Navegando por Palavras-chave "Metatarsalgia"
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- ItemSomente MetadadadosCan ultrasound of plantar plate have normal appearance with a positive drawer test?(Elsevier B.V., 2015-03-01) Fernandes, Eloy de Avila [UNIFESP]; Mann, Tania Szejnfeld [UNIFESP]; Puchnick, Andrea [UNIFESP]; Tertulino, Franklin de Freitas [UNIFESP]; Cannato, Camila Testoni [UNIFESP]; Nery, Caio [UNIFESP]; Correa Fernandes, Artur da Rocha [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Objectives: the aims of this study were (1) to evaluate the reliability of ultrasound (US) examination in the identification and measurement of the metatarsophalangeal plantar plate (MTP-PP) in asymptomatic subjects and (2) to establish the correlation of US findings with those of physical examination and magnetic resonance imaging (MRI), once it is an important tool in the evaluation of the instability syndrome of the second and third rays.Materials and Methods: US examinations of the second and third MTP-PPs were performed in eight asymptomatic volunteers, totaling 32 MTP joints, by three examiners with different levels of experience in musculoskeletal US. Plantar plate dimensions, integrity and echogenicity, the presence of ruptures, and confidence level in terms of structure identification were determined using conventional US. Vascular flow was assessed using power Doppler. US data were correlated with data from physical examination and MRI.Results: MTP-PPs were ultrasonographically identified in 100% of cases, always showing homogeneous hyperechoic features and no detectable vascular flow on power Doppler, with 100% certainty in identification for all examiners. There was excellent US inter-observer agreement for longitudinal measures of second and third toe MTP-PPs and for transverse measures of the second toe MTP-PP. the MTP drawer test was positive for grade 1 MTP instability in 34.4% of joints with normal US results. Transverse MTP-PP measures were significantly higher in individuals with positive MTP drawer test. US measures and characteristics of MPT-PPs were positively correlated with those of MRI.Conclusions: US is efficient in identifying and measuring MPT-PPs and may complement physical examination. A grade 1 positive MTP drawer test may be found in asymptomatic individuals with normal MPT-PPs, as assessed by imaging. (C) 2014 Elsevier Ireland Ltd. All rights reserved.
- ItemSomente MetadadadosEstudo da fórmula metatarsal em pacientes com metatarsalgia primária(Universidade Federal de São Paulo (UNIFESP), 2014-03-26) Arie, Eduardo Kenzo [UNIFESP]; Yi, Liu Chiao [UNIFESP]; http://lattes.cnpq.br/6106154677645509; http://lattes.cnpq.br/4983707270335833; Universidade Federal de São Paulo (UNIFESP)Purpose: To verify the prevalence of types of metatarsal formula (FM) in patients with primary metatarsalgia, through x-rays. Assess the association between shortening of the first metatarsal and metatarsalgia in comparison to a control group (CG). Analyze the intra and interobserver reproducibility by methods of transverse lines (MLT) of Morton and arcs (MA) of Hardy & Clapham. Methods: a cross-sectional observational study was conducted in 112 radiographs of the feet, being 56 of GM and 56 of GC evaluated in the period between december 2012 and june 2013. The measurements were made by three third-year residents in orthopaedics, with previous training methods, using a template to decrease the chance of error and disagreement. Results: there was no agreement on any of the two methods by Bland-Altman graphs, but through the intraclass correlation coefficient was verified a greater intra and interobserver reproducibility by MLT (0,78 and 0,85) in relation to the MA (0,73 and 0,60). When comparing both groups, it was observed statistical difference (p ≤ 0,05) with a shortening of the first metatarsal (3,39mm) higher in GC in relation to GM (2,14mm). In patients with primary metatarsalgia, FM type index minus was more prevalent by MLT (62,5%) and the type zero plus by MA (71,4%). Conclusions: In this study, it was observed that the prevalence of FM depends on the method of measurement. When comparing both groups, there was association of the shortening of the first metatarsal with the GC. There were no intra and interobserver agreement in any of the proposed methods.
- ItemSomente MetadadadosEstudo das alterações radiográficas e de ressonância magnética relacionadas à lesão da placa plantar metatarsofalângica do segundo pododáctilo(Universidade Federal de São Paulo (UNIFESP), 2020-07-02) Mann, Tania Szejnfeld [UNIFESP]; Fernandes, Eloy De Avila [UNIFESP]; Universidade Federal de São PauloObjective: To investigate whether the protrusion measurements of the second metatarsal, performed using Coughlin’s method, on radiographs and MRI images are related and reproducible. Check if the greater relative length of the second metatarsal is associated with metatarsophalangeal plantar plate lesion. Evaluate, through forefoot MRI, the prevalence of degenerative lesions of the plantar plate of the 2nd metatarsophalangeal joint in individuals with metatarsalgia and describe its main characteristics in MRI. Methods: Radiographic images of the feet with load and forefoot MRI of 166 consecutive patients (211 feet) were retrospectively evaluated. Two independent observers measured the protrusion of the second metatarsus using Coughlin’s method. Using MRI images, the plantar plate of the second toe was independently assessed by the observers, and classified as normal, complete rupture or degenerative lesion. Results: The measurements of the second metatarsal protrusion performed by the two observers showed almost perfect correlation (r = 0.882), however, it was found that the measurements obtained on the radiograph are approximately 35% greater than those obtained on MRI. There was a statistical difference in the measure of protrusion of the second metatarsal between the normal and ruptured groups. Using a ROC curve, it was possible to determine that the protrusion of 5.47 mm, measured on radiography, or 3.14 mm, on MRI, is associated with plantar plate lesion. Degenerative lesion of the plantar plate, identified on MRI as a heterogeneous thickening or thinning of the plantar plate, was best observed in coronal intermediate-weighted sequences, and recorded in 24% of our sample. The presence of pericapsular fibrosis below the transverse intermetatarsal ligament is an indirect finding related to this lesion. Conclusion: We found that the protrusion measurements of the second metatarsal, performed using Coughlin’s method on radiographs and MRI, are related and reproducible, considering that this measure is 35% lower in MRI than radiography. It was also verified that the protrusion of the second metatarsal is a factor that favors the lesion of the metatarsophalangeal plantar plate of the second toe. Degenerative lesions of the plantar plate were identified in a quarter of our sample, being best seen in coronal intermediate-weighted images, and pericapsular fibrosis below the transverse intermetatarsal ligament, best visualized in T1-weighted coronal-short axis, was the indirect finding that most related to this injury.
- ItemAcesso aberto (Open Access)Intervenções conservadoras e cirúrgicas no tratamento da metatarsalgia: revisão sistemática(Universidade Federal de São Paulo, 2023-12-15) Arie, Eduardo Kenzo [UNIFESP]; Silva, Maria Stella Peccin da [UNIFESP]; http://lattes.cnpq.br/0428199048138850; http://lattes.cnpq.br/4983707270335833Objetivo: Metatarsalgia é uma síndrome dolorosa frequente que pode levar a um importante comprometimento da capacidade funcional e da qualidade de vida do indivíduo, especialmente nos pacientes com artrite reumatoide. O objetivo deste estudo foi avaliar a eficácia e a segurança das intervenções conservadoras e cirúrgicas no tratamento da metatarsalgia. Métodos: Em 25 de abril de 2023, pesquisamos as bases de dados CENTRAL, MEDLINE, EMBASE, LILACS e PEDro. Também buscamos estudos em andamento nas plataformas de registro da OMS e ClinicalTrials.gov e as referências dos estudos incluídos. Identificamos todos os ensaios clínicos randomizados de intervenções para metatarsalgia comparados a outras intervenções, intervenção simulada ou nenhuma intervenção. Dois revisores avaliaram independentemente os estudos quanto à elegibilidade, extraíram os dados e avaliaram o risco de viés. Avaliamos a qualidade das evidências pelo GRADE. Resultados: Incluímos 15 estudos randomizados com um total de 616 pacientes com metatarsalgia. Em oito estudos os pacientes eram portadores de artrite reumatoide, sendo três ensaios clínicos para cirurgias de reconstrução do antepé reumatoide. Evidências de moderada qualidade em dois estudos mostraram diferença significativa na escala visual analógica da dor a favor da palmilha com suporte metatarsal quando comparada à intervenção simulada. Evidência de moderada qualidade mostrou que não houve diferença na melhora da dor e da função no desbridamento cirúrgico com bisturi afiado, quando comparado a nenhuma intervenção associada aos cuidados padrão para o tratamento de calosidades plantares dolorosas do pé reumatóide. A maioria dos estudos apresentou tamanho de amostra pequeno e limitações metodológicas com risco de viés incerto de detecção, atrito e relato, diminuindo a qualidade das evidências. Conclusão: Os resultados são muito limitados para se avaliar os efeitos dos tratamentos em termos de eficácia e segurança das intervenções praticadas. Estudos maiores e de melhor qualidade são necessários para pesquisas futuras.