Pedro V. Munuera

Relationship between tightness of the posterior muscles of the lower limb and plantar fasciitis.

Background: The aim of this study was to determine whether tightness of the posterior muscles of the lower extremity was associated with plantar fasciitis. Methods: A total of 100 lower limbs of 100 subjects, 50 with plantar fasciitis and 50 matching controls were recruited. Hamstring and calf muscles were evaluated through the straight leg elevation test, popliteal angle test, and ankle dorsiflexion (knee extended and with the knee flexed). All variables were compared between the 2 groups. In addition, ROC curves, sensitivity, and specificity of the muscle contraction tests were also calculated to determine their potential predictive powers. Results: Differences between the 2 groups for the tests used to assess muscular shortening were significant (P < .001) in all cases. The straight leg elevation test and ankle dorsiflexion with the knee extended presented respective sensitivities of 94% and 100% and specificities of 82% and 96% as diagnostic tests for the participants in this study. Conclusion: Tightness of the posterior muscles of the lower limb was present in the plantar fasciitis patients, but not in the unaffected participants. Clinical Relevance: The results of this study suggest that therapists who are going to employ a stretching protocol for treatment of plantar fasciitis should look for both hamstring as well as triceps surae tightness. Stretching exercise programs could be recommended for treatment of plantar fasciitis, focusing on stretching the triceps surae and hamstrings, apart from an adequate tissue-specific plantar fascia-stretching protocol. Level of Evidence: Level III, case control study.

Length of the first metatarsal and hallux in hallux valgus in the initial stage

The aim of this study was to confirm whether the length of the first metatarsal and the length of the hallux are greater than normal in the initial phase of the hallux valgus deformity. In a sample of 152 radiographs (98 of normal feet and 54 of incipient hallux valgus feet), the length of the first metatarsal and the hallux was measured according to methods previously described. Comparisons were made between normal and hallux valgus feet, and between male and female feet. The results show significant differences between the two groups in the first metatarsal (P  <  0.0001) and hallux (P < 0.001). In the male feet, these differences are more marked (when comparing the length of the hallux between the female hallux valgus feet and the female normal feet, P > 0.05). This indicates that in men with hallux valgus, the excess in length of the first metatarso-digital segment is greater than in women that develop this deformity, at least in its initial phase. According to these results, the size of the first metatarso-digital segment could be involved in the development of the hallux valgus deformity.RésuméLe but de cette étude est de confirmer l’excès de longueur du premier métatarsiens et du gros orteil lors de la survenue d’une déformation en hallux valgus. Cent cinquante-deux radiographies ont été analysées, 98 pieds normaux, 54 pieds présentant un début d’hallux valgus. La longueur du premier métatarsien et de l’hallux ont été mesurées et la comparaison a été réalisée entre les deux variétés de pieds, et entre les hommes et les femmes. Les résultats de cette étude montrent qu’il existe une différence significative entre les deux groupes P < 0.0001 pour le premier métatarsien et p < 0.001 pour la longueur du gros orteil. Cette différence est beaucoup plus marquée chez l’homme que chez la femme. Cette étude montre donc que chez l’homme présentant un hallux valgus, l’excès de longueur du premier métatarsien et du gros orteil sont plus importants que chez la femme, au moins au début de la déformation. Ceci doit être pris en compte lors de la survenue d’un Hallux Valgus.

Bipartite hallucal sesamoid bones: relationship with hallux valgus and metatarsal index

ObjectiveThe objective was to relate the incidence of the partition of the hallucal sesamoid bones to the size of the first metatarsal and the hallux valgus deformity.Materials and MethodsIn a sample of 474 radiographs, the frequency of appearance of bipartite sesamoids was studied. The length and relative protrusion of the first metatarsal, and the hallux abductus angle, were measured and compared between the feet with and without sesamoid partition.ResultsThe results showed that 14.6% of the feet studied had at least one partite sesamoid, that the sesamoid most frequently divided was the medial, and that unilateral partition was the most common. No difference was found in the incidence of partite sesamoids between men and women, or between left and right feet.ConclusionProtrusion and length of the first metatarsal are greater in feet with partite sesamoids than in feet without this condition. A significantly higher incidence of bipartite medial sesamoid was obtained in feet with hallux valgus compared with normal feet.

Radiographic Study of the Size of the First Metatarso-Digital Segment in Feet with Incipient Hallux Limitus

BACKGROUND The aim of this study is to confirm whether the absolute and relative lengths of the first metatarso-digital segment is greater than normal in incipient hallux limitus deformity. METHODS In a sample of 144 dorsoplantar radiographs under weightbearing conditions (94 of normal feet and 50 of feet with a slightly stiff hallux), measurements were made of the relative first metatarsal protrusion, the length and width of the first metatarsal and of the proximal phalanx of the hallux, the length of the distal phalanx of the hallux, and the total length of the hallux. RESULTS There were significant differences between the two types of feet in the relative first metatarsal protrusion, the width of the first metatarsal, the length and width of the proximal phalanx of the hallux, the length of the distal phalanx, and the total length of the hallux. CONCLUSION The size of the first metatarso-digital segment could be implicated in the development of hallux limitus deformity.

The short-term effect of custom-made foot orthoses in subjects with excessive foot pronation and lower back pain: A randomized, double-blinded, clinical trial:

Study design: randomized, double-blinded, clinical trial. Background: Low back pain is one of the commonest disorders affecting the back. The literature reflects how over time excessive pronation of the foot has become to be recognized as linked to chronic low back pain, and how the problem can evolve for the better with the use of compensating foot orthoses. Objectives: The main objective of this study is to answer the question of whether the use of a certain type of custom-made foot orthosis alleviates low back pain. Material and methods: In a sample of 51 participants with excessive subtalar pronation and chronic low back pain (43 women and 8 men), the effect of custom-made foot orthoses in low back pain was studied. The study design was a randomized, double-blinded, clinical trial with two groups: experimental, treated with the custom-made foot orthoses, and control, treated with a placebo. Low back pain was evaluated by a visual analog scale for pain and Oswestry’s Disability Index Questionnaire for lower back pain at two moments—on the day of inclusion in the study and after 4 weeks of treatment. Results: The evolution of the low back pain showed significant differences in the experimental group, showing a significant reduction of pain and disability (p < 0.001, visual analog scale; p < 0.001, Oswestry’s Index). Conclusions: In the sample studied, the use of custom-made foot orthoses to control foot pronation had a short-term effect in reduction of perceived low back pain. Clinical relevance If subtalar joint hyperpronation plays a fundamental role in the pathomechanics of lower limb, and this can facilitate the development of low back pain, then controlling the abnormal mobility of subtalar joint by means of foot orthoses should improve this symptom. This article could help solve this controversy.

Medial deviation of the first metatarsal in incipient hallux valgus deformity.

Background: The aim of this study was to determine whether excessive medial deviation of the first metatarsal (excessive intermetatarsal angle) is present in the initial phase of hallux valgus. Methods: The intermetatarsal angle between the first and second metatarsals (1–2 IMA) was radiographically studied in 49 normal feet and in 49 feet with mild hallux valgus deformity. Results: The results demonstrated a statistically significant difference in the mean intermetatarsal angle between the two groups (8.76 degrees in normal feet; 9.98 degrees in affected feet). However, we believe that is not clinically significant. Other authors, comparing the 1–2 IMA in patients with or without more advanced hallux valgus, reported greater differences than those obtained in this study. Conclusions: Excessive medial deviation of the first metatarsal is not a causal factor but rather a consequence of hallux valgus deformity.

Metatarsus Adductus Angle in Male and Female Feet Normal Values With Two Measurement Techniques

BACKGROUND The literature contains several techniques for calculating metatarsal adductus angle. Most common systems use the fourth metatarsal cuboid joint and the fifth metatarsal cuboid joint. Although both systems are quite different, normal values of metatarsus adductus angle have not been established with each system of measurement. METHODS Two hundred six radiographic images of feet in dorsoplantar projection were used to measure the metatarsus adductus angle using two different reference points: the joint between the fourth metatarsal and the cuboid and the joint between the fifth metatarsal and the cuboid. RESULTS Comparison of the results of the two measurement techniques showed significant differences (P < .05). The values of the metatarsus adductus angle also showed significant differences in men versus women (P < .05). The reliability of the measurements was checked by using an intra- and inter-evaluator test performed by two evaluators. CONCLUSION Data showed the reliability of both systems of measurement, although significant differences in the metatarsal adductus angle mean value were found using these systems of measurement in the same foot. On the other hand, significant differences were found in mean values of metatarsus adductus angle between male and female feet.

Length of the sesamoids and their distance from the metatarsophalangeal joint space in feet with incipient hallux limitus.

BACKGROUND We designed this study to verify whether the sesamoids of the first metatarsal head are longer than normal in feet with incipient hallux limitus, and whether feet with incipient hallux limitus are in a more proximal than normal sesamoid position. METHODS In a sample of 183 dorsoplantar radiographs under weightbearing conditions (115 of normal feet and 68 of feet with slightly stiff hallux), measurements were made of the length of both the medial and the lateral sesamoids and of the distance between these bones to the distal edge of the first metatarsal head. These variables were compared between the normal and the hallux limitus feet. The relationship between these variables and the hallux dorsiflexion was also studied. RESULTS We found significant differences between the two types of foot in the medial and lateral sesamoid lengths, but no significant difference in the distance between the sesamoids to the distal edge of the first metatarsal. A poor-to-moderate inverse correlation was found between hallux dorsiflexion and medial sesamoid length and between hallux dorsiflexion and lateral sesamoid length. CONCLUSIONS The length of the sesamoid bones of the first metatarsal head could be implicated in the development of the hallux limitus deformity.

Relative metatarsal protrusion in the adult : A preliminary study

We performed a bibliographic review of the systems proposed by various researchers to evaluate physiologic metatarsal protrusion. The system of measurement devised by Hardy and Clapham to evaluate the protrusion between the first and second metatarsals was adapted to study the whole metatarsal parabola. We studied the five metatarsals of 52 normal feet. Mean metatarsal protrusion relative to the second metatarsal was +1.21% for the first metatarsal, -3.84% for the third metatarsal, -9.66% for the fourth metatarsal, and -16.91% for the fifth metatarsal.

Effects of rearfoot-controlling orthotic treatment on dorsiflexion of the hallux in feet with abnormal subtalar pronation : A preliminary report

The aim of this study was to determine whether the treatment of abnormal subtalar pronation restores functional (as opposed to structural) limited dorsiflexion of the first metatarsophalangeal joint (functional hallux limitus). We studied 16 feet of eight individuals with abnormal subtalar pronation. Orthoses were made for all of the feet, and hallux dorsiflexion was measured during weightbearing. Each patient was unshod without the orthosis, unshod with the orthosis fitted on the same day, and unshod with the orthosis fitted approximately 5 months later. The results suggest that in functional hallux limitus caused by abnormal subtalar pronation, hallux dorsiflexion will gradually be restored by the use of foot orthoses to control the abnormal subtalar pronation.