Keller's arthroplasty in adults with hallux valgus and hallux rigidus.

BACKGROUND: The role of Keller's resection arthroplasty in the management of adult hallux valgus with hallux rigidus is debatable. There are no studies addressing this particular problem. METHODS: This study is a retrospective review of 32 patients (49 feet), conducted by an independent assessor. Subjective and objective criteria were used to assess the results of surgery. There were 30 women and 2 men with an average age at surgery of 62.5years. RESULTS: The results of surgery in terms of relief of pain, cosmesis and use of regular footwear were satisfactory. Excellent and good subjective results were obtained in 39% and 37% of cases respectively. Radiological analysis revealed decrease in the intermetatarsal and first metatarsophalangeal angle in a significant number of cases. Final results assessed by Vallier's modification of Bonney and MacNab criteria, revealed excellent to good results in 87% of feet. A significant number of complications were noted but there was no association between the occurrence of complications and the final result or the subjective functional grade. There was no association between the amount of resection of proximal phalanx and occurrence of metatarsalgia or the final outcome. CONCLUSION: The results of this study suggest that Keller's arthroplasty has a role in patients with adult hallux valgus associated with degenerative changes in the first metatarsophalangeal joint.

Differences in foot pressures between Caucasians and Indians.

BACKGROUND: Indians are the largest single ethnic minority group in the United Kingdom and form more than one million of the current population. No studies have investigated foot pressure differences between Caucasians and Indians. OBJECTIVE: The aim of our study was to investigate the in-shoe pressure differences in Caucasians and Indians using the Pedar(®)-m (Novel GmbH, Germany). METHODS: The study included 12 Caucasians and 21 Indians. Peak pressure (PP), contact area (CA), contact time (CT), pressure-time integral (PTI), force-time integral (FTI), instant of peak pressure (IPP), maximum force (MaxF) and mean force (MeanF) were recorded. RESULTS: Caucasians had higher significant PP compared to Indians under the heel (293 kPa vs. 251 kPa; P<0.001), 1st metatarsal head (294 kPa vs. 233 kPa; P=0.01), 2nd metatarsal head (266 kPa vs. 236 kPa; P=0.03), 3rd metatarsal head (254 kPa vs. 223 kPa; P=0.04), and the 5th metatarsal head (168 kPa vs. 133 kPa; P=0.04). There was no significant difference in the contact area between the two race groups. The PTI was statistically significantly higher in Caucasians in the region of the 1st metatarsal head (79 kPas vs. 62 kPas; P=0.03) and 5th metatarsal head (58 kPas vs. 44 kPas; P=0.03). There were no significant differences among CT, FTI, IPP, MaxF and MeanF among them. CONCLUSION: The PP under the heel, 1st, 2nd, 3rd and 5th metatarsal heads and the PTI under the 1st and 5th metatarsal heads in Caucasians is higher than in Indians. There is no difference in the CA.

Foot pressure differences in men and women.

BACKGROUND: Women and men are anatomically and physiologically different in a number of ways. Anthropometric studies have shown considerable differences in the foot bones of both genders. These differences could potentially mean different foot pressures in men and women. OBJECTIVE: The aim of our study was to investigate any potential foot pressure differences between males and females using the Pedar-M (Novel gmbh, Germany) in-shoe foot pressure measurement system. METHODS: Twenty-eight subjects (16 females and 12 males) were recruited. Peak pressure, contact area, contact time, pressure-time integral, force-time integral, instant of peak pressure, maximum force and mean force were recorded and subsequently analysed. RESULTS: In males, contact area was significantly larger in all regions of the foot compared with females. There were no significant between gender differences in peak pressure, contact time, pressure-time integral and instant of peak pressure. Force-time integral was significantly greater in males than females under the 1st, 3rd, and 4th metatarsal heads. Maximum force was also significantly higher in males under the heel, 1st and 3rd metatarsal heads. Mean force was greater in males under the 3rd metatarsal head. CONCLUSION: There were no peak pressure differences; however the contact area of the male foot was larger than that in females.

Normal pressure values and repeatability of the Emed ST4 system.

The aims of this study were to assess the repeatability of the Emed ST4 system and identify the range of pressure values observed in the normal foot. Fifty-three healthy subjects, 17 females (32%) and 36 males (68%), were recruited. Measurements were performed on two occasions approximately 12 days apart. Peak pressure (PP), contact area (CA), contact time (CT), pressure-time integral (PTI), force-time integral (FTI) and instant of peak pressure (IPP) were recorded. The coefficient of repeatability (CR) was less than 16.9% for all 122 parameters considered. The highest areas of PP were found under the second and third metatarsal heads, with mean (S.D.) equal to 361 kPa (104) and 330 kPa (84), respectively, followed by the great toe 321 kPa (141) and heel 313 kPa (77). CA was highest under the heel at 35 cm(2) (5). The percentage CT was in the range 75-85% under the metatarsal heads, and 70% under the hallux. PTI was highest under metatarsal heads one to three and hallux. FTI was highest under the heel. Emed ST4 system was found to be repeatable. The ranges of the parameters documented can be applied in orthopaedic clinics as part of the assessment of pathological conditions.

The Pedar in-shoe system: repeatability and normal pressure values.

The Pedar system is one of the most commonly used systems for in-shoe pressure measurement. Good repeatability is necessary to ensure the consistency of measurements on which clinical judgements are based. In addition, there is a need to establish a range of normal in-shoe pressure values, which will help to identify abnormalities. The aim of this study was to assess the repeatability of the Pedar system and determine the pressure values in normal subjects. Fifty-three subjects, 17 females (32%) and 36 males (68%), were recruited and measurements were performed twice with an average gap of 12 days (range 1-32 days) using only one brand of standardised running shoes (Donnay International). Peak pressure (PP), contact area (CA), contact time (CT), pressure-time integral (PTI), force-time integral (FTI) and instant of peak pressure (IPP) were calculated. The coefficient of repeatability (CR), expressed as a percentage of the mean, was no greater than 15.3% for all 122 parameters considered. The highest PP areas were under the great toe, with mean (S.D.) equal to 280.4 (83.0) kPa and heel 264.3 (44.1) kPa, followed by the first 248 (70.1) kPa, second 246.5 (48.3) kPa, and third 224.7 (50.4) kPa metatarsal heads. The CA was highest under the heel at 41.54 cm(2). The CT of the metatarsals was 77% to 87% of the total CT while that of the hallux was 75%. The PTI and FTI were highest under the heel. We concluded that the Pedar system was repeatable. The normal pressure values identified can therefore be used to provide a reference range in clinical practice using this specific type of footwear.