Medial Column Biomechanics

Chan, Francis; Bowlby, Melinda A.; Christensen, Jeffrey C.

doi:10.1016/j.cpm.2019.08.004

Cited by 8 publications

(6 citation statements)

References 44 publications

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“…The naviculocuneiform (NC) joint has an important role in numerous pathologies of the foot and ankle including primary and secondary arthritis, medial column instability, pes planovalgus deformity, and navicular stress fractures, among others. 2 , 8 , 10 There is little published demonstrating the anatomic features of the NC joint complex or how it may relate to the development of these pathologies. There are studies in the published literature that investigate NC joint biomechanics as they relate to range of motion.…”

Section: Introductionmentioning

confidence: 99%

“…It has been shown that the NC joint proportionally contributes the most to first ray range of motion in the sagittal plane, which has been linked to bunion deformities and other pathologies, demonstrating its importance in normal biomechanics. 2 Knowledge of the articular anatomy of the NC joint in the context of the function of the joint may assist in understanding the development of NC joint pathology. A common procedure to treat NC joint arthritis is arthrodesis; however, nonunion rates have been found to be as high as 6.5%, which may be contributed to by inadequate cartilage resection.…”

Section: Introductionmentioning

confidence: 99%

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Anatomy of the Naviculocuneiform Joint Complex

Borrelli,

Albiero,

Jastifer

2024

Foot & Ankle Orthopaedics

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Background: The purpose of this study was to quantify the articular surfaces of the naviculocuneiform (NC) joint to help clinicians better understand common pathologies observed such as navicular stress fractures and arthrodesis nonunions. Methods: Twenty cadaver NC joints were dissected and the articular cartilage of the navicular, medial, middle, and lateral cuneiforms were quantified by calibrated digital imaging software. Statistical analysis included calculating the mean cartilage surface area dimensions of the distal navicular and proximal cuneiform bones. Length measurements on the navicular were obtained to estimate the geographic location of the interfacet ridges. Lastly, all facets of the articular surfaces were described in regard to the shape and location of cartilaginous or fibrous components. Results were compared using Student t tests. Results: Navicular cartilage was present over 75.4% of the surface area of the proximal NC joint, compared with 72.6% of combined cuneiform cartilage distally. The mean height of the deepest (dorsal-plantar) measurement of navicular articular cartilage was 18 ± 3 mm. The mean heights of the distal medial, middle, and lateral cuneiform articular facets were 15 ± 1 mm, 17 ± 2 mm, and 15 ± 2 mm, respectively. Conclusion: There is significant variation among the articular surfaces of the NC joint. Additionally, the central third of the navicular was calculated to lie in the inter-facet ridge between the medial and middle articular facets of the navicular. Clinical Relevance: Surgeons may consider this study data when performing joint preparation for NC arthrodesis as cartilage was present to a mean depth of 18 mm at the NC joint. Additionally, this study demonstrates that the central third of the navicular, where most navicular stress fractures occur, lies in the interfacet ridge between the medial and middle articular facets of the navicular.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Anatomy of the Naviculocuneiform Joint Complex

Borrelli,

Albiero,

Jastifer

2024

Foot & Ankle Orthopaedics

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“…2,11,12 The MLA can be supported by both passive and active systems. 13 The passive system includes the bones of the medial longitudinal column of the foot (i.e., talus, navicular, medial cuneiform, and the first metatarsal), which are connected with plantar ligaments and plantar fascia. The active system consists of the extrinsic and intrinsic foot muscles.…”

Section: Background and Rationalementioning

confidence: 99%

“…The MLA of the foot is supported by passive and active systems. 13 Passive system that supports the MLA are the bones of the medial longitudinal column of the foot i.e. the talus, the navicular, the medial cuneiform, and the first metatarsal which are connected with plantar ligaments, and the plantar fascia.…”

Section: Passive Systemmentioning

confidence: 99%

“…14,36,37 When the hallux is extended, tension in the plantar fascia increases and causes the first ray plantarflexion 38 which creates a shortened foot, raised arch, supinated rearfoot, and externally rotated leg. 13 However, the windlass mechanism may not be able to be activated for meaningful arch raising with the presence of malalignment of any bones or impaired joint mobility in the foot. A radiographic study of 100 weight-bearing feet found a positive correlation between first metatarsal pronation and the height of the MLA (r = 0.93, p < 0.001).…”

Section: Passive Systemmentioning

confidence: 99%

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Effects of lower extremity muscle strengthening exercise and foot orthoseson medial longitudinal arch height in individuals with flexible flatfoot

Engkananuwat

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Background: Foot orthoses and lower extremity exercises have been widely recommended to improve medial longitudinal arch (MLA) height in adults with flexible flatfoot. However, there is little evidence to guide the choice between foot orthoses or lower extremity exercises. Objectives: This study comprised two separate studies. Study 1 aimed to establish the more effective exercise protocol by comparing the MLA height in groups performing foot exercises with and without gluteus medius (GMed) muscle strengthening exercise. Study 2 compared the established exercise protocol in Study 1 with foot orthoses to determine the actual effectiveness of each intervention. Main outcome measures: Navicular drop (ND), arch height index (AHI), plantar pressure, static balance, dynamic balance, and lower extremity muscle strength were measured at baseline, 4 weeks, and 8 weeks. Results: Study 1 included 52 participants with bilateral flatfoot who were randomly assigned to either the foot exercise group (n = 26) or the foot plus GMed exercise group (n = 26). After 4 and 8 weeks, the foot plus GMed exercise group showed significant improvements in all outcome measures, except dynamic balance, compared to the foot exercise group. Study 2 included 38 bilateral flatfoot participants who were randomly assigned to either the foot plus GMed exercise group (n = 19) and the foot orthoses group (n = 19). The foot plus GMed exercise group showed significant improvements in all outcome measures, except plantar pressure, static and dynamic balance in certain directions, compared to the foot orthoses group. Conclusion: Adding GMed muscle strengthening exercise to foot exercise proved to be more effective in supporting the MLA compared to performing foot exercise alone. In healthy adults with flexible flatfoot, lower extremity exercise was found to be more effective than foot orthoses in improving MLA height and related parameters.

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Case #6: Management of Stage 3 Hallux Limitus Deformity with Acellular Dermal Allomatrix for Resurfacing of the First Metatarsal Head

Visser

2022

Challenges in Foot and Ankle Reconstructive Surgery

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Medial Column Biomechanics

Cited by 8 publications

References 44 publications

Anatomy of the Naviculocuneiform Joint Complex

Anatomy of the Naviculocuneiform Joint Complex

Effects of lower extremity muscle strengthening exercise and foot orthoseson medial longitudinal arch height in individuals with flexible flatfoot

Case #6: Management of Stage 3 Hallux Limitus Deformity with Acellular Dermal Allomatrix for Resurfacing of the First Metatarsal Head

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