Fibrodysplasia Ossificans Progressiva and Its Implications in Podiatric Medicine: A Case Report.

The purpose of this case report is to show the clinical presentation of a rare genetic disorder, called fibrodysplasia ossificans progressiva, on the development of the foot in a newborn. Shortened great toes and malformations of the first metatarsals are present in all affected individuals at birth. Irreversible heterotopic endochondral ossification of soft tissues occurs in the first decade of life, often resulting in permanent immobility by the third decade of life. Trauma caused by surgical excision of nodules, dental procedures, or injections can further exacerbate this condition. Early diagnosis is imperative for these patients to prevent irreversible damage that may result from unnecessary invasive interventions. This case report presents a boy aged 2 years 3 months who was born with bilateral bunion deformity. The goal is to raise awareness of this disorder in the podiatric community, especially for those who work with pediatric patients.

Digital formula is conditioned by deformities and footwear characteristics in older people. A comparison between general population and population with psychiatric disorders

Forefoot morphology is determined by toe length. It is hereditary and unlikely to change during a person’s lifetime, although certain factors may lead to modifications. This study examines whether extrinsic factors such as footwear or deformities are associated with changes in the morphology of the forefoot and its pathologies. A study was made of the forefoot morphology, deformities and footwear of 331 participants divided into two populations: a control group (168 participants) and a population of people living in an institution (163 participants with psychiatric disorders). The results show that although Egyptian foot is the most common morphology in both populations, square foot was more prevalent among the women in the control population than among the women in the institution group. In addition, the type of footwear used by the women in the control population was mostly high-heeled constrictive street footwear, compared to the non-constrictive home footwear worn by the women in the institution population, p-value < 0.001. A high prevalence of square feet was observed in the control group women with hallux valgus (HV), p-value 0.008. A relationship was detected between the presence of HV and its prevalence in participants with square foot, concurrent with the use of constrictive footwear and mostly affecting women. The combination of HV and constrictive footwear could explain the high prevalence of the square foot morphology. These footwear characteristics can be considered risk factors in the alteration of the digital formula and aggravation of the deformity suffered in older women

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A radiographic review of the subacromial architecture: a South African study

The subacromial space, which is occupied by the subacromial bursa, rotator cuff complex and the long head of the biceps brachii tendon, is a well-known area of study due to its association with subacromial disease. Although it is demarcated by the coraco-acromial arch and the supraglenoid tubercle, degenerative changes in these osteological components often lead to mechanical narrowing and subsequent tendon abrasion. In addition to the morphological characteristics, the morphometry of the subacromial architecture is considered to play an important role in maintaining glenohumeral stability. Accordingly, the present study outlined the morphometry of the subacromial architecture and the acromial morphology from a radiological perspective. A total of 120 true lateral-outlet view radiographs (n = 120), representative of 58 males and 62 females of the Black (12), Coloured (10), Indian (27) and White (71) race groups, were analysed. In addition to calculation of the standard and population-specific means, the acromial classification scheme of Bigliani et al. (1986) was adopted. A trend of ascending values from Type III (16.7%) to Type II (37.5%) to Type I (45.8%) acromia was noted. Various shapes of the subacromial space were observed, viz. rhomboidal (20.0%), trapezoidal (65.8%) and triangular (14.1%). Since a statistically significant P value of 0.030 was recorded for the comparison of acromial type with the shape of the subacromial space, the shape of the subacromial space appeared to be dependent on the acromial type. While the parameters were determined with regard to the demographic representation of South Africa, this study also provided standard mean values which were not previously reported. Furthermore, the correlation of the acromio-glenoidal length with side, gender and shape of the subacromial space reflected levels of significance and highlighted this parameter as a diagnostic determinant of subacromial disease due to its tendency to change in accordance with the demographic and morphological factors

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Analysis of Serial Radiographs of the Foot to Determine Normative Values for the Growth of the First Metatarsal to Guide Hemiepiphysiodesis for Immature Hallux Valgus.

BACKGROUND: Hallux valgus deformity in the immature patient can be difficult to manage, as osteotomy can result in recurrence with additional growth. Lateral hemiepiphysiodesis of the first metatarsal offers a promising alternative, by permitting gradual correction of the intermetatarsal angle with growth. An important limitation of this approach is the lack of normative tables of first metatarsal growth to guide timing of intervention. METHODS: First metatarsal lengths were measured from anteroposterior foot radiographs of children. For females, 95 patients totaling 894 radiographs were used ranging from 6 months to 18 years of age. For males, 122 patients totaling 1018 radiographs were measured ranging from 8 months to 19.5 years of age. All patients with image series including a closed proximal metatarsal physis were sorted into an older group, with multipliers generated by setting last image to a multiplier of 1. Patients with serial imaging not inclusive of a closed physis were classified as a younger group, with multipliers based off of the multiplier at age 7 from the older group. First metatarsal multiplier values were then compared with published multiplier values for the overall foot. RESULTS: For both females and males, the multipliers followed a logarithmic curve versus age, with R values of 0.921 and 0.888, respectively. Comparison of the first metatarsal multiplier values with previously studied multiplier values of the entire foot showed high correlation with ICC=0.955 for females and ICC=0.969 for males. CONCLUSIONS: The pattern of growth of the first metatarsal follows a logarithmic regression curve. These normative tables allow for clinical prediction of first metatarsal remaining growth based on age and sex, and in turn guide timing of hemiepiphysiodesis for the surgical correction of hallux valgus deformity. CLINICAL RELEVANCE: The normative tables generated in this study can be used for the calculation of hemiepiphysiodesis and the timing of intervention. Future clinical correlation studies will be important.

Clinical presentation of congenital convex pes valgus.

Congenital convex pes valgus, frequently termed vertical talus in past descriptions, is a malformed foot that requires early diagnosis and treatment. A brief review of clinical features and a case presentation are provided to enhance the understanding of this complex deformity. A successful treatment regimen for infants and children is described, involving manipulation and early surgical correction.

[Congenital hallux valgus]. / Alluce varo congenito.

Congenital hallux varus is a rare deformity. The authors discuss 3 clinical cases observed and define the specific features of the anomaly. The clinical and radiographic pictures are described, emphasising essential aspects and possible variations, including the rare occurrence of congenital varus of a single interphalangeal joint. Differential diagnosis is discussed and surgical indications determined.

Surgery for congenital deformities of the feet.

There are a multitude of congenital deformities that can occur in the feet. Some are very common and others are more remote. They can frequently be corrected with conservative care, such as splinting, casting, and various exercises over a period of time. Those that are not resolved by conservative measures can generally be surgically improved or corrected. A few conditions should be left for surgical resolution after maturity occurs.

[Hallux valgus: results of the surgical management of hallux valgus]. / Alluce valgo: risultati del trattamento chirurgico dell'alluce valgo.

The Authors purpose to analyse on the basis of a critical examination of the operated hallux valgus with 2 different surgical technics the causes of failure and to give more exact indications about choosing the right surgical system.

[Bilateral congenital camptodactylia of the IF of the hallux. Presentation of case]. / Campto-clinodattilia congenita bilaterale della if dell'alluce. Presentazione di un caso.

The Authors describe a bilateral congenital case of flexion and valgism of the IF of the hallux, since they are not mentioned in literature. On the basis of the operative examination it is thought that the etiopathogenesis may consist of a congenital retraction of the capsule, in plantar aspect, and of the collateral ligaments; they advise that surgical treatment should be carried out before the start of ambulation. The correction obtained proved stable over time.

[The etiology of hallux valgus]. / Etiologie du hallux valgus

Modifications of the forefoot in weightbearing are conductive to hallux valgus, some are congenital and constitutional: supination of the forefoot, adductus of the metatarsal bones, metatarsus varus primus brevis. Others are acquired: transversal flatfoot. Measurement of the different angles observed on a dorsi-plantar X-ray in relation to the external and internal limits of the Lisfranc joint has an etiological signification. To look for changes in the weightbearing configuration of the foot, an element in the formation of hallux valgus, is of use in the choice of a method of correction.