RADIOLOGICAL ALTERATIONS IN THE OSSIFICATION NUCLEUS OF THE FIRST RADIO OF THE FOOT.

Abstract

Introduction: The x-ray test, introduced at the beginning of the XX century, originated a succession of descriptions of alterations in the different secondary ossification nuclei of the long bones, systematically considered as osteocondrosis cases. Osteocondrosis is a wide concept including etiological, pathological, histological, clinical and radiological data, there being no unique criterium about the concept in the literarure. There are no clear data in the literature about the prevalence of radiological alterations in the forefoot ossification nuclei. In most cases such ‘alterations’ are rather anatomical variants in the development and growth of the ossification nuclei.

The aim of the present study was to determine the different radiological alterations observed in our series and their possible relation with other variables (sex, foot pathology and forefoot morphology).

Material and Methods: A serie of 971 dorso-plantar radiographs from 225 patients were retrospectively analysed. The presence, or lack, of each nucleus and its radiological aspect were observed. The different alterations of the nuclei were classified as: normal, sclerotic, sclerotic and notch, sclerotic and flattened, sclerotic and fragmented, and fragmented. Likewise, a statistical analysis was performed relating the alterations of each nucleus with the forefoot morphology (digital and metatarsal formulae) and the main pathologies motivating the x-ray examination (traumatism, our control group; flatfoot; hallux valgus; clubfoot).

Results: We could not find any asymmetry or dimorphism in our series. The prevalence of different alterations of each nucleus was higher in younger children, excepting in the ossification nucleus of the proximal phalanx.

In the 46.3% of the cases there are radiological alterations in the ossification nucleus of the proximal phalanx. In such cases, the 79.2% were sclerotic.

In the flatfoot patients a higher frequency regarding the apperance of radiological alterations was shown significant (p< 0.05) for first cuneiform, proximal metatarsal, and proximal phalanx nuclei.

In the cases with evident alterations of the proximal or distal metatarsal nuclei, the 100% of the cases was related to egyptian digital formula.

The retrospective study did not provide us with additional clinical information about symptoms that could define osteocondrosis in each case.

Conclusions: There is a higher prevalence regarding to radiological alterations of the ossification nuclei of the first radio of the foot.

The biomechanical alterations of the gait in the flat-foot patients, or its treatment (insole), could be related to radiological alterations of such nuclei.