Javier Ramos-Ortega

Hallux abductus interphalangeus in normal feet, early-stage hallux limitus, and hallux valgus.

BACKGROUND Excessive deviation of the distal phalanx in abduction frequently occurs in advanced stages of hallux rigidus but not in hallux valgus. Therefore, theoretically there should be no significant differences in the hallux interphalangeal angle (HIPA) between individuals with normal feet, those with hallux valgus, and those with mild hallux limitus. The objective of the present study was thus to determine if significant differences in HIPA exist in the early stages of hallux valgus or hallux limitus deformities. METHODS The hallux interphalangeal angle was measured in three groups of participants: a control group with normal feet (45 participants), a hallux valgus group (49 participants), and a hallux limitus group (48 participants). Both of the pathologies were at an early stage. A dorsoplantar radiograph under weightbearing conditions was taken for each individual, and measurements (HIPA and hallux abductus angle [HAA]) were taken using AutoCAD (Autodesk Inc, San Rafael, California) software. Intergroup comparisons of HIPA, and correlations between HIPA, HAA, and hallux dorsiflexion were calculated. RESULTS The comparisons revealed no significant differences in the values of HIPA between any of the groups (15.2 ± 5.9 degrees in the control group, 15.5 ± 3.9 degrees in the hallux valgus group, and 16.15 ± 4.3 in the hallux limitus group; P  =  0.634). The Pearson correlation coefficients in particular showed no correlation between hallux dorsiflexion, HAA, and HIPA. CONCLUSIONS For the study participants, there were similar deviations of the distal phalanx of the hallux with respect to the proximal phalanx in normal feet and in feet with the early stages of the hallux limitus and hallux valgus deformities.

Normal Values of Metatarsal Parabola Arch in Male and Female Feet

There is not any method to measure metatarsal protrusion in the whole metatarsal. The aim of this research is to know the normal metatarsal parabola in male and female feet. The system of measurement devised by Hardy and Clapham to evaluate the protrusion between metatarsals I and II was adapted to study the whole metatarsal parabola and applied to the five metatarsals of 169 normal feet, 72 female feet and 97 male feet. Authors measured all metatarsal protrusion relative to metatarsal II. The results obtained show a female metatarsal protrusion relative to metatarsal II of +1.27% for metatarsal I, −3.36% for metatarsal III, −8.34% for metatarsal IV, and −15.54% for metatarsal V. Data obtained for male metatarsal parabola were +0.5% for metatarsal I, −3.77 for metatarsal III, −9.57 for metatarsal IV, and −17.05 for metatarsal V. Differences between both metatarsal parabola were significant.

Metatarsal pain and plantar hyperkeratosis in the forefeet of female professional flamenco dancers.

OBJECTIVES The objectives of this study were to determine the frequency of metatarsal pain and of hyperkeratosis on the plantar forefoot in female professional flamenco dancers, and to determine whether there is a relationship between the two disorders. METHOD Forty-four female professional flamenco dancers, with a minimum activity of 25 hrs/wk, participated in this cross-sectional study. The presence or absence of metatarsal pain while dancing was recorded, and plantar pressures were measured on a pressure platform, both barefoot and shod with the usual dance shoe. The heel height of the dance shoe was also measured. RESULTS Of the dancers, 80.7% experienced metatarsal pain while dancing, and 84.1% presented with plantar hyperkeratosis. Plantar hyperkeratosis coincided with the presence of metatarsal pain in 67.04% of the feet studied. The maximum load point in the feet when the dancers were barefoot was located 59.5% in the rearfoot and 40.5% in the forefoot; when dancers wore their specific flamenco dancing shoes, it was located 52.4% in the rearfoot and 47.6% in the forefoot. CONCLUSIONS Metatarsal pain and plantar hyperkeratosis in the forefoot are common foot disorders in female flamenco dancing. The incidence of the maximum load point being located in the forefoot, and the difference between the results of the tests while shod or barefoot, are both too low to support the idea that the raised heels of flamenco shoes are a major contributing factor for these injuries. Therefore, these disorders may be caused by chronic repetitive trauma suffered during the practice of footwork dancing.

Angular position of the cleat according to torsional parameters of the cyclist's lower limb.

Objective:The aim of this work was to study the relationship of torsional and rotational parameters of the lower limb with a specific angular position of the cleat to establish whether these variables affect the adjustment of the cleat. Design:Correlational study. Setting:Motion analysis laboratory. Participants:Thirty-seven male cyclists of high performance. Interventions:The variables studied of the cyclists lower limb were hip rotation (internal and external), tibial torsion angle, Q angle, and forefoot adductus angle. Main Outcome Measures:The cleat angle was measured through a photograph of the sole and with an Rx of this using the software AutoCAD 2008. The variables were photograph angle (photograph), the variable denominated cleat-tarsus minor angle, and a variable denominated cleat-second metatarsal angle (Rx). Analysis included the intraclass correlation coefficient for the reliability of the measurements, Students t test performed on the dependent variables to compare side, and the multiple linear regression models were calculated using the software SPSS 15.0 for Windows. Results:The Students t test performed on the dependent variables to compare side showed no significant differences (P = 0.209 for the photograph angle, P = 0.735 for the cleat-tarsus minor angle, and P = 0.801 for the cleat-second metatarsal angle). Values of R and R2 for the photograph angle model were 0.303 and 0.092 (P = 0.08), the cleat/tarsus minor angle model were 0.683 and 0.466 (P < 0.001), and the cleat/second metatarsal angle model were 0.618 and 0.382, respectively (P < 0.001). Conclusions:The equation given by the model was cleat-tarsus minor angle = 75.094 − (0.521 × forefoot adductus angle) + (0.116 × outward rotation of the hips) + (0.220 × Q angle).

Ankle sprain as a work-related accident: status of proprioception after 2 weeks

Purpose This study aims at verifying whether proprioception is abnormal or not, two weeks after a grade 1 and 2 ankle sprain in the scope of work-related accident. Methods A descriptive, observation and transversal study was designed to compare speed, movement and oscilation of centre of pressure in employees of companies signed up to a mutual company. Participants’ healthy feet comprised the control group, and feet that had undergone an ankle sprain due to a work-related accident comprised the cases group. The following stability tests were undertaken to both the healthy and injuried feet using a force plate: Monopodal Romberg test with eyes open, Monopodal Romberg test with eyes open on a 30 mm thick foam rubber, Monopodal Romberg test with eyes closed, and Romberg test as monopodal support with eyes closed on a 30 mm thick foam rubber. A multiple logistic regression analysis was performed. From the results of this regression model the COR curve test was performed. Results 71.7% accuracy in the predictions was attained. The equation was as follows: Condition (injured or healthy) = 0.052⋅% RGC AP Movement − 0.81⋅MREO AP Movement. The variable MREO antero-posterior movement was used in the COR curve methodology. The area under the curve was greater than 0.65 and at a 95% confidence interval the 0.75 value was included, which in our case was the injured subject condition. Values for sensitivity, specificity, positive predictive value and negative predictive value were 0.667, 0.633, 64.5%, and 65.5%, respectively. Conclusion The participants in this study showed a diminished capacity for postural control in an ankle two weeks after an ankle sprain.

Three-dimensional variations in the lower limb caused by the windlass mechanism

Background The windlass mechanism was described as the effect caused by the extension of the first metatarsalphalangeal joint (1st MTPJ). Quantify the degrees of movement produced in the leg by means of the Bioval® sensor system, after performing two measurements in the 1st MTPJ, 45° extension and maximum extension. Methods Tests-post-test study with just one intervention group, performed in the Clinical Podiatry Area of the Faculty of Nursing, Physiotherapy and Podiatry of the University of Seville. Subjects were included as of age 20, with a value from 0° to 3° valgus, Helbing line, a value from 0° to +5° for the foot postural index, and a localisation axis for the normalised subtalar joint. Subjects with surgical operations of the first ray, fractures and surgical operations in the leg, pathologies in the first ray and rheumatic diseases were excluded. Measurement was performed with the Bioval® system by means of inserting four sensors in the bone structures involved in the windlass mechanism. Results With the 45° wedge we observed a direct correlation among the variables extension–plantar flexion 1st MTPJ and rotation of the femur. With maximal extension of the 1st MTPJ we obtained a direct relationship between the variable extension of the 1st MTPJ and the variables plantar flexion and prono-supination of the 1st metatarsal as well as with the variables tibia rotation and femur rotation. Conclusion Kinematic analysis suggested that the higher the degree of extension the more movement will be generated. This reduces the level of impact the more distal the structure with respect to the 1st MTPJ, which has an impact on the entire leg. Because of the kinematic system used wasn’t suitable, its impact wasn’t exactly quantified.