The Role of Peroneus Longus Insertion on First Metatarsal Against metatarsus varus force
10.4055/jkoa.1996.31.3.584
- Author:
Kyung Tae LEE
;
Hyun Cheol KIM
- Publication Type:Original Article
- Keywords:
Peroneus longus;
Metatarsus varus
- MeSH:
Cadaver;
Foot;
Head;
Leg;
Ligaments;
Metatarsal Bones;
Metatarsus;
Posture;
Skin;
Sutures;
Tendons;
Tibia;
Toes
- From:The Journal of the Korean Orthopaedic Association
1996;31(3):584-589
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
It is likely that the peroneus longus tendon acts as a structure resisting the varus force upon the first column of the foot. Our 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 sprcimen was positioned in a 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 location : First metatarsal (one bead in the head, another bead in the base). The second metatarsal (again one bead in the head, on e 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 footto assure proper positioning of the foot. Thereafter, the soft tissue between the first and second toe were cut sequentially : (1) Transection of the skin of the first web space 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 transaction 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).
