Introduction: Many studies have demonstrated that individuals who engage in running exercises appear to develop musculo-skeletal injuries more frequently (1). Considering the foot, the most common injuries include stress fractures of the metatarsals, plantar fasciitis, tibialis posterior lesions and ankle sprains. Studies have been conducted who analysed the loading characteristics of the foot in repeated measurement designs –before and after exercise- in order to find a pathomechanical pathway for metatarsal stress fractures (2,3,4). The published studies evaluated the in-shoe plantar pressure during treadmill running (2,3) or barefoot after a marathon (4). To date, no investigation have been conducted who evaluated the impact of a regular training session onto the forefoot loading characteristics.

The objective of this investigation was therefore to identify changes in loading characteristics of the foot after a 90 minute running exercise.

Methods: Thirty-two volunteer athletes (4 women, 28 men) were recruited to participate in this study and gave their informed consent. During the pre-training session, participants were asked to run barefoot at a self-selected speed across a plantar pressure platform (RSscan International, 0,5m × 0,4m, 4 sensors/cm², 300Hz) that was embedded in a 16 meter walkway (EVA foam, shore 60). The post-training measurements were performed in the same location and according to the same method. Three left and three right steps were captured for each session and each participant. One observer localised 6 anatomical regions on the footprints using the multi-mask function of the software (Scientific version 7.0). For these regions (the five metatarsal heads and the hallux) the following dependent variables were analyzed: Peak Pressure, Impulse, Time to Peak, Start Time and End Time.

Intra-individual differences between both conditions were tested for significance with the paired student T-test.

Results: The contact time of the whole foot was not significantly different between the pre-and post training sessions, which indicates repeatable gait.

Also, no significant differences were found between the various parameters of the two sessions, and this for all the 6 regions under investigation.

However, in some participants a clear different Peak Pressure pattern, was found in the pre-and post exercise situation.

Conclusion: The results of this study show no significant changes in the loading characteristics as reported by other publications.

Introduction: There are very few data on baropodometric semiology in hallux valgus. Based on the analysis of fore-foot cases, we will try to show if there are early baropodometric signs of perturbation of support by the first ray.

Material: We compared clinical, radiological and baropodometric data from 105 feet (35 women, 18 men, average age: 55). The MT1/MT2 angle measured 1.26° to 22.02°, with an average of 11.94°, standard deviation 3.65. The MT1/MT5 angle was 15.04° to 39.56° with an average of 28.13°, standard deviation 4.76.

Methods: We recorded angles and differences in the lengths of metatarsi on anteroposterior X-rays. A Novel platform and its Emed software (Munich, Germany) enabled to record ground forces. We divided into ten weight-bearings zones: rear and mid-foot, the five metatarsi, the hallux, the second toe and the lateral toes. For each zone, we studied the distribution of the integral force time (IFT) and the instant of the step when the greatest force and pressure occurred. We compared those three criteria with the MT1/MT2 angle and the type of functional complaint from the patient.

Results: For the metatarsal zones, we identified four types of « baropodometric » populations depending on the radiological and clinical analysis. The asymptomatic population had maximal IFT on the medium metatarsi, and the instant of greatest simultaneous force and pressure was in the last quarter of the weight-bearing phase. The second population was the asymptomatic population with maximal IFT on the head of the first metatarsi, but the chronology of maximal force and pressure had no perturbation. The third type was a very symptomatic population with a higher IFT on MT1, for which the greatest ground force occurred very early compared with the other metatarsi (at about the middle of the weight-bearing phase). The fourth population had no systematic pattern for IFT or maximal ground forces phases.

Discussion: The development of a hallux valgus leads to an increase in the load of the head of MT1 (increase in the IFT). Then, as the deformity worsens and the meta-tarsosesamoid dislocates, weight-bearing on the first ray occurs earlier, with the diaphysis of MT1 before leading to a total disorganisation of the chronological phases of the forefoot.

Conclusion: Dynamic baropodometric study of the fore-foot can predict if a hallux valgus will worsen, and if our correction will remain stable.

Introduction: To guide one’s surgical options if conservative treatment in metatarsalgia fails, a good understanding of the anatomy and the biomechanics of a normal forefoot is primordial. The recognition of a so-called ideal morphotype may serve as a guide, through technical or other means (clinical examination, X-rays, baropodometry,..), to obtain a calculated and subtle reconstruction of all the symptomatic elements.

Material and Methods: Between 2000 and 2005, 68 patients were operated by the same surgeon and were all, but five, reviewed retrospectively by an independent examiner.

The study of the 184 osteotomies performed (of which 177 Weil osteotomies), made use of clinical, and radiological computerised analysis.

Results: We have not been able to find a significant correlation between a harmonious curve of Maestro and postoperative recurrence or transfert metatarsalgia.

Discussion: The cause of transfert metatarsalgia is often hard to find. Known, and so evitable, are important shortening and a fault in the preoperative adjustment. Despite a precise preoperative planning and a perfectly performed surgical technique, the surgeon sometimes encounters the development of plantar callosities beneath metatarsal heads adjacent to the operated ones. Lots of variables are still unknown or not recognised: mobility at the Lisfranc, gastrocnemius retraction.

We have noted a significant relationship between the preoperative (in-)stability and the risk of developing transfert metatarsalgia (p-value = 0.03). A metatarso-phalangeal articulation, unstable in the preop setting, has 0.36 times less the risk of leading to this complication than if the operation was performed on a stable articulation preoperatively. A stable articulation would so be an indirect sign of a good tolerance by the adjacent rays.

Conclusion: One can question if the reconstruction of an architectural harmonious forefoot using the ideal curve of Maestro at any price is necessary, since we were not able do demonstrate a guaranteed postoperative pain relief. A respect of the so-called ideal morphotype of the forefoot on the dorsoplantar upright X-rays seems insufficient in the assurance of a balanced distribution of plantar pressures postoperatively. Certainly, this morphotype most probably avoids an elevated rate of complications, but may not be considered as the only criteria to be achieved.

The clinical examination stays the most essential element. Only the preoperatively symptomatic and unstable metatarsals should probably undergo this osteotomy.

Background: Iatrogenic hallux varus is a very disappointing potential complication following hallux valgus surgery. Depending on its clinical and radiological form, a possible surgical technique is the reconstruction of the lateral components of the first metatarsophalangeal joint.

Methods: A new surgical technique of ligamentoplasty based upon the use of the abductor hallucis tendon is described. The new method was applied in 5 patients (6 feet) with a mean follow-up of 25.8 months. Four hallux varus deformities were operated by only the transplant of the abductor hallucis tendon and two were associated with the use of an osseous buttress.

Results: We found a radiographic correction of most of the factors considered as being at the origin of the iatrogenically induced deformity. All of our patients considered the result as very good and no complications were noticed.

Conclusion: This new technique is a reliable, anatomic reconstruction with the use of the tendon participating in the physiopathology of the hallux varus deformity. No other functional tendon is harvested.

Discussion: Total ankle replacement shows continuous progress. Many implants are proposed to the surgeon. The purpose of this study is to evaluate the matching between the components and the anatomy on different levels of tibial cut.

Methods: 18 cadaveric distal tibias were cut at a distance of 0, 3, 6 and 9 mm from the joint space. The mediolateral and anteroposteriror length were measured; and the surface as well. These same measurements were performed to the tibial components of 5 different prosthesis (AES®, Hintegra®, Mobility®, Salto®, Star®). For each tibial cut, we selected tibial components that matched the mediolateral length. Then, these components were classified in function of their anterioposterior matching for the different levels of cut.

Results: We showed that some components are more universal than the others because of a maximal contact surface and an anteroposterior cortical support.

Conclusion: The longevity of the TAA depends on the stress forces, the matching surface, the components coating and the bone quality. This is a preliminary study wich certainly needs to take into consideration with others factors like occurrence or absence of stabilizing keel and differents methods of component fixation.

Purpose of the study: Frequently described in pediatric orthopedics, supramalleolar osteotomies are theoretically logical in adults, but relatively little studied.

Material and methods: Supramalleolar osteotomy was performed for misaligned callus formation or secondary osteoarthrtitis of the ankle joint in fourteen patients in our institution since 1987. Among these fourteen patients, nine were reviewed, of which three underwent surgery for misaligned callus of the distal third of the tibia measuring more than six degrees and asymptomatic at the time of surgery. The six other patients suffered pain with associated tibiotalar osteoarthritis for four. These six patients also underwent surgery. The nine patients were reviewed clinically and radiographially.

Results: Mean follow-up was 53 months (range 6–202 months). Mean time to bone healing measured radiographically was 12.2 weeks (range 9–18 weeks). The difference in time to healing between closed and open wedge osteotomies was not significant (p=0.1, Student’s test). The difference in the preoperative AOFAS score compared with the last follow-up score was statistically significant (p=0.01) with an improvement in the AOFAS pain score (p=0.03). Function scores of open and closed wedge osteotomies were not statistically different (p=0.5). In the four patients who presented ankle osteoarthritis at the time of surgery, there was no postoperative progression of the joint degradation. Conversely, in two patients whose joint was free of signs of osteoarthritis at the time of surgery, stage I signs appeared. These two patients were reviewed at 46 and 202 months respectively from the osteotomy which in both cases had been performed to prevent the supposedly deleterious effect of a distal tibial callus misaligned 10°.

Conclusion: Open and closed wedge supramalleolar osteotomies are the preferred procedure for distal tibial callus misalignment measuring more than 10° with the reservation that the underlying joints are sufficiently mobile, the advantage of osteotomy over arthrodesis being closely related to this factor. Arthrodesis might however be considered if joint pain predominates the clinical picture.

Purpose: Dwyer osteotomy remains controversial as shown by the numerous series reported. Conclusions have varied and there is no real consensus. The cause of these divergent opinions is related to the variability of indications (association or not with active neurological disease) and surgical schools. Interpretation of outcome and comparisons are hindered.

Material and methods: We reviewed 22 cases of Dwyer osteotomy of the calcaneum performed between 1972 and 2002. The lateral approach was used for closed osteotomy. Mean follow-up was ten years (1–30). Patients were aged 8 to 55 years. The objective and subjective rating system of Laaveg and Panseti (1980) was used. Indications were: neurological pes cavus (n=13) including five unilateral and four bilateral cases, pes equinovarus sequela of clubfoot (n=n=2), idiopathic varus of the hindfood with ankle instability (n=5), posttraumatic varus sequela of a compartment syndrome (n=2).

Discussion: Dwyer osteotomy is rarely performed alone and is frequently associated with other interventions (tendon lengthening and transfer, forefoot procedure, toe procedure) making it difficult to interpret results. Our study was not designed to draw definitive conclusion but rather to compare our indications and results with earlier reports.

Conclusion: Dwyer osteotomy performed with a rigorous technique appears to be an effective means for correcting constitutional varus. The site of the osteotomy and bone resection are particularly important. There are few complications. Bone healing is generally achieved. The procedure is an excellent solution for patients with associated ankle instability because it provides an easy and effective way to correct moderate varus. It is also a good solution for revision of clubfoot when aponeurotic and tendon release is also indicated. Results are insufficient for neurological pes cavus when there is residual or active tendon imbalance. It can however be a temporary solution in the young patient who will undergo arthrodesis later.

Purpose: We are often tempted to set aside (forget?) a certain number of cases we treated during our “learning curve”. We decided to review our first 56 cases of Scarf osteotomies five years after surgery. We detailed outcome, failures, and current modifications of the surgical technique.

Material and methods: End 1991 beginning 1992, we performed Scarf osteotomy on the first metatarsal in 56 feet for correction of hallux valgus in 33 patients aged 22 to 73 yeas (mean 49.7 years). Metatarso-phalangeal deviation of the first row was 20° to 70° (mean 38.5°) associated with metatarus varus from 12° to 24° (mean 16.6°). There were seven types of hallus valgus. Sesamoid deviation was classed in five categories. There were 20, 15 and 19 Greek, square and Egyptian feet respectively. Associated procedures included 26 osteotomies of the first phalanx of the great toe: twelve for angulation, ten for shortening, and six for angulation and shortening. For the other rows, there were five Gauthier osteotomies of the neck of the second metatarsal for overload syndrome of the second row and one Gauthier osteotomy of the second and third metatarsals for metatarso-phalangeal dislocation.

Results: The patient-assessed subjective result deteriorated with time: excellent 36 (64.2%), good 18 (32.1%), fair 2 (3.7%) at one year and excellent 32 (57.2%), good 15 (26.7%), fair 7 (12.5%), mediocre 1 (2.6%) at five years. Objective results for deformations were: postoperative metatarso-phalangeal angle of the first row 10° to 35° (mean 19°) and metatarsus varus 10° to 18° (mean 11.3°). The morphological result was practically acquired at one year, there was little further accentuation of the deformation with time. There was a clear improvement of the sesamoid position. These positive results cannot mask seven cases with angles of 30° and three with 35°. There was no case of hallux varus in this series. There were two “failures” requiring revision, one for recurrent and bothersome bone deformation and the other for metatarsalgia that developed only after correction of the hallux valgus.

Discussion, conclusion: This review disclosed two problems: insufficient correction and the development of postoperative metatarsalgia. The defective corrections were attributed to insufficient translation in the early cases and to the osteotomy which did not lower (or even raise) the metatarsal head. We have changed the osteotomy line in order to widen the translation surface and also to lower more the metatarsal head.