Search Results (35)

Introduction and Objectives: The thickness of the plantar fat pad (PFP) beneath the metatarsal heads may play a protective role in preventing forefoot disorders such as metatarsalgia. However, reference values for plantar adipose tissue thickness in this region among healthy individuals are currently unavailable. Therefore, the aim of this study was to determine, by means of ultrasound imaging, the thickness of the PFP beneath the five metatarsal heads and to analyze its possible relationship with body mass index (BMI). Materials and Methods: Thirty-five young adults (17 males and 18 females) with neutral feet, free from deformities or pain, participated in the study. Using a VINNO E35 ultrasound device, the thickness of the PFP beneath each of the five metatarsal heads was quantified. A linear transducer was positioned longitudinally along the axis of each metatarsal. The distance between the dermis and the flexor tendon was measured from the second to the fifth metatarsal heads, and from the fibular sesamoid for the first metatarsal head. Results: The central forefoot showed the greatest PFP thickness (2nd metatarsal head, 7.1 ± 0.9 mm; 3rd metatarsal head, 6.9 ± 0.9 mm). No significant differences in PFP thickness were found between sexes. However, a positive correlation was observed between BMI and PFP thickness at the fourth metatarsal head (r = 0.358, p = 0.035). Conclusions: The study demonstrated greater PFP thickness beneath the second and third metatarsal heads, with no significant sex-related differences. These findings indicate a consistent anatomical pattern independent of sex in young, healthy individuals. Moreover, a moderate influence of BMI was identified at the fourth metatarsal head, which could represent a potential protective mechanism against forefoot overload. 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

Hallux sesamoid pain arises from various pathological conditions, such as fracture nonunion, painful plantar keratosis, sesamoiditis, and avascular necrosis. Traditionally, sesamoidectomy is the primary surgical approach for these conditions, but its outcomes are inconsistent. In recent years, extracorporeal shock wave therapy (ESWT) and platelet-rich plasma (PRP) have gained popularity as effective conservative treatments in orthopedic practice. This review explored treatment approaches that avoid sesamoidectomy. First, we examined studies on ESWT and PRP for hallux sesamoid pathologies. We also reviewed research on ESWT and PRP for other foot conditions with similar characteristics to evaluate whether these treatments could be applicable to different types of sesamoid pathologies. Finally, we discussed surgical alternatives to sesamoidectomy and introduced several novel techniques. Full article

Background/Objective: The recurrence of hallux valgus (HV) after primary surgical correction remains a clinical challenge, often requiring combined approaches to address both bony realignment and soft tissue imbalance. While locking plates have shown some biomechanical advantages in HV correction, evidence regarding their application in revision procedures is limited. This study presents a retrospective single-surgeon experience with a small cohort, aiming to describe radiographic and functional outcomes and to share practical insights rather than provide definitive conclusions. Methods: In this retrospective case series, patients undergoing revision surgery for failed HV correction over the past ten years at a single tertiary institution were analyzed. Radiographic parameters—hallux valgus angle (HVA), intermetatarsal angle (IMA), distal metatarsal articular angle (DMAA), and sesamoid position—were assessed. Functional outcomes included the American Orthopaedic Foot and Ankle Society (AOFAS) score and the Visual Analog Scale for pain. Surgical strategies were tailored according to recurrence mechanisms, and some cases involved Wilson osteotomy with intramedullary plate fixation. The Mann–Whitney U test and the Wilcoxon signed-rank test were applied to assess efficacy. Results: A total of 11 feet treated by one surgeon were included. Both soft tissue procedures and combined osteotomy with intramedullary plate fixation led to statistically significant but preliminary improvements in HVA, IMA, DMAA, and sesamoid alignment. Functional scores improved, and the complication rate was within the range reported in the previous literature. Conclusions: This retrospective single-surgeon study with a limited sample size suggests that Wilson osteotomy combined with intramedullary plate fixation may represent a joint-preserving and biomechanically supportive option for recurrent HV, particularly in cases with large DMAAs and severe sesamoid displacement. However, the findings should be interpreted cautiously given the small cohort, retrospective design, and absence of multi-angle radiographic visualization. The results highlight a potential approach in specific clinical settings rather than a definitive solution. Larger, prospective, multi-center studies are required to confirm long-term utility. Full article

Introduction: The optimal management of hallux sesamoid fracture nonunions remains a subject of ongoing debate, particularly in the context of personalized medicine. This systematic review aimed to synthesize current evidence regarding surgical strategies for this rare but disabling condition. Methods: A comprehensive literature search was conducted in accordance with the PRISMA guidelines. Results: Six studies met the inclusion criteria, encompassing a total of 80 patients. Surgical techniques varied and included open and arthroscopic sesamoidectomy, autologous bone grafting (alone or combined with screw fixation), and percutaneous screw fixation. When reported, outcomes were generally favorable, with union rates ranging from 90.5% to 100% and with consistent postoperative improvements in clinical function. Complication and reoperation rates were both 6.5%. The most frequent reoperation was sesamoidectomy for persistent pain or nonunion, followed by hardware removal. Conclusions: Despite the limited and low-quality evidence, available data suggest that individualized surgical planning can lead to favorable outcomes with low complication rates. Sesamoidectomy remains the most reliable salvage procedure in refractory cases. These findings support a personalized, stepwise approach to treatment—prioritizing sesamoid preservation, when feasible, while reserving excision for symptomatic nonunions. Further studies are needed to validate tailored algorithms and refine patient-specific decision-making in this challenging clinical scenario. Full article

Background/Objectives: Accurate visualization of the Achilles tendon enthesis is critical for distinguishing mechanical, degenerative, and inflammatory pathologies. Although ultrasonography is the first-line modality for suspected enthesis disease, recent technical advances may expand the role of magnetic resonance imaging (MRI). This study evaluated the utility of ultra-short echo time (UTE) and zero echo time (ZTE) sequences versus proton density-weighted imaging (PD-WI) for depicting the enthesis organ in healthy volunteers. Methods: In this institutional review board (IRB)-approved prospective single-center study, 50 asymptomatic adult volunteers underwent 3-Tesla hindfoot MRI with fat-suppressed PD-WI, UTE, and ZTE between 2018 and 2023. Four radiologists assessed image quality, signal-to-noise ratio, visibility, and abnormal high signal intensities (SIs) of the periost, sesamoid, and enthesis fibrocartilages (PCa, SCa, and ECa, respectively). Statistical tests included Chi-square, McNemar, paired Wilcoxon, and Benjamini–Hochberg adjustments for multiple comparisons. Results: The median age was 36 years (range: 20–51); 58% women were included. PD-WI and ZTE sequences were always available while UTE was unavailable in 24% of patients. PD-WI consistently failed to concomitantly visualize all fibrocartilages. ZTE and UTE visualized all fibrocartilages in 72% and 92.1% of volunteers, respectively, with significant differences favoring ZTE and UTE over PD-WI (p < 0.0001) and UTE over ZTE (p = 0.027). Inter-rater agreement exceeded 80% except for SCa on ZTE (68%, 95%CI: 53.2–80.1). Abnormal SCa findings in asymptomatic patients were more frequent with UTE (23.7%) and ZTE (34%) than with PD-WI (2%) (p = 0.0045). Conclusions: At 3-Tesla, UTE and ZTE sequences reliably depict the enthesis organ of the Achilles tendon, outperforming PD-WI. However, the high sensitivity of these sequences also presents challenges in interpretation. Full article

Background and Objectives: Sesamoiditis is a painful and functionally limiting condition that affects the sesamoid bones of the hallux, frequently seen in athletic populations. Despite its clinical relevance, there are no standardised guidelines for its conservative management. This systematic review aims to evaluate the effectiveness of conservative treatments for sesamoiditis by summarising individual-level data from published studies. Materials and Methods: A comprehensive literature search was conducted in PubMed/MEDLINE, Scopus, ISI/Web of Science, and PEDro (Physiotherapy Evidence Database) up to December 2024 in accordance with PRISMA 2020 guidelines and following a protocol specifically devised for rare or underrepresented medical conditions. Eligible studies included case reports and case series involving patients aged ≥16 years who were conservatively treated for clinically and/or radiologically diagnosed sesamoiditis. Data on patient demographics, diagnosis, type and duration of treatment, pain- (Visual Analogue Scale (VAS) and Numeric Rating Scale (NRS)) and function-related (Foot and Ankle Ability Measure (FAAM) and Foot and Ankle Outcome Score (FAOS)) outcomes, and return to activity were extracted. Study quality was assessed using Joanna Briggs Institute (JBI) critical appraisal tools. Pooled effect sizes were computed where applicable. Results: Out of 2380 initial records, 11 studies comprising 59 patients (29 females) were included. Treatments varied widely, including orthotics, corticosteroid injections, physical therapy, and biologic approaches such as concentrated bone marrow aspirate (CBMA). VAS scores improved in 66% of cases. NRS scores returned to baseline in some patients after initial improvement, revealing recurrence. FAAM and FAOS subscales showed functional improvements, particularly in sports-specific domains. Return to activity varied: in a case series, 45.4% resumed pain-free sports participation, while others remained symptomatic. Conclusions: Conservative treatment options for sesamoiditis showed variable effectiveness with promising outcomes in selected patients. Corticosteroid injections and orthotics appeared beneficial, but high recurrence and limited functional recovery persisted in some cases. Standardised treatment protocols and high-quality prospective studies are needed to improve clinical decision-making and optimise non-surgical management. Full article

Background/Objectives: Assessing the learning curve is essential for surgical techniques that require precision and technical adaptation. Although modified Reverdin–Isham and Akin percutaneous osteotomies (RIAOs) are well-established procedures for the treatment of hallux valgus (HV), their percutaneous nature and specific technical demands justify the evaluation of the learning curve. Therefore, this study aimed to assess the learning curve of RIAOs for the HV correction, using for the first time a Bayesian approach. Methods: Modified RIAOs were applied to treat mild-to-moderate HV in patients who were prospectively enrolled. The hallux valgus angle (HVA), inter-metatarsal angle (IMA), distal metatarsal articular angle (DMAA) and tibial sesamoid position were assessed. Clinical outcomes were evaluated with the American Orthopaedic Foot & Ankle Society (AOFAS) Scale, Visual Analog Scale (VAS) and Numerical Rating Scale (NRS). Surgery and fluoroscopy times were recorded. To evaluate the learning curve, a Bayesian analysis using a change point model was performed. Results: Analysis of 142 patients revealed three distinct phases in the learning curve, with a plateau reached after 112 procedures. Over time, the mean operation duration decreased from 55 to 27 min, and fluoroscopy time decreased from 60 to 28 s. Conclusions: A flexible change point model was used to model a learning curve, guaranteeing a robust interpretation of the data. The correction of the HV angles showed similar results in the three phases of the curve, demonstrating that the surgeon achieved positive results from the beginning of the surgery. Full article

Although the stifle joint of wild felines shares several characteristics observed in domestic cats, other characteristics are specific to each species. This study aimed to evaluate the stifle joints of eight Puma concolor, including two young and six adults, through different imaging examinations. All stifles were assessed using radiographs and computed tomography (CT). Magnetic resonance imaging (MRI) was performed on the stifles of one animal using 7 Tesla equipment. In all imaging modalities, the four sesamoid bones were detected. Meniscal mineralization was identified in the stifles of three adult animals and one young animal. The cruciate ligaments and menisci were identified on CT, with MRI providing better visualization. The mean values of CT measurements (cm²) in the sagittal section included patella (2.475), medial fabella (0.481), lateral fabella (0.772), popliteal sesamoid (0.222), and medial meniscus (0.051). No differences were found in HU values between the central trabecular bone of the patella and popliteal sesamoid, the cortical bone of the patella and lateral and medial fabellas, or the cortical bone of the patella and popliteal sesamoid. In conclusion, the descriptions of the stifle of Puma concolor from the different imaging methods contribute to understanding the species and can serve as a basis for identifying alterations. Full article

The paper presents a detailed gross anatomical description of the elements of the pelvic limb in the African green monkey and provides comparative and differential elements on pelvic limb monkey osteology. The osteometric investigation adds value to the gross morphological and radiological investigation, adjoining metric data to the gross descriptive data set. The main methodology used was the gross morphological investigation, doubled by regular osteometrical and radiographical assessments. For each of the elements, several morphological aspects are described, pointing to the specific and differential aspects that might serve as landmarks in the specific diagnosis of different adaptative changes, related to the type of locomotion. For the pelvis, the aspect of the symphysis, the overall shape of the pelvic inlet, the iliac wing aspect and the acetabular shape are listed as significant elements. The femur has a spherical head with an inferior position of the femoral fovea and a well-developed (tall) greater trochanter, lacking the third trochanter. The medial condyle of the femur is better developed than the lateral one and an evident extensor’s fossa is noted at the level of the distal shaft. The proximal lateral condyloid surface in the tibia is slightly larger than the medial one, with noticeable intercondilar eminences. The fibula is long and unfused with the tibia. Some specific anatomical features are listed only for the talus and calcaneus from tarsals. The study revealed the presence of the gastrocnemius sesamoid bones and the proximal sesamoidi bones as well. Investigation presents a series of osteometrical data with an attempt to show some basic metrical differences among the investigated specimens. Full article

Background: Hallux valgus is a prevalent foot deformity conventionally treated with open surgical techniques, which carry risk of complications due to extensive soft tissue dissection. Minimally invasive surgeries (MISs) as alternatives offer comparable outcomes, reduced pain, and faster recovery; however, their challenges include the risk of shortening of the first metatarsal. This study aimed to assess the efficacy of our modified MIS hallux valgus correction technique and investigate the factors that affect first metatarsal shortening. Methods: Twenty-nine feet treated with modified MIS hallux valgus surgery between 2017 and 2022 were included with an average follow-up of 29 months. Clinical outcomes were evaluated with the Manchester–Oxford Foot Questionnaire (MOXFQ), Foot Function Index (FFI), and visual analog scale for pain. Radiographic evaluations included the intermetatarsal angle (IMA), hallux valgus angle (HVA), distal metatarsal articular angle (DMAA), first metatarsal length, and sesamoid grade. Results: Functional and radiographic outcomes were significantly improved (p < 0.0001 and p < 0.001, respectively). Significant correlations between patient satisfaction and the MOXFQ, FFI, and VAS scores were found, with no significant correlations between patient satisfaction and radiographic outcomes. Non-purchasing of the lateral cortex of the proximal osteotomy site was identified to increase risk of first metatarsal shortening (odds ratio [OR] = 22.09, p = 0.0064). Conclusions: Our modified MIS for hallux valgus correction showed favorable radiographic and functional outcomes. Proximal lateral cortex purchasing should be targeted to reduce postoperative shortening of the first metatarsal. Full article

Background: Hallux valgus is a common forefoot disorder with hundreds of proposed management techniques. Distal chevron osteotomy with a modified McBride procedure has been traditionally recommended for mild hallux valgus because of its simple and less invasive nature with fewer complications, faster recovery, and reliable outcomes. In recent years, the indications for this procedure have expanded to include hallux valgus with severe deformities. This study aims to compare the radiographic outcomes of the surgical treatment for moderate versus severe hallux valgus patients from the perspective of sesamoid bone reduction. Materials and Methods: A retrospective review of medical records identified 99 feet from 94 patients that were treated with distal chevron osteotomy with a modified McBride procedure. These feet were divided by the preoperative hallux valgus angle and intermetatarsal angle into the moderate and severe groups. Results: Postoperative radiographic parameters significantly improved in both groups after treatment, indicating adequate deformity correction. Improvement in the sesamoid position was better in the moderate group compared to that in the severe group. The recurrence rate in the severe group was higher than that in the moderate group without statistical significance. Conclusions: Based on the radiographic results of the postoperative position following sesamoid reduction, the distal chevron osteotomy with a modified McBride procedure is effective for treating moderate hallux valgus deformities. However, this treatment strategy may be associated with a higher recurrence rate in cases of severe hallux valgus deformity. A complete reduction in the sesamoids should be emphasized during the management of severe hallux valgus deformity. Full article

The fabella is a rare sesamoid bone found within the posterior aspect of the knee joint. Patients can suffer from fabella syndrome which is characterized as pain with extension of the knee, ultimately limiting motion and causing a clicking or catching sensation. There is debate in the literature regarding operative excision versus nonoperative management for patients with fabella syndrome. This review seeks to provide a comprehensive overview of fabella anatomy and fabella syndrome presentation, diagnosis, treatment, and outcomes. Full article

Background/Objectives: Reverdin–Isham osteotomy is effective in correcting moderate hallux valgus deformity but has certain limitations when correcting a deformity in the sagittal plane. This study aimed to evaluate the impact on pain, functionality, and radiological measures of angular corrections, and the safety of the Reverdin–Isham lateral translation technique through minimally invasive surgery in the treatment of a moderate hallux valgus compared to Reverdin–Isham standard osteotomy. Methods: A pilot 6-month prospective cohort study was conducted on adults over 18 years old with a hallux valgus in at least one foot. The study exposure was the use of the Reverdin–Isham lateral translation technique. The outcome variables were pain and functionality through VAS and AOFAS scales, respectively, and radiological measurements of the first toe metatarsophalangeal angle (MPA), first space intermetatarsal angle (IMA), proximal articular set angle (PASA), distal articular set angle (DASA), metatarsal formula, and position of sesamoids in the AP projection. Results: The study involved 60 participants. Results indicate significant reductions in pain and radiological measures in both cohorts: MPA improved by 23.13 degrees, IMA by 5.93 degrees, and sesamoid position by 4.23 degrees in patients who underwent the lateral translation technique versus 13.20, 3.30, and 1.57 degrees, respectively, in patients who experienced the standard Reverdin–Isham technique. The lateral translation method showed greater reductions in these metrics compared to the standard Reverdin–Isham technique (p < 0.05). Conclusions: Percutaneous Reverdin–Isham techniques, both standard and with lateral translations, effectively corrected moderate hallux valguses. However, the lateral translation method provided greater reductions in MPA, IMA, and sesamoid positions, making it more suitable for deformities with IMAs over 15 degrees. Full article

Background: The purpose of this study was to establish a standardized structured workflow to compare findings from high-resolution, optimized reconstructions from post-mortem computed tomography (pmCT) with autopsy results in the detection of fractures of the laryngohyoid complex in strangulation victims. Method: Forty-two strangulation cases were selected, and pmCT scans of the laryngohyoid complex were obtained. Both pmCT scans and autopsy reports were analyzed using a structured template and compared using Cohen’s kappa coefficient (κ) and the McNemar test. The study also compared the prevalence of ossa sesamoidea and non-fusion of the major and minor horns of the hyoid bone between both diagnostic methods. Results: The detection of fractures showed a very good correlation between autopsy and pmCT results (κ = 0.905), with the McNemar test showing no statistically significant difference between the two methods. PmCT identified 28 sesamoid bones, 45 non-fusions of the major horns, and 47 non-fusions of the minor horns of the hyoid bone, compared to four, six, and zero, respectively, identified by autopsy (p < 0.0001). Conclusions: Autopsy and pmCT findings correlate well and can be used in a complementary manner. PmCT is superior to autopsy in identifying dislocations and detecting anatomical variations in the laryngohyoid complex, which can lead to misinterpretations during autopsy. Therefore, we do not advocate replacing autopsy with pmCT but propose using a structured workflow, including our standardized reporting template, for evaluating lesions in the laryngohyoid complex. Full article