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KMID : 0361619960310030584
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Journal of the Korean Orthopaedic Association
1996 Volume.31 No. 3 p.584 ~ p.589
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The Role of Peroneus Longus Insertion on First Metatarsal Against metatarsus varus force
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Abstract
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It is likely that the peroneus longus tendon acts as a structure resisting the varus force upon the first column of foot. Out study was designed to examine the possibility that absence of the peroneus longus insertion into the first metatarsal
and
first
cuneiform will destabilize the first metatarsal.
The fresh frozen cadaveric specimens of the lower leg were obtained. There were six right feet. The specimens appeared normal visually and roentgenographically.
The tibial remnant was rodded by an intramedullary rod and the specimen was positioned in specially designed rig so that standing position of the foot was simulated. The tibia was then loaded with twenty pounds. To obtain reproducible
radiographic
landmarks radioopaque beads were implanted underneath the level of the cortex through small drill holes
in the following locations: first metatarsal (one bead in the head, another bead in the base). The second metatarsal(again one bead in the head, one bean in the base).
To simulate the contraction of the peroneus longus muscle a suture was placed into the proximal end of the tendon, brought through two pulleys and loaded with a five pound weight. To create a varus force on the first metatarsal a stab incision
was
made
over the base of the first metatarsal at its medial aspect and a suture was passed through the base of the first metatarsal. The suture was guided over a pulley and loaded with ten pounds.
The second metatarsal head was fixed to the bottom of the rig with a smooth Steinmann pin. At this point an AP roentgenogram was taken of the foot to assure proper positioning of the foot. Thereafter, the soft tissue between the first and second
tow
were cut sequentially: (1) Transection of the skin of the first who sapce both dorsally and plantarly. (2)Transection of the adductor hallucis tendon and the intermetatarsal ligament. (3) Transection of the peroneus longus tendon at its
insertion.
Each
step in the transection of the soft tissues was followed by another X-ray examination. In each roentgenogram the proximal and distal beads in the first and second metatarsal were connected by a line and the angles between those lines were
measured.
The results were statistically analyzed with the Friedman Chi square test between each step of the ten feet. Following the first and second step angular changes are not significant. Following the final step, adding release of the tendon insertion
of the
peroneus longus, the angle changes from 15.95 to 20.55 degrees(difference 4.60 degrees) and this is significant(p<0.05).
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KEYWORD
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