Ultrasonographic measurement of the mechanical properties of the sole under the metatarsal heads

Wang, Chung-Li; Hsu, Ta-Cheng; Shau, Yio-Wha; Shieh, Jeng-Yi; Hsu, Kuang-Hung

doi:10.1002/jor.1100170513

Cited by 26 publications

(27 citation statements)

References 19 publications

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“…Previous work investigating ST strain beneath the second MT head without footwear included subjects without any known medical conditions (no DM or PN) (Cavanagh, 1999;Wang et al, 1999;Hsu et al, 2005;Weijers et al, 2005) and who were younger (Cavanagh, 1999;Wang et al, 1999;Weijers et al, 2005) than the subjects in this study. The subjects in two of the studies were tested in non-weight bearing positions using an ultrasound transducer applied to the plantar surface of the foot, and the results demonstrated ST strain of 47.3 and 47.7% (Wang et al, 1999;Hsu et al, 2005). The small contact area of the ultrasound transducers (4.73-5.02 cm 2 ) may have contributed to these greater magnitudes of ST strain relative to our finding.…”

Section: Discussionmentioning

confidence: 99%

“…During their toe-off posture which was similar to the testing position employed in our study, ST strain at the second MT head was 35%, consistent with our finding of 38.2%. Cavanagh (1999) used ultrasound for determining ST strain, but in contrast to Wang et al (1999) and Hsu et al (2005), Cavanagh mounted the transducer flush with the floor to allow the entire forefoot to be in contact during the terminal stance of actual gait. Given this dynamic loading with full weight bearing, his results for average maximum ST strain during the stance phase of gait were 45.7 (6.7)%.…”

Section: Discussionmentioning

confidence: 99%

“…Ultrasonography has been utilized to measure ST strain of the foot with some success (Cavanagh, 1999;Wang et al, 1999;Hsu et al, 2005). Gefen et al (2001) investigated ST strain of the heel pad with digital radiographic fluoroscopy in conjunction with an optical method to measure plantar pressures.…”

Section: Introductionmentioning

confidence: 99%

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Effect of footwear and orthotic devices on stress reduction and soft tissue strain of the neuropathic foot

Lott

Hastings²,

Commean

et al. 2007

Clinical Biomechanics

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Background-Ground reaction forces from walking result in stress (pressure) and soft tissue strain at the plantar aspect of the foot. Excessive plantar pressure and tissue strain on the insensate foot may lead to ulceration. Our study investigated the effect of therapeutic footwear and custom-made orthotic inserts on pressure and tissue strain along the second ray of the plantar foot, and how these two variables are associated.Methods-Twenty subjects (mean age 57.3 [SD 9.3], 12 male, 8 female, body mass index 32.5 [SD 7.4]) with diabetes mellitus, peripheral neuropathy, and a history of a plantar ulcer participated. Plantar pressure data were recorded during computed tomography scans for four conditions (barefoot, shoe, shoe+total contact insert, and shoe+total contact insert+metatarsal pad). For each condition tested, tissue strain and plantar pressure were determined at the second metatarsal head and at 15 other points along the second ray. Intepretation-Footwear and orthotic devices tested in this study decreased pressure and soft tissue strain at the second ray of the foot, and these two variables were strongly related. A better understanding of the role tissue strain plays in distributing plantar forces may lead to improvements in the design of orthotic devices. Findings-Differences

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Effect of footwear and orthotic devices on stress reduction and soft tissue strain of the neuropathic foot

Lott

Hastings²,

Commean

et al. 2007

Clinical Biomechanics

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“…Wang et al 8 aferem a altura do 1º metatarsal a partir do ponto mais plantar da sua cabeça, medindo um volume composto por tecidos moles e sesamóides.…”

Section: Caracterização Da Casuística Utilizadaunclassified

“…A relação, proporção e controle adequados dos componentes ósseos, musculares, tendíneos e cápsulo-ligamentares, integram esse ajuste fino durante a carga bípede, criando uma transição suave e funcional com o solo durante o ciclo da marcha 8,11,13 .…”

Section: Introductionunclassified

Estudo radiográfico axial do antepé para a avaliação do alinhamento da cabeça dos metatarsais no plano coronal

Sposeto¹

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Ao meu irmão Tiago, presente em todos os momentos.À minha querida esposa Valdinélia, incansável companheira, me dando suporte, amor, carinho e tranquilidade nos momentos mais difíceis.Às minhas duas preciosas filhas, Laís e Clara, fonte de motivação para ser uma pessoa melhor. AGRADECIMENTOSAo Prof. Dr. Tulio Diniz Fernandes, não apenas por me orientar nessa dissertação, com seus ensinamentos científicos e acadêmicos, mas principalmente, por toda ajuda na minha formação como ortopedista e traumatologista. INTRODUCTION:Many authors consider the differences in the relative length of metatarsals in the axial plane, the cause of inadequate load distribution during the gait, overloading the forefoot plantar structures, culminating with metatarsalgia. The realignment of the metatarsal formula is the goal of surgical treatment of this syndrome. However, many studies have shown a 15% rate of metatarsalgia recurrence after the reconstruction in the axial plane, questioning the importance of the metatarsal heads alignment in the coronal plane. OBJECTIVE: This study aims to evaluate the alignment pattern of metatarsal heads in the coronal plane in individuals with and without metatarsalgia. METHODS: A cross-sectional study evaluated 106 individuals between 30 and 65 years old. They were divided in two groups of 106 feet each, one without foot pathologies and another group with metatarsalgia between the 2nd, 3rd and 4th metatarsals. The recruitment was performed at the IOT HC FMUSP for both groups, respecting the criteria of inclusion, exclusion and applying the Informed Consent Term. Individuals with midfoot, hindfoot and ankle deformities, patients with previous surgeries or fractures in the foot, rheumatologic diseases and osteoneuromuscular syndromes were not included. After the selection, the subjects were submitted to one weightbearing forefoot axial radiograph, evaluating the coronal plane in order to verify the heights of the metatarsals heads, and other weightbearing anteroposterior foot radiograph, determining the length of each ray. Statistical analysis was performed comparing the measurements between groups. RESULTS: A hundred six individuals were evaluated, forming two groups with 106 feet each. The group with metatarsalgia presented 34 male patients feet (32%), with a mean age of 49.5 years. Thirtythree feet with hallux valgus were identified in the metatarsalgia group. In the non-pathological group were found 54 male patients feet (51%), with a mean age of 44.6 years. Anthropometric variables such as foot size, body weight, height and BMI between the groups did not present statistical difference. The metatarsal heads in both groups were distributed in curved line in the coronal plane, following the formula M1 M3> M4 = M5. The distal support of the 1st ray was positioned more plantar in the metatarsalgia group (p = 0.000). CONCLUSION:The metatarsal heads in individuals with metatarsalgia and no hallux valgus, were aligned in the coronal plane following this formula M1 M3> M4 = M5, with M1

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Plantar pressures and relative lesser metatarsal lengths in older people with and without forefoot pain

Menz

Fotoohabadi

Munteanu

et al. 2012

Journal Orthopaedic Research

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Forefoot pain is a common problem in older people. We determined whether plantar pressures during gait and the relative lengths of the lesser metatarsals differ between older people with and without plantar forefoot pain. Dynamic plantar pressure assessment during walking was undertaken using the Tekscan MatScan 1 system in 118 community-dwelling older people (44 males and 74 females), mean age 74 (standard deviation ¼ 5.9) years, 43 (36%) of whom reported current or previous plantar forefoot pain. The relative lengths of metatarsals 1-5 were determined from weightbearing X-rays. Participants with current or previous plantar forefoot pain exhibited significantly (p ¼ 0.032) greater peak plantar pressure under metatarsal heads 3-5 (1.93 AE 0.41 kg/cm 2 vs. 1.74 AE 0.48 kg/cm 2 ). However, no differences were found in relative metatarsal lengths between the groups. These findings indicate that older people with forefoot pain generate higher peak plantar pressures under the lateral metatarsal heads when walking, but do not exhibit relatively longer lesser metatarsals. Other factors may be responsible for the observed pressure increase, such as reduced range of motion of the metatarsophalangeal joints and increased stiffness of plantar soft tissues. Keywords: aging; foot deformities; plantar pressure; metatarsalgia Plantar forefoot pain, often referred to as metatarsalgia, is a common problem in older people, affecting about 25% of those >65 years of age. 1,2 Although several classification systems have been proposed, 3-6 three broad categories are generally recognized: (i) primary, referring to symptoms arising from anatomical or biomechanical foot abnormalities; (ii) secondary, referring to symptoms arising from systemic conditions such as rheumatoid arthritis; and (iii) iatrogenic, referring to symptoms typically arising as a result of complications of forefoot surgery. 7 Given the range of causes of forefoot pain, its pathogenesis is poorly understood, but may include interdigital neuroma, interdigital bursitis, tendon pathology, effusion of the metatarsophalangeal joints, or tears of the plantar plate. 8 It has been suggested that primary metatarsalgia might be caused by the presence of abnormally long lesser metatarsals leading to excessive loading of the metatarsal heads when walking. 7,9,10 However, evidence to support this proposed mechanism is limited. Two studies have evaluated plantar pressures in people with and without metatarsalgia, with one reporting an increase in peak pressure under the lateral forefoot, 11 but another reporting no difference. 12 Two studies failed to find a correlation between metatarsal length and plantar pressures, 12,13 and Dreeben et al. 13 found no consistent length pattern in individuals with metatarsalgia compared to asymptomatic controls.Despite this limited evidence, a number of conservative interventions have been recommended for primary metatarsalgia with the aim of reducing forefoot plantar pressures, including footwear modifications, foot orthoses, and foref...

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Ultrasonographic measurement of the mechanical properties of the sole under the metatarsal heads

Cited by 26 publications

References 19 publications

Effect of footwear and orthotic devices on stress reduction and soft tissue strain of the neuropathic foot

Effect of footwear and orthotic devices on stress reduction and soft tissue strain of the neuropathic foot

Estudo radiográfico axial do antepé para a avaliação do alinhamento da cabeça dos metatarsais no plano coronal

Plantar pressures and relative lesser metatarsal lengths in older people with and without forefoot pain

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