bluuebunny/crossref_metadata_2025 huggingface dataset:
Rearfoot-Forefoot Orientation and Traumatic Risk for Runners
Authors: Busseuil Catherine , Freychat Philippe , Guedj Elisabeth Brunet , Lacour Jean R.
Published: March 2013

Factors making runners more susceptible to injuries were identified with a comparative study between a healthy control group (216) and runners (66) suffering from overuse pathology. On static and dynamic footprint, the angles α0 (static) and α1 (dynamic) between heel and forefoot have been measured. Analysis showed that the injured subjects have a more pronated foot than control group subjects. These results suggest that the pronating foot configuration would be an injury risk factor.
Tissue Concentrations after a Single-Dose, Orally Administered Ofloxacin in Patients with Diabetic Foot Infections
Authors: Kuck Emile M. , Bouter K. Paul , Hoekstra Joost B.L. , Conemans Jean M.H. , Diepersloot Rob J.A.
Published: March 2013

We studied the penetration of orally administered ofloxacin at the site of diabetes-related foot infections in patients with a planned debridement of the lesion. A total of nine patients received 800 mg of oral ofloxacin 120 to 150 minutes before surgery. During surgery, vital margin tissue and a serum sample were obtained. Serum and tissue concentrations of ofloxacin were measured. From seven patients sufficient amounts of tissue were obtained. Mean serum concentration was 7.0 ± 3.5 mg/liter; mean tissue concentrations was 11.5 ± 8.4 mg/kg. Mean serum and tissue concentrations exceed the minimal inhibitory concentration90 (MIC90) of commonly involved pathogens. This indicates that orally administered ofloxacin can be an effective treatment for infected diabetic foot lesions.
Osteoid Osteoma in the Talar Neck: A Report of Two Cases
Authors: Chuang Shih-Youeng , Wang Shyu-Jye , Au Man-Kuan , Huang Guo-Shu
Published: March 2013

This article describes two cases of juxta-articular osteoid osteoma of talar neck. Both patients were initially treated as having ankle sprains or arthritis before diagnosis of osteoid osteoma. A high index of suspicion and appropriate imaging studies are important to make an early diagnosis of this disorder. Once diagnosis is confirmed, en bloc resection and autogenous bone graft can cure the disorder.
Tophaceous Gout of the Navicular Bone as a Cause of Medial Inflammatory Tumor of the Foot
Authors: Thomas Eric , Olive Patrick , Canovas François , Medioni Dan , Leroux Jean-Louis , Baldet Pierre , Bonnel François , Blotman Francis
Published: March 2013

A case of tophaceous gout of the navicular bone in a 24-year-old woman is reported. Emphasis is placed on the conditions that might have been precipitating, i.e., anorexia nervosa and alcoholism, and the mechanisms by which increased uric acid level may be explained. The main radiographic patterns of tophaceous gout of the foot are recalled to avoid unnecessary surgery in future cases.
Tarsal Tunnel Syndrome: Diagnosis, Surgical Technique, and Functional Outcome
Authors: Bailie David S. , Kelikian Armen S.
Published: March 2013

During a 10-year period, 47 patients underwent surgical management for tarsal tunnel syndrome (TTS). Of these, 34 (36 feet) were available for complete retrospective analysis by record review, questionnaire, and physical examination. An additional 10 patients were evaluated by record review alone. The mean age was 38 years (range, 12–65 years). Overall, average follow-up was 35 months (range, 15–102 months). All patients had nonsurgical care for an average of 16 months before surgery (range, 1–72 months).

The symptom triad of pain, paresthesias, and numbness was the most common clinical presentation. All had a positive Tinel's sign and nerve compression test (NCT) at the tarsal tunnel. Electrodiagnostic studies were abnormal in 38 feet (81%). Two-point discrimination was diminished significantly by an average of 6.7 mm.

At a follow-up examination two-point discrimination improved by an average of 3.8 mm ( P < 0.001). Eighteen feet continued to have a positive Tinel's sign and had a residual NCT. Subjectively, patients were satisfied with the surgical outcome in 72% of the cases. Postoperative improvement in the median Symptom Severity Score and the Functional Foot Score reflected this satisfaction. The perioperative complication rate was 30%.

We conclude that the diagnosis of TTS is made primarily on history and clinical evaluation with electrodiagnostic studies supporting the diagnosis in 81%. Surgical treatment is warranted after nonsurgical management has failed. Division of the deep portion of the abductor hallucis fascia is important to ensure a complete release.
The Effects of Foot Position and Load on Tibial Nerve Tension
Authors: Daniels Tim R. , Lau John Tak-Choy , Hearn Trevor C.
Published: March 2013

Patients with tarsal tunnel syndrome of unknown etiology do poorly after surgical decompression. Although surgical decompression addresses the soft tissue constraints, it ignores the role of osseous support. Some authors have suggested that a pes planus deformity (i.e., valgus hindfoot and abducted forefoot) is an unrecognized cause of tarsal tunnel syndrome due to increased tibial nerve tension.

An in vitro study was performed on nine cadaveric feet to determine the effects of foot position and load on tibial nerve tension. Tensile forces placed through the tibial nerve were measured when the foot was placed in dorsiflexion, eversion, combined dorsiflexion-eversion, and then under cyclical load and increasing internal rotation at 5° increments from 0° to 20°. The nerve tension was reassessed after the creation of a pes planus deformity under the previous conditions.

Tibial nerve tension in the stable and unstable foot was significantly increased by eversion, dorsiflexion, and combined dorsiflexion-eversion. Tibial nerve tension was significantly greater in an unstable foot when compared with a stable foot during eversion, dorsiflexion, and combined dorsiflexion-eversion.

In the stable foot, tibial nerve tension was significantly increased during axial loading with increasing internal rotation when compared with 0° rotation. The increased tibial nerve tension in the stable foot was significant with increasing internal rotation when 0° was compared with 10°, 15°, and 20°. In the unstable foot, the tibial nerve tension was significantly increased with increasing internal rotation compared with the nerve tension at 0° of rotation. The increased tibial nerve tension in the unstable foot was significant with increasing internal rotation when 0° was compared with 5°, 10°, 15°, and 20°.

When stability of the foot and internal rotation were compared independently, each factor increased tibial nerve tension. However, these factors acting together did not significantly compound the increase in nerve tension. This study demonstrates that tibial nerve tension is increased in an unstable foot compared with a stable foot during eversion, dorsiflexion, combined dorsiflexion-eversion, and cyclical load with increasing internal rotation.
Complications of Plantar Fascia Rupture Associated with Corticosteroid Injection
Authors: Acevedo Jorge I. , Beskin James L.
Published: March 2013

From 1992 to 1995, 765 patients with a clinical diagnosis of plantar fasciitis were evaluated by one of the authors. Fifty-one patients were diagnosed with plantar fascia rupture, and 44 of these ruptures were associated with corticosteroid injection. The authors injected 122 of the 765 patients, resulting in 12 of the 44 plantar fascia ruptures. Subjective and objective evaluations were conducted through chart and radiographic review. Thirty-nine of these patients were evaluated at an average 27-month follow-up. Thirty patients (68%) reported a sudden onset of tearing at the heel, and 14 (32%) had a gradual onset of symptoms. In most cases the original heel pain was relieved by rupture. However, these patients subsequently developed new problems including longitudinal arch strain, lateral and dorsal midfoot strain, lateral plantar nerve dysfunction, stress fracture, hammertoe deformity, swelling, and/or antalgia. All patients exhibited diminished tension of the plantar fascia upon examination by the stretch test. Comparison of calcaneal pitch angles in the affected and uninvolved foot showed a statistically significant difference of 3.7° ( P = 0.0001). Treatment included NSAIDs, rest or cross-training, stretching, orthotics, and boot-brace immobilization. At an average 27-month follow-up, 50% had good/excellent scores and 50% had fair/poor scores. Recovery time was varied. Ten feet were asymptomatic by 6 months post rupture, four feet by 12 months post rupture, and 26 feet remained symptomatic 1 year post rupture. Our findings demonstrate that plantar fascia rupture after corticosteroid injection may result in long-term sequelae that are difficult to resolve.
Anatomic Investigation of the Deep Posterior Compartment of the Leg
Authors: Cheney Robert A. , Melaragno Paul G. , Prayson Michael J. , Bennett Gordon L. , Njus Glen O.
Published: March 2013

The purpose of this study is to critically investigate the anatomy of the deep posterior compartment of the leg. Specifically, the relationship of the deep posterior compartment to the superficial posterior compartment and their insertion onto the posteromedial border of the tibia are assessed.

Cross-sectioning of 10 fresh-frozen cadaver legs was performed at 2-cm increments. The inferior surface of each section was photographed. The photographs were visually analyzed, and the fascial separation between the posterior compartments along with their relationship to the posteromedial border of the tibia were recorded for each specimen. Magnetic resonance images in the axial plane of 10 healthy, normal volunteers’ lower extremities at 2-cm increments were obtained and analyzed.

All specimens and images demonstrated that the medial fascial attachment of the deep posterior compartment was along the posteromedial aspect of the tibia in the proximal third of the leg and was not superficially accessible. In the proximal third of the leg, the superficial posterior compartment fascial attachment overlapped the deep posterior compartment by inserting medial and anterior to the deep posterior compartment fascial attachment. In the middle and distal thirds of the leg, the medial fascial attachment of the deep posterior compartment shifted medially and anteriorly, making the deep posterior compartment superficially accessible. The surgeon must appreciate the change in the anatomic relationships along the medial side of the leg while performing double-incision four-compartment fasciotomy release to obtain a complete release of the muscular portion of the deep posterior compartment.
Surgical Treatment of Neuroarthropathic Foot Deformity
Authors: Sammarco G. James , Conti Stephen F.
Published: March 2013

Twenty-seven feet with neuroarthropathic fracture resulting in significant deformity were treated with surgical reconstruction. The average age of the patients was 57 years with 21 patients having diabetes mellitus an average of 24 years. Five patterns of midfoot collapse were identified. The most common patterns involved abduction and dorsal displacement of the forefoot with equinus of the hindfoot. Preoperative evaluation included a medical assessment, adequate control of blood sugar, and a comprehensive vascular evaluation. Five patients presented for surgical consultation with open plantar ulcers. Four were healed with total contact casting alone whereas one patient required an exostectomy to heal the ulcer before surgery.

After reconstruction, all feet had improvement in their weightbearing posture. For feet with midfoot involvement, the average anteroposterior talo-first metatarsal angle increased 5°, and the average lateral talo-first metatarsal angle decreased 6.5°. There was no significant loss of correction at long term follow-up. The average time in a cast postoperatively was 5.7 months, and the time to unrestricted weightbearing was 7 months. All patients were able to wear over-the-counter footwear postoperatively. Significant complications included six nonunions and two feet with extension of the neuroarthropathic process. One nonunion required revision surgery, and the feet with extension of their neuroarthropathic fractures required conversion of a triple arthrodesis to a pantalar fusion and the addition of a triple arthrodesis after a successful midfoot fusion. No infections or amputations occurred as a result of the surgery. Function increased and pain decreased as a result of successful arthrodesis.

Surgical reconstruction of midfoot, hindfoot, and ankle neuroarthropathic deformity is a viable alternative to amputation for patients who fail nonoperative care. Proper preoperative evaluation and assessment will result in a rate of complications comparable to foot surgery in nondiabetic patients.
A Long Posterior Flap in Below-Knee Amputations for Peripheral Vascular Disease: Rationale and Technique
Authors: Manoli Arthur
Published: March 2013

Three photographs are presented that illustrate the rationale for the use of the long posterior flap in below-knee amputations for peripheral vascular disease and diabetes mellitus.
Salvage Treatment of Failed Hallux Valgus Operations with Proximal First Metatarsal Osteotomy and Distal Soft-Tissue Reconstruction
Authors: Kitaoka Harold B. , Patzer Gary L.
Published: March 2013

We reviewed the results of 15 patients (16 feet) in whom a hallux valgus procedure had failed. Salvage was by proximal crescentic first metatarsal osteotomy with distal soft-tissue reconstruction. Results based on a clinical scale considering the level of pain, activity limitations, support requirement, footwear limitations, and alignment were good in 11, fair in two, and poor in three. Patients were satisfied with the results in 10 feet, satisfied with reservations in four feet, and dissatisfied in two feet. Complications were: transfer metatarsalgia in three, hallux varus in one, and osteotomy nonunion in one. One of the patients required reoperation to bone graft a proximal osteotomy. Metatarsal osteotomy was helpful in the salvage treatment of recurrent, symptomatic hallux valgus when the first metatarsophalangeal joint was functional and painless.
Surgical Treatment of Patients with Painful Instability of the Second Metatarsophalangeal Joint
Authors: Gazdag Andre , Cracchiolo Andrea
Published: March 2013

An unstable second metatarsophalangeal joint may produce pain in the forefoot. Eighteen patients (20 feet) had a transfer of the flexor digitorum longus to the extensor side of the base of the proximal phalanx performed as the primary procedure to stabilize this painful joint. Most patients had a hallux valgus deformity that also required correction, because it either was also symptomatic or was preventing adequate reduction of the second toe. A ruptured plantar plate of the second metatarsophalangeal joint was demonstrated in 13 feet and in these joints appeared to be the cause of the vertical instability. However, all feet showed an unstable joint upon clinical examination. A vertical-stress test almost always reproduced the patient's pain while demonstrating instability in the joint; this was the most prominent physical finding in these patients.

Eleven patients (13 feet) had an excellent result. Seven patients (seven feet) had a fair result, but they complained only of mild and occasional pain at the joint on exertion. Although difficult to quantify, it appears that postoperative stiffness in the joint provided some of the joint stability seen in our patients. The flexor tendon transfer appears to be a satisfactory method to treating the unstable metatarsophalangeal joint and of relieving patients' pain, but may not, however, restore a normal alignment of the second toe. Correction of other forefoot deformities as hallux valgus and hammertoes may also be important in restoring metatarsophalangeal stability.
An Evaluation of the Use of Gait Plate Inlays in the Short-Term Management of the Intoeing Child
Authors: Redmond Anthony Charles
Published: March 2013

A method of short-term intervention in cases of symptomatic intoeing in young children was evaluated. Foot placement angle (FPA) in subjects (N = 18) suffering from symptomatic intoeing was compared before and during the wearing of “gait plate” inlays in the footgear. The median preintervention FPA in the study group was −9.5° (i.e., 9.5° of intoeing). After the addition of gait plate inlays, this angle fell to −3.5° (Wilcoxon's matched pairs test P < 0.0001). There was no correlation found between the site of the underlying pathology, gender, or age in relation to either the degree of original intoeing or resulting improvement. There was a significant negative correlation (Spearman's correlation coefficient −0.512, P < 0.001) between the FPA at diagnosis and the subsequent improvement.
Biomechanical Consequences of Sequential Plantar Fascia Release
Authors: Murphy G. Andrew , Pneumaticos Spiros G. , Kamaric Emir , Noble Phillip C. , Trevino Saul G. , Baxter Donald E.
Published: March 2013

Plantar fascia release has long been a mainstay in the surgical treatment of persistent heel pain, although its effects on the biomechanics of the foot are not well understood. With the use of cadaver specimens and digitized computer programs, the changes in the medial and lateral columns of the foot and in the transverse arch were evaluated after sequential sectioning of the plantar fascia. Complete release of the plantar fascia caused a severe drop in the medial and lateral columns of the foot, compared with release of only the medial third. Equinus rotation of the calcaneus and a drop in the cuboid indicate that strain of the plantar calcaneocuboid joint capsule and ligament is a likely cause of lateral midfoot pain after complete plantar fascia release.
Differences in Impulse Distribution Patterns in Patients with Plantar Fasciitis
Authors: Bedi Harvinder S. , Love Bruce R. T.
Published: March 2013

The impulse distribution based upon vertical foot-floor reaction forces and time under the fore-, mid-, and hindfoot was determined using Tekscan's F-Scan system. This was compared in 40 barefoot patients with longstanding plantar fasciitis with an equal number of normal subjects. The patient group tended to load the hind- and midfoot to a lesser extent than the control group. Consequently, a greater proportionate load was borne by the forefoot. This result was highly significant for both the midfoot ( P < 0.001) and forefoot ( P = 0.002) comparisons. An objective biomechanical method such as this may be useful as a diagnostic aid, to identify individuals predisposed to this condition, and for evaluating the efficacy of various treatment modalities.
Treatment of Diabetic (Neuropathic) Foot Ulcers with Two-Stage Debridement and Closure
Authors: Kumagai Steven G. , Mahoney Craig R. , Fitzgibbons Timothy C. , McMullen Scott T. , Connolly Thomas L. , Henkel Loree
Published: March 2013

We reviewed 33 patients with 37 wounds treated between November of 1991 and December of 1995 in the Wound Care Center. A two-stage debridement and closure technique for neuropathic foot ulcers was performed. Patients selected included those with obvious osteomyelitis and those who had failed nonsurgical treatment. The approach included initial surgical excision of the ulcer with biopsy, bone resection with biopsy, and deep culture. The second-stage procedure 4 to 8 days later included debridement of the wound and delayed closure.

Intravenous antibiotic treatment using a central line was given postoperatively in patients with documented osteomyelitis for at least 6 weeks and in patients with infected soft tissues only for about 4 weeks. All patients remained nonweightbearing for 4 weeks; this was felt necessary to prevent separation of the wound edges. Four wounds in four patients failed to heal, and two of these went on to amputation. Satisfactory healing occurred in 29 of 33 patients and in 33 of 37 wounds. The authors conclude that two-stage surgical debridement and closure is an acceptable treatment in selected nonhealing diabetic (neuropathic) foot ulcers.
Risk of Contamination of the Wound in a Hydrotherapeutic Tank
Authors: Stanwood Walter , Pinzur Michael S.
Published: March 2013

Over a 4-week period, samples for culture were taken from active hydrotherapeutic tanks (whirlpools) from two institutions in a university medical center. Samples were obtained in the morning before treatments began, and in the evening after, the final patient had been treated. Specific attention was directed toward recovery of S. aureus, P. aeruginosa, and E. coli, organisms felt to be especially dangerous for the diabetic dysvascular patients utilizing the hydrotherapeutic tanks involved in this study. Only eleven of 96 cultures (11.5%) were positive for these prospective pathogens. Of the positive cultures, nine (9.4%) were taken from near the agitator-jet, and only two (2.1%) from the floor of the hydrotherapeutic tanks, where the extremity is likely to be placed. Our results reveal that hydrotherapeutic immersion is not likely to expose patients with open wounds to potential iatrogenic contamination of the wound.
An Unusual Cause of Posterior Tibial Tendon Degeneration
Authors: Beals Timothy C. , Manoli Arthur
Published: March 2013

A case demonstrating a mechanical cause of posterior tibial tendon degeneration is reported. The possible etiologies for degeneration of the posterior tibial tendon are discussed.
Posttraumatic Posterior Tibialis Tendon Insertional Elongation with Functional Incompetency: A Case Report
Authors: Marks Richard M. , Schon Lew C.
Published: March 2013

We present a case report and literature review of distal intrasubstance rupture of the posterior tibial tendon with progressive pes planovalgus secondary to tendon incompetence. Three months after a severe ankle sprain, a 25-year-old basketball player presented with ankle weakness and pain. Treatment by advancement of the posterior tibial tendon to the navicular and medial displacement osteotomy of the calcaneal tuberosity restored alignment, strength, and full function.
Late Results of Subtalar Distraction Fusion
Authors: Burton Douglas C. , Olney Bradford W. , Horton Greg A.
Published: March 2013

Between 1990 and 1994, 15 subtalar distraction fusions were performed on 14 patients for sequelae of calcaneus fractures. Twelve patients (13 feet) were available for a minimum 2-year follow-up and constituted the composition of this study. All patients complained of lateral ankle pain and had CT evidence of calcaneofibular abutment and radiographic evidence of loss of heel height preoperatively. The average age at time of surgery was 56 years (range, 23–81 years), and the average follow-up was 47 months (range, 25–75 months). The only change in surgical technique from that previously described was the use of a bone spreader rather than a femoral distractor for distraction of the subtalar joint. The average preoperative talocalcaneal angle improved from 27° (range, 19–37°) to 33° (range, 23–45°) postoperatively ( P < 0.003). The mean talar declination angle improved from 11° (range, 6–18°) to 16° (range, 7–27°) postoperatively ( P < 0.003). The mean heel height increased from 71 mm (range, 60–83 mm) to 76 mm (range, 63–91 mm) postoperatively ( P < 0.0001). All patients completed the AOFAS Ankle-Hindfoot scale at latest follow-up, and the average score was 76.1 (range, 57–94). Eleven of 13 outcomes were rated as very satisfactory or satisfactory. Twelve of 13 said they would ‘definitely yes’ do surgery again. We have found that subtalar distraction fusion for late complications of calcaneus fracture in a carefully selected population can provide a consistent and satisfactory outcome.
Reconstruction Operations for Acquired Flatfoot: Biomechanical Evaluation
Authors: Kitaoka Harold B. , Luo Zong-Ping , An Kai-Nan
Published: March 2013

A major limitation of operations commonly performed for acquired flatfoot is inadequate correction of alignment. The authors defined the efficacy of two operations, deltoid ligament reconstruction and flexor digitorum longus tendon transfer, for treatment of posterior tibial tendon dysfunction with flatfoot deformity. Twelve fresh-frozen foot specimens were used. A flatfoot deformity was created, and, to simulate the midstance phase of gait, loads were applied axially to the plantar surface of the foot and to appropriate tendons. Foot position improved substantially after deltoid ligament reconstruction but not after flexor digitorum longus tendon transfer. The average increase in arch height after deltoid ligament reconstruction was 10.3 ± 8.9 mm and after flexor digitorum longus tendon transfer, −0.6 ± 2.0 mm. Mean arch height after deltoid ligament reconstruction was 2.2 ± 1.7 mm less than intact arch height and, after flexor digitorum longus tendon transfer, 13.2 ± 9.0 mm less than intact arch height. Improvement in metatarsal-talar, calcaneal-talar, and talar-tibial positions was significantly greater after deltoid ligament reconstruction than after flexor digitorum longus tendon transfer. Although the authors do not advocate clinical use, the deltoid ligament reconstruction was more effective than flexor digitorum longus tendon transfer in restoring arch alignment in flatfoot.
Use of Ready-Made Insoles in the Treatment of Lesser Metatarsalgia: A Prospective Randomized Controlled Trial
Authors: Kelly Andrew , Winson Ian
Published: March 2013

Two insoles designed to treat primary lesser metatarsalgia were compared in terms of their effect on plantar pressures and the subjective symptom relief.

A prospective single blind randomized trial of 8 weeks' treatment in 46 feet in 33 patients was performed. Subjective outcome measures were visual analogue pain scores and estimated compliance. Objective outcome measures were dynamic plantar pressures using the Musgrave Footprint® System.

In group 1 (Viscoped), 6 of 18 patients rated themselves much improved or somewhat improved, and in group 2 (Langer) the proportion was 12 of 15 ( P = 0.02). Reported mean compliance was 16% higher in the Langer group. Plantar forefoot pressure was lowered by the insoles in all cases. The reduction was significantly greater ( P < 0.001) in group 2, both in absolute pressure and as a percentage of initial pressure.

Group 2 (Langer) was significantly better in terms of reduction of peak metatarsal pressure. All the subjective outcome measures were better for the group 2 (Langer).
Insufficiency Stress Fractures of the Foot and Ankle in Postmenopausal Women
Authors: Kaye Robert A.
Published: March 2013

Eleven consecutive patients with 12 stress fractures of the foot or ankle were seen between October 1992 and July 1995. Charts were reviewed retrospectively for clinical information. The patients were all postmenopausal females. Average age was 62 years. Onset of symptoms was not associated with a specific episode of trauma. There were eight metatarsal fractures, three distal fibular fractures, and one fracture of the medial malleolus. Fractures were confirmed by radiographs, bone scan, or MRI in 9 of the 11 cases. Nonsurgical treatment utilizing rest, decreased activity, mechanical support, and analgesics resulted in successful union of the fracture except in one patient. Only four of the patients had been taking hormone or calcium supplements before injury. Just one patient had a prior bone density measurement, although four had a definite fracture previously and two had history suggestive of previous stress fracture.

A careful history considering risk factors for osteoporosis should be obtained when an insufficiency type stress fracture is diagnosed. Bone density measurements should be considered for patients with this type of injury. Appropriate medical therapy directed at the treatment of the underlying osteoporosis in addition to orthopaedic management of the fracture constitute the treatment objectives. This dual approach may prevent subsequent injury.
Arthrodesis of the Ankle Secondary to Replacement
Authors: Carlsson Åke S. , Montgomery Fredrik , Besjakov Jack
Published: March 2013

One hundred total ankle arthroplasties were performed in our department between 1974 and 1994, and of these, 21 have been reoperated on with arthrodesis due to septic or nonseptic failures after 6 months to 15 years (median 40 months). Immobilization using a Hoffman external fixator was the dominating method. The total ankles were of six different designs. Sixteen of the 21 patients suffered from rheumatoid arthritis.

Four of the 21 ankles did not fuse whereas 17 did: 13 at the first attempt and 4 after repeat arthrodesis. At the time of the review, two patients had died. Of the remaining 15 patients whose ankles had fused, all but one were satisfied or somewhat satisfied with the result. Twelve of these 15 ankles rated excellent or good according to the Mazur and Kofoed scoring systems. We conclude that arthrodesis can be performed successfully after a failed ankle arthroplasty.
Lipoma of the Toe
Authors: Vandeweyer E. , Van Geertruyden J. , de Fontaine S.
Published: March 2013

Lipoma is a common benign soft tissue tumor. It may arise in any location, but most frequently it is located on the trunk, chest, upper thigh, upper arm, and shoulder. Reports of a lipoma in the foot exist, but the occurrence of the tumor in this location is very rare. Lipomas of the toe have only been reported in children, some imitating or having associated gigantism. We present a benign lipoma occurring on the plantar aspect of the second toe in an adult.
A Calcaneal Fracture with Extrusion of the Posterior Facet
Authors: Mehta Sanjay , Ostrum Robert F.
Published: March 2013

This is a case report of a 19-year-old woman who sustained multiple fractures including a right calcaneal fracture with extrusion of the posterior facet. The medial soft-tissue injury led to a full thickness skin loss. Despite loss of subtalar motion and decreased toe movement, she is satisfied with her result. The importance of the soft-tissue injuries, especially to the skin and tendons, associated with severely displaced calcaneal fracture dislocations is emphasized by this case report.
Osteochondral Lesions of the Proximal Phalanx of the Great Toe: A Report of Two Cases
Authors: Kinoshita Mitsuo , Okuda Ryuzo , Morikawa Junichi , Yasuda Toshito , Jotoku Tsuyoshi , Abe Muneaki
Published: March 2013

Two cases of osteochondral lesions of the proximal phalanx of the great toe at the interphalangeal joint are presented. This condition is characterized by pain, swelling, and tenderness at the interphalangeal joint. The roentgenographic characteristics resemble osteochondritis dissecans. Curettage and bone grafting to the lesion is effective. These conditions in adolescent soccer players may be caused by chronic repetitive overloading of the interphalangeal joint using soccer shoes with soft, supple, and narrow toe boxes.
Case Report: Fracture of the Posterior Medial Tubercle of the Talus Secondary to Direct Trauma
Authors: Wolf Robert S. , Heckman James D.
Published: March 2013

Isolated fracture of the posterior medial tubercle of the talus is a rare injury, generally thought to result from a pronation-dorsiflexion force causing avulsion of the insertion of the posterior talotibial ligament. Originally described by Cedell, the fracture has subsequently been reported three times to our knowledge, with all cases being attributed to indirect trauma. We describe an isolated fracture of the posterior medial tubercle of the talus caused by direct trauma. The fracture of the posterior medial tubercle remained ununited, failed to respond to conservative therapy, and was treated successfully with surgical excision.
Bilateral Peroneal Tubercle Osteochondroma of the Calcaneus: Case Report
Authors: Karakurum Günhan , Öznur Ali , Atilla Bülent
Published: March 2013

A case of bilateral symmetric osteochondroma of the peroneal tubercle in a 24-year-old woman is presented. This lesion is discussed along with its etiology and related findings.
Peroneus Brevis Tendon Tears: Pathophysiology, Surgical Reconstruction, and Clinical Results
Authors: Krause John O. , Brodsky James W.
Published: March 2013

Chronic peroneus brevis tendon tears are frequently overlooked or misdiagnosed. They are a more common problem than previously noted. Twenty patients were reviewed in the largest clinical series of its kind. The most reliable diagnostic sign was persistent swelling along the peroneal tendon sheath. The pathophysiologic mechanism is subclinical, or overt, subluxation of the tendon over the posterolateral edge of the fibula. This produces multiple longitudinal splits. Treatment is primarily surgical and must address both the split tendon and the subluxation that caused it. A new classification that guides surgical treatment is proposed. Debridement and repair are recommended for grade 1 tendons, which have damage to less than 50% of the cross-sectional area. Excision of the damaged segment and tenodesis to the peroneus longus are recommended for grade 2 tendons, which have destruction of greater than 50% of the cross-sectional area. Both methods must be augmented by stabilization of the etiologic subluxation. The average postoperative AOFAS score was 85. Return to maximum function is prolonged, but good-to-excellent results were found in the majority of patients.
Peroneal Tendon Injuries
Authors: Clarke Henry D. , Kitaoka Harold B. , Ehman Richard L.
Published: March 2013

Injury to the peroneal tendons is a frequently overlooked cause of persistent lateral ankle pain after trauma. Peroneal tendon anatomy, biomechanics, diagnostic studies, and traumatic disorders were reviewed.
The Medial Collateral Ligaments of the Human Ankle Joint: Anatomical Variations
Authors: Milner Clare Elizabeth , Soames Roger William
Published: March 2013

This study aimed to investigate anatomical variations within the medial collateral ligament complex of the human ankle joint. Osteoligamentous preparations of 40 ankles from 20 cadavers were studied. Six different component bands of the medial collateral ligament complex were observed: four superficial bands (tibiospring, tibionavicular, superficial posterior tibiotalar, and tibiocalcaneal ligaments), of which only the tibiospring and tibionavicular ligaments were constant, and two deep bands (deep posterior tibiotalar and deep anterior tibiotalar ligaments), of which only the deep posterior tibiotalar ligament was constant. No pattern was observed in the distribution of additional bands. A consistent and universally accepted system for naming the various bands of the medial collateral ligament is necessary to enable easy and accurate comparisons between studies. We suggest that this system should be based on the attachments of the ligaments.
Mechanical Comparison of Biplanar Proximal Closing Wedge Osteotomy with Plantar Plate Fixation Versus Crescentic Osteotomy with Screw Fixation for the Correction of Metatarsus Primus Varus
Authors: Campbell John T. , Schon Lew C. , Parks Brent G. , Wang Yingbo , Berger Barry I.
Published: March 2013

Proximal crescentic metatarsal osteotomy is a clinically successful technique for correcting metatarsus primus varus in hallux valgus surgery. However, there have been instances of dorsal elevation of the metatarsal head with this technique. Mechanical testing on 10 matched pairs of cadaver feet was performed to evaluate a new technique combining a biplanar closing wedge osteotomy and plantar plate fixation versus crescentic metatarsal osteotomy. The specimens were tested in cantilever-bending mode on an MTS Mini Bionix test frame. The mean load-to-failure values were 127.2 ± 81.9 N (SD) for biplanar osteotomy with plate fixation and 44.9 ± 43.3 N for crescentic osteotomy ( P = 0.019); the mean stiffness values at the initial portion of the load-deflection curve were 83.11 ± 73.76 N/mm and 31.95 ± 43.00 N/mm, respectively ( P = 0.012). The biplanar wedge osteotomy with plantar plate fixation demonstrated significantly stronger fixation than the crescentic osteotomy, with higher mean load-to-failure and stiffness values. This newly described technique may provide an acceptable alternative for patients at risk for dorsal elevation of the metatarsal, particularly those who are noncompliant or have osteopenia. Clinical study will determine whether this new technique offers satisfactory long-term results.
Treatment of Superficial and Deep Peroneal Neuromas by Resection and Translocation of the Nerves into the Anterolateral Compartment
Authors: Dellon A. Lee , Aszmann Oskar C.
Published: March 2013

An approach to the treatment of dorsal foot pain of neuroma origin is described based upon principals demonstrated to be effective in the treatment of upper extremity dorsoradial neuromas: translocation of the appropriate nerves into a muscle environment away from the joint. In the lower extremity, this requires identification of the appropriate nerves by anesthetic block, resection of the dorsal foot neuroma(s), and translocation of the nerves into the muscles of the anterolateral compartment. This approach yielded excellent results in 9 of the 11 patients with a mean follow-up of 29 months.
Cost-Effectiveness Comparison of Three Methods of Internal Fixation for Arthrodesis of the First Metatarsophalangeal Joint
Authors: Watson Anthony D. , Kelikian Armen S.
Published: March 2013

We used decision-analysis modeling to determine the most cost-effective fixation device among Herbert screws, AO screws, and the Luhr plate for first metatarsophalangeal joint arthrodesis. The model considered patient-reported outcomes at minimum 2-year follow-up, patient charges for the entire course of care, and event and outcome incidences within each fixation group. AO screws had the lowest average cost of utility and, therefore, are the most cost-effective fixation device for first metatarsophalangeal joint arthrodesis even though utility is highest with the Luhr plate. Operating room costs and union rate most strongly influenced cost-effectiveness.
Verrucous Carcinoma of the Nail Bed
Authors: Van Geertruyden Jean P. , Olemans Catherine , Laporte Marianne , Noël Jean-Christophe
Published: March 2013

Verrucous carcinoma is a rare, highly keratinizing variant of squamous cell carcinoma of the skin or mucosae characterized by a local aggressiveness but a low potential for metastasis. The plantar form is also known as epithelioma cuniculatum. Fingers and toes are rarely affected, and tumors of the nail bed are exceptional. Clinically, the lesion presents like a wart and is then often misdiagnosed. Treatment of choice is wide surgical excision. A case of verrucous carcinoma of the nail apparatus is presented, and diagnosis is discussed.
Congenital Absence of the Hallux Fibular Sesamoid: A Case Report and Review of the Literature
Authors: Jeng Clifford L. , Maurer Alan , Mizel Mark S.
Published: March 2013

Congenital absence of the fibular sesamoid of the hallux is an extremely rare condition. We could find only one previously reported case in the literature. The authors present a second case of congenital absence of the fibular sesamoid and a review of the literature regarding the clinical significance of this anomaly.
Juvenile Tillaux Fracture Simulating Syndesmosis Separation: A Case Report
Authors: Steinlauf Steven D. , Stricker Stephen J. , Hulen Christopher A.
Published: March 2013

The juvenile Tillaux fracture is an avulsion fracture (Salter-Harris type-3) of the anterolateral corner of the distal tibial epiphysis. We present a case in which the severely displaced Tillaux fragment became incarcerated between the distal tibia and fibula, simulating a syndesmotic separation radiographically. To our knowledge, such a fracture pattern as not been previously described. Preoperative computerized tomography provided accurate imaging of the unusual fracture pattern. Open extrication of the fracture fragment was followed by spontaneous reduction of the syndesmosis. The Tillaux fracture healed following open reduction with pin fixation, and the patient had an excellent functional and radiographic result at 2-year follow-up.
Flexor Hallucis Longus Tendon Injury in Dancers and Nondancers
Authors: Sammarco G. James , Cooper Paul S.
Published: March 2013

Thirty-one cases of flexor hallucis longus injuries in 26 patients were treated over a 16-year period (1977–1993). Groups were divided into dance-related injuries (group I) and other causes (group II). The two groups were compared with regard to age, activity, duration of symptoms, operative findings, histopathology, and postoperative time to resumption of full activities. Twenty-seven cases required surgery for unsuccessful nonoperative treatment. In group I, 71% of patients had a partial longitudinal tear of the flexor hallucis longus compared with 30% in group II. Another common finding was isolated tenosynovitis (21% in group I and 53% in group II). Eight cases had magnetic resonance imaging (MRI) evaluations before surgery. Clinical correlation was found to be an important factor in interpreting the MRI. Dancers tended to have symptoms for a longer period of time before seeking treatment than did nondancers. Follow-up was 19.2 months for dancers and 25 months for nondancers. Surgical correction of tenosynovitis, pseudocyst, and tendon tear yielded good or excellent results in 14 of 15 dancers and 9 of 11 nondancers. Surgical treatment of tendon tears and other pathologic tendon conditions gave consistently good results in patients with refractory flexor hallucis longus disease.
Tibiotalocalcaneal Arthrodesis: Anatomic and Technical Considerations
Authors: McGarvey William C. , Trevino Saul G. , Baxter Donald E. , Noble Philip C. , Schon Lew C.
Published: March 2013

In the first of this two-part cadaver investigation, we inserted a specially designed, pointed device (simulating a 12-mm nail) in an antegrade fashion in each of eight fresh-frozen cadaver tibial specimens; the tibial isthmus was used as a centralizing guide. The exit point was noted, and the specimen was dissected to identify the structures at risk. In all specimens, we found that the device placed the lateral plantar artery and nerve at risk (average minimal distance from device to structure, 0 mm) and that damage to the flexor hallucis brevis and plantar fascia occurred. In addition, in six of the eight specimens, the device skewered or skived the flexor hallucis longus tendon. We also noted that in each specimen the exit point was the sustentaculum tali, not the body of the calcaneus as expected. Thus, there was less calcaneal bone-to-rod interface for stability, and distal locking would be less effective in the lateral-to-medial direction because of the lack of medial bone stock. On the basis of the results of the first portion of the study, we investigated an alternative approach to retrograde tibial nailing to reduce the risk of injury to the plantar and medial structures of the foot. We performed a medial malleolar resection, medially displaced the talus, inserted the device in an antegrade fashion, and dissected the specimens to analyze the structures at risk. We found that malleolar resection and medial translation of the distal extremity an average of 9.3 mm (range, 7–11 mm) increased the average minimal distance from the tip of the device to the neurovascular bundle to 18.4 mm (range, 14–32 mm). We also found that there was no damage to the flexor hallucis longus and that all eight specimens demonstrated bony contact completely surrounding the nail device within the tuberosity portion of the calcaneus (assessed by postoperative radiographs). The results of this study suggest that malleolar resection and medial translation of the distal extremity before retrograde nailing of the tibia may reduce the risk of vital structure injury and enhance the rigidity of the fixation.
Effect of Calcaneal Osteotomy and Lateral Column Lengthening on the Plantar Fascia: A Biomechanical Investigation
Authors: Horton Greg A. , Myerson Mark S. , Parks Brent G. , Park Yong-Wook
Published: March 2013

Medial calcaneal displacement osteotomy or lateral column lengthening fusion has been advocated to augment tendon transfer in planovalgus foot deformity associated with chronic posterior tibial tendon insufficiency. It is hypothesized that plantar fascia tightening occurs with these procedures, helping to restore a more normal longitudinal arch. To investigate this further, nine fresh-frozen cadaver below-knee specimens were used. A flatfoot model was created by sectioning of the posterior tibial tendon, spring ligament, talonavicular capsule, and deltoid ligament. A liquid-metal strain gauge, calibrated to measure fractional changes in length, was sutured proximally to the origin and distally into the thickest portion of the medial band of the plantar fascia. Specimens were axially loaded to 400 N and plantar fascia strain was measured. Fractional length changes in the plantar fascia were then measured after a medial displacement calcaneal osteotomy and after a lateral column lengthening through the calcaneocuboid joint. Tightening of the plantar fascia did not occur with either medial calcaneal displacement or lateral column lengthening. The plantar fascia became significantly less taut with both medial displacement and lateral column lengthening. We found that lateral column lengthening produced significantly looser plantar fascia than did medial displacement of the calcaneal tuberosity.
Structural and Functional Reconstruction After Resection of Aneurysmal Bone Cyst of the Fifth Metatarsal: A Case Study
Authors: Donald Jay Arenson , Cohen Michael D.
Published: March 2013

We report a case of a primary benign bone tumor (aneurysmal bone cyst [ABC]) involving the distal portion of the fifth metatarsal, identified in an adolescent. The tumor, histologically identified as an ABC with reparative giant cell reaction, became symptomatic. Treatment included resection, followed by reconstruction of the fifth metatarsal using grafts of autologous bone with preservation of function in the metatarsophalangeal joint. The basis for selecting this form of treatment is discussed, as well as the natural history of ABC and giant cell reparative granuloma. Restoration of form and function is illustrated by this case study with a 23-month follow-up.
Bunion Correction Using Proximal Chevron Osteotomy: A Single-Incision Technique
Authors: Sammarco G. James , Russo-Alesi Frank G.
Published: March 2013

Proximal chevron first metatarsal osteotomy with lateral capsulotomy, adductor tenotomy, and binding of the first and second metatarsals was reviewed in 88 consecutive cases. Seventy-two cases in 55 patients are reported, with an average clinical follow-up of 41 months. The hallux valgus angle improved an average of 15°, from 32.0° preoperative to an average of 17.0° postoperatively. The intermetatarsal I-II angle improved an average of 5.5°, from 15.3° preoperatively to 9.0° postoperatively. The lateral plantar first metatarsal angle did not change. First metatarsal length was decreased by 2.0 mm. Union occurred at an average of 2 months. Sesamoid position improved 49%, from a preoperative average subluxation of 80% to a postoperative average subluxation of 29%. Subjective foot score profiles improved from a preoperative average of 70.1/100 to a postoperative average of 94.4/100 with respect to pain, deformity, motion, disability, and cosmesis. There were 10 patients with complications, including three patients with delayed unions, two with second metatarsal stress fractures, one with hallux varus, two with hallux limitus, one with progressive arthritis, one with cellulitis, and one with hallux elevatus. Eighty-four percent of the patients stated that they would undergo the procedure again without reservation, 9% would proceed with reservation, and 7% would not proceed with surgery again if offered. This technique provides reliable successful long-term results for the treatment of moderate and severe symptomatic bunion, hallux valgus, and metatarsus primus varus.