Objectives Hallux valgus is associated with tarsometatarsal arthritis; its pathophysiology remains unknown. Therefore, we aimed to elucidate the relationship between arthritis of the second and third tarsometatarsal joints and incongruity of the first tarsometatarsal joint in the sagittal plane. Methods Forty-three patients (64 feet) with hallux valgus who underwent surgery at University Hospital Kyoto Prefectural University of Medicine were included and divided into two groups: control (without second and third tarsometatarsal joint degeneration) and osteoarthritis (with second and third tarsometatarsal joint degeneration). Intergroup comparisons of the incongruity of the first tarsometatarsal joint in the sagittal plane, age, body mass index, hallux valgus angle, first-second intermetatarsal angle, metatarsus adductus angle, Meary's angle, and calcaneal pitch angle were performed. Results The proportion of patients with incongruity of the first tarsometatarsal joint was significantly higher in the osteoarthritis group than in the control group. Logistic regression analysis identified incongruity of the first tarsometatarsal joint and metatarsus adductus angle as significant related factors for arthritis of the second and third tarsometatarsal joints. Conclusions Incongruity of the first tarsometatarsal joint in the sagittal plane was involved in the development of arthritis of the second and third tarsometatarsal joints in patients with hallux valgus.

足底腱膜炎患者を対象に未治療例5例,他院での治療歴のある難治例で,西洋医学的治療のみ行った15例(非漢方群),難治例で西洋医学的治療に加えて漢方治療を行った15例(漢方群)について治療内容と効果を検討した。3 群で年齢と初診時疼痛 VAS に差はなかった。未治療例は従来の西洋治療で軽快し,治療期間も短かった。漢方群は当科での初期治療が効果不十分な症例に対して治療開始3ヵ月ごろから漢方薬を開始していることが多かった。 このため漢方群はより難治な症例が多く,最終観察時疼痛 VAS が不良で,治療期間も長かった。漢方治療はすべてエキス剤の内服で,有効例は4例,薏苡仁湯と通導散の併用が2例,薏苡仁湯単独が1例,薏苡仁湯,通導散および桂枝茯苓丸加薏苡仁の併用が1例であった。疎経活血湯は3例に使用し無効であった。この結果から難治性足底腱膜炎は風寒湿,血虚に加えて気滞,瘀血の病態を呈していると推察された。

Category: Other Introduction/Purpose: Calcaneal pitch and Meary’s angles are commonly used to assess longitudinal foot arches on lateral-view radiographs. Several different methods have been described in literatures to obtain the talar, first metatarsal, calcaneal, and plantar axes, but their reliability and reproducibility still remain to be evaluated. The aim of this study was to determine the most reproducible methods for radiographically evaluating the longitudinal axes. Methods: Standing radiographic images of 40 feet from consecutive outpatients, 22 feet with a severe cavus deformity and 48 feet with a severe flatfoot deformity, were obtained to measure the longitudinal axes of the talus, first metatarsal, calcaneus and plantar surface by using six, five, four and three different methods, respectively, that were described in the previous reports (Figure). Interobserver and intraobserver correlation coefficients were calculated by three observers. Results: The best interobserver and intraobserver correlation coefficients were obtained for methods that used a line bisecting the angle formed by the lines tangential to the superior and inferior margins of the talus (Method B), a line connecting the center of the first metatarsal head and the midpoint of the visualized base of the first metatarsal (Method J), and a line drawn tangential to the inferior surface of the calcaneus (Method L). For the plantar axis, the method that used the horizontal plane [reference axis] was considered the best. Conclusion: The above mentioned methods were considered ideal for the radiographic assessment of longitudinal foot arches, even in severely deformed feet. This study could contribute to standardized assessments of foot deformities.

•Calcaneal pitch and Meary’s angle are commonly used to assess foot arches.•The radiographic methods for evaluating tarsal axes differ among reports.•The most reproducible methods were determined in this study.•The talar axis was obtained from the tangents of its superior and inferior margins.•The first metatarsal axis was determined from the centres of its head and base.•The calcaneal axis was obtained from the tangent of its inferior surface.

RATIONALE:Cerebral venous thrombosis (CVT) is a cerebrovascular disorder that causes venous infarction and intracerebral hemorrhage (ICH) with occlusion of cerebral veins, and its incidence is estimated to be 5 per 1 million people per year, accounting for 0.5% to 1.0% of all strokes. Despite advances in the recognition of CVT, the diagnosis and treatment may be difficult because of the diversity of underlying risk factors. A rare case of ICH due to CVT during surgery is described.PATIENT CONCERNS:A 69-year-old-man presented to our department with a history of paralyzed extremities after a backward fall and head trauma. The patient had a history of pharyngeal cancer treated with neck dissection and radiotherapy. Computed tomography (CT) images showed continuous ossification of the posterior longitudinal ligament (OPLL) at C2-5 levels and a fracture line at the caudal end plate of the C5 body. The diagnosis was traumatic cervical cord injury, so that posterior cervical decompression and fusion was performed. Immediately after surgery, the patient developed an epileptic seizure and the disturbance of consciousness persisted. MR venography and contrast CT images showed absence of flow from the superior sagittal sinus to the transverse sinus.DIAGNOSES:The diagnosis in this case was ICH due to CVT.INTERVENTIONS:The patient was treated with anticoagulation using unfractionated heparin.OUTCOMES:The patient ultimately made a complete recovery from CVT.LESSONS:Although risk factors for CVT are diverse, head and neck injury, patient's position during surgery, and postoperative radical neck dissection for pharyngeal cancer might have been the factors in this case. While the measures to prevent this disease are uncertain, early diagnosis and treatment are needed to avoid serious complications.

Background: In chronic lateral ankle instability (CLAI), the instability of the ankle joint results in repeated microtrauma to the articular cartilage. How the lesion condition or stage is affected by the presence of lateral instability in medial osteochondral lesions of the talus (OLT) is unclear. We aimed to examine whether CLAI is associated with the size and staging of medial OLT on radiographs, magnetic resonance (MR) images, and arthroscopy. Methods: Forty-five patients with medial OLTs in 45 ankles were reviewed. Radiographs were assessed for damage and lesion classification. The tibio-talar tilting angle (TTA) was measured. The patients were divided into two groups: the CLAI group and the stable group. The lesion classification on radiographs, MR images, and arthroscopy, and size on MR images were statistically compared. Results: The CLAI group had a mean TTA of 8.15 +/- 3.41, whereas the stable group had a mean TTA of 2.24 +/- 1.64. The CLAI group had a lower clinical score than the stable group at the initial visit to our clinic. The CLAI group presented with lesions of significantly shorter longitudinal and transverse diameters. Stages of medial OLT on radiographs, MR images, and arthroscopic evaluation were earlier in the CLAI group than those in the stable group. Conclusions: Patients with CLAI presented in the early stages of OLT and had significantly smaller lesions than those without CLAI. The patients without CLAI may be selected for surgery at an early phase. (C) 2019 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved.

BackgroundWe report a rare case of calcific tendinopathy in the posterior tibial tendon (PTT) at the navicular insertion.CaseConservative treatments other than extracorporeal shock wave therapy (ESWT) were ineffective. Calcium deposition disappeared from the PTT on plain radiographs at 6 months after ESWT.DiscussionIn this case, a 14-year-old boy with calcific tendinopathy of the PTT who had not benefited from conservative treatments was effectively treated using ESWT.

The objective of the present study was to elucidate the relationship between the state of the posterior tibial tendon (PIT) on magnetic resonance images and foot deformity. The cases included 34 feet in 27 patients with PIT deformity and the controls included 18 feet in 12 patients who had undergone magnetic resonance imaging for other foot diseases. The PIT was closely examined on the magnetic resonance images and classified using the Conti classification. The control feet with no injury to the PIT were classified as grade 0. The talonavicular coverage angle, lateral talo-first metatarsal angle, medial cuneiform to fifth metatarsal height, calcaneal pitch angle, and varus-valgus angle were measured as radiographic parameters for flatfoot deformation, and the relation between the Conti classification and each parameter was examined statistically. A significant difference was observed in the talonavicular coverage angle between grade 0 and the other grades; the lateral talo-first metatarsal angle between grade 0 and the other grades and between grades 1 and 3; the medial cuneiform to fifth metatarsal height among grades 0, 2, and 3 and grades 1, 2, and 3; the calcaneal pitch angle between grades 1 and 3; and the varus-valgus angle among grades 0, 2, and 3 and between grades 1 and 3. Eversion of the forefoot was observed, along with an advanced collapse in the medial longitudinal arch, from an early stage of PIT injury. (C) 2017 by the American College of Foot and Ankle Surgeons. All rights reserved.

Pedography provides excellent visualization of the footprint. However, the correlation between the footprint images and radiographic measures has not been thoroughly evaluated. Therefore, the objectives of our study were to examine the correlation between the pedography-based measures of foot morphology and radiographic measurements and to propose reference values for the diagnosis of flatfoot using footprint imaging. The plantar footprints of 100 right feet were photographed using a pedography standing platform. The sole and arch areas were measured to calculate the footprint index (FPI). The lateral talar-first metatarsal angle (LTM) and calcaneal pitch angle (CP) were measured on standing lateral radiographs, and the talonavicular coverage angle was measured on frontal radiographs. The Pearson moment correlation between the FPI and radiography-based measures was calculated. The area under the receiver operating characteristic curve was calculated using an LTM of <-4° as the identifying criterion of flatfoot. The sensitivity and specificity of FPI were calculated for LTM values <-4°. The FPI correlated with the LTM (y = -17.964 ± 52.644x, R = 0.588) and CP (y = 9.2304 ± 27.739x, R = 0.659) but not with the talonavicular coverage angle (y = 26.01 ± 15.78x, R = 0.207). The area under the receiver operating characteristic curve was 0.753, with a cutoff FPI of 0.208, yielding a sensitivity of 0.462 and specificity of 0.934 for flatfoot identification. Pedography could provide an easy screening tool for flatfoot, with an FPI cutoff of 0.208, yielding a specificity of 93.4%.

Objective: To examine the recurrence of deformity after silicone implant arthroplasty combined with resection arthroplasty for severe forefoot deformity in patients with rheumatoid arthritis.Methods: We reviewed the long-term results of this procedure for 27 feet in 15 patients. Their average age and disease duration at the time of operation were 58.6 years and 17.5 years, respectively, and the average follow-up period was 10.3 years.Results: An improved hallux valgus angle (45.3 degrees preoperatively, 23.6 degrees 6 months after operation) was maintained. By contrast, deformity and dislocation of lesser toe had recurred at the final follow-up; the angle between the proximal phalanx and the metatarsal of the second toe improved 13.4 degrees with recurrence of 22.5 degrees, the angle between the proximal phalanx and ground surface improved 22.4 degrees with recurrence of 34.5. Furthermore, claw toe deformity at the final follow-up was significantly worse in the group whose hallux valgus deformity was observed 6 months after operation.Conclusion: This procedure could maintain the alignment of the first metatarsophalangeal joint, but the recurrence of claw toe deformity is a problem and the relation between the first toe and the lesser toe is an important consideration.

Sweep imaging with Fourier transform (SWIFT) method has been developed to image tissues with very short T2 values, such as cortical bone. The purpose of this study was to measure the T1 value of the rat cortical bone. It was approximately 120 ms on 7.04T. This result could thus be useful for studying bony tissue according to the SWIFT method in the future.

•The inflammation surrounding the PF is improved by the stimulation of soft tissue healing by removal of inflammatory debris and promotion of neovascularization in ESWT.•These two point may have contributed most to the improvement in clinical symptoms.

The present study aimed to diagnose complete rupture (CR) and longitudinal rupture (LR) of the posterior tibial tendon (PTT) from the magnetic resonance imaging findings in patients with PTT dysfunction and to analyze and compare the radiographs from each group to identify radiographic indicators related to the progression of PTT injury that would allow the radiographic diagnosis of CR. We evaluated 32 feet in 27 patients with PTT dysfunction (mean age 66.5, range 49 to 82, years). Radiographs were used to acquire weightbearing anteroposterior images of the foot, which were used to measure the talonavicular coverage angle. Lateral images of the foot were also acquired with the patients in the standing position. These were used to measure the lateral talometatarsal angle, calcaneal pitch angle, and medial cuneiform-fifth metatarsal height. From the axial MRI findings, the patients were divided into a CR group and an LR group, and the radiographic attributes of the CR group were analyzed. Of the 32 feet in 27 patients, 12 feet (37.5%) in 11 patients displayed CR and 20 feet (62.5%) in 18 patients displayed LR. The talonavicular coverage angle was 48.3° ± 17.3° in the CR group and 33.6° ± 13.6° in the LR group (p = .012), and the talometatarsal angle was -28.8° ± 22.5° in the CR group and -25.4° ± 14.4° in the LR group (p = .596). The calcaneal pitch angle was 10.4° ± 6.7° in the CR group and 10.2° ± 8.0° in the LR group (p = .935). Finally, the medial cuneiform-fifth metatarsal height was -4.2 ± 7.1 mm in the CR group and 2.1 ± 4.7 mm in the LR group (p = .005). When a medial cuneiform-fifth metatarsal height of ≤0 mm or talonavicular coverage angle of ≥50° was used as the diagnostic criterion for CR on weightbearing radiographs, the sensitivity was 71.4%, specificity 88.9%, and diagnostic accuracy 81.3%; hence, we believe these to be satisfactory diagnostic criteria for CR.

To report the operative findings of ankle arthroscopy during open reduction and internal fixation of acute ankle fractures.This was a retrospective review of 254 consecutive patients with acute ankle fractures who were treated with open reduction and internal fixation of the fractures, and ankle arthroscopy was performed at the same time. The accuracy of fracture reduction, the presence of syndesmosis disruption and its reduction, and the presence of ligamentous injuries and osteochondral lesions were documented. Second-look ankle arthroscopy was performed during syndesmosis screw removal 6 weeks after the key operation.There were 6 patients with Weber A, 177 patients with Weber B, 51 patients with Weber C, and 20 patients with isolated medial malleolar fractures. Syndesmosis disruption was present in 0% of patients with Weber A fracture, 52% of patients with Weber B fracture, 92% of patients with Weber C fracture, and 20% of the patients with isolated medial malleolar fracture. Three patients with Weber B and one patient with Weber C fracture have occult syndesmosis instability after screw removal. Osteochondral lesion was present in no patient with Weber A fracture, 26% of the Weber B cases, 24% of the Weber C cases, and 20% of isolated medial malleolar fracture cases. The association between the presence of deep deltoid ligament tear and syndesmosis disruption (warranting syndesmosis screw fixation) in Weber B cases was statistically significant but not in Weber C cases. There was no statistically significant association between the presence of posterior malleolar fracture and syndesmosis instability that warrant screw fixation.Ankle arthroscopy is a useful adjuvant tool to understand the severity and complexity of acute ankle fracture. Direct arthroscopic visualization ensures detection and evaluation of intra-articular fractures, syndesmosis disruption, and associated osteochondral lesions and ligamentous injuries.Level IV, case series.

Tsuyoshi Sukenari, Motoyuki Horii, Kazuya Ikoma, Masamitsu Kido, Shigeki Hayashi, Yusuke Hara, MD, Tetsuro Yamasaki, Ken-ichi Matsuda, Mitsuhiro Kawata, Toshikazu Kubo. Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan, Department of Anatomy and Neurobiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.

It has previously been found that valgus hindfoot alignment (HFA) improves 3 weeks following total knee arthroplasty (TKA) for varus knee osteoarthritis (OA). In the present study, HFA was evaluated prior to TKA, as well as 3 weeks and 1 year following TKA. Using these multiple evaluations, the chronological effects of TKA on HFA were investigated.

This study examined the coronal alignment of the hindfoot in varus osteoarthritis of the knee before and after total knee arthroplasty (TKA) in 100 legs using a novel imaging method. We categorized the preoperative hindfoot alignment into varus (30 legs) and valgus (70 legs) groups; imaging of the hindfoot was conducted preoperatively and postoperatively, and the varus-valgus angle (VVA) was measured as the hindfoot alignment. The femorotibial angle improved significantly after TKA. We found that the VVA improved significantly after TKA in the hindfoot valgus group (P<0.001), but not in the varus group (P=0.554), and we speculate that the hindfoot alignment in the valgus group improved as a result of a residual compensatory capacity in the hindfoot.

To elucidate the relationship of diffusion tensor imaging (DTI) with structural changes and muscle function in skeletal muscle.