Background: Progressive collapsing foot deformity (PCFD) is recognized as a 3-dimensional deformity centered around the talus. Previous studies have described some features of talar motion in the ankle mortise in PCFD, such as sagging in the sagittal plane or valgus tilt in the coronal plane. However, axial plane alignment of the talus in the ankle mortise in PCFD has not been investigated extensively. The purpose of this study was to examine this axial plane alignment of PCFD vs controls using weightbearing computed tomography (WBCT) images and to determine if talar rotation in the axial plane is associated with increased abduction deformity, as well as to assess the medial ankle joint space narrowing in PCFD that may be associated with axial plane talar rotation. Methods: Multiplanar reconstructed WBCT images of 79 patients with PCFD and 35 control patients (39 scans) were retrospectively analyzed. The PCFD group was divided into 2 subgroups depending on preoperative talonavicular coverage angle (TNC): moderate abduction (TNC 20-40 degrees, n=57) and severe abduction (TNC >40 degrees, n=22). Using the transmalleolar (TM) axis as a reference, the axial alignment of the talus (TM-Tal), calcaneus (TM-Calc), and second metatarsal (TM-2MT) were calculated. Difference between TM-Tal and TM-Calc was calculated to examine talocalcaneal subluxation. A second method to assess talar rotation within the mortise utilized an angle between the lateral malleolus and the talus (LM-Tal) in the axial slices of WBCT. In addition, the prevalence of medial tibiotalar joint space narrowing was assessed. These parameters were compared between the control and PCFD groups, and between moderate and severe abduction groups. Results: The talus was significantly more internally rotated with respect to the ankle TM axis and the lateral malleolus in PCFD patients compared to controls, and in the severe abduction group compared with the moderate abduction group, using both measurement methods. Axial calcaneal orientation did not differ between groups. There was significantly greater axial talocalcaneal subluxation in the PCFD group, and this was also greater in the severe abduction group. The prevalence of medial joint space narrowing was higher in PCFD patients. Conclusion: Our findings suggest that talar malrotation in the axial plane should be considered an underlying feature of abduction deformity in PCFD. The malrotation occurs in both the talonavicular and ankle joints. This rotational deformity should be corrected at the time of reconstructive surgery, especially in cases of severe abduction deformity. In addition, medial ankle joint narrowing was observed in PCFD patients, with a higher prevalence of medial ankle joint narrowing in those with severe abduction. Level of Evidence: Level III, case-control study.
Mercury, an environmental health hazard, is a neurotoxic heavy metal. In this study, the effect of methylmercury (MeHg) exposure was analyzed on sexual behavior in Drosophila melanogaster (fruit fly), because neurons play a vital role in sexual functions. The virgin male and female flies were fed a diet mixed with different concentrations of MeHg (28.25, 56.5, 113, 226, and 339 µM) for four days, and the effect of MeHg on copulation of these flies was studied. While male and female control flies (no MeHg) and flies fed with lower concentrations of MeHg (28.25, 56.5 µM) copulated in a normal manner, male and female flies exposed to higher concentrations of MeHg (113, 226, and 339 µM) did not copulate. When male flies exposed to higher concentrations of MeHg were allowed to copulate with control female flies, only male flies fed with 113 µM MeHg were able to copulate. On the other hand, when female flies exposed to higher concentrations of MeHg were allowed to copulate with control male flies, none of the flies could copulate. After introduction of male and female flies in the copulation chamber, duration of wing flapping by male flies decreased in a MeHg-concentration-dependent manner from 101 ± 24 seconds (control) to 100.7 ± 18, 96 ±12, 59 ± 44, 31 ± 15, and 3.7 ± 2.7 seconds at 28.25, 56.5, 113, 226, and 339 µM MeHg, respectively. On the other hand, grooming in male and female flies increased in a MeHg-concentration-dependent manner. These findings suggest that MeHg exposure causes sexual dysfunction in male and female Drosophila melanogaster. Further studies showed that MeHg exposure increased oxidative stress and decreased triglyceride levels in a concentration–dependent manner in both male and female flies, suggesting that MeHg-induced oxidative stress and decreased triglyceride levels may partly contribute to sexual dysfunction in fruit flies.
Background: Patients with hallux rigidus who do not experience significant pain relief after cheilectomy often require a conversion to metatarsophalangeal (MTP) fusion. However, it is unclear whether the previous cheilectomy affects outcomes of the subsequent fusion. The aim of this study was to compare patient-reported outcomes and complications in patients undergoing MTP fusion for hallux rigidus between patients with a history of cheilectomy and those undergoing a fusion as a primary procedure. Methods: This retrospective cohort study included patients who underwent MTP fusion who had preoperative and minimum 1-year postoperative Patient Reported Outcomes Measurement Information System (PROMIS) scores. Patients were divided into a “primary MTP fusion” cohort and a “prior cheilectomy” cohort based on their history of a previous cheilectomy. Preoperative, postoperative, and improvement in PROMIS scores, along with rates of complications including nonunion, infection, interphalangeal (IP) joint pain, and removal of hardware were compared between groups. Results: The prior cheilectomy group had significantly lower preoperative physical function scores than the primary MTP fusion group ( P < .05). Postoperatively, the prior cheilectomy group had worse physical function ( P < .017) and global physical health ( P < .017) scores. However, there were no significant differences in pre- to postoperative change in PROMIS scores. There were no significant differences in rates of nonunion ( P = .99), infection ( P = .99), or hardware removal ( P = .99). More patients in the prior cheilectomy group had IP joint pain ( P = .034). Conclusion: This study found that a prior cheilectomy may not affect serious complication rates of a subsequent fusion, but it may be associated with worse baseline function. Overall, our results suggest that a prior failed cheilectomy does not influence the amount of improvement in function and pain from MTP fusion. Level of Evidence: Level III, retrospective cohort study.
Background: Patients with hallux valgus commonly present with concomitant flatfoot deformity. First-ray hypermobility, among other biomechanical factors, has been suggested as a potential link between these deformities. However, not all hallux valgus patients exhibit symptoms associated with flatfoot deformity, and the necessity of correcting the asymptomatic flatfoot at the time of hallux valgus correction is unclear. We aimed to investigate the relationship between asymptomatic flatfoot and patient-reported and radiographic outcomes after the Lapidus procedure. Methods: This study included 142 patients who underwent the Lapidus procedure for hallux valgus at a single institution. Sixty-one patients met radiographic criteria for flatfoot. No patients exhibited symptoms related to flatfoot deformity on review of clinical notes. Preoperative, minimum 1-year postoperative, and change in Patient-Reported Outcomes Measurement Information System (PROMIS) scores between asymptomatic flatfoot and control groups were compared. Radiographic outcomes including hallux valgus angle (HVA), intermetatarsal angle (IMA), Meary angle, talonavicular coverage angle (TNCA), and calcaneal pitch (CP) were compared. Results: Preoperatively, the flatfoot group had higher BMI 22.6 vs 24.6 ( P < .01) and IMA 15.32 vs 14.0 degrees ( P < .05). Both groups demonstrated preoperative to postoperative improvement in PROMIS physical function ( P < .01), pain interference ( P < .001), pain intensity ( P < .001), and global physical health ( P < .001). There were no preoperative or postoperative differences in PROMIS scores between groups. Postoperatively, there were no differences in HVA or IMA between groups; however, the flatfoot group exhibited greater deformity in Meary angle, TNCA, and CP (all P < .001). Conclusion: There were no significant postoperative differences in patient-reported outcomes of the Lapidus procedure between patients with and without asymptomatic flatfoot, and both groups achieved similar radiographic correction of their hallux valgus deformity. The Lapidus procedure appears to be a reasonable surgical option for hallux valgus correction in patients with asymptomatic flatfoot deformity. Level of Evidence: Level III, retrospective cohort study.
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