in medial mid foot. Therefore redistribute plantar pressure to the more normal pattern in Hallux Valgus subjects. So it could be one of the effective methods to prevent the progression of this deformity in its initial steps of formation.

  1. Novel magnetic resonance imaging evaluation for valgus instability of the knee caused by medial collateral ligament injury

    International Nuclear Information System (INIS)

    Ikuma, Hisanori; Abe, Nobuhiro; Furumatsu, Takayuki; Uchida, Youichiro; Fujiwara, Kazuo; Nishida, Keiichiro; Ozaki, Toshifumi

    2008-01-01

    Instability of the knee after the medial collateral ligament (MCL) injury is usually assessed with the manual valgus stress test, even though, in recent years, it has become possible to apply magnetic resonance imaging (MRI) to the assessment of the damage of the ligament. The valgus instability of 24 patients (12 isolated injuries and 12 multiple ligament injuries) who suffered MCL injury between 1993 and 1998 was evaluated with the Hughston and Eilers classification, which involves radiographic assessment under manual valgus stress to the injured knees. We developed a novel system for classifying the degree of injury to the MCL by calculating the percentage of injured area based on MRI and investigated the relationship between this novel MRI classification and the magnitude of valgus instability by the Hughston and Eilers classification. There was a significant correlation between the 2 classifications (p=0.0006). On the other hand, the results using other MRI based classification systems, such as the Mink and Deutsch classification and the Petermann classification, were not correlated with the findings by the Hughston and Eilers classification in these cases (p>0.05). Since MRI is capable of assessing the injured ligament in clinical practice, this novel classification system would be useful for evaluating the stability of the knee and choosing an appropriate treatment following MCL injury. (author)

  2. Equivalent correction in scarf and chevron osteotomy in moderate and severe hallux valgus: a randomized controlled trial.

    NARCIS (Netherlands)

    Deenik, A.; Mameren, H. van; Visser, E. de; Waal Malefijt, M.C. de; Draijer, F.; Bie, R. de

    2008-01-01

    BACKGROUND: Chevron osteotomy is a widely accepted osteotomy for correction of hallux valgus.(18) Algorithms were developed to overcome the limitations of distal osteotomies. Scarf osteotomy has become popular as a versatile procedure that should be able to correct most cases of acquired hallux

  3. Effects of using hallux valgus (HV splint, HV splint plus exercise or HV splint plus electrical stimulation (ES on treatment of flexible HV in Young Population

    Directory of Open Access Journals (Sweden)

    Abbas Rahimi

    2012-10-01

    Full Text Available Background and Aim: The dramatically increased incidence of hallux valgus (HV deformity is more related to the cultural rather than genetic parameters. Satisfaction rate following either conservative or surgical treatments are very low. The current study aimed to compare the effects of three commonly used conservative treatments including hallux valgus (HV splint, HV splint plus electrical stimulation (ES currents, or HV splint plus exercise to treat this deformity. Materials & Methods: Thirty-six university students with a mild to moderate HV deformity were recruited in this study. Before starting the study, anterior-posterior view radiographies were taken from their feet. HV angle (HVA less than 20º was considered as normal, between 21-25º as mild, between 26-40 º as moderate and higher than 40 degrees was considered as a sever HV deformity. Then, the subjects were divided into three groups (n=12 and were randomly placed into Splint, Splint plus Exercise, and Splint plus Exercise plus ES groups for 6 weeks. At the end of week six, the radiographies were repeated and the pre/post treatments HVA were compared. Results: The results of the current study showed a non-significant 4.7% reduction of HVA in Splint group (p=0.12. However, 15.4% reduction of HVA occurred in Splint plus Exercise group, which was significant (p=0.005.The subjects used Splint plus Electrical stimulation showed a significant 13.9% reduction in HVA (p=0.008. Furthermore, AOFAS scores of the subjects revealed no significant differences among treatment groups in terms of pain reduction.Conclusion: Although using a HV splint alone could not significantly reduce the HVA, mixing it with either exercise or ES could significantly expedite its corrective effects. It should be mentioned that correction of the deformity was not always associated with decreasing the subjects’ pain, which might be due to the immediate counter force of the splint. Repeating the study with a long

  4. The Valgus Inclination of the Tibial Component Increases the Risk of Medial Tibial Condylar Fractures in Unicompartmental Knee Arthroplasty.

    Science.gov (United States)

    Inoue, Shinji; Akagi, Masao; Asada, Shigeki; Mori, Shigeshi; Zaima, Hironori; Hashida, Masahiko

    2016-09-01

    Medial tibial condylar fractures (MTCFs) are a rare but serious complication after unicompartmental knee arthroplasty. Although some surgical pitfalls have been reported for MTCFs, it is not clear whether the varus/valgus tibial inclination contributes to the risk of MTCFs. We constructed a 3-dimensional finite elemental method model of the tibia with a medial component and assessed stress concentrations by changing the inclination from 6° varus to 6° valgus. Subsequently, we repeated the same procedure adding extended sagittal bone cuts of 2° and 10° in the posterior tibial cortex. Furthermore, we calculated the bone volume that supported the tibial component, which is considered to affect stress distribution in the medial tibial condyle. Stress concentrations were observed on the medial tibial metaphyseal cortices and on the anterior and posterior tibial cortices in the corner of cut surfaces in all models; moreover, the maximum principal stresses on the posterior cortex were larger than those on the anterior cortex. The extended sagittal bone cuts in the posterior tibial cortex increased the stresses further at these 3 sites. In the models with a 10° extended sagittal bone cut, the maximum principal stress on the posterior cortex increased as the tibial inclination changed from 6° varus to 6° valgus. The bone volume decreased as the inclination changed from varus to valgus. In this finite element method, the risk of MTCFs increases with increasing valgus inclination of the tibial component and with increased extension of the sagittal cut in the posterior tibial cortex. Copyright © 2016 Elsevier Inc. All rights reserved.

  5. Hallux Valgus and Lesser Toe Deformities are Highly Heritable in Adult Men and Women: the Framingham Foot Study

    Science.gov (United States)

    Hannan, Marian T.; Menz, Hylton B.; Jordan, Joanne M.; Cupples, L. Adrienne; Cheng, Chia-Ho; Hsu, Yi-Hsiang

    2013-01-01

    Objective To estimate heritability of three common disorders affecting the forefoot: hallux valgus, lesser toe deformities and plantar forefoot soft tissue atrophy in adult Caucasian men and women. Methods Between 2002-2008, a trained examiner used a validated foot exam to document presence of hallux valgus, lesser toe deformities and plantar soft tissue atrophy in 2,446 adults from the Framingham Foot Study. Among these, 1,370 participants with available pedigree structure were included. Heritability (h2) was estimated using pedigree structures by Sequential Oligogenic Linkage Analysis Routines (SOLAR) package. Results were adjusted for age, sex and BMI. Results Mean age of participants was 66 years (range 39 to 99 years) and 57% were female. Prevalence of hallux valgus, lesser toe deformities and plantar soft tissue atrophy was 31%, 29.6% and 28.4%, respectively. Significant h2 was found for hallux valgus (0.29 ~ 0.89, depending on age and sex) and lesser toe deformity (0.49 ~ 0.90 depending on age and sex). The h2 for lesser toe deformity in men and women aged 70+ years was 0.65 (p= 9×10−7). Significant h2 was found for plantar soft tissue atrophy in men and women aged 70+ years (h2 = 0.37; p=3.8×10−3). Conclusion To our knowledge, these are the first findings of heritability of foot disorders in humans, and they confirm the widely-held view that hallux valgus and lesser toe deformities are highly heritable in European-descent Caucasian men and women, underscoring the importance of future work to identify genetic determinants of the underlying genetic susceptibility to these common foot disorders. PMID:23696165

  6. Epidemiology of Shoe Wearing Patterns Over Time in Older Women: Associations With Foot Pain and Hallux Valgus.

    Science.gov (United States)

    Menz, Hylton B; Roddy, Edward; Marshall, Michelle; Thomas, Martin J; Rathod, Trishna; Peat, George M; Croft, Peter R

    2016-12-01

    Foot problems are prevalent in older women and are thought to be associated with footwear. This study examined women's shoe wearing patterns over time and evaluated associations between footwear characteristics and foot pain and hallux valgus. Women aged 50-89 years (n = 2,627) completed a survey that included drawings of four toe-box shapes and four heel heights. For each life decade, participants indicated which footwear style they wore most of the time. Foot pain in the past 12 months and hallux valgus were documented by self-report. Logistic regression examined associations between heel height, toe-box shape, foot pain and hallux valgus. Wearing shoes with a high heel and very narrow toe box between the ages of 20 and 29 was common, but decreased to less than 10% by the age of 40. Compared with women who had worn shoes with a very wide toe box, the likelihood of hallux valgus increased in those who had worn shoes with a wide (odds ratio [OR] 1.96, 95% CI 1.03-3.71), narrow (2.39, 1.29-4.42) and very narrow (2.70, 1.46-5.00) toe box between the ages of 20 and 29 and those who wore shoes with a very narrow toe box (1.93, 1.10-3.39) between the ages of 30 and 39. Women wear shoes with a lower heel and broader toe box as they age. Wearing constrictive footwear between the ages of 20 and 39 may be critical for developing hallux valgus in later life. © The Author 2016. Published by Oxford University Press on behalf of The Gerontological Society of America.

  7. Small angle spectrometers: Summary

    International Nuclear Information System (INIS)

    Courant, E.; Foley, K.J.; Schlein, P.E.

    1986-01-01

    Aspects of experiments at small angles at the Superconducting Super Collider are considered. Topics summarized include a small angle spectrometer, a high contingency spectrometer, dipole and toroid spectrometers, and magnet choices

  8. Contact Angle Goniometer

    Data.gov (United States)

    Federal Laboratory Consortium — Description:The FTA32 goniometer provides video-based contact angle and surface tension measurement. Contact angles are measured by fitting a mathematical expression...

  9. Joint ventures

    DEFF Research Database (Denmark)

    Sørensen, Karsten Engsig

    Afhandlingen analysere de konkurrenceretlige og selskabsretlige regler som er bestemmende for hvordan et joint venture samarbejde er struktureret......Afhandlingen analysere de konkurrenceretlige og selskabsretlige regler som er bestemmende for hvordan et joint venture samarbejde er struktureret...

  10. Lengthening of the shortened first metatarsal after Wilson's osteotomy for hallux valgus.

    Science.gov (United States)

    Singh, D; Dudkiewicz, I

    2009-12-01

    Metatarsalgia is a recognised complication following iatrogenic shortening of the first metatarsal in the management of hallux valgus. The traditional surgical treatment is by shortening osteotomies of the lesser metatarsals. We describe the results of lengthening of iatrogenic first brachymetatarsia in 16 females. A Scarf-type osteotomy was used in the first four cases and a step-cut of equal thicknesses along the axis of the first metatarsal was performed in the others. The mean follow-up was 21 months (19 to 26). Relief of metatarsalgia was obtained in the six patients in whom 10 mm of lengthening had been achieved, compared to only 50% relief in those where less than 8 mm of lengthening had been gained. One-stage step-cut lengthening osteotomy of the first metatarsal may be preferable to shortening osteotomies of the lesser metatarsals in the treatment of metatarsalgia following surgical shortening of the first metatarsal.

  11. Bilateral carpal valgus deformity in hand-reared cheetah cubs (Acinonyx jubatus).

    Science.gov (United States)

    Bell, Katherine M; van Zyl, Malan; Ugarte, Claudia E; Hartman, Angela

    2011-01-01

    Four hand-reared cheetah cubs (Acinonyx jubatus) exhibited progressively severe bilateral valgus deformity of the carpi (CV) during the weaning period. Radiographs of the thoracic limbs suggested normal bone ossification, and serum chemistry was unremarkable. All affected cubs developed CV shortly after the onset of gastroenteritis, which was treated medically, and included use of a prescription diet. A sudden decrease in growth rate was associated with gastrointestinal disease. Before gastroenteritis and CV, affected cubs had higher growth rates than unaffected cubs, despite similar mean daily energy intake. Return to normal thoracic limb conformation was consequent to dietary manipulation (including a reduction in energy intake and vitamin and mineral supplementation), as well as decreased growth rates and recovery from gastroenteritis. The cause of the CV is likely to have been multi-factorial with potentially complex physiological interactions involved. © 2010 Wiley-Liss, Inc.

  12. Modified Wilson’s Osteotomy for Hallux Valgus Deformity. A New Approach

    Science.gov (United States)

    Xarchas, Konstantinos C; Mavrolias, Dimitrios; Kyriakopoulos, Georgios

    2014-01-01

    We introduce a new set of modifications and present the results from 48 patients (a total of 60 feet operated), who underwent this modified Wilson’s osteotomy for the correction of Hallux Valgus. Patients were of an average age of 52 years old (from 21 to 75 years of age) and were followed up for a mean of 12 months post-operatively. Patient evaluation was made with the symptom scoring system as presented by Kataraglis et al., with the final outcome being satisfactory in all of the cases. This set of modifications introduced to the original Wilson’s osteotomy, proved to offer a stable, predictable and satisfactory outcome in all cases and we strongly recommend it. PMID:25352929

  13. Use of 3D Printed Bone Plate in Novel Technique to Surgically Correct Hallux Valgus Deformities

    Science.gov (United States)

    Smith, Kathryn E.; Dupont, Kenneth M.; Safranski, David L.; Blair, Jeremy; Buratti, Dawn; Zeetser, Vladimir; Callahan, Ryan; Lin, Jason; Gall, Ken

    2016-01-01

    Three-dimensional (3-D) printing offers many potential advantages in designing and manufacturing plating systems for foot and ankle procedures that involve small, geometrically complex bony anatomy. Here, we describe the design and clinical use of a Ti-6Al-4V ELI bone plate (FastForward™ Bone Tether Plate, MedShape, Inc., Atlanta, GA) manufactured through 3-D printing processes. The plate protects the second metatarsal when tethering suture tape between the first and second metatarsals and is a part of a new procedure that corrects hallux valgus (bunion) deformities without relying on doing an osteotomy or fusion procedure. The surgical technique and two clinical cases describing the use of this procedure with the 3-D printed bone plate are presented within. PMID:28337049

  14. Coracoclavicular joint

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Kun Sang; Park, Chan Il; Ahn, Jae Doo; Lim, Chong Won [Seoul National University College of Medicine, Seoul (Korea, Republic of)

    1970-10-15

    The coracoclvicular joint, a rear abnormality which may be the cause of pain in the shoulder and limitation of motion of the shoulder joint, is discussed. A case of coracoclvicular joint with shoulder pain was observed in 65 yrs old Korean male.

  15. Automated Assessment of Dynamic Knee Valgus and Risk of Knee Injury During the Single Leg Squat

    Science.gov (United States)

    Lee, Alexander; Raina, Sachin; Kulić, Dana

    2017-01-01

    Many clinical assessment protocols of the lower limb rely on the evaluation of functional movement tests such as the single leg squat (SLS), which are often assessed visually. Visual assessment is subjective and depends on the experience of the clinician. In this paper, an inertial measurement unit (IMU)-based method for automated assessment of squat quality is proposed to provide clinicians with a quantitative measure of SLS performance. A set of three IMUs was used to estimate the joint angles, velocities, and accelerations of the squatting leg. Statistical time domain features were generated from these measurements. The most informative features were used for classifier training. A data set of SLS performed by healthy participants was collected and labeled by three expert clinical raters using two different labeling criteria: “observed amount of knee valgus” and “overall risk of injury”. The results showed that both flexion at the hip and knee, as well as hip and ankle internal rotation are discriminative features, and that participants with “poor” squats bend the hip and knee less than those with better squat performance. Furthermore, improved classification performance is achieved for females by training separate classifiers stratified by gender. Classification results showed excellent accuracy, 95.7 % for classifying squat quality as “poor” or “good” and 94.6% for differentiating between high and no risk of injury. PMID:29204327

  16. Impact of podiatry resident experience level in hallux valgus surgery on postoperative outcomes.

    Science.gov (United States)

    Fleischer, Adam E; Yorath, Martin C; Joseph, Robert M; Baron, Adam; Nordquist, Thomas; Moore, Braden J; Robinson, Richmond C O; Reilly, Charles H

    2014-06-15

    Despite modern advancements in transosseous fixation and operative technique, hallux valgus (i.e., bunion) surgery is still associated with a higher than usual amount of patient dissatisfaction and is generally recognized as a complex and nuanced procedure requiring precise osseous and capsulotendon balancing. It stands to reason then that familiarity and skill level of trainee surgeons might impact surgical outcomes in this surgery. The aim of this study was to determine whether podiatry resident experience level influences midterm outcomes in hallux valgus surgery (HVS). Consecutive adults who underwent isolated HVS via distal metatarsal osteotomy at a single US metropolitan teaching hospital from January 2004 to January 2009 were contacted and asked to complete a validated outcome measure of foot health (Manchester-Oxford Foot Questionnaire) regarding their operated foot. Resident experience level was quantified using the surgical logs for the primary resident of record at the time of each case. Associations were assessed using linear and logistic regression analyses. A total of 102 adult patients (n = 102 feet) agreed to participate with a mean age of 46.8 years (standard deviation 13.1, range 18-71) and average length of follow-up 6.2 y (standard deviation 1.4, range 3.6-8.6). Level of trainee experience was not associated with postoperative outcomes in either the univariate (odds ratio 0.99 [95% confidence interval, 0.98-1.01], P = 0.827) or multivariate analyses (odds ratio 1.00 [95% confidence interval, 0.97-1.02], P = 0.907). We conclude that podiatry resident level of experience in HVS does not contribute appreciably to postoperative clinical outcomes. Copyright © 2014 Elsevier Inc. All rights reserved.

  17. Evaluation of the Pain and Foot Functions in Women with Hallux valgus deformities

    Directory of Open Access Journals (Sweden)

    Burcu Talu

    2016-06-01

    Full Text Available Objectives: The aim of this study was to investigate whether deformity affects pain and associated functional status in women with hallux valgus (HV. Methods: The study included 27 women (mean age: 40.5±10.3 years diagnosed with HV and with a deformity level of two or more as determined using the Manchester scale. Demographic data of the participants were recorded. In addi­tion, Visual Analog Scale (VAS was used to determine the intensity of pain during walking. To determine the function affected by pain and deformity, Foot Function Index (FFI, and the American Orthopaedic Foot and Ankle Society MTP-IP (AOFAS MTP-IP Scale along with AOFAS Midfoot (MF Scale were used. Results: Based on the study results, we determined a statistically significant relationship between foot function and pain among our patients (p<0.05. These significant relationships were observed between the pain and total scores of the Foot Function Index (p<0.05, the pain parameter of AOFAS MTP-IP and the pain and total scores of AOFAS midfoot-pain scale (p<0.05. Conclusion: It was concluded that when assessing and planning treatment for hallux valgus, all health profession­als dealing with foot health, pathologies, deformities and treatment should consider the patient as a whole, bearing in mind that pathologies can affect not only the perceived symptoms of individuals, but also their normal functions through various physical and social limitations. J Clin Exp Invest 2016; 7 (2: 144-149

  18. The reliability and validity of radiographic measurements for determining the three-dimensional position of the talus in varus and valgus osteoarthritic ankles

    OpenAIRE

    Nosewicz, Tomasz L.; Knupp, Markus; Bolliger, Lilianna; Hintermann, Beat

    2012-01-01

    Objective To assess the most accurate radiographic method to determine talar three-dimensional position in varus and valgus osteoarthritic ankles, we evaluated the reliability and validity of different radiographic measurements. Materials and methods Nine radiographic measurements were performed blindly on weight-bearing mortise, sagittal, and horizontal radiographs of 33 varus and 33 valgus feet (63 patients). Intra- and interobserver reliability was determined with the intraclass coefficien...

  19. Hallux valgus and hallux rigidus: a comparison of impact on health-related quality of life in patients presenting to foot surgeons in Australia

    Directory of Open Access Journals (Sweden)

    Landorf Karl B

    2008-12-01

    Full Text Available Abstract Background Hallux valgus and hallux rigidus are common foot conditions that lead to a deterioration in health status. Patients with significant pain or deformity from these conditions frequently resort to surgery. In this project, the foot health status of patients with hallux valgus and hallux rigidus presenting to foot surgeons in Australia was compared. Methods Foot health status was measured in 120 participants using the Foot Health Status Questionnaire (FHSQ, a validated 0 – 100 point health status instrument. All participants had presented for surgical advice regarding hallux valgus/rigidus. The mean age of participants was 48.0 years (SD ± 14.3, range 19 – 79. Results In the sample, 68% of participants were diagnosed with hallux valgus and 32% with hallux rigidus. Participants with hallux rigidus had greater levels of pain and functional limitation compared with hallux valgus. The mean difference for pain was 13.8 points (95% CI 4.6 to 22.9 and the mean difference for function was 15.0 points (95% CI 5.3 to 24.7. Both conditions result in similarly negative levels of impact on shoe fit and overall foot health. Conclusion This study found measurable differences in foot health status between hallux valgus and hallux rigidus in participants presenting for surgical consultation. While both appear to have a negative impact on health status, hallux rigidus has a more significant impact.

  20. Hallux valgus and hallux rigidus: a comparison of impact on health-related quality of life in patients presenting to foot surgeons in Australia

    Science.gov (United States)

    Gilheany, Mark F; Landorf, Karl B; Robinson, Priscilla

    2008-01-01

    Background Hallux valgus and hallux rigidus are common foot conditions that lead to a deterioration in health status. Patients with significant pain or deformity from these conditions frequently resort to surgery. In this project, the foot health status of patients with hallux valgus and hallux rigidus presenting to foot surgeons in Australia was compared. Methods Foot health status was measured in 120 participants using the Foot Health Status Questionnaire (FHSQ), a validated 0 – 100 point health status instrument. All participants had presented for surgical advice regarding hallux valgus/rigidus. The mean age of participants was 48.0 years (SD ± 14.3, range 19 – 79). Results In the sample, 68% of participants were diagnosed with hallux valgus and 32% with hallux rigidus. Participants with hallux rigidus had greater levels of pain and functional limitation compared with hallux valgus. The mean difference for pain was 13.8 points (95% CI 4.6 to 22.9) and the mean difference for function was 15.0 points (95% CI 5.3 to 24.7). Both conditions result in similarly negative levels of impact on shoe fit and overall foot health. Conclusion This study found measurable differences in foot health status between hallux valgus and hallux rigidus in participants presenting for surgical consultation. While both appear to have a negative impact on health status, hallux rigidus has a more significant impact. PMID:19077213

  1. ADOLESCENT CHONDROLYSIS OF THE mp JOINT*

    African Journals Online (AJOL)

    1971-02-20

    Feb 20, 1971 ... slight reduction of joint space and osteophyte formation at the capital margin ... ring and irregularity of the subchondral line and an increase of CE angle, .... Unfortunately histological examination was not carried out. As the hip ...

  2. Hálux valgo: estudo comparativo entre duas técnicas cirúrgicas de osteotomia proximal de adição Hallux valgus: comparative study between two surgical techniques of proximal addition osteotomy

    Directory of Open Access Journals (Sweden)

    Luiz Carlos Ribeiro Lara

    2012-12-01

    Full Text Available OBJETIVO: Comparar clínica e radiograficamente os resultados da correção do hálux valgo, através de duas técnicas de osteotomia de adição: uma utilizando-se da exostose ressecada e outra, mediante a fixação com placa para cunha de adição. MÉTODOS: Avaliamos 24 pés em 19 pacientes, com média de idade de 51,3 anos, portadores de hálux valgo, com seguimento médio de 50,1 meses. Submeteram-se à técnica de osteotomia de adição com exostose óssea (OAEO 13 pés e à osteotomia de adição com placa para cunha de adição (OPCA 11 pés. Foram avaliados no pré e pós operatório o escore AOFAS, os ângulos intermetatársicos 1 e 2, e ângulo de valgismo do hálux. RESULTADOS: Na técnica OAEO a média no pré-operatório do AOFAS foi 46,6 pontos, AIM 14º e AVH 32º, enquanto no pós-operatório AOFAS 81,3 pontos, AIM 9º e AVH 25ºcom 92,3% de resultados satisfatórios. Na técnica OPCA a média no pré-operatório do AOFAS foi 42,1 pontos, AIM 15º e AVH 29º, enquanto no pós-operatório AOFAS 77,4 pontos, AIM 11º e AMF 23º com 81,8% de resultados satisfatórios. CONCLUSÕES: Ambas as técnicas cirúrgicas mostraram-se eficazes no tratamento do hálux valgo, clínica e radiograficamente, sem diferença estatística entre elas. Nível de evidência III, Estudo retrospectivo comparativo.OBJECTIVE: To clinically and radiographically compare the results of treatment of hallux valgus, by two addition osteotomy techniques: one using resected exostosis, and the other using a plate fixation for addition wedge. METHODS: We evaluated 24 feet of 19 patients, mean age 51.3 years, affected by hallux valgus, with a mean follow-up of 50.1 months. 13 feet underwent addition osteotomy with resected exostosis (AORE and 11 patients (11 feet underwent addition osteotomy with plate (AOP. The AOFAS score, intermetatarsal 1 and 2 angles, and hallux valgus angle were evaluated before and after surgery. RESULTS: In the AORE technique, the mean

  3. Post-operative X-ray morphology: Joints. Handbook and atlas for clinical and practical use. Postoperative Roentgenmorphologie: Gelenke. Handbuch und Atlas fuer Klinik und Praxis

    Energy Technology Data Exchange (ETDEWEB)

    Vogel, H.

    1987-01-01

    The description of X-ray findings after operations with the object of implanting protheses in joints makes up most of the contents of this book. The reconstruction of joints after trauma is only marginally dealt with. Among the various indications for implanting protheses, the replacement of joints destroyed by wear and trauma is the most important. Also considered were X-ray examinations after hallux-valgus operations and plastic surgery on hands and feet, as well as X-ray findings following operations on the lumbar part of the vertebral column (disc surgery).

  4. Validation of the Korean Version of the Manchester-Oxford Foot Questionnaire in Patients With Hallux Valgus.

    Science.gov (United States)

    Park, Man-Jun; Ko, Young-Chul; Huh, Jung-Wook; Park, Sook-Hyun; Park, Tae-Hong; Park, Joon-Hyung

    The Manchester-Oxford Foot Questionnaire (MOXFQ) is a practical, reliable, and valid questionnaire for hallux valgus surgery and has been translated into several languages. However, the MOXFQ has not been translated into Korean. In the present study, we aimed to translate and evaluate the validity and reliability of the Korean version of the MOXFQ for patients affected by hallux valgus. In accordance with the guidelines of cross-cultural adaptation, we translated the English version of MOXFQ into Korean and then backward translated it into English. We sent out letters that included the Korean version of the MOXFQ, a visual analog scale measure of pain, and a validated Korean version of the short-form 36-item Health Survey to 135 patients with hallux valgus. A retest was administered after 2 weeks. Of the 135 patients, 104 responded to the first questionnaire, and 82 of the first-time responders returned their second questionnaires. We evaluated the test-retest reliability, internal consistency, concurrent validity, and construct validity of the Korean version of the MOXFQ. The intraclass correlation coefficient for test-retest reliability was 0.82 for the total MOXFQ and ranged from 0.81 to 0.82 for the 3 subscales. Cronbach's alpha for the total MOXFQ was 0.85 and ranged from 0.8 to 0.92 for the 3 subscales. Concurrent and construct validity was supported by significant correlation with the visual analog scale and short-form 36-item Health Survey subscale scores. The Korean version of the MOXFQ was tested, and it was found to be a valid and reliable instrument for patients with hallux valgus. Copyright © 2016 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  5. A patient-based questionnaire to assess outcomes of foot surgery: validation in the context of surgery for hallux valgus.

    Science.gov (United States)

    Dawson, Jill; Coffey, Jane; Doll, Helen; Lavis, Grahame; Cooke, Paul; Herron, Mark; Jenkinson, Crispin

    2006-09-01

    A patient-based outcome measure with good measurement properties is urgently needed for use in clinical trials of foot surgery. We evaluated an existing foot pain and disability questionnaire (the Manchester Foot Pain and Disability Questionnaire) for its suitability as an outcome measure in the context of hallux valgus corrective surgery. Interviews with patients led to initial changes, resulting in 20 candidate questionnaire items with five response categories each. These were tested in a prospective study of 100 patients (representing 138 foot operations) undergoing hallux valgus corrective surgery. Analysis of underlying factor structure, dimensionality, internal reliability, construct validity and responsiveness of the questionnaire items in relation to (i) SF-36 general health survey and (ii) American Orthopaedic Foot & Ankle Society (AOFAS) hallux clinical scale resulted in a final 16 item questionnaire (the 'Manchester-Oxford Foot Questionnaire' (MOXFQ)), consisting of three domains/scales: 'Walking/standing' (seven items), 'Pain' (five items) and 'Social interaction' (four items) each having good measurement properties. All three domains were unidimensional. The new 16-item MOXFQ has good measurement properties in the context of outcomes assessment of surgery for hallux valgus. Future studies should assess the MOXFQ in the context of surgery for other foot and ankle conditions.

  6. Validity and reliability of the Turkish version of the Manchester-Oxford Foot Questionnaire for hallux valgus deformity evaluation.

    Science.gov (United States)

    Talu, Burcu; Bayramlar, Kezban; Bek, Nilgün; Yakut, Yavuz

    2016-01-01

    The aim of this study was to evaluate the reliability and validity of the Turkish version of the Manchester-Oxford Foot Questionnaire (MOXFQ) in patients affected by hallux valgus in order to assess the accuracy of this cross-cultural adaption. Thirty female volunteers aged between 18 and 55 years were included in the study. Subjects with hallux valgus were asked to complete the MOXFQ and the Short-Form 36 Health Survey (SF-36). After receiving permission from the author, the MOXFQ was translated into Turkish twice and then back translated to English, after which its compatibility was evaluated. The Turkish version of the MOXFO was applied twice, 1-3 days apart, to the study subjects. Internal consistency and test-retest reliability were assessed using Cronbach's alpha and intraclass correlation coefficient (ICC), respectively. Construct validity was assessed with the use of Spearman's rank correlation coefficient, using a priori hypothesized correlations with SF-36 domains. Subjects achieved similar scores at the first and second administration of the questionnaire (validity was supported by the presence of all the hypothesized correlations, with SF-36 within its physical parameters. The Turkish version of the MOXFQ is a valid and reliable tool for evaluating foot pain and functional status in patients affected by hallux valgus.

  7. Unstable recent intracapsular femoral neck fractures in young adults: Osteosynthesis and primary valgus osteotomy using broad dynamic compression plate

    Directory of Open Access Journals (Sweden)

    Singh M

    2008-01-01

    Full Text Available Background: Displaced intracapsular femoral neck fractures continue to be a difficult problem to treat. Various treatment modalities and their modifications have been proposed to improve the outcome. Osteosynthesis and primary valgus angulation osteotomy is one of them. Technique and outcome in a consecutive series of recent intracapsular femoral neck fractures in young adults, from a single center, is presented. Materials and Methods: Fifty-five patients of recent (< 3 weeks old displaced intracapsular fracture neck femur (Garden III and IV, Pauwels III, with or without comminution in the age group 20-50 years (mean 35.4±10.4 years were subjected to osteosynthesis and primary valgus intertrochanteric osteotomy using contoured broad dynamic compression plate (DCP. The patients were followed up from two to six years (mean 4.6 years. Results: Fifty-one fractures united by six months of the index procedure (92.7% union range. Avascular necrosis (AVN developed in six patients (11%. The other complications were shortening (six, coxa vara (two, infection (two and delayed union at osteotomy site (one. Excellent results were achieved in 48, good/fair in four and poor in three patients. Conclusion: Osteosynthesis with cancellous screw and primary valgus intertrochanteric osteotomy stabilized by a contoured broad DCP is a simple, easy to perform, biological treatment. Failure in a particular case can be treated with any appropriate second procedure. Level of Evidence: IV

  8. Minimal Clinically Important Differences for American Orthopaedic Foot & Ankle Society Score in Hallux Valgus Surgery.

    Science.gov (United States)

    Chan, Hiok Yang; Chen, Jerry Yongqiang; Zainul-Abidin, Suraya; Ying, Hao; Koo, Kevin; Rikhraj, Inderjeet Singh

    2017-05-01

    The American Orthopaedic Foot & Ankle Society (AOFAS) score is one of the most common and adapted outcome scales in hallux valgus surgery. However, AOFAS is predominantly physician based and not patient based. Although it may be straightforward to derive statistical significance, it may not equate to the true subjective benefit of the patient's experience. There is a paucity of literature defining MCID for AOFAS in hallux valgus surgery although it could have a great impact on the accuracy of analyzing surgical outcomes. Hence, the primary aim of this study was to define the Minimal Clinically Important Difference (MCID) for the AOFAS score in these patients, and the secondary aim was to correlate patients' demographics to the MCID. We conducted a retrospective cross-sectional study. A total of 446 patients were reviewed preoperatively and followed up for 2 years. An anchor question was asked 2 years postoperation: "How would you rate the overall results of your treatment for your foot and ankle condition?" (excellent, very good, good, fair, poor, terrible). The MCID was derived using 4 methods, 3 from an anchor-based approach and 1 from a distribution-based approach. Anchor-based approaches were (1) mean difference in 2-year AOFAS scores of patients who answered "good" versus "fair" based on the anchor question; (2) mean change of AOFAS score preoperatively and at 2-year follow-up in patients who answered good; (3) receiver operating characteristic (ROC) curves method, where the area under the curve (AUC) represented the likelihood that the scoring system would accurately discriminate these 2 groups of patients. The distribution-based approach used to calculate MCID was the effect size method. There were 405 (90.8%) females and 41 (9.2%) males. Mean age was 51.2 (standard deviation [SD] = 13) years, mean preoperative BMI was 24.2 (SD = 4.1). Mean preoperative AOFAS score was 55.6 (SD = 16.8), with significant improvement to 85.7 (SD = 14.4) in 2 years ( P value

  9. Optimal reconstruction angles

    International Nuclear Information System (INIS)

    Cook, G.O. Jr.; Knight, L.

    1979-07-01

    The question of optimal projection angles has recently become of interest in the field of reconstruction from projections. Here, studies are concentrated on the n x n pixel space, where literative algorithms such as ART and direct matrix techniques due to Katz are considered. The best angles are determined in a Gauss--Markov statistical sense as well as with respect to a function-theoretical error bound. The possibility of making photon intensity a function of angle is also examined. Finally, the best angles to use in an ART-like algorithm are studied. A certain set of unequally spaced angles was found to be preferred in several contexts. 15 figures, 6 tables

  10. Temporomandibular joint

    International Nuclear Information System (INIS)

    Westesson, P.L.; Hatala, M.; Tallents, R.H.; Katzberg, R.W.; Musgrave, M.; Levitt, S.

    1990-01-01

    This paper determines the frequency of MR signs of abnormal temporomandibular joints (TMJs) in asymptomatic volunteers. Forty-two volunteers with 84 clinically normal TMJs were imaged in the sagittal and coronal planes with surface coil MR imaging. Sagittal closed and open and coronal closed views were obtained bilaterally in all volunteers. The images were classified as normal (superior disk position) or abnormal (disk displacement of degenerative joint disease). Eighteen joints in 11 volunteers were abnormal; 12 had disk displacement with reduction and six had disk displacement without reduction, with associated degenerative joint disease in three of the six. Asymptomatic internal derangement and degenerative joint disease occur in about one-fourth of asymptomatic volunteers

  11. Ultrasound evaluation of intrinsic plantar muscles and fascia in hallux valgus: A case-control study.

    Science.gov (United States)

    Lobo, César Calvo; Marín, Alejandro Garrido; Sanz, David Rodríguez; López, Daniel López; López, Patricia Palomo; Morales, Carlos Romero; Corbalán, Irene Sanz

    2016-11-01

    A cross-sectional area (CSA) and thickness reduction of the abductor hallucis (AbH) is shown in subjects with hallux valgus (HV). To date, other soft-tissue structures have not been researched in relation with HV. The aim of this study was to compare the CSA and thickness of the intrinsic plantar muscles and fascia (PF) between feet with and without HV. Therefore, a cross-sectional and case-control study was performed using B-mode with an iU22 Philips ultrasound system and a 5 to 17-MHz transducer. The CSA and thickness were measured for the AbH, flexor digitorum brevis (FDB) and flexor hallucis brevis (FHB), and also the thickness for the anterior, middle, and posterior PF portions. A convenience sample of 40 feet, 20 with HV and 20 without HV, was recruited from a clinical and research center. A multivariate regression analysis using linear regression was performed to evaluate the ultrasound imaging measurements (α = 0.05). Consequently, statistically significant differences were observed between the groups (P plantar fascia thickness increase in favor of the HV group. On the contrary, the FDB thickness and CSA did not show statistically significant differences (P ≥ 0.05). In conclusion, the CSA and thickness of the AbH and FHB intrinsic plantar muscles are reduced, whereas the thickness of the anterior, middle, and posterior PF portions are increased, in subjects with HV compared with those without HV.

  12. Rotational Osteotomy for Hallux Valgus. A New Technique for Primary and Revision Cases

    Science.gov (United States)

    Ortiz, Cristian; Wagner, Emilio

    2017-01-01

    More than 200 different surgical techniques exist for hallux valgus (HV). Some of them are designed for mild, moderate, or severe deformities depending on their correction power. Nevertheless, they all correct only the coronal and/or sagittal plane deformity. Just a handful of them correct the known axial malrotation that exists in most HV cases. This malrotation is one possible factor that could be the source of recurrence of an operated HV as it has been described. We describe a new technique which simultaneously corrects the metatarsal internal rotation and varus deformity by rotating the metatarsal through an oblique plane osteotomy. This is performed with no bone wedge resection. Also, there is a broader bone surface contact than on a transverse proximal osteotomy. This technique is easy to remember and relatively simple to perform in primary and revision cases. The authors results show that it is as safe and effective as other procedures, with some advantages to be discussed. Levels of Evidence: Diagnostic Level 5. See Instructions for Authors for a complete description of levels of evidence. PMID:28286430

  13. Increased hallux angle in children and its association with insufficient length of footwear: A community based cross-sectional study

    Directory of Open Access Journals (Sweden)

    Kundi Michael

    2009-12-01

    Full Text Available Abstract Background Wearing shoes of insufficient length during childhood has often been cited as leading to deformities of the foot, particularly to the development of hallux valgus disorders. Until now, these assumptions have not been confirmed through scientific research. This study aims to investigate whether this association can be statistically proven, and if children who wear shoes of insufficient length actually do have a higher risk of a more pronounced lateral deviation of the hallux. Methods 858 pre-school children were included in the study. The study sample was stratified by sex, urban/rural areas and Austrian province. The hallux angle and the length of the feet were recorded. The inside length of the children's footwear (indoor shoes worn in pre-school and outdoor shoes were assessed. Personal data and different anthropometric measurements were taken. The risk of hallux valgus deviation was statistically tested by a stepwise logistic regression analysis and the relative risk (odds ratio for a hallux angle ≥ 4 degrees was calculated. Results Exact examinations of the hallux angle could be conducted on a total of 1,579 individual feet. Only 23.9% out of 1,579 feet presented a straight position of the great toe. The others were characterized by lateral deviations (valgus position at different degrees, equalling 10 degrees or greater in 14.2% of the children's feet. 88.8% of 808 children examined wore indoor footwear that was of insufficient length, and 69.4% of 812 children wore outdoor shoes that were too short. A significant relationship was observed between the lengthwise fit of the shoes and the hallux angle: the shorter the shoe, the higher the value of the hallux angle. The relative risk (odds ratio of a lateral hallux deviation of ≥ 4 degrees in children wearing shoes of insufficient length was significantly increased. Conclusions There is a significant relationship between the hallux angle in children and footwear that is

  14. Increased hallux angle in children and its association with insufficient length of footwear: A community based cross-sectional study

    Science.gov (United States)

    2009-01-01

    Background Wearing shoes of insufficient length during childhood has often been cited as leading to deformities of the foot, particularly to the development of hallux valgus disorders. Until now, these assumptions have not been confirmed through scientific research. This study aims to investigate whether this association can be statistically proven, and if children who wear shoes of insufficient length actually do have a higher risk of a more pronounced lateral deviation of the hallux. Methods 858 pre-school children were included in the study. The study sample was stratified by sex, urban/rural areas and Austrian province. The hallux angle and the length of the feet were recorded. The inside length of the children's footwear (indoor shoes worn in pre-school and outdoor shoes) were assessed. Personal data and different anthropometric measurements were taken. The risk of hallux valgus deviation was statistically tested by a stepwise logistic regression analysis and the relative risk (odds ratio) for a hallux angle ≥ 4 degrees was calculated. Results Exact examinations of the hallux angle could be conducted on a total of 1,579 individual feet. Only 23.9% out of 1,579 feet presented a straight position of the great toe. The others were characterized by lateral deviations (valgus position) at different degrees, equalling 10 degrees or greater in 14.2% of the children's feet. 88.8% of 808 children examined wore indoor footwear that was of insufficient length, and 69.4% of 812 children wore outdoor shoes that were too short. A significant relationship was observed between the lengthwise fit of the shoes and the hallux angle: the shorter the shoe, the higher the value of the hallux angle. The relative risk (odds ratio) of a lateral hallux deviation of ≥ 4 degrees in children wearing shoes of insufficient length was significantly increased. Conclusions There is a significant relationship between the hallux angle in children and footwear that is too short in length. The

  15. A relação do ângulo da articulação metatarsofalangeana e de medidas antropométricas com a postura dos pés de idosos Relationship between the metatarsophalangeal joint angle and anthropometric measures and foot posture among older adults

    Directory of Open Access Journals (Sweden)

    AP Castro

    2009-02-01

    Full Text Available OBJETIVOS: Verificar a relação entre o ângulo da articulação metatarsofalangeana I (Ang-I e a idade, as medidas antropométricas e a postura dos pés de mulheres e homens idosos. MÉTODOS: A amostra foi composta por 227 mulheres idosas, com média de idade de 69,6 anos (±6,8 e 172 homens idosos, com média de idade de 69,4 anos (±6,7. As variáveis estudadas foram: a largura e o perímetro da cabeça dos metatarsos, a altura da cabeça do metatarso I e do dorso do pé, o comprimento do pé, os ângulos articulares Ang-I e metatarsofalangeana V, o índice do arco e o índice postural do pé. As medidas foram tomadas com instrumentos analógicos. Os dados foram analisados por meio de Correlação de Pearson. RESULTADOS: O Ang-I não apresentou relação com a idade e com o índice do arco, porém apresentou associação positiva com a largura e o perímetro da cabeça dos metatarsos, com o índice postural do pé e com o ângulo da articulação metatarsofalangeana V e associação negativa com a altura do dorso do pé. CONCLUSÕES: Foram encontradas relações entre maior Ang-I e maiores largura e perímetro de antepé, maior ângulo da articulação metatarsofalangeana V, pés mais pronados e com menor altura do dorso do pé.OBJECTIVES: To investigate the relationship between the first metatarsophalangeal joint angle (Ang-I, the age, anthropometric measures and foot posture of older adults. METHODS: The sample was composed of 227 older women with a mean age of 69.6 (±6.8 years and 172 older men with a mean age of 69.4 (±6.7 years. The studied variables were: the width and circumference of the metatarsal heads, the height of the first metatarsal head and the dorsum of the foot, the length of the foot, the Ang-I and fifth metatarsophalangeal joint angles, the arch index and the foot posture index. The measurements were taken with analog instruments. The data were analyzed using Pearson's correlation. RESULTS: There was no association

  16. Effect of medial arch support foot orthosis on plantar pressure distribution in females with mild-to-moderate hallux valgus after one month of follow-up.

    Science.gov (United States)

    Farzadi, Maede; Safaeepour, Zahra; Mousavi, Mohammad E; Saeedi, Hassan

    2015-04-01

    Higher plantar pressures at the medial forefoot are reported in hallux valgus. Foot orthoses with medial arch support are considered as an intervention in this pathology. However, little is known about the effect of foot orthoses on plantar pressure distribution in hallux valgus. To investigate the effect of a foot orthosis with medial arch support on pressure distribution in females with mild-to-moderate hallux valgus. Quasi-experimental. Sixteen female volunteers with mild-to-moderate hallux valgus participated in this study and used a medial arch support foot orthosis for 4 weeks. Plantar pressure for each participant was assessed using the Pedar-X(®) in-shoe system in four conditions including shoe-only and foot orthosis before and after the intervention. The use of the foot orthosis for 1 month led to a decrease in peak pressure and maximum force under the hallux, first metatarsal, and metatarsals 3-5 (p hallux and the first metatarsal head by transferring the load to the other regions. It would appear that this type of foot orthosis can be an effective method of intervention in this pathology. Findings of this study will improve the clinical knowledge about the effect of the medial arch support foot orthosis used on plantar pressure distribution in hallux valgus pathology. © The International Society for Prosthetics and Orthotics 2014.

  17. Neuromuscular properties of different spastic human joints vary systematically.

    Science.gov (United States)

    Mirbagheri, M M; Settle, K

    2010-01-01

    We quantified the mechanical abnormalities of the spastic wrist in chronic stroke survivors, and determined whether these findings were representative of those recorded at the elbow and ankle joints. System identification techniques were used to characterize the mechanical abnormalities of these joints and to identify the contribution of intrinsic and reflex stiffness to these abnormalities. Modulation of intrinsic and reflex stiffness with the joint angle was studied by applying PRBS perturbations to the joints at different joint angles over the range of motion. Age-matched healthy subjects were used as control.

  18. Study on the constitutive model for jointed rock mass.

    Directory of Open Access Journals (Sweden)

    Qiang Xu

    Full Text Available A new elasto-plastic constitutive model for jointed rock mass, which can consider the persistence ratio in different visual angle and anisotropic increase of plastic strain, is proposed. The proposed the yield strength criterion, which is anisotropic, is not only related to friction angle and cohesion of jointed rock masses at the visual angle but also related to the intersection angle between the visual angle and the directions of the principal stresses. Some numerical examples are given to analyze and verify the proposed constitutive model. The results show the proposed constitutive model has high precision to calculate displacement, stress and plastic strain and can be applied in engineering analysis.

  19. Angles in hyperbolic lattices

    DEFF Research Database (Denmark)

    Risager, Morten S.; Södergren, Carl Anders

    2017-01-01

    It is well known that the angles in a lattice acting on hyperbolic n -space become equidistributed. In this paper we determine a formula for the pair correlation density for angles in such hyperbolic lattices. Using this formula we determine, among other things, the asymptotic behavior of the den......It is well known that the angles in a lattice acting on hyperbolic n -space become equidistributed. In this paper we determine a formula for the pair correlation density for angles in such hyperbolic lattices. Using this formula we determine, among other things, the asymptotic behavior...... of the density function in both the small and large variable limits. This extends earlier results by Boca, Pasol, Popa and Zaharescu and Kelmer and Kontorovich in dimension 2 to general dimension n . Our proofs use the decay of matrix coefficients together with a number of careful estimates, and lead...

  20. Joint diseases

    International Nuclear Information System (INIS)

    Weissman, S.D.

    1989-01-01

    The authors discuss how x-ray examination is essential in the diagnosis and evaluation of the arthritides. Most arthritides are first suspected by the clinician, and x-ray evaluation of these entities along with laboratory testing is important for confirmation of the clinical diagnosis and in staging of the disease process. Several arthritides are often diagnosed first by the podiatrist on x-ray evaluation, including pseudogout, ankylosing spondylitis, early rheumatoid arthritis, degenerative joint disease, and tuberculosis of bone. The joint responds to insult in only a limited number of ways that become apparent on x-ray. The soft tissues surrounding the joint, the articulating bones, and alignment of the joint space may all be involved by the arthritic process. On roentgenographic examination, the soft tissues must be examined for edema, masses, calcifications, and atrophy. The articulating bones must be examined for demineralization, erosions, osteophytes, periosteal reaction, cysts and sclerosis

  1. Joint pain

    Science.gov (United States)

    ... or conditions. It may be linked to arthritis , bursitis , and muscle pain . No matter what causes it, ... Autoimmune diseases such as rheumatoid arthritis and lupus Bursitis Chondromalacia patellae Crystals in the joint: Gout (especially ...

  2. Joint Commission

    Science.gov (United States)

    ... for the latest publication of The Joint Commission Journal on Quality and Patient Safety (JQPS). . How We Work Process improvement program breeds quality culture, empowers staff An article in Quality Progress, June ...

  3. Clinical features of symptomatic patellofemoral joint osteoarthritis

    Science.gov (United States)

    2012-01-01

    Introduction Patellofemoral joint osteoarthritis (OA) is common and leads to pain and disability. However, current classification criteria do not distinguish between patellofemoral and tibiofemoral joint OA. The objective of this study was to provide empirical evidence of the clinical features of patellofemoral joint OA (PFJOA) and to explore the potential for making a confident clinical diagnosis in the community setting. Methods This was a population-based cross-sectional study of 745 adults aged ≥50 years with knee pain. Information on risk factors and clinical signs and symptoms was gathered by a self-complete questionnaire, and standardised clinical interview and examination. Three radiographic views of the knee were obtained (weight-bearing semi-flexed posteroanterior, supine skyline and lateral) and individuals were classified into four subsets (no radiographic OA, isolated PFJOA, isolated tibiofemoral joint OA, combined patellofemoral/tibiofemoral joint OA) according to two different cut-offs: 'any OA' and 'moderate to severe OA'. A series of binary logistic and multinomial regression functions were performed to compare the clinical features of each subset and their ability in combination to discriminate PFJOA from other subsets. Results Distinctive clinical features of moderate to severe isolated PFJOA included a history of dramatic swelling, valgus deformity, markedly reduced quadriceps strength, and pain on patellofemoral joint compression. Mild isolated PFJOA was barely distinguished from no radiographic OA (AUC 0.71, 95% CI 0.66, 0.76) with only difficulty descending stairs and coarse crepitus marginally informative over age, sex and body mass index. Other cardinal signs of knee OA - the presence of effusion, bony enlargement, reduced flexion range of movement, mediolateral instability and varus deformity - were indicators of tibiofemoral joint OA. Conclusions Early isolated PFJOA is clinically manifest in symptoms and self-reported functional

  4. Biomechanical analysis of the support in race walking. Relationship between footprint, subtalar joint angles, and plantar pressures Análisis biomecánico del apoyo plantar en la marcha atlética. Relación entre la huella plantar, ángulos de la articulación subastragalina y presiones plantares

    Directory of Open Access Journals (Sweden)

    M. Meana

    2010-09-01

    Full Text Available

    The aims were to describe the behavior of the subtalar joint and foot in the race walk, and seek for correlations between them and the footprint. 12 race walkers participated in the study. The arch index was calculated on their footprints. Plantar pressures were measured and 3D photogrammetry used on a single support while they race walked at their own competitive speed. Maximum pressures were calculated in each region of the foot and also the maximum and minimum values of the three angles that describe the subtalar joint. The maximum pronation was higher than that described in the walking gait and similar to that of the running gait (-13.6 ± 3.90. In the beginning of the support the subtalar joint was between the walking and the running gaits. This suggests that the cushioning mechanism of this joint is adjusted according to the type of locomotion. The region of the foot that registered higher pressures was the external rearfoot (21.02 kPa/kg followed by the internal forefoot (13.12 kPa/kg, showing a different behaviour to that of the running gait, in which both present similar maximum pressures. The subjects with lower arches tended to support with the internal face of the foot (r=-0.713 and with the leg inclined medially (r=0.874. Likewise, the racewalkers with higher arches registered higher pressures in the external part of the rearfoot, whereas the lowest ones did it in the internal part of the midfoot.
    Key Words: Biomechanics, race walk, footprint, subtalar joint, plantar pressure.

    Los objetivos fueron describir el comportamiento de la articulación subastragalina y el pie en la marcha atlética y buscar correlaciones entre estos y la huella plantar. Participaron 12 marchadores. Se calculó el índice del arco sobre sus huellas plantares. Se registraron presiones plantares y se aplicó fotogrametría 3D durante un apoyo

  5. Results of total knee replacement with a cruciate-retaining model for severe valgus deformity--a study of 48 patients followed for an average of 9 years.

    Science.gov (United States)

    Koskinen, Esa; Remes, Ville; Paavolainen, Pekka; Harilainen, Arsi; Sandelin, Jerker; Tallroth, Kaj; Kettunen, Jyrki; Ylinen, Pekka

    2011-06-01

    The objectives of the present study were to find out the results and the factors affecting survival after primary knee arthroplasty with a cruciate-retaining prosthesis in severe valgus deformity. Forty-eight patients (52 knees) participated in the current follow-up study. All patients were followed at least 5 years or to first revision. Mean follow-up time was 9 years (range, 1 to 17 years).The Kaplan-Meier analysis revealed 79% (95% CI 68% to 91%) survival rate with revision for any reason and 81% (95% CI 70% to 93%) survival rate with revision for instability as an endpoint at 10 years. Preoperatively TFA was 23° (range, 15°-51°) in valgus and 7° (range, 21° valgus-4° varus) in valgus postoperatively. Of the 14 re-operated patients, eight were revised because of progressive postoperative medial collateral ligament instability. All re-operations were performed during the first 4 years of the follow-up. The mean TFA was 15.5° valgus postoperatively for those eight and the odds ratio for a revision was 2 (95% CI 1-3, p = 0.025) when compared to the rest of the study population. The residual valgus deformity increases the risk of re-operation and it should be avoided. If proper soft-tissue balance cannot be achieved or there is no functional medial collateral ligament present more constrained implants should be used. In selected cases where both bony correction and ligament balancing have properly been achieved the use of a cruciate-retaining type of prosthesis is justified. Copyright © 2010 Elsevier B.V. All rights reserved.

  6. Running in ostriches (Struthio camelus): three-dimensional joint axes alignment and joint kinematics.

    Science.gov (United States)

    Rubenson, Jonas; Lloyd, David G; Besier, Thor F; Heliams, Denham B; Fournier, Paul A

    2007-07-01

    Although locomotor kinematics in walking and running birds have been examined in studies exploring many biological aspects of bipedalism, these studies have been largely limited to two-dimensional analyses. Incorporating a five-segment, 17 degree-of-freedom (d.f.) kinematic model of the ostrich hind limb developed from anatomical specimens, we quantified the three-dimensional (3-D) joint axis alignment and joint kinematics during running (at approximately 3.3 m s(-1)) in the largest avian biped, the ostrich. Our analysis revealed that the majority of the segment motion during running in the ostrich occurs in flexion/extension. Importantly, however, the alignment of the average flexion/extension helical axes of the knee and ankle are rotated externally to the direction of travel (37 degrees and 21 degrees , respectively) so that pure flexion and extension at the knee will act to adduct and adbuct the tibiotarsus relative to the plane of movement, and pure flexion and extension at the ankle will act to abduct and adduct the tarsometatarsus relative to the plane of movement. This feature of the limb anatomy appears to provide the major lateral (non-sagittal) displacement of the lower limb necessary for steering the swinging limb clear of the stance limb and replaces what would otherwise require greater adduction/abduction and/or internal/external rotation, allowing for less complex joints, musculoskeletal geometry and neuromuscular control. Significant rotation about the joints' non-flexion/extension axes nevertheless occurs over the running stride. In particular, hip abduction and knee internal/external and varus/valgus motion may further facilitate limb clearance during the swing phase, and substantial non-flexion/extension movement at the knee is also observed during stance. Measurement of 3-D segment and joint motion in birds will be aided by the use of functionally determined axes of rotation rather than assumed axes, proving important when interpreting the

  7. Ultrasound evaluation of intrinsic plantar muscles and fascia in hallux valgus

    Science.gov (United States)

    Lobo, César Calvo; Marín, Alejandro Garrido; Sanz, David Rodríguez; López, Daniel López; López, Patricia Palomo; Morales, Carlos Romero; Corbalán, Irene Sanz

    2016-01-01

    Abstract A cross-sectional area (CSA) and thickness reduction of the abductor hallucis (AbH) is shown in subjects with hallux valgus (HV). To date, other soft-tissue structures have not been researched in relation with HV. The aim of this study was to compare the CSA and thickness of the intrinsic plantar muscles and fascia (PF) between feet with and without HV. Therefore, a cross-sectional and case-control study was performed using B-mode with an iU22 Philips ultrasound system and a 5 to 17-MHz transducer. The CSA and thickness were measured for the AbH, flexor digitorum brevis (FDB) and flexor hallucis brevis (FHB), and also the thickness for the anterior, middle, and posterior PF portions. A convenience sample of 40 feet, 20 with HV and 20 without HV, was recruited from a clinical and research center. A multivariate regression analysis using linear regression was performed to evaluate the ultrasound imaging measurements (α = 0.05). Consequently, statistically significant differences were observed between the groups (P plantar fascia thickness increase in favor of the HV group. On the contrary, the FDB thickness and CSA did not show statistically significant differences (P ≥ 0.05). In conclusion, the CSA and thickness of the AbH and FHB intrinsic plantar muscles are reduced, whereas the thickness of the anterior, middle, and posterior PF portions are increased, in subjects with HV compared with those without HV. PMID:27828846

  8. Influence of first proximal phalanx geometry on hallux valgus deformity: a finite element analysis.

    Science.gov (United States)

    Morales-Orcajo, Enrique; Bayod, Javier; Becerro-de-Bengoa-Vallejo, Ricardo; Losa-Iglesias, Marta; Doblare, Manuel

    2015-07-01

    Hallux abducto valgus (HAV), one of the most common forefoot deformities, occurs primarily in elderly women. HAV is a complex disease without a clearly identifiable cause for its higher prevalence in women compared with men. Several studies have reported various skeletal parameters related to HAV. This study examined the geometry of the proximal phalanx of the hallux (PPH) as a potential etiologic factor in this deformity. A total of 43 cadaver feet (22 males and 21 females) were examined by means of cadaveric dissection. From these data, ten representative PPHs for both genders were selected, corresponding to five percentiles for males (0, 25, 50, 75, and 100%) and five for females. These ten different PPHs were modeled and inserted in ten foot models. Stress distribution patterns within these ten PPH models were qualitatively compared using finite element analysis. In the ten cases analyzed, tensile stresses were larger on the lateral side, whereas compressive stresses were larger on the medial side. The bones of males were larger than female bones for each of the parameters examined; however, the mean difference between lateral and medial sides of the PPH (mean ± SD) was larger in women. Also the shallower the concavity at the base of the PPH, the larger the compressive stresses predicted. Internal forces on the PPH, due to differences in length between its medial and lateral sides, may force the PPH into a less-stressful position. The geometry of the PPH is a significant factor in HAV development influencing the other reported skeletal parameters and, thus, should be considered during preoperative evaluation. Clinical assessment should evaluate the first ray as a whole and not as isolated factors.

  9. Nuevo tratamiento percutáneo para la corrección quirúrgica del hallux valgus.

    OpenAIRE

    D' Angelo, Fabio

    2017-01-01

    En la literatura se han descrito más de 100 procedimientos que pueden aplicarse al tratamiento del Hallux Valgus (HV) y el criterio de selección será tomado en base a la evolución de la deformidad, edad del paciente y calidad del hueso, entre otros. Cuando se habla de corrección quirúrgica del HV, comúnmente pensamos en una técnica quirúrgica que contempla una serie de gestos sobre las partes blandas y sobre las estructuras oseas, como las osteotomías del metatarso y/o de la falange. ...

  10. Intrinsic constraint of unlinked total elbow replacements--the ulnotrochlear joint.

    Science.gov (United States)

    Kamineni, S; O'Driscoll, S W; Urban, M; Garg, A; Berglund, L J; Morrey, B F; An, K N

    2005-09-01

    Many unlinked total elbow replacement designs with radically differing articular geometries exist, suggesting that there is no consensus regarding an optimal design. A feature inherent to the articular design is the intrinsic constraint afforded to the joint by the implant. Our aim was to compare the intrinsic constraints of unlinked implants with that of the normal ulnotrochlear joint. We tested twelve cadaveric ulnotrochlear joints with a custom-made multiple-axis materials testing machine. With compressive loads ranging from 10 to 100 N, the joints were moved in either valgus or varus directions at 90 degrees of flexion. The ulnotrochlear components from a single example of five medium-sized unlinked elbow replacements (Ewald, Kudo, Pritchard ERS, Sorbie-Questor, and Souter-Strathclyde) were also tested. The recorded measurements included the torques and forces, angular displacement, and axial displacement of the humerus relative to the ulna. In general, the peak torque and the constraint ratio significantly increased with increasing compressive load for the implants as well as for the normal elbow. In valgus displacement, the Souter-Strathclyde implant had the highest and the Sorbie-Questor had the smallest peak torque and the Souter-Strathclyde had the highest and the Ewald had the smallest constraint ratio. In varus displacement, the Kudo had the highest and the Ewald had the smallest peak torque and constraint ratio. The constraint ratio is a characteristic that is useful for describing elbow joint behavior and for comparing the behavior of implants with that of the human elbow. Of the unlinked implants tested, the Souter-Strathclyde and Kudo prostheses most closely approximated the behavior of the human elbow joint. Implants that resemble the human elbow in appearance do not replicate normal behavior consistently, whereas other implants that do not resemble the human elbow closely do not deviate markedly from human behavior. Thus, much basic information

  11. [Austin's horizontal V-shaped sliding osteotomy of the metatarsal head [Chevron-osteotomy) in the treatment of hallux valgus].

    Science.gov (United States)

    Steinböck, G

    1996-08-01

    From 1983 to 1995, 1587 patients suffering from hallux abductovalgus were treated with the Austin bunionectomy. The operation consists of a medial exostosis removal, a V-shaped laterally directed displacement osteotomy of the metatarsal head, lateral release and medial reefing of the capsulo-ligamentous structures. Lateral transposition is facilitated by performing a sufficient lateral release consisting of dissection of the lateral metatarsophalangeal ligament and separation of the adductor tendon from the base of the phalanx and the lateral sesamoid. In the case of intermetatarsal angles greater than 15 degrees, the metatarsal-sesamoid ligament is also severed just above the lateral sesamoid. The periosteum is stripped in a limited fashion dorsally and toward the plantar, leaving its insertion at the metatarsal head intact. After this procedure, reposition of the metatarsal head onto the sesamoids is usually possible and is maintained by reconstruction of the medial metatarsal-sesamoid ligament. In the author's own research material, metatarsophalangeal angles larger than 50 degrees and intermetatarsal angles of over 20 degrees could be corrected. Pronation of the toe is usually corrected by tenotomy of the abductor tendon near the base of the phalanx. Avascular necrosis is extremely rare with a careful operative technique. In our extensive research material, four cases of AVN were recognized. Provided there is free motion of the joint (60-0-20), mild radiological signs of osteoarthritis are no contraindication for the operation. Even in the aged, good results can be achieved provided there are no trophic problems. The Austin bunionectomy has proved to be a versatile method for treating bunion problems. The possibility of transposing the metatarsal head laterally, toward the plantar, proximally and distally by altering the direction of the osteotomy, as well as tilting it medially or laterally, has made this osteotomy an invaluable tool for addressing various

  12. Joint Intentionality

    Directory of Open Access Journals (Sweden)

    Koreň Ladislav

    2016-03-01

    Full Text Available According to the shared intentionality hypothesis proposed by Michael Tomasello, two cognitive upgrades – joint and collective intentionality, respectively – make human thinking unique. Joint intentionality, in particular, is a mindset supposed to account for our early, species-specific capacity to participate in collaborative activities involving two (or a few agents. In order to elucidate such activities and their proximate cognitive-motivational mechanism, Tomasello draws on philosophical accounts of shared intentionality. I argue that his deference to such cognitively demanding accounts of shared intentional activities is problematic if his theoretical ambition is in part to show that and how early (prelinguistic and precultural capacities for joint action contribute to the development of higher cognitive capacities.

  13. The quadriceps angle

    DEFF Research Database (Denmark)

    Miles, James Edward; Frederiksen, Jane V.; Jensen, Bente Rona

    2012-01-01

    : Pelvic limbs from red foxes (Vulpes vulpes). METHODS: Q angles were measured on hip dysplasia (HD) and whole limb (WL) view radiographs of each limb between the acetabular rim, mid-point (Q1: patellar center, Q2: femoral trochlea), and tibial tuberosity. Errors of 0.5-2.0 mm at measurement landmarks...

  14. open angle glaucoma (poag)?

    African Journals Online (AJOL)

    there is a build up of pressure due to poor outflow of aqueous humor. The outflow obstruction could occur at the trabecular meshwork of the anterior chamber angle or subsequently in the episcleral vein due to raised venous pressure. Such build up of pressure results in glaucoma . Elevated intraocular pressure remains the ...

  15. The lateral angle revisited

    DEFF Research Database (Denmark)

    Morgan, Jeannie; Lynnerup, Niels; Hoppa, R.D.

    2013-01-01

    measurements taken from computed tomography (CT) scans. Previous reports have observed that the lateral angle size in females is significantly larger than in males. The method was applied to an independent series of 77 postmortem CT scans (42 males, 35 females) to validate its accuracy and reliability...... method appears to be of minimal practical use in forensic anthropology and archeology....

  16. At Right Angles

    Indian Academy of Sciences (India)

    Home; Journals; Resonance – Journal of Science Education; Volume 17; Issue 9. At Right Angles. Shailesh A Shirali. Information and Announcements Volume 17 Issue 9 September 2012 pp 920-920. Fulltext. Click here to view fulltext PDF. Permanent link: https://www.ias.ac.in/article/fulltext/reso/017/09/0920-0920 ...

  17. Wide angle isotope separator

    International Nuclear Information System (INIS)

    Kantrowitz, A.

    1976-01-01

    A method and apparatus is described for particle separation. The method uses a wide angle radially expanding vapor of a particle mixture. In particular, selective ionization of one isotope type in the particle mixture is produced in a multichamber separator and the ionized isotope type is accelerated out of the path of the vapor expansion for separate collection

  18. Joint imaging

    International Nuclear Information System (INIS)

    Hengst, W.

    1984-01-01

    Joint imaging is a proven diagnostic procedure which has become indispensable to the detection and treatment of different joint diseases in almost all disciplines. The method is suited for early diagnosis of joint affections both in soft tissue and bone which cannot be detected by X-ray or other procedures. The local activity accumulation depends on the rate of metabolism and is visualized in the scan, which in turn enables the extension and floridity of focal lesions to be evaluated and followed-up. Although joint scans may often give hints to probabilities relevant to differential diagnosis, the method is non-specific and only useful if based on the underlying clinical picture and X-ray finding, if possible. The radiation exposure is very low and does not represent a hazard in cases of adequate assessment of indication. In pregnant women and children the assessment of indication has to be based on very strict principles. The method is suited for out-patient diagnosis and can be applied in all installations equipped with a gamma camera and a technetium generator. (orig.) [de

  19. Joint purpose?

    DEFF Research Database (Denmark)

    Pristed Nielsen, Helene

    2013-01-01

    Starting from Crenshaw´s point that antiracism often fails to interrogate patriarchy and that feminism often reproduces racist practices (1991: 1252), this paper asks: What are the theoretical reasons for believing that feminism and anti-racism can be regarded as fighting for the joint purpose...

  20. Lindgren-Turan metodu ile halluks valgus cerrahisi uygulanan hastaların yaşam kalitesi

    Directory of Open Access Journals (Sweden)

    Erhan Şükür

    2012-12-01

    Full Text Available Objectives: In this study, we aimed to investigate thechanges in health-related life quality via EQ-5D surveyin patients with hallux valgus deformity who were treatedwith Lindgren-Turan method.Materials and methods: Totally 60 patients (30 patientsin Stockholm and 30 patients in Istanbul with halluxvalgus deformity who were treated with Lindgren-Turanmethod were included in the study. The health-related lifequality levels were preoperatively and postoperatively recordedand compared for all patients via EQ-5D surveyand changes were noted. Visual analogue scale (VASwas used to evaluate the patient’s response to the questionof how much healthy they feel. Radiological parameterswere not taken into account in the course of lifequality comparison.Results: Pain and discomfort were found to be the mostcommon complaints (87% among the patients in the preoperativeperiod which were followed by restricted motioncaused by the deformity and difficulty in daily activities(60%. VAS score were significantly much worse in Turkishpatients in the preoperative period. All parameters, includingespecially daily personal care and hygiene, weresignificantly improved postoperatively. VAS score whichwas questioning the general health status of the patientswas also increased significantly (p<0.01.Conclusions: Lindgren-Turan method for the surgicaltreatment of hallux valgus provides a significant recoveryin patient’s health-related life quality. J Clin Exp Invest2012; 3(4: 510-513Key words: Health, life quality, outpatient surgery, halluxvalgus

  1. Effect of rock joint roughness on its cyclic shear behavior

    Directory of Open Access Journals (Sweden)

    S.M. Mahdi Niktabar

    2017-12-01

    Full Text Available Rock joints are often subjected to dynamic loads induced by earthquake and blasting during mining and rock cutting. Hence, cyclic shear load can be induced along the joints and it is important to evaluate the shear behavior of rock joint under this condition. In the present study, synthetic rock joints were prepared with plaster of Paris (PoP. Regular joints were simulated by keeping regular asperity with asperity angles of 15°–15° and 30°–30°, and irregular rock joints which are closer to natural joints were replicated by keeping the asperity angles of 15°–30° and 15°–45°. The sample size and amplitude of roughness were kept the same for both regular and irregular joints which were 298 mm × 298 mm × 125 mm and 5 mm, respectively. Shear test was performed on these joints using a large-scale direct shear testing machine by keeping the frequency and amplitude of shear load under constant cyclic condition with different normal stress values. As expected, the shear strength of rock joints increased with the increases in the asperity angle and normal load during the first cycle of shearing or static load. With the increase of the number of shear cycles, the shear strength decreased for all the asperity angles but the rate of reduction was more in case of high asperity angles. Test results indicated that shear strength of irregular joints was higher than that of regular joints at different cycles of shearing at low normal stress. Shearing and degradation of joint asperities on regular joints were the same between loading and unloading, but different for irregular joints. Shear strength and joint degradation were more significant on the slope of asperity with higher angles on the irregular joint until two angles of asperities became equal during the cycle of shearing and it started behaving like regular joints for subsequent cycles.

  2. Prevalence of hallux valgus in the general population: a systematic review and meta-analysis

    Directory of Open Access Journals (Sweden)

    Vicenzino Bill

    2010-09-01

    Full Text Available Abstract Background Hallux valgus (HV is a foot deformity commonly seen in medical practice, often accompanied by significant functional disability and foot pain. Despite frequent mention in a diverse body of literature, a precise estimate of the prevalence of HV is difficult to ascertain. The purpose of this systematic review was to investigate prevalence of HV in the overall population and evaluate the influence of age and gender. Methods Electronic databases (Medline, Embase, and CINAHL and reference lists of included papers were searched to June 2009 for papers on HV prevalence without language restriction. MeSH terms and keywords were used relating to HV or bunions, prevalence and various synonyms. Included studies were surveys reporting original data for prevalence of HV or bunions in healthy populations of any age group. Surveys reporting prevalence data grouped with other foot deformities and in specific disease groups (e.g. rheumatoid arthritis, diabetes were excluded. Two independent investigators quality rated all included papers on the Epidemiological Appraisal Instrument. Data on raw prevalence, population studied and methodology were extracted. Prevalence proportions and the standard error were calculated, and meta-analysis was performed using a random effects model. Results A total of 78 papers reporting results of 76 surveys (total 496,957 participants were included and grouped by study population for meta-analysis. Pooled prevalence estimates for HV were 23% in adults aged 18-65 years (CI: 16.3 to 29.6 and 35.7% in elderly people aged over 65 years (CI: 29.5 to 42.0. Prevalence increased with age and was higher in females [30% (CI: 22 to 38] compared to males [13% (CI: 9 to 17]. Potential sources of bias were sampling method, study quality and method of HV diagnosis. Conclusions Notwithstanding the wide variation in estimates, it is evident that HV is prevalent; more so in females and with increasing age. Methodological quality

  3. The reliability and validity of radiographic measurements for determining the three-dimensional position of the talus in varus and valgus osteoarthritic ankles

    NARCIS (Netherlands)

    Nosewicz, Tomasz L.; Knupp, Markus; Bolliger, Lilianna; Hintermann, Beat

    2012-01-01

    To assess the most accurate radiographic method to determine talar three-dimensional position in varus and valgus osteoarthritic ankles, we evaluated the reliability and validity of different radiographic measurements. Nine radiographic measurements were performed blindly on weight-bearing mortise,

  4. Trampoline fracture of the proximal tibial metaphysis in children may not progress into valgus: a report of seven cases and a brief review.

    Science.gov (United States)

    Kakel, R

    2012-06-01

    Fracture of the proximal tibial metaphysis in children is a rare injury but notorious for carrying the risk of subsequent valgus deformity of the tibia. Trampoline-caused fracture of the proximal tibial metaphysis in children may not progress into valgus. We followed up six children who collectively sustained seven fractures of the proximal tibial metaphysis while trampolining with other heavier and/or older children. Initial and follow-up x-rays were reviewed by an orthopaedic surgeons and two radiologists. None of the patients developed valgus deformity with follow-up. Trampoline is associated with a specific type of injury to the proximal tibia when children are trampolining with other heavier children even without falling off the trampoline. This fracture is linear and complete, often non-displaced. Unlike "other" proximal tibial metaphyseal fractures, trampoline-associated proximal tibial metaphysical fracture in children is not associated with a risk of subsequent valgus deformity. Level 4. case series. Copyright © 2012 Elsevier Masson SAS. All rights reserved.

  5. Comparison of Quaternion and Euler Angle Methods for Joint Angle Animation of Human Figure Models

    National Research Council Canada - National Science Library

    Usta, Umit

    1999-01-01

    .... The model is then manipulated with user inputs by a mouse. As part of this research, the real-time display of human arm tracking with two inertial sensors, human walking, inverse kinematics, and key frame animation...

  6. Small angle neutron scattering

    International Nuclear Information System (INIS)

    Bernardini, G.; Cherubini, G.; Fioravanti, A.; Olivi, A.

    1976-09-01

    A method for the analysis of the data derived from neutron small angle scattering measurements has been accomplished in the case of homogeneous particles, starting from the basic theory without making any assumption on the form of particle size distribution function. The experimental scattering curves are interpreted with the aid the computer by means of a proper routine. The parameters obtained are compared with the corresponding ones derived from observations at the transmission electron microscope

  7. Determination of solid angle

    International Nuclear Information System (INIS)

    Qiu, S.; Amano, H.; Kasai, A.

    1988-01-01

    The solid angle in extended alpha source measurement for a series of counting geometries has been obtained by two methods: (1) calculated by means of the Nelson Blachmen series; (2) interpolated from the data table given by Gardner. A particular consequence of the application of the Nelson Blachmen series was deduced which was different from that given by the original author. The applicability of these two methods, as well as an experimentally measured method, is also evaluated. (author)

  8. Automated measurement of diagnostic angles for hip dysplasia

    DEFF Research Database (Denmark)

    de Raedt, Sepp; Mechlenburg, I.; Stilling, M.

    2013-01-01

    automatically calculated. Previous work in automating the measuring of angles required the manual segmentation or delineation of the articular joint surface. In the current work automatic segmentation is established using graph-cuts with a cost function based on a sheetness score to detect the sheet...

  9. Optical Enhancement of Exoskeleton-Based Estimation of Glenohumeral Angles

    Science.gov (United States)

    Cortés, Camilo; Unzueta, Luis; de los Reyes-Guzmán, Ana; Ruiz, Oscar E.; Flórez, Julián

    2016-01-01

    In Robot-Assisted Rehabilitation (RAR) the accurate estimation of the patient limb joint angles is critical for assessing therapy efficacy. In RAR, the use of classic motion capture systems (MOCAPs) (e.g., optical and electromagnetic) to estimate the Glenohumeral (GH) joint angles is hindered by the exoskeleton body, which causes occlusions and magnetic disturbances. Moreover, the exoskeleton posture does not accurately reflect limb posture, as their kinematic models differ. To address the said limitations in posture estimation, we propose installing the cameras of an optical marker-based MOCAP in the rehabilitation exoskeleton. Then, the GH joint angles are estimated by combining the estimated marker poses and exoskeleton Forward Kinematics. Such hybrid system prevents problems related to marker occlusions, reduced camera detection volume, and imprecise joint angle estimation due to the kinematic mismatch of the patient and exoskeleton models. This paper presents the formulation, simulation, and accuracy quantification of the proposed method with simulated human movements. In addition, a sensitivity analysis of the method accuracy to marker position estimation errors, due to system calibration errors and marker drifts, has been carried out. The results show that, even with significant errors in the marker position estimation, method accuracy is adequate for RAR. PMID:27403044

  10. Optimised robot-based system for the exploration of elastic joint properties.

    Science.gov (United States)

    Frey, M; Burgkart, R; Regenfelder, F; Riener, R

    2004-09-01

    Numerous publications provide measured biomechanical data relating to synovial joints. However, in general, they do not reflect the non-linear elastic joint properties in detail or do not consider all degrees of freedom (DOF), or the quantity of data is sparse. To perform more comprehensive, extended measurements of elastic joint properties, an optimised robot-based approach was developed. The basis was an industrial, high-precision robot that was capable of applying loads to the joint and measuring the joint displacement in 6 DOF. The system was equipped with novel, custom-made control hardware. In contrast to the commonly used sampling rates that are below 100 Hz, a rate of 4 kHz was realised for each DOF. This made it possible to implement advanced, highly dynamic, quasi-continuous closed-loop controllers. Thus oscillations of the robot were avoided, and measurements were speeded up. The stiffness of the entire system was greater than 44 kNm(-1) and 22 Nm deg(-1), and the maximum difference between two successive measurements was less than 0.5 deg. A sophisticated CT-based referencing routine facilitated the matching of kinematic data with the individual anatomy of the tested joint. The detailed detection of the elastic varus-valgus properties of a human knee joint is described, and the need for high spatial resolution is demonstrated.

  11. Transverse morphology of the sacroiliac joint: effect of angulation and implications for fluoroscopically guided sacroiliac joint injection

    International Nuclear Information System (INIS)

    Ling, B.C.; Lee, J.W.; Man, H.S.J.; Grace, M.G.A.; Lambert, R.G.W.; Jhangri, G.S.

    2006-01-01

    Effects of angulation of computed tomography (CT) reconstruction plane on sacroiliac (SI) joint morphology were studied, and factors influencing the approach to fluoroscopically guided SI joint injection were assessed. CT scans of pelvises were reformatted on 41 subjects, aged 51.7 (±15.1) years. Transverse images were reconstructed at the caudal 3 cm of the SI joint tilting plane of reconstruction from -30 to +30 at 15 increments. Anteroposterior diameter of joint (depth), angle from sagittal plane (orientation angle), and distance from skin were measured. Joint contour was classified, and presence of bone blocking access to the joint was recorded. Comparison between angles were analysed by t-test. Relationships between variables were assessed by a Pearson correlation test. Depth was shorter with angulation in the inferior direction (P<0.01). Orientation angle increased with superior angulation (P<0.01). Distance from skin increased (P<0.01) with angulation in either direction. Joint contour was significantly different from baseline at each angle (P<0.001) but highly variable. Inferior angulation resulted in interposition of ilium between skin and SI joint, and superior angulation caused bone block due to the lower sacrum. None of these features was identified without tilting of the reconstruction plane, and effects were more pronounced with steeper angulation

  12. Transverse morphology of the sacroiliac joint: effect of angulation and implications for fluoroscopically guided sacroiliac joint injection

    Energy Technology Data Exchange (ETDEWEB)

    Ling, B.C.; Lee, J.W.; Man, H.S.J.; Grace, M.G.A.; Lambert, R.G.W. [Department of Radiology and Diagnostic Imaging, University of Alberta Hospital, Edmonton (Canada); Jhangri, G.S. [Department of Public Health Sciences, University of Alberta Hospital, Edmonton (Canada)

    2006-11-15

    Effects of angulation of computed tomography (CT) reconstruction plane on sacroiliac (SI) joint morphology were studied, and factors influencing the approach to fluoroscopically guided SI joint injection were assessed. CT scans of pelvises were reformatted on 41 subjects, aged 51.7 ({+-}15.1) years. Transverse images were reconstructed at the caudal 3 cm of the SI joint tilting plane of reconstruction from -30 to +30 at 15 increments. Anteroposterior diameter of joint (depth), angle from sagittal plane (orientation angle), and distance from skin were measured. Joint contour was classified, and presence of bone blocking access to the joint was recorded. Comparison between angles were analysed by t-test. Relationships between variables were assessed by a Pearson correlation test. Depth was shorter with angulation in the inferior direction (P<0.01). Orientation angle increased with superior angulation (P<0.01). Distance from skin increased (P<0.01) with angulation in either direction. Joint contour was significantly different from baseline at each angle (P<0.001) but highly variable. Inferior angulation resulted in interposition of ilium between skin and SI joint, and superior angulation caused bone block due to the lower sacrum. None of these features was identified without tilting of the reconstruction plane, and effects were more pronounced with steeper angulation.

  13. Joint Operation Planning

    National Research Council Canada - National Science Library

    2006-01-01

    .... It sets forth joint doctrine to govern the joint operation planning activities and performance of the Armed Forces of the United States in joint operations, and provides the joint doctrinal basis...

  14. Value of radiographic examination of the knee joint for the orthopedic surgeon

    International Nuclear Information System (INIS)

    Pietsch, M.; Hofmann, S.

    2006-01-01

    Extended radiographic examinations offer excellent options for diagnosis and strategy for treatment of the knee joint. The whole-leg radiograph is indispensable in measuring alignment for osteotomy or total knee arthroplasty (TKA). Fluoroscopically assisted varus-valgus stress radiographs provide the possibility for verifying mechanical function of the implanted knee prosthesis. Ultrasound examinations have been widely replaced by magnetic resonance imaging (MRI). MRI is the golden standard to examine intra-articular structures of the knee (meniscus, ligaments, cartilage) and surrounding soft tissue. For evaluating femoral and tibial torsion and determining axial rotation of TKA, computed tomography (CT) is best qualified. Imaging of the patellofemoral joint (patella instability) is difficult; CT scans in combination with true lateral radiographs seem to be helpful. (orig.) [de

  15. Elbow joint laxity after experimental radial head excision and lateral collateral ligament rupture

    DEFF Research Database (Denmark)

    Jensen, Steen Lund; Olsen, Bo Sanderhoff; Tyrdal, Stein

    2005-01-01

    The objectives of this experimental study were to investigate the effect of radial head excision and lateral collateral ligament (LCL) division on elbow joint laxity and to determine the efficacy of radial head prosthetic replacement and LCL repair. Valgus, varus, internal rotation, and external...... rotation of the ulna were measured during passive flexion-extension and application of a 0.75-Nm torque in 6 intact cadaveric elbows and after (1) either excision of the radial head or division of the LCL, (2) removal of both constraints, (3) isolated radial head prosthetic replacement, (4) isolated LCL...... normalized varus laxity but resulted in a 2.9 degrees increase in external rotatory laxity. The combined procedures restored laxity completely. The radial head is a constraint to varus and external rotation in the elbow joint, functioning by maintaining tension in the LCL. Still, removal of both constraints...

  16. Effect of hammer mass on upper extremity joint moments.

    Science.gov (United States)

    Balendra, Nilanthy; Langenderfer, Joseph E

    2017-04-01

    This study used an OpenSim inverse-dynamics musculoskeletal model scaled to subject-specific anthropometrics to calculate three-dimensional intersegmental moments at the shoulder, elbow and wrist while 10 subjects used 1 and 2 lb hammers to drive nails. Motion data were collected via an optoelectronic system and the interaction of the hammer with nails was recorded with a force plate. The larger hammer caused substantial increases (50-150%) in moments, although increases differed by joint, anatomical component, and significance of the effect. Moment increases were greater in cocking and strike/follow-through phases as opposed to swinging and may indicate greater potential for injury. Compared to shoulder, absolute increases in peak moments were smaller for elbow and wrist, but there was a trend toward larger relative increases for distal joints. Shoulder rotation, elbow varus-valgus and pronation-supination, and wrist radial-ulnar deviation and rotation demonstrated large relative moment increases. Trial and phase durations were greater for the larger hammer. Changes in moments and timing indicate greater loads on musculoskeletal tissues for an extended period with the larger hammer. Additionally, greater variability in timing with the larger hammer, particularly for cocking phase, suggests differences in control of the motion. Increased relative moments for distal joints may be particularly important for understanding disorders of the elbow and wrist associated with hammer use. Copyright © 2016 Elsevier Ltd. All rights reserved.

  17. The influence of flip angle on the magic angle effect

    International Nuclear Information System (INIS)

    Zurlo, J.V.; Blacksin, M.F.; Karimi, S.

    2000-01-01

    Objective. To assess the impact of flip angle with gradient sequences on the ''magic angle effect''. We characterized the magic angle effect in various gradient echo sequences and compared the signal- to-noise ratios present on these sequences with the signal-to-noise ratios of spin echo sequences.Design. Ten normal healthy volunteers were positioned such that the flexor hallucis longus tendon remained at approximately at 55 to the main magnetic field (the magic angle). The tendon was imaged by a conventional spin echo T1- and T2-weighted techniques and by a series of gradient techniques. Gradient sequences were altered by both TE and flip angle. Signal-to-noise measurements were obtained at segments of the flexor hallucis longus tendon demonstrating the magic angle effect to quantify the artifact. Signal-to-noise measurements were compared and statistical analysis performed. Similar measurements were taken of the anterior tibialis tendon as an internal control.Results and conclusions. We demonstrated the magic angle effect on all the gradient sequences. The intensity of the artifact was affected by both the TE and flip angle. Low TE values and a high flip angle demonstrated the greatest magic angle effect. At TE values less than 30 ms, a high flip angle will markedly increase the magic angle effect. (orig.)

  18. Variable angle correlation spectroscopy

    International Nuclear Information System (INIS)

    Lee, Y.K.; Lawrence Berkeley Lab., CA

    1994-05-01

    In this dissertation, a novel nuclear magnetic resonance (NMR) technique, variable angle correlation spectroscopy (VACSY) is described and demonstrated with 13 C nuclei in rapidly rotating samples. These experiments focus on one of the basic problems in solid state NMR: how to extract the wealth of information contained in the anisotropic component of the NMR signal while still maintaining spectral resolution. Analysis of the anisotropic spectral patterns from poly-crystalline systems reveal information concerning molecular structure and dynamics, yet in all but the simplest of systems, the overlap of spectral patterns from chemically distinct sites renders the spectral analysis difficult if not impossible. One solution to this problem is to perform multi-dimensional experiments where the high-resolution, isotropic spectrum in one dimension is correlated with the anisotropic spectral patterns in the other dimensions. The VACSY technique incorporates the angle between the spinner axis and the static magnetic field as an experimental parameter that may be incremented during the course of the experiment to help correlate the isotropic and anisotropic components of the spectrum. The two-dimensional version of the VACSY experiments is used to extract the chemical shift anisotropy tensor values from multi-site organic molecules, study molecular dynamics in the intermediate time regime, and to examine the ordering properties of partially oriented samples. The VACSY technique is then extended to three-dimensional experiments to study slow molecular reorientations in a multi-site polymer system

  19. The development and validation of a custom built device for assessing frontal knee joint laxity.

    Science.gov (United States)

    Ismail, Shiek Abdullah; Simic, Milena; Clarke, Jillian L; Lopes, Thiago Jambo Alves; Pappas, Evangelos

    2017-12-01

    This study reports the development and validation of a quantitative technique of assessing frontal knee joint laxity through a custom built device named KLICP. The objectives of this study were to determine: (i) the intra- and inter-rater reliability and (ii) the validity of the device when compared to real time ultrasound. Twenty-five participants had their frontal knee joint laxity assessed by the KLICP, by manual varus/valgus tests and by ultrasound. Two raters independently assessed laxity manually by three repeated measurements, repeated at least 48h later. Results were validated by comparing them to the medial and lateral joint space opening measured by the ultrasound. Intraclass correlation coefficients and standard error of measurement reliability were calculated. Pearson's correlation coefficients were calculated to determine the correlation between the KLICP and the joint space. Intra-rater reliability (intra-session) for each rater was good on both sessions (0.91-0.98), intra-rater reliability (inter-sessions) was moderate to good (0.62-0.87), and inter-rater reliability (intra-session) was good (0.75-0.80). There is low agreement for intra-rater (inter-session) and for inter-rater (intra-session) reliability. The KLICP measurement has a significant positive fair to moderate correlation to the ultrasound measurement at the left (r: 0.61, p: 0.01) and right (r: 0.48, p: 0.02) knee in the valgus direction and at the left (r: 0.51, p: 0.01) and right (r: 0.39, p: 0.05) knee in the varus direction. There is low agreement between the KLICP and the RTU. Reliability and agreement was good only when measured for intra-rater, within session. Copyright © 2017 Elsevier B.V. All rights reserved.

  20. Effectiveness of surgery for adults with hallux valgus deformity: a systematic review.

    Science.gov (United States)

    Klugarova, Jitka; Hood, Victoria; Bath-Hextall, Fiona; Klugar, Miloslav; Mareckova, Jana; Kelnarova, Zuzana

    2017-06-01

    Hallux valgus (HV) is a common foot deformity. In severe stages of this condition, surgery is often necessary. Currently, there is no systematic review comparing the effectiveness of surgery over conservative treatment. The objective of this review was to establish the effectiveness of surgery compared to conservatory management for adults with HV. The current review included adults (18 years or over) with HV deformity, excluding adults with neurological problems causing foot deformities, for example, cerebral palsy, neuropathy, stroke and multiple sclerosis. The review included any type of HV surgery compared to no surgery, conservative treatment or different types of HV surgeries. The primary outcome was gait measurement, and secondary outcomes included quality of life, patient satisfaction, pain assessed using any validated assessment tool and adverse events. The review included randomized controlled trials. The search strategy aimed to find both published and unpublished studies. A three-step search strategy was utilized in 16 databases without language and date limitations. Papers selected for retrieval were assessed by two independent reviewers for methodological validity prior to inclusion in the review using standardized critical appraisal instruments developed by the Joanna Briggs Institute (JBI). Data were extracted from papers included in the review using the standardized data extraction tool developed by the JBI. Quantitative data were, where possible, pooled in statistical meta-analysis using RevMan5 (Copenhagen: The Nordic Cochrane Centre, Cochrane). Effect sizes expressed as risk ratio (for categorical data) and mean differences (MD) or standardized MD (for continuous data) and their 95% confidence intervals were calculated for analysis. Where statistical pooling was not possible, the findings have been presented in narrative form. Searching identified 2412 citations. After removal of duplicates, paper retrieval and critical appraisal, 25 studies

  1. Combining valgus knee brace and lateral foot wedges reduces external forces and moments in osteoarthritis patients

    NARCIS (Netherlands)

    Jafarnezhadgero, Amir Ali; Oliveira, Anderson S.; Mousavi, Seyed Hamed; Madadi-Shad, Morteza

    Osteoarthritis progression can be related to the external knee adduction and flexion moments during walking. Lateral foot wedges and knee braces have been used as treatment for osteoarthritis, but little is known about their influence on knee joint moments generated in the sagittal and frontal

  2. Association of Gastrocnemius Muscle Stiffness With Passive Ankle Joint Stiffness and Sex-Related Difference in the Joint Stiffness.

    Science.gov (United States)

    Chino, Kintaro; Takashi, Hideyuki

    2017-11-15

    Passive ankle joint stiffness is affected by all structures located within and over the joint, and is greater in men than in women. Localized muscle stiffness can be assessed by ultrasound shear wave elastography, and muscle architecture such as fascicle length and pennation angle can be measured by B-mode ultrasonography. Thus, we assessed localized muscle stiffness of the medial gastrocnemius (MG) with consideration of individual variability in the muscle architecture, and examined the association of the muscle stiffness with passive ankle joint stiffness and the sex-related difference in the joint stiffness. Localized muscle stiffness of the MG in 16 men and 17 women was assessed at 10° and 20° plantar flexion, neutral anatomical position, 10° and 20° dorsiflexion. Fascicle length and pennation angle of the MG were measured at these joint positions. Passive ankle joint stiffness was determined by the ankle joint angle-torque relationship. Localized MG muscle stiffness was not significantly correlated with passive ankle joint stiffness, and did not show significant sex-related difference, even when considering the muscle architecture. This finding suggest that muscle stiffness of the MG would not be a prominent factor to determine passive ankle joint stiffness and the sex-related difference in the joint stiffness.

  3. Wearable human body joint and posture measuring system

    NARCIS (Netherlands)

    Dunias, P.; Gransier, R.; Jin, A.; Statham, A.; Willems, P.

    2011-01-01

    In many medical applications, especially the orthopaedic setting, ambulatory, monitoring of human joint angles could be of substantial value to improving rehabilitation strategies and unravelling the pathomechanics of many degenerative joint diseases (e.g. knee osteoarthritis). With the ageing of

  4. Equilibrium contact angle or the most-stable contact angle?

    Science.gov (United States)

    Montes Ruiz-Cabello, F J; Rodríguez-Valverde, M A; Cabrerizo-Vílchez, M A

    2014-04-01

    It is well-established that the equilibrium contact angle in a thermodynamic framework is an "unattainable" contact angle. Instead, the most-stable contact angle obtained from mechanical stimuli of the system is indeed experimentally accessible. Monitoring the susceptibility of a sessile drop to a mechanical stimulus enables to identify the most stable drop configuration within the practical range of contact angle hysteresis. Two different stimuli may be used with sessile drops: mechanical vibration and tilting. The most stable drop against vibration should reveal the changeless contact angle but against the gravity force, it should reveal the highest resistance to slide down. After the corresponding mechanical stimulus, once the excited drop configuration is examined, the focus will be on the contact angle of the initial drop configuration. This methodology needs to map significantly the static drop configurations with different stable contact angles. The most-stable contact angle, together with the advancing and receding contact angles, completes the description of physically realizable configurations of a solid-liquid system. Since the most-stable contact angle is energetically significant, it may be used in the Wenzel, Cassie or Cassie-Baxter equations accordingly or for the surface energy evaluation. © 2013 Elsevier B.V. All rights reserved.

  5. Fracture line index of fibular stalk and the ankle joint bone in the classification of the ankle joint trauma

    International Nuclear Information System (INIS)

    Wu Jun; Zhang Qiang

    2003-01-01

    Objective: To evaluate the fracture line index of fibular stalk and the ankle joint bone in the classification of the ankle joint trauma. Methods: Measure fracture line index of fibular stalk and the ankle joint in 217 adult cases of fracture and dislocation of ankle joint. And the cases were classified by the results of the measurement. Results: Measurement was unavailable in 9 cases of tearing fracture. In 31 cases, the lesions could not be particularly classified. And in the rest 176 cases the trauma were precisely classified. The over all successful rate was 81.6%. Conclusion: Fracture line index of fibular stalk and the ankle joint bone are valuable in classification of the trauma of the angle joint. While the specificity of this method is low in differentiating the adducting and abducting fracture of the medial angle, in which a combined investigation is recommended

  6. Joint torques and joint reaction forces during squatting with a forward or backward inclined Smith machine.

    Science.gov (United States)

    Biscarini, Andrea; Botti, Fabio M; Pettorossi, Vito E

    2013-02-01

    We developed a biomechanical model to determine the joint torques and loadings during squatting with a backward/forward-inclined Smith machine. The Smith squat allows a large variety of body positioning (trunk tilt, foot placement, combinations of joint angles) and easy control of weight distribution between forefoot and heel. These distinctive aspects of the exercise can be managed concurrently with the equipment inclination selected to unload specific joint structures while activating specific muscle groups. A backward (forward) equipment inclination decreases (increases) knee torque, and compressive tibiofemoral and patellofemoral forces, while enhances (depresses) hip and lumbosacral torques. For small knee flexion angles, the strain-force on the posterior cruciate ligament increases (decreases) with a backward (forward) equipment inclination, whereas for large knee flexion angles, this behavior is reversed. In the 0 to 60 degree range of knee flexion angles, loads on both cruciate ligaments may be simultaneously suppressed by a 30 degree backward equipment inclination and selecting, for each value of the knee angle, specific pairs of ankle and hip angles. The anterior cruciate ligament is safely maintained unloaded by squatting with backward equipment inclination and uniform/forward foot weight distribution. The conditions for the development of anterior cruciate ligament strain forces are clearly explained.

  7. Subtalar joint stress imaging with tomosynthesis.

    Science.gov (United States)

    Teramoto, Atsushi; Watanabe, Kota; Takashima, Hiroyuki; Yamashita, Toshihiko

    2014-06-01

    The purpose of this study was to perform stress imaging of hindfoot inversion and eversion using tomosynthesis and to assess the subtalar joint range of motion (ROM) of healthy subjects. The subjects were 15 healthy volunteers with a mean age of 29.1 years. Coronal tomosynthesis stress imaging of the subtalar joint was performed in a total of 30 left and right ankles. A Telos stress device was used for the stress load, and the load was 150 N for both inversion and eversion. Tomographic images in which the posterior talocalcaneal joint could be confirmed on the neutral position images were used in measurements. The angle of the intersection formed by a line through the lateral articular facet of the posterior talocalcaneal joint and a line through the surface of the trochlea of the talus was measured. The mean change in the angle of the calcaneus with respect to the talus was 10.3 ± 4.8° with inversion stress and 5.0 ± 3.8° with eversion stress from the neutral position. The result was a clearer depiction of the subtalar joint, and inversion and eversion ROM of the subtalar joint was shown to be about 15° in healthy subjects. Diagnostic, Level IV.

  8. The double Brewster angle effect

    Science.gov (United States)

    Thirion-Lefevre, Laetitia; Guinvarc'h, Régis

    2018-01-01

    The Double Brewster angle effect (DBE) is an extension of the Brewster angle to double reflection on two orthogonal dielectric surfaces. It results from the combination of two pseudo-Brewster angles occurring in complementary incidence angles domains. It can be observed for a large range of incidence angles provided that double bounces mechanism is present. As a consequence of this effect, we show that the reflection coefficient at VV polarization can be at least 10 dB lower than the reflection coefficient at HH polarization over a wide range of incidence angle - typically from 20 to 70∘. It is experimentally demonstrated using a Synthetic Aperture Radar (SAR) image that this effect can be seen on buildings and forests. For large buildings, the difference can reach more than 20 dB. xml:lang="fr"

  9. Joint Instability and Osteoarthritis

    Directory of Open Access Journals (Sweden)

    Darryl Blalock

    2015-01-01

    Full Text Available Joint instability creates a clinical and economic burden in the health care system. Injuries and disorders that directly damage the joint structure or lead to joint instability are highly associated with osteoarthritis (OA. Thus, understanding the physiology of joint stability and the mechanisms of joint instability-induced OA is of clinical significance. The first section of this review discusses the structure and function of major joint tissues, including periarticular muscles, which play a significant role in joint stability. Because the knee, ankle, and shoulder joints demonstrate a high incidence of ligament injury and joint instability, the second section summarizes the mechanisms of ligament injury-associated joint instability of these joints. The final section highlights the recent advances in the understanding of the mechanical and biological mechanisms of joint instability-induced OA. These advances may lead to new opportunities for clinical intervention in the prevention and early treatment of OA.

  10. Joint instability and osteoarthritis.

    Science.gov (United States)

    Blalock, Darryl; Miller, Andrew; Tilley, Michael; Wang, Jinxi

    2015-01-01

    Joint instability creates a clinical and economic burden in the health care system. Injuries and disorders that directly damage the joint structure or lead to joint instability are highly associated with osteoarthritis (OA). Thus, understanding the physiology of joint stability and the mechanisms of joint instability-induced OA is of clinical significance. The first section of this review discusses the structure and function of major joint tissues, including periarticular muscles, which play a significant role in joint stability. Because the knee, ankle, and shoulder joints demonstrate a high incidence of ligament injury and joint instability, the second section summarizes the mechanisms of ligament injury-associated joint instability of these joints. The final section highlights the recent advances in the understanding of the mechanical and biological mechanisms of joint instability-induced OA. These advances may lead to new opportunities for clinical intervention in the prevention and early treatment of OA.

  11. Changes in the Width of the Tibiofibular Syndesmosis Related to Lower Extremity Joint Dynamics and Neuromuscular Coordination on Drop Landing During the Menstrual Cycle.

    Science.gov (United States)

    Okazaki, Michie; Kaneko, Masaaki; Ishida, Yukisato; Murase, Norio; Katsumura, Toshihito

    2017-09-01

    Many injuries of the lower extremities, especially the knee and ankle, occur during sports activity, and the incidence rate is higher in women than in men. The hypothesis was that phases of the menstrual cycle affect the width of the tibiofibular syndesmosis during drop landing in healthy young women and that such changes at the tibiofibular joint also affect the dynamics and neuromuscular coordination of the lower extremities. Descriptive laboratory study. Participants included 28 healthy young women (mean age, 21.0 ± 0.8 years). Blood samples were collected to determine plasma levels of estradiol and progesterone immediately before the performance of the task: drop landing on a single leg from a 30-cm platform. Using ultrasonography, the distance between the tibia and the distal end of the fibula, regarded as the width of the tibiofibular syndesmosis, was measured in an upright position without flexion of the ankle. The peak ground-reaction force (GRF) on landing was measured using a force platform. The time to peak GRF (Tp-GRF) was measured as the time from initial ground contact to the peak GRF. Hip, knee, and ankle joint angles during the single-leg landing were calculated using a 3-dimensional motion analysis system. Muscle activities of the lower extremities were measured using surface electromyography. The width of the tibiofibular syndesmosis was significantly greater in the luteal phase when compared with the menstrual, follicular, and ovulation phases (by 5%-8% of control). Also, during the luteal phase, the Tp-GRF was significantly shorter than in the follicular phase (by 6%); hip internal rotation and knee valgus were significantly greater than in the menstrual phase (by 43% and 34%, respectively); knee flexion was significantly less than in the menstrual and follicular phases (by 7%-9%); ankle dorsiflection was significantly less than in the follicular phase (by 11%); ankle adduction and eversion were significantly greater than in the menstrual and

  12. Angle Performance on Optima XE

    International Nuclear Information System (INIS)

    David, Jonathan; Satoh, Shu

    2011-01-01

    Angle control on high energy implanters is important due to shrinking device dimensions, and sensitivity to channeling at high beam energies. On Optima XE, beam-to-wafer angles are controlled in both the horizontal and vertical directions. In the horizontal direction, the beam angle is measured through a series of narrow slits, and any angle adjustment is made by steering the beam with the corrector magnet. In the vertical direction, the beam angle is measured through a high aspect ratio mask, and any angle adjustment is made by slightly tilting the wafer platen during implant.Using a sensitive channeling condition, we were able to quantify the angle repeatability of Optima XE. By quantifying the sheet resistance sensitivity to both horizontal and vertical angle variation, the total angle variation was calculated as 0.04 deg. (1σ). Implants were run over a five week period, with all of the wafers selected from a single boule, in order to control for any crystal cut variation.