The forefoot is the anterior aspect of the foot, composed of the five metatarsal bones, the fourteen phalanges and associated soft tissue structures. [1] [2] It is a common site of pathology in podiatry, and is the anatomic region involved in such conditions as hallux valgus, hallux rigidus, and Morton's neuroma, among others. [3] In cases of severe deformity, such as in Charcot joints seen with diabetic neuropathy, the forefoot can be reconstructed by arthroplasty. [4]
The foot is an anatomical structure found in many vertebrates. It is the terminal portion of a limb which bears weight and allows locomotion. In many animals with feet, the foot is a separate organ at the terminal part of the leg made up of one or more segments or bones, generally including claws and/or nails.
Toes are the digits of the foot of a tetrapod. Animal species such as cats that walk on their toes are described as being digitigrade. Humans, and other animals that walk on the soles of their feet, are described as being plantigrade; unguligrade animals are those that walk on hooves at the tips of their toes.
A bunion, also known as hallux valgus, is a deformity of the joint connecting the big toe to the foot. The big toe often bends towards the other toes and the joint becomes red and painful. The onset of bunions is typically gradual. Complications may include bursitis or arthritis.
Clubfoot is a congenital or acquired defect where one or both feet are rotated inward and downward. Congenital clubfoot is the most common congenital malformation of the foot with an incidence of 1 per 1000 births. In approximately 50% of cases, clubfoot affects both feet, but it can present unilaterally causing one leg or foot to be shorter than the other. Most of the time, it is not associated with other problems. Without appropriate treatment, the foot deformity will persist and lead to pain and impaired ability to walk, which can have a dramatic impact on the quality of life.
A varus deformity is an excessive inward angulation of the distal segment of a bone or joint. The opposite of varus is called valgus. Ex: Varus deformity results in a decreased Q angle of the knee joint.
A valgus deformity is a condition in which the bone segment distal to a joint is angled outward, that is, angled laterally, away from the body's midline. The opposite deformation, where the twist or angulation is directed medially, toward the center of the body, is called varus. Common causes of valgus knee in adults include arthritis of the knee and traumatic injuries.
Knee replacement, also known as knee arthroplasty, is a surgical procedure to replace the weight-bearing surfaces of the knee joint to relieve pain and disability, most commonly offered when joint pain is not diminished by conservative sources. It may also be performed for other knee diseases, such as rheumatoid arthritis. In patients with severe deformity from advanced rheumatoid arthritis, trauma, or long-standing osteoarthritis, the surgery may be more complicated and carry higher risk. Osteoporosis does not typically cause knee pain, deformity, or inflammation, and is not a reason to perform knee replacement.
Replacement arthroplasty, or joint replacement surgery, is a procedure of orthopedic surgery in which an arthritic or dysfunctional joint surface is replaced with an orthopedic prosthesis. Joint replacement is considered as a treatment when severe joint pain or dysfunction is not alleviated by less-invasive therapies. It is a form of arthroplasty, and is often indicated from various joint diseases, including osteoarthritis and rheumatoid arthritis.
Hallux rigidus or stiff big toe is degenerative arthritis and stiffness due to bone spurs that affects the metatarsophalangeal joints (MTP) at the base of the hallux.
The Hubscher maneuver is a method of evaluating the flexibility of a pes planus or flat foot type. The test is performed with the patient weight bearing, with the foot flat on the ground, while the clinician dorsiflexes the hallux and watches for an increasing concavity of the Arches of the foot. A positive result results from the flatfoot being flexible. A negative result results from the flatfoot being rigid. In a Jack's test, the patient raises the rearfoot off the ground, thus passively dorsiflexing the hallux in Closed Kinetic Chain. This will result in an increase of the arch height in cases of Dynamic (Flexible) Flat Foot. If the deformity is a Static (rigid) Flat foot, the height of the arch will be unaffected by raising up the heel on the forefoot.
Hallux varus is a deformity of the great toe joint where the hallux is deviated medially away from the first metatarsal bone. The hallux usually moves in the transverse plane. Unlike hallux valgus, also known as hallux abducto valgus or bunion, hallux varus is uncommon in the West but it is common in cultures where the population remains unshod.
Foot and ankle surgery is a sub-specialty of orthopedics and podiatry that deals with the treatment, diagnosis and prevention of disorders of the foot and ankle. Orthopaedic surgeons are medically qualified, having been through four years of college, followed by 4 years of medical school or osteopathic medical school to obtain an M.D. or D.O. followed by specialist training as a resident in orthopaedics, and only then do they sub-specialise in foot and ankle surgery. Training for a podiatric foot and ankle surgeon consists of four years of college, four years of podiatric medical school (D.P.M.), 3–4 years of a surgical residency and an optional 1 year fellowship.
Ankle replacement, or ankle arthroplasty, is a surgical procedure to replace the damaged articular surfaces of the human ankle joint with prosthetic components. This procedure is becoming the treatment of choice for patients requiring arthroplasty, replacing the conventional use of arthrodesis, i.e. fusion of the bones. The restoration of range of motion is the key feature in favor of ankle replacement with respect to arthrodesis. However, clinical evidence of the superiority of the former has only been demonstrated for particular isolated implant designs.
Pigeon toe, also known as in-toeing, is a condition which causes the toes to point inward when walking. It is most common in infants and children under two years of age and, when not the result of simple muscle weakness, normally arises from underlying conditions, such as a twisted shin bone or an excessive anteversion resulting in the twisting of the thigh bone when the front part of a person's foot is turned in.
Orthotics is a medical specialty that focuses on the design and application of orthoses, or braces. An orthosis is "an externally applied device used to influence the structural and functional characteristics of the neuromuscular and skeletal systems." Orthotists are professionals who specialize in designing these braces.
Locomotor effects of shoes are the way in which the physical characteristics or components of shoes influence the locomotion neuromechanics of a person. Depending on the characteristics of the shoes, the effects are various, ranging from alteration in balance and posture, muscle activity of different muscles as measured by electromyography (EMG), and the impact force. There are many different types of shoes that exist, such as running, walking, loafers, high heels, sandals, slippers, work boots, dress shoes, and many more. However, a typical shoe will be composed of an insole, midsole, outsole, and heels, if any. In an unshod condition, where one is without any shoes, the locomotor effects are primarily observed in the heel strike patterns and resulting impact forces generated on the ground.
Syndesmosis procedure is one of the more than twenty bunion surgeries currently being performed. While the majority of bunion surgeries involve the breaking and shifting of bones, syndesmosis procedure is one of few surgical techniques that use a soft-tissue or non-osteotomy (non-bone-breaking) approach to afford the same correction. More than 130 different surgical techniques have been described for correction of one single condition of the foot: the bunion deformity.
Orthopedic surgery is the branch of surgery concerned with conditions involving the musculoskeletal system. Orthopedic surgeons use both surgical and nonsurgical means to treat musculoskeletal injuries, sports injuries, degenerative diseases, infections, bone tumours, and congenital limb deformities. Trauma surgery and traumatology is a sub-specialty dealing with the operative management of fractures, major trauma and the multiply-injured patient.
Philip Radovic, D.P.M., is a professor and podiatric surgeon practicing in South Orange County, California.
Treace Medical Concepts, Inc. is a medical device company, headquartered in Ponte Vedra Beach, Florida, specializing in the design, manufacture, and marketing of foot and ankle surgical devices and biologics. Lapiplasty, Treace’s novel primary surgical product, advanced the treatment of bunions, surgically correcting the metatarsal bone, for the first time, in all three dimensions.