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Background Although Lisfranc injuries are uncommon, representing approximately 0.2% of all fractures, they are complex and can result in persistent pain, degenerative arthritis, and loss of function. Both open reduction and internal fixation (ORIF) and primary fusion have been proposed as treatment options for these injuries, but debate remains as to which approach is better. Questions/purposes We asked whether ORIF or primary fusion led to (1) fewer reoperations for hardware removal; (2) less frequent revision surgery; (3) higher patient outcome scores; and (4) more frequent anatomic reduction. Methods A systematic review was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Three trials met the criteria for inclusion within the meta-analysis. Qualifying articles for the meta-analysis had data extracted independently by two authors (NS, AF). The quality of each study was assessed using the Center for Evidence Based Medicine’s evaluation strategy; data were extracted from articles rated as good and fair: two and one article, respectively. Results The risk ratio for hardware removal was 0.23 (95% confidence interval [CI], 0.11–0.45; p < 0.001) indicating more hardware removal for ORIF than fusion. For other revision surgery, the risk ratio for ORIF was 0.36 (95% CI, 0.08–1.59; p = 0.18) favoring neither. Similarly, neither was favored using patient-reported outcomes; the standard mean difference was calculated to be 0.50 (95% CI, −2.13 to 3.12; p = 0.71). When considering the risk of nonanatomic alignment, neither was favored (risk ratio, 1.48; 95% CI, 0.34–6.38; p = 0.60). Conclusions The surgeon should consider the increased risk of hardware removal along with its associated morbidity and discuss this with the patient preoperatively when considering ORIF of Lisfranc injuries. Because no new trials have been performed since 2012, further randomized controlled trials will be needed improve our understanding of these interventions. Level of Evidence Level I, therapeutic study.

The major methods of evaluating the foot arch in clinical practice in patients with foot deformities are medial longitudinal arch measurement using body surface somatometry and radiographic morphometry. Although these methods are widely used, they are considered problematic in terms of differences in scores between the methods. In this study, we developed a new geometric shape analysis method for the bony arrangement of the foot using the two-dimensional fast Fourier transform (2D-FFT), which incorporates mathematical anatomy using x-ray radiographs. Lateral radiographs of the foot bones were obtained using ImageJ2 provided by the National Institutes of Health. The 2D-FFT images show the characteristic directional power spectrum extending from low to high frequencies in the first and third quadrants on the normal, low and high arched foot respectively. The current method of reflecting the bone arrangement status of the metatarsal and tarsal bones may have the potential to establish a new radiographic evaluation method for assessing abnormal foot–bone alignment. As a result, the foot bone 2D-FFT method can be useful in assessing the medial longitudinal arch and predicting the prognosis of these patients.

ObjectivesTo investigate, in anti-cyclic citrullinated peptide antibody positive (CCP+) at-risk individuals without clinical synovitis, the prevalence and distribution of ultrasound (US) bone erosions (BE), their correlation with subclinical synovitis and their association with the development of inflammatory arthritis (IA).MethodsBaseline US scans of 419 CCP+ at-risk individuals were analysed. BE were evaluated in the classical sites for rheumatoid arthritis damage: the second and fifth metacarpophalangeal (MCP2 and MCP5) joints, and the fifth metatarsophalangeal (MTP5) joints. US synovitis was defined as synovial hypertrophy (SH) ≥2 or SH ≥1+power Doppler signal ≥1. Subjects with ≥1 follow-up visit were included in the progression analysis (n=400).ResultsBE were found in ≥1 joint in 41/419 subjects (9.8%), and in 55/2514 joints (2.2%). The prevalence of BE was significantly higher in the MTP5 joints than in the MCP joints (p<0.01). A significant correlation between BE and US synovitis in the MTP5 joints was detected (Cramer’s V=0.37, p<0.01). The OR for the development of IA (ever) was highest for the following: BE in >1 joint 10.6 (95% CI 1.9 to 60.4, p<0.01) and BE and synovitis in ≥1 MTP5 joint 5.1 (95% CI 1.4 to 18.9, p=0.02). In high titre CCP+ at-risk individuals, with positive rheumatoid factor and BE in ≥1 joint, the OR increased to 16.9 (95% CI 2.1–132.8, p<0.01).ConclusionsIn CCP+ at-risk individuals, BE in the feet appear to precede the onset of clinical synovitis. BE in >1 joint, and BE in combination with US synovitis in the MTP5 joints, are the most predictive for the development of clinical arthritis.

Background. We assessed the diagnostic value of swab cultures by comparing them with corresponding cultures of percutaneous bone biopsy specimens for patients with diabetic foot osteomyelitis. Methods. The medical charts of patients with foot osteomyelitis who underwent a surgical percutaneous bone biopsy between January 1996 and June 2004 in a single diabetic foot clinic were reviewed. Seventy-six patients with 81 episodes of foot osteomyelitis who had positive results of culture of bone biopsy specimens and who had received no antibiotic therapy for at least 4 weeks before biopsy constituted the study population. Results. Pathogens isolated from bone samples were predominantly staphylococci (52%) and gram-negative bacilli (18.4%). The distributions of microorganisms in bone and swab cultures were similar, except for coagulase-negative staphylococci, which were more prevalent in bone samples (P <.001). The results for cultures of concomitant foot ulcer swabs were available for 69 of 76 patients. The results of bone and swab cultures were identical for 12 (17.4%) of 69 patients, and bone bacteria were isolated from the corresponding swab culture in 21 (30.4%) of 69 patients. The concordance between the results of cultures of swab and of bone biopsy specimens was 42.8% for Staphylococcus aureus, 28.5% for gram-negative bacilli, and 25.8% for streptococci. The overall concordance for all isolates was 22.5%. No adverse events— such as worsening peripheral vascular disease, fracture, or biopsy-induced bone infection— were observed, but 1 patient experienced an episode of acute Charcot osteoarthropathy 4 weeks after bone biopsy was performed. Conclusions. These results suggest that superficial swab cultures do not reliably identify bone bacteria. Percutaneous bone biopsy seems to be safe for patients with diabetic foot osteomyelitis.

A well-preserved and articulated partial foot and ankle of Australopithecus sediba, including an associated complete adult distal tibia, talus, and calcaneus, have been discovered at the Malapa site, South Africa, and reported in direct association with the female paratype Malapa Hominin 2. These fossils reveal a mosaic of primitive and derived features that are distinct from those seen in other hominins. The ankle (talocrural) joint is mostly humanlike in form and inferred function, and there is some evidence for a humanlike arch and Achilles tendon. However, Au. sediba is apelike in possessing a more gracile calcaneal body and a more robust medial malleolus than expected. These observations suggest, if present models of foot function are correct, that Au. sediba may have practiced a unique form of bipedalism and some degree of arboreality. Given the combination of features in the Au. sediba foot, as well as comparisons between Au. sediba and older hominins, homoplasy is implied in the acquisition of bipedal adaptations in the hominin foot.

The current investigation proposes a novel hybrid methodology for the diagnosis of the foot fractures. The method uses a combination of deep learning methods and a metaheuristic to provide an efficient model for the diagnosis of the foot fractures problem. the method has been first based on applying some preprocessing steps before using the model for the features extraction and classification of the problem. the main model is based on a pre-trained ZFNet. The final layers of the network have been substituted using an extreme learning machine (ELM) in its entirety. The ELM part also optimized based on a new developed metaheuristic, called enhanced snow ablation optimizer (ESAO), to achieve better results. for validating the effectiveness of the proposed ZFNet/ELM/ESAO-based model, it has been applied to a standard benchmark from Institutional Review Board (IRB) and the findings have been compared to some different high-tech methods, including Decision Tree / K-Nearest Neighbour (DT/KNN), Linear discriminant analysis (LDA), Inception-ResNet Faster R-CNN architecture (FRCNN), Transfer learning‑based ensemble convolutional neural network (TL-ECNN), and combined model containing a convolutional neural network and long short-term memory (DCNN/LSTM). Final results show that using the proposed ZFNet/ELM/ESAO-based can be utilized as an efficient model for the diagnosis of the foot fractures.

Several elements of the Ardipithecus ramidus foot are preserved, primarily in the ARA-VP-6/500 partial skeleton. The foot has a widely abducent hallux, which was not propulsive during terrestrial bipedality. However, it lacks the highly derived tarsometatarsal laxity and inversion in extant African apes that provide maximum conformity to substrates during vertical climbing. Instead, it exhibits primitive characters that maintain plantar rigidity from foot-flat through toe-off, reminiscent of some Miocene apes and Old World monkeys. Moreover, the action of the fibularis longus muscle was more like its homolog in Old World monkeys than in African apes. Phalangeal lengths were most similar to those of GORILLA: The Ardipithecus gait pattern would thus have been unique among known primates. The last common ancestor of hominids and chimpanzees was therefore a careful climber that retained adaptations to above-branch plantigrady.

A newly discovered partial hominin foot skeleton from eastern Africa indicates the presence of more than one hominin locomotor adaptation at the beginning of the Late Pliocene epoch. Here we show that new pedal elements, dated to about 3.4 million years ago, belong to a species that does not match the contemporaneous Australopithecus afarensis in its morphology and inferred locomotor adaptations, but instead are more similar to the earlier Ardipithecus ramidus in possessing an opposable great toe. This not only indicates the presence of more than one hominin species at the beginning of the Late Pliocene of eastern Africa, but also indicates the persistence of a species with Ar. ramidus -like locomotor adaptation into the Late Pliocene. The 3.4-million-year-old partial hominin foot skeleton indicates the coexistence of more than one hominin species between 3 and 4 million years ago, each with its own way of getting around. Fellow travellers: walking with hominins A 3.4-million-year-old partial skeleton of a hominin foot unearthed in Ethiopia offers an intriguing riddle. The only hominin previously known from that date was Australopithecus afarensis (to which 'Lucy' belonged), which was fully bipedal, and had essentially modern feet. The latest specimen, however, shows evidence for an opposable big toe, more like that seen in modern apes or in the hominin Ardipithecus ramidus , which lived one million years earlier. The new find suggests the coexistence of more than one hominin species in the Pliocene epoch, three to four million years ago, each with its own way of getting around.

This study examined the relationships between the foot bone morphologies and sprint performance in sprinters. Foot images in 56 male sprinters obtained using magnetic resonance imaging. The relative lengths of the forefoot bones of the big and second toes, which were calculated as total lengths of the forefoot bones for each toe normalized to the foot length, correlated significantly with personal best 100-m sprint time ( r  =  − 0.293 and − 0.459, both P s < 0.05). The relative lengths of the rearfoot talus and calcaneus normalized to the foot length also correlated significantly with the sprint performance ( r  =  − 0.378 and − 0.496, both P s < 0.05). Furthermore, the relative height of the calcaneus, but not the talus, normalized to body height correlated significantly with sprint performance ( r  =  − 0.690, P  < 0.001). Additionally, the relative calcaneus height correlated significantly with the foot arch height index ( r  = 0.420, P  = 0.001), and the foot arch height index correlated significantly with sprint performance ( r  =  − 0.517, P  < 0.001). These findings suggest that the taller calcaneus may be a key morphological factor for achieving superior sprint performance, potentially via modeling the longer forefoot and rearfoot bones and functional foot morphology in sprinters.

Most birds have an opposable digit 1 (hallux) allowing the foot to grasp, which evolved from the non-opposable hallux of early theropod dinosaurs. An important morphological difference with early theropods is the twisting of the long axis of its metatarsal. Here, we show how embryonic musculature and the onset of its activity are required for twisting of metatarsal 1 (Mt1) and retroversion of the hallux. Pharmacologically paralyzed embryos do not fully retrovert the hallux and have a straight Mt1 shaft, phenocopying the morphology of early tetanuran dinosaurs. Molecular markers of cartilage maturation and ossification show that differentiation of Mt1 is significantly delayed compared to Mt2-4. We hypothesize on how delayed maturation may have increased plasticity, facilitating muscular twisting. Our experimental results emphasize the importance of embryonic muscular activity in the evolutionary origin of a crucial adaptation.