bluuebunny/crossref_metadata_2025 huggingface dataset:
Simultaneous Open Dislocation of the Metatarsophalangeal and Interphalangeal Joints of the Hallux: A Case Report
Authors: Henderson Clyde E. , Denno Gordon J.
Published: March 2013

Simultaneous open dislocations of the hallux metatarsophalangeal and interphalangeal joints is previously unreported. Reducibility of the isolated metatarsophalangeal joint dislocation is often implied by the sesamoid separation and/or the existence of a sesamoid fracture. In the open dislocations of the metatarsophalangeal and interphalangeal joints of the hallux reported in this article, the ease of reduction is related instead to the severe disruption of the capsule.
Osteochondritis Dissecans of the Talus
Authors: Powell Jack H. , Whipple Terry L.
Published: March 2013

Osteochondritis dissecans of the body of the talus is a common entity; however, osteochondritis dissecans of the head of the talus has not been found in the orthopaedic literature. The authors report a case of a defect in the talar head following trauma to the ankle, which has radiographic characteristics of osteochondritis dissecans.
Subchondral Pathways to the Superior Surface of the Human Talus
Authors: Berry James L. , Thaeler-Oberdoerster Deborah A. , Greenwald A. Seth
Published: March 2013

The suggestion that the blood supply to subchondral bone plays an active role in the nutrition of adult articular cartilage is a source of controversy. Morphological confirmation of the presence of subchondral defects extending through the basal cartilage layer of the adult human talus is presented. Perfusion of a fluorescent dye through these breaks offers the possibility that they may serve as active pathways for the transport of nutrients to the cartilage. The distribution patterns of the defects in areas of intermittent cartilage loading is noted and its significance is discussed.
Biomechanics of Hallux Valgus and Spread Foot
Authors: Snijders C.J. , Snijder J.G.N. , Philippens M.M.G.M.
Published: March 2013

In this biomechanical study a model is introduced of the force phenomena which seem to dominate in the hallux valgus complex during standing and push-off. The model was verified by measuring the forces under the big toe in three directions with the help of a force plate. It is shown that the force in the musculus flexor hallucis longus is accompanied by unfavorable side effects when the hallux shows a valgus position. On the basis of the biomechanics in this article, arthrodesis of the first metatarsophalangeal joint could be recommended as suitable treatment.
External Fixation Arthrodesis of the Ankle Joint Following Trauma
Authors: Kenzora John E. , Simmons Shelton C. , Burgess Andrew R. , Edwards Charles C.
Published: March 2013

Arthrodesis is currently the treatment of choice for symptomatic degenerative arthropathy of the ankle. Thirty-seven patients underwent arthrodesis for post-traumatic disorders using either a Hoffmann external fixator or a Calandruccio frame. There was degenerative joint disease in 19 (51%), septic arthritis in 11 (30%), severe comminution in five (14%), and uncontrollable equinus in two (5%). The patients were divided into two groups. Twenty-six (70%) were considered to have sustained high energy open or comminuted injuries and 11 (30%), low energy injuries. Twenty-nine (78%) achieved a radiologic fusion following one operation. Four eventually united with further surgery for a final arthrodesis rate of 89%. In the high energy group 18 of 26 (69%) achieved primary fusion. Four united with additional surgery for a final arthrodesis rate of 85%. Two of these required subsequent amputations and two others, a triple arthrodesis which also failed to control chronic pain. Thus, a total of 18 of the 26 patients (69%) achieved a successful result. Also included in the high energy group were three patients with uncontrolled sepsis who underwent amputation before union occurred and one with a painful non-union. All 11 of the patients (100%) who originally sustained low energy injuries achieved a successful arthrodesis. The most common complication was pin tract infection requiring incision, drainage, and oral antibiotics in 16 patients (43%). None of these progressed to chronic osteomyelitis.
The Anatomy and Physiology of the Peripheral Nerve
Authors: Battista Arthur F. , Lusskin Ralph
Published: March 2013

The anatomy and physiology of nerve tissue and the peripheral nerve are reviewed. The importance of the anatomical and physiological understanding of nerve tissue in the surgical repair of nerve injuries is discussed. This includes an outline of the light and electron microscopic histology of nerve and a short review of axoplasmic flow. In addition, the nerve coverings, endoneurium, perineurium, and epineurium, are described. The relationship of these coverings to the surgical therapy of nerve injuries is outlined. By maintaining, where possible, nerve fascicle continuity and by restoring, where practical, the normal physiology of distorted but not disrupted fascicles, with the use of careful internal neurolysis, optimal clinical return of function should be achieved.
Management of Acute Lower Extremity Nerve Injuries
Authors: Aldea Peter A. , Shaw William W.
Published: March 2013

While repair of acute nerve injuries in the lower extremity has not been as aggressive as in the upper extremity, there should now be more effective early intervention. Newer microsurgical techniques can be used along with increased understanding of peripheral nerve internal anatomy to obtain more satisfactory repair and reconstruction of the injured nerves. The anatomy and vulnerability of the nerves in the leg are reviewed, and the decision process is analyzed in the context of the functional deficits following such injuries. A priority of goals in lower extremity nerve repair should be established to ensure salvage of the foot.
Surgical Management of Late Post-traumatic and Ischemic Neuropathies Involving the Lower Extremities: Classification and Results of Therapy
Authors: Lusskin Ralph , Battista Arthur , Lenzo Salvatore , Price Andrew
Published: March 2013

Traumatic/ischemic events such as fractures, dislocations, lacerations, compression, vascular injuries, and embolus can result in several degrees of nerve injury with resultant sequelae of paralysis, sensory loss, and irritative phenomena (pain, hyperesthesia, and dysesthesia). Neuroma pain may prevent rehabilitation following amputation or nerve lacerations. Thirty-four patients with the late sequelae of traumatic/ischemic neuropathies underwent 36 neural operations using magnification techniques to define and repair neural lesions. Major bone and joint reconstruction could be performed at the same operation with protection of arterial and venous supply. A recovery score using defined criteria for motor, sensory, and irritative (pain) recovery has been developed to quantify the end results in compression/ischemia, contusion/stretch, laceration, idiopathic/irritative disorder, and painful neuroma. Excellent and good results were found in 39 of the 87 specific deficits analyzed (45%). Thus, there is the possibility of improved results in these late neuropathies with therapy before irrevocable muscle fibrosis occurs and intractable pain develops.
Sensory Nerve Neuromas—Leading to Failed Foot Surgery
Authors: Kenzora John E.
Published: March 2013

Sensory nerve neuromas caused by incisions on the dorsum of the foot are a common cause of failed foot surgery and can be severely painful and disabling. Thirty-seven patients with 55 symptomatic sensory nerve neuromas were evaluated and treated at the Painful Foot Center. Ten patients with moderately severe symptoms chose not to undergo surgery and were treated with oversized shoes with or without protective orthoses. Twenty-seven patients underwent surgery. Four with spindle neuromas were treated by neurolysis. Two improved slightly, one remained the same, and one became worse. Twenty-three were treated by proximal resection with or without burial of the nerve stump into an appropriate muscle belly. Thirteen of the 23 obtained good results, four obtained fair results, and six obtained poor results. Thus, a total of 20 patients (74%) obtained clinically satisfactory results, and seven (26%), unsatisfactory results. It is much easier to prevent a sensory neuroma by meticulous surgical technique than to treat a highly sympatomatic neuroma.
Functional Evaluation of Nonsensate Free Flaps to the Sole of the Foot
Authors: Gidumal Ramesh , Carl Allen , Evanski Phillip , Shaw William , Waugh Theodore R.
Published: March 2013

Free flap transfer for soft tissue defects involving the sole of the foot have been important in limb salvage. The functional capacity of 16 patients is documented. From our data, free flaps to weightbearing surfaces of the foot give satisfactory results in patients less than 40 years old and salvage is rewarding. Older patients had less than satisfactory results. When the only alternative is an amputation, free flap salvage may still be indicated.
Common Forefoot Problems in Runners
Authors: Lillich James S. , Baxter Donald E.
Published: March 2013

Forefoot injuries constitute a significant portion of the problems that affect runners. With the increasing popularity of recreational running, more emphasis on the treatment of specific running injuries has surfaced. For the orthopaedic surgeon interested in treating runners, a thorough understanding of foot anatomy, biomechanics, shoes, orthotics, running surfaces, and conservative and surgical treatment options is mandatory.

Runners place high demands on their feet and therefore require careful evaluation prior to embarking on a specific treatment course. This article represents a current overview of common problems affecting the forefoot of recreational and world-class runners. Treatment plans are based on the senior author's experience in the care of runners over the past 14 years.
Nonoperative Treatment of Stress Fractures of the Proximal Shaft of the Fifth Metatarsal (Jones' Fracture)
Authors: Acker James H. , Drez David
Published: March 2013

Early operative fixation of stress fractures of the proximal diaphysis of the fifth metatarsal has been advocated because of the high potential for delayed union, nonunion, and refracture. Case reports are given of three athletes with stress fractures of the proximal shaft of the fifth metatarsal who were treated nonoperatively and who returned to early athletic participation without recurrent symptoms or refracture. Treatment of this injury should be individualized because of the potential for nonunion and the ability of this fracture to heal.
The Relationship of Injuries of the Leg, Foot, and Ankle to Proximal Thigh Strength in Athletes
Authors: Nicholas James A. , Marino Michael
Published: March 2013

Rehabilitation programs designed to restore leg, ankle, and foot function following injury frequently ignore the proximal muscles. During athletics, these knee, hip, and trunk muscles derive much of their functional power from the foot and ankle. They also serve to integrate distal segment motions into a total movement pattern such as jumping, running, or kicking. The linkage system, which is a theoretical concept, describes the normal biomechanical and physiological interactions between proximal and distal musculoskeletal structures. Immobilization or injury of distal segments interrupts the normal generation, summation, and transmission of muscular forces across joints. Adequate measures must be taken to properly assess proximal structures for weakness and tightness and to prescribe specific exercises to prevent the migration of the effects of injury away from the involved segment.
Injuries to the Hallucal Sesamoids in the Athlete
Authors: Richardson E. Greer
Published: March 2013

The sesamoids of the great toe, which are small and seemingly insignificant bones, can be the site of disabling pathology for the athlete. Sesamoiditis, osteochondritis, partite sesamoids with stress fractures, displaced fractures, and osteomyelitis have all been reported in the athlete. Bursitis beneath the tibial sesmoid and flexor hallucis brevis tendonitis also occur in the athlete and may be confused with sesamoid injury. Excision of the involved bone is the recommended treatment for displaced fractures and for less severe conditions such as sesamoiditis, osteochondritis, and nondisplaced fractures, if conservative management fails to relieve symptoms.
The Use of Footprint Contact Index II for Classification of Flat Feet in a Nigerian Population
Authors: Didia B C. , Omu E T. , Obuoforibo A A.
Published: March 2013

The objective index as developed by Qaura, Deodhar, and Jit, in 1980 was used to estimate the incidence of flat foot (pes planus) in 990 school pupils (532 females and 458 males) between the ages of 5 and 14 years. The ratio of contact area to the total area of the middle of the footprint (contact index 1) (4/10), usually measured with a planimeter, is accepted as the true representative of the condition of arches. In this field study, contact index II (ratio of contact width to the total width of the foot) which is simple, reliable, and correlates with contact index I has been used to assess flat foot. The mean for the contact index and standard deviation have been calculated. Feet have been considered as normal up to 1 SD around the mean value of the index and values greater or lesser than this have been considered abnormal. Furthermore, mean ± 1 SD to 2 SD has been considered as possible flat foot, whereas mean ± 3 SD and above has been taken as definite flat foot.

On the whole, bilateral flat foot is not common among children of school age in Port Harcourt (0.60%). It is, however, more common in females (0.75%) than males (0.44%). Unilateral flat foot (2.22%) is found to be more common than bilateral flat foot. Early introduction to the use of shoes may predispose to flat foot. We were not in a position to say if any of the subjects found with flat foot would have a painful foot. Clinically speaking it could become important when flat foot co-exists with painful feet or even with pain extending up to the vertebral column.
Occult Malunion of Ankle Fractures—A Cause of Disability in the Athlete
Authors: Yablon Isadore G.
Published: March 2013

Occult malunion of the ankle is a condition in which the talus appears to be situated in its normal position on standard radiographs. The lateral malleolus, however, is incompletely reduced. This causes a subluxation of the distal tibiofibular joint and some degree of talar instability. The malunion of the lateral malleolus is best visualized on lateral radiographs or tomograms. This condition can be corrected by osteotomizing the lateral malleolus and restoring the integrity of the distal tibiofibular joint by pulling the lateral malleolus distally and internally rotating it.
Triple Arthrodesis in Young Children: A Salvage Procedure After Failed Releases in Severely Affected Feet
Authors: Galindo Mayo J. , Siff Sherwin J. , Butler James E. , Cain Thomas E.
Published: March 2013

A total of 19 triple arthrodeses were performed in 13 children aged 10 years or less for severe hindfoot deformities after failure of soft tissue releases. This was considered a salvage procedure and an alternative to talectomy. The average age at surgery was 8.4 years and average follow-up was 4 years. There were 68% excellent and good results, 16% fair, and 16% poor results. The nonunion rate was 7% of joints. Average shortening of the foot was 0.81 in but was not significant when compared with a group of clubfoot control patients. Except for one infection, fair and poor results were due to residual rather than recurrent deformity.

Triple arthrodesis may be indicated in the young child for residual hindfoot deformity as an alternative to talectomy. The potential problems of increased nonunion, severe compromise of foot length, and recurrence of deformity were not observed in this series.
Talar Compression Syndrome
Authors: Brodsky Alexander E. , Khalil Momtaz A.
Published: March 2013

Ballet dancers frequently stand on the tips of their toes in the en pointe and demi-pointe positions, resulting in compression of the posterior structures of the ankle during repeated plantar flexion of the foot, producing the talar compression syndrome. This mechanism may result in posterior block or impingement of an os trigonum or Stieda's process. When the dancer attempts to force the foot into plantar flexion, the os trigonum or the Stieda's process may be impinged between the calcaneus and the posterior edge of the tibia. Pain and tenderness are localized at the posterolateral aspect of the ankle behind the peroneal tendons. In nondancing members of the population, these conditions are usually asymptomatic. It is the requirement of the classical dance for a well-pointed foot that produces symptoms. We are reporting up to 7 years follow-up of six professional ballet dancers in whom we removed the os trigonum for symptomatic talar compression syndrome, caused by the trauma of the en pointe position of toe dancing. Two patients had bilateral operations. All six patients returned to professional dancing within a few months and remained asymptomatic. The anatomy of this condition is reviewed, as well as the diagnosis and treatment.
Outbreak of Wound Infections Following Outpatient Podiatric Surgery due to Contaminated Bone Drills
Authors: Rutala William A. , Weber David J. , Thomann Charlotte A.
Published: March 2013

An outbreak of podiatric infections due to an uncommon strain of Proteus mirabilis occurred following outpatient podiatric surgery. An evaluation of the operating room environment failed to reveal the strain of P. mirabilis from any site other than three bone drills. Thus, the drills served as the reservoir for the organism that was subsequently inoculated onto the hands of the surgeon or directly to a patient during bone drilling. The gas sterilization procedure that was used to sterilize the drills was found deficient. No additional cases of P. mirabilis infection have been observed since the elimination of the contaminated drills.
Reconstruction of the Lateral Ligamentous Structures of the Ankle with a Modified Watson-Jones Procedure
Authors: Barbari Stephan G. , Brevig Knut , Egge Tor
Published: March 2013

A modified Watson-Jones tenodesis using a split of the peroneus longus for correction of chronic lateral ankle instability has been used in a series of 43 ankles. The range of follow-up varied between 2 and 10 years (median 56 months). Functional stability was achieved in most cases. One of the major aims of this study was to analyze the different aspects related to persisting symptoms. The need of a standardized rating system for comparison of the results of the various types of reconstruction procedures is emphasized.
Functional Characteristics of the Foot and Plantar Aponeurosis under Tibiotalar Loading
Authors: Sarrafian Shahan K.
Published: March 2013

Structurally the foot is equivalent to a twisted plate. The hindpart is located in the sagittal plane and the forepart in the transverse plane. The transition induced by the twist creates the transverse and the longitudinal arches. Under vertical loading of the foot plate by the tibiotalar column, compressive forces are created on the dorsum and tensile forces on the plantar aspect of the foot plate. The plantar aponeurosis acting as a tie-rod when under tension relieves the tensile forces from the plantar aspect of the foot plate. The increased tension in the plantar aponeurosis in the weightbearing position of the foot occurs with anterior flexion of the leg or with hyperextension of the toes. In the plantigrade position when vertical loading and external rotation are simultaneously applied by the tibiotalar column on the foot, the hindfoot and the midfoot are supinated, and the forefoot is pronated. The medial longitudinal arch is higher, the foot is shorter, and the plantar aponeurosis is relaxed. The foot is then more flexible. With vertical loading and simultaneous internal rotation, the hindfoot and the midfoot are pronated, and the forefoot is supinated. The medial longitudinal arch is lower, the foot is longer, and the plantar aponeurosis is tense. The foot is then more rigid and a better lever arm. Demonstrations are presented both in living and in anatomic dissections.
Ankle Fractures
Authors: Bauer Mats , Johnell Olof , Redlund-Johnell Inga , Johnsson Kjell
Published: March 2013

The results of three separate studies on ankle fractures are presented. Clinical information is provided concerning the epidemiology and a comparison of closed versus open treatment, and a discussion is presented concerning what results can be expected 30 years after closed treatment for an ankle fracture.
Supination-Eversion Fractures of the Ankle Joint: Changes in Incidence over 30 Years
Authors: Bauer Mats , Bengnér Urban , Johnell Olof , Redlund-Johnell Inga
Published: March 2013

The sex- and age-specific incidence has been calculated for ankle fractures from the first part of the 1950s and compared with the 1980s, a 30-year interval. The fractures were also classified according to Lauge-Hansen. Altogether 1784 fractures were found. During that time interval ankle fractures had become more common, particularly those with extensive skeletal involvement, such as the stage IV supination-eversion fractures, which today have an incidence pattern more typical of a fragility fracture in elderly women.
Pictorial Review: Cross-Sectional Imaging of the Foot and Ankle
Authors: Sartoris David J. , Resnick Donald
Published: March 2013

Cross-sectional imaging techniques are becoming increasingly important for the evaluation of foot and ankle disorders. Computed tomography affords superior depiction of osseous anatomy, and is useful in the assessment of acute fractures, degenerative joint disease, and postoperative alterations. Magnetic resonance imaging is particularly well suited to soft tissue disease, including neoplasms, tendinitis, myopathy, and infection, owing to its excellent contrast discrimination capabilities.
Osteochondral Disruption of the Second Metatarsal: A Variant of Freiberg's Infraction?
Authors: Young M. Christine , Fornasier Victor L. , Cameron Hugh U.
Published: March 2013

A case of Freiberg's Infraction of the second metatarsal is presented. The metatarsal head was resected and its pathology proved very informative. Necrotic bone was not found, but a shearing type of separation was identified at the level of “tidewater mark” in the articular cartilage and was the major observation. This suggested the possibility that in adults Freiberg's Infraction rather than true avascular necrosis may be in fact the result of a shearing-compression type of injury occurring at the interface between mineralized and nonmineralized articular cartilage (tidewater mark). An anatomical examination of metatarsophalangeal joints in cadavers showed that during walking at the “toe off” position, the toes dorsiflex to force the metatarsal head into plantar flexion. The proximal phalanges ride dorsally over the metatarsal heads producing a shearing force that would support our interpretation of the observations made in the case presented.
Occurrence of the Plantaris Tendon in Patients Sustaining Subcutaneous Rupture of the Achilles Tendon
Authors: Incavo Stephen J. , Alvarez Richard G. , Trevino Saul G.
Published: March 2013

Many surgeons treat closed subcutaneous rupture of the Achilles tendon with primary surgical repair. Reinforcement of the primary repair can be accomplished easily using the plantaris tendon. Unfortunately, in the population of patients who sustain this injury, the plantaris is absent in 60% of patients. This is a statistically significant difference when compared to the absence of the plantaris tendon of less than 10% in reported cadaveric studies.
Selective Tarsal Arthrodesis: An in Vitro Analysis of the Effect on Foot Motion
Authors: Gellman Harris , Lenihan Michael , Halikis Nick , Botte Michael J. , Giordani Mauro , Perry Jacquelin
Published: March 2013

Five different intertarsal arthrodeses were simulated in 15 fresh cadaver feet/ankles utilizing external fixation. Pin placement was verified radiographically. Range of motion measurements were performed before pin placement, after pin placement, and after simulated arthrodesis. The deficit in foot motion created by selected limited intertarsal fusions was then measured.

The prearthrodesis range of motion measurements were found to be dorsiflexion (DF), 27°; plantarflexion (PF), 57°; total inversion (INVT), 29°; eversion total (EVT), 22°; hindfoot varus (VRH), 16°; hindfoot valgus (VLH), 12°.

The deficits in motion after arthrodesis were as follows. Ankle (tibiotalar): DF, 50.7%; PF, 70.3%; INVT, 8.7%; EVT, 9.4%; VRH, 34.6%; VLH, 27.8%. Hindfoot arthrodesis (Tibiotalar calcaneal): DF, 53%; PF, 71.3%; INVT, 49.5%; EVT, 47.6%, VRH, 100%; VLH, 100%. Pantalar (Tibotalar calcanea cuboid navicular): DF, 62.8%; PF, 82.2%; INVT, 71.7%; EVT, 67.4%; VRH, 100%; VLH, 100%. Triple (Talocalcaneal cuboid navicular): DF, 12.5%; PF, 15.5%; INVT, 50%; EVT, 51.4%; VRH, 60.5%; VLH, 60.5%. Total tarsal arthrodesis: DF, 78.5%; PF, 90.2%, INVT, 87.5%; EVT, 83.6%; VRH, 100%; VLH, 100%.
Forefoot Surgery in Rheumatoid Arthritis: Subjective Assessment of Outcome
Authors: Hasselo Lael G. , Willkens Robert F. , Toomey Hugh E. , Karges David E. , Hansen Sigvard T.
Published: March 2013

Forefoot surgical outcomes were evaluated in 26 patients with rheumatoid arthritis. A total of 45 procedures were reviewed with emphasis on first ray intervention. Disease duration and aggressiveness of preceding medical therapy were combined to establish a disease severity index. Patients operated were predominantly in the midrange of disease severity. Subjective data on the relief of pain, callus, and deformity were favorable but this benefit was not long lasting inasmuch as patients were most satisfied in the period immediately following surgery and less so as time elapsed from intervention. Fusion of the first metatarsophalangeal joint seemed better than resection alone, indicating that stability should be the primary goal for surgical intervention of the rheumatoid forefoot.
Proximal Medial Longitudinal Arch Incision for Plantar Fascia Release
Authors: Ward William G. , Clippinger Frank W.
Published: March 2013

A curved, oblique plantar incision in the proximal aspect in the medial longitudinal arch was used to release the plantar fascia in eight feet with recalcitrant plantar fasciitis. Seven feet became pain free and the eighth was 75% improved. Normal sensation to the heel was preserved in all cases. No painful scars or neuromas of the calcaneal branch of the posterior tibial nerve developed. This approach represents a significant improvement over previously reported surgical approaches.
Biomechanics of the Accessory Navicular Synchondrosis
Authors: Sella Enzo J. , Lawson Jack P.
Published: March 2013

The accessory navicular is commonly considered an asymptomatic variant, but when traumatized, it can become the source of clinical symptoms.

The accessory naviculars were divided into Types I, IIa and b, and III based on their appearance and location with relationship to their parent navicular. Only Type IIa and b accessory naviculars have a synchondrosis. The synchondrosis of Type IIa and b can undergo tension, shear, and compression forces causing avulsion or a painful pseudarthrosis to develop.
Bilateral Symmetrical Synchondrosis of Navicular First Cuneiform Joint Presenting as a Lytic Lesion
Authors: Hynes Richard A. , Romash Michael M.
Published: March 2013

This is a case report of a tarsal coalition involving a bilateral symmetrical synchondrosis of the navicular first cuneiform bones in a 37-year-old Hispanic man. After presentation with chronic foot pain and failure of conservative treatment, arthrodesis was performed on one foot with good relief. At this time increased pain has developed in the opposite foot. To our knowledge, this is the first reported case of bilateral symmetrical navicular first cuneiform synchondrosis.
Osteomyelitis of the Foot Due to Actinomyces meyeri: A Case Report
Authors: Pang David K. , Abdalla Michael
Published: March 2013

Anaerobic osteomyelitis occurs uncommonly with Actinomyces as a cause of approximately half of the reported cases. Although Actinomyces is a common organism in the mouth flora, it is an uncommon pathogen in osteomyelitis occurring in the extremity. The following reports the only known case of anaerobic osteomyelitis of the foot secondary to A. meyeri.
Calcaneal Fractures: Three-dimensional Treatment
Authors: Romash Michael M.
Published: March 2013

A series of 22 calcaneal fractures operated over 4 yr is presented. Radiographic evaluation of these fractures using axial, lateral, anteroposterior, and oblique medial projection (Broden's view) with varying tube angulation toward the head and computerized axial tomography in two planes, coronal and transverse, were done. This repeatedly demonstrated intra-articular splitting fractures along the axis of the os calcis through the posterior facet, extending to the calcaneocuboid joint. These fractures were surgically reduced as described by McReynolds with sequential medial and lateral approaches. Intraoperative X-rays demonstrate the three-dimensional nature of this injury. Bohler's angle may be reconstituted with apparent reduction of the posterior facet when projected laterally; however, Broden's and axial views show persistent widening and split of the posterior facet.

The 22 patients have been followed from 12 to 46 mo. All have heels of normal width and wear standard shoes. The first two cases, done only medially, have less than anatomic reconstruction of the subtalar joint. Functional results have been encouraging. Of six active duty members so treated, three returned to full duty, a second who was medically retired as a result of other injuries had minimal heel problems, and fifth had a contralateral open pilon fracture which hampers him, and the sixth patient is now 4 mo postbilateral calcaneal fractures with return to duty anticipated. Most of the 22 have some decrease in subtalar motion without apparent gait abnormality. No cases of medial or lateral impingement or tendinitis are present.

Fractures of the calcaneus are amendable to open reduction and internal fixation. Sequential medial and anterolateral exposure allow anatomic reconstruction in three dimensions, avoiding pitfalls of two-dimensional analysis and treatment.
Atraumatic Avascular Necrosis of the Head of the Talus: A Case Report
Authors: Schmidt David M. , Romash Michael M.
Published: March 2013

Avasular necrosis of the talus has frequently been reported following trauma. The incidence of avascular necrosis has been reported to be as high as 50% for Hawkins 8 Type II talar fractures and to range from 75–100% for Type III fracture-dislocations. 3 , 16 The resultant avascular necrosis has been reported to occur primarily in the body and dome of the talus with apparent sparing of the head of the talus.

The close association of trauma to avascular necrosis of the talus has been alluded to by Cobey 3 and others. 10 , 12 , 14 , 17 Reports of avascular necrosis of the talus, without an antecedant history of trauma, have been rare. 13 This paper presents a case of atraumatic avascular necrosis of the talar head.
Acinetobacter calcoaceticus Foot Infection Secondary to High-pressure Injection Injury: A Case Report
Authors: Wesley Dietz John , Goodrich Jacob Allan , Bruce Brown William
Published: March 2013

Injection injuries are surgical emergencies occurring most often in the hand and frequently associated with widespread tissue necrosis and infection. This report presents a case of high-pressure injection injury of the foot associated with extensor hallucis longus laceration and infection with Acinetobacter calcoaceticus variant anitratus. This injury occurred with a high-pressure “water-blaster” tool used to remove paint from pavement. Similar injuries in the foot have not been reported. A. calcoaceticus is a widely distributed normal flora of low virulence, often waterborne, which is rarely found in orthopaedic infections in young healthy patients. Clinical features of high-pressure injection injuries, principles of treatment, and the characteristics of A. calcoaceticus are reviewed.
Giant Cell Tumor of the Metatarsal
Authors: Burns Thomas P. , Weiss Mark , Snyder Mark , Hopson Clark N.
Published: March 2013

The following is a report of a giant cell tumor of a metatarsal, description of treatment, and review of the literature. Giant cell tumors comprise approximately 5–8% of the primary bone tumors. Metatarsal bones are a very rare primary site of involvement. Clinically aggressive or benign behavior cannot be predicted histologically. Treatment should be aggressive, as in this case where en bloc resection and bone graft were performed. Results were excellent with 4 yr follow-up.
Review of the Girdlestone-Taylor Procedure for Clawtoes in Myelodysplasia
Authors: Cyphers Stephen M. , Feiwell Earl
Published: March 2013

To clarify the role the flexor tendon to extensor hood transfer (Girdlestone-Taylor procedure) may have in correction of clawtoes in myelodysplasia, 20 patients with residual paralysis from myelomeningocele who underwent the procedure between 1976 and 1985 were reviewed. They were evaluated for the effectiveness of the procedure and occurrence of late deformities. A total of 25 feet with 65 toes were evaluated in patients ranging in age from 0.6 to 38.8 years.

Results were classified as good if toes were straight, fair if mild deformity was present, and poor if definite clawing was noted. The overall results showed 60% good, 34% fair, and 6% poor results. Toes followed less than 24 months had more good results than those with longer follow-up. There was little difference in the results between great toes and lesser toes. No serious complications occurred.

Our results indicate a sufficient level of success to utilize this method for correction of flexible claw toe deformities without resorting to bony procedures. We suggest this should be particularly useful in children.
The Mechanical Characteristics of the Collateral Ligaments of the Human Ankle Joint
Authors: Siegler Sorin , Block John , Schneck Carson D.
Published: March 2013

In the present study, the tensile mechanical properties of all of the collateral ligaments of the human ankle joint were determined, in vitro, from tensile tests conducted on 120 ligaments obtained from 20 fresh lower limbs.

The ultimate load of the lateral collateral ligaments increased in an anteroposterior sequence, with the anterior fibulotalar ligament less than the fibulocalcaneal ligament and less than the posterior fibulotalar ligament. For the medial collateral ligaments, the increasing order of ultimate load was found to be tibiocalcaneal ligament, tibionavicular ligament, tibiospring ligament, posterior tibiotalar ligament. The posterior tibiotalar ligament and tibiospring ligament, so frequently neglected in the anatomical and orthopaedic literature, demonstrated the highest yield force and ultimate load of all of the collateral ligaments of the ankle. Additionally, the tibiospring ligament showed high yield and ultimate elongation properties probably related to its distal attachment to the spring ligament. The fibulocalcaneal ligament was found to have high linear elastic modulus suggesting some type of unique material properties or internal fiber organization.

Knowledge of the mechanical characteristics of the ligaments of the ankle joint contributes to an understanding of their normal function, pathomechanics of injury, and their optimal surgical reparative procedure and reconstructive material. A knowledge of the normal mechanical properties of the ankle ligaments provides a data base to evaluate which of the multiplicity of present tendon graft materials has mechanical properties similar to those of the ligaments to be replaced. Those tendon grafts will be the most suitable for replacement of specific ligaments. Finally, data on the mechanical properties of these ligaments offer the possibility for evaluating any future biological or prosthetic grafts.
Metastatic Tumors of the Foot and Ankle
Authors: Hattrup Steven J. , Amadio Peter C. , Sim Franklin H. , Lombardi Robert M.
Published: March 2013

In a review of the Mayo Clinic files, 17 biopsy-proven cases of metastatic tumors of the foot and ankle were found; 4 additional cases were considered to have metastatic disease on the basis of clinical and radiographic evidence but no histological confirmation was available. Lung, kidney, and colon were the most common sites of the primary tumors. The patients survived as long as 28 months after discovery of the metastasis. Treatment consisted of individualized combinations of orthotics, surgery, and radiotherapy to maintain mobility. In 9 of these 17 cases, no primary lesion was identified at the time the metastasis was diagnosed. Metastatic tumors of the foot present special problems in diagnosis and management.
Musculoskeletal Demands on Flamenco Dancers: A Clinical and Biomechanical Study
Authors: Bejjani F. J. , Halpern N. , Pio A. , Dominguez R. , Voloshin A. , Frankel V. H.
Published: March 2013

The flamenco dancer acts on the floor like a drummer. The percussive footwork and vibration patterns created during dancing impose unusual demands on the musculoskeletal system. This study investigated the clinical and biomechanical aspects of this task.

Using the electrodynogram and skin-mounted accelerometers, foot pressures as well as hip and knee vibrations were recorded in 10 female dancers after a thorough clinical evaluation. A health questionnaire was also distributed to 29 dancers.

Foot pressures and acceleration data reveal the percussive nature of the dance. Some clinical findings, like calluses, are related to pressure distribution. Urogenital disorders, as well as back and neck pain, may be related to the vibrations generated by the flamenco dance form. The hip joint seems to absorb most of the impacts.

“Vibration-pressure” diagrams are suggested as a useful tool for evaluating a dancer's biomechanical behavior, as well as the effect of floors and footwear on this behavior.
Hypermobility in Hallux Valgus
Authors: Carl Allen , Ross Susan , Evanski Phillip , Waugh Theodore
Published: March 2013

Hypermobility has been implicated as one of the etiological components in common foot problems such as hallux valgus but has not been substantiated by experimental data. Twenty patients with symptomatic untreated hallux valgus and 20 controls were evaluated with a simple hypermobility scoring system. A statistically significant correlation was found to reveal that female patients aged 20 to 40 yr with symptomatic hallux valgus have a mild generalized hypermobility when compared to a similar group of control patients. The presence of such ligamentous laxity would seem to support the need for bony correction in such patients as soft tissue procedures would have a greater propensity for malalignment due to the underlying hypermobility in combination with everyday environmental stresses of trauma and overuse.
High Resolution Computed Tomography in the Chronically Painful Ankle Sprain
Authors: Meyer J.M. , Hoffmeyer P. , Savoy X.
Published: March 2013

A series of 31 consecutive patients with chronic residual ankle pain following ankle sprain were analyzed using high resolution CT scanning. In 13 patients avulsed intra-or juxta-articular fragments of traumatic origin were detected; 12 of these patients had surgical revision. The usefulness of CT scanning in chronic post-traumatic residual ankle pain in the presence of negative standard x-rays is stressed.
Computed Tomography Scan and Magnetic Resonance Imaging of Ankle Tendons: An Overview
Authors: Sadka Rosenberg Zehava , Cheung Yvonne , Jahss Melvin H.
Published: March 2013

CT and MRI are both effective in the diagnosis of ankle tendon injuries. MRI is the preferred study, however, because of its superior soft tissue contrast resolution, multiplanar capabilities, lack of beam hardening artifacts, and lack of ionizing radiation. CT can serve as an excellent substitute when financial considerations and availability preclude the use of MRI. CT is also superior in evaluating bony abnormalities associated with tendon injuries.
Experimental Decompression of the Fascial Compartments of the Foot—The Basis for Fasciotomy in Acute Compartment Syndromes
Authors: Myerson Mark S.
Published: March 2013

Surgical decompression of the foot by fasciotomy is the only effective means of preventing the late consequences of a compartment syndrome i.e., myoneural ischemia. In this study, a slit catheter system was used to monitor the compartment pressures in experimentally induced compartment syndromes of the foot. The ease and rate of decompressing the intracompartmental pressures via a double incision dorsal approach versus a medial longitudinal approach were compared in 40 paired fresh cadaver specimens. In both methods, intracompartmental pressure is satisfactorily decompressed. However, it takes longer after effective fasciotomies for pressures to normalize via the dorsal approach (11 min versus 1 min; P < 0.01). The double incision dorsal approach is easier to perform and may be the method of choice for fasciotomy associated with fractures of the forefoot requiring internal fixation.
Foot Pressure Studies in the Assessment of Forefoot Arthroplasty in the Rheumatoid Foot
Authors: Betts Roderic P. , Stockley Ian , John M. Getty C. , Rowley David I. , Duckworth Thomas , Franks Christopher I.
Published: March 2013

To assess the results of forefoot arthroplasty, dynamic and static foot pressure studies have been made of the rheumatoid foot in both a prospective study group of 60 feet and in a retrospective study group of 18 feet. Significant reductions of pressure in the forefoot were found. Problems associated with the first and fifth metatarsals were considered.
Relationship Between Adolescent Bunions and Flatfeet
Authors: Kalen Vicki , Brecher Allan
Published: March 2013

Pes planus has been suggested as a factor in the development of bunions in adolescents. This study objectively evaluated the radiographs of 36 adolescents with 66 hallux valgus deformities for the presence of associated flatfeet. The bunion deformity in these adolescents was also characterized. Only 26.6% of these adolescents had an increased intermetatarsal angle and 8.1% an abnormal metatarsus varus angle as compared with the published norms. Measurements of pes planus including talar pitch, calcaneal plantar angle, dorsoplantar talonavicular angle, and lateral talocalcaneal angle showed an incidence of flatfeet in adolescents with bunions that was 8 to 24 times greater than expected.
Basal Osteotomy of the First Metatarsal for the Correction of Metatarsus Primus Varus Associated With Hallux Valgus
Authors: Wanivenhaus Axel H. , Feldner-Busztin Herbert
Published: March 2013

At the University of Vienna Department of Orthopaedics, 26 feet in 21 patients were treated with a basal osteotomy for hallux valgus associated with metatarsus primus varus. In 85% of the cases, a satisfactory result was achieved. Critical analysis revealed shortening of the first metatarsal and elevation of its head, which resulted in excess lateral straining of the foot and metatarsalgia. In 15 cases, osteoarthritis in the metatarsocuneiform joint was also increased. Given these results, an osteotomy that prevents shortening of the first metatarsal and elevation of the head of the first metatarsal, or one that takes these facts into account, seems ideal.
Solitary Plasmacytoma of the Cuboid
Authors: Kenneth Burkus LCDR. J. , Timothy J. Bonatus LT.
Published: March 2013

Solitary plasmacytoma is an isolated malignant lesion of plasma cell origin. More than half of the reported cases of solitary plasmacytomas occur in the spine. Lesions occurring in the appendicular skeleton have a lower local recurrence rate and a favorable long-term survival rate. This is the first report of a solitary plasmacytoma involving a bone of the foot. With accurate diagnosis and effective medical treatment, long-term remission can be anticipated.
Silicone Implant Arthroplasty for Second Metatarsophalangeal Joint Disorders with and without Hallux Valgus Deformities
Authors: Cracchiolo Andrea , Kitaoka Harold B. , Leventen Edward O.
Published: March 2013

Subluxation or dislocation of the second metatarsophalangeal joint (MTPJ) is usually associated with a hammertoe deformity and, frequently, with a significant hallux valgus deformity. Although the joint itself may be painful, there is also pain in the hammertoe deformity, especially when the patient is wearing closed shoes. A painful intractable plantar keratosis is usually present. We reviewed all of our patients with second MTPJ subluxation or dislocation, in whom a double-stem silicone implant had been used to relocate the joint. In 31 feet of 28 patients, 32 implants were used. All but six feet with advanced degenerative joint disease secondary to Freiberg's infraction had severe associated forefoot pathology that necessitated surgical correction. Several feet had previous bunion operations as well as operations on the second toe. In addition to the second toe, we performed hallux valgus corrections in 23 feet, seven of which were revision procedures. At an average follow-up time of 37 months, good results were seen in 20 feet (63%), good results with reservations in eight feet (25%), and failure in four feet (12%). Transfer metatarsalgia was the most frequent complication. The implants remained stable, and in only one was there a suspected fracture. More optimum results might have been achieved had there been better correction of the hallux valgus deformities, more frequent correction of the hammertoe deformity, and less resection of the second metatarsal head. These patients with pathology usually involving both the first and second MTPJ are difficult to treat, therefore. Their results are less predictable and not as favorable as those achieved for patients with isolated similar deformities.
Soft Tissue Tumors of the Foot and Ankle
Authors: Seale Karen S. , Lange Thomas A. , Monson David , Hackbarth Donald A.
Published: March 2013

Seven patients with malignant soft tissue tumors of the foot and ankle were retrospectively reviewed. Emphasis was placed on the value of various diagnostic modalities used preoperatively for staging and the adequacy of treatment rendered using current tumor surgery principles. The malignant tumors included synovial cell sarcoma (four), clear cell sarcoma (one), fibrosarcoma (one), and melanoma (one). Surgical management of the malignant lesions included intracapsular excision, marginal excision, wide excision, and radical amputation.
Strain in the Lateral Ligaments of the Ankle
Authors: Renstrom P. , Wertz M. , Incavo S. , Pope M. , Ostgaard H.C. , Arms S. , Haugh L.
Published: March 2013

Strain was measured in the normal anterior talofibular ligament (ATF) and the calcaneofibular ligament (CF) using Hall effect strain transducers in five cadaveric ankles. These measurements were made in both ligaments with the ankle in neutral position and with the foot moving from 10° dorsiflexion to 40° plantarflexion in an apparatus that permits physiologic motion. The ankle ligaments were then tested with the foot placed in six different positions that combined supination, pronation, external rotation, and internal rotation. In the neutral position, through a range of motion of 10° dorsiflexion to 40° plantarflexion, the anterior talofibular ligament underwent an increasing strain of 3.3%. No significant strain increase was found with internal rotation. The only significant difference from the strains at the neutral position was in external rotation, which decreased strain 1.9%. In all positions, increased strain occurred with increased plantarflexion. The calcaneofibular ligament was essentially isometric in the neutral position throughout the flexion arc. The calcaneofibular ligament strain was significantly increased by supination and external rotation. However, with increasing plantarflexion in these positions, the strain in the calcaneofibular ligament decreased. Therefore, plantarflexion has a relaxing effect on the calcaneofibular ligament. Thus, the anterior talofibular and calcaneofibular ligaments are synergistic, such that when one ligament is relaxed, the other is strained and vice versa.