The Venous Pump of the First Metatarsophalangeal Joint: Clinical Implications

2007 ◽  
Vol 28 (8) ◽  
pp. 902-909 ◽  
Author(s):  
Andreas Elsner ◽  
Gereon Schiffer ◽  
Axel Jubel ◽  
Jürgen Koebke ◽  
Prof. J. Andermahr
Keyword(s):  
Venous Blood ◽  
Metatarsophalangeal Joint ◽  
Joint Capsule ◽  
Ankle Injuries ◽  
Active Movement ◽  
Venous Blood Flow ◽  
First Metatarsophalangeal Joint ◽  
Anatomy And Physiology ◽  
Venous Circulation ◽  
Venous Valves

Background: Although the anatomy and physiology of the venous circulation of the ankle and midfoot are well documented, the physiologic importance of forefoot mobility has not been reported in the literature. The question of this study was whether the first metatarsophalangeal (MTP) joint may operate, like the ankle, as a “pump” to encourage venous return. Methods: Forty-nine cadaver foot specimens were examined using dissection, plastination, vessel infiltration, and maceration, and radiographic (including venography, MRI, and magnetic resonance angiography) techniques. The anatomy and physiology were described and compared to the ankle joint. Forty patients had biphasic Doppler flow studies. Results: The major finding was the medial drainage of the plantar venous sinus, which is fibrotically bound to the joint capsule. Functional venous valves were evident distally and within fibrous vascular lumens. Mobilization of the first MTP joint led to compression and emptying of the veins. Passive mobilization of the first MTP joint led to an average flow increase of 55% ± 7 ( p < 0.0001), while active movement led to an average increase of 78% ± 7 ( p < 0.0001). Conclusions: Our described connection between the joint capsule and veins indicates a “toe-ankle pump” with a significant increase of venous blood flow during motion of the MTP joint. Possible clinical applications for an external MTP pump include anti-edema or thromboprophylactic therapy, especially in patients with foot or ankle injuries. A new toe-pump has been designed based on these results.

scholarly journals Observing and understanding arterial and venous circulation differences in a physiology laboratory activity

2015 ◽  
Vol 39 (4) ◽  
pp. 405-410 ◽  
Author(s):  
Caroline Altermann ◽  
Rithiele Gonçalves ◽  
Marcus Vinícius S. Lara ◽  
Ben-Hur S. Neves ◽  
Pâmela B. Mello-Carpes
Keyword(s):  
Blood Flow ◽  
Venous Blood ◽  
Short Report ◽  
Venous Blood Flow ◽  
Daily Lives ◽  
Laboratory Activity ◽  
Venous Circulation ◽  
Group A ◽  
Physiology Laboratory ◽  
Arteries And Veins

The purpose of the present article is to describe three simple practical experiments that aim to observe and discuss the anatomic and physiological functions and differences between arteries and veins as well as the alterations observed in skin blood flow in different situations. For this activity, students were divided in small groups. In each group, a volunteer is recruited for each experiment. The experiments only require a sphygmomanometer, rubber bands, and a clock and allow students to develop a hypothesis to explain the different responses to the interruption of arterial and venous blood flow. At the end, students prepare a short report, and the results are discussed. This activity allows students to perceive the presence of physiology in their daily lives and helps them to understand the concepts related to the cardiovascular system and hemodynamics.

scholarly journals The postural system as a functional venous pump

2020 ◽  
pp. 1-6
Author(s):  
Vladimir Usachev ◽  
Pierre-Marie Gagey
Keyword(s):  
Blood Flow ◽  
Venous Blood ◽  
The Body ◽  
Popliteal Vein ◽  
Venous Blood Flow ◽  
Venous Circulation ◽  
Postural System

Background: In the 90s, Inamura et al. have drawn our attention to the role played by the postural system in the return venous circulation, thanks to plethysmographic recordings which gave free rein to the imagination of the authors to suppose the functioning mechanisms of this venous pump. In 2010, two anatomists, Uhl & Gillot, transformed our representation of the venous network and made assumptions about the functioning of the venous pump. Objective/ Methods: The aim of this work is to verify these hypotheses by scanning the venous blood flow at the level of the sinus soleus and the popliteal vein during various posture-kinetic situations. Conclusion: These studies fully confirm the hypotheses. It is therefore likely that the postural system intervenes not only in the phenomena of stabilisation of the body, but also in the back venous circulation.

scholarly journals Chronic cerebral venous dysfunction: view of the problem

2021 ◽  
Vol 17 (1) ◽  
pp. 42-49
Author(s):  
O.Ye. Kovalenko ◽  
N.G. Prityko
Keyword(s):  
Blood Flow ◽  
Venous Insufficiency ◽  
Venous Blood ◽  
Clinical Manifestations ◽  
Venous Blood Flow ◽  
Cranial Cavity ◽  
Chronic Cerebrospinal Venous Insufficiency ◽  
Venous Circulation ◽  
Chronic Disorders ◽  
The Brain

The article presents an analytical review of the results of domestic and foreign studies on chronic disorders of cerebral venous circulation, which is given less attention against the arterial system due to blurred manifestations, especially early, anatomical variability of the venous system, even in healthy, difficulty in diagnosis. When the balance of arterial and venous inflow is disturbed and this state exa­cerbates, irreversible changes evolve other structures of the cranial ca­vity — primarily in the brain (consistent with the concept of Monroe-Kelly). Chronic disorders of cerebral venous circulation may have different causes and varying degrees of severity. The equivalent of chronic cerebral venous insufficiency (SCVD), terminologically accepted in our country, in some countries is considered as chronic venous cerebrospinal insufficiency, which emphasizes the pathogenetic link of disorders of cerebral venous blood flow and extracranial veins, which is, in our opinion, is logical and reasonable. Recognition of chronic cerebrospinal venous insufficiency has aroused intense interest for a better understanding of the role of extracranial venous pathology and developmental options. Although the diagnosis was originally based on Doppler sonography, there are currently no diagnostic imaging methods, non-invasive or invasive, that can serve as the gold standard for detecting venous abnormalities indicative of chronic cerebrospinal venous insufficiency. The results of some studies are discussed, in particular, the hypothesis that chronic cerebrospinal venous insufficiency plays a role in the pathoge-nesis of multiple sclerosis or in many concomitant clinical manifestations. The affinity of the pathogenesis of idiopathic intracranial hypertension, Ménière’s disease, spondylotic vertebrobasilar insufficiency syndrome is analyzed. Attention is also focused on the other opinion of scientists when the increase in venous blood supply to the brain and other formations in the head cavity under certain conditions is considered as a compensatory reaction. The anatomical and physiological features of the venous system of the cranial cavity are considered, which substantiate the clinical manifestations of venous dysfunction, methods of diagnosis and treatment of pathology. Summarizing the above, chronic venous blood circulation in the cranial cavity, which is largely associated with problems of extracranial venous blood flow, not only in itself is a very characteristic syndrome complex t that adversely affects neurological functions due to cerebral hypoxia and metabolic changes, deteriorates the quality of life, but also has a negative impact on the course of the disease or has a pathogenetic link with other diseases, in particular, may be accompanied by different levels of blood pressure.

A Novel Technique for Soft-Tissue Defect Repair After Traumatic Rupture of the Extensor Hallucis Longus Tendon

2021 ◽  
Vol 111 (3) ◽  
Author(s):  
Ellianne Nasser ◽  
William Clark ◽  
Michael Gibboney
Keyword(s):  
Tendon Rupture ◽  
Metatarsophalangeal Joint ◽  
Soft Tissue Defect ◽  
Joint Capsule ◽  
Traumatic Rupture ◽  
First Metatarsophalangeal Joint ◽  
Novel Approach ◽  
Extensor Hallucis Longus ◽  
Physiologic Function ◽  
Capsular Defect

Background Surgical repair of extensor hallucis longus (EHL) tendon rupture with a concomitant capsular defect has not been reported in the literature. This case presents a novel approach to EHL tendon rupture repair along with repair of a first metatarsophalangeal joint capsule defect. Methods A case study is presented of a 61-year-old man with a traumatic EHL tendon rupture and capsular defect treated with an EHL tendon turndown flap and tenodesis to the extensor hallucis brevis and capsularis tendons with autograft flap reconstruction of the first metatarsophalangeal joint capsule. Discussion A 61-year-old man presented with an acute traumatic EHL tendon rupture and first metatarsophalangeal joint capsule compromise after a chainsaw injury. He subsequently lost dorsiflexion of his hallux, and magnetic resonance imaging confirmed a 2.2-cm gap in the EHL tendon. He was treated with an EHL tendon turndown flap and tenodesis to the extensor hallucis brevis and capsularis tendons to reestablish dorsiflexion to the hallux. The injury was noted to infiltrate the first metatarsophalangeal joint capsule and was treated with an autograft of the first metatarsophalangeal joint capsule for a capsular defect. At 1-year follow-up the patient has regained dorsiflexion of the hallux and is back to activities such as snow skiing without pain. Conclusions Ruptures of the EHL tendon with first metatarsophalangeal joint capsule defects have not been reported in the literature. Herein, a novel approach was used to reestablish physiologic function to the EHL tendon and provide sufficient coverage of the first metatarsophalangeal joint.

Regulation of free radical outflow from an isolated muscle bed in exercising humans

2004 ◽  
Vol 287 (4) ◽  
pp. H1689-H1699 ◽  
Author(s):  
Damian M. Bailey ◽  
Ian S. Young ◽  
Jane McEneny ◽  
Lesley Lawrenson ◽  
Jeannie Kim ◽  
...  
Keyword(s):  
Free Radical ◽  
Ex Vivo ◽  
Venous Blood ◽  
Knee Extensor ◽  
Lipid Hydroperoxides ◽  
Venous Blood Flow ◽  
Paramagnetic Resonance ◽  
Alkyl Radicals ◽  
Venous Circulation ◽  
Exercise Induced

Incremental knee extensor (KE) exercise performed at 25, 70, and 100% of single-leg maximal work rate (WRMAX) was combined with ex vivo electron paramagnetic resonance (EPR) spectroscopic detection of α-phenyl- tert-butylnitrone (PBN) adducts, lipid hydroperoxides (LH), and associated parameters in five males. Blood samples were taken from the femoral arterial and venous circulation that, when combined with measured changes in femoral venous blood flow, permitted a direct examination of oxidant exchange across a functionally isolated contracting muscle bed. KE exercise progressively increased the net outflow of LH and PBN adducts (100% > 70% > 25% WRMAX, P < 0.05) consistent with the generation of secondary, lipid-derived oxygen (O2)-centered alkoxyl and carbon-centered alkyl radicals. Radical outflow appeared to be more intimately associated with predicted decreases in intracellular Po2(iPo2) as opposed to measured increases in leg O2uptake, with greater outflow recorded between 25 and 70% WRMAX( P < 0.05 vs. 70–100% WRMAX). This bias was confirmed when radical venoarterial concentration differences were expressed relative to changes in the convective components of O2extraction and flow (25–70% WRMAXP < 0.05 vs. 70–100% WRMAX, P > 0.05). Exercise also resulted in a net outflow of other potentially related redox-reactive parameters, including hydrogen ions, norepinephrine, myoglobin, lactate dehydrogenase, and uric acid, whereas exchange of lipid/lipoproteins, ascorbic acid, and selected lipid-soluble anti-oxidants was unremarkable. These findings provide direct evidence for an exercise intensity-dependent increase in free radical outflow across an active muscle bed that was associated with an increase in sarcolemmal membrane permeability. In addition to increased mitochondrial electron flux subsequent to an increase in O2extraction and flow, exercise-induced free radical generation may also be regulated by changes in iPo2, hydrogen ion generation, norepinephrine autoxidation, peroxidation of damaged tissue, and xanthine oxidase activation.

The Modified Oblique Keller Procedure: A Technique for Dorsal Approach Interposition Arthroplasty Sparing the Flexor Tendons

2003 ◽  
Vol 24 (7) ◽  
pp. 521-522 ◽  
Author(s):  
Kenneth J. Mroczek ◽  
Stuart D. Miller
Keyword(s):  
Soft Tissues ◽  
Metatarsophalangeal Joint ◽  
Hallux Rigidus ◽  
Resection Arthroplasty ◽  
Joint Capsule ◽  
Great Toe ◽  
Interposition Arthroplasty ◽  
Dorsal Approach ◽  
First Metatarsophalangeal Joint ◽  
Satisfactory Outcome

A first metatarsophalangeal joint resection arthroplasty that combines a modest metatarsal cheilectomy with an oblique resection of the phalanx base (preserving the flexor hallucis brevis attachment) combined with interposition arthroplasty of the dorsal joint capsule sewn to the plantar soft tissues is presented. Numerous surgical procedures have been described for the treatment of hallux rigidus, including dorsal cheilectomy, resection arthroplasty, joint replacement, and arthrodesis. The Keller procedure has been abandoned by many because of shortening of the great toe and loss of push-off power. The modified oblique Keller technique described here allows for intraoperative transition from cheilectomy to resection arthroplasty with what appears to be a satisfactory outcome, maintaining plantarflexion power and hallux length.

Extensor Hallucis Capsularis: Frequency and Identification on MRI

2006 ◽  
Vol 27 (3) ◽  
pp. 181-184 ◽  
Author(s):  
Nathan Boyd ◽  
Hugh Brock ◽  
Albert Meier ◽  
Richard Miller ◽  
Gary Mlady ◽  
...  
Keyword(s):  
Metatarsophalangeal Joint ◽  
Tendon Graft ◽  
Joint Capsule ◽  
Correct Prediction ◽  
Physical Parameters ◽  
Foot And Ankle ◽  
First Metatarsophalangeal Joint ◽  
Extensor Hallucis Longus ◽  
Mri Evaluation

Background: The extensor hallucis capsularis (EHC) is the most common name given to the accessory tendon sporadically seen medial to the extensor hallucis longus (EHL). We performed cadaver dissections and MRI evaluation to determine the frequency of its occurrence, the pattern of its origin and insertion, and its potential suitability as tendon graft. Methods: The EHC was examined by dissection in 81 cadaver feet. Physical parameters pertaining to EHC size and location were recorded. MRI was performed on six cadaver legs to determine if the EHC can be identified radiographically. MRI images were evaluated independently by a foot and ankle specialist and a radiologist. Results: The EHC was present in 71 (88%) of the specimens. It originated from the EHL tendon or muscle in 93% and inserted into the first metatarsophalangeal joint capsule in 99% of cases. All EHC tendons were less than or equal to 4 mm in width; only 16% were more than 2 mm wide. Correct prediction of the presence or absence of EHC by MRI varied according to EHC width: two of two in tendons more than 2 mm, five of eight in tendons 1 to 2 mm, and zero of two in tendons 1 mm or less. Conclusion: Up to 14% of the population may have an EHC tendon suitable for grafting in reconstructive surgeries, particularly surgeries related to hallux dysfunction. MRI may have a role in the preoperative identification of the EHC.

Capsular Interposition for the Keller Bunionectomy with the Use of Soft-Tissue Anchors

2005 ◽  
Vol 95 (2) ◽  
pp. 180-182 ◽  
Author(s):  
Keith D. Cook
Keyword(s):  
Soft Tissue ◽  
Metatarsophalangeal Joint ◽  
Joint Space ◽  
Joint Capsule ◽  
Past Century ◽  
First Metatarsophalangeal Joint ◽  
The Past ◽  
Joint Pathology ◽  
Capsular Flap

The Keller procedure has been used during the past century for the treatment of first metatarsophalangeal joint pathology. Many modifications to the procedure have been made, including interposition of the joint capsule into the first metatarsophalangeal joint space. Capsular interposition is often the most difficult step in performing the Keller bunionectomy. This article describes a new, simplified technique for capsular interposition with the use of a dorsal capsular flap and soft-tissue anchors. (J Am Podiatr Med Assoc 95(2): 180–182, 2005)

scholarly journals Blood flow-induced Notch activation and endothelial migration enable embryonic vascular remodeling

2016 ◽  
Author(s):  
Bart Weijts ◽  
Edgar Gutierrez ◽  
Semion K Saikin ◽  
Ararat J Ablooglu ◽  
David Traver ◽  
...  
Keyword(s):  
Blood Flow ◽  
Vascular Remodeling ◽  
Venous Blood ◽  
Arterial Blood Flow ◽  
Venous Blood Flow ◽  
Upstream Migration ◽  
Venous Circulation ◽  
Arterial Blood ◽  
Arteries And Veins ◽  
Notch Activation

Arteries and veins are formed independently by different types of endothelial cells (ECs). In vascular remodeling, arteries and veins become connected and some arteries become veins. It is unclear how ECs in transforming vessels change their type and how fates of individual vessels are determined. In embryonic trunk, vascular remodeling transforms arterial intersegmental vessels (ISVs) into a functional network of arteries and veins. We found that, once an ISV is connected to venous circulation, venous blood flow promotes upstream migration of ECs that results in displacement of arterial ECs by venous ECs, completing the transformation of this ISV into a vein without trans-differentiation of ECs. Arterial blood flow initiated in two neighboring ISVs prevents their transformation into veins by activating Notch signaling in ECs. Together, different responses of ECs to arterial and venous blood flow lead to the formation of a balanced network with equal numbers of arteries and veins.

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