Essential Reading

1
Essential Reading

• Why I like it.
• Anatomy
• Good Science
• Good support for treatment methodology

2
Essential Reading

• Authors
• Bossley CJ. Cairney PC.
• Title
• The intermetatarsophalangeal bursa--its
  significance in Morton's metatarsalgia.
• Source
• Journal of Bone Joint Surgery - British Volume.
  62-B(2)184-7, 1980 May.

3
Essential Reading

• Abstract
• The intermetatarsophalangeal bursa was
  investigated by dissection, radiography and
  injection. In the web spaces between the second
  and third and the third and fourth digits the
  bursa lies superior to the transverse metatarsal
  ligament but projects distally to it, closely
  applied to the neurovascular bundle.. It is
  suggested that inflammatory changes in this bursa
  could account for the pathological and
  histological findings in this condition.

4
Essential Reading

• Authors
• Frank PW. Bakkum BW. Darby SA.
• Title
• The communicating branch of the lateral plantar
  nerve a descriptive anatomic study.
• Source
• Clinical Anatomy. 9(4)237-43, 1996.

5
Essential Reading

• Abstract
• Both feet of 40 embalmed human cadavers were
  dissected to show the frequency of occurrence and
  anatomical variation of the communicating branch.
  The communicating branch was present in 66.2 of
  the feet we studied with no large gender-based
  differences. Branches occurred bilaterally in
  52.5 of cadavers, while 27.5 had branches
  unilaterally. The occurrence of this branch does
  not correlate well with the likelihood of
  development of Morton's neuroma. Differences in
  diameter of the communicating branch ranged from
  less than 0.5 mm to as large as the common
  plantar digital nerves themselves, about 2 mm.

6
Essential Reading

• Authors
• Coughlin MJ. Pinsonneault T.
• Title
• Operative treatment of interdigital neuroma. A
  long-term follow-up study.
• Source
• Journal of Bone Joint Surgery - American
  Volume. 83-A(9)1321-8, 2001 Sep.

7
Essential Reading

• Abstract
• Sixty-six (seventy-one feet, seventy-four
  neuromas) returned at an average of 5.8 years for
  a follow-up evaluation. RESULTS Overall
  satisfaction was rated as excellent or good by
  fifty-six (85) of the sixty-six patients.
  Forty-six (65) of the seventy-one feet were
  pain-free at the time of final follow-up.
• CONCLUSION With careful preoperative evaluation
  and patient selection, resection of a symptomatic
  interdigital neuroma through a dorsal approach
  can result in a high percentage of successful
  results more than five years following the
  procedure.

8
Essential Reading

• Authors
• Gaynor R. Hake D. Spinner SM. Tomczak RL.
• Title
• A comparative analysis of conservative versus
  surgical treatment of Morton's neuroma.
• Source
• Journal of the American Podiatric Medical
  Association. 79(1)27-30, 1989 Jan.

9
Essential Reading

• Abstract
• The authors present a study of the treatment of
  Morton's neuroma. Sixty patients, involving 65
  feet treated, were studied. Conservative
  treatments were compared to surgical excision of
  the neuroma. As a result of the findings in this
  study, the authors recommend surgical excision as
  the initial treatment of choice.

10
Essential Reading

• Authors
• Nashi M. Venkatachalam AK. Muddu BN.
• Title
• Surgery of Morton's neuroma dorsal or plantar
  approach?.
• Source
• Journal of the Royal College of Surgeons of
  Edinburgh. 42(1)36-7, 1997 Feb.

11
Essential Reading

• Abstract
• In this prospective study, 52 patients with 55
  neuromas were studied in two groups. 26 patients
  underwent excision of the neuroma through a
  plantar approach and 26 through a dorsal
  approach. Average follow-up was 3.1 years after
  excision. Histology confirmed a neuroma in 51
  cases. Results show that in the dorsal group
  weight-bearing and return to work was faster, and
  the duration of hospital stay was shorter, than
  in the plantar group. There were five painful
  scars in the plantar group and two in the dorsal
  group.

12
Essential Reading

• Authors
• Dellon AL. Mackinnon SE.
• Title
• Tibial nerve branching in the tarsal tunnel.
• Source
• Archives of Neurology. 41(6)645-6, 1984 Jun.

13
Essential Reading

• Abstract
• To provide an anatomical basis for diagnosis and
  treatment of the tarsal tunnel syndrome, the
  relationship of the tibial nerve to the tarsal
  tunnel was investigated in 31 feet of 20
  cadavers. The bifurcation into medial and lateral
  plantar nerves occurred within 1 cm of the
  malleolar-calcaneal axis in 90 of the feet.

14
Essential Reading

• Authors
• Kim J. Dellon AL.
• Title
• Pain at the site of tarsal tunnel incision due to
  neuroma of the posterior branch of the saphenous
  nerve.
• Source
• Journal of the American Podiatric Medical
  Association. 91(3)109-13, 2001 Mar.

15
Essential Reading

• Abstract
• 16 patients with pain at the incision site after
  tarsal tunnel decompression. The pain was
  eliminated by a block of the distal saphenous
  nerve, demonstrating that the pain was due to a
  neuroma of this nerve. The pain was treated by
  resection of the distal saphenous nerve and
  implantation into the soleus muscle. At a mean of
  18.5 months after surgery (range, 6 to 33
  months), excellent relief of pain was achieved in
  76 of cases and good relief of pain in 24 of
  cases.

16
Essential Reading

• Authors
• Burchiel KJ. Johans TJ. Ochoa J.
• Title
• The surgical treatment of painful traumatic
  neuromas.
• Source
• Journal of Neurosurgery. 78(5)714-9, 1993 May.

17
Essential Reading

• Abstract
• It is concluded that 1) neuroma excision,
  neurectomy, and nerve release for injury-related
  pain of peripheral nerve origin yield substantial
  subjective improvement in a minority of patients
  2) external neurolysis of proximal mixed nerves
  is ineffective in relieving pain 3) surgically
  proving the existence of a neuroma with confirmed
  excision may be preferable 4) traumatic neuroma
  pain is only partly due to a peripheral source
  5) demographic and neurological variables do not
  predict success 6) the presence of a discrete
  nerve syndrome and mechanical hyperalgesia
  modestly predict pain relief 7) ongoing
  litigation is the strongest predictor of failure
  and 8) change in work status is not a likely
  outcome.

18
Essential Reading

• Authors
• Donley BG. McCollum MJ. Murphy GA. Richardson EG.
• Title
• Risk of sural nerve injury with intramedullary
  screw fixation of fifth metatarsal fractures a
  cadaver study.
• Source
• Foot Ankle International. 20(3)182-4, 1999
  Mar.

19
Essential Reading

• Abstract
• An anatomic study demonstrating the proximity of
  the sural nerve branches to the head of an
  intramedullary screw used for fixation of
  fractures of the proximal fifth metatarsal.
  Irritation of or injury to the nerve during screw
  insertion may explain the persistence of pain
  after screw removal in some patients.
  Furthermore, patients could sustain injury to the
  sural nerve at the time of screw removal. Careful
  surgical technique, including the use of drill
  guides and tissue protectors, may help lessen the
  risk of sural nerve injury and subsequent neuroma
  formation.

20
Essential Reading

• Authors
• Rondhuis JJ. Huson A.
• Title
• The first branch of the lateral plantar nerve and
  heel pain.
• Source
• Acta Morphologica Neerlando-Scandinavica.
  24(4)269-79, 1986.

21
Essential Reading

• Abstract
• The course and ramification pattern of the
  lateral plantar nerve was studied in serial
  sections from 4 fetal feet and in dissections
  from 34 adult feet with special reference to the
  so called first branch. This branch was found in
  all of the observed fetal and adult specimen.
  From its originating point the nerve runs
  immediately distally to the medial process of the
  calcaneal tuberosity in a lateral direction to
  the proximal part of the abductor digiti minimi
  muscle. During its course the FB gives two
  branches. One of them penetrates sometimes the
  insertion of the quadratus plantae muscle,
  whereas in adult feet it always sends fibres to
  the periosteum around the medial process of the
  calcaneal tuberosity and the long plantar
  ligament.

22
Essential Reading

• Authors
• Bock P. Kristen KH. Kroner A. Engel A.
• Title
• Hallux valgus and cartilage degeneration in the
  first metatarsophalangeal joint.
• Source
• Journal of Bone Joint Surgery - British Volume.
  86(5)669-73, 2004 Jul.

23
Essential Reading

• Abstract
• Prospectively examined 265 first
  metatarsophalangeal joints of 196 patients with a
  mean age of 54.2 years at operation for the
  existence of cartilage lesions.
• A statistically significant correlation was found
  between the grade of cartilage lesion and the
  hallux valgus angle, both for the changes within
  the metatarsophalangeal and the metatarsosesamoid
  joints.

24
Essential Reading

• Authors
• Sarrafian SK. Topouzian LK.
• Title
• Anatomy and physiology of the extensor apparatus
  of the toes.
• Source
• Journal of Bone Joint Surgery - American
  Volume. 51(4)669-79, 1969 Jun.

25
Essential Reading

• Authors
• Schneider W. Csepan R. Knahr K.
• Title
• Reproducibility of the radiographic
  metatarsophalangeal angle in hallux surgery.
• Source
• Journal of Bone Joint Surgery - American
  Volume. 85-A(3)494-9, 2003 Mar.

26
Essential Reading

• Abstract
• Calculated the intraobserver and interobserver
  coefficients of repeatability for five methods
  with use of twenty preoperative and twenty
  postoperative standardized plain dorsoplantar
  weight-bearing radiographs of patients undergoing
  chevron distal osteotomy.
• RESULTS Preoperatively - small differences
  among the five methods. Postoperatively-
  substantial differences.
• CONCLUSIONS Dont recommend the first metatarsal
  shaft is as a reference for the axis. Poor
  measurement accuracy, especially postoperatively.
  Use a line is from the center of the first
  metatarsal head through the center of the base of
  the first metatarsal, - most precise method and
  was least biased by postoperative effects.

27
Essential Reading

• Authors
• Torkki M. Malmivaara A. Seitsalo S. Hoikka V.
  Laippala P. Paavolainen P.
• Title
• Surgery vs orthosis vs watchful waiting for
  hallux valgus a randomized controlled trial.
• Source
• JAMA. 285(19)2474-80, 2001 May 16.

28
Essential Reading

• Abstract
• OBJECTIVE To compare the effectiveness of
  surgical and orthotic treatment with no treatment
  in patients with hallux valgus.
• DESIGN AND SETTING Randomized multi-centre
  controlled trial, with a follow-up period of 12
  months.
• MAIN OUTCOME MEASURES Pain intensity during
  walking on a visual analog scale (0-100), patient
  assessment of global improvement, number of
  painful days, cosmetic disturbance, footwear
  problems, functional status, and treatment
  satisfaction, compared among treatment groups.
• CONCLUSIONS Surgical osteotomy is an effective
  treatment for painful hallux valgus. Orthoses
  provide short-term symptomatic relief.

29
Essential Reading

• Authors
• Nigg BM. Stergiou P. Cole G. Stefanyshyn D.
  Mundermann A. Humble N.
• Title
• Effect of shoe inserts on kinematics, center of
  pressure, and leg joint moments during running.
• Source
• Medicine Science in Sports Exercise.
  35(2)314-9, 2003 Feb.

30
Essential Reading

• Abstract
• PURPOSE To assess the effect of four different
  shoe inserts on the path of the center of
  pressure (COP), to quantify the effect of these
  inserts on selected knee joint moments during
  running, and to assess the potential of COP data
  to predict the effects of inserts/orthotics on
  knee joint moments.

31
Essential Reading

• Title
• Foot orthotics affect lower extremity kinematics
  and kinetics during running.
• Source
• Clinical Biomechanics. 18(3)254-62, 2003 Mar.

32
Essential Reading

• Abstract
• OBJECTIVE To quantify the effects of posting and
  custom-molding of foot orthotics on lower
  extremity kinematics and kinetics during running.
  RESULTS Posting of foot orthotics reduced
  maximum foot eversion and ankle inversion moment
  and increased vertical loading rate and maximum
  knee external rotation moment (PRELEVANCE The potential of foot orthotics for
  reducing pain and injuries is convincing.

33
Essential Reading

• Authors
• Williams DS 3rd. McClay Davis I. Baitch SP.
• Title
• Effect of inverted orthoses on lower-extremity
  mechanics in runners.
• Source
• Medicine Science in Sports Exercise.
  35(12)2060-8, 2003 Dec.

34
Essential Reading

• Abstract
• PURPOSE The purpose of this study was to compare
  the three-dimensional kinematics and kinetics of
  the rearfoot and knee during running while
  varying orthotic intervention.
• CONCLUSIONS The differences in kinetic
  parameters at the rearfoot may result in fewer
  injuries of the rearfoot soft tissue structures
  when using inverted orthotics. These alterations
  in lower-extremity mechanics associated with
  inverted orthoses provide clinicians some
  evidence for prescribing this device.