Sonomorphometrie des Vorfußes bei Probanden mit indolentem und dolentem Vorfuß

Summary Sonomorphometrics of the forefoot concerning subjects with and without painful fore-foots This study shall help to clarify the architecture of the forefoot, concerning especially the transversal arch. Alltogether 49 subjects were examined, 40 of them (23 male, 17 female) with, 9 (all fe-male) without painful forefoot. The age-mean of the group without pain was 44 (ranging from 17-77 years of age), that of the group without pain was 56 (ranging from 25-81 years of age). All subjects had to undergo a standardised clinical examination, including a blueprint of the foot and sonographic diagnostics. The hypothesis of the existence of a transversal arch in the foot can definitely be negated after taking the conclusion of this study into consideration. Even the reference group of subjects with painful foorefoots showed similar results. Both groups showed, under different loading situations, a similar linear rise from lat. to med. metatarsal head of the bone to ground distance (z-measurement). In the longitudinal axis (y-measurement) the heads of the metatarsus showed a c-formed arch, the vertex being the head of metatarsal bone 2. Concluding the results, a plantarisation of the metatarsal heads and a broadening of the complete forefoot took place under rising loading, independent on wether forefoot symptoms existed or not. Comparing the painful forefoot to the forefoot without pain, one can see a plantarisation of the painful forefoot, metatarsal head I excluded, independent of the loading. A general lengthening of the foot under loading in comparison to no loading could not be verified. Comparing the two groups, only the group with painful forefeet showed a significant change in length under rising loading, while the painfree reference group showed no difference in length. The only exception being, without pressure, the head of metatarsal bone 1. No significant rise of distance could be shown on the painful foot. Difference of weight was of no relevance, age only mattered in a few cases. With rising age plantarisation without significant broadening takes place in the dolent forefoot more often whereas with painfree forefeet one can see a significant broadening of the forefoot without plantarisation. The summarised results of this study are unambiguous, even though they don´t go along with the academic opinion so far known. The sonography used to collect the results is a standardised an safe examination method, which shows a direct static picture of the metatarsal bone heads. Plantar loading measurement methods, no matter how complex they are, only give indirect information about the position of the metatarsal bone head. Their advantage is the ability to make a dynamic analysis of the gait. The development of a method in further forefoot diagnostics, that combines a real, not reconstructed, three- dimensional image of the metatarsus with an analytic gait measurement, should be the ultimate goal. Finite Element studies that give the results of measured feet, mostly feet of cadaver, and which usually work with three- dimensional reconstructions of two- dimensional CT´s, are first steps in the right direction. Even though this study shows up with excellent results, it only covers part of the questions concerning the form and structure of the painful and painless forefoot under different loading situations.