DOCSLIB.ORG

Bilateral Hallux Varus Deformity Correction with a Suture Button Construct

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Bilateral Hallux Varus Deformity Correction with a Suture Button Construct A Case Report & Literature Review Bilateral Hallux Varus Deformity Correction With a Suture Button Construct Andrew R. Hsu, MD, Christopher E. Gross, MD, and Johnny L. Lin, MD common surgery for hallux varus correction is transfer of the Abstract extensor hallucis longus partially or completely under the deep Hallux varus deformity typically results from transverse intermetatarsal ligament to the lateral aspect base soft-tissue overcorrection at the metatarsopha- of the proximal phalanx.10,11 However, complications include langeal joint during surgery for hallux valgus. weakened extension and the inability to fix an overcorrected There are several soft-tissue procedures avail- intermetatarsal angle. Alternatively, the abductor hallucis can able for flexible hallux varus deformity includ- be tenotomized or transferred to the base of the proximal ing transfer of the extensor hallucis longus or phalanx to reconstruct the lateral capsular ligaments.8,9 The abductor hallucis. To our knowledge, there have lateral capsular ligaments can be reinforced or reconstructed not been any previous reports in the literature of with fascia lata or soft-tissue anchors, but these procedures rely bilateral hallux varus deformities in the setting of on adequate healthy tissue remaining around the MTP joint.9,12 potential pregnancy-related ligamentous laxity The Mini TightRope (Arthrex Inc, Naples, Florida) is an im- combined with iatrogenic injury. We present the planted suture endobutton device that has previously been used 13 case of an isolated bilateral hallux varus defor- for hallux valgus repair. The suture button technique has also mity occurring after pregnancy and prior bunion been used to recreate ligaments and tendons in syndesmotic 14,15 14 surgery. The simultaneous operations using disruptions of the ankle, Lisfranc fracture dislocations, 16 17 the Mini TightRope device (Arthrex Inc,AJO Naples, acromioclavicular joint dislocations, biceps tendon rupture, Florida) were considered a success with the and general tendon reinforcement and reconstruction proce- 18 patient having pain relief and return to regular dures. The suture button technique can be individually ten- activities with normal shoewear. sioned for each deformity correction and used in a minimally invasive manner to expedite weight-bearing and postopera- tive recovery. Pappas and Anderson19 were the first to describe hallux varus correction using the suture button technique to DOallux varus deformity typicallyNOT results from soft-tis- re-establish COPY the lateral collateral ligaments around the MTP sue overcorrection at the metatarsophalangeal (MTP) joint. Gerbert and colleagues20 have reported the preoperative Hjoint during surgery for hallux valgus.1 The incidence indications, surgical technique, and potential complications of of hallux varus after hallux valgus surgery is reported to range hallux varus repair with the suture button technique. from 2% to 15%.1,2 Deformity can result from over tightening To our knowledge, there are no previous reports of bilateral the medial capsule of the MTP joint, excessive lateral release, hallux varus deformities in the setting of potential pregnancy- excision of the fibular sesamoid, or excessive resection of the related ligamentous laxity combined with iatrogenic injury. medial aspect of the first metatarsal head.2,3 The traditional Mc- We present the case of an isolated bilateral hallux varus defor- Bride procedure with excision of the fibular sesamoid has the mity occurring after pregnancy and previous bunion surgery highest reported incidence of hallux varus.4 Patients with hal- that was successfully treated using the Mini TightRope device lux varus managed conservatively early on have been reported (Arthrex Inc). to have decreased symptoms in 22% of cases.5 In patients that The patient provided written informed consent for print do not respond to conservative treatment, deformity correction and electronic publication of this case report. can be achieved using medial capsular release, corrective oste- otomies,6,7 tendon transfers, and arthrodesis.2 Delayed surgery Case Report can lead to pain, stiffness, and arthritic changes in addition to A 43-year-old African American female actress presented to patient difficulty with shoewear. clinic with progressively worsening bilateral great toe pain A variety of soft-tissue procedures have been described and varus deformity that started during pregnancy and im- for flexible joints without bony abnormality that release the mediately worsened following the birth of her daughter medial capsule and rebalance hallux alignment.2,8,9 The most 3 years ago. The patient had no history of trauma to her feet and Authors’ Disclosure Statement: The authors report no actual or potential conflict of interest in relation to this article. www.amjorthopedics.com March 2013 The American Journal of Orthopedics® 121 Bilateral Hallux Varus Deformity Correction A. R. Hsu et al had bilateral bunionectomy proce- capsular release was needed due dures 15 years prior at an outside to the flexible nature of the defor- institution. She noted that both of mity. The identical procedure was her feet developed a crescent moon then performed on the contralat- shape, making it painful and dif- eral foot. Both feet were wrapped ficult to wear normal shoes. Her using a forefoot bandage to main- past medical history was positive tain the alignment of the hallux. for hypertension and migraines. The postoperative regimen con- On physical examination, the pa- sisted of using a postoperative shoe tient had a varus deformity of the for 6 weeks. Forefoot bandages were great toe bilaterally, greater on the changed every 2 weeks for 6 weeks left than the right. Bilateral hal- total. Weight-bearing was restricted lux varus deformities were easily, for the first 2 weeks, followed by passively, correctable. Standing 2 weeks of heel weight-bearing, radiographs showed evidence of Figure 1. Preoperative anteroposterior standing and 2 weeks of flatfoot weight- previous proximal osteotomies radiograph showing retained hardware from previous bearing. No further splinting or and distal first metatarsal osteoto- foot surgeries and increased hallux varus deformity immobilization was recommended mies that were well-healed (Fig- bilaterally greater on the left than the right. after 6 weeks. Use of accommoda- ure 1). The hallux varus deformity tive shoes was permitted based on measured 23° on the left and 16° the level of soft-tissue swelling and on the right. Due to unsuccessful clinical exam. nonoperative management, surgi- At 6-week follow-up, the pa- cal reconstruction was offered. tient was recovering well and had In the operating room, both a hallux valgus angle of 3° on the lower extremities were prepped left and 7° on the right (Figure 2). and draped in the usual sterile There were no signs of hallux varus fashion. An Esmarch bandage was AJO or valgus of either foot with hallux used at the level of the calf for in- dorsiflexion to 80° on the left and traoperative hemostasis. An inci- 60° on the right with no pain at sion was made over the first web either MTP joint. At 9-month fol- space and the lateral capsule of low-up, the patient was pain free the first MTP joint was identified and overall very pleased with the and found to be notably lax. Next, Figure 2. Postoperative weight-bearing radiograph functional and cosmetic results 2 DOseparate incisions were madeNOT at 6-week follow-up showing good alignmentCOPY and of her procedures, with a minor on the medial side of the first consolidation with appropriate hallux valgus angles concern that there was a mild re- MTP joint, one over the proximal bilaterally. currence on the right side. The phalanx and one over the first meta- patient had normal range of mo- tarsal head. After all soft tissue was tion at bilateral MTP joints and cleared and the location verified on full strength. Weight-bearing ra- fluorosopic imaging as being extra- diographs showed a hallux val- articular, two 1.2-mm guidewires gus angle of -3° on the left and were drilled from medial to lat- -6° on the right (Figure 3). The pa- eral exiting at the insertion sites tient is now 1-year status postsur- of the lateral capsule in the proxi- gery and continues to be pain free mal phalanx and first metatarsal. wearing normal shoewear during A 2.7-mm cannulated drill was regular activities with no further then passed over the wire before recurrence and no plans for further passing a Mini TightRope device operative intervention. (Arthrex Inc). The lateral capsule was then incised and oversewn Discussion in a pants-over-vest fashion with The case presented here is unique the joint in a corrected and con- Figure 3. Postoperative weight-bearing radiograph in that the patient had bilateral hal- gruous position. The Mini Tight- at 9-month follow-up showing neutral alignment on lux varus deformities that arose in Rope device (Arthrex Inc) was then the left with a mild amount hallux varus angulation on temporal association with preg- the right with continued proper alignment of the Mini manually tensioned to maintain TightRopes (Arthrex Inc). nancy and childbirth. Although the desired correction. No medial the patient had previous bilateral 122 The American Journal of Orthopedics® March 2013 www.amjorthopedics.com Bilateral Hallux Varus Deformity Correction A. R. Hsu et al bunion surgery 15 years prior to presentation, she reported are significantly higher forces on the forefoot, midfoot, and that her bilateral hallux pain and deformity
Load more

Recommended publications
  • ICD-10 Diagnoses on Router
    L ARTHRITIS R L HAND R L ANKLE R L FRACTURES R OSTEOARTHRITIS: PRIMARY, 2°, POST TRAUMA, POST _____ CONTUSION ACHILLES TEN DYSFUNCTION/TENDINITIS/RUPTURE FLXR TEN CLAVICLE: STERNAL END, SHAFT, ACROMIAL END CRYSTALLINE ARTHRITIS: GOUT: IDIOPATHIC, LEAD, CRUSH INJURY AMPUTATION TRAUMATIC LEVEL SCAPULA: ACROMION, BODY, CORACOID, GLENOID DRUG, RENAL, OTHER DUPUYTREN’S CONTUSION PROXIMAL HUMERUS: SURGICAL NECK 2 PART 3 PART 4 PART CRYSTALLINE ARTHRITIS: PSEUDOGOUT: HYDROXY LACERATION: DESCRIBE STRUCTURE CRUSH INJURY PROXIMAL HUMERUS: GREATER TUBEROSITY, LESSER TUBEROSITY DEP DIS, CHONDROCALCINOSIS LIGAMENT DISORDERS EFFUSION HUMERAL SHAFT INFLAMMATORY: RA: SEROPOSITIVE, SERONEGATIVE, JUVENILE OSTEOARTHRITIS PRIMARY/SECONDARY TYPE _____ LOOSE BODY HUMERUS DISTAL: SUPRACONDYLAR INTERCONDYLAR REACTIVE: SECONDARY TO: INFECTION ELSEWHERE, EXTENSION OR NONE INTESTINAL BYPASS, POST DYSENTERIC, POST IMMUNIZATION PAIN OCD TALUS HUMERUS DISTAL: TRANSCONDYLAR NEUROPATHIC CHARCOT SPRAIN HAND: JOINT? OSTEOARTHRITIS PRIMARY/SECONDARY TYPE _____ HUMERUS DISTAL: EPICONDYLE LATERAL OR MEDIAL AVULSION INFECT: PYOGENIC: STAPH, STREP, PNEUMO, OTHER BACT TENDON RUPTURES: EXTENSOR OR FLEXOR PAIN HUMERUS DISTAL: CONDYLE MEDIAL OR LATERAL INFECTIOUS: NONPYOGENIC: LYME, GONOCOCCAL, TB TENOSYNOVITIS SPRAIN, ANKLE, CALCANEOFIBULAR ELBOW: RADIUS: HEAD NECK OSTEONECROSIS: IDIOPATHIC, DRUG INDUCED, SPRAIN, ANKLE, DELTOID POST TRAUMATIC, OTHER CAUSE SPRAIN, ANKLE, TIB-FIB LIGAMENT (HIGH ANKLE) ELBOW: OLECRANON WITH OR WITHOUT INTRA ARTICULAR EXTENSION SUBLUXATION OF ANKLE,
    [Show full text]
  • Loss of Correction in Cubitus Varus Deformity After Osteotomy
    Loss of correction in cubitus varus deformity after osteotomy Chao You Shenzhen children's hospital Yibiao Zhou Shenzhen children's hospital https://orcid.org/0000-0001-9754-1089 Jingming Han ( [email protected] ) Research article Keywords: cubitus varus osteotomy Loss of correction Posted Date: May 5th, 2020 DOI: https://doi.org/10.21203/rs.3.rs-26279/v1 License: This work is licensed under a Creative Commons Attribution 4.0 International License. Read Full License Page 1/14 Abstract Purpose Cubitus varus deformity in the pediatric population is an infrequent but clinically important disease to orthopedic surgeons. Since these patient populations are different in many respects, we sought out to investigate the rates of loss of correction over time as well as the factors associated with loss of correction in pediatric patients undergoing osteotomy for treatment of cubitus varus deformity. Methods Between 2008-7 and 2017-7, we treated 30 cases of cubital varus had underwent the the osteotomy. We compared preoperative and postoperative clinical and imaging parameters (H-cobb angle,Baumman angle) for all patients. Postoperative evaluation was performed by telephone interview. Results In our study,there were 30 patients,included 17 males and 13 females.the mean age was 75 months old.In the rst follow-up,Approximately 80 % of patients had a loss of correction of H-cobband 83% of patients at the second follow-up. The Baumann angle also had a loss of correction,about 57% was lost at the rst follow-up,and 43% was lost at the second follow-up. The average interval between the rst follow-up and the second follow-up was 24 days The H-cobb angle mean loss was 2.4°.There was a statistically signicant difference between the H-cobb angle measured before surgery and the angle measured after surgery (p <0.05).
    [Show full text]
  • Angular Limb Deformities in Foals: Treatment and Prognosis*
    Article #4 CE Angular Limb Deformities in Foals: Treatment and Prognosis* Nicolai Jansson, DVM, PhD, DECVS Skara Equine Hospital Skara, Sweden Norm G. Ducharme, DVM, MSc, DACVS Cornell University ABSTRACT: This article presents an overview of the clinical management of foals with angular limb deformities. Both conservative and surgical treatment options exist; the choice of which to use should be based on the type, severity, and location of the deformity as well as the age of the foal. Conservative measures include controlled exercise, rigid external limb support, and corrective hoof trimming. Surgical treatment modalities comprise tech- niques for manipulating physeal growth and, after physeal closure, various corrective osteotomy or ostectomy methods. The prognosis is generally good if treatment is initi- ated well in advance of physeal closure. ngular limb deformities and their treat- Conservative Treatment ment in foals and young horses constitute In most foals born with mild to moderate a significant part of the orthopedic prob- angular deformities, spontaneous resolution A 2 lems that veterinarians must manage. This article occurs within the first 2 to 4 weeks of life. In discusses the clinical management and prognosis newborn foals, periarticular laxity is the most of these postural deformities. likely cause, and these foals require no special treatment other than a short period of con- TREATMENT trolled exercise. In our opinion, mildly and The absence of controlled studies has moderately affected foals should not be confined impaired the accumulation of scientific data to a stall because exercise is important for nor- guiding the management of angular limb defor- mal muscular development and resolution of the mities in foals (Table 1).
    [Show full text]
  • Knee Arthroplasty in Patients with Rheumatoid Arthritis
    Ann. rheum. Dis. (1974), 33, 1 Ann Rheum Dis: first published as 10.1136/ard.33.1.1 on 1 January 1974. Downloaded from Knee arthroplasty in patients with rheumatoid arthritis B. BLUM,* A. G. MOWAT, G. BENTLEY, AND J. R. MORRIS Rheumatology Unit, Nuffield Departments ofMedicine and Orthopaedic Surgery, University ofOxford, Nuffield Orthopaedic Centre, Oxford MacIntosh metallic tibial plateau prostheses have based upon the failure of conservative therapy mani been used in the Nuffield Orthopaedic Centre since fested by unrelievable pain, limitation of function, and 1966 in the knees of patients with rheumatoid arthri- deformity. In all cases there was greater articular surface tis, following the description of the use of these damage than could be expected to be improved by synovectomy. The radiographic appearances were prostheses for the relief of pain and the correction of otherwise not important unless there was gross joint deformity by MacIntosh (1966). Since that time collapse or destruction, since there was considerable thfre have been several reports of the use of these discrepancy between the radiographic appearances and prostheses in both rheumatoid and osteoarthrotic the findings at operation. knees (Potter, 1969; MCCollum, Goldner, and Lang, 1970; Clary and Couk, 1972; Jessop and Moore, Methods 1972; Kay and Martins, 1972; MacIntosh and METHOD OF REVIEW Hunter, 1972; Potter, Weinfeld, and Thomas, 1972). At final review the patients were interviewed and examined In view of the different indications for and the by an independent orthopaedic surgeon (B.B.), followingcopyright. results of the operation described by these various a standard protocol* which assessed the technical success authors, it seemed valuable to undertake an in- of the procedure and stressed functional improvements dependent review of the patients treated in this and difficulties.
    [Show full text]
  • Conformational Limb Abnormalities and Corrective Farriery for Foals
    Conformational Limb Abnormalities and Corrective Farriery for Foals For the past couple of years the general public has questioned the horse industry, and one of the questions is “Are we breeding horses more prone to breakdown with injuries”? It seems that we hear more often now that there are more leg and foot problems than ever before. Is it that we are more aware of conformational deficits and limb deviations, or are there some underlying factors that make our horses prone to injury? To improve, or even just maintain the breed, racing should prove soundness as well as speed and stamina. 1 The male side is usually removed from the bloodline if unable to produce good results at the racetrack. However, the female may have such poor conformation that she never even gets into training, but yet she enters the broodmare band. The generational effect of this must surely lead to an increase in the number of conformational deficits in our foals and yearlings.1 Something that we hear quite often is “Whoever saw the perfect horse”? and “There are plenty of horses with poor conformation that win races”. That doesn’t mean we should not continue to attempt to produce horses with good conformation. There is an acceptable range of deviation from the ideal, and therefore these deformities have to be accepted if it does not jeopardize the overall athletic soundness of the horse. Although mild conformational deficits may not significantly impact soundness, more significant limb deformities cause abnormal limb loading, lameness, gait abnormalities, and interference issues. 2 Developmental deformities of the limb include angular, flexural, and rotational limb deformities.
    [Show full text]
  • Realignment Surgery As Alternative Treatment of Varus and Valgus Ankle Osteoarthritis
    CLINICAL ORTHOPAEDICS AND RELATED RESEARCH Number 462, pp. 156–168 © 2007 Lippincott Williams & Wilkins Realignment Surgery as Alternative Treatment of Varus and Valgus Ankle Osteoarthritis Geert I. Pagenstert, MD*; Beat Hintermann, MD*; Alexej Barg, MD*; André Leumann, MD†; and Victor Valderrabano, MD, PhD† In patients with asymmetric (varus or valgus) ankle osteo- Level of Evidence: Level IV, therapeutic study. See the arthritis, realignment surgery is an alternative treatment to Guidelines for Authors for a complete description of levels of fusion or total ankle replacement in selected cases. To deter- evidence. mine whether realignment surgery in asymmetric ankle os- teoarthritis relieved pain and improved function, we clini- cally and radiographically followed 35 consecutive patients Surgical treatment for patients with symptomatic ankle with posttraumatic ankle osteoarthritis treated with lower osteoarthritis (OA) is controversial, particularly in me- leg and hindfoot realignment surgery. We further questioned if outcome correlated with achieved alignment. The average chanically induced, malaligned ankle OA in which joint patient age was 43 years (range, 26–68 years). We used a cartilage is partially preserved. These patients typically are standardized clinical and radiographic protocol. Besides dis- in their economically important, active middle ages be- tal tibial osteotomies, additional bony and soft tissue proce- cause early trauma is the predominant (70–80%) etiology dures were performed in 32 patients (91%). At mean fol- of their ankle OA.49,58 Currently, treatment recommenda- lowup of 5 years (range, 3–10.5 years), pain decreased by an tions after failed nonoperative therapy are polarized be- average of 4 points on a visual analog scale; range of ankle tween fusion2,11,33 and total ankle replacement motion increased by an average of 5°.
    [Show full text]
  • Osteotomy Around the Knee: Evolution, Principles and Results
    Knee Surg Sports Traumatol Arthrosc DOI 10.1007/s00167-012-2206-0 KNEE Osteotomy around the knee: evolution, principles and results J. O. Smith • A. J. Wilson • N. P. Thomas Received: 8 June 2012 / Accepted: 3 September 2012 Ó Springer-Verlag 2012 Abstract to other complex joint surface and meniscal cartilage Purpose This article summarises the history and evolu- surgery. tion of osteotomy around the knee, examining the changes Level of evidence V. in principles, operative technique and results over three distinct periods: Historical (pre 1940), Modern Early Years Keywords Tibia Osteotomy Knee Evolution Á Á Á Á (1940–2000) and Modern Later Years (2000–Present). We History Results Principles Á Á aim to place the technique in historical context and to demonstrate its evolution into a validated procedure with beneficial outcomes whose use can be justified for specific Introduction indications. Materials and methods A thorough literature review was The concept of osteotomy for the treatment of limb defor- performed to identify the important steps in the develop- mity has been in existence for more than 2,000 years, and ment of osteotomy around the knee. more recently pain has become an additional indication. Results The indications and surgical technique for knee The basic principle of osteotomy (osteo = bone, tomy = osteotomy have never been standardised, and historically, cut) is to induce a surgical transection of a bone to allow the results were unpredictable and at times poor. These realignment and a consequent transfer of weight bearing factors, combined with the success of knee arthroplasty from a damaged area to an undamaged area of joint surface.
    [Show full text]
  • First Metatarsophalangeal Joint Replacement with Total Arthroplasty in the Surgical Treatment of the Hallux Rigidus R
    Acta Biomed 2014; Vol. 85, Supplement 2: 113-117 © Mattioli 1885 Original article First metatarsophalangeal joint replacement with total arthroplasty in the surgical treatment of the hallux rigidus R. Valentini, G. De Fabrizio, G. Piovan Clinica Ortopedica e Traumatologica, Università degli Studi di Trieste, Azienda Ospedaliero-Universitaria “Ospedali Riuniti” di Trieste Abstract. The hallux rigidus, especially in advanced stage, has always been a challenge as regards the surgical treatment. Over the years there have been various surgical techniques proposed with the aim of relieving pain, correcting deformity and maintain a certain degree of movement. For some years we have addressed the prob- lem with the replacement metatarsophalangeal joint arthroplasty with Reflexion system. As far as our experi- ence we have operated and monitored 25 patients (18 females and 7 males) of mean age 58.1 years, operated with this technique from June 2008 to June 2011. It reached an average ROM of 72° (extension and flexion 45° and 27°) with a good functional recovery in 8 patients, and this articulation was good (50° - 40°) in 12 patients and moderate in 5 with a articular range from 40°- 30°. The clinical results, according to our experience, appear to be favorable, as even patient satisfaction is complete. (www.actabiomedica.it) Key words: hallux rigidus, metatarsophalangeal, arthroprosthesis Introduction The pathology of stiff big toe has ranked about Regnauld classification (5) in three stages, so that the Degenerative disease of the first metatarsal- I stage is characterized by wear of the joint with mini- phalangeal articulation, the so-called “Hallux rigi- mal osteophytes reaction, the II stage is reached when dus”, especially in advanced phase, has always been the joint line is further reduced, the articular surfaces a sort of challenge as a surgical treatment.
    [Show full text]
  • Skeletal Malalignment and Anterior Knee Pain: Rationale, Diagnosis, and Management
    Ch11.qxd 10/07/05 7:20 PM Page 185 11 Skeletal Malalignment and Anterior Knee Pain: Rationale, Diagnosis, and Management Robert A. Teitge and Roger Torga-Spak Introduction Association of Skeletal Any variation from optimal skeletal alignment Malalignment and Patellofemoral may increase the vector forces acting on the patellofemoral joint causing either ligament fail- Joint Pathology ure with subsequent subluxation or cartilage Abnormal skeletal alignment of the lower failure as in chondromalacia or arthrosis or both extremity has been associated with various ligament and cartilage failure (Figure 11.1). patellofemoral syndromes and biomechanical Anterior knee pain may result from these abnor- abnormalities. Our understanding of these asso- mal forces or their consequences. ciations continues to develop as many refer- The mechanical disadvantage provided by a ences consider only one aspect of the analysis. skeleton with a geometrical or architectural flaw In the frontal plane, malalignment has been distributes abnormal stresses to both the liga- shown to influence the progression of patello- ments and the joints of the misaligned limb. femoral joint arthritis.4,12 Varus alignment Ligament overload and subsequently failure increases the likelihood of medial patello- (insufficiency) may occur with a single traumatic femoral osteoarthrosis progression while valgus episode as well as repetitive episodes of minor alignment increases the likelihood of lateral trauma or chronic overload. Skeletal malalign- patellofemoral osteoarthrosis progression. ment may cause chondromalacia patella and Fujikawa13 in a cadaveric study found a marked subsequently osteoarthritis by creating an alteration of patellar and femoral contact areas increased mechanical leverage on the with the introduction of increased varus align- patellofemoral joint that can exceed the load ment produced by a varus osteotomy.
    [Show full text]
  • Correlation of Rearfoot Angle to Q-Angle in Patellofemoral Pain Syndrome: a Prospective Study
    International Journal of Research in Orthopaedics Dileep KS et al. Int J Res Orthop. 2017 Jul;3(4):688-691 http://www.ijoro.org DOI: http://dx.doi.org/10.18203/issn.2455-4510.IntJResOrthop20172089 Original Research Article Correlation of rearfoot angle to Q-angle in patellofemoral pain syndrome: a prospective study K. S. Dileep1*, Krishna Harish2, Rameez P. Mohammed3 1Department of Orthopaedics, K.S. Hegde Medical Academy, Deralakatte, Mangalore, Karnataka, India 2Musculoskeletal Disorders and Sports Physiotherapist Principal, Malabar Medical College, Allied Sciences, Kerala, India 3Physiotherapist, Jayashree Hospital, Mangalore, Karnataka, India Received: 22 April 2017 Revised: 05 May 2017 Accepted: 08 May 2017 *Correspondence: Dr. K. S. Dileep, E-mail: [email protected] Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. ABSTRACT Background: Objective of the study was to evaluate the correlation between rearfoot posture to Q-angle in patients with patellofemoral pain syndrome. Methods: This is a two-year prospective observational study in which all patients with patellofemoral pain syndrome in the age group of 20-30 years were included in the study. The static Q-angle and the rearfoot angles of these subjects were measured and analyzed statistically for their correlation. Results: There were sixty patients who fulfilled the inclusion criteria of the study. Pearson product moment correlation showed 27% subjects having rearfoot valgus and 73% having rearfoot varus angle.
    [Show full text]
  • Biomechanics of Nerve and Muscle
    The Biomechanics of the Human Lower Extremity DR.AYESH BASHARAT BSPT, PP.DPT. M.Phil (Gold-medalist) Hip joint One of the largest and most stable joint: The hip joint Rigid ball-and-socket configuration (Intrinsic stability) The femoral head Femoral head : convex component Two-third of a sphere, Cover with cartilage Rydell (1965) suggested : most load----- superior quadrant Femur Long, strong & most weight bearing bone. But most weakest structure of it is its neck. During walk in single leg support move medially to support C0G. This results in the leg being shortened on non-weight bearing side. Fracture of femur-neck common as bone tissue in the neck of the femur is softer than normal. Acetabulum Concave component of ball and socket joint Facing obliquely forward, outward and downward Covered with articular cartilage Provide static stability Labrum: a flat rim of fibro cartilage Acetabulum Also contain Transverse acetabular ligament provide stability Ligaments and Bursae •Iliofemoral ligament: Y shaped extremely strong= anterior stability •Pubofemoral ligament: anterior stability • Ischiofemoral ligament: posterior stability • Ligamentum teressupplies a direct attachment from rim of acetabulum to head of femur Iliopsoas burs b/w illiopsoas & capsule Trochantric bursitis The femoral neck Frontal plane (the neck-to-shaft angle/ angle of inclination), Transverse plane (the angle of anteversion) Neck-to- shaft angle : 125º, vary from 110º to 135-140º Effect : lever arms Angle of anteversion :12º Effect : during gait >12º :internal rotation <12º :external rotation aa The anteverted femur effect the biomechanics of not only hip joint but also disturbed the knee and ankle joint normal mechanics during different physical activities a Structure of the Hip Sacrum Ilium Acetabulum Femoral head Pubis Ischium Femur The pelvic girdle includes the two ilia and the sacrum,.
    [Show full text]
  • Original Article: Correlation Between Subtalar Varus Angle
    Online Journal of Health and Allied Sciences Peer Reviewed, Open Access, Free Online Journal This work is licensed under a Published Quarterly : Mangalore, South India : ISSN 0972-5997 Creative Commons Attribution- Volume 8, Issue 3; Jul-Sep 2009 No Derivative Works 2.5 India License Original Article: Correlation between subtalar varus angle and disability in patients with patellofemoral arthritis Patel Birenkumar Jagdishbhai, Student, Gauri Shankar, Asst. Professor KJ Pandya College of Physiotherapy, Sumandeep Vidyapeeth University, Pipariya, Waghodia Road, Vadodara- 391760, Gujarat, INDIA Address For Correspondence: Gauri Shankar, KJ Pandya College of Physiotherapy, Sumandeep Vidyapeeth University, Pipariya, Waghodia Road, Vadodara - 391760 Gujarat, INDIA E-mail: [email protected] Citation: Patel BJ, Shankar G. Correlation between subtalar varus angle & disability in patients with patellofemoral arthritis. Online J Health Allied Scs. 2009;8(3):10 URL: http://www.ojhas.org/issue31/2009-3-10.htm Open Access Archives: http://cogprints.org/view/subjects/OJHAS.html and http://openmed.nic.in/view/subjects/ojhas.html Submitted: Apr 24, 2009; Accepted: Nov 2, 2009; Published: Nov 15, 2009 Abstract: This study aimed at establishing a relationship if any between Aim: To find the correlation between subtalar varus angle & subtalar varus angle and disability in patient with patel- disability in patients with patellofemoral arthritis. Methods: A lofemoral pain. total of 30 subjects aged (48.86±5.74) referred to the depart- Materials and Methods: ment of physiotherapy, with patellofemoral arthritis and ful- A total of 30 subjects aged (48.86±5.74) referred to the depart- filling the criteria of inclusion were recruited for the study, ment of physiotherapy, Dhiraj General Hospital, Baroda, Gu- sampling method being convenient sampling.
    [Show full text]