Foot and ankle radiology
Maneesh Bhatia in Essentials of Foot and Ankle Surgery, 2021
Foot and ankle pain are common presenting symptoms that can have a significant impact on the quality and activity of daily living. The foot is imaged in an oblique axial plane through the long axis of the metatarsal bone. TPT maintains the longitudinal arch of the foot in conjunction with the spring ligamentous complex. Patients present with persistent lateral foot pain after a history of trauma with ankle inversion. Predisposing factors include hypertrophy of the abductor hallucis muscle, which is often seen in long distance runners, hindfoot valgus deformity, calcaneal spur, plantar fasciitis and seronegative spondyloarthropathies. Patients present with sensory changes in the lateral one-third of the plantar surface of the foot as well as motor weakness of the abductor digiti minimi. Early identification and treatment of Charcot neuropathic osteoarthropathy is key as delayed diagnosis can lead to foot and ankle deformity, foot ulceration, osteomyelitis and amputation.
Medial Plantar Nerve Syndrome (Jogger ’s Foot)
Marko M. Pecina, Andrew D. Markiewitz, Jelena Krmpotic-Nemanic in Tunnel Syndromes, 2001
The tibial nerve enters the tarsal tunnel and divides into a medial and a plantar nerve. They accompany their vascular supply separated only by a thin membrane (see Figures 50.1 to 50.3). The innervation of the plantar medial nerve on the planta pedis can be compared with the innervation of the median nerve in the hand (see Figure 50.4). Having passed the medial (upper) canal of lacuna vasonervorum of the tarsal tunnel, the nerve lies behind the vessels situated above the abductor hallucis muscle. The nerve crosses below the talus and the navicular bone. Then, the nerve crosses the lateral margin of the abductor hallucis muscle lying between the fibromuscular part of the muscle and the navicular tuberosity (i.e., the nerve is lying within the osteofibro-muscular tunnel, where it can often be compressed). The medial plantar nerve follows the medial margin of the flexor digitorum brevis muscle under the flexor hallucis longus tendon and the flexor digitorum longus muscle. At the level of the metatarsal bones, the nerve branches into the digital plantar communis nerves (Figure 51.1). Before its ramification, the nerve provides cutaneous branches to the medial part of the planta pedis and muscular branches to the abductor hallucis muscle, the flexor digitorum brevis muscle, the medial head of the flexor pollicis brevis muscle, and to the two medial lumbrical muscles. The digital plantar communis nerves branch at the base of the toes into the digital plantar proprii nerves, which supply the plantar side of the first, second, third and medial side of the fourth toe.
Delayed wound healing after forefoot surgery in patients with rheumatoid arthritis
Published in Modern Rheumatology, 2015
Shinichiro Ishie, Hiromu Ito, Masayuki Azukizawa, Moritoshi Furu, Masahiro Ishikawa, Hiroko Ogino, Yosuke Hamamoto, Shuichi Matsuda
Objective. To elucidate the systemic and local risk factors and the effect of surgical procedures for delayed wound healing after forefoot surgery in patients with rheumatoid arthritis (RA). Methods. Fifty forefoot surgeries were performed in 39 patients using resection arthroplasty or a joint-preserving procedure (25 feet for each procedure). The associations between the occurrence of delayed wound healing and clinical variables, radiological assessment, or surgical procedures were analyzed. Results. Delayed wound healing was recorded in nine feet of eight patients. The duration of RA was significantly longer in the delayed healing group than that in the healed group. Age, sex, smoking history, concomitant diabetes, and RA medication did not differ between the groups. Radiological evaluation showed significant differences between groups in metatarsophalangeal dorsal flexion angle. The shortened length of the fourth and the fifth metatarsal bones affected the occurrence of the complication. The joint-preserving procedure had significantly less delayed wound healing compared with resection arthroplasty. Conclusions. Preoperative dorsoplantar deformity and perioperative tissue damage can cause delayed wound healing after forefoot surgery in RA patients.
Growth without growth hormone: can growth and differentiation factor 5 be the mediator?
Published in Growth Factors, 2015
Biana Shtaif, Nitzan Dror, Meytal Bar-Maisels, Moshe Phillip, Galia Gat-Yablonski
Growth without growth hormone (GH) is often observed in the setup of obesity; however, the missing link between adipocytes and linear growth was until now not identified. 3T3L1 cells were induced to differentiate into adipocytes and their conditioned medium (CM) (adipocytes CM, CMA) was added to metatarsals bone culture and compared to CM derived from undifferentiated cells. CMA significantly increased metatarsals bone elongation. Adipogenic differentiation increased the expression of growth and differentiation factor (GDF)-5, also found to be secreted into the CMA. GDF-5 significantly increased metatarsal length in culture; treatment of the CMA with anti-GDF-5 antibody significantly reduced the stimulatory effect on bone length. The presence of GDF-5 receptor (bone morphogenetic protein receptor; BMPR1) in metatarsal bone was confirmed by immunohistochemistry. Animal studies in rodents subjected to food restriction followed by re-feeding showed an increase in GDF-5 serum levels concomitant with nutritional induced catch up growth. These results show that adipocytes may stimulate bone growth and suggest an additional explanation to the growth without GH phenomenon.
Changes in radiographic findings and plantar pressure distribution following forefoot reconstructive surgery for patients with rheumatoid arthritis
Published in Modern Rheumatology, 2020
Hyunho Lee, Hajime Ishikawa, Tatsuaki Shibuya, Chinatsu Takai, Yumi Nomura, Daisuke Kobayashi, Asami Abe, Hiroshi Otani, Satoshi Ito, Kiyoshi Nakazono, Keinosuke Ryu, Takao Ishii, Shu Saito, Kaoru Abe, Akira Murasawa
Objectives: To evaluate changes in radiographic findings and plantar pressure distribution after rheumatoid forefoot surgery. Methods: This study was performed on patients with rheumatoid arthritis (RA) who underwent Swanson implant arthroplasty for the 1st metatarsophalangeal (MTP) joint combined with shortening oblique osteotomy at the 2nd through 5th metatarsal necks (group Sw, 55 feet). The following two groups were used as controls: group NS, consisting of 75 feet in RA patients without scheduled forefoot surgery, and group HC, consisting of 24 feet in healthy female subjects. Plantar pressure distribution, and radiographic findings of hallux valgus angle, the angle between the metatarsal bones, talocalcaneal angle, calcaneal pitch angle and calcaneo-first metatarsal angle (CFMA) were measured pre- and one year postoperatively. Peak pressure was measured in nine sections. Results: Calcaneal pitch angle decreased and CFMA increased in group Sw. Peak pressure at the 1st interphalangeal joint (IP) and the 2nd and 3rd MTPs in group Sw decreased, while that at midfoot increased. Conclusion: While the clinical outcome in group Sw was favorable, postoperative longitudinal arch decreased. Postoperative peak pressure at the 2nd through 5th MTPs was comparable with that in group NS; however, it was significantly lower than that in group HC.
Related Knowledge Centers
- Talus
- Metatarsus
- Calcaneus
- Tarsal Bones
- Foot Bones
- Phalanges of Toes
- Long Bone