Treatment of metatarsalgia based on claw toe deformity through soft tissue release of the metatarsophalangeal joint and resection of the proximal interphalangeal joint: Evaluation based on foot kinematics and plantar pressure distribution

INTRODUCTION: This study investigated the effect of operative claw toe correction with release of the metatarsophalangeal (MTP) joint, repositioning of the plantar fat pad and resection of the proximal interphalangeal joint on foot kinematics, plantar pressure distribution and Foot Function Index (FFI). METHODS: Prospective experimental study with pretest-posttest design. The plantar pressure, 3D foot kinematics and the FFI of 15 patients with symptomatic claw toes were measured three months before and 12months after surgery. Mean pressure, peak pressure and pressure time integral per sensor and various foot angles were calculated for the pre- and posttest and compared to a control group (N=15). RESULTS: Claw toe patients have increased pressure under the distal part of the metatarsal head and less pressure under the proximal part of the metatarsal heads compared to healthy controls. After surgery, there was a redistribution of pressure, resulting in a significant decrease of pressure under the distal part and an increase under the proximal part of the metatarsal head, providing a more equal plantar pressure distribution. Except for some small areas under the forefoot, heel and toes, there were no significant differences in pressure distribution between the operated feet and controls. Small, but significant differences between the pre- and postoperative condition were found for the lateral arch angle, calcaneus/malleolus supination and tibio-talar flexion. The score on the FFI improved statistically significant. DISCUSSION: These findings imply that the present operative procedure results in a more equal distribution of the plantar pressure under the forefoot and decrease of pain and offers successful treatment of metatarsalgia based on claw toe deformity.status: publishe

The concurrent validity and reliability of virtual reality to measure shoulder flexion and scaption range of motion

Background Shoulder pain commonly has a detrimental impact on patient’s work and social activities. Although pain is the most common reason for seeking care, a reduction in shoulder range of motion (ROM) is another common impairment. ROM assessment is used as an evaluation tool and multiple methods are available to measure shoulder ROM. Virtual reality (VR) has been introduced into shoulder rehabilitation, mostly when exercise and ROM measurement is indicated. This study evaluated the concurrent validity and system reliability of active ROM measurements of VR for people with and without shoulder pain.Methods Forty volunteers participated in this study. Virtual goniometry was used to assess active shoulder ROM. Participants performed flexion and scaption to six predetermined angles. Measurements from the VR goniometer and smartphone inclinometers were recorded simultaneously. To assess reliability, two identical test sequences were performed.Results The concurrent validity ICCs were 0.93 for shoulder flexion and 0.94 for shoulder scaption. The VR goniometer application on average systematically overestimated the ROM compared to the smartphone inclinometer. The mean difference between goniometer values was −11.3 degrees for flexion and −10.9 for scaption. The system reliability was excellent with an overall ICC of 0.99 for the flexion movements and 0.99 for the scaption movements.Conclusion Although the VR system demonstrated excellent reliability, and high ICC’s for concurrent validity, the large range between the lower and upper 95% CI limits suggests it lacks measurement precision. This suggests VR, as used in this study, should not be used interchangeably with other measurement tools.</p

Measuring equipment used in the Netherlands (<b>Figure 1A</b>) and in Malawi (<b>Figure 1B</b>).

<p>Abbreviations used in <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0057209#pone-0057209-g001" target="_blank">Figure 1B:</a> A = board for placement of the feet, B = board for placement of the camera,1 = longitudinal line, 2 = mediolateral line</p

Static foot geometry.

<p><a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0057209#pone-0057209-g002" target="_blank">Figure 2A:</a> Medial Angle. Angle between the center of the medial malleolus, the navicular tuberculum and the medial center of the first distal metatarsal head. <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0057209#pone-0057209-g002" target="_blank">Figure 2B:</a> Navicular height/foot length ratio.</p

Mean plantar pressure.

<p>Left panel: The MP distribution for the Malawian group; middle panel: The MP distribution for the Dutch group; Right panel: The difference in MP between the Malawian and Dutch group. The coloured squares indicate that the MP is statistically different (p<0.007) between the groups and the black small lines indicate that the groups were not significantly different. Note that for both groups only pixels are shown with a mean output above 0.5N</p

Trajectory of the Center of Pressure.

<p>Upper left panel: the MP distribution for the Dutch group including the CoP path of the Dutch and Malawian group. Upper right panel: Difference in relative vCoP: Malawi group minus Dutch. Lower panels: the difference in CoP path for the mediolateral (left panel) and anteroposterior (right panel) direction. The red bars indicate that the CoP path/vCoP differs significantly between both groups.</p