bluuebunny/crossref_metadata_2025 huggingface dataset:
The Effect of a Viscoelastic Orthotic on the Incidence of Tibial Stress Fractures in an Animal Model
Authors: Milgrom C. , Burr D.B. , Boyd R.D. , Robin G.C. , Higgins W.L. , Radin E.L.
Published: March 2013

The hypothesis that training with viscoelastic orthotics may lower tibial stress fracture morbidity was studied using an animal model. No difference was found in the incidence of tibial stress fractures between groups trained with and groups trained without viscoelastic orthotics. The results in the animal model do not support the need for a clinical trial.
Passive Motion of the First Metatarsal Cuneiform Joint: Preoperative Assessment
Authors: Romash Michael M. , Fugate Douglas , Yanklowit Barney
Published: March 2013

Surgical treatment of hallux valgus with metatarsus primus varus aims to normalize the intermetatarsal angle, reduce the exostosis, and realign the proximal phalanx. These goals can be achieved by numerous osseous and soft-tissue procedures. The surgeon must be aware of the many treatment options and be able to select the appropriate procedure for each foot.
Dorsal Closing Wedge Metatarsal Osteotomy: A Trigonometric Analysis
Authors: Harper Marion C.
Published: March 2013

Dorsal closing wedge osteotomies are commonly done in order to elevate and shorten the metatarsals in the management of severe metatarsalgia with callus formation. A trigonometric analysis reveals that a proximal closing wedge with a small (i.e., 2-mm) base will significantly elevate (approximately 1 cm), and slightly shorten a typical lesser metatarsal. Larger proximal wedge osteotomies in a lesser metatarsal would appear to have the potential for excessive elevation of the metatarsal head. Because of differences in metatarsal width and length, a proximal wedge in the first metatarsal will elevate the metatarsal head approximately twice the width of the wedge base. A distal closing wedge osteotomy will elevate a lesser metatarsal head approximately the width of the wedge base.
A Comparison of Nonweight-Bearing and Weight-Bearing Radiographs of the Foot
Authors: Shereff Michael J. , DiGiovanni Louis , Bejjani Fadi J. , Hersh Alexander , Kummer Frederick J.
Published: March 2013

This study compares the standardized measurements of the foot in nonweight-bearing and weight-bearing radiographs. Both normal and hallux valgus patients were studied. The results show that some changes thought to occur with weight-bearing cannot be consistently demonstrated. Obtaining both weight-bearing and nonweight-bearing views may not be routinely indicated in all patients.
Necrosis Leading to Amputation Following Clubfoot Surgery
Authors: Hootnick David R. , Packard David S. , Levinsohn E. Mark
Published: March 2013

Amputation after clubfoot surgery is a rare and catastrophic complication. This case report involves an amputation necessitated by postoperative necrosis on the medial side of the foot. To our knowledge, only one brief published report of necrosis following clubfoot surgery exists in the literature, and that report contains little clinical information. Although we know of several additional cases of necrosis following clubfoot surgery, the details of these cases remain unavailable to us for publication. The clubfoot deformity is almost always associated with vascular deficiencies involving the anterior tibial and dorsalis pedis arteries, as well as their derivatives. Since the area of necrosis in this case report coincided with the anatomic distribution of the derivatives of the congenitally reduced or absent dorsalis pedis artery, we suggest that insufficient blood flow to the dorsal and medial sides of the foot, and to the hallux contributed to the necrosis. In our opinion, the surgeon should assume that an abnormal vascular pattern, as described here, is present unless proven otherwise.
Rupture of the Intersesamoid Ligament of a Soccer Player's Foot
Authors: Capasso Giovanni , Maffulli Nicola , Testa Vittorino
Published: March 2013

The traumatic dislocation of the lateral sesamoid of the flexor hallucis brevis tendon in a soccer player is reported. It was treated surgically by open reduction and ligamentoplasty of the ruptured intersesamoid ligament. Fourteen months after the injury, the patient is fully asymptomatic, and has returned to full activity.
The Use of the Powered Metaphyseal Stapler for Reconstructive Procedures in the Adult Foot
Authors: Weltmer John B. , Cracchiolo Andrea
Published: March 2013

We have evaluated the Powered Metaphyseal Stapler in various procedures in the adult foot to determine the effectiveness of this form of internal fixation. Thirty-five patients had 40 operations (five bilateral). In all but one case there was both clinical and radiographic evidence of a solid bony union. Backing out of the staples has been a minor problem that has required staple removal in three patients. The Powered Metaphyseal Stapler appears to offer a most satisfactory option for internal fixation in the foot, when used in metaphyseal or cancellous bone, as either primary or adjuvant fixation.
Assessment in Congenital Talipes Equinovarus
Authors: Porter R. W. , Roy A. , Rippstein J.
Published: March 2013

We have examined the intra- and interobserver repeatability of several measurements of the original deformity and the postoperative correction in children with congenital talipes equinovarus deformity. A neonatal photograph and a preoperative soft tissue radiograph had acceptable repeatability as a method of early assessment. The postoperative range of movement measured by goniometer was adequate for one examiner, (mean: 2–6°), but poor between examiners (mean: 5–14°). Postoperative radiographic measurement between observers was more repeatable than the range of movement. The combined talocalcaneal angle had good repeatability in young children.
Elongation and Forces of Ankle Ligaments in a Physiological Range of Motion
Authors: Nigg B. M. , Skarvan G. , Frank C. B. , Yeadon M. R.
Published: March 2013

The purposes of this study were: (1) to measure the distances between the insertion sites of selected ankle ligament fibers, (2) to measure the force-elongation characteristics of isolated bone-ligament-bone preparations, and (3) to relate the force measurements to angular positions of the ankle. The findings can be used to discuss clinically the correlation between possible ligament injuries and associated foot movement. Three fresh cadaveric ankles were dissected to expose the anterior talofibular ligament, the calcaneofibular ligament, and the superficial deltoid ligament. The ankles were first mounted on a fixture, and insertion to insertion distances of the ligament fibers were measured for selected positions of the ankle/subtalar joint. Bone-ligament-bone preparations were then removed, returned to their anatomical length and uniaxial force-extension testing was performed. The forces in each ligament were recorded for distances corresponding to those measured in situ for various ankle positions. These results allowed: (1) estimation of the forces in these three ligaments in various ankle positions, (2) identification of positions where ligaments were carrying no force, and (3) identification of positions where they carry large forces.

The clinical analysis reveals that the anterior talofibular ligament is sensitive to excessive plantarflexion or dorsiflexion, the calcaneofibular ligament is sensitive to excessive inversion or eversion as well as dorsiflexion or plantarflexion, and that the deltoid ligament appears to be sensitive to plantarflexion, external rotation, and eversion. The fact that all three ligaments tested demonstrated different ranges of tension supports the view that there are optimal positions for testing ankle ligament integrity.
The Incidence of Ankle Sprains in Soccer
Authors: Ekstrand Jan , Tropp Hans
Published: March 2013

This study investigated the relationship between exposure time and ankle sprains in soccer. Forty-one teams (639 players) from four male senior soccer divisions at different levels of skill (divisions I-VI) were followed prospectively for 1 year. The exposure to soccer and the number of injuries per player were higher in higher divisions, but the injury incidence, percentage of ankle injuries and incidence of ankle injuries were the same at different levels of skill. Of all injuries 17 to 20% were ankle sprains and the incidence varied between 1.7 to 2.0 ankle injuries per 1000 hours of exposure. Since players with previous ankle problems run an increased risk of reinjury we suggest that these players receive preventive advice.
Correction of Hallux Valgus with Metatarsocuneiform Stabilization
Authors: Mauldin Donald Maurice , Sanders Melanie , Whitmer Wade Wyatt
Published: March 2013

51 feet in 30 patients were evaluated clinically and radiographically an average of 27.6 months after undergoing a modified McBride bunionectomy with a metatarsocuneiform stabilization. An inlay block of bone was used after achieving corrected position of the first metatarsal. The retrospective review included an anteroposterior x-ray, in which definite trabecular bridging was present in only 25.5% of the cases. The metatarsocuneiform joint was asymptomatic regardless of its x-ray appearance. The average intermetatarsal angle was reduced from 14.6° to 8.7°. This procedure attempts to restore near-normal anatomy, thereby preventing transfer metatarsalgia from shortening or elevation of the first metatarsal. Acceptable correction is possible in both moderate and severe deformities.
Tarsometatarsal Involvement in Juvenile Spondyloarthropathy
Authors: Levi S. , Ansell B.M. , Klenerman L.
Published: March 2013

Patients with juvenile spondyloarthropathy who carry HLA B27 antigen or have a family history of ankylosing spondylitis may have marked tarsometatarsal arthritis. This may be associated with hindfoot involvement and result in a supination deformity. Spontaneous fusion with complete obliteration of the tarsometatarsal joints may occur.
Acute Lateral Ankle Ligament Injuries: A Literature Review
Authors: Boruta Peter M. , Bishop John O. , Braly W. Grant , Tullos Hugh S.
Published: March 2013

The average general orthopaedic surgeon examines and treats a considerable number of acute lateral ankle ligament sprains in a busy office practice. A cursory review of recent articles published on this subject will present a confusing picture regarding diagnosis and treatment of Grade III injuries. An air of controversy surrounds the interpretation of diagnostic x-rays, and the management of these common ankle problems. This review article is presented to summarize current thoughts on the anatomy, biomechanics, diagnosis, and treatment of acute lateral ankle ligament sprains.
Shoes for the Insensitive Foot: The Effect of a “Rocker Bottom” Shoe Modification on Plantar Pressure Distribution
Authors: Schaff Peter S. , Cavanagh Peter R.
Published: March 2013

The purpose of this study was to examine the effects on plantar pressure of the rocker bottom shoe, which is a frequently used intervention for the ulcerated diabetic foot. In-shoe pressure distribution was recorded during walking in a conventional extra-depth shoe which was then modified into a rocker bottom configuration with a 24° rocker, and the experiment was repeated. Peak pressures in the rocker shoe were reduced by ≈30% compared to the conventional shoe in the medial and central forefoot and in the toe regions, but pressures were elevated in the heel, the midfoot, and in the lateral forefoot regions. These experiments suggest that a correctly designed rocker bottom shoe may reduce the risk of ulceration in certain areas of the foot. However, since pressures in some regions can also be elevated by this type of footwear, attention to individual design is critical.
A Quantitative Assessment of the Effect of Metatarsal Pads on Plantar Pressures
Authors: Holmes George B. , Timmerman Laura
Published: March 2013

The treatment of metatarsalgia secondary to the plantar prominence of the metatarsal heads has lead to the development of numerous orthotic devices designed to decrease pressures in these areas. In spite of the considerable cost of some of these devices, there has yet to be much objective evidence of their efficacy. This study assessed the effect of a simple metatarsal pad on pressures transmitted to the metatarsal heads. Quantitative measurements of dynamic peak pressures for 10 asymptomatic subjects with and without metatarsal pads were made using the pedobarograph. Female volunteers had a reduction in peak metatarsal pressures from 12% to 60% when a small metatarsal pad was appropriately applied to the foot. In two of five males there was a decrease in metatarsal pressure of 14% to 44%. One male had no change in pressure, while two others had an increase in pressure from 8% to 28%. When properly positioned and appropriately monitored, metatarsal pads can be an inexpensive and effective means of reducing metatarsal pressures.
The Assessment of Dynamic Foot-to-Ground Contact Forces and Plantar Pressure Distribution: A Review of the Evolution of Current Techniques and Clinical Applications
Authors: Alexander Ian J. , Chao Edmund Y.S. , Johnson Kenneth A.
Published: March 2013

The objective documentation of foot function before and after therapeutic intervention will be greatly enhanced by the utilization of devices capable of measuring dynamic foot pressure distribution. Efforts to develop this technology date back to the late 19th century, but only with recent advances in computers has it been possible to produce quantitatively accurate high resolution foot pressure distribution with high sampling rates and easily interpreted graphic displays. Over the years, a variety of methods have been employed to study foot pressure. Many of these techniques have already improved our understanding of the foot and its function, and have had an impact on the way we practice. Effective clinical utilization of these new investigative tools depends on an understanding of their scientific basis, capabilities and limitations.
Plantar Warts
Authors: Griffin Glover Michael
Published: March 2013

Plantar warts are an extremely common problem which can be very painful and debilitating. As is often the case with common problems, the knowledge of the disease and its treatments is inversely proportional to the frequency of the disease. Often the lay person knows as much and has as strong an opinion on treatment as the treating physician. In addition, most communities have someone who has the reputation of being able to bewitch warts off. 32 , 52 This review will attempt to make some order of myriad facts and suppositions regarding this infection. Hopefully, this will aid the physician in the diagnosis and treatment of the patient with plantar warts.
Crescentic Osteotomy for Hallux Valgus: A Biomechanical Study of Variables Affecting the Final Position of the First Metatarsal
Authors: Lippert Frederick G. , McDermott John E.
Published: March 2013

The position of the first metatarsal following a crescentic osteotomy for hallux valgus is a function of the size of the saw cut and orientation of the osteotomy. This study reports the effect of these variables, recommended technique, and potential pitfalls when using the crescent osteotomy. Using molded polyurethane foam metatarsals and a precision drill press which controlled the saw cuts, the following variables were studied: (1) orientation of the saw cut to the metatarsal, (2) the saw size (diameter of the saw relative to the shaft width of the osteotomy site), and (3) the direction toward which the crescent faces (proximal/distal). Best correction can be obtained if the saw diameter is larger than the diameter of the osteotomy site (allowing a greater degree of correction before impingement), the saw tip is tilted slightly toward the sesamoids (which ensures that the metatarsal does not rotate medially with correction), and the saw is rotated laterally to cause slight declination of the toe.
Chevron Osteotomy Fixed with Absorbable Polyglycolide Pins
Authors: Hirvensalo Eero , Böstman Ole , Tormala Pertti , Vainionpää Soppo , Rokkanen Pentti
Published: March 2013

Seventy-eight chevron osteotomies augmented by internal fixation with self-reinforced polyglycolide pins, 2 mm in diameter, were performed in 60 patients suffering from a painful hallux valgus. The mean metatarsophalangeal angle was 31°, and there was a metatarsus primus varus varying from 10° to 20°. The average follow-up time was 14 (range, 12 to 31) months. No postoperative redisplacement or disturbance of healing of the osteotomy was observed, but recurrence of hallux valgus occurred in 8 feet (10%), each initially with a moderate to severe hallux valgus. Some pain at the first metatarsophalangeal joint during physical activity remained in 12 feet (15%). There was a mean shortening of 2.5 mm of the first metatarsal bone, and the most significant shortening was associated with pain in the forefoot. The metatarsophalangeal joint motion was not decreased. The subjective overall result was excellent or good in 75% of the patients. Because of the biodegradability of the implants used, no secondary procedures to remove the implants were necessary.
Tibio-Talar Stability in Bimalleolar Ankle Fractures: A Dynamic In Vitro Contact Area Study
Authors: Clarke Hugh J. , Michelson James D. , Cox Quentin G.K. , Jinnah Riyaz H.
Published: March 2013

A dynamic weight-bearing model has been developed in a cadaveric ankle model to assess the contact areas of the talus in varying degrees of bimalleolar ankle fractures. A surgically created transverse fibula osteotomy with up to 6 mm of displacement did not cause a significant change in the contact area. Sectioning of the deltoid ligament, regardless of fibular displacement, created a 15% to 20% decrease in the contact area ( P < .001). This model represents a clinically relevant situation, as it examines motion of an unconstrained, axillary loaded ankle. Additional medial side disruption increases ankle instability by allowing anterior and lateral translation of the talus out of the mortise. Isolated lateral malleolar displacement does not appear to cause ankle instability.
Glove Perforation in Foot Surgery
Authors: Maffulli Nicola , Testa Vittorino , Capasso Giovanni
Published: March 2013

A total of 391 pairs of gloves were tested for punctures after 100 consecutive foot surgery operations to assess the rate, site, procedure, and maneuver during which glove puncture accidents took place. Evidence of perforation was found in 23% of the gloves used. The surgeons are significantly more at risk of glove perforation than the other members of the operating team.
Traumatic Boutonnière Deformity as a Cause of Acute Hammer Toe: A Case Report
Authors: Rau Frederick D. , Manoli Arthur
Published: March 2013

Traumatic boutonnière deformity, well-described when occurring in the fingers, can occur in a lesser toe. The deformity mimics that of a hammer toe, but the onset is acute, and develops immediately after trauma. Open repair of the central slip rupture and recentralization of the displaced lateral bands of the extensor mechanism with temporary pinning of the toe can give an excellent result.
Perineural Fibrosis of Superficial Peroneal Nerve Complicating Ankle Sprain: A Case Report
Authors: Acus Raymond W. , Flanagan J. Patrick
Published: March 2013

The peroneal nerve is susceptible to traction injury during inversion ankle sprains. 1 , 2 , 4 , 6 – 9 Previously, these traction lesions have been identified only at the fibular neck and popliteal fossa level. 2 , 5 , 8 , 10 This report illustrates a previously unreported condition of perineural fibrosis of the superficial peroneal nerve at the level of the ankle following an inversion ankle sprain. Perineural fibrosis should be considered in the differential diagnosis of patients with persistent pain after ankle sprain.
Foot and Ankle Disorders Resulting From Lyme Disease
Authors: Faller Jason , Thompson Francesca , Hamilton William
Published: March 2013

Ten cases of Lyme disease involving the foot and ankle are reported. Onset of symptoms was months to years before diagnosis. A variety of clinical foot and ankle problems resulted. Careful case histories and serologic testing resulted in proper diagnosis and treatment.
Traumatic Epidermal Inclusion Cysts Due to Shoe Impingement: A Report of Two Cases
Authors: Craigen Michael A. C. , Anderson Eric G.
Published: March 2013

Two cases are presented of bilateral traumatic inclusion cysts occurring on the dorsum of the first metatarsophalangeal joint. Both cases were women who wore high-heeled fashion shoes and the cysts occurred where the edge of the shoe impinged on a particularly prominent extensor hallucis longus tendon. Inclusion cysts have not previously been reported on the dorsum of the foot and their occurrence where impingement exists confirms a traumatic etiology. The importance of identifying the causative factor in such cases is emphasized.
Foot Fellows Review: Tibialis Posterior: A Review of Anatomy and Biomechanics in Relation to Support of the Medial Longitudinal Arch
Authors: Kaye Robert A. , Jahss Melvin H.
Published: March 2013

The medial longitudinal arch is unique among homo sapiens. This specialization of the human foot is believed to be necessary to the habitual bipedal gait pattern. Mechanical integrity of the arch depends on static and dynamic anatomic factors. The posterior tibial tendon in particular is situated to provide dynamic support along the plantar aspect of the foot and arch. Evaluation of the phasic activity of the posterior tibial muscle appears to confirm this premise. Furthermore, changes in the longitudinal arch that occur when the posterior tibialis is deficient lend further evidence that it is important in maintenance of the normal arch.
Three Dimensional Analysis of Calcaneal Fractures
Authors: Allon Steven M. , Mears Dana C.
Published: March 2013

Thirty calcaneal fractures in 22 patients were evaluated by conventional radiographs, two dimensional computed tomography scans (2D CT) and three dimensional computed tomography reformations (3D CT). A special protocol for the reproducible procurement of high quality 3D CT scans was developed and is presented for the first time. Computer-generated three dimensional plastic models of fractured calcanei and videotaped presentations of fractured calcanei were made in selected cases. This study is the first to reproducibly demonstrate the usefulness of 3D CT scans in visualizing a calcaneal fracture. This information highlights the rotational displacement of major fracture fragments (multiplanar malrotation) and can facilitate the preparation of an appropriate surgical approach and reconstruction.
Local Fasciocutaneous Flap Skin Coverage for the Dorsal Foot and Ankle
Authors: Hallock Geoffrey G.
Published: March 2013

Recalcitrant wounds of the distal leg and foot are notorious for requiring complex solutions even when deceptively small or benign in appearance. The simplicity of local flap options is always preferable, but is limited about the dorsal foot and ankle region. Inclusion of the well-defined deep fascia with the overlying integument in this area permits creation of local fasciocutaneous flaps that may be an important viable alternative. Over the past 6 years, 13 patients have had 15 such fasciocutaneous flaps for ankle or dorsal foot soft tissue reconstruction, with vascular ischemia being the most common etiology. Although four major complications occurred (27%), no limb amputation was a sequela as local wound care was satisfactory for eventual healing. Seven of these patients (54%) either declined or technically were not candidates for a complicated microvascular tissue transfer, which usually would have been preferable, but nevertheless all results proved satisfactory.
Pressure Distribution Patterns under the Feet of Children in Comparison with Adults
Authors: Hennig Ewald M. , Rosenbaum Dieter
Published: March 2013

Peak pressures and regional impulses were determined under the feet of 15 children and 111 adults by means of a capacitive pressure distribution platform. The measurements were taken during walking and running and revealed insights into foot function during the process of locomotion skill acquisition. Considerably reduced peak pressures in the infant group could be attributed to a softer foot structure and a lower body-weight to foot-contact area ratio. An almost three times higher relative load under the midfoot of the infant foot shows that the longitudinal foot arch is still a weak structure. Within a few months of gait development remarkable changes toward an adult loading pressure pattern were observed.
An Irreducible Fracture-Dislocation of a Lesser Toe: A Case Report
Authors: Fugate Douglas S. , Thomson Jeffrey D. , Christensen Kevin P.
Published: March 2013

Lesser toe dislocations are unusual injuries that are amenable to closed reduction in most cases. We present a case of an isolated lesser toe fracture-dislocation that required an open reduction due to soft tissue interposition.
Metatarsal Head Resection for Bunionette: Long-Term Follow-Up
Authors: Kitaoka Harold B. , Holiday Allan D.
Published: March 2013

The extraosseous and intraosseous vascular anatomy to the fifth metatarsal as visualized in a group of below-the- knee amputation specimens has been described. The extrinsic circulation to the area is provided by the dorsal metatarsal artery, the plantar metatarsal arteries, and the fibular plantar marginal artery. These three source arteries supply branches to the metatarsal and adjacent joints. The intraosseous vascularity consists of a periosteal plexus, a nutrient artery, and a system of metaphyseal and capital vessels.
The Lateral Ligamentous Support of the Subtalar Joint
Authors: Harper Marion C.
Published: March 2013

A review of the ligamentous structures spanning the subtalar joint laterally, as well as within the sinus and canalis tarsi, is presented based on previous descriptions and a series of anatomic dissections. Defined supporting structures are categorized into superficial, intermediate, and deep layers. Of these, the inferior extensor retinaculum is seen to be a discrete, substantial structure readily accessible for ligament reconstructions involving both the ankle and subtalar joints.
Repair of Fibular Ligaments: Comparison of Reconstructive Techniques using Plantaris and Peroneal Tendons
Authors: Brunner R. , Gaechter A.
Published: March 2013

The results of treatment of chronic ligamentous insufficiency of the lateral hindfoot using plantaris tendon grafting (52 ankles) or peroneal tenodesis (128 ankles) were compared with an average followup of 66 months. In two-thirds of all cases an instability of the subtalar joint was present, isolated or combined with an instability of the talocrural joint. The overall outcome with both methods was good, but the results after plantaris repair were slightly more favorable. This fact is underlined by the frequency of reoperations: 1.9% after plantaris repair compared with 9.4% after peroneal tenodesis. We conclude that plantaris repair is the method of choice.
Loading of the Contralateral Foot in Peripheral Vascular Insufficiency Below-Knee Amputees
Authors: Pinzur Michael S. , Perona Paul , Patwardhan Avinash , Havey Robert
Published: March 2013

Seven ambulatory peripheral vascular insufficiency below-the-knee amputees underwent gait analysis to determine the local pressures on seven prominent plantar regions in their remaining limb. Patients occupied significantly less stance phase time on their remaining limbs. Peak, mean, and total pressures measured at each of the seven prominent areas was decreased as compared with laboratory age and sex matched controls. The results of this study suggest that the risk of contralateral limb amputation surgery is related to systemic peripheral vascular insufficiency or local factors, and not increased loading of the remaining contralateral “limb-at-risk.”
Long-Term Followup of Physeal Injury to the Ankle
Authors: Caterini Roberto , Farsetti Pasquale , Ippolito Ernesto
Published: March 2013

Sixty-eight patients with a distal physeal injury to the tibia and/or the fibula were reviewed, with an average followup of 27 years and 4 months from the initial lesion. The average age at injury was 12 years and 6 months, whereas the average age at follow-up was 40 years. Seventeen patients had a type I Salter-Harris injury, 27 type II, 10 type III, and 14 type IV. All the patients but six were treated conservatively. According to our criteria of evaluation, 47 patients had a good result, 13 fair and eight poor. The type of Salter-Harris lesion, the amount of the initial displacement and the quality of reduction were the three main parameters which determined the end-result. Radiographic signs of osteoarthritis were present in 11.8% of our patients and all of them had presented type III or IV lesions, except for one who had a type II lesion.
Cadaver Correlation of Peroneal Tendon Changes with Magnetic Resonance Imaging
Authors: Sobel Mark , Bohne Walter H.O. , Markisz John A.
Published: March 2013

Magnetic resonance imaging (MRI) is used to show the soft tissues of the body. The presence of anomalous tendons and muscles can be detected. Chronic lateral ankle pain and instability can be associated with peroneal tendon pathology and MRI may be used to assess both longitudinal attrition of the peroneus brevis tendon, as well as the presence of the peroneus quartus which may be useful in lateral ankle reconstruction. Tenography can occasionally present technical difficulties and can lead to patient dissatisfaction. 8
Rupture of the Posterior Tibial Tendon Associated with Closed Ankle Fracture
Authors: Monto Raymond Rocco , Moorman Claude T. , Mallon William J. , Nunley James A.
Published: March 2013

Rupture of the posterior tibial tendon has rarely been associated with closed ankle fractures. All previous cases have been in association with pronation-external rotation type fractures in which the medial malleolus has been fractured. This case represents the first such report of a severed posterior tibial tendon in the absence of a medial malleolar fracture and reemphasizes the importance of critically evaluating intraoperative radiographs following the open reduction and internal fixation of closed ankle fractures to assess the possibility of soft tissue interposition. In the event of an acute rupture of the posterior tibial tendon, the authors recommend primary tendon repair.
Os Trigonum Syndrome: A Clinical Entity in Ballet Dancers
Authors: Wredmark Torsten , Carlstedt Carl A. , Bauer Henrik , Saartok Tönu
Published: March 2013

Thirteen Swedish National classic ballet dancers were surgically treated for an “os trigonum syndrome.” Their main symptom was an impingement pain in the hind foot while actively plantarflexing the ankle during ballet dancing. The surgical procedure included excision of an os trigonum or a prominent lateral posterior process of the talus, together with division of the flexor hallucis tendon sheath if it was thickened. This procedure was safe and resulted in return of the dancers to the same level of ballet dancing within 5 to 10 weeks.
Rupture of the Flexor Hallucis Longus after Hallux Valgus Surgery: Case Report and Comments on Technique for Adductor Release
Authors: Brand Jefferson C. , Smith Ronald W.
Published: March 2013

A case of flexor hallucis longus (FHL) rupture following hallux valgus surgery is reported here. The authors conjecture that the FHL rupture was caused by a partial laceration of the FHL at the time of the surgical hallux valgus correction. The authors treated the painful problem by surgically debriding the distal stump of the FHL from under the first metatarsophalangeal joint (MP) and ten-odesing the the proximal stump to the flexor digitorum longus (FDL). The authors describe a technique that minimizes the complications of an adductor tenotomy associated with a distal chevron type of hallux valgus correction.
The Akin Procedure: An Analysis of Results
Authors: Frey Carol , Jahss Melvin , Kummer Frederick J.
Published: March 2013

This paper reports the initial and long-term results of 45 Akin procedures done at the Hospital for Joint Diseases/Orthopaedic Institute from 1966 to 1985. Indications for 36 of the 45 operated feet were for an essentially asymptomatic great toe valgus deformity which caused symptoms to develop in the second toe and in 9 of 45 feet for residual hallux valgus after previous hallux valgus surgery. Excellent and good results were reported in 89% of the patients. The most common technical problem reported in 22% of the patients was plantar angulation at the osteotomy site. The only technical problem that was associated with longterm complications was bone apposition of less than 50% which may have lead to a nonunion in one case and recurrence of deformity in another. Shortening of the hallux was observed in all cases secondary to the closing wedge osteotomy. Shortening can be limited if a minimum of bone is removed from the proximal phalanx. A mathematical analysis is presented in this paper which can be used to provide guidelines to osteotomy size so that a minimum of bone necessary for correction can be removed. The Akin procedure should be performed within certain guidelines. Rarely is an Akin procedure alone indicated for the correction of a hallux valgus deformity. In most patients the proximal phalangeal osteotomy needs to be performed in combination with some other procedure to correct all components of the hallux valgus deformity. Furthermore the procedure can be used with success in those patients who present with an essentially asymptomatic great toe valgus deformity at the metatarsophalangeal joint or the interphalangeal joint which causes symptoms and/or deformity to develop in the second toe. One should avoid using an Akin procedure on the hallux deformity associated with an abnormal intermetatarsal angle, or degenerative changes or incongruity of the metatarsophalangeal joint.
A Chevron-Akin Double Osteotomy for Correction of Hallux Valgus
Authors: Mitchell Laura A. , Baxter Donald E.
Published: March 2013

Chevron osteotomy of the distal metatarsal combined with Akin osteotomy of the proximal phalanx is described for treatment of painful hallux valgus. Sixteen patients (24 feet) who underwent the Chevron-Akin osteotomy were retrospectively reviewed by questionnaire, physical examination, and comparison of preoperative and postoperative standing X-rays. After a mean follow-up of 29 months, there was 95% satisfaction with regard to pain relief and appearance of the foot. Good postoperative range of motion of the great toe was recorded subjectively and objectively. Mean improvement of the first intermetatarsal angle was 4.1° ( P = 0.05). The average preoperative hallux valgus angle was 27° (range 13–40°). Mean improvement with the double osteotomy was 14.3° ( P = 0.05). There was no significant shortening of the first ray with the double osteotomy. Degenerative changes of the first metatarsophalangeal joint were seen in two feet with intra-articular extension of the Akin osteotomy. One malunion occurred with shifting of the Chevron osteotomy after pin removal. The Chevron-Akin osteotomy compares favorably with the isolated distal Chevron osteotomy. In this series there was no compromise of joint motion, and a superior correction of the hallux valgus deformity was obtained.
Reinforced Anatomical Reconstruction of the Anterior Talofibular Ligament in Chronic Anterolateral Instability Using a Periosteal Flap
Authors: Sjølin Søren Upton , Dons-Jensen Henning , Simonsen Ole
Published: March 2013

Twenty-eight consecutive ankles with chronic severe lateral instability were treated by reinforced anatomic recon-struction using a periosteal flap from the lateral aspect of the fibula. At the followup after a median of 24 months, 86% had excellent or good functional results. This result compares favorably with other techniques. As the results after tenodesis appear to deteriorate with time, anatomic reconstruction is recommended. No complications were encountered. No statistical correlation was found between clinical and radiological versus functional instability at followup.
Risk Factors for Lateral Ankle Sprain: A Prospective Study Among Military Recruits
Authors: Milgrom Charles , Shlamkovitch Natan , Finestone Aaron , Eldad Arieh , Laor Arie , Danon Yehuda L. , Lavie Ofer , Wosk Joseph , Simkin Ariel
Published: March 2013

In a prospective study of risk factors for lateral ankle sprain among 390 male Israeli infantry recruits, a 18% incidence of lateral ankle sprains was found in basic training. There was no statistically significant difference in the incidence of lateral ankle sprains between recruits who trained in modified basketball shoes or standard lightweight infantry boots. By multivariate stepwise logistic regression a statistically significant relationship was found between body weight × height 2 (a magnitude which is proportional to the mass moment of inertia of the body around a horizontal axis through the ankle), a previous history of ankle sprain, and the incidence of lateral ankle sprains. Recruits who were taller and heavier and thus had larger mass moments of inertia ( P = 0.004), and those with a prior history of ankle sprain ( P = 0.01) had higher lateral ankle sprain morbidity in basic training.
Partial Calcanectomy for the Treatment of Osteomyelitis of the Calcaneus
Authors: Woll T. Scott , Beals Rodney K.
Published: March 2013

Seven patients underwent partial calcanectomy for chronic osteomyelitis. An average of 20 months followup demonstrated no recurrences, 80% excellent, and 20% good results. Gait assessment, range of motion, and manual motor testing demonstrated minimal functional deficits and full return to preoperative activities. Partial calcanectomy for chronic osteomyelitis of the calcaneus is a simple procedure with low morbidity, rapid convalescence, and good functional results. The high success rate and patient acceptance define it as a well tolerated alternative to more complex procedures.
Congenital Lipofibromatosis Associated with Macrodactyly of the Foot
Authors: Grogan Dennis P. , Bernstein R. Matthew , Habal Mutaz B. , Ogden John A.
Published: March 2013

Congenital lipofibromatosis of the foot, a type of paracrine growth disorder, is a distinct clinical entity that must be differentiated from other causes of macrodactyly, with specific diagnostic and therapeutic considerations. Eleven skeletally immature patients with congenital lipofibromatosis and macrodactyly of the foot were studied. Diagnostic histopathologic criteria were documented. The most specific pathologic finding of congenital lipofibromatosis is an overabundance of fibrofatty tissue on the plantar aspect of the foot and involved toes. Surgical defatting or debulking procedures, ray resection, and phalangeal epiphysiodesis produced significant cosmetic improvement. Syndactylization and phalangeal resection were not as beneficial.
Simple Bunionectomy with Medial Capsulorrhaphy
Authors: Kitaoka Harold B. , Franco Mark G. , Weaver Amy L. , Ilstrup Duane M.
Published: March 2013

Bunionectomy with medial capsulorrhaphy was performed on 54 feet (37 patients) and follow-up was obtained on 49 feet (33 patients) at a mean of 4.8 years postoperatively. Results were excellent in 17 feet, good in 16, fair in 7, and poor in 9. Mean motion of the first metatarsophalangeal joint was 81°. The primary reason for failure was recurrent deformity. Patients were dissatisfied with the results in 41% of the feet. Mean intermetatarsal 1–2 angle increased 1.7° and mean metatarsophalangeal-1 angle increased 4.8°. The operation was significantly more successful in patients who underwent it for painful medial eminence. Bunionectomy with medial capsulorrhaphy is recommended for elderly patients with symptoms primarily due to prominent medial eminence, and its application for the young patient with significant hallux valgus deformity is limited.
Biomechanics of the Lateral Ligaments of the Ankle: An Evaluation of the Effects of Axial Load and Single Plane Motions on Ligament Strain Patterns
Authors: Cawley Patrick W. , France E. Paul
Published: March 2013

Strain behavior in the anterior talofibular and calcaneofibular ligaments of the ankle, with and without axial load, was evaluated using human cadaveric specimens, a specially designed instrumented test fixture, and Hall-Effect strain transducers. Ligament strain patterns were significantly altered with axial loading in some conditions. This data may have clinical relevance both in the diagnosis and rehabilitation of lateral ligament injuries.
Practical Considerations for the Use of the Pedobarograph
Authors: Holmes George B. , Timmerman Laura , Willits Neil H.
Published: March 2013

The pedobarograph functions as a device for the dynamic, quantitative measurement of pedal pressures. To date, little attention has been paid to various practical questions concerning its operation. For example, the number and timing of trials sufficient to provide meaningful information upon which to reliably base investigational or management decisions has yet to be addressed. Twenty volunteers were used for the measurement of pedal pressures for 15 trials during three separate sessions. Statistical analysis for the determination of MIVQUE(0) estimates and maximum likelihood estimates were used to determine the individual variability, the variability of the specific area of the foot, the daily variability, and the trial-to-trial variability. This analysis indicated that for the assessment of pedal pressures in a clinical setting, the variance factors were sufficiently minimized by obtaining multiple measurements. The improvement in the estimate of error by obtaining trials on different days was overshadowed by the potential benefit of doing extra trials on a single day. Three trials on 1 day should sufficiently reduce estimates of error for both clinical and investigational purposes.
Magnetic Resonance Imaging of Anomalous Leg Muscles: Accessory Soleus, Peroneus Quartus and the Flexor Digitorum Longus Accessorius
Authors: Buschmann William R. , Cheung Yvonne , Jahss Melvin H.
Published: March 2013

Since the availability of magnetic resonance imaging (MRI), the suspected diagnosis of an accessory muscle of the lower extremity can now be confirmed without the need for invasive procedures. The accessory soleus, peroneus quartus, and flexor digitorum longus accessorius are anomalous muscles of the lower extremity that can be diagnosed by MRI. These accessory muscles are probably more common than once thought and can now be easily distinguished from other space occupying lesions that can occur around the ankle. MRI of these anomalous muscles enables one to make a definitive diagnosis without a biopsy. In those symptomatic patients, the origins and insertions of these accessory muscles can be accurately evaluated by MRI prior to any anticipated surgical intervention.
Posttraumatic Proximal Migration of the First Metatarsophalangeal Joint Sesamoids: A Report of Four Cases
Authors: Graves Stanley C. , Prieskorn David , Mann Roger A.
Published: March 2013

Four cases are presented with plantar plate injury to the first metatarsophalangeal (MTP) joint and proximal retraction of the sesamoids by the flexor hallucis brevis. No history of dislocation occurred in any patient, although two had associated fractures of a sesamoid bone. Clinical and radiographic aids to the diagnosis are discussed. Clinical findings included diffuse pain beneath the first MTP joint and pain with extremes of joint motion in all patients. The anterior-posterior (AP) radiographic technique was the most helpful in determining the proximal migration of the sesamoids. By taking the AP view with both feet on the cassette and by centering the beam perpendicular to it, the diagnosis of plantar plate disruption can easily be made. Initial treatment of this disorder was nonoperative using a stiff soled shoe. With conservative treatment, two of the patients returned to preinjury activities. One patient required sesamoidectomy for resistant pain, and the final patient is still unable to return to his preinjury job requiring standing and heavy lifting.
Pseudoaneurysm of the Dorsalis Pedis Artery After Lisfranc Amputation
Authors: Lieberman Jay R. , Goldstock Leonard E. , Jacobs Richard L.
Published: March 2013

Pseudoaneurysm formation is usually associated with laceration, fracture, or iatrogenic arterial injury. 2 However, it may also develop as a result of blunt trauma. 5

We report the case of a pseudoaneurysm of the dorsalis pedis artery after a Lisfranc amputation in an individual with diabetes mellitus, Charcot joint changes in the left forefoot, and atherosclerosis of the distal vessels.
The Use of Night Splints for Treatment of Recalcitrant Plantar Fasciitis
Authors: Wapner Keith L. , Sharkey Peter F.
Published: March 2013

This study reports the results of the use of molded ankle foot orthosis night splints for the treatment of recalcitrant plantar fasciitis on 14 patients with a total of 18 symptomatic feet. All patients had symptoms for greater than 1 year and had previously undergone treatment with nonsteroidal anti-inflammatory medicines, cortisone injections, shoe modifications, and physical therapy without resolution. All patients were provided with custom-molded polypropylene ankle foot orthoses in 5° of dorsiflexion to be used as a night splint. With continued use of nonsteroidal anti-inflammatory medication, Tuli heel cups, Spenco liners, and general stretching exercises, successful resolution occurred in 11 patients in less than 4 months. There were three failures. It is felt that the use of night splints provides a useful, cost-effective adjunct to current therapeutic regimens of plantar fasciitis.
Analysis of the Forefoot on Pointe in the Ballet Dancer
Authors: Tuckman Alan S. , Werner Frederick W. , Bayley James C.
Published: March 2013

The forefoot positions of nine ballet dancers standing on pointe were determined using a mold technique. These molds revealed three positions of the toes: (1) no crossing of the three medial toes; (2) crossing of the third toe behind the second; and (3) crossing of the hallux partially in front of the second. Almost half of all the toes seen on the molds had some deformation of the toenails. These molds also indicated a wide variability in the amount and location of contact between the shoes and toes.
The Use of a Grommet Bone Liner for Flexible Hinge Implant Arthroplasty of the Great Toe
Authors: Swanson Alfred B. , de Groot Swanson Genevieve , Maupin B. Kent , Shi Sho-min , Peters John G. , Alander Dirk H. , Cestari Valeria A.
Published: March 2013

Press-fit titanium grommets were developed to shield flexible hinged silicone implants used for arthroplasty of the radiocarpal, metacarpophalangeal, and metatarsophalangeal joints. Since 1985, 179 titanium circumferential grommets were used in 90 first metatarsophalangeal joints with excellent, pain-free, functional results and favorable bone response around the implant stems and at the bone-grommet interface. There were no complications due to particulate reactivity, implant fracture, or grommet fracture. The use of circumferential titanium grommets appears to be a safe and effective method to improve the long-term durability of flexible hinge implant arthroplasty of the first metatarsophalangeal joint.
Acute Rupture of the Tibialis Anterior Tendon: A Case Report
Authors: Rimoldi Reynold L. , Oberlander Michael A. , Waldrop John I. , Hunter Stephen C.
Published: March 2013

Acute rupture of tendons on the dorsum of the foot is rare and the diagnosis can be difficult. We present the case of a 51-year-old man who sustained an acute rupture of the tibialis anterior tendon. Pain about the medial aspect of the midfoot and ambulation with a steppage gait were the keys to formulating a correct diagnosis. The tendon was repaired primarily 10 days after injury. At his final follow-up examination 6 months after surgery, the patient was asymptomatic and ambulated with a normal gait.