Search Results (219)

Background: We present a retrospective radiographic analysis showcasing the ability to correct hallux valgus using the Lapidus arthrodesis without focused frontal plane rotation of the first metatarsal. Methods: A total of 33 feet in 30 patients who had undergone Lapidus arthrodesis for the treatment of hallux abducto valgus deformity from 1 August 2015 to 31 December 2020 were identified. The median age of the cohort was 55.4 years (range, 33–78 years), 23 were female (76.7%), three (10%) underwent bilateral Lapidus arthrodesis, and the median duration of follow-up was 15.9 months (range, 5–72 months). Results: The median (minimum, maximum) preoperative first intermetatarsal angle was 16° (13°, 28°), and at final follow-up it was 5° (0°, 6°) (p < 0.001). The median (minimum, maximum) preoperative hallux abductus angle was 37° (26°, 51°), and at final follow-up it was 8.5° (0°, 22.5°) (p < 0.001). The median (minimum, maximum) preoperative tibial sesamoid position was 6 (4, 7), and at final follow-up it was 3 (2, 5) (p = 0.001). Conclusions: We found the radiographic first metatarsal lateral round sign to be ambiguous. Qualitative comparison of the results of this investigation with prior studies describing outcomes following Lapidus arthrodesis with focused frontal plane rotation of the first metatarsal suggests that similar outcomes can be achieved without employment of a decisive frontal plane rotation of the first metatarsal. Our findings lead us to believe that correction of substantial hallux abducto valgus deformities can be accomplished using the Lapidus procedure combined with lateral release of the first metatarsophalangeal joint without focused derotation of the first metatarsal. Full article

Background: The aim of this study was to investigate the effect of dry needling (DN) applied to the abductor hallucis (ABH) muscle on pain function and angle in patients with hallux valgus (HV). Methods: The study included 31 HV patients. Patients were randomly divided into two groups. The first group received toe-spread-out (TSO) exercise. The second group received three sessions of DN for myofascial trigger points in the ABH muscle in addition to TSO exercise. Visual analog scale (VAS) (rest, activity) and foot function index (FFI) (pain, disability, activity) were used for clinical evaluation. Hallux valgus angle (HVA) and intermetatarsal angle (HVA) were measured. The evaluations were performed at baseline and at the first and fourth weeks following treatment. Results: VAS-rest baseline–fourth week and baseline–first week changes were significantly superior in the TSO-plus-DN group compared to the TSO group (p = 0.023, p = 0.039, respectively). FFI-disability baseline–fourth week change was significantly superior in the TSO-plus-DN group compared to the TSO group (p = 0.040). HVA and IMA baseline–fourth week changes were significantly superior in the TSO-plus-DN group compared to the TSO group (p = 0.001, p = 0.045, respectively). Conclusions: According to our findings, the combination of DN for the ABH muscle with TSO exercise may be recommended for the treatment of patients with mild-to-moderate HV. Full article

Background: The Lapidus procedure has become a cornerstone in the surgical management of hallux valgus, especially in cases with associated tarsometatarsal instability. This study investigated and compared the radiographic outcomes of three distinct Lapidus constructs, aiming to provide valuable insights into the optimal fusion configurations for achieving long-term stability improvement and maintaining the intermetatarsal angle (IMA) postoperatively. Methods: In this retrospective study, the objective was to assess and compare the outcomes of three different fusion constructs used in the Lapidus procedure: group 1, transverse screw fixation; group 2, metatarsal cuneiform screw fixation; and group 3, combined transverse and metatarsal cuneiform screw fixation. The study encompassed 32 feet: 11 in group 1, 8 in group 2, and 13 in group 3. The primary focus was to evaluate postoperative stability through radiographic imaging complemented by clinical assessments and an examination of complications. Statistical analyses were used to compare outcomes across the three fixation groups immediately, 3 months, 6 months, and 1 year postoperatively. Results: Radiographic assessments demonstrated successful fusion, and patients reported improvements in pain and function and overall satisfaction with the procedure. Complication rates were within an acceptable range. The IMA in all three groups exhibited a significant reduction postoperatively compared with preoperative measurements. Group 3 demonstrated a notably stronger initial reduction in the IMA compared with groups 1 and 2, and they maintained a statistically significantly more stable IMA value and exhibited a lower recurrence rate compared with the other two groups 1 year postoperatively. Conclusions: These findings endorse the use of Lapidus fusion with these three constructs, particularly with combined transverse and metatarsal cuneiform screw fixation, as a dependable and efficacious surgical approach in addressing hallux valgus with concomitant tarsometatarsal instability. Full article

Background: Hallux valgus (HV) is a complex forefoot deformity influenced by interactions between osseous alignment, ligamentous restraint, and muscle–tendon forces. While the biomechanical role of ligament laxity and bone geometry has been extensively investigated, the contribution of tibialis anterior (TA) tendon insertion variability to medial column mechanics remains insufficiently understood. Materials and Methods: A patient-specific finite element model of the foot was developed from high-resolution computed tomography data. Five anatomically documented TA distal insertion configurations were modeled, representing different distributions of attachment to the medial cuneiform and first metatarsal base. All simulations were performed under identical boundary and loading conditions representative of the stance phase of gait. Global (full-foot) and local (first bone and first metatarsal) mechanical responses were quantified using total deformation, equivalent von Mises stress, and strain distributions. Results: Marked differences in mechanical behavior were observed across TA insertion types. The metatarsal-dominant configuration (Type 3) demonstrated the highest global and local deformation values (global deformation: 1.0928 mm; first bone deformation: 1.0928 mm) and elevated strain distributions, whereas the medial-dominant configuration (Type 2) showed minimal deformation (global: 0.0727 mm; first bone: 0.0350 mm) but the highest global equivalent von Mises stress (5.7698 MPa). The single-band insertion to the medial cuneiform (Type 5) produced the greatest localized stress in the first bone region (3.8634 MPa). Representative strain maps revealed distinct spatial redistribution patterns within the medial column associated with TA insertion geometry. Conclusions: This patient-specific finite element analysis indicated that distal TA insertion variability alone can substantially modify deformation, stress, and strain patterns within the medial column. These findings suggested that TA insertion anatomy may act as a biomechanical modulator of first-ray mechanics and should be considered in future studies investigating hallux valgus pathomechanics and personalized treatment strategies. Full article

Background: Intrinsic foot muscle strengthening and orthotic devices such as toe spacers are commonly used to improve foot alignment and function. However, evidence regarding the combined effects of strengthening exercises and interdigital spacers remains limited. Objective: To examine whether adding a silicone toe spacer to a foot strengthening exercise program provides additional benefits compared with exercise alone. Design: Randomized controlled trial. Setting: University biomechanics laboratory. Participants: Twenty-five healthy adults (mean age 23.8 ± 1.3 years) without lower limb injury or neurological disorders were randomly allocated to one of two intervention groups. Interventions: Participants performed a six-week foot strengthening program (22 sessions). One group performed exercises alone, while the second group performed the same exercises while wearing a silicone interdigital toe spacer. Main outcome measures: The primary outcome was hallux valgus angle. Secondary outcomes included active and passive hallux range of motion (ROM), ankle dorsiflexion ROM (weight-bearing lunge test), navicular drop, and postural stability during single-leg stance assessed using center-of-pressure (CoP) measures. Results: Both groups demonstrated improvements over time in hallux valgus angle (p = 0.001, η² = 0.361), active hallux range of motion (p < 0.001, η² = 0.545), and ankle dorsiflexion (p < 0.001). However, no significant between-group differences were observed for the primary outcome or most secondary outcomes. A significant time × group interaction was observed only for passive hallux range of motion (p = 0.040, η² = 0.170), indicating greater improvement in the exercise-only group. Navicular drop and postural stability variables did not change significantly. Conclusions: A six-week foot strengthening program improved hallux alignment, hallux mobility, and ankle dorsiflexion in healthy adults. The addition of a silicone toe spacer did not provide additional short-term benefits compared with exercise alone. Full article

Background/Objectives: Foot impairments are common in older adults, but the independent associations of specific foot indices with locomotive syndrome (LS) severity remain unclear. We examined hallux valgus angle (HV), navicular height (NH), and passive ankle dorsiflexion (ADF). Methods: This cross-sectional study included 119 community-dwelling older adults classified into LS stages 0–3. Bilateral measures were summarized as maximum HV and minimum NH/ADF, reflecting the worst-affected side. Proportional-odds ordinal logistic regression modeled LS stage (0–3) with foot indices and covariates (age, sex, body mass index [BMI]). Extended models additionally adjusted for Timed Up and Go (TUG), gait speed, or single-leg stance (SLS). Sensitivity analysis used binary logistic regression (LS ≥ 2 vs. <2). Results: Greater ADF was independently associated with lower LS severity (OR per 1°, 0.91; 95% CI, 0.85–0.98; p < 0.01), whereas higher BMI was associated with greater LS severity (OR per 1 kg/m², 1.15; 95% CI, 1.01–1.30; p < 0.05). HV and NH were not significant. After adjustment for TUG, gait speed, or SLS, ADF remained inversely associated with LS severity (ORs, 0.92–0.93; p < 0.05), while the BMI association was attenuated. In binary logistic regression, greater ADF was associated with lower odds of LS ≥ 2 (OR per 1°, 0.85; 95% CI, 0.76–0.94; p < 0.005). Conclusions: Reduced passive ankle dorsiflexion is independently associated with greater LS severity, robust after accounting for key mobility and balance measures. Interventions targeting ankle mobility may represent a potentially modifiable factor and warrants confirmation in longitudinal and interventional studies. Full article

Background: The origin of hallux abducto valgus (HAV) is considered to be multifactorial; however, evidence regarding the factors involved in its development is scattered and often contradictory. Understanding the factors that contribute to the onset of HAV is crucial for informing both prevention and clinical management strategies. This review aims to explore the etiological factors associated with the development of HAV. Methods: A literature search was conducted in PubMed, Embase, Web of Science and Scopus. The search included observational studies that investigated etiological or risk factors related to the development of HAV. Methodological quality was assessed using the Joanna Briggs Institute (JBI) checklists, and the level of evidence was classified according to the Oxford Centre for Evidence-Based Medicine (OCEBM). Results: A total of 36 observational studies (20 cross-sectional and 16 case–control) were included, involving 14,500 participants, predominantly females. Genetic evidence indicated strong familial aggregation and variants in collagen- and extracellular matrix-related genes as potential hereditary determinants. The most consistent biomechanical factors were first-ray hypermobility, abnormal foot pronation and reduced activity of the abductor hallucis muscle. Additionally, female sex, older age and prolonged use of narrow or inadequate footwear were identified as recurring predictive variables. Overall, the findings support a complex etiological model based on the interaction of intrinsic and extrinsic factors. Conclusions: The development of HAV appears to be determined by the interaction of genetic, structural and biomechanical factors that alter first-ray stability and forefoot function. Current evidence supports a multifactorial etiological model with a strong hereditary component and higher susceptibility in women. Longitudinal studies employing standardized methods are needed to establish causal relationships and quantify the relative contribution of each factor. Full article

Background: The number of patients with rheumatoid arthritis (RA) undergoing forefoot arthroplasty has increased to better control the disease. Despite patients frequently expressing concerns regarding postoperative foot appearance and footwear-related expectations, no study has investigated postoperative changes in foot length and width in patients with RA. The aim of this study was to evaluate the effect of surgical procedures for rheumatoid forefoot deformities on variations in radiologically determined foot length and width. Methods: In total, 72 feet of 50 women and 3 men (average age: 66.7 years) underwent joint-preserving arthroplasty (n = 33) and arthrodesis of the first metatarsophalangeal joint with shortening osteotomy of the lesser metatarsals or resection arthroplasty of the lesser metatarsal heads (n = 39); procedures were carried out in our institute from August 2013 to February 2020. The mean disease duration was 23.5 years, and the average follow-up period was 17.5 months. Pre- and postoperative hallux valgus angle (HVA), intermetatarsal angle (IMA) of the first and second metatarsals (M1M2A), and IMA of the first and fifth metatarsals (M1M5A) were measured on weightbearing radiographs as well as foot length and width. We also evaluated the correlation between changes in radiographic parameters and variations in radiologically determined foot length and width. Results: Radiologically determined foot width changed significantly from 10.1 cm to 9.7 cm (p < 0.01), while no significant difference was found between pre- and postoperative radiologically determined foot length. HVA, M1M2A, and M1M5A were significantly improved after the surgery (p < 0.01, p < 0.01, and p < 0.01, respectively). A significant negative correlation was found between the variation in radiologically determined foot length and changes in HVA (r = −0.29, p = 0.02) and M1M5A (r = −0.23, p < 0.05), while a significant positive correlation was found between the variation in the foot width and changes in HVA (r = 0.34, p < 0.01), M1M2A (r = 0.55, p < 0.01), and M1M5A (r = 0.45, p < 0.01). There were no significant differences between operative procedures regarding variation in radiologically determined foot length and width. Conclusions: Surgical procedure for rheumatoid forefoot deformity improved radiographic parameters and reduced radiographic foot width while maintaining foot length. Full article

Background: Hallux valgus affects footwear tolerance, body image, and social participation, particularly among white-collar women who adhere to formal dress codes. While clinical outcomes of hallux valgus surgery are well described, little is known about how women in office-based occupations experience postoperative recovery. This study explored the lived experiences of women at least 12 months after surgical correction of mild-to-moderate hallux valgus using distal first-metatarsal osteotomy with adjustable intramedullary T-plate fixation. Methods: A qualitative interpretivist approach was employed. Semi-structured interviews were conducted with purposively selected Turkish-speaking white-collar women who underwent surgery between January 2021 and January 2024. All had ≥12 months of follow-up. Interviews were transcribed verbatim and analyzed using reflexive thematic analysis guided by Consolidated Criteria for Reporting Qualitative Research (COREQ) principles. Trustworthiness was supported through member checking, an audit trail, negative case analysis, and peer debriefing. Data saturation was reached at 27 interviews. Results: Twenty-seven women (mean age 43.04 ± 4.66 years) participated. Six themes emerged: (1) expectations and motivations; (2) postoperative physical experience; (3) aesthetic perception; (4) psychological responses; (5) social and domestic support; and (6) footwear identity and adaptation. Participants described meaningful gains in comfort, confidence, and mobility. The ability to choose footwear freely, rather than endure pain, was central to their sense of recovery. Improvements in self-image and ease in professional and social settings were also emphasized. Conclusions: Across six interrelated themes, white-collar women described postoperative recovery as a multidimensional process encompassing footwear autonomy, body image, occupational confidence, physical experience, psychological responses, and social support. These findings highlight the importance of incorporating footwear expectations and workplace needs into preoperative counselling and postoperative care. Full article

Background: Caregivers often seek medical assistance when their child experiences podiatric medical ailments. Podiatric medical diseases such as ingrown toenails, callosities, warts, metatarsus varus, and hallux valgus frequently occur in children and adolescents. However, treatment, prevention, and rehabilitation are often based on empirical experiences; thus, as a first endeavor, clinical and epidemiologic mapping of podiatric medical diseases in children is warranted. We describe the prevalence of common foot conditions—callosities, ingrown toenails, hallux valgus, metatarsus varus, and warts—among Danish schoolchildren aged 6 to 16 years. Methods: In this cross-sectional study, we evaluated foot conditions in children in first (aged 6–8 years), fifth (aged 10–12 years), and ninth (aged 14–16 years) grades. The clinical status of the feet was examined by teams of two podiatric physicians each. Specifically, we evaluated deformities of the foot, foot pathologies, and their anatomical localization. Results: Of 501 children (1002 extremities) evaluated, 417 had one or more of the investigated foot deformities or pathologies. We found 266 various foot pathologies among Danish schoolchildren. Metatarsus varus (53%) and callosities (46%) were the most frequently occurring foot conditions. The prevalence of foot pathologies of ingrown toenails and warts was 14% and 12%, respectively. The prevalence of ingrown toenails, metatarsus varus, and hallux valgus increased with age. Conclusions: This study found that foot pathologies such as warts and ingrown toenails and conditions such as metatarsus varus and callosities are common in Danish primary school students. These findings of high prevalences of foot pathologies and conditions motivate future research projects to clarify how this affects general health and subsequently the relation to pain, health challenges, socioeconomics, and quality of life. Full article

Background: Flatfoot is an alteration of the normal structure of the foot, characterized by a partial or total reduction of the medial longitudinal plantar arch, valgus deformity of the heel, and abduction of the forefoot. While treatments often include strengthening of the intrinsic foot muscles, evidence of its efficacy in adults with flatfoot remains limited. Objectives: The main objective of this review was to evaluate the effects of strengthening the plantar intrinsic muscles in adults with flatfoot. Methods: Searches were conducted in PubMed, Embase, Cochrane, PEDro, and Web of Science databases up to October 2023. The review protocol was developed and followed according to the PRISMA Extension for Scoping Reviews (PRISMA-ScR) guidelines. Studies included were those published on intrinsic muscle strengthening in adult populations. A qualitative synthesis of all included articles was performed, along with a quantitative sub-analysis of randomized controlled trials and a critical methodological assessment. Results: Eleven studies involving a total of 374 participants were selected. Most studies identified the “short foot exercise” as the optimal exercise for isolating and training the plantar intrinsic foot muscles. The most commonly analyzed variables were the Foot Posture Index and the Navicular Drop Test. Conclusions: Strengthening the plantar intrinsic muscles enhances the height of the medial longitudinal arch, improves hindfoot posture and balance, and increases hallux abductor muscle activity. This strengthening, whether achieved through short foot exercises alone or in combination with other techniques, is effective in treating adult flatfoot. Current literature suggests that a duration of 4–6 weeks may be sufficient to achieve beneficial outcomes. Full article

Central sensitization of pain (CSP) is defined as the “increased responsiveness of nociceptive neurons in the central nervous system (CNS) to normal or subthreshold afferent input” The primary objective of this study is to compare the prevalence of CSP between patients presenting with foot and ankle conditions and those presenting with low back pain. Materials and Methods: A cross-sectional study was conducted comparing a cohort of patients with a first consultation for foot and ankle disorders to another cohort with a first consultation for lumbar spine pain at the same institution. Demographic variables, pain duration, main diagnosis, and a series of questionnaires assessing pain and disability were collected. The Central Sensitization Inventory (CSI) was administered to determine the presence of CSP within the groups. Statistical analyses were performed using STATA. Results: A total of 195 patients presenting with foot/ankle conditions and 252 patients with low back pain were included. Among the foot/ankle cohort, 16.4% (95% CI, 10.92–21.9%) were classified as having CSP, compared to 22.2% (95% CI, 16.85–27.6%) in the lumbar pain cohort. The difference in CSP prevalence between groups was not statistically significant (difference 5.79%, Chi² = 2.357, p = 0.125). However, the difference in mean scores on Part A of the CSI was statistically significant (31.82 ± 13.88 vs. 25.20 ± 14.31, z = 4.237, p < 0.001). Among foot/ankle pathologies, plantar fasciitis showed the highest prevalence of CSP (21.9%), followed by hallux valgus (18.8%). A significant association was observed between CSP and higher levels of pain and disability. Female patients demonstrated a higher prevalence of CSP. Conclusions: Patients with low back pain exhibited higher CSI scores and a greater prevalence of central sensitization compared with those with foot and ankle disorders. Recognizing these mechanisms may help clinicians tailor more effective, multidisciplinary treatment strategies. Full article

Background/Objectives: Flexible symptomatic flat foot in children can be surgically treated with calcaneus stop screws. This raises the question of whether pre- and postoperative radiographs (X-ray) can be analyzed in two planes using AI. Methods: In this monocentric retrospective study, angle measurements generated by Bone Metrics AI (Gleamer) were compared with manual measurements using Centricity™ (GE Healthcare). A total of 659 X-rays from 124 operated feet (2014–2024) were available, of which 422 were analyzable by AI and 299 met defined quality criteria. Bland–Altman plots were used to assess agreement. Linear and logistic regression analysis examined the influence of age, gender, accessory navicular bone, additional foot pathologies, and flat foot severity on comparability of the measurement methods and measurability by the AI. Finally, radiographs meeting and missing quality criteria were compared. Results: AI measurements were comparable to manual measurements for calcaneus inclination, hallux valgus, 1st–2nd and 1st–5th metatarsal angle both pre- and post-operatively. For the talus-1st metatarsal and medial arch angles, AI results differed significantly (p < 0.001 and p ≤ 0.013) from manual measurement. AI generated talus-1st metatarsal angle was measured larger by 6.14°, 95% [−7.14; −5.14] pre-operatively and 2.80°, 95% [−3.79; −1.81] post-operatively. Medial arch angle was smaller by 1.63° pre-operatively, 95% [1.03; 2.23] and 0.52° post-operatively, 95% CI [0.11; 0.93] with AI. Post-operative measurability was not significantly lower than pre-operative. AI measured angles on incorrectly taken radiographs as often or more often than on correctly taken ones. Discussion: Screw implantation did not negatively impair measurability or AI accuracy. However, age, gender, and flat foot severity influenced AI performance. Bad radiograph quality did not affect AI measurability negatively, indicating that AI cannot yet distinguish between X-rays suitable and unsuitable for angle measurements. Conclusions: Manual measurements are still indispensable in the diagnosis of children’s flat feet. In the future, continuous training of the AI is expected to bring it into line with manually measured radiological values. Full article

Background/Objectives: Hallux valgus (HV), a common foot deformity, is difficult to quantify beyond traditional angular measurements. This study introduces a novel dynamic distance mapping technique to visualize HV progression and identify spatial features linked to severity. Methods: A retrospective analysis of 335 feet from 178 patients undergoing HV surgery at Hasharon Hospital, Israel (2014–2024), utilized custom Python software to annotate 24 landmarks on preoperative standing anteroposterior radiographs. This generated 276 normalized Euclidean distances, analyzed via Pearson correlation against HV angles (HVA, IMA, DMAA, HIA). Results: Seven distances correlated negatively (r > 0.4, p < 0.05) and seven positively with HVA, involving the distal phalanx, sesamoids, and second metatarsal. Eleven distances showed strong positive correlation (r > 0.4, p < 0.05) with IMA, reflecting displacement patterns. Moderate correlations were observed with DMAA (six negative, r −0.3 to −0.4; two positive, r 0.3 to 0.4, p < 0.05) and HIA (two negative, r −0.3 to −0.4, p < 0.05). Visualizations highlighted progressive spatial changes. Conclusions: Dynamic distance mapping provides valuable insights into hallux valgus (HV) progression, as evidenced by significant correlations with HVA and IMA, supporting its potential role in surgical planning. However, its ability to capture 3D deformities requires validation against weightbearing computed tomography (WBCT). Future research should explore correlations with specific indications for corrective osteotomies to enhance clinical applicability. Full article

Background: Distal metatarsal chevron osteotomy is widely used in hallux valgus surgery, and many different osteotomy methods have been described in the literature because of its complications, such as nonunion, loss of reduction, and osteolysis. This study aimed to biomechanically compare the newly defined Parmaksızoğlu osteotomy and the distal chevron osteotomy. Methods: A total of 14 sawbone models were divided into two groups, and Parmaksızo
glu and distal chevron osteotomies were performed with the created incision guides. For biomechanical tests, fatigue testing was performed on the samples with 1,000 cycles of axial loading up to 10 N at a 15° angle. Rigidity, dorsal angulation, and deforming force values were recorded. Results: In the chevron osteotomy group, the average rigidity value of the 1,000th cycle was measured as 3.69 N/mm, the dorsal angulation value was 1.95°, and the average deforming force value was 20.14 N. In the Parmaksızo
glu osteotomy group, the average rigidity value of the 1,000th cycle was measured as 2.28 N/mm, the dorsal angulation value was 2.12°, and the average deforming force value was 26.72 N. Conclusions: In this study, Parmaksızo
glu osteotomy and chevron osteotomy were compared in terms of rigidity, dorsal angulation, and deforming force, and no statistically significant superiority of one technique over the other was observed. It has been statistically shown that the Parmaksızo
glu osteotomy, which has demonstrated a lower complication rate and a higher American Orthopaedic Foot & Ankle Society score in previous studies, has biomechanically similar features to the distal chevron osteotomy. Full article