Javier Pascual Huerta

Relationship of Body Mass Index, Ankle Dorsiflexion, and Foot Pronation on Plantar Fascia Thickness in Healthy, Asymptomatic Subjects

BACKGROUND We sought to investigate the thickness of plantar fascia, measured by means of ultrasonographic evaluation in healthy, asymptomatic subjects, and its relationship to body mass index, ankle joint dorsiflexion range of motion, and foot pronation in static stance. METHODS One hundred two feet of 51 healthy volunteers were examined. Sonographic evaluation with a 10-MHz linear array transducer was performed 1 and 2 cm distal to its insertion. Physical examination was also performed to assess body mass index, ankle joint dorsiflexion, and degree of foot pronation in static stance. Both examinations were performed in a blinded manner. RESULTS Body mass index showed moderate correlation with plantar fascia thickness at the 1- and 2-cm locations. Ankle dorsiflexion range of motion showed no correlation at either location. Foot pronation showed an inverse correlation with plantar fascia thickness at the 2-cm location and no correlation at the 1-cm location. CONCLUSION Body mass index and foot supination at the subtalar joint are related to increased thickness at the plantar fascia in healthy, asymptomatic subjects. Although the changes in thickness were small compared with those in patients with symptomatic plantar fasciitis, they could play a role in the mechanical properties of plantar fascia and in the development of plantar fasciitis.

Cadence, Age, and Weight as Determinants of Forefoot Plantar Pressures Using the Biofoot In-shoe System

BACKGROUND We evaluated normal plantar pressures and studied the effect of weight, cadence, and age on forefoot plantar pressures in healthy subjects by using the Biofoot (Instituto de Biomecánica de Valencia, Valencia, Spain) in-shoe measurement system. METHODS The feet of 45 healthy subjects with no evident foot or lower-limb diseases were measured with the Biofoot in-shoe system. The forefoot was divided into seven areas: the first through fifth metatarsal heads, the hallux, and the second through fifth lesser toes. Three trials of 8 sec each were recorded twice in each subject, and the mean was used to analyze peak and mean plantar pressures. A multiple regression model including weight, age, and cadence was run for each metatarsal head, the hallux, and the lesser toes. Intraclass correlation coefficients and coefficients of variation were also calculated to assess reliability. RESULTS The second metatarsal head had the greatest peak (960 kPa) and mean (585.1 kPa) pressures, followed by the third metatarsal head. Weight and cadence combined explained 18% and 23% of peak plantar pressure at the second and third metatarsal heads, respectively (P < .001). The intraclass correlation coefficient varied from 0.76 to 0.96 for all variables. The coefficient of variation between sessions ranged from 5.8% to 9.0%. CONCLUSION The highest peak and mean plantar pressures were found at the second and third metatarsal heads in healthy subjects. Weight, cadence, and age explained a low variability of this pressure pattern. The Biofoot in-shoe system has good reliability to measure plantar pressures. These data will have implications for the understanding of normal foot biomechanics and its determinants.

Analysis of Gastrocnemius Recession and Medial Column Procedures as Adjuncts in Arthroereisis for the Correction of Pediatric Pes Planovalgus: A Radiographic Retrospective Study

UNLABELLED The radiographic outcomes of 28 feet in 20 pediatric patients with pes planovalgus treated with subtalar arthroereisis, arthroereisis combined with gastrocnemius recession, or arthroereisis combined with gastrocnemius recession and medial column reconstruction were retrospectively analyzed. Preoperative and postoperative radiographic angles for talar declination, calcaneal inclination, and first metatarsal declination in the lateral view, and the angle formed between the longitudinal axis of the talus and the longitudinal axis of the lesser tarsus in the anteroposterior view were compared. Overall, analyses revealed statistically significant differences in the preoperative and postoperative radiographic angles for the 4 measured angles. Analysis by treatment group revealed statistically significant differences in correction of the angle measured in the anteroposterior view. Arthroereisis with gastrocnemius recession showed the greatest correction of this angle (median 19 degrees, range 11 degrees to 34 degrees) compared with the other treatment groups. There were no statistically significant differences in the degree of correction of the calcaneal inclination or talar declination angles, whereas a statistically significant difference in the correction of first metatarsal declination was observed. The greatest degree of angular change was achieved with medial column reconstruction (median 7 degrees, range 0 degrees to 9 degrees). Gastrocnemius recession displayed a notable effect on the correction of transverse plane deformity when used as an adjunct to arthroereisis. However, medial column reconstruction has a negative impact on the degree of correction in the transverse plane when it is used as an adjunct to arthroereisis and gastrocnemius recession. LEVEL OF CLINICAL EVIDENCE 4.

Effect of 7-Degree Rearfoot Varus and Valgus Wedging on Rearfoot Kinematics and Kinetics During the Stance Phase of Walking

BACKGROUND The scientific evidence behind the mechanical function of foot orthoses is still controversial. Research studies that have investigated the kinematic effect of foot orthoses on the lower extremity have shown variable results, with orthoses causing either no significant change or a small significant change in foot kinematics. METHODS The right limbs of 12 healthy asymptomatic individuals were studied in three walking conditions: barefoot, with a 7 degrees rearfoot varus wedge, and with a 7 degrees rearfoot valgus wedge. Kinematic and kinetic variables measured were the foot progression angle, the peak internal tibial rotation angle, and net ankle inversion moments during the stance phase in the three conditions. RESULTS There were statistically significant differences in the foot progression angle between the barefoot and varus wedge conditions and between the varus and valgus wedge conditions. There were no significant changes in peak internal tibial rotation among the three conditions tested. However, rearfoot varus wedges significantly reduced net ankle inversion moments compared with barefoot and rearfoot valgus wedges. CONCLUSIONS These results support the idea that foot orthoses work by methods other than by changing kinematic parameters. The present study supports the concept that foot orthoses work primarily by altering kinetics, with their effects on kinematics being secondary.

A proposed subungual exostosis clinical classification and treatment plan.

Subungual exostosis is a slow-growing, benign outgrowth of normal bone under the nail that affects the nail unit. The most common location in the foot is the dorsal surface of the distal phalanx of the big toe. Clinically, it can appear in combination with a variety of nail disorders, masking the underlying bone condition, which is frequently unrecognized or misdiagnosed. A new classification system for these lesions is proposed on the basis of the clinical signs and symptoms present during examination and the associated disorders of the nail plate. Also, a therapeutic algorithm that describes surgical approaches to the different presentations of this disorder is presented. (J Am Podiatr Med Assoc 99(6): 519-524, 2009)

Static Response of Maximally Pronated and Nonmaximally Pronated Feet to Frontal Plane Wedging of Foot Orthoses

BACKGROUND Research on foot orthoses has shown that their effect on the kinematics of the rearfoot is variable, with no consistent patterns of changes being demonstrated. It has also been hypothesized that the mechanical effect of foot orthoses could be subject specific. The purpose of our study was to determine if maximally pronated feet have a different response to frontal plane wedging of foot orthoses than do nonmaximally pronated feet during static stance. METHODS One hundred six feet of 53 healthy asymptomatic subjects were divided into two groups (maximally pronated and nonmaximally pronated) on the basis of their subtalar joint rotational position during relaxed bipedal stance. Functional foot orthoses were constructed for each subject and the relaxed calcaneal stance position was measured while standing on five separate frontal plane orthosis wedging conditions, 10 degrees valgus, 5 degrees valgus, no wedging, 5 degrees varus, and 10 degrees varus, to assess changes in calcaneal position. RESULTS Relative to the no-wedging condition, there were statistically significant differences (P < .05) in calcaneal position between the maximally pronated and the nonmaximally pronated feet with the 10 degrees valgus and the 10 degrees varus wedging conditions. No significant differences in calcaneal position were found with the 5 degrees varus and the 5 degrees valgus wedging conditions. CONCLUSIONS Our study shows that the response to foot orthoses is variable between individuals. Maximally pronated subjects do not exhibit the same response to frontal plane wedging of foot orthoses as do nonmaximally pronated with 10 degrees wedging. Intrinsic biomechanical factors such as subtalar joint position may influence the response to foot orthoses.

Plantar epidermoid inclusion cyst as a possible cause of intractable plantar keratosis lesions

Inclusion cysts are benign lesions that appear as a consequence of traumatic inclusion of epidermal cells into the dermis. They can be painful if they appear under pressure areas, especially the metatarsal heads. We report a case of a 36-year-old woman with an intractable plantar keratosis lesion under the third metatarsal head of 3 yearsʼ duration. Ultrasonography revealed the presence of a subcutaneous mass with a growing epidermoid. It was surgically excised, and pathology confirmed the diagnosis of a plantar epidermoid cyst. All symptoms disappeared after the excision of the lesion. This case should alert the clinician about the existence of keratotic lesions in the metatarsal heads commonly diagnosed and treated as intractable plantar keratosis, although they are not directly derived from metatarsal overload. Some of the lesions could be directly derived from skin problems aggravated by pressure from the metatarsal head. This should be taken into consideration when addressing the management of these lesions. (J Am Podiatr Med Assoc 99(2): 148-152, 2009)

Variability of the dynamic stiffness of foot joints. Effect of gait velocity variation

BACKGROUND Comparison of dynamic stiffness of foot joints was previously proposed to investigate pathological situations with changes in the properties of muscle and passive structures. Samples must be controlled to reduce the variability within groups being compared, which may arise from different sources, such as gait speed or foot posture index (FPI). METHODS In this work, variability in the measurement of the dynamic stiffness of ankle, midtarsal and metatarsophalangeal joints was studied in a controlled sample of healthy adult male subjects with normal FPI, and the effect of gait speed was analyzed. In Experiment I, dynamic stiffnesses were obtained in three sessions, five trials per session, for each subject, taking the mean value across trials as representative of each session. In Experiment II, five trials were considered at slow, comfortable, and fast velocities RESULTS: Results showed similar inter- and intra-session errors and intra-subject errors within sessions, indicating the goodness of using five trials per session for averaging. Intra- and inter-subject variability data provided can be used to select the sample size in future comparative analyses. Significant differences with gait speed were observed in most dynamic stiffnesses considered, with a general rise when gait speed increased, especially at the midtarsal joint, this being attributed to an active modulation produced by the central nervous system. CONCLUSIONS Differences from gait speed were higher than intra- and inter-session repeatability errors for the propulsion phases at the ankle and midtarsal joints, comparative analyses at these phases needing a more exhaustive control of gait speed to reduce the required sample size. s.