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We examined the effects of lower limb segmental muscle vibration (SMV) on intracortical and spinal excitability in 13 healthy participants (mean age: 34.9 ± 7.8 years, 12 males, 1 female). SMV at 30 Hz was applied to the hamstrings, gastrocnemius, and soleus muscles for 5 min. Paired-pulse transcranial magnetic stimulation protocols were used to investigate motor-evoked potential (MEP) amplitude, short-interval intracortical inhibition (SICI) and short-interval intracortical facilitation (SICF) from the abductor hallucis muscle (AbdH). These assessments were compared to the results of a control experiment (i.e., non-vibration) in the same participants. F-waves were evaluated from the AbdH on the right (vibration side) and left (non-vibration side) sides, and we calculated the ratio of the F-wave amplitude to the M-response amplitude (F/M ratio). These assessments were obtained before, immediately after, and 10, 20, and 30 min after SMV. For SICI, there was no change immediately after SMV, but there was a decrease over time (before vs. 30 min after, p = 0.021; immediately after vs. 30 min after, p = 0.015). There were no changes in test MEP amplitude, SICF, or the F/M ratio. SMV causes a gradual decrease in SICI over time perhaps owing to long-term potentiation. The present results may have implications for the treatment of spasticity.

Heel pad loss can cause serious problems in weight-bearing and locomotion. The medial plantar artery (MPA) flap is a suitable “like for like” replacement. Nineteen patients whose heels were reconstructed with MPA flap between July 2015 and February 2020 were studied. All patients were assessed based on flap survival, functionality, and patient satisfaction. Loss of heel pad was due to diabetic ulcer (11), trauma (6), tumor (1), and unstable scar (1). The largest flap measured 9 × 7 cm. Sixteen flaps were done as fasciocutaneous flaps and three in combination with abductor hallucis muscle (AbdH). All the flaps survived. The average functional scores at 6, 12, 18, and 24 months were 86.86, 89.62, 89.38 and 97.33 based on AOSAS-AH score. Average patients' satisfaction was 8.7/10. To conclude, the MPA system is a versatile vascular axis providing “like for like” tissue for heel pad reconstruction which is reliable and durable.

Background Dellon et al. have reported that chronic nerve compression of the tibial nerve inside the tarsal tunnel, caused by diabetes mellitus, can be relieved following open decompression surgery. However, the large skin incision resulting from Dellon's procedure may cause wound healing problems. The authors report the possibility of a minimally invasive full endoscopic procedure. Methods Operations were performed under local anesthesia without a pneumatic tourniquet. An anesthetic agent was applied at the proximal part of the flexor retinaculum of the foot, and a hypodermic needle was advanced into the tarsal tunnel. Tarsal tunnel pressure and blood circulation of the tibial nerve using indocyanine green assessment were measured preoperatively. One 1-cm portal skin incision was made at the anesthetized area and the Universal Subcutaneous Endoscope system was inserted into the tarsal tunnel. The flexor retinaculum, tibial nerve, blood vessels, and abductor hallucis muscle fascia were identified under endoscopic observation. After decompression of the tarsal tunnel, the authors measured tarsal tunnel pressure and blood circulation of the tibial nerve for analysis of the effectiveness of the endoscopic decompression during the procedure. Results Fourteen operations were compiled and analyzed. Postoperative clinical status was improved based on the preoperative modified Toronto Clinical Neuropathy Score. The mean tarsal tunnel pressure dropped to 4.5 mmHg during surgery from the initial preoperative 49.4 mmHg in resting position. Endoscopic indocyanine green assessment showed more than 30 percent improvement of the vascularity surrounding the tibial nerve. Conclusion The authors' minimally invasive full endoscopic procedure is a viable alternative approach for tarsal tunnel syndrome patients with diabetic foot neuropathy. Clinical question/level of evidence Therapeutic, IV.

Purpose: Previous research has indicated that the structure and function of abductor hallucis muscle (AbdH) would be adversely affected by hallux valgus (HV). However, the influence of long-distance running on AbdH in HV feet has not been explored. Therefore, this pilot study aimed to compare the imaging differences of AbdH between normal and HV feet after long-distance running. Methods: A total of 14 male adults were divided into two groups (Normal Foot Group (NFG), Hallux Valgus Group (HVG)) based on their foot morphology. A B-mode ultrasonic scanner was utilized for measuring AbdH thickness, cross-sectional area, and pennation angle before and after 5-km running test. Perceived soreness was monitored simultaneously using the visual analogue scale. Results: AbdH showed significantly differences between groups before and after the running test. Compared with NFG, HVG exhibited smaller value before the test while greater changes in all parameters although pennation angle failed to reach the significant level. Conclusions: These results further confirmed that HV could lead to the morphological alterations of AbdH. Also, AbdH of people with HV would endure more fatigue and soreness when performed the same long-distance running test with normal counterparts. Nevertheless, more studies are much needed for further verification.

BACKGROUND: Hallux valgus deformity of the big toe in adolescents accounts for 22%44% of all relevant cases. Despite a relatively large number of surgical treatment methods proposed to correct this deformity, treatment results are not always satisfactory. The problem of imbalance between the external traction of the abductor hallucis muscle and the contracted adductor muscle in hallux valgus remains controversial and is not covered in the literature. AIM: This study aimed to examine the results of hallux valgus deformity treatment, following the suggested combined technique. MATERIALS AND METHODS: Eight teenage patients (10 feet), aged 15 years on average, were assessed. Patients were undergoing treatment in the department of pediatric orthopedics of the Dana Hospital, Tel Aviv, within the period from 2015 to 2019. The average postoperative observation period was 30 months. This study suggested a new combined technique, including (1) modified oblique Chevron osteotomy with a V-shaped cut in the distal aspect of the first metatarsal with the dorsal wedge excision performed at the apex of its angulation, (2) valgus osteotomy of the medial cuneiform bone with the insertion of the V-shaped bone allograft, and (3) transfer of the dorsal portion of the pre-split tendon of abductor hallucis muscle to the base of the triangular medial capsular flap of the first metatarsophalangeal joint (MPJ). The tendon received optimal tension to restore the muscular balance. RESULTS: This surgical technique provided safe and stable correction of the hallux valgus deformity, restored muscular balance, avoided movement restriction of the first MPJ, and restored the function and strength of the abductor halluces muscle that prevented the recurrence of the deformity. The number of good and excellent results was much greater than those in published reports. CONCLUSIONS: Despite a relatively small group of patients, the suggested technique has shown improvements in hallux valgus deformity in adolescents.

Hallux valgus (HV) is a foot deformity with deviation of the greater toe and the first metatarsal. There is little evidence on training the abductor hallucis muscle (AbdH) to treat HV because of the difficulty in implementing the necessary interventions. Although neuromuscular electrical stimulation (NMES) has been used to induce voluntary exercise, there is currently no study on NMES for AbdH. We aimed to verify the immediate effect of NMES on the AbdH muscle function. For the NMES group (n = 15), electrical stimulation was applied for 20 min. In the sham group (n = 15), the stimulating device was set but not turned on. Electromyogram, HV angle (HVA) at rest and during abduction of the big toe, and strength of the AbdH were evaluated. Analysis of covariance was used to investigate differences within groups using the baseline as the covariate. NMES significantly improved the maximal voluntary isometric contractions (%MVIC), HVA at exercise, and muscle strength (%MVIC

Purpose Little is known about the reliability and value of intraoperative neurophysiological monitoring (IONM) in patients with Duchenne muscular dystrophy (DMD) undergoing scoliosis correction surgery. The aim of this study was to investigate the feasibility of IONM and the cortical excitability in these patients. Methods Fifteen patients with DMD and scoliosis and 15 patients with adolescent idiopathic scoliosis (AIS) underwent scoliosis correction surgery with the use of IONM. IONM consisted of transcranial electrical stimulation motor evoked potential (Tc-MEP) and somatosensory evoked potential (SSEP) monitoring. The highest Tc-MEP amplitudes were collected to test the feasibility. Preoperative compound muscle action potentials (CMAPs) and transcranial magnetic stimulation (TMS)-MEPs were recorded to test the cortical excitability. SSEPs were scored as elicitable or not elicitable. Results Tc-MEP amplitudes were significantly lower in the DMD group for both the gastrocnemius and tibialis anterior muscles. However, the abductor hallucis muscle had similar amplitudes in both the DMD as the AIS group. TMS/CMAP and Tc-MEP/CMAP ratios were similar in the DMD and AIS group (P = 0.126 and P = 0.792 respectively). Conclusions Tc-MEP and SSEP monitoring is feasible, particularly when Tc-MEPs are recorded from the abductor hallucis muscle in patients with DMD. Similar TMS/CMAP and Tc-MEP/CMAP ratios show that there were no differences observed in cortical excitability between the groups. IONM seems a feasible and valuable neurophysiological tool to signal possible surgically induced damage to the spinal cord during scoliosis correction surgery in patients with DMD.

Background: Tarsal tunnel syndrome (TTS) is an entrapment neuropathy in which the tibial nerve is compressed within the tarsal tunnel and causes sensory disturbance in the sole of the foot. In this manuscript, we summarized our early surgical cases of TTS. Materials and Methods: Six feet in five patients with TTS were treated surgically. The patients were aged 31–70 years (mean 53.1 years), and all of them complained of pain or dysesthesia of the sole of the foot sparing the heel. Magnetic resonance imaging (MRI) and nerve conduction test were performed preoperatively. In surgery, flexor retinaculum was dissected (tarsal tunnel opening [TTO]), the posterior tibial nerve was freed from the arteriovenous complex (neurovascular decompression [NVD]), and fascia of the abductor hallucis muscle was excised to decompress the medial and lateral plantar nerve (releasing fascial of abductor hallucis muscle [RFAH]). Results: Preoperative MRI confirmed that all seven cases were idiopathic TTS. Moreover, NCD demonstrated delayed sensory conduction velocity but not delayed distal motor latency. Surgical decompression was beneficial in 5 feet. The recurrence of symptoms was found in one case within 1 postoperative month. Conclusion: Surgical treatment for idiopathic TTS with TTO, NVD, and RFAH was generally good. However, symptoms recurred in one instance. Some methods to prevent adhesion and granulation in the reconstructed tarsal tunnel should be considered.

Highlights • Hemangioma is a rare slow growing benign soft tissue tumor of foot. • Its rarity could lead to delay in diagnosis and treatment for the patient. • Wide excision of the tumor is a valuable treatment option for this type of tumor., Introduction Haemangioma is a slow growing benign soft tissue tumor and its presentation in the foot is rare. Intramuscular haemangioma (IH) are usually found before 30 years of age, with gender predominance is still inconclusive. Presentation of case An 18-year-old woman came with pain and mass in the left foot for the past 3 years. Magnetic Resonance Imaging (MRI) of the left foot shown a heterogenous multilobulated mass, with previously thought originated from flexor digitorum brevis (FDB) muscle. Wide excision was performed and intraoperative findings showed that the mass actually originated from abductor hallucis muscle. Post-operative histopathological findings confirmed the diagnosis of cavernous-type of intramuscular haemangioma. Discussion The rare occurrence of intramuscular haemangioma of the foot can cause a delayed diagnosis and treatment to the patient. The differential diagnosis include lipoma, fibroma, enlargement of the lymph nodes, compartment syndrome, hematoma, hernia, and soft-tissue sarcoma. Anytime a soft tissue mass is identified in the skeletal muscle of a young adult, haemangioma should be considered. Conclusion Literature research identified very few cases of intramuscular haemangioma of the foot. Wide excision of the muscle is a feasible surgical treatment option.

Often times, conservative treatment is unsuccessful in long-term resolution of recalcitrant verrucae plantaris lesions. In addition to being aesthetically displeasing, severe cases that are left untreated can be debilitating, often leading to chronic pain, gait abnormalities, and further cutaneous spread. Inoculation through implantation of verrucae plantaris into a muscle was previously postulated to provoke an immune response against the human papilloma virus, resulting in auto-immunization. The purpose of this study was to determine the rate of recurrence following two methods of treatment: A) Surgical removal and subsequent implantation of verruca plantaris into the contralateral abductor hallucis muscle belly and B) Surgical excision of verrucae plantaris. A retrospective chart review of 43 consecutive patients was performed. Group A was comprised of 25 patients who underwent surgical removal of verrucae plantaris followed by implantation of a biopsied specimen into the contralateral abductor hallucis muscle belly. Group B was comprised of 18 patients who underwent only surgical removal of the verrucae. The presence or absence of verrucous lesions was recorded at a post-operative follow-up at an average of 27.5 months. Correlations between recurrence of disease and age, sex, and medical comorbidities were evaluated. Our results suggest that implantation of verruca plantaris into the abductor hallucis muscle belly yields no significant difference in clinical recurrence rates when compared to surgical removal.

Morphological changes of the abductor hallucis muscle (AbH) in flexible flatfoot (FF) individuals influence regulations of the medial longitudinal arch (MLA). Prolonged and repeated stretching of AbH in flexible flatfoot may cause changes in muscle reflex properties and further influence postural performance. However, AbH muscle reflex under different postural conditions have never been examined. The purpose of this study was to investigate differences in AbH H-reflex and postural performance between individuals with normal foot (NF) alignment and FF under prone, double-leg stance (DLS), and single-leg stance (SLS) conditions.Cross-sectional study.University laboratory.Individuals with FF (n = 12) and NF (n = 12).AbH H-reflex, AbH EMG and center of pressure (CoP) displacement.Under all postural conditions, AbH H-reflex was significantly lower in the FF group (P .05). Under the SLS condition, AbH EMG was significantly higher in the FF group (P .05), and CoP displacement for the medial-lateral and anterior-posterior directions were significantly higher in the FF group (P .05).With increased postural demand, FF individuals maintained their postural stability by recruiting greater AbH activities than through automatic stretch reflex, but FF individuals still showed inferior posture stability.

Lumbosacral spinal stenosis is a narrowing of the spinal canal, which compresses the nerves travelling through the lower back into the lower limbs. Symptomatic patients often have intermittent neurogenic claudication, and with diagnostic procedures at rest, it is difficult to evaluate it objectively Measurement of conduction in the cauda equine at rest and after walking may be a valuable tool in lumbosacral spinal stenosis work-up. The aim of our study was to compare results of magnetic in electrical stimulation, and the peripheral motor conduction time. Methods: M and F waves and compound muscle action potentials were recorded after L1 MS, S1 MS, and L1 ES. Results: The compound muscle action potential latency on L1 MS was 26.9 ± 2.6 milliseconds and on L1 ES was 25.6 ± 2.2 milliseconds, and the peripheral motor conduction time was 27.0 ± 2.5 milliseconds (analysis of variance P = 0.0008). The compound muscle action potential amplitude was 12 ± 11% of M-wave on L1 MS, 32 ± 18% on S1 MS, and 31 ± 17% on L1 ES. Conclusions: Dorsal MS reliably elicits responses in the abductor hallucis muscle. The latency of compound muscle action potentials on L1 MS is comparable to peripheral motor conduction time. A potential drawback of MS may be too weak stimulation at the proximal end of the cauda equina.

The role of intrinsic muscles of the foot in the medial longitudinal arch mechanism was investigated in several recent studies. It is determined that the abductor hallucis muscle (AHM) has an important role in dynamic support of the arch. Objective of our preliminary study was to establish a relationship between the navicular drop index (NDI) and the AHM abduction force. A single group exploratory design was used. The participants were 127 athletes aged 8-16 years (m/f 74/53; 11.99 ± 2.11 years; 156.21 cm ± 15.51 cm; 47.61 kg ± 13.96 kg; 2-5 training h/week), examined at a regular sport medical checkup. Abductor hallucis force was measured by a digital Algometer FPX 25/220, which is a newly developed approach that should be properly assessed in further studies to establish standardization and qualification of the algometer for this specific use. Navicular drop test has been performed as originally developed by Brody. Data were analyzed using Student's t-test, Mann-Whitney U test, contingency coefficients and logistic regression. Average NDI was found to be significantly different comparing the group with positive abduction force and the group that cannot perform the active abduction. Logistic regression indicated that the variable representing impossible active abduction was significantly associated with NDI. Preliminary results showed that there was a strong relationship between the hallux active abduction force and NDI in young athletes: the higher abduction force correlates to lower NDI. To determine clinical relevance of our investigation, further study is planned in which hallux active abduction force and NDI would be compared and correlated pre- and postspecific strengthening program. © 2021 BMJ Publishing Group. All rights reserved.

OBJECTIVE: To examine the peripheral nervous system (PNS) in spinal cord injured (SCI) patients using two novel methods: (1) MScanFit MUNE; a motor unit number estimation method detecting motor unit loss and (2) muscle velocity recovery cycles (MVRCs) measuring muscle membrane properties which has previously shown depolarization of the muscle membrane in denervated muscles.METHODS: Thirty chronic SCI patients (lesion above Th10) and twenty-five gender -and age matched healthy controls (HC) were examined. MScanFit was recorded from peroneal nerve to anterior tibial muscle (TA) and tibial nerve to abductor hallucis muscle after excluding localized mononeuropathies. MVRCs were recorded from TA.RESULTS: Nerve conduction studies showed mononeuropathy in 8 patients (27%) (sciatic (2), -or peroneal nerve (6)). SCI patients had in average reduced motor unit number compared with HC and prolonged muscle refractory period and reduced supernormality.SIGNIFICANCE: A high prevalence of nerve lesion and a diffuse affection of the PNS following SCI are highly relevant findings that should be accounted for when planning neurorehabilitation for persons living with SCI.

Introduction Distal tarsal tunnel syndrome (DTTS) is characterised by compression of the tibial nerve as it passes underneath the abductor hallucis muscle belly. There is no current consensus on treatment for DTTS. This study was conducted to compare and evaluate the effect of ultrasound-guided botulinum toxin A (BTX-A) versus ultrasound-guided corticosteroid injection (CSI) for the treatment of DTTS. Methods This study was a single-centre, randomized, and double-blinded trial. The study protocol was submitted to the local ethics committee board and subsequently registered in a research registry. 88 patients with DTTS were randomly divided into 2 groups according to the treatment received. The patients were evaluated over 12 weeks. Evaluation was via the Foot Health Status Questionnaire (FHSQ). The primary outcome measures were pain and the secondary outcomes were function and the use of oral analgesics. All of the assessments were performed at baseline and at 3, 6, and 12 weeks after treatment. Results This is a randomized controlled trial evaluating the efficacy of BTX-A versus CSI in the treatment of DTTS. This study has limited inclusion and exclusion criteria and a well-controlled intervention. Conclusions The results of this trial will provide more evidence on which method can better treat DTTS. Trial registration We have registered this trial with the Australian New Zealand Clinical Trials Registry and the temporary trial number is 380,105.

Background The aim of this study was to provide a safe ultrasound-guided minimally invasive surgical approach for a distal tarsal tunnel release concerning nerve entrapments. Methods and results The study was carried out on ten fresh-frozen feet. All of them have been examined by high-resolution ultrasound at the distal tarsal tunnel. The surgical approach has been marked throughout the course of the medial intermuscular septum (MIS, the lateral fascia of the abductor hallucis muscle). After the previous steps, nerve decompression was carried out through a MIS release through a 2.5 mm (± 0.5 mm) surgical portal. As a result, an effective release of the MIS has been obtained in all fresh-frozen feet. Conclusion The results of our anatomic study indicate that this novel ultrasound-guided minimally invasive surgical approach for the release of the MIS might be an effective, safe and quick decompression technique treating selected patients with a distal tarsal tunnel syndrome.

BACKGROUND Intraoperative neuromonitoring using tc-MEPs satisfactorily detects motor tract integrity changes during spinal surgery. However, tc-MEP is affected by anesthesia and other factors, in which the stimulation threshold increases because the waveform amplitude decreases over time with the accumulation and boluses of anesthetics. METHODS We conducted a retrospective study of 139 patients. The average age was 30 years. Tc-MEPs were recorded bilaterally from the tibialis anterior muscle and the abductor hallucis muscle. Statistical tests were used to investigate the changes to evaluate anesthetic effects. RESULTS There were no significant differences in tc-MEP amplitude change (%) between the groups of propofol (13 %), remifentanil (22 %) and sufentanil (26 %, p < 0.01). Significant differences were found between the groups of propofol, remifentanil, and sufentanil (20 %) and bolus sufentanil (‒30 %), and bolus ketamine (730 %, p < 0.008). Major differences were observed between bolus sufentanil (‒30 %) and bolus ketamine (730 %, p < 0.001). When comparing tc-MEPs with no amplitude, no significant difference was found between the groups of propofol (26 %), remifentanil (24 %), and sufentanil (28 %, p < 0.007). Substantial difference was found between the groups of propofol, remifentanil, and sufentanil (mean 26 %) and the group where ketamine boluses were administered. We didn't observe any loss of amplitude (0 %, p < 0.0002). CONCLUSION IONM may be useless in patients where boluses of sufentanil are administered and also with Medical Research Council grades 3 and below. Consider applying IONM in patients with severe spinal deformity along with a higher age of over 50 and neurological deficit. Increasing stimulus intensity or facilitation techniques may be considered to improve the usefulness of tc-MEP. Our concept of findings supports the neurophysiological monitoring findings in other studies (Tab. 10, Ref. 45).

Despite the high availability of surface electromyography (sEMG), it is not widely used for testing the effectiveness of exercises that activate intrinsic muscles of foot in people with hallux valgus. The aim of this study was to assess the effect of the toe-spread-out (TSO) exercise on the outcomes of sEMG recorded from the abductor hallucis muscle (AbdH). An additional objective was the assessment of nerve conduction in electroneurography. The study involved 21 patients with a diagnosed hallux valgus (research group A) and 20 people without the deformation (research group B) who performed a TSO exercise and were examined twice: before and after therapy. The statistical analysis showed significant differences in the third, most important phase of TSO. After the exercises, the frequency of motor units recruitment increased in both groups. There were no significant differences in electroneurography outcomes between the two examinations in both research groups. The TSO exercise helps in the better activation of the AbdH muscle and contributes to the recruitment of a larger number of motor units of this muscle. The TSO exercises did not cause changes in nerve conduction. The sEMG and ENG are good methods for assessing this exercise but a comprehensive assessment should include other tests as well.

Objective: Despite suggestions that atrophied, or weak toe flexor muscles are associated with the formation of toe deformities, there has been little evidence to support this theory. This study aimed to determine whether the size of the toe flexor muscles differed in older people with and without toe deformities. \ud Methods: Forty-four older adults (>60 years) were recruited for the study. Each participant\ud had their feet assessed for the presence of hallux valgus or lesser toe deformities. Intrinsic and extrinsic toe flexor muscles were imaged with an ultrasound system using a standardised protocol. Assessor blinded muscle thickness and cross-sectional area was measured using Image J software. \ud Results: Participants with lesser toe deformities (n=20) were found to have significantly smaller quadratus plantae (p=0.003), flexor digitorum brevis (p=0.013), abductor halluces (p=0.004) and flexor halluces brevis (p=0.005) muscles than the participants without any toe deformities (n=19). Female participants with hallux valgus (n=10) were found to have significantly smaller abductor hallucis (p=0.048) and flexor halluces brevis (p=0.013) muscles than the female participants without any toe deformities (n=10; p\ud Conclusion: This is the first study to use ultrasound to investigate the size of the toe flexor muscles in older people with hallux valgus and lesser toe deformities compared to otherwise healthy older adults. The size of the abductor hallucis and flexor hallucis brevis muscles were decreased in participants with hallux valgus whereas the quadratus plantae, flexor digitorum brevis, abductor hallucis and flexor halluces brevis muscles were smaller in those participants with lesser toe deformities.

The medial and lateral plantar nerves are branched from the tibial nerve and move to the tip of the toes. A variation of medial plantar nerve was found on the left side of a 78-year-old Korean male cadaver. The tibial nerve was divided into the lateral and medial plantar nerves beneath the plantar flexor. The medial plantar nerve passed deep to plantar aponeurosis and superficial to the flexor digitorum brevis. It gave off a common plantar digital nerve and then divided into three proper plantar digital nerves near the metatarsal bases. In this article, we report a superficial course of the medial plantar nerve and describe its unique morphology and discuss the clinical significance of this variation.

Hallux valgus is a common foot disorder. In patients with hallux valgus, the anatomy and biomechanics of foot is subject to alterations.The aim of this clinical and neurophysiological study is to compare the activity of abductor hallucis (AbdH) muscle between the group of patients with hallux valgus and control group of healthy people, with the use of surface electromyography.The study involved 44 feet with diagnosed hallux valgus (research group) and 42 feet without deformation (control group). The X-ray images, measurements of range of motion in the first metatarsophalangeal joint and in hallux interphalangeal joint, and the surface electromyography study recorded from AbdH muscle were performed.Considering the amplitude of motor unit action potential, study participants with hallux valgus demonstrate significantly less activity of AbdH muscle than people without hallux valgus deformity. This activity is not dependent on the severity of valgus, age, or range of motion.It is speculated that the changes of the AbdH function may occur in the period before clinical appearance of hallux valgus deformity, or at the onset of distortion development. Further studies are needed for a comprehensive assessment of AbdH muscle in patients with hallux valgus.

Objective To identify the anatomical motor points of the abductor hallucis muscle in cadavers. Methods Motor nerve branches to the abductor hallucis muscles were examined in eight Korean cadaver feet. The motor point was defined as the site where the intramuscular nerve penetrates the muscle belly. The reference line connects the metatarsal base of the hallux (H) to the medial tubercle of the calcaneus (C). The x coordinate was the horizontal distance from the motor point to the point where the perpendicular line from the navicular tuberosity crossed the reference line. The y coordinate was the perpendicular distance from the motor point to the navicular tuberosity. Results Most of the medial plantar nerves to the abductor hallucis muscles divide into multiple branches before entering the muscles. One, two, and three motor branches were observed in 37.5%, 37.5%, and 25% of the feet, respectively. The ratios of the main motor point from the H with respect to the H-C line were: main motor point, 68.79%±5.69%; second motor point, 73.45%±3.25%. The mean x coordinate value from the main motor point was 0.65±0.49 cm. The mean value of the y coordinate was 1.43±0.35 cm. All of the motor points of the abductor hallucis were consistently found inferior and posterior to the navicular tuberosity. Conclusion This study identified accurate locations of anatomical motor points of the abductor hallucis muscle by means of cadaveric dissection, which can be helpful for electrophysiological studies in order to correctly diagnose the various neuropathies associated with tibial nerve components.

Myofascial pain syndrome is characterized by pain and a limited range of joint motion caused by muscle contracture related to motor-end-plate dysfunction and the presence of myofascial trigger points (MTrPs). It is the most frequent cause of musculoskeletal pain, with a worldwide prevalence varying between 13.7% and 47%. Of the patients with myofascial pain syndrome, approximately 17% have pain in the medial hindfoot area. The abductor hallucis muscle is located in the medial, posterior region of the foot and is related to painful plantar syndromes. The objective of this study was to describe the distribution of the medial plantar nerve and their anatomical relationship with MTrPs found in the literature. Thirty abductor hallucis muscles were dissected from 15 human cadavers (8 males and 7 females). The muscles were measured, and the distribution data of the medial plantar nerve branches in each quadrant were recorded. For statistical analysis, we used generalized estimation equations with a Poisson distribution and a log logarithm function followed by Bonferroni multiple comparisons of the means. The data are expressed as the mean ± standard deviation. The level of significance was adjusted to 5% (p<0.05). A high concentration of nerve branches was observed in the first quadrant (Q1) of the abductor hallucis muscle, which is the same area in which the MTrPs are described. The topography of the entry points of the branches of the medial plantar nerve to the abductor hallucis muscle correlates with the topography of the muscular trigger points. The anatomical structure of the MTrPs may be useful for a better understanding of the pathophysiology of myofascial disorders and provide a basis for surgical and clinical treatments.

Introduction In this study we collected reference values for the across-tarsal-tunnel conduction of the motor tibial nerve (mTN). Methods The mTN compound muscle action potentials (CMAPs) from the abductor hallucis muscle were obtained by stimulating below/above the malleolus and the popliteal fossa. The effect of weight, height, body mass index (BMI), foot and leg length, sex, and age were evaluated using univariate and multivariate correlation analyses, and predictive equations for each mTN conduction parameter were developed. Results On the basis of data from 185 subjects, there were differences between women and men in all anthropometric parameters and for some nerve conduction values. Through multivariate analysis, age, but not sex, was found to have a significant impact. Height affected both distal and proximal conduction velocity. BMI affected CMAP amplitude. Discussion mTN conduction is influenced by various demographic and anthropometric factors. For all intrinsic factors, height demonstrated the greatest effect on mTN conduction across the tarsal tunnel.

Low-dose droperidol has been widely used as an antiemetic during and after surgery. Although high-dose droperidol affects motor-evoked potential, the effects of low-dose droperidol on motor-evoked potential amplitude are unclear. The aim of this study was to investigate whether low-dose droperidol affects motor-evoked potential amplitude. We retrospectively reviewed the data of patients who underwent spine surgery under general anesthesia with motor-evoked potential monitoring from February 2016 to 2017. The outcome was the motor-evoked potential amplitude of the bilateral abductor pollicis brevis muscle, tibialis anterior muscle, and abductor hallucis muscle within 1 and 1-2 h after droperidol administration, compared with the baseline motor-evoked potential value. Thirty-four patients were analyzed. The median dose of droperidol was 21 µg/kg. The motor-evoked potential amplitudes of all muscles were significantly reduced after droperidol administration and recovered to baseline values within 2 h. The reduction of all motor-evoked potential amplitudes after droperidol administration was 37-45% of baseline values. There were no significant differences in other drugs administered. There were no serious adverse effects of droperidol administration. Motor-evoked potential amplitude was suppressed by low-dose droperidol. During intraoperative motor-evoked potential monitoring in spine surgery, anesthesiologists should pay careful attention to the timing of administration of droperidol, even at low doses. Based on the results of this study, we are conducting a randomized controlled trial.

Background This study aims to analyse the clinical results of ultrasound-guided surgery for the decompression of the tibial nerve, including its distal medial and lateral branches, to treat tarsal tunnel syndrome. These structures are the complete flexor retinaculum and the deep fascia of the abductor hallucis muscle, including individualised release of the medial and lateral plantar nerve tunnels. Method This is a retrospective review of 81 patients (36 men and 45 women) with an average age of 41 years old (32–62) and an average clinical course of 31 months (8–96) compatible with idiopathic tarsal tunnel syndrome, who underwent ultrasound-guided decompression of the proximal and distal tarsal tunnel between February 2015 and November 2017 (both months included), with a minimum follow-up of 18 months. Results Based on the Takakura et al. scale for the 81 patients, 76.54% obtained excellent results, 13.58% good results, and 9.87% poor results. The patients with the longest course of symptoms displayed the worst results. Conclusion Although 9% of patients did not improve, ultrasound-guided tarsal tunnel release might be a viable alternative to conventional open approaches.

BACKGROUND: Lateralising calcaneal osteotomy for pes cavus is generally regarded to be harder to shift than a medialising calcaneal osteotomy for pes planus. The aim of our study was to determine the structures which restrain a lateral shift. METHODS: Lateralising calcaneal osteotomy was performed on four soft-embalmed cadavers via a standard lateral approach and the lateral calcaneal shift was measured before and after the release of flexor retinaculum. Further exploratory dissection around the osteotomy site revealed the abductor hallucis muscle to be the main restraint to the lateral shift of the calcaneus. Subsequently, lateralising calcaneal osteotomy was performed on another four cadavers and the abductor hallucis muscle fascia as well as the plantar fascia was released. The lateral shift was measured before and after the fascia release, and compared with the results achieved following the flexor retinaculum release in the first four cadavers. RESULTS: Lateralising calcaneal osteotomy alone resulted in an average of 4.5-mm lateral shift in the first four cadaveric specimens. Releasing the flexor retinaculum led to a further 3-mm increase of lateral shift on average. In the next four cadaveric specimens, lateralising calcaneal osteotomy alone resulted in an average of 5.5-mm lateral shift. Release of abductor hallucis muscle fascia and the plantar fascia in these four specimens increased the lateral shift by an additional 7 mm on average. Hence, release of abductor hallucis muscle fascia resulted in an extra 4-mm shift on average compared with what is achieved with flexor retinaculum release. CONCLUSIONS: Abductor hallucis muscle fascia was discovered to be one of the main structures limiting the lateral shift in lateralising calcaneal osteotomy. Release of fascia over this muscle as well as the plantar fascia should help in improving lateral shift. Further experimental and clinical research is necessary to confirm the findings of this pilot study.

Introduction This study investigated whether the prolongation of the cauda equina conduction time (CECT) was related to the type of neurogenic intermittent claudication due to lumbar spinal stenosis. Methods In total, 149 patients who underwent surgery due to lumbar spinal stenosis with neurogenic intermittent claudication were classified into three groups as follows: cauda equina-type(n = 67), radicular-type(n = 29), and mixed-type(n = 53). Cauda equina conduction time was measured by placing disc electrodes on the abductor hallucis muscle, electrically stimulating the tibial nerve of the ankle and recording the compound muscle action potentials and F-waves. Motor evoked potentials from the abductor hallucis muscle were measured after magnetically stimulating the lumbosacral spine. Cauda equina conduction time was calculated from the latencies of compound muscle action potentials, F-waves, and motor evoked potentials. The measurement of the dural sac cross-sectional area were assessed using computed tomography myelography or MRI. Results The values of CECT were as follows: cauda equina-type, 5.6 ± 1.1 ms; mixed-type, 5.1 ± 0.9 ms; and radicular-type, 4.0 ± 0.9 ms. The values of dural sac cross-sectional area were as follows: cauda equina-type, 42.8 ± 18.7 mm; mixed-type, 49.6 ± 20.9 mm; and radicular-type, 75.3 ± 19.1 mm. In the cauda equina-type and mixed-type patients, CECT was significantly prolonged and there were negative correlations between CECT and dural sac cross-sectional area. Conclusions Cauda equina conduction time differed according to the type of lumbar spinal stenosis. The prolongation of CECT may be caused by the demyelination of the CE. Cauda equina conduction time may be a useful measure for evaluating the dysfunction of the CE rather than radiculopathy for patients with lumbar spinal stenosis.

Introduction: Bowel and bladder function are at risk during tumor resection and other surgeries of the conus, cauda equina, and nerve roots. This study demonstrates the ability to acquire triggered electromyography (t-EMG) from the external urethral sphincter (EUS) muscles by utilizing a urethral catheter with an electrode attached. Methods: A retrospective analysis of neurophysiological monitoring data from two medical centers was performed. Seven intradural tumors and three tethered cord release surgeries that used urethral sphincter electrodes to record t-EMG were included in the analysis. The patients consisted of five females and five males with ages ranging from eight months to 67 years (median: 49 years). Our neuromonitoring paradigm included upper and lower extremity somatosensory evoked potentials (SSEPs) and transcranial electrical motor evoked potentials (TCeMEPs), as well as spontaneous and triggered electromyography (EMG) from the external anal sphincter (EAS), EUS muscles and lower extremity muscles bilaterally. A catheter with urethral electrodes attached was used for recording spontaneous electromyography (s-EMG), t-EMG, and TCeMEPs from the skeletal muscle of the EUS. Train of four (TOF) was also recorded from the abductor hallucis muscle as well for monitoring the level of muscle relaxant. Results: We were able to successfully record t-EMG responses from the EUS muscles in all patients (100%). It is worthy to note that only one patient presented preoperatively with bladder incontinence, urgency, and frequency. Almost immediately in the postoperative phase, the patient’s frequency and urgency improved, and the bladder function normalized within two weeks of having the tumor removed. Conclusions: In this small series, we were able to acquire t-EMG in 100% of patients when recorded from the EUS using a urethral catheter with electrodes built into it. T-EMGs can be attempted in surgeries that put the function of the pelvic floor at risk. More study is needed to establish better statistical methods, better modality efficacy, and a better understanding of intraoperative countermeasures that may be employed when an alert is encountered to prevent impending neurological sequelae.

Introduction Post-surgical lumbar spine syndrome is the result of failed or unsuccessful back surgery. It is defined as failure to relieve pain and disability in the lower back and extremities following surgery. This case report suggests inclusion of neurogenic hallux valgus to the list of potential complications following failed lumbar spine surgery. Case report A severe unilateral hallux valgus deformity with an irreducible dislocation of the metatarsophalangeal joint due to complete wasting of the abductor hallucis muscle was diagnosed in a 73-year-old woman admitted for a hip fracture. The patient reported that the deformity developed after a failed lumbar spine surgery, which included decompression and stabilization of L2-S1 with posterior instrumentation 6 years previously. The deformity progressively deteriorated over a 3-year-period. Three months following the hip fracture surgery, the patient went through a neurological examination and an electrophysiological study. The findings indicated that the left hallux valgus deformity most likely developed because of the abductor hallucis muscle wasting due to S1 nerve root injury secondary to the failed lumbar spine surgery. Conclusion Post-surgical lumbar spine syndrome may be a reasonable causative etiology of a severe unilateral hallux valgus deformity with an irreducible dislocation of the metatarsophalangeal joint due to complete wasting of the abductor hallucis muscle secondary to S1 nerve root injury.

Background:This study investigated the effect of Vibram FiveFingers Bikila minimalist shoes on intrinsic foot musculature. We hypothesized that a gradual transition into minimalist shoes will increase the thickness of the abductor hallucis muscle.Methods:Forty-one individuals were divided into four groups: control (traditional shod) (n = 9), restricted walking in Vibram FiveFingers (n = 11), running in Vibram FiveFingers (n = 10), and unlimited walking in Vibram FiveFingers (n = 11). At baseline, 12 weeks, and 24 weeks, the thickness of the abductor hallucis muscle was determined using ultrasound. Statistical analysis was performed to determine the significance of differences in muscle thickness at the three different time points.Results:The mean thickness of the abductor hallucis muscle at 24 weeks was significantly greater than that at baseline for the restricted walking (P = .005) and running (P < .001) groups. In the unlimited walking group, the mean thickness of the muscle at 12 weeks was significantly greater than that at baseline (P < .05) but not at 24 weeks. There were no significant differences in muscle thickness among the three time points for the control group (P = .432).Conclusions:This study demonstrated that wearing Vibram FiveFinger Bikila footwear over a controlled period of time, an unlimited amount of time, as well as transitioning runners over a 6-month period of time using the 10% philosophy for increasing mileage, significantly increases intrinsic muscle thickness of the abductor hallucis. The abductor hallucis muscle aids in support of the medial longitudinal arch, and an increase in this muscle thickness may help reduce running-related injuries thought to arise from arch weakness.

Purpose: The purpose of this study was to determine the intraand inter-rater reliability of muscle thickness (MT) measurements of the abductor hallucis (AbdH) in subjects with hallux valgus (HV), using ultrasonography performed at different inward pressures of approximately 0.5 kg, 1.0 kg, 1.5 kg, and 2.0 kg, with no pressure control. Methods: Thirty-two subjects with HV were recruited. The thicknesses of both sides of the AbdH were measured randomly by two different examiners for assessment of the intraand inter-rater reliability. The measurement values were analyzed using the intra-class correlation coefficient (ICC) with a 95% confidence interval (CI). ICC (2,1) was used to determine the inter-rater reliability of MT measurements of the AbdH, while ICC (3,1) was used to assess the intra-rater reliability. Results: The results showed higher ICC values for intra-rater reliability compared to inter-rater reliability, and the value for inter-rater reliability with no pressure control (ICC=0.74 [95%CI=0.53-0.87]) was smaller compared to pressures of 0.5 kg, 1.0 kg, 1.5 kg, and 2.0 kg. Other inward pressures for intraand inter-rater reliability also showed excellent values (ICC=0.86-0.96). Conclusion: The findings showed that maintaining consistent inward pressure is essential for reliable results in measurement of the MT of the AbdH by different examiners in a clinical setting.

Vascular Leiomyoma is a benign soft tissue tumor that originates from the tunica media of blood vessels. This rare slow growing tumor requires histopathological examination for accurate diagnosis. As a result, preoperative diagnosis is difficult. We present the case of a 55 year old female referred to our surgical practice with a symptomatic slow growing mass on her right medial arch. Prior to excisional biopsy, ultrasonographic examination showed a 4mm unilocular anechoic avascular cyst within the subdermal layer overlying the abductor hallucis muscle belly. Whilst rare, vascular leiomyomas should be considered as a differential diagnosis for all slow growing foot and ankle masses.

Anatomic constraints of the foot make it vulnerable to infection when the primary defense, the soft-tissue envelope is compromised due to vicinity of tendons, joints and bone to the skin. Reconstructive efforts in the presence of osteomyelitis compounds the clinical picture. Treatment of midfoot osteomyelitis can have devastating outcomes with loss of biomechanic integrity of the foot, and often loss of part of the foot which at that level results in significant functional deficits. When primary closure is not an option due to potential loss of structural and ultimately biomechanic integrity; soft tissue defects in the presence of exposed tendon, joint or bone with intact vasculotome require expeditious and predictable coverage options. Local muscle flaps belong to the same armamentarium as local random flaps and free flaps considering their unique intricacies. The abductor hallucis muscle flap has been employed for covering soft tissue defects of different etiologies encompassing from the medial hindfoot and ankle to the medial plantar forefoot often with concomitant osteomyelitis of the underlying bone. In this case report, we describe a technique of a proximally based abductor hallucis flap for a patient with traumatic Lisfranc dislocation that developed surgical site infection complicated by osteomyelitis of the tarsometatarsal joint.

Introduction. The aim of this study is to elucidate the impairment of excitation-contraction (E-C) coupling in ICU-acquired weakness (ICUAW) using a unique electrophysiologic method in patients received the intensive care in ICU. Methods. We examined 13 patients with ICUAW and 11 normal controls. We performed successive recordings of electrophysiological tests after ICU admission. First, CMAPs of abductor hallucis muscle (AH) and sural SNAPs were recorded using a conventional method. In addition, the tibial nerve was stimulated at the popliteal fossa using a supramaximal rectangular pulse to record CMAPs from soleus muscle (SOL). Simultaneously, movement- related potential (MRP) was recorded using an accelerometer (SV1101; NEC, Tokyo Japan) taped at the base of hallux and calculated E-C coupling time (ECCT) based on the latency differences between soleus CMAP and MRP. Results. We recorded significantly decreased CMAP amplitudes in 6 AHs and 8 SOLs and significantly longer CMAP durations in 2 SOLs. Also, we recorded significantly decreased MRPs in 9 patients and significantly prolonged ECCTs in 10 patients. These abnormal findings were detected even in very short durations of ICU stay such as 2-3 days. The durations of ICU stay seemed to be correlated with involvement of CMAP amplitudes of AH/SOL, MRPs and ECCTs. Ten patients showed decreased SOL-CMAP amplitude concomitant with decreased MRP and/or prolonged ECCT in spite of preservation of SOL-CMAP duration. In addition, CMAP amplitudes of AH/SOL and MRP were significantly smaller in patients than in controls. Furthermore, CMAP durations of AH and ECCTs were significantly longer in patients than in controls. Conclusion. The E-C coupling may be impaired in the very early stages of CIM. Noninvasive measurement of MRP and ECCT is easy to perform, and may be useful to detect the impairment of E-C coupling in the early stages of ICUAW.

Background The intrinsic foot muscles (IFMs) are important contributors to optimal foot function. While assessment of IFM morphology using ultrasound imaging in non-weight bearing has been established, this does not evaluate the foot in its primary functional position of weight bearing. Research question Is ultrasound imaging a reliable and clinically feasible method of measuring IFM morphology in weight bearing, do these measures differ to those from non-weight bearing and are they associated with participant characteristics? Methods Ultrasound images were obtained by a single rater from twenty-four healthy participants on two occasions, one week apart. Images were taken in weight bearing (bilateral stance) and non-weight bearing (seated). Cross-sectional area and thickness of the abductor hallucis muscle, and dorsoplantar thickness of the muscles of the first interstitium were measured from acquired images. A second rater also acquired images at the first session. Participant characteristics included age, height, weight, sex, foot posture and foot mobility. Results Measurements of IFM morphology demonstrated high reliability within and between test sessions, as well as between raters (ICCs > 0.8). Our findings suggest that changes of 10–18% could be considered to exceed measurement error. Larger IFM size was related to larger body size (taller, heavier), foot posture (longer foot, higher arch, wider midfoot) and male sex. Significance This study is the first to describe a reliable and clinically feasible method of measuring IFM morphology in weight bearing. These measurements could be used in future studies to assess IFM morphology in patient populations and to evaluate the effect of intervention. Body size and foot posture explained between 20 and 41% of the variance in measurements and should be considered when comparing IFM morphology between individuals. The establishment of reliable measurements in weight bearing provides a crucial step towards the future evaluation of IFM function using ultrasound imaging.

OBJECTIVES The purpose of the study was to determine whether ultrasound (US)-guided surgery is a viable type of surgery for performing an effective release/decompression of the constricting structures that are responsible for focal nerve compression in tarsal tunnel syndrome. METHODS Ultrasound guidance was used on cadaveric specimens to delineate the anatomic course of the nerves and vessels in the medial ankle that comprise the structures involved in tarsal tunnel syndrome. Ultrasound guidance was used on cadaveric specimens and assisted in delineating a safe surgical zone to adequately and effectively release these constrictive structures of the proximal and distal tarsal tunnels. The US-guided tarsal tunnel release/decompression was performed through 2 small 1- to 2-mm portals. After US-guided release, anatomic dissection was used to check the efficacy (release of the flexor retinaculum and deep abductor hallucis muscle) and safety (absence of neurovascular or tendon injury) of the procedure. RESULTS In 12 fresh cadaveric specimens, US-guided release of the tibial nerve (proximal tarsal tunnel) and its branches (distal tarsal tunnel) at the medial ankle was effective in all 12 specimens (100% release rate), without any signs of compromise or injury into the neurovascular structures. CONCLUSIONS Ultrasound-guided tarsal tunnel release is a feasible surgical procedure that can be safe and effective with the proper training, although further investigation is warranted. This type of surgery may promote faster recovery with less postoperative morbidity, including pain, but this will be the subject of a further investigation.

Background/objective: Tarsal tunnel syndrome is a relatively rare entrapment neuropathy with the lateral and medial plantar nerves entrapped inside of the tarsal tunnel. When conservative treatment fails, standard open decompression of the nerve can be achieved by releasing the flexor retinaculum of the foot through a several-centimetre-long skin incision made along the tarsal tunnel. By contrast, we made a 1-cm portal incision at the proximal part of the medial ankle, and endoscopic tarsal tunnel release of the flexor retinaculum of the foot and part of the abductor hallucis muscle was achieved using the Universal Subcutaneous Endoscope (USE) system. Methods: Our procedure was performed under local anaesthesia without a pneumatic tourniquet on an outpatient basis. The USE system was inserted into the tarsal tunnel at the proximal part of the medial ankle; the nerves, vessels, flexor retinaculum, tendons of the foot, and the abductor hallucis muscle were then endoscopically identified. Decompression of the lateral and medial plantar nerves entrapped inside of the tarsal tunnel was then achieved by releasing the flexor retinaculum of the foot and part of the abductor hallucis muscle with a push knife under complete endoscopic observation. Results: Results from eight feet of five patients were compiled and analyzed. All showed improved clinical signs compared with their preoperative condition. Conclusion: Our less invasive endoscopic management for tarsal tunnel syndrome using the USE system produces sufficient results.

Purpose: The purpose of this study was to effect of application methods of stretching exercise on angular variation and muscle activation changes in the hallux valgus. Method : This study was performed on twenty subjects. Twenty subjects were divided into two groups; Agonist Contraction(AC)(n=10), Hold-relax with Agonist Contraction(HR-AC)(n=10). Both of the group performed the exercise 5 times a week for 6 weeks. The data was analyzed by the paired t-test for comparing before and after changes of factors in each group and the independent t-test for comparing the between groups. Result : In the within group comparisons, HR-AC group abductor hallucis muscle activity showed significant difference between before and after the intervention(p

OBJECT The occurrence of compressive cervical myelopathy (CCM) increases in adults over 50 years of age. In addition, diabetes mellitus (DM) is a frequent comorbidity for people of this age and may impact the severity of CCM. The authors assessed motor pathway function in diabetic patients with CCM to investigate the correlation between electrophysiological parameters and clinical symptoms. METHODS Motor evoked potentials (MEPs) were measured from the abductor digiti minimi muscle (ADM) and the abductor hallucis muscle (AH) following transcranial magnetic stimulation, as were M- and F-waves following electrical stimulation of the ulnar and tibial nerves, in 22 patients with CCM and diabetes mellitus (DM) who had not experienced symptomatic diabetic neuropathy (CCM-DM group), in 92 patients with CCM alone (CCM group), and in 24 healthy adults (control group). The peripheral conduction time (PCT; measured from the ADM and AH) was calculated as follows: (M-wave latency + F-wave latency −1)/2. The central motor conduction time (CMCT; measured from the ADM and AH) was calculated by subtracting the PCT from the onset latency of the MEPs. The Japanese Orthopaedic Association (JOA) score for cervical myelopathy was obtained before and 1 year after surgery as a clinical outcome measure. RESULTS MEP, PCT, and CMCT parameters in the CCM-DM and CCM groups were significantly longer than those in the control group (p = 0.000−0.007). The PCTs in the CCM-DM group were significantly longer than those in the CCM group (p = 0.001−0.003). No significant differences were detected in the MEP and CMCT parameters between the CCM-DM and CCM groups (p = 0.080–1.000). The JOA score before surgery in the CCM-DM group was 10.7 ± 2.0 points and was significantly lower than that in the CCM group (12.2 ± 2.5 points, p = 0.015). In the CCM-DM group, JOA scores before surgery correlated with MEP-AH (r = −0.610, p = 0.012) and PCT-AH (r = −0.676, p = 0.004) values, but not with CMCT values, while the JOA scores were related to both MEP and CMCT parameters in the CCM group. The JOA scores improved to 13.8 ± 2.2 points after surgery (p = 0.001) and correlated with MEP-AH (r = −0.667, p = 0.005) and PCT-AH (r = −0.611, p = 0.012) in the CCM-DM group. CONCLUSIONS The results suggest that MEP, PCT, and CMCT parameters each reveal abnormalities in the upper and lower motor neurons even in patients with DM. The results also show a prolonged PCT in CCM-DM patients, despite having no history of diabetic neuropathy. Corticospinal tract impairments are similar between CCM and CCM-DM patients, while the JOA score of the CCM-DM patients is lower than that in the CCM patients. The JOA score in CCM-DM patients may be influenced by additional impairments in peripheral nerves or other diabetic complications. These electrophysiological studies may be useful for screening motor pathway function for CCM in patients with DM.

The proximal segment of peripheral nerves is assumed to be involved in both demyelinating and axonal types of Guillain-Barré syndrome (GBS). However, electrophysiological examinations have not yet clarified if this segment is involved. We measured cauda equina conduction time (CECT) in nine demyelinating GBS and seven axonal GBS patients. Compound muscle action potentials (CMAPs) were recorded from the abductor hallucis muscle. Electrical stimulation was given at the ankle and the knee, and magnetic stimulation was given over the first sacral (S1) and first lumbar (L1) spinous processes using a magnetic augmented translumbosacral stimulation (MATS) coil. CECT was obtained by subtracting S1-level latency from L1-level latency. CECT was prolonged in all the patients with demyelinating GBS who had leg symptoms, whereas motor conduction velocity (MCV) at the peripheral nerve trunk was normal in all the patients. In all the patients with axonal GBS having leg symptoms, CECT and MCV were normal and no conduction blocks were detected between the ankle and the neuro-foramina. The cauda equina is much more frequently involved than the peripheral nerve trunk in demyelinating GBS. In axonal GBS, usually, CECT is normal and segmental lesions are absent between the ankle and the neuro-foramina. Therefore, the CECT measurement should be very useful for directly detecting demyelinating lesions in GBS.

[Purpose] This study investigated whether the toe-spread-out exercise affects the hallux valgus angle, the cross-sectional area of the abductor hallucis muscle, and the hallux valgus angle during active abduction. [Subjects and Methods] Twenty-four subjects with hallux valgus were randomly assigned to orthosis and orthosis plus toe-spread-out exercise groups. The orthosis group wore the orthosis for 8 weeks, while the orthosis plus toe-spread-out group also performed the toe-spread-out exercise. The hallux valgus angle, the cross-sectional area of the abductor hallucis muscle, and the hallux valgus angle during active abduction were measured initially and after 8 weeks by radiography and ultrasonography. [Results] While there were no significant changes in the three parameters in the orthosis group, there were significant differences in the orthosis plus toe-spread-out exercise group after 8 weeks. In addition there were significant differences in the three measures between the two groups. [Conclusion] The toe-spread-out exercise reduces the hallux valgus angle and hallux valgus angle during active abduction, and increases the cross-sectional area of the abductor hallucis muscle. The toe-spread-out exercise is recommended for patients with mild to moderate hallux valgus.

Purpose The purpose of this study was to investigate the effect of an eight-week neuromuscular electrostimulation program on the intrinsic foot muscle strength. The results were compared with those from a passive and an active control group. Methods 74 healthy participants were recruited and divided into three groups: a neuromuscular electrostimulation group (n = 19), a passive control group (n = 15) with no further intervention, and an active control group following a running protocol with minimal shoes (n = 40). The electrostimulation and running groups followed a training protocol consisting of two sessions per week over a period of eight weeks. Three characteristics of intrinsic foot muscle strength were investigated: cross sectional area of the abductor hallucis muscle, longitudinal arch stability, and intrinsic foot muscle fatigue. Results After eight weeks of intervention, the cross sectional area increased by 16.3% for the running group with a large effect size (0.801) according to Cohen’s d. The electrostimulation group showed no such effect. The increase in the cross sectional area had no impact on longitudinal arch stability or intrinsic foot muscle fatigue results. Conclusion This study investigated neuromuscular electrostimulation as a prevention and rehabilitation strategy. The results indicate that, compared to minimally shod running, the effects of electrostimulation on healthy participants might be too small to be detected. Further, the results provide evidence that the static navicular drop test is not sensitive enough to indicate intrinsic foot muscle strength. This appears clinically relevant, as this test is often used by therapists to evaluate patients’ longitudinal arch function.

Background: The present study aimed to investigate the correlation between abductor hallucis (AH) muscle motor evoked potential (MEP) amplitude and foot arch anatomy. Methods: Twelve healthy individuals underwent foot arch measurement using a digital photographic technique and measurements of cortical excitability using transcranial magnetic stimulation applied on the cortical representation area of the right AH muscle. Truncated foot length and dorsal height were then measured and used to create the arch height index (AHI). Resting motor threshold, MEP amplitude (using a stimulation intensity of 110% resting motor threshold), and cortical silent period duration were also measured. Results: Mean ± SE values were as follows: truncated foot length, 16.72 ± 0.3 cm; dorsal height, 5.62 ± 0.13 cm; AHI, 0.34 ± 0.01; resting motor threshold, 81.6% ± 2.12%; MEP amplitude, 0.71 ± 0.1 mV; and cortical silent period duration, 108.05 ± 0.45 msec. A significant correlation was found between MEP amplitude and AHI (Spearman's rho: P < .01). Conclusions: These results indicate that AH muscle functional neuroanatomy measurements are reliable and might be used by clinicians and therapists to investigate foot arch physiology and monitor the efficacy of treatments and rehabilitative protocols.

Loss of soft tissue coverage distally around the foot poses threats of amputation of the exposed boney structures. An amputation of a portion of the foot leads to loss of the biomechanical structural integrity of the foot. This promulgates an imbalance with its inherent risks of developing new ulcers. This in turn potentiates the limb loss cycle. The reverse abductor hallucis muscle flap is ideally suited for small to moderate-sized defects in the vicinity of the first metatarsophalangeal joint based on its arc of rotation. In this article, we present cases of 5 patients who failed local wound care and healing by secondary intention for at least 6 months duration. The patients were treated successfully using reverse abductor hallucis muscle flap.

PURPOSE Comparison of T1-T4 decrement between upper and lower extremity muscles can indicate differences between recovery time from neuromuscular blockade, which may have repercussions for neurophysiologic intraoperative monitoring. We investigated decrement between T1 and T4 hand and foot muscle responses on quantitative train-of-four (TOF) test. METHODS Study analyzed differences between recovery of foot, abductor hallucis muscle, and hand, first dorsal interosseous muscle, by application of quantitative TOF test on 147 patients undergoing lumbar spine surgery. T1 to T4 decrements on hand and foot TOF were obtained and classified into different groups, depending on elapsed time after administration of neuromuscular blocking agents and its dose. RESULTS There are significant differences between T1-T4 decrements obtained on hand and foot (P < 0.05). T1-T4 decrement determined on abductor hallucis muscle was lower indicating more rapid recovery than the first dorsal interosseous muscle (P < 0.05). Interestingly, quite opposite, more pronounced decrement in foot TOF than hand was showed in 4% (5 out of all 147 cases). CONCLUSIONS The observed difference between recovery of hand and foot muscles suggests that quantitative TOF test should be performed on extremities for which accurate data about the level of neuromuscular blockade is sought. During lumbar spine surgery monitoring, in addition to hand TOF, foot TOF should be included.

Facial reanimation surgery using a free muscle flap for facial paralysis, in which gracilis muscle flap was used, was first reported by Harii1 in 1976. Subsequently, many muscle flaps for the surgery have been reported, such as latissimus dorsi (LD) muscle,2–4 rectus abdominis muscle,5 rectus femoris muscle,6 abductor hallucis muscle,7 internal oblique muscle,8 biceps femoris muscle,9 and pectoral minor muscle.10 Currently, in Asian countries, the LD muscle flap is the most commonly used among these muscle flaps because it has a long vascular pedicle and nerve. However, the LD muscle flap has 1 problem, that is, its thickness. In surgery, if the LD muscle flap is to be transplanted without thinning in the subcutaneous pocket of the cheek, (1) insertion of the muscle flap inside the pocket may be difficult due to its thickness, (2) convex deformation occurs due to its thickness, and (3) contraction of the muscle flap is too strong, and problems such as facial expression becoming asymmetrical in shape when the patient smiles occur. Therefore, in many cases, a method to shave the LD muscle flap before transplanting is followed, leading to substantially satisfactory results being stably obtained.2,3 However, there are no reports clearly indicating to what degree the muscle flap may be safely shaven. The purpose of this study is to anatomically investigate the three-dimensional route of the thoracodorsal artery, vein, and nerve inside the LD muscle used for facial reanimation and to clarify the degree to which the muscle flap may be safely shaven.