Safety Area for Proximal Metatarsal Procedures

Chuckpaiwong, Bavornrit; Korwutthikulrangsri, Ekkapoj

doi:10.1177/1071100713477619

Cited by 4 publications

(3 citation statements)

References 17 publications

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“…In this study, the shortest distance from the deep plantar arch to the second, third, and fourth metatarsals in the axial plane was 0.5 mm, 2.2 mm, and 2.8 mm, respectively. Other reports have focused on the deep plantar artery, which is the deep branch of the dorsalis pedis artery [ 17 , 22 ]. Consistent with the findings of those studies, we found that the deep plantar artery ran close to the medial side of the second metatarsal and connected with the dorsalis pedis artery to form the deep plantar arch.…”

Section: Discussionmentioning

confidence: 99%

“…Proximal metatarsal osteotomies are very effective for correcting forefoot deformities because they allow precise control of the shortening and elevation of the metatarsal head [ 15 , 16 ]. However, surgery that involves the lesser metatarsals can lead to iatrogenic disruption of the blood supply to the metatarsals and adjacent structures [ 17 ].…”

Section: Introductionmentioning

confidence: 99%

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Distances from the deep plantar arch to the lesser metatarsals at risk during osteotomy: a fresh cadaveric study

Tonogai

Hayashi

Tsuruo

et al. 2018

Journal of Foot and Ankle Research

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BackgroundThe deep plantar arch is formed by anastomosis of the lateral and deep plantar arteries. Osteotomy of the lesser metatarsals is often used to treat metatarsalgia and forefoot deformity. Although it is known that some blood vessels supplying the lesser metatarsals are prone to damage during osteotomy, there is little information on the distances between the deep plantar arch and the three lesser metatarsals. The aims of this study were to identify the distances between the deep plantar arch and the lesser metatarsals and to determine how osteotomy could damage the arch.MethodsEnhanced computed tomography scans of 20 fresh cadaveric feet (male, n = 10; female, n = 10; mean age 78.6 years at the time of death) were assessed. The specimens were injected with barium via the external iliac artery, and the distance from the deep plantar arch to each lesser metatarsal was measured on axial and sagittal images.ResultsThe shortest distances from the deep plantar arch to the second, third, and fourth metatarsals in the axial plane were 0.5, 2.2, and 2.8 mm, respectively. The shortest distances from the distal epiphysis to a line passing through the deep plantar arch perpendicular to the longitudinal axis of the lesser metatarsal in the sagittal plane were 47.0, 45.7, and 46.4 mm, respectively, and those from the tarsometatarsal joint were 23.0, 21.0, and 18.6 mm. The deep plantar arch ran at the level of the middle third, within the proximal portion of this third in 11/20 (55.0%), 7/20 (35.0%), and 5/16 (31.2%) specimens, respectively, and at the level of the proximal third in 9/20 (45.0%), 13/20 (65.0%), and 11/16 (68.8%).ConclusionsOverpenetration into the medial and plantar aspect of the second metatarsal or the proximal and plantar aspect of the fourth metatarsal during shaft or proximal osteotomy could easily damage the deep plantar arch. Shaft or proximal osteotomy approximately 45–47 mm proximal to the distal epiphysis or 18–23 mm distal to the tarsometatarsal joint on the plantar aspect could interrupt blood flow in the deep plantar arch.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Distances from the deep plantar arch to the lesser metatarsals at risk during osteotomy: a fresh cadaveric study

Tonogai

Hayashi

Tsuruo

et al. 2018

Journal of Foot and Ankle Research

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“…Consideration of potential injury to the D-PL artery and the risk for surgical complications related to proximal metatarsal procedures and amputation warrant a closer look at the vascular positional anatomy in this area. Previous studies have investigated the location of the D-PL artery and have provided general guidelines to surgeons 1,2,5 . The present study was therefore undertaken to obtain a more detailed understanding of the anatomical relationship of the D-PL artery to the first metatarsal, with the aim to develop and provide cautionary guidelines to aid surgeons when dissecting in the region of the proximal first intermetatarsal space and for fixation placement.…”

Section: Japma Article In Pressmentioning

confidence: 99%

Location of the Deep Plantar Artery: A Cadaveric Study

Whelan¹,

Lazoritz²,

Kiser³

et al. 2020

Journal of the American Podiatric Medical Association

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BACKGROUND: The deep plantar (D-PL) artery originates from the dorsalis pedis artery in the proximal first intermetatarsal space, an area where many procedures are performed to address deformity, traumatic injury and infection. The potential risk to injury of the D-PL artery is concerning. The D-PL artery provides vascular contribution to the base of the first metatarsal and forms the D-PL arterial arch with the lateral plantar artery. METHODS: In an effort to improve our understanding of the positional relationship of the D-PL artery to the first metatarsal, dissections were performed on 43 embalmed cadaver feet to measure the location of the D-PL artery with respect to the base of the first metatarsal. Images of the dissected specimens were digitally acquired and saved for measurement using in-house written software. The mean, standard deviation and 95% confidence intervals were calculated for all measurement parameters. RESULTS: We found that the origin of the D-PL artery was located at 11.5 ± 3.9 mm (95% CI: 4.5 - 24.7 mm) distal to the first metatarsal base and 18.6% ± 6.5% (95% CI: 8.1% to 43.4%) its length in reference to the proximal base. The average inter-rater reliability across all measurements was 0.945. CONCLUSIONS: Our study helps to clarify the anatomic location of the D-PL artery by providing parameters to aid the surgeon when performing procedures in the proximal first intermetatarsal space. Care must be taken when performing procedures in the region to avoid unintended vascular injury to the D-PL artery.

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