Vincent J Hetherington | Kent State University (original) (raw)

Papers by Vincent J Hetherington

The Austin procedure is primarily a transpositional V osteotomy of the head of the first metatars... more The Austin procedure is primarily a transpositional V osteotomy of the head of the first metatarsal for the management of hallux valgus. The procedure was first reported in the podiatric literature and attributed to Dr. Austin by Miller and Croce. The procedure was presented initially by Dr. Dale Austin in his 1981 publication. The procedure as described is a horizontally directed V osteotomy performed in the metaphyseal bone of the first metatarsal, with the arms of the V at an angle of 60°. Transposition of the head of the metatarsal laterally from one-fourth to one-half the width of the metatarsal shaft addresses the increase in intermetatarsal angle (Fig. 12-1). Redirection by rotation of the metatarsal head is performed to address abnormal transverse plane alignment of the articular surface of the metatarsal head. The osteotomy is fixated by impaction via manual pressure and the protruding portion of the metatarsal shaft is then resected. The osteotomy is combined with soft tis...

Several authors have attempted to classify metatarsalgia. Helal classified metatarsalgia into pri... more Several authors have attempted to classify metatarsalgia. Helal classified metatarsalgia into primary, secondary, and unrelated to weight distribution. Primary metatarsalgia is defined as pain across the area of the metatarsophalangeal joints associated with plantar keratoses. It may be a result of functional problems such as wearing a high-heeled shoe or structural problems associated with, for example, a short first metatarsal, limb length discrepancies, or pes cavus. Also included by Helal as primary metatarsalgia were Freiberg's disease, hallux valgus, hallux rigidus, and problems of iatrogenic and traumatic origin. Secondary metatarsalgia was caused by systemic disease such as rheumatoid arthritis. Metatarsalgias attributed to tarsal tunnel and vascular insufficiency are those types of metatarsalgia unrelated to load distribution. Regnauld defined metatarsalgia into diffuse, localized, subcutaneous soft tissue, and cutaneous metatarsalgia. Diffuse metatarsalgia is an exampl...

PubMed, Nov 1, 1992

The authors provide a simplified system for the initial approach and diagnostic evaluation of the... more The authors provide a simplified system for the initial approach and diagnostic evaluation of the more commonly occurring ulcerations encountered by the Podiatric physician. This system provides a logical basis for evaluation, identification, and therapeutic intervention of lower extremity ulcers.

PubMed, May 1, 1988

The authors present results of their experiences with the Austin procedure in a group of patients... more The authors present results of their experiences with the Austin procedure in a group of patients approximately 24 months postoperatively. The overall patients' satisfaction rate was 96%. The overall clinical rating was 77%. Reasons for poor results were analyzed.

PubMed, 1992

This study was designed to examine the external morphology of the metatarsophalangeal joint and o... more This study was designed to examine the external morphology of the metatarsophalangeal joint and of the hallux. Approximately 187 first metatarsals and their associated proximal phalanges where measured for ten linear variables from human skeletal specimens housed in the Cleveland Museum of Natural History. The variables represented seven articular characteristics of the head of the first metatarsal, the length of first metatarsal, and the height and width of the base of the first proximal phalanx. Descriptive statistics for each of the variables are presented along with comparisons on gender and race. Strong differences comparing the means of the males and females were found; however, only minor differences were found between the blacks and whites. Correlation coefficients between all variables were found to be statistically significant; however, some relationships were more distinct than others. These data are presented as an aid in the accurate sizing of future prosthetic first metatarsophalangeal joint designs.

PubMed, Sep 1, 1993

The authors review pyrolytic carbon as a biomaterial. Its potential applications in bone and join... more The authors review pyrolytic carbon as a biomaterial. Its potential applications in bone and joint surgery are discussed. This manuscript includes work performed in the early 1980s through present day research.

PubMed, Sep 1, 1992

The following is a pilot study designed to examine the forces in and around the first metatarsoph... more The following is a pilot study designed to examine the forces in and around the first metatarsophalangeal joint during the contact phase of the normal gait cycle. The architecture of this study was designed to be simple, effective, and repeatable with minimal complications. This study used a force plate to examine ground reaction forces with the simultaneous use of a video tape recorder to provide overlapping images of the angular displacement of the proximal phalanx on the first metatarsophalangeal joint coinciding with these ground reaction forces. Peak ground reaction force was found to be 1.16 x body weight while the proximal phalanx was found to be maximally dorsiflexed just 0.09 seconds after the peak ground reaction force. The mean range of motion during this process was found to be 31.54 degrees.

PubMed, May 1, 1990

Previous studies of first metatarsophalangeal joint range of motion have resulted in varying valu... more Previous studies of first metatarsophalangeal joint range of motion have resulted in varying values for dorsiflexion of this joint. These values reflect assisted dorsiflexion of the first metatarsophalangeal joint, which has been believed to be the same value that would be obtained during the toe-off phase of gait. These values range from 60 degrees to 90 degrees. This study attempts to obtain measurements during toe-off and to compare obtained values with those of assisted dorsiflexion from the previously mentioned studies.

PubMed, 1989

The analysis of motion of the first metatarsophalangeal joint in this study demonstrates the char... more The analysis of motion of the first metatarsophalangeal joint in this study demonstrates the character of motion about this joint. Four instantaneous centers of rotation were calculated in the first metatarsal head that formed an arc encircling an area of increased stress patterns. The joint motion is made up of rolling, sliding, and compression. The fact that there is more than one center of motion contradicts the theory of a simple hinge joint. The joint is a dynamic acetabulum or "hammock," as described by Kelikian. That is, the first metatarsal head moves within a stable support comprised of the base of the proximal phalanx, the sesamoids, soft tissue, and muscle tendons. The nature of first metatarsophalangeal joint motion must be considered when contemplating surgical procedures of the first metatarsophalangeal joint.

Journal of Foot & Ankle Surgery, 2004

The purpose of this study was to examine the effect on the biocompatibility and biologic fixation... more The purpose of this study was to examine the effect on the biocompatibility and biologic fixation of atomic oxygen-textured pyrolytic carbon. The implants consisted of unalloyed pyrolytic carbon rods, with half the length of the rod textured by atomic oxygen, and the other half retaining the as-deposited surface that normally occurs during the manufacturing process. The rods were implanted transcortically across the distal portion of the femurs of 6 adult male rabbits for 8 weeks. The implants were assessed mechanically by measuring the interface strength between the implant and the bone. The implant-bone interface was also examined by light microscopy. No adverse reaction to either the as-deposited or the textured pyrolytic carbon was seen. Percent bone apposition was greater for textured implants than for the as-deposited implants; however, it was not significant. The bone apposition efficiency factor, calculated by dividing the interface strength by the fraction of bone apposition, was greater for the textured implants than for the as-deposited implants. This indicates that the fixation obtained was more effective for the textured implants. The findings of this study suggest that biologic fixation of pyrolytic carbon implants can be enhanced by surface texturing by using direct exposure to atomic oxygen, without compromising its biocompatibility.

The Foot, Sep 1, 1999

The authors present two cases of recurrent extension deformity of the fifth toe. In both cases, r... more The authors present two cases of recurrent extension deformity of the fifth toe. In both cases, regeneration of the extensor digitorum longus to the fifth toe was the cause of the recurring deformity. This article discusses the two cases, and describes a method of surgical intervention used to correct the recurrent deformities. The procedure includes syndactylization of the fourth and

Journal of Biomedical Materials Research, Sep 15, 1998

Hemiarthroplasty is one method used to treat osteoarthritic joints. Often, however, an adverse re... more Hemiarthroplasty is one method used to treat osteoarthritic joints. Often, however, an adverse response of the articular cartilage to the metal implants occurs. The purpose of this study was to evaluate and compare the response of a surgically created defect to pyrolytic carbon and cobalt-based alloy hemiarthroplasties. The cartilage on the lateral side of the tibial plateau of a canine knee joint was abraded to create a full-thickness defect. Two small holes were drilled into the exposed subchondral bone. Next, either a carbon or metal implant was placed in the lateral femoral condyle. The implantation period was 1 year. Histologic examination of the tibial defects revealed a smooth bony surface for both implant groups. In addition, there was no evidence of a residual adverse inflammatory response nor of a significant increase in subchondral bone formation for either group. Surface cracks resulting from the presence of the implant were seen in 14% of the carbon implant specimens and in 100% of the metal implants. Fibrocartilage regeneration was seen in 86% of the carbon implants and in 25% of the metal implants. Thus the carbon appears to be better tolerated mechanically compared to wrought cobalt-chromium alloy. Pyrolytic carbon shows promise for use in hemiarthroplasty.

Journal of the American Podiatric Medical Association, Nov 1, 2012

The general public has become increasingly concerned about the accomplishments of education. Accr... more The general public has become increasingly concerned about the accomplishments of education. Accrediting bodies are holding institutions of higher education accountable for educational services and are demanding a variety of assessment activities. This article presents the plan for assessment of student achievement at the

... 28-1 Chapter 29 Podiatric Sports Medicine James E. Lichniak and Phillip R. Perlman ... 31-1 C... more ... 28-1 Chapter 29 Podiatric Sports Medicine James E. Lichniak and Phillip R. Perlman ... 31-1 Chapter 32 The Plague of HIV/AIDS: Role of Podiatric Medicine Leonard A. Levy ... Chapter 37 Management of Lower Extremity Ulcers Kenneth G. Canter, Gerit D. Mulder, David J. Neese ...

The Foot, Jun 1, 2004

Lasers have been used in medicine for more than 40 years. They currently have many applications, ... more Lasers have been used in medicine for more than 40 years. They currently have many applications, including surgery, treatment of tumors, dental disease and pain. More recently, they have been examined for the potential application of enhancing wound healing. Ulcers in diabetic patients are more difficult to heal, due to reduced microcirculation and other disorders that affect wound healing. Thus, the treatment of diabetic ulcers is one of great significance. There are several different types of lasers being examined for the treatment of diabetic ulcers. These include the argon, helium-neon (HeNe), gallium-aluminum-arsenide (GaAlAs), gallium-arsenide (GaAs) and neodymium:yttrium-aluminum-garnet (Nd:YAG) lasers. This article reviews the possible effects that laser irradiation produces to improve wound healing. Animal and clinical studies in the area of lasers for diabetic wound healing are also presented.

The Foot, Jun 1, 2019

The process of repeated handling and steam sterilization of bone screws and allows debris to depo... more The process of repeated handling and steam sterilization of bone screws and allows debris to deposit on the surface and inside cannulated screws. Individually packaged screws could alleviate these potential problems. This research intended to evaluate the effect that multiple cycles of sterilization may have, if any, on the mechanical integrity of cannulated screws. The results indicate that the mechanical integrity of the screws tested was not compromised.

Journal of Foot & Ankle Surgery, 1997

Two aspects of surgery were studied: the antibiotic usage and tourniquet application. The authors... more Two aspects of surgery were studied: the antibiotic usage and tourniquet application. The authors analyzed the rate of infection and the number of tourniquet complications that resulted from the surgeries. The infection rate was 0.65%, and there were no tourniquet complications. Using the information learned from the study and reviewing pertinent literature, recommendations were made to further enhance patient care.

Journal of Foot & Ankle Surgery, Jul 1, 2004

The purpose of this study was to evaluate a 980-nm gallium-aluminum-arsenide diode laser for woun... more The purpose of this study was to evaluate a 980-nm gallium-aluminum-arsenide diode laser for wound healing. Using genetically diabetic and nondiabetic mice, two 6-mm wounds were created on the back of each mouse by using a punch biopsy. The mice were assigned to 1 of 4 subgroups for laser treatment at different fluence and frequency of treatment: 5 W (18 J/cm 2) every 2 days, 5 W (18 J/cm 2) every 4 days, 10 W (36 J/cm 2) every 2 days, and 10 W (36 J/cm 2) every 4 days. In addition, control mice were used and the wounds were allowed to heal naturally. Wound healing was evaluated on days 5, 12, and 19 by percentage of wounds healed and percent wound closure. A maximum of 5 mice per subgroup were killed at days 7, 14, and 21, and histology was conducted on the wound sites. For diabetic mice receiving 5 W every 2 days, the percentage of wounds healed after 19 days was 100% versus 40% in the control group. Only 20% of wounds in the 10-W diabetic subgroups achieved healing during the same period. For the subgroups whose wounds did not completely heal, all but the 10 W every 2 days subgroup had average closure of Ͼ90%. The 100% closure for the 5 W every 2 days subgroup was significantly greater than the other subgroups. For nondiabetic mice, 100% of the wounds in the 5 W every 4 days and control subgroups were completely healed, whereas 90% of the wounds from the 5 W every 2 days and the 10 W every 4 days subgroups were completely healed. In the latter 2 subgroups, wound closure was 99.4% and 98.8%, respectively. These differences were not significant. The histologic results confirmed these findings. In conclusion, treatment at 18 J/cm 2 shows a beneficial effect on wound healing in diabetic mice and does not have a detrimental effect in nondiabetic mice.

Journal of the American Podiatric Medical Association, 2016

Metatarsus adductus is a structural deformity that may be associated with hallux valgus and that ... more Metatarsus adductus is a structural deformity that may be associated with hallux valgus and that may lead to metatarsal pain and functional abnormality of the foot. Correcting hallux valgus is complicated in these cases because of the deviation in adduction of the lesser metatarsals, especially the second metatarsal that occupies the first intermetatarsal space. We report the case of a 49-year-old man who underwent a scarf osteotomy in the first metatarsal, shortening and abductor oblique distal osteotomies of the lesser metatarsals, and arthrodesis of the central toes with Z-lengthening of the capsule and long extensor tendons of the toes.