Metatarsal Bones
Tarsal Bones
Metatarsalgia
Metatarsophalangeal Joint
Tarsal Joints
Bone and Bones
Fractures, Stress
Hallux Valgus
Bone Remodeling
Bone Density
Foot Deformities
Toe Joint
Patterns of weight distribution under the metatarsal heads. (1/165)
The longitudinal arch between the heel and the forefoot and the transverse arch between the first and fifth metatarsal heads, absorb shock, energy and force. A device to measure plantar pressure was used in 66 normal healthy subjects and in 294 patients with various types of foot disorder. Only 22 (3%) of a total of 720 feet, had a dynamic metatarsal arch during the stance phase of walking, and all had known abnormality. Our findings show that there is no distal transverse metatarsal arch during the stance phase. This is important for the classification and description of disorders of the foot. (+info)Fractures of the proximal fifth metatarsal. (2/165)
Fractures of the proximal portion of the fifth metatarsal may be classified as avulsions of the tuberosity or fractures of the shaft within 1.5 cm of the tuberosity. Tuberosity avulsion fractures cause pain and tenderness at the base of the fifth metatarsal and follow forced inversion during plantar flexion of the foot and ankle. Local bruising, swelling and other injuries may be present. Nondisplaced tuberosity fractures are usually treated conservatively, but orthopedic referral is indicated for fractures that are comminuted or displaced, fractures that involve more than 30 percent of the cubo-metatarsal articulation surface and fractures with delayed union. Management and prognosis of both acute (Jones fracture) and stress fracture of the fifth metatarsal within 1.5 cm of the tuberosity depend on the type of fracture, based on Torg's classification. Type I fractures are generally treated conservatively with a nonweight-bearing short leg cast for six to eight weeks. Type II fractures may also be treated conservatively or may be managed surgically, depending on patient preference and other factors. All displaced fractures and type III fractures should be managed surgically. Although most fractures of the proximal portion of the fifth metatarsal respond well to appropriate management, delayed union, muscle atrophy and chronic pain may be long-term complications. (+info)Parathyroid hormone-related peptide (PTHrP)-dependent and -independent effects of transforming growth factor beta (TGF-beta) on endochondral bone formation. (3/165)
Previously, we showed that expression of a dominant-negative form of the transforming growth factor beta (TGF-beta) type II receptor in skeletal tissue resulted in increased hypertrophic differentiation in growth plate and articular chondrocytes, suggesting a role for TGF-beta in limiting terminal differentiation in vivo. Parathyroid hormone-related peptide (PTHrP) has also been demonstrated to regulate chondrocyte differentiation in vivo. Mice with targeted deletion of the PTHrP gene demonstrate increased endochondral bone formation, and misexpression of PTHrP in cartilage results in delayed bone formation due to slowed conversion of proliferative chondrocytes into hypertrophic chondrocytes. Since the development of skeletal elements requires the coordination of signals from several sources, this report tests the hypothesis that TGF-beta and PTHrP act in a common signal cascade to regulate endochondral bone formation. Mouse embryonic metatarsal bone rudiments grown in organ culture were used to demonstrate that TGF-beta inhibits several stages of endochondral bone formation, including chondrocyte proliferation, hypertrophic differentiation, and matrix mineralization. Treatment with TGF-beta1 also stimulated the expression of PTHrP mRNA. PTHrP added to cultures inhibited hypertrophic differentiation and matrix mineralization but did not affect cell proliferation. Furthermore, terminal differentiation was not inhibited by TGF-beta in metatarsal rudiments from PTHrP-null embryos; however, growth and matrix mineralization were still inhibited. The data support the model that TGF-beta acts upstream of PTHrP to regulate the rate of hypertrophic differentiation and suggest that TGF-beta has both PTHrP-dependent and PTHrP-independent effects on endochondral bone formation. (+info)FGF signaling inhibits chondrocyte proliferation and regulates bone development through the STAT-1 pathway. (4/165)
Several genetic forms of human dwarfism have been linked to activating mutations in FGF receptor 3, indicating that FGF signaling has a critical role in chondrocyte maturation and skeletal development. However, the mechanisms through which FGFs affect chondrocyte proliferation and differentiation remain poorly understood. We show here that activation of FGF signaling inhibits chondrocyte proliferation both in a rat chondrosarcoma (RCS) cell line and in primary murine chondrocytes. FGF treatment of RCS cells induces phosphorylation of STAT-1, its translocation to the nucleus, and an increase in the expression of the cell-cycle inhibitor p21WAF1/CIP1. We have used primary chondrocytes from STAT-1 knock-out mice to provide genetic evidence that STAT-1 function is required for the FGF mediated growth inhibition. Furthermore, FGF treatment of metatarsal rudiments from wild-type and STAT-1(-/-) murine embryos produces a drastic impairment of chondrocyte proliferation and bone development in wild-type, but not in STAT-1(-/-) rudiments. We propose that STAT-1 mediated down regulation of chondrocyte proliferation by FGF signaling is an homeostatic mechanism which ensures harmonious bone development and morphogenesis. (+info)Intermediate-term outcome of primary digit amputations in patients with diabetes mellitus who have forefoot sepsis requiring hospitalization and presumed adequate circulatory status. (5/165)
PURPOSE: The intermediate success and outcome of primary forefoot amputations in patients with diabetes mellitus who have sepsis limited to the forefoot and presumed adequate forefoot perfusion, as determined by means of noninvasive methods, was studied. METHODS: Cases of a university hospital-based practice from January 1984 to April 1998 were retrospectively reviewed. Patients included had diabetes mellitus with forefoot sepsis requiring immediate hospitalization for digit amputations who had adequate arterial circulation for healing based on noninvasive and clinical assessment: palpable pedal pulses (29%), "compressible" ankle pressure of 70 mm Hg or higher (48%), pulsatile metatarsal waveforms (67%), and/or toe pressure higher than 55 mm Hg (36%). All patients underwent a primary single- or multiple-digit amputation (through the interphalangeal joint, metatarsal head, or metatarsal shaft). Additional forefoot procedures (debridement, digit amputation) were performed during the follow-up period as needed for persistent or recurrent infection. The main outcome variables were recurrent or persistent foot infection (defined as requiring rehospitalization for antibiotics, wound care, and/or reoperation), the number of repeat operations and hospitalizations for salvage of limbs with recurrent or persistent infections, and time to complete forefoot healing or foot amputation. RESULTS: Ninety-two patients who had diabetes mellitus with 97 forefoot infections comprised the study group. Ninety-seven primary digit amputations (34 through interphalangeal joints, 28 through metatarsal heads, 35 through metatarsal shafts) were performed. The median length of hospital stay was 10 days. There were no operative deaths. The mean follow-up period was 21 months (range, 3 days to 105 months). The primary amputation healed (without persistent infection) in only 38 limbs (39%), at a mean time of 13 +/- 10 weeks. Twenty-three limbs (24%) had not healed the primary amputation without evidence of persistent infection at last follow-up (mean, 12 weeks). Infection persisted in 35 limbs (36%), and infection recurred in 15 of 38 (40%) healed limbs. An average of 1.0 reoperations (range, 0 to 3) and 1.6 rehospitalizations (range, 1 to 4) were involved in salvage attempts in these recurrent/persistent infections. Five persistent and five recurrent infections ultimately healed (mean, 53 weeks). Complete healing was achieved in only 33 of 97 limbs (34%). Twenty-two foot amputations (20 transtibial, two Syme's) were performed (mean, 49 +/- 74 weeks; 20 for persistent infection). Eighteen persistent/recurrent infections remained unhealed at the last follow-up examination (mean, 105 weeks). CONCLUSION: Patients with diabetes mellitus who have sepsis limited to the forefoot requiring acute hospitalization and undergoing primary digit amputations have a high incidence of intermediate-term, persistent, and recurrent infection, leading to a modest rate of limb loss, despite having apparently salvageable lesions and noninvasive evidence of presumed adequate forefoot perfusion. (+info)A densitometric analysis of the human first metatarsal bone. (6/165)
Bone responds to the stresses placed on it by remodeling its structure, which includes shape, trabecular distribution and density distribution. We studied 49 pairs of cadaveric human 1st metatarsal bones in an attempt to establish the pattern of density distribution and to correlate it with the biomechanical function of the bone. We found that the head is denser than the base, the dorsal portion of the whole metatarsal is denser than the plantar portion and the lateral portion of the whole metatarsal is denser than the medial aspect. The same pattern of density with respect to dorsal vs plantar and lateral vs medial was also seen in the head when it was examined alone. When we compared the 4 portions of the head with the same portion of the metatarsal as a whole we found that only the medial portion of the head was less dense than its respective portion of the whole metatarsal. All of these patterns of density distribution are consistent with respect to age, sex and laterality. We have also hypothesised as to the relationship between density distribution seen both in the whole metatarsal and in the metatarsal head and their biomechanical function in the gait cycle. (+info)Total dislocations of the navicular: are they ever isolated injuries? (7/165)
Isolated dislocations of the navicular are rare injuries; we present our experience of six cases in which the navicular was dislocated without fracture. All patients had complex injuries, with considerable disruption of the midfoot. Five patients had open reduction and stabilisation with Kirschner wires. One developed subluxation and deformity of the midfoot because of inadequate stabilisation of the lateral column, and there was one patient with ischaemic necrosis. We believe that the navicular cannot dislocate in isolation because of the rigid bony supports around it; there has to be significant disruption of both longitudinal columns of the foot. Most commonly, an abduction/pronation injury causes a midtarsal dislocation, and on spontaneous reduction the navicular may dislocate medially. This mechanism is similar to a perilunate dislocation. Stabilisation of both medial and lateral columns of the foot may sometimes be essential for isolated dislocations. In spite of our low incidence of ischaemic necrosis, there is always a likelihood of this complication. (+info)Autologous morsellised bone grafting restores uncontained femoral bone defects in knee arthroplasty. An in vivo study in horses. (8/165)
The properties of impacted morsellised bone graft (MBG) in revision total knee arthroplasty (TKA) were studied in 12 horses. The left hind metatarsophalangeal joint was replaced by a human TKA. The horses were then randomly divided into graft and control groups. In the graft group, a unicondylar, lateral uncontained defect was created in the third metatarsal bone and reconstructed using autologous MBG before cementing the TKA. In the control group, a cemented TKA was implanted without the bone resection and grafting procedure. After four to eight months, the animals were killed and a biomechanical loading test was performed with a cyclic load equivalent to the horse's body-weight to study mechanical stability. After removal of the prosthesis, the distal third metatarsal bone was studied radiologically, histologically and by quantitative and micro CT. Biomechanical testing showed that the differences in deformation between the graft and the control condyles were not significant for either elastic or time-dependent deformations. The differences in bone mineral density (BMD) between the graft and the control condyles were not significant. The BMD of the MBG was significantly lower than that in the other regions in the same limb. Micro CT showed a significant difference in the degree of anisotropy between the graft and host bone, even although the structure of the area of the MBG had trabecular orientation in the direction of the axial load. Histological analysis revealed that all the grafts were revascularised and completely incorporated into a new trabecular structure with few or no remnants of graft. Our study provides a basis for the clinical application of this technique with MBG in revision TKA. (+info)The metatarsal bones are a group of five long bones in the foot that connect the tarsal bones in the hindfoot to the phalanges in the forefoot. They are located between the tarsal and phalangeal bones and are responsible for forming the arch of the foot and transmitting weight-bearing forces during walking and running. The metatarsal bones are numbered 1 to 5, with the first metatarsal being the shortest and thickest, and the fifth metatarsal being the longest and thinnest. Each metatarsal bone has a base, shaft, and head, and they articulate with each other and with the surrounding bones through joints. Any injury or disorder affecting the metatarsal bones can cause pain and difficulty in walking or standing.
The metatarsus is the region in the foot between the tarsal bones (which form the hindfoot and midfoot) and the phalanges (toes). It consists of five long bones called the metatarsals, which articulate with the tarsal bones proximally and the phalanges distally. The metatarsus plays a crucial role in weight-bearing, support, and propulsion during walking and running. Any abnormalities or injuries to this region may result in various foot conditions, such as metatarsalgia, Morton's neuroma, or hammertoes.
The tarsal bones are a group of seven articulating bones in the foot that make up the posterior portion of the foot, located between the talus bone of the leg and the metatarsal bones of the forefoot. They play a crucial role in supporting the body's weight and facilitating movement.
There are three categories of tarsal bones:
1. Proximal row: This includes the talus, calcaneus (heel bone), and navicular bones. The talus articulates with the tibia and fibula to form the ankle joint, while the calcaneus is the largest tarsal bone and forms the heel. The navicular bone is located between the talus and the cuneiform bones.
2. Intermediate row: This includes the cuboid bone, which is located laterally (on the outside) to the navicular bone and articulates with the calcaneus, fourth and fifth metatarsals, and the cuneiform bones.
3. Distal row: This includes three cuneiform bones - the medial, intermediate, and lateral cuneiforms - which are located between the navicular bone proximally and the first, second, and third metatarsal bones distally. The medial cuneiform is the largest of the three and articulates with the navicular bone, first metatarsal, and the intermediate cuneiform. The intermediate cuneiform articulates with the medial and lateral cuneiforms and the second metatarsal. The lateral cuneiform articulates with the intermediate cuneiform, cuboid, and fourth metatarsal.
Together, these bones form a complex network of joints that allow for movement and stability in the foot. Injuries or disorders affecting the tarsal bones can result in pain, stiffness, and difficulty walking.
Metatarsalgia is a general term used to describe pain and inflammation in the ball of the foot (the metatarsal region). This is often caused by excessive pressure or stress on the metatarsal heads, usually due to factors such as poor foot mechanics, high-impact activities, or ill-fitting shoes. The pain can range from mild discomfort to sharp, intense sensations, and may be accompanied by symptoms like tingling, numbness, or burning in the toes. It's important to note that metatarsalgia is not a specific diagnosis but rather a symptom of an underlying issue, which should be evaluated and treated by a healthcare professional.
The metatarsophalangeal (MTP) joint is the joint in the foot where the metatarsal bones of the foot (the long bones behind the toes) connect with the proximal phalanges of the toes. It's a synovial joint, which means it's surrounded by a capsule containing synovial fluid to allow for smooth movement. The MTP joint is responsible for allowing the flexion and extension movements of the toes, and is important for maintaining balance and pushing off during walking and running. Issues with the MTP joint can lead to conditions such as hallux valgus (bunions) or hammertoe.
The tarsal joints are a series of articulations in the foot that involve the bones of the hindfoot and midfoot. There are three main tarsal joints:
1. Talocrural joint (also known as the ankle joint): This is the joint between the talus bone of the lower leg and the tibia and fibula bones of the lower leg, as well as the calcaneus bone of the foot. It allows for dorsiflexion and plantarflexion movements of the foot.
2. Subtalar joint: This is the joint between the talus bone and the calcaneus bone. It allows for inversion and eversion movements of the foot.
3. Tarsometatarsal joints (also known as the Lisfranc joint): These are the joints between the tarsal bones of the midfoot and the metatarsal bones of the forefoot. They allow for flexion, extension, abduction, and adduction movements of the foot.
These joints play an important role in the stability and mobility of the foot, allowing for various movements during activities such as walking, running, and jumping.
Medical professionals define "flatfoot" or "pes planus" as a postural deformity in which the arch of the foot collapses, leading to the entire sole of the foot coming into complete or near-complete contact with the ground. This condition can be classified as flexible (the arch reappears when the foot is not bearing weight) or rigid (the arch does not reappear). Flatfoot can result from various factors such as genetics, injury, aging, or certain medical conditions like rheumatoid arthritis and cerebral palsy. In some cases, flatfoot may not cause any symptoms or problems; however, in other instances, it can lead to pain, discomfort, or difficulty walking. Treatment options for flatfoot depend on the severity of the condition and associated symptoms and may include physical therapy, orthotics, bracing, or surgery.
"Bone" is the hard, dense connective tissue that makes up the skeleton of vertebrate animals. It provides support and protection for the body's internal organs, and serves as a attachment site for muscles, tendons, and ligaments. Bone is composed of cells called osteoblasts and osteoclasts, which are responsible for bone formation and resorption, respectively, and an extracellular matrix made up of collagen fibers and mineral crystals.
Bones can be classified into two main types: compact bone and spongy bone. Compact bone is dense and hard, and makes up the outer layer of all bones and the shafts of long bones. Spongy bone is less dense and contains large spaces, and makes up the ends of long bones and the interior of flat and irregular bones.
The human body has 206 bones in total. They can be further classified into five categories based on their shape: long bones, short bones, flat bones, irregular bones, and sesamoid bones.
Stress fractures are defined as small cracks or severe bruising in bones that occur from repetitive stress or overuse. They most commonly occur in weight-bearing bones, such as the legs and feet, but can also occur in the arms, hips, and back. Stress fractures differ from regular fractures because they typically do not result from a single, traumatic event. Instead, they are caused by repeated stress on the bone that results in microscopic damage over time. Athletes, military personnel, and individuals who engage in high-impact activities or have weak bones (osteoporosis) are at increased risk of developing stress fractures. Symptoms may include pain, swelling, tenderness, and difficulty walking or bearing weight on the affected bone.
A growth plate, also known as an epiphyseal plate or physis, is a layer of cartilaginous tissue found near the ends of long bones in children and adolescents. This region is responsible for the longitudinal growth of bones during development. The growth plate contains actively dividing cells that differentiate into chondrocytes, which produce and deposit new matrix, leading to bone elongation. Once growth is complete, usually in late adolescence or early adulthood, the growth plates ossify (harden) and are replaced by solid bone, transforming into the epiphyseal line.
Hallux Valgus is a medical condition that affects the foot, specifically the big toe joint. It is characterized by the deviation of the big toe (hallux) towards the second toe, resulting in a prominent bump on the inner side of the foot at the base of the big toe. This bump is actually the metatarsal head of the first bone in the foot that becomes exposed due to the angulation.
The deformity can lead to pain, stiffness, and difficulty wearing shoes. In severe cases, it can also cause secondary arthritis in the joint. Hallux Valgus is more common in women than men and can be caused by genetic factors, foot shape, or ill-fitting shoes that put pressure on the big toe joint.
"Hallux" is a medical term that refers to the big toe or great toe, which is the first digit of the human foot. It is derived from Latin, where "hallus" means "big toe." In some contexts, specific pathologies or conditions related to the big toe may also be referred to as hallux issues, such as hallux valgus (a common foot deformity where the big toe drifts toward the second toe) or hallux rigidus (a form of degenerative arthritis that affects the big toe joint).
Bone remodeling is the normal and continuous process by which bone tissue is removed from the skeleton (a process called resorption) and new bone tissue is formed (a process called formation). This ongoing cycle allows bones to repair microdamage, adjust their size and shape in response to mechanical stress, and maintain mineral homeostasis. The cells responsible for bone resorption are osteoclasts, while the cells responsible for bone formation are osteoblasts. These two cell types work together to maintain the structural integrity and health of bones throughout an individual's life.
During bone remodeling, the process can be divided into several stages:
1. Activation: The initiation of bone remodeling is triggered by various factors such as microdamage, hormonal changes, or mechanical stress. This leads to the recruitment and activation of osteoclast precursor cells.
2. Resorption: Osteoclasts attach to the bone surface and create a sealed compartment called a resorption lacuna. They then secrete acid and enzymes that dissolve and digest the mineralized matrix, creating pits or cavities on the bone surface. This process helps remove old or damaged bone tissue and releases calcium and phosphate ions into the bloodstream.
3. Reversal: After resorption is complete, the osteoclasts undergo apoptosis (programmed cell death), and mononuclear cells called reversal cells appear on the resorbed surface. These cells prepare the bone surface for the next stage by cleaning up debris and releasing signals that attract osteoblast precursors.
4. Formation: Osteoblasts, derived from mesenchymal stem cells, migrate to the resorbed surface and begin producing a new organic matrix called osteoid. As the osteoid mineralizes, it forms a hard, calcified structure that gradually replaces the resorbed bone tissue. The osteoblasts may become embedded within this newly formed bone as they differentiate into osteocytes, which are mature bone cells responsible for maintaining bone homeostasis and responding to mechanical stress.
5. Mineralization: Over time, the newly formed bone continues to mineralize, becoming stronger and more dense. This process helps maintain the structural integrity of the skeleton and ensures adequate calcium storage.
Throughout this continuous cycle of bone remodeling, hormones, growth factors, and mechanical stress play crucial roles in regulating the balance between resorption and formation. Disruptions to this delicate equilibrium can lead to various bone diseases, such as osteoporosis, where excessive resorption results in weakened bones and increased fracture risk.
Foot injuries refer to any damage or trauma caused to the various structures of the foot, including the bones, muscles, tendons, ligaments, blood vessels, and nerves. These injuries can result from various causes such as accidents, sports activities, falls, or repetitive stress. Common types of foot injuries include fractures, sprains, strains, contusions, dislocations, and overuse injuries like plantar fasciitis or Achilles tendonitis. Symptoms may vary depending on the type and severity of the injury but often include pain, swelling, bruising, difficulty walking, and reduced range of motion. Proper diagnosis and treatment are crucial to ensure optimal healing and prevent long-term complications.
Bone density refers to the amount of bone mineral content (usually measured in grams) in a given volume of bone (usually measured in cubic centimeters). It is often used as an indicator of bone strength and fracture risk. Bone density is typically measured using dual-energy X-ray absorptiometry (DXA) scans, which provide a T-score that compares the patient's bone density to that of a young adult reference population. A T-score of -1 or above is considered normal, while a T-score between -1 and -2.5 indicates osteopenia (low bone mass), and a T-score below -2.5 indicates osteoporosis (porous bones). Regular exercise, adequate calcium and vitamin D intake, and medication (if necessary) can help maintain or improve bone density and prevent fractures.
Foot deformities refer to abnormal changes in the structure and/or alignment of the bones, joints, muscles, ligaments, or tendons in the foot, leading to a deviation from the normal shape and function of the foot. These deformities can occur in various parts of the foot, such as the toes, arch, heel, or ankle, and can result in pain, difficulty walking, and reduced mobility. Some common examples of foot deformities include:
1. Hammertoes: A deformity where the toe bends downward at the middle joint, resembling a hammer.
2. Mallet toes: A condition where the end joint of the toe is bent downward, creating a mallet-like shape.
3. Claw toes: A combination of both hammertoes and mallet toes, causing all three joints in the toe to bend abnormally.
4. Bunions: A bony bump that forms on the inside of the foot at the base of the big toe, caused by the misalignment of the big toe joint.
5. Tailor's bunion (bunionette): A similar condition to a bunion but occurring on the outside of the foot, at the base of the little toe.
6. Flat feet (pes planus): A condition where the arch of the foot collapses, causing the entire sole of the foot to come into contact with the ground when standing or walking.
7. High arches (pes cavus): An excessively high arch that doesn't provide enough shock absorption and can lead to pain and instability.
8. Cavus foot: A condition characterized by a very high arch and tight heel cord, often leading to an imbalance in the foot structure and increased risk of ankle injuries.
9. Haglund's deformity: A bony enlargement on the back of the heel, which can cause pain and irritation when wearing shoes.
10. Charcot foot: A severe deformity that occurs due to nerve damage in the foot, leading to weakened bones, joint dislocations, and foot collapse.
Foot deformities can be congenital (present at birth) or acquired (develop later in life) due to various factors such as injury, illness, poor footwear, or abnormal biomechanics. Proper diagnosis, treatment, and management are essential for maintaining foot health and preventing further complications.
A toe joint, also known as a metatarsophalangeal (MTP) joint, is the articulation between the bones in the foot (metatarsals) and the bones in the toes (phalanges). There are five MTP joints in each foot, one for each toe except for the big toe, which has its own separate joint called the first metatarsophalangeal joint.
The MTP joints allow for movement and flexibility of the toes, enabling activities such as walking, running, and standing. Problems with these joints can lead to pain, stiffness, and difficulty moving, making it important to maintain their health and mobility through proper foot care and exercise.
Callosities are areas of thickened and hardened skin that develop as a result of repeated friction, pressure, or irritation. They typically appear on the hands and feet, particularly on the palms and soles, and can vary in size and shape. Callosities are not harmful but can cause discomfort or pain if they become too thick or develop cracks or sores. They are often seen in people who have jobs or hobbies that involve manual labor or frequent use of their hands, such as musicians, athletes, and construction workers.