RESUMO

The plantar aponeurosis (PA), which is a thickened layer of deep fascia located on the plantar surface of the foot, is comprised of three parts. There are differing opinions on its nomenclature since various authors use the terms PA and plantar fascia (PF) interchangeably. In addition, the variable classifications of its parts has led to confusion. In order to assess the nature of the PA, this study documented its morphology. Furthermore, a pilot histological analysis was conducted to examine whether the structure is an aponeurosis or fascia. This study comprised of a morphological analysis of the three parts of the PA by micro- and macro-dissection of 50 fetal and 50 adult cadaveric feet, respectively (total n=100). Furthermore, a pilot histological analysis was conducted on five fetuses (n=10) and five adults (n=10) (total n=20). In each foot, the histological analysis was conducted on the three parts of the plantar aponeurosis, i.e. the central, lateral, and medial at their calcaneal origin (total n=60). Fetuses: i) Morphology: In 66 % (33/50) of the specimens, the standard anatomical pattern was observed, viz. three parts (i.e. central, lateral, medial) that originated from the medial and lateral processes of the calcaneal tuberosity and inserted onto the metatarsals. In 18 % (9/50) of the specimens, a two-part structure was observed. Variable origins of the medial part were noted in 16 % (8/50) of the specimens. In order to document these variations, the central part of the PA was divided into three segments (i.e. upper, middle, lower): a) In 63 % (5/8) of the specimens, the medial part arose from the middle segment; b) In 37 % (3/8) of the specimens, the medial part arose from the middle and upper segments. ii) Histological analysis: a) The central part contained longitudinally arranged semi-dense type I collagen fibres with fibroblasts; b) The lateral part displayed semi-dense type I collagen fibres with fibroblasts, hyaluronic acid, corpusculum sensorium fusiforme (Ruffini corpuscle) and corpusculum lamellosum (Pacinian corpuscle); c) The medial part comprised of loose connective tissue with elastic and reticular fibres. Adults: i) Morphology: In 100 % of the specimens, the standard anatomical pattern was observed. ii) Histological Analysis: a) In the central part, longitudinally arranged type I collagen fibres with fibroblasts were visible; b) The lateral part contained longitudinally arranged type I collagen fibres with fibroblasts; c) The medial part comprised of loose connective tissue, type I and type III collagen fibres, elastic and reticular fibres. In the current study, the morphology of the PA in fetuses and adults conformed to the standard anatomical description with variations in the origin of the medial part observed in fetuses. In addition, the fetal specimens displayed a two-part structure of the PA when the medial part was absent. Microscopically, the findings suggest that only the central and lateral parts may be considered as the PA, whilst the medial part may be termed the PF.

La aponeurosis plantar (AP), que es una capa engrosada de fascia profunda localizada en la superficie plantar del pie, está compuesta de tres partes. Hay diferentes opiniones sobre su nomenclatura, ya que varios autores utilizan los términos AP y fascia plantar (FP) de forma intercambiable. Además, las distintas clasificaciones de sus partes han dado lugar a confusión. Con el fin de evaluar la naturaleza de la AP, este estudio documentó su morfología. Además, se realizó un análisis histológico para examinar si la estructura es una aponeurosis o fascia. Este estudio consistió en un análisis morfológico de las tres partes de la AP de 50 pies de fetos y 50 pies de cadáveres adultos, por micro y macrodisección, respectivamente (total n = 100). Además, se realizó un análisis histológico en cinco fetos (n = 10) y cinco adultos (n = 10) (total n = 20). En cada pie, el análisis histológico se realizó sobre las tres partes de la aponeurosis plantar, es decir, la central, lateral y medial en su origen calcáneo (total n = 60). Fetos: i) Morfología: En el 66 % (33/50) de los especímenes, se observó el patrón anatómico estándar, es decir, tres partes (central, lateral y medial) que se originaron a partir de los procesos medial y lateral de la tuberosidad calcánea y se insertaban en los metatarsianos. En 18 % (9/50) de los especímenes, se observó una estructura de dos partes. Los orígenes variables de la parte mediana se visualizaron en el 16 % (8/50) de los especímenes. Para documentar estas variaciones, la parte central de la AP se dividió en tres segmentos (superior, medio, inferior): en el 63 % (5/8) de los casos, la parte mediana surgió del segmento medio; en el 37 % (3/8) de los casos, los casos la parte medial surgió de los segmentos medio y superior. ii) Análisis histológico: a) La parte central contenía fibras de colágeno tipo I semi-densas dispuestas longitudinalmente con fibroblastos; b) La parte lateral mostró fibras de colágeno tipo I semi-densas con fibroblastos, ácido hialurónico, corpúsculo sensorial fusiform (corpúsculo de Ruffini) y corpúsculo lamellosum (corpúsculo de Pacini); c) La parte medial comprende tejido conjuntivo suelto con fibras elásticas y reticulares. Adultos: i) Morfología: En el 100 % de los especímenes se observó el patrón anatómico estándar. ii) Análisis histológico: a) En la parte central, se observaron fibras de colágeno de tipo I con disposición longitudinal de fibroblastos; b) La parte lateral contenía fibras de colágeno de tipo I dispuestas longitudinalmente con fibroblastos; c) La parte medial estaba compuesta de tejido conectivo suelto, fibras de colágenos tipo I y tipo III, fibras elásticas y reticulares. En el presente estudio, la morfología de la AP en fetos y adultos se ajustó a la descripción anatómica estándar con variaciones en el origen de la parte medial observada en fetos. Además, los especímenes fetales mostraron una estructura de dos partes de la AP cuando la parte medial estaba ausente. Microscópicamente, los hallazgos sugieren que sólo las partes central y lateral pueden considerarse como AP, mientras que la parte medial puede denominarse FP.

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In early theropod dinosaurs-the ancestors of birds-the hallux (digit 1) had an elevated position within the foot and had lost the proximal portion of its metatarsal. It no longer articulated with the ankle, but was attached at about mid-length of metatarsal 2 (mt2). In adult birds, the hallux is articulated closer to the distal end of mt2 at ground level with the other digits. However, on chick embryonic day 7, its position is as in early theropods at half-length of mt2. The adult distal location is acquired during embryonic days 8-10. To assess how the adult phenotype is acquired, we produced fate maps of the metatarsals of day 6 chicken embryos injecting the lipophilic tracer DiI. The fates of these marks indicate a larger expansion of the metatarsals at their proximal end, which creates the illusory effect that d1 moves distally. This larger proximal expansion occurs concomitantly with growth and early differentiation of cartilage. Histological analysis of metatarsals shows that the domains of flattened and prehypertrophic chondrocytes are larger toward the proximal end. The results suggest that the distal position of the hallux in the avian foot evolved as a consequence of an embryological period of expansion of the metatarsus toward the proximal end. It also brings attention to the developmental mechanisms leading to differential growth between epiphyses and their evolutionary consequences.

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The zygodactyl orientation of toes (digits II and III pointing forwards, digits I and IV pointing backwards) evolved independently in different extant bird taxa. To understand the origin of this trait in modern birds, we investigated the development of the zygodactyl foot of the budgerigar (Psittaciformes). We compared its muscular development with that of the anisodactyl quail (Galliformes) and show that while the musculus abductor digiti IV (ABDIV) becomes strongly developed at HH36 in both species, the musculus extensor brevis digiti IV (EBDIV) degenerates and almost disappears only in the budgerigar. The asymmetric action of those muscles early in the development of the budgerigar foot causes retroversion of digit IV (dIV). Paralysed budgerigar embryos do not revert dIV and are anisodactyl. Both molecular phylogenetic analysis and palaeontological information suggest that the ancestor of passerines could have been zygodactyl. We followed the development of the zebra finch (Passeriformes) foot muscles and found that in this species, both the primordia of the ABDIV and of the EBDIV fail to develop. These data suggest that loss of asymmetric forces of muscular activity exerted on dIV, caused by the absence of the ABDIV, could have resulted in secondary anisodactyly in Passeriformes.

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Metatarsal growth was studied in 780 human fetal metatarsal bones, crown-rump length ranging from 120 to 260 mm and gestational age ranging from 14 to 23 wk postconception. Total length, diaphyseal length and diameter were measured and statistical analysis performed. Means and standard deviations for each measurement were calculated at 1 wk intervals. These data were correlated with crown-rump length and gestational age and an equation was constructed in an attempt to predict gestational age.

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Introducción. Secundario a la ruptura del amnios, pequeños filamentos de éste pueden anudar estructura en desarrollo produciendo: constricciones anulares, pseudosindactilia, amputaciones intrauterinas y constricción del cordón umbilical. Este patrón de malformación conocido como secuencia de bridas amnióticas es en la mayoría de los casos de etiología desconocida. El riesgo de recurrencia es insignificante. Caso clínico. Se informa el caso de un recién nacido pretérmino, obtenido por cesárea debido a sufrimiento fetal agudo, en quien se encontró el pie derecho amputado incrustado en las membranas placentarias. Además, los dedos segundo, tercero y cuarto de la mano izquierda se observaron amputados a nivel de la articulación interfalángica distal. Conclusiones. Se considerá importante comunicar este caso de secuencia de bridas amnióticas en el cual se encontró el pie derecho amputado unido a las membranas fetales. Este caso ilustra la importancia de evaluar en forma sistemática la placenta ya que de otra manera este diagnóstico podría pasar inadvertido

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The length of the human fetal foot was studied in 106 feet from 53 unfixed staged human fetuses (35 males and 18 females) by means of the allometric formula log Y = log b+k log X. The gestational age ranged from 13 to 26 weeks postconception. The measurement taken from the heel to the tip of the longest toe was regarded here as the maximum length of the foot. Growth in length of the foot was analysed in relation to crown-rump length. Our results show that foot length growth is correlated to crown-rump growth and is allometrically positive. No statistically significant difference was found between right and left feet or between male and female fetuses.

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The Ballard Maturational Score was refined and expanded to achieve greater accuracy and to include extremely premature neonates. To test validity, accuracy, interrater reliability, and optimal postnatal age at examination, the resulting New Ballard Score (NBS) was assessed for 578 newly born infants and the results were analyzed. Gestational ages ranged from 20 to 44 weeks and postnatal ages at examination ranged from birth to 96 hours. In 530 infants, gestational age by last menstrual period was confirmed by agreement within 2 weeks with gestational age by prenatal ultrasonography (C-GLMP). For these infants, correlation between gestational age by NBS and C-GLMP was 0.97. Mean differences between gestational age by NBS and C-GLMP were 0.32 +/- 1.58 weeks and 0.15 +/- 1.46 weeks among the extremely premature infants (less than 26 weeks) and among the total population, respectively. Correlations between the individual criteria and C-GLMP ranged from 0.72 to 0.82. Interrater reliability of NBS, as determined by correlation between raters who rated the same subgroup of infants, ws 0.95. For infants less than 26 weeks of gestational age, the greatest validity (97% within 2 weeks of C-GLMP) was seen when the examination was performed before 12 hours of postnatal age. For infants at least 26 weeks of gestational age, percentages of agreement with C-GLMP remained constant, averaging 92% for all postnatal age categories up to 96 hours. The NBS is a valid and accurate gestational assessment tool for extremely premature infants and remains valid for the entire newborn infant population.

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Several anatomical parameters are useful in the assessment of gestational age. This work studies the foot length growth analysed against age, crown-rump length (C-R) and body weight (W) in eighty human fresh fetuses (staging from 14 to 38 weeks post-conception). These data were correlated with the following statistical methods: simple regression, power formula (allometric method), exponential and reciprocal models. The foot length growth presents very high and statistically significant coefficients of correlations with fetal parameters (P less than 0.001); the allometric method was the best method for this analysis. Foot length grows with moderate (against the age and C-R) or slight (against the W) positive allometry. This study presents statistically significant curves of the foot length growth in relation to fetal parameters. These curves are useful in anatomy, forensic medicine, feto-pathology, medical imaging, obstetrics and pediatrics.

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El pie equino-varo congenito aparece en la literatura medica desde 1830. Como etiologia se han propuesto factores extrinsecos, herencia poligenica o mendeliana, anormalidades citogeneticas, causas miogenicas o neurogenicas; pero continua siendo una deformidad idiopatica caracterizada por: inversion y adduccion del antepie, varo del retropie y equino del pie; que evoluciona en 3 fases: desplazamiento de las superficies oseas, retracciones de las partes blandas hasta fijar la posicion viciosa y finalmente irreductibilidad absoluta. Anatomopatologicamente se han descrito alteraciones posicionales oseas en tibia, calcaneo, astragalo, escafoides y cuboides; modificaciones de los tejidos blandos consistentes en retracciones en las superficies medial, dorsal y posterior del pie, y alargamientos en la superficie lateral; cambios articulares tibio-talares, talo-naviculares, calcaneo-cuboideas y subastragalina. Propone un protocolo de examen para precisar el Dx., controlar la evolucion y evaluar los resultados del tratamiento. Describe las tecnicas de valoracion clinica y radiologica y presenta una escala de analisis de datos referida a evaluacion de movilidad de la articulacion subtalar, equino, antepie, retropie y talon. Presenta la revision de 629 historias clinicas de 3 hospitales, con diagnostico de pie equino varo congenito operado entre enero de 1973 y junio de 1984, de las cuales se seleccionaron los ninos menores de 2 anos (132). Se encontro predominio del sexo masculino, del grado II (Harold Walker) y correlacion familiar en primer grado (3.0 por ciento ); no se establecio relacion con enfermedades o medicamentos en la gestacion

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The application of the growth-rate standards, extablished for Caucasian embryos and fetuses in a previous report, to Black and Central American racial groups has been investigated. Comparison between menstrual age and crown-to-rump length indicated differences in the 10 to 15 weeks' gestation range. However, growth rates for the same groups were practically identical between the 15th and 20th weeks of pregnancy. This finding suggests that the actual rate of growth is closely similar in the respective ethnic groups and that apparent discrepancies reflect erroneous, or purposefully false, menstrual histories rather than dissimilar growth patterns. Largely identical rates of development were suggested by the crown-rump length to foot length to body weight interrelations among the various racial groups. A moderate, but rather predictable, deviation from the earlier established standards was noted in the crown-rump length versus foot length ratios of Black American fetuses, providing the only exception to what appears to be a practically identical rate of growth for the investigated ethnic groups in the first half of gestation. The evaluation of the results was extended to involve the effect of educational and social factors on currently available data of embryonic and fetal growth. It is suggested that heretofore unconsidered factors may affect the validity of widely quoted standards of intrauterine growth.

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