Highlights • Measurements of foot structure were performed on 5311 boys and 4844 girls, for a total of 20,310 ft. of 10,155 children aged from 6 to 18 years. • The foot length (FL) and the navicular ...height (NH) were measured, and the arch height ratio (AHR (%) = NH × 100/FL) was calculated. • The FL in boys showed an extension from the age of 6 to 14. In girls, the extension was observed from the age of 6 to 13. • The NH in boys increased from the age of 6 to 13. In girls, the NH increased from the age of 8 to 13. • The AHR was almost flat until 10–11 years old, but elevated in 11–13 year old boys and in 10–12 year old girls.
The aim of this study was to report the five scales comprising the rating system that the Japanese Society for Surgery of the Foot (JSSF) devised (JSSF standard rating system) and the newly offered ...interpretations and criteria for determinations of each assessment item.
We produced the new scales for the JSSF standard system by modifying the clinical rating systems established by the American Orthopaedic Foot and Ankle Society (AOFAS scales) and the Japanese Orthopaedic Association’s foot rating scale (JOA scale). We also provided interpretations of each assessment item and the criteria of determinations in the new standard system.
We improved the ambiguous expressions and content in the conventional standard rating systems so they would be easily understood by Japanese people. The result was five scales in total. Four were designed for use specifically for ankle-hindfoot, midfoot, hallux metatarsophalangeal- interphalangeal, and lesser metatarsophalangeal- ineterphalangeal sites; and the fifth was for the foot and ankle with rheumatoid arthritis. Furthermore, we described interpretations and criteria for determinations with regard to evaluation items in each scale.
Conventionally, the AOFAS scales or the JOA scale have been separately applied depending on the sites or disorders concerned, but it was often difficult to decide on scores during practical evaluations because of differing expressions in different languages and also because of ambiguity in the interpretation of each evaluation item and in scoring standards as well. JSSF improved these scales and added definite interpretations of evaluation items as well as criteria for the rating (to be reported here in part I). Because these steps were expected to improve the reliability of outcomes assessed by each scale, we examined the reliability in scores of the newly developed scales, which are reported in part II (in this issue).
This study evaluated the validity and inter- and intraclinician reliability of (1) the Japanese Society of Surgery of the Foot (JSSF) standard rating system for four sites ankle-hindfoot (AH), ...midfoot (MF), hallux (HL), and lesser toe (LT) and the rheumatoid arthritis (RA) foot and ankle scale and (2) the Japanese Orthopaedic Association's foot rating scale (JOA scale).
Clinicians from the same institute independently evaluated participating patients from their institute by two evaluations at a 1- to 4-week interval. Statistical evaluation was as follows. (1) The intraclass correlation coefficient (ICC) was calculated from data collected from at least two examinations of each patient by at least two evaluating clinicians (Data A). (2) Total scores for the two evaluations were determined from the distribution of differences in data between the two evaluations (Data B); each item was evaluated by determining Cohen's coefficient of agreement. (3) The relation between patient satisfaction and total score was investigated only for patients who underwent surgery (Data C). Spearman's rank correlation coefficient was obtained.
Participants were 65 clinicians and 610 patients, including those with disorders of the AH (313), MF (47), HL (153), and LT (50) and those with RA (47). From Data A, the ICC was high for AH and HL by JSSF scales and for AH, MF, and LT by the JOA scale. From Data B, the coefficient showed high validity for both scales for AH, with almost no difference between the two scales; the validity for HL was higher with the JOA scale than with the JSSF scale. From Data C, correlations were significant between patient satisfaction and outcome for AH and HL by the JSSF scales and for AH, HL, and LT by the JOA scale.
The validity of both scales was high. Clinical evaluation of the therapeutic results using these scales would be highly reliable.
A comparative analysis of ankle stress X-ray findings and the condition of injured ligaments in patients with chronic lateral ankle instability was performed to determine a method of identifying the ...condition of injured ligaments prior to operation.
Altogether, 36 males and 80 females were included in the study. The average age at the time of operation was 29.4 years. Anterior drawer distances and talar tilt angles were measured manually. During the operations, the injured ligaments were classified into 25 categories.
The condition of the injured ligaments in patients with a talar tilt angle of more than 15 degrees had injured ligaments that were almost avulsed and degenerated or completely absent.
Category:
Bunion
Introduction/Purpose:
X-ray measurement for hallux valgus has been conducted with various results in the evaluation. However, it was not quite clarified yet and it still remains ...questionable why a mild case shifts to a severe case during the course. We report about the difference between the severity and the foot shape.
Methods:
The study subjects were 206 feet of 138 patients.
Mild case: 80 feet, mean age 53 y.o (A)
Moderate case: 61 feet, 62 y.o (B)
Severe case: 65 feet, 67 y.o (C)
For the examination items, HVA, M1-2 angle, and M1-5 angle were measured with the x-ray frontal radiograph for loading position, and First, Second, Fifth intermetatarsal angle (M1Y/M2Y/M5Y) on sagittal plane were also measured. We also evaluated the foot arch ratio with Yokokura Method, then compared/examined those results after dividing the cases into the mild, moderate, and severe group with age bracket.
Results:
The age of Group C were older than Group A, B.
M1-2 angle: In younger generation, three is significant difference between Group A and B.
M1-5 angle: Significant in 60 s between A and B. In 70 s, significant: all group.
Navicular height: all group is low arch with aging. Significant between A and C
It is becoming low arch at Lisfranc level with aging in all group.
There is significantly low height at M5 with aging in all group.
On sagittal plane, bone axis of M1 and M2 is lowered at 40 s in Group A and B and 70 s in Group C.
Conclusion:
In hallux valgus, the foot shape was changed in coronal and sagittal plane.
It means the collapse of bone structure at foot and ankle.
It may possibly be shifting to a severe case with aging.
However, we could not find any result definitely suggesting such condition.
Category:
Trauma
Introduction/Purpose:
Treatment of talus fracture is difficult. Because talus fracture often cause the avascular necrosis, and necessitate a prolonged non-weight-bearing period or ...arthrodesis in these cases. Identification of the fracture type that results in necrosis before a surgery may help in the determination of the planning of treatment and the prognosis. However, necrosis cannot be identified directly by a conventional fracture classification. We investigated the sites in which fracture lines of the talus are visible by using CT to determine the association between fracture of the talus and the occurrence of necrosis.
Methods:
Twenty-five patients (25 feet; 18 men and 7 women; mean age at the first visit, 48.4 years range, 15–80 years) treated through 2003 to 2013 were included in this study.
Fracture lines were assessed using radiography and CT. According to the conventional classification, 12 neck fractures and 13 body fractures were found. The Inokuchi–Ogawa classification was used to assess the fracture line on the subtalar joint surfaces. A fracture line was defined as the line connecting 1 with the other point as follows: (a) the sulcus tali ; (b) the sinus tarsi; (c) between the lateral process and the lateral tubercle; and (d) the medial tubercle. MRI was used for the assessment of necrosis. The subjects were divided into the non-necrosis group (group A) and the necrosis group (group B), and relationship between fracture lines and appearance of necrosis was examined.
Results:
With the exclusion of 2 unclassifiable cases, group A consisted of 15 feet, whereas group B consisted of 8 feet. At the Inokuchi–Ogawa classification, 1fracture line was found in 8 feet,2:5, and and 3:1 in group A. In group B, all cases showed multiple fracture lines. Among the lines connecting a-b, a-c, and b-d, fracture was observed in more than 2 lines in the all cases .
Conclusion:
The most important factor for determining the prognosis of talus fracture is the presence or absence of necrosis. The results of this study indicate that fracture lines connecting a-b, a-c, and b-d interrupt major blood routes, and talus fracture more than 2 fracture lines were highly likely to develop avascular necrosis. Thus, fracture lines may predict the occurrence of necrosis and possible sites of its occurrence.
Kinematic analysis of patients who have ruptured the ligaments of the ankle joint was performed to evaluate the function of those ligaments. Ten patients with ruptured lateral collateral ligaments ...and 10 normal volunteers were examined. Patients' ages ranged from 17 to 29, averaging 20.9 years old. We performed kinematic evaluation by a three-dimensional optical analytic technique using surface markers. According to our results, the ankles with lateral ligament injury abnormally pronated and rotated externally at the time of heel strike and abnormally supinated and rotated internally during the acceleration phase.
An 89-year-old man with diabetes mellitus was admitted to the hospital because of a low-grade fever and a disturbance in consciousness. He had been diagnosed as having diabetes mellitus at the age of ...22 years and had been taking oral hypoglycemic drugs for 16 years at least. A few days before admission, a loss of appetite was noticed by his family; he developed a stupor on the day of admission. On physical examination, his lower extremities were pale and his skin temperature was low. Laboratory tests showed an increase in his white blood cell count and his blood culture was positive for Staphylococcus aureus. An MRI showed that the abdominal aorta was totally occluded beneath the renal arteries, and no significant collateral circulation was observed. He was given antibiotics and anticoagulants, but his general condition continued to worsen. Laboratory tests showed renal failure and liver dysfunction, indicating multi-organ failure. On the 24th day of admission, he died of respiratory and heart failure. An autopsy showed the aorta to be totally occluded beneath the renal arteries by an embolism; atherosclerotic changes were rather mild. Acute plaque change on the surface of the aorta may have induced the sudden development of emboli in the aorta.
The treatment and prognosis of neck fractures (extra-articular) and body fractures (intra-articular) of the talus are different. Ratios between neck fractures and body fractures reported by different ...investigators vary widely (from 6:1 to 1:1), because it is difficult to differentiate fractures crossing the anteromedial aspect of the trochlea. We examined 215 fractures of the talus. By examining the inferior surface fracture line, we found that the 61 fractures crossing the anteromedial aspect of the trochlea could be differentiated into 28 neck fractures and 33 body fractures. We suggest classifying fractures of the talus based on the inferior, not superior, surface fracture line.
Calcaneal fractures in children Inokuchi, S; Usami, N; Hiraishi, E ...
Journal of pediatric orthopaedics,
1998-July/August, Volume:
18, Issue:
4
Journal Article
Peer reviewed
Calcaneal fractures are rare in children but frequent in adults. We report 18 cases (20 feet) of pediatric calcaneal fractures before the distal tibial growth line closed to assess the ...characteristics of pediatric calcaneal fractures and reveal differences in treatment and prognosis between children and adults. Twelve (60%) of the fractures were extraarticular, a higher percentage than in adults, and only four (20%) were intraarticular fractures associated with displacement. One case of avulsion fracture of the portion of the calcaneus where the Achilles tendon inserts, in which there was large displacement, and one intraarticular fracture were treated surgically. The outcome was good, including the surgical cases. One of the reasons that calcaneal fractures are considered rare in children is that they are missed, and thus care is required in making the diagnosis.
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