bluuebunny/crossref_metadata_2025_split huggingface dataset:
Extraosseous and Intraosseous Arterial Supply to the First Metatarsal and Metatarsophalangeal Joint
Authors: Shereff Michael J. , Yang Quing Ming , Kummer Frederick J. 
Published: March 2013

The extraosseus and intraosseous circulation to the first ray was evaluated by means of vascular injection techniques. The first metatarsal and metatarsophalangeal joint receive their blood supply from the first dorsal metatarsal artery, the first plantar metatarsal artery, and the superficial branch of the medial plantar artery. These three source arteries provide variable numbers of branches to the base, shaft, and head of the first metatarsal. Ramifications of branches to the head form an extensive capsular network that is more consistent and abundant on the dorsal and lateral aspects of the joint. The source of intraosseous vascularity consists of a diffuse network of fine periosteal arteries enveloping the diaphysis of the metatarsal, a single nutrient artery that perforates the first metatarsal at the lateral aspect of the shaft distally, and a system of metaphyseal and capital arteries that appear to constitute a major source of blood supply to the metatarsal head.
Foot Breadth in Children—Its Relationship to Limb Dominance and Age
Authors: Didia B.C. , Nyenwe E.A. 
Published: March 2013

A total of 996 school pupils between the ages of 5 and 12 yr were studied for the relationship between foot breadth and limb dominance. The test of significance and chi-square analysis were used in the calculation. Limb dominance is divided into upper limb dominance (handedness) and lower limb dominance (footedness). No asymetry or difference was found between the right and left foot ( P < 0.69) in terms of foot breadth. A significant correlation between limb dominance and foot breadth was not found ( P < 0.01). An ipsolateral relationship exists between the two forms of limb dominance—92.37% of right handers are right footed while 51.85% of left handers are left footed. As an offshot of this work an equation for the estimation of a child's age from his foot breadth is given.
Compartment Syndromes of the Foot: Current Concepts
Authors: Manoli Arthur 
Published: March 2013

The foot has been mentioned as a site for the development of a compartment syndrome for approximately 9 years. Despite this, very little information exists in the literature containing specifics on the nature of the disorder. Very recent work has shown that crush injuries, forefoot and midfoot fractures and dislocations, and calcaneal fractures are prone to the development of foot compartment syndromes (FCS). The classical clinical signs of pain with passive stretch of the involved muscles, and dysfunction of the nerves that pass through the involved compartments are less helpful in the diagnosis of the syndrome in the foot than elsewhere. Tense swelling of the foot may be of some help in arousing suspicion that a FCS has developed, but the diagnosis is best made by invasive catherization of the foot compartments. Since recent work has discovered that at least nine foot compartments exist, multi-stick catherization is recommended. Fasciotomy should be performed when the pressures are significantly elevated, to prevent the development of late contractures. A communication exists between a newly-found compartment of the foot, the calcaneal compartment, and the deep posterior compartment of the leg. A combined pattern of FCS and deep posterior compartment syndromes of the leg exists, and should be remembered by the clinician treating injuries of the foot or leg. Also, a foot injury alone may cause a deep posterior compartment syndrome in the leg. Claw-toe deformity seems to be the primary late sequela of FCS. Local procedures may be of only temporary benefit.
Results of Arthrodesis of the Tarsus: Talocalcaneal, Midtarsal, and Subtalar Joints
Authors: Scranton Pierce E. 
Published: March 2013

A 10-year prospective study was carried out on arthrodesis surgery of the major tarsal joints of the foot. The guiding principle of the study was that foot symmetry would be preserved, except where both feet were deformed. Correction in the frontal, coronal, and sagittal planes would be used to restore normal talocalcaneal relationships. In patients with normal relationships, triple, subtalar (talocalcaneal), and isolated tarsal arthrodesis would be carried out by iliac-crest-inlay grafting to preserve tarsal relationships. In 41 patients, 47 arthrodeses were carried out. There were 31 triple arthrodeses, 10 talocalcaneal fusions, four talonavicular fusions, and two naviculocuneiform fusions. In patients with deformity, significant improvement in the angles of anteroposterior talocalcaneal divergence and lateral talocalcaneal convergence was recorded. There were 27 good results, 15 fair results, and five poor results. Supplementary bone grafting and the use of internal fixation improved the rate of arthrodesis.
The Intraosseous Blood Supply of the Fifth Metatarsal: Implications for Proximal Fracture Healing
Authors: Smith Judith W. , Arnoczky Steven P. , Hersh Alexander 
Published: March 2013

Fractures of the proximal fifth metatarsal can be divided into two distinct groups based on anatomical location and clinical course. Fractures of the tuberosity often heal well with nonoperative treatment, whereas fractures occurring in the proximal diaphysis (up to 1.5 cm distal to the tuberosity) have significantly increased risk for delayed union or nonunion. It is the purpose of this paper to describe the intraosseous vascular anatomy of the fifth metatarsal, and the clinical implications for basilar fracture healing. Ten fresh-frozen amputation or cadaver specimens were studied following arterial injection with India ink or barium sulfate suspension. The intraosseous blood supply to the fifth metatarsal tuberosity arose from numerous metaphyseal vessels penetrating the nonarticular surfaces of the tuberosity in a random, radiate pattern. The blood supply to the proximal diaphysis was derived primarily from the nutrient artery, which gave rise to longitudinal intramedullary branches. The arterial supply to the tuberosity joined the supply of the proximal diaphysis in the area just distal to the tuberosity, corresponding to the region of poor prognosis for fracture healing. This suggests that a relative lack of blood supply following a proximal diaphyseal fracture may contribute to delayed union and nonunion.
Clinical Significance of Magnetic Resonance Imaging in Preoperative Planning for Reconstruction of Posterior Tibial Tendon Ruptures
Authors: Conti Stephen , Michelson James , Jahss Melvin 
Published: March 2013

A retrospective study of attenuated/ruptured posterior tibial tendons was conducted of all patients who underwent tendon reconstruction over a 4-year period. The study comprised 20 feet in 19 patients having an average age of 53.3 years, with an average follow-up of 2 years. Preoperative magnetic resonance images were taken and graded for assignment to one of three magnetic resonance imaging (MRI)-based groups. The surgical grade was determined intraoperatively based on a previously described classification scheme. No medical or rheumatologic conditions predisposing to failure could be identified. Failure was defined as postoperative progression of pain and deformity which required subsequent triple arthrodesis. There were six failures at an average of 14.7 months. Surgical evaluation was not correlated to outcome following reconstruction. MRI grading, however, was predictive of outcome. The superior sensitivity of MRI for detecting intramural degeneration in the posterior tibial tendon that was not obvious at surgery may explain why MRI is better than intraoperative tendon inspection for predicting the outcome of reconstructive surgery. Therefore, it may be helpful to obtain preoperative MRI when this particular reconstruction of the posterior tibial tendon is contemplated, since this provides the best measure of tendon integrity and appears to be the best predictor of clinical success after such surgery.
Investigations into the Fat Pads of the Sole of the Foot: Heel Pressure Studies
Authors: Jahss Melvin H. , Kummer Frederick , Michelson James D. 
Published: March 2013

The fat pads of the heel have a structure that is optimized for load bearing. In various diseases and aging, the load-carrying ability of the heel pad is clinically impaired. The loading pattern was examined in subjects having normal heel pads and those with atrophic heel pads, both with and without clinical symptoms. Normal heel pads showed a broad region of high pressure, which accounted for a high percentage of the total load transmission. In contrast, the atrophic heels showed a high but narrow peak pressure. However, most of the load was transmitted over a large area of low pressure. There was no difference between symptomatic and asymptomatic heels. The mechanical behavior of the fat pad is discussed with particular reference to the anatomic structure of the pads. Pad thickness and septal integrity are both important to the mechanical characteristics of the fat pad. The load-bearing patterns observed are discussed in terms of the mechanical components influencing fat pad resilience. These results have direct relevance to understanding the pathophysiology of heel pain secondary to degeneration of the fat pad.
A Method for Measuring Foot Pressures Using a High Resolution, Computerized Insole Sensor: The Effect of Heel Wedges on Plantar Pressure Distribution and Center of Force
Authors: Rose Nicholas E. , Feiwell Lawrence A. , Cracchiolo Andrea 
Published: March 2013

A new, high resolution, pressure-sensitive insole was tested and found to provide reproducible measurements of static and dynamic plantar pressures inside the shoe of normal test subjects under certain conditions. However, calibration between separate sensors was poor and the sensor pads showed significant wear with use. This system was also used to investigate the effect of heel wedges on plantar foot pressure to determine whether this system was sensitive enough to detect the effect of a gross shoe modification on plantar foot pressure. Medial heel wedges decreased plantar pressures under the first and second metatarsals as well as under the first toe, and shifted the center of force laterally in all portions of the foot. Lateral heel wedges decreased pressures under the third, fourth, and fifth metatarsals, increased pressures under the first and second metatarsals, and shifted the center of force medially in all portions of the foot. Our evaluations indicate that it is possible to measure static and dynamic plantar foot pressures within shoes and to study the possible effect of shoe modifications on plantar pressures in controlled gait trials.
The Dynamics of Peroneus Brevis Tendon Splits: A Proposed Mechanism, Technique of Diagnosis, and Classification of Injury
Authors: Sobel Mark , Geppert Mark J. , Olson Eric J. , Bohne Walther H. O. , Arnoczky Steven P. 
Published: March 2013

The etiology of peroneus brevis splits is unclear. 16 , 26 Because longitudinal splits in the peroneus brevis tendon do not necessarily effect the integrity or strength of the tendon, it is difficult to ascertain whether or not injury to the peroneus brevis tendon is present. Recent clinical, anatomic, and histologic reports have suggested that the split develops from prolonged mechanical attrition within the fibular groove as a result of ankle trauma with resultant lateral ankle instability and incompetency of the superior peroneal retinaculum with resultant subluxation of the peroneal tendons. 15 , 17 , 22 – 25 This cascade of events may result in splitting of the peroneus brevis tendon. The purpose of this paper was to report the investigation of the mechanism by which peroneus brevis splits develop, to describe a technique of diagnosis, and to propose a classification of injury. Peroneus brevis splits are the result of a dynamic mechanical insult at the fibular groove. Laxity of the superior peroneal retinaculum combined with peroneus longus mechanical compression causes the peroneus brevis to splay out and eventually split over the sharp posterior edge of the fibula. Anatomic factors, such as a shallow fibular groove (congenital convex groove) or the presence of an anomalous low-lying peroneus brevis muscle belly or peroneus quartus tendon, 4 , 7 , 25 may also play a role in this mechanism by interfering with the competence of the superior peroneal retinaculum.
Unilateral External Fixation for Severe Pilon Fractures
Authors: Bonar Susan K. , Marsh J. Lawrence 
Published: March 2013

Twenty-one patients with severe tibial plafond fractures were treated by unilateral large screw external fixation. In 15 patients, this was combined with limited internal fixation. The fractures were classified according to the methods of Ovadia and Beals. 12 There were nine type lll, four type IV, and eight type V fractures, and according to the methods of Rüedi and Allgöwer, nine type II and 12 type III fractures. Seven fractures were open. In five fractures, no attempt was made at articular reconstruction due to severe comminution. Four of these fractures required ankle arthrodeses and one type IIIB fracture received a late amputation. All other fractures healed. There were no cases of wound infection, skin slough, or osteomyelitis. Large screw external fixation in the talus and calcaneus was not associated with significant early or late complications. The less extensive tissue dissection in an area prone to wound complications may account for the low rates of infections, wound complications, and nonunion.
Magnetic Resonance Imaging and the Evaluation of Tarsal Tunnel Syndrome
Authors: Frey Carol , Kerr Roger 
Published: March 2013

The bones, soft tissue contents, and boundaries of the tarsal tunnel can be imaged with sufficient detail to show all the major structures within it. Pathological conditions affecting these structures can also be identified. The purpose of this paper was to determine the ability of magnetic resonance imaging to help in the evaluation of tarsal tunnel syndrome. Thirty-three patients with 40 feet were used for this study. All patients presented with complaints of pain along the course of the posterior tibial nerve or its branches and a positive Tinel's sign. Nerve conduction studies were obtained on 29 feet. All feet were evaluated with a magnetic resonance imaging study of the tarsal tunnel. Twenty-one feet eventually required surgery. Magnetic resonance imaging revealed an inflammatory or mass lesion in the tarsal tunnel in the majority of cases. The magnetic resonance imaging findings were confirmed at surgery in 19 patients. The information provided by magnetic resonance imaging can enhance surgical planning by indicating the extent of decompression required.
Digital Nerves of the Foot: Anatomic Variations and Implications Regarding the Pathogenesis of Interdigital Neuroma
Authors: Levitsky Kenneth A. , Alman Benjamin A. , Jevsevar David S. , Morehead James 
Published: March 2013

Seventy-one cadaveric feet were dissected, with attention to communicating branches of the digital nerves, the diameters of the digital nerves, the distance between the metatarsal heads, and the presence or absence of interdigital neuromas. A communicating branch was absent in 52 feet (73.2%) and present in 19 specimens (26.8%). The communication was from the fourth to the third web space common digital nerve (i.e., from the lateral to the medial plantar nerve) in 11 specimens. A reverse communication, from the third to the fourth web space common digital nerve (i.e., from the medial to the lateral plantar nerve), was present in eight specimens. Neuromas were identified in the second web space in 26 specimens and in the third web space in 32 feet. The common digital nerve to the third web space was not thicker in feet with a contribution from the fourth to the third web space nerve. Additionally, the incidence of third web space neuroma in feet with this type of communication was not significantly greater than in those feet without an internervous communication. However, the intermeta-tarsal head distances and the ratios of the intermetatarsal head distance to the digital nerve diameter in web spaces 2 and 3 were significantly smaller in comparison to spaces 1 and 4 ( P < .05). The morphometric data lend support to theories that explain the propensity for neuroma formation in both the second and third web spaces on a mechanical basis. The data do not support those theories that explain an increased incidence of third web space neuroma formation based on a communication from the fourth to the third web space digital nerve.
Management of Metatarsus Adductovarus
Authors: Pentz Anthony S. , Weiner Dennis S. 
Published: March 2013

A retrospective analysis of 795 patients treated for metatarsus adductovarus by a standardized outpatient approach by one of the authors (D.S.W.) from 1970 to 1983 was conducted to evaluate the efficacy of a straight metal bar and attached reverse last shoe protocol. Criteria for inclusion were developed excluding those milder cases in which spontaneous resolution was expected and indeed occurred. Nearly uniform excellent results were encountered, with a 99% likelihood of obtaining a fully corrected foot. Surgical intervention was deemed necessary in under 1% of cases seen. The authors also examined birth weights and rank in relation to metatarsus adductovarus. Those children with the deformity had a mean birth weight of 7.6 pounds, without statistical variance from normal average birth weights. We were unable to establish any statistical association with birth rank. In light of the results of this study, which compare favorably with serial casting, we recommend this approach as a more economical and less disruptive and cumbersome technique for parent, patient, and physician.
Bilateral Accessory Soleus: A Report on Four Patients with Partial Fasciectomy
Authors: Peterson David A. , Stinson Warren , Carter John 
Published: March 2013

Four young adults (average age 24 years) presented with complaints of posterior ankle pain after running. Bilateral accessory soleus muscles were diagnosed using magnetic resonance imaging or CT scan. Symptoms were present an average of 3 years before diagnosis. Two patients had previous surgery (ankle arthroscopy, tarsal tunnel release, and leg compartment release) before diagnosis and treatment. Obliteration of Kager's triangle (posterior ankle fat pad) was present on six out of eight lateral ankle radiographs. Posteromedial prominence was present on four out of eight ankles. Operative exploration confirmed the presence of five muscles and fasciectomy was performed. Follow-up (17 to 29 months) showed good relief of symptoms in all patients and return to long-distance running for three patients. Dissection of 47 preserved cadavers revealed three accessory soleus muscles in the 94 extremities (two muscles were bilateral in one cadaver).
Jones' Fractures and Related Fractures of the Proximal Fifth Metatarsal
Authors: Lawrence Steven J. , Botte Michael J. 
Published: March 2013

At least three fracture types occur in the proximal fifth metatarsal: the Jones' fracture, the proximal diaphysial stress fracture, and the tuberosity avulsion fracture. Each has distinct characteristics. The diaphysial stress fracture is commonly confused with the Jones' fracture, thereby obscuring vital differences in prognosis and treatment. Anatomical and biomechanical characteristics, as well as vascular studies of the proximal portion of the fifth metatarsal, are discussed in an attempt to better understand their diverse healing potentials. Guidelines for treatment are controversial, and must frequently be individualized. Although surgical intervention for certain proximal fifth metatarsal fracture types may speed recovery time, most fractures heal with immobilization. Treatment of displaced, intra-articular fractures, delayed unions, and nonunions usually requires operative methods.
Achilles Tendon Injuries: A Comparison of Surgical Repair Versus No Repair in a Rat Model
Authors: Murrell George A.C. , Lilly Edward G. , Collins Alison , Seaber Anthony V. , Goldner Richard D. , Best Thomas M. 
Published: March 2013

Controversy exists regarding the treatment of Achilles tendon ruptures. The aim of this study was to determine whether surgical repair of the rat Achilles tendon offered any biomechanical, functional, or morphological advantage over no repair. Thirty-two male Sprague-Dawley rats were randomly allocated into four groups: (1) sham operated (skin incision only), (2) no repair (complete division of the Achilles tendon and plantaris tendon without repair), (3) internal splint (plantaris left intact), and (4) Achilles repair (with a modified Kessler-type suture). Functional performance was determined from the measurements of hindpaw prints utilizing the Achilles Functional Index. On day 15, the animals were killed, and biomechanical and histological evaluations were performed on both the injured and uninjured Achilles tendon constructs. All groups subjected to Achilles tendon division had a significant initial functional impairment that gradually improved so that by day 15 there were no functional or failure load impairments in any group. The injured tendons in all three groups subjected to Achilles tendon division had a 13-fold increase in the cross-sectional area and were less stiff and more deformable than uninjured and sham-operated tendons on day 15 ( P < .001). The magnitude of the biomechanical and morphological changes at postoperative day 15 and the initial impairment and rate of functional recovery were similar for no repair, internal splint, and Achilles repair groups. In summary, this study demonstrates that surgical repair of the Achilles tendon in the rat does not offer any advantage over nonoperative management.
The Blood Supply to the Great Toe Sesamoids
Authors: Chamberland Patricia D. C. , Smith Judith W. , Fleming Lamar L. 
Published: March 2013

The purpose of this study was to define the intraosseous and extraosseous blood supply of the hallucal sesamoids by studying a total of 10 fresh-frozen, below-knee specimens with no evidence of vascular disease. Most specimens were injected with high grade India ink, cleared using a standard Spalteholz technique, and processed to delineate the extraosseous and intraosseous blood supply to include soft tissue dissection and coronal sectioning. Two additional specimens were injected with blue Mercox acrylic solution to further define the extraosseous vasculature. The major extraosseous blood supply to the sesamoids is via the posterior tibial artery. This vessel then branches into the medial plantar artery which further divides upon entering the medial and lateral sesamoids in their proximal poles. Vessels in the peripheral soft tissues, although abundant, do not seem to penetrate the cortex of the sesamoids. The intraosseous blood supply to the sesamoids seems to be threefold. Mainly, sesamoid arteries enter the lateral and medial sesamoids from the proximal aspect via a single vessel. This proximal vessel proceeds distally with a network of branching. Plantar, nonarticular vessels enter the sesamoids, constituting a second source of vascularity. Finally, small vessels also enter the sesamoids through medial and lateral capsular attachments. Based on this study, a possible explanation for avascular necrosis and nonunion of sesamoids is proposed, and an optimal surgical approach is discussed. A medial operative approach avoiding the proximal pole of the sesamoids will preserve the main arterial source. The plantar surface of the sesamoids should also be avoided. Minimal dissection through the circumferential soft tissue vascular sleeve is recommended.