bluuebunny/crossref_metadata_2025 huggingface dataset:
Arthrodesis of the First Metatarsophalangeal Joint to Salvage Failed Silicone Implant Arthroplasty
Authors: Hecht Paul J. , Gibbons Michael J. , Wapner Keith L. , Cooke Chris , Hoisington Samuel A.
Published: March 2013

Between 1987 and 1992, all patients presenting to the senior author with a symptomatic failed silicone implant arthroplasty refractory to conservative treatment were converted to a metatarsophalangeal joint arthrodesis. Internal fixation was achieved with either dual intramedullary threaded Steinmann pins or an obliquely placed AO compression screw and a three- or four-hole one-third tubular dorsal neutralization plate. Bone grafting was used to maintain hallux length. Successful arthrodesis was achieved in all five feet in patients with rheumatoid arthritis. Subjectively, patients improved from an average of 0.69 before arthrodesis to 4.89 after arthrodesis. The average walking tolerance improved from 1.11 to 4.80, and the overall level of satisfaction improved from 0.0 to 4.79. The patient's ability to wear shoes improved from 0.87 to 3.1.

Successful arthrodesis produces a foot that is more functional and durable than excisional arthroplasty. Subjectively, these patients stated that their level of pain, walking tolerance, and overall satisfaction improved significantly after the arthrodesis. Clinically, there was no evidence of transfer lesions, tenderness, or hallux subluxation. Hallux length was well maintained after surgery with bone grafting, but it was more difficult to obtain the alignment goals. The average postoperative metatarsophalangeal dorsiflexion angle was 15.6° and the first metatarsophalangeal angle was 3.1°. Despite this, patient satisfaction was high.

Arthrodesis of the first metatarsophalangeal joint using a bone graft to salvage failed silicone implant arthroplasty produces acceptable subjective and radiographic results. Although technically demanding, it provides long-term stability to the hallux, restores weightbearing, and allows for maintenance of a propulsive gait. We recommend this procedure instead of an excisional arthroplasty to maintain high level of function and overall patient satisfaction.
Endoscopic Plantar Fascia Release: A Cross-sectional Anatomic Study
Authors: Reeve Fredrick , Laughlin Richard T. , Wright Douglas G.
Published: March 2013

Endoscopic plantar fascia release is a new procedure proposed to treat heel pain and plantar fasciitis. The purpose of this study was to assess the structures at risk during plantar fascia release using this method. Ten fresh-frozen cadaver feet were divided into two groups. All specimens underwent cannula placement inferior to the plantar fascia. Five of the specimens had plantar fascia release using the endoscopic technique. Six of the specimens were then frozen and cut in transverse, sagittal, and coronal sections to visualize the relationship between the cannula and plantar fascia and surrounding structures. Gross dissection was performed on the remaining four specimens. The amount of plantar fascia released, the relationship to the nerve to abductor digiti minimi, and the fascia of the abductor hallucis muscle were assessed. The average distance from the cannula margin to the nerve to the abductor digiti minimi was 6 mm at the medial border of the plantar fascia. The average amount of plantar fascia released was 90%. Although a complete release was attempted, the fascia to the abductor hallucis was not released in any of the specimens. The nerve to the abductor digiti minimi was not damaged in any of the specimens. On coronal sections, the nerve was closer to the cannula and plantar fascia release than previously reported.
Varus Tilt of the Tibial Plafond as a Factor in Chronic Ligament Instability of the Ankle
Authors: Sugimoto Kazuya , Samoto Norihiro , Takakura Yoshinori , Tamai Susumu
Published: March 2013

The authors performed a radiographic study of 136 patients with acute ligament sprains and 85 patients with chronic lateral ligament instability of the ankle. Varus angulation of the tibial plafond, varus angulation of the line passing both malleolar ends, and varus angulation of the medial malleolus were measured on the AP views, and dorsal angulation of the tibial plafond was measured on the lateral views. The varus angles of the tibial plafond, the line passing both malleolar ends, and the medial malleolus were larger as mean values in patients with chronic ligament instability than in the patients with acute ligament sprain. The varus tilt of the tibial plafond is more often seen in patients with chronic ligament instability of the ankle than in patients with acute ligament sprains.
Successes and Pitfalls in the Healing of Neuropathic Forefoot Ulcerations with the IPOS Postoperative Shoe
Authors: Needleman Richard L.
Published: March 2013

Unnecessary amputations can be avoided with the healing of foot ulcerations in neuropathic feet. Traditional approaches have relied on relieving plantar and other extrinsic foot pressures. A retrospective review was performed of the office records of patients with Wagner grade 1 and 2 neuropathic forefoot ulcerations who were prescribed an IPOS (Niagara Falls, NY) postoperative shoe. A total of 33 patients were in the chart review. Twenty-three of these patients were located and agreed to participate in a telephone survey. Patients showed a compliance of 78%. Seventy-seven percent of the patients healed their ulcers and wore prescription inserts and extra-depth shoes at a mean of 8 weeks. Seventy-eight percent of our telephone survey patients were either satisfied or satisfied with reservations. Problems or complications from wearing the IPOS postoperative shoe occurred with 38% of all patients.
Nonsurgical Treatment of Monarticular Nontraumatic Synovitis of the Second Metatarsophalangeal Joint
Authors: Mizel Mark S. , Michelson James D.
Published: March 2013

Thirteen patients with second metatarsophalangeal joint synovitis in 14 feet were seen during 4.5 years for monarticular nontraumatic synovitis of the metatarsophalangeal joint. They were treated with a nonsurgical regimen of intra-articular corticosteroids, along with the modification of a regular laced shoe to provide a rockerbottom effect. Nine feet of 8 patients were available for follow-up at an average of 75 months. Seven feet were asymptomatic, with no recurrence. One patient with bilateral involvement continued with symptoms unchanged. There were no recurrences. The treatment was unsuccessful for one patient who underwent surgical synovectomy. The above regimen seems to satisfactorily resolve the symptoms in 70% of the patients treated.
Fastest Reduction of Posttraumatic Edema: Continuous Cryotherapy or Intermittent Impulse Compression?
Authors: Stöckle U. , Hoffmann R. , Schütz M. , von Fournier C. , Südkamp N.P. , Haas N.
Published: March 2013

Sixty patients with foot or ankle trauma were randomized and treated in three groups. In intermittent impulse compression, an air pad under the foot was inflated every 20 seconds, thus activating the venous foot pump. In continuous cryotherapy, ice water circulates between the ice box and the cold pad. The ice water was changed once per day. In standard therapy, the injured extremity was treated with cool packs, which were changed 4 times per day.

Beginning at admission, every 24 hours the circumference was measured around the ankle, midfoot, and forefoot. After 24 hours of treatment, there was a 47% reduction in swelling with the A-V Impulse System, 33% with continuous cryotherapy, and 17% with cool packs. After 4 days of postoperative treatment, the A-V Impulse System reduced the swelling by 74% versus 70% with continuous cryotherapy and 45% with cool packs.

Both new methods are preferable to cool packs. Because of the better preoperative results, the A-V Impulse System proved to be the most effective device.
Hallux Valgus in Men: Effect of the Distal Metatarsal Articular Angle on Hallux Valgus Correctiong
Authors: Coughlin Michael J.
Published: March 2013

The results of hallux valgus correction were reviewed for 34 male patients (41 feet). The severity of the preoperative deformity determined the operative technique of correction. A distal soft tissue procedure with proximal first metatarsal osteotomy was performed in 30 patients (35 feet) with an average correction of the hallux valgus angle of 22°. A chevron procedure was performed in five cases and a McBride procedure in one other case, all with less severe deformities. Complications included one deep wound infection, one broken screw at the metatarsal osteotomy site, and three cases of hallux varus. No patients underwent reoperation. Undercorrection was noted in 10 of 35 cases (29%) where a distal soft tissue procedure with proximal first metatarsal osteotomy was performed.

A nonsubluxated (congruent) metatarsophalangeal (MTP) joint associated with a hallux valgus deformity was present in 15 of 41 (37%) of all cases and 10 of 35 (29%) of cases that underwent a distal soft tissue procedure with proximal metatarsal osteotomy (DSTR with PMO). A subluxated (noncongruent) MTP joint associated with hallux valgus was present in 26 of 41 (63%) of all cases and 25 of 35 (71 %) of cases undergoing a DSTR with PMO. There was a highly significant difference in the average distal metatarsal articular angle (DMAA) as measured in the nonsubluxated (congruent) MTP joints (20.7°) and the subluxated (noncongruent) MTP joints with hallux valgus (10°) ( P = 0.0001). The average distal metatarsal articular angle for all cases undergoing DSTR with PMO was 13°. When the postoperative hallux valgus angle was compared with the DMAA, the average residual hallux valgus angle was 10.1°. With a subluxated (noncongruent) first MTP joint with hallux valgus (a low DMAA), the percent of hallux valgus correction (hallux valgus correction [in degrees])preoperative hallux valgus deformity [in degrees]) was 77%. In patients with a nonsubluxated (congruent) first MTP joint with hallux valgus (a high DMAA), the percent correction was 46%, an almost twofold difference in percent correction.

There was a close correlation between the preoperative DMAA and the postoperative hallux valgus angle in both the subluxated and congruent subgroups ( P = 0.0003). With an intra-articular repair (a DSTP with PMO), the magnitude of correction of a hallux valgus deformity is limited at the MTP joint by the distal metatarsal articular angle.
Pathologic Anatomic Variations in Subtalar Anatomy
Authors: Scranton Pierce E. , McDermott John E.
Published: March 2013

Thirteen patients presenting with symptomatic pathologic variations or congenital deformities of the subtalar joint are presented. These variations included: four abnormal posterior talar processes, five patients with asymmetric subtalar joint development, and four congenital complete subtalar coalitions with a secondary ball-and-socket joint. In each case these adult patients had been unaware of the variation and had been symptom free until “awakening” sprain or fracture trauma brought about symptoms. The nonoperative and operative management of these variations is reviewed.
Combination Chevron Plus Akin Osteotomy for Hallux Valgus: Should Age Be a Limiting Factor?
Authors: Tollison Michael E. , Baxter Donald E.
Published: March 2013

Current literature consistently precludes the chevron osteotomy for bunion correction in patients older than age 50 years. We retrospectively reviewed 47 patients (73 bunions) with an average age of 62 years (range, 55–81 years old) who had a chevron-Akin double osteotomy. The mean follow-up was 4 years, 6 months (range, 2 years, 3 months to 8 years, 2 months). The overall satisfaction rate was 95%. No significant pain or stiffness in the first metatarsophalangeal joint occurred in comparison with other bunion procedures. Radiographic results were better for patients with a preoperative intermetatarsal angle of less than 15° and tibial sesamoid position of less than or equal to 2.

We disagree with the current recommendation that age older than 50 years is a contraindication to a chevron procedure. The Akin osteotomy adds additional intraoperative correction of the hallux angulation and rotation; thus, the chevron-Akin double osteotomy is a useful combination procedure. We recommend this procedure for the mild to moderate bunion deformity even in elderly patients.
Stress Radiography and Stress Examination of the Talocrural and Subtalar Joint on Helical Computed Tomography
Authors: van Hellemondt F.J. , Louwerens J.W.K. , Sijbrandij E.S. , van Gils A.P.G.
Published: March 2013

The main objective of this study was to compare subtalar inversion stress views using the Brodén view with inversion stress views on helical computed tomography (CT). One of the drawbacks of routine radiography is the imaging of three-dimensional structures in a two-dimensional plane. We investigated whether the use of helical CT would lead to a more objective and clearer measurable method to determine the amount of tilt in the subtalar joint. A group of 15 patients with unilateral chronic instability complaints and clinically suspected subtalar instability was examined. The contralateral asymptomatic foot was used as control.

A variable amount of subtalar tilt (range, 4° to 18°) was demonstrated in all cases on stress radiographs, without finding significant difference between the symptomatic and asymptomatic feet. However, contrary to the findings at the talocrural level, subtalar tilt was found in none of the patients using helical CT. Thus, we now doubt that the tilt seen during stress examination using the Brodén view is the true amount of tilt. It may be that the lateral opening, seen on these radiographs, largely results from imaging two planes that have made a translatory and rotatory movement relative to each other in an oblique direction. It is concluded that the Brodén stress examination might not be useful for screening patients with subtalar instability.

Associated anomalies not visible on the radiographs were detected by helical CT. In four cases, narrowing of the articular cartilage and irregular and hypertrophic bone formation at the middle facet joint of the subtalar joints were found. It is likely that these changes cause disturbance of function of this joint and it is suggested that the subjective complaint of instability with “giving way” is not only caused by hypermobility, but can be caused by other disturbances of normal motion.
Effect of Proximal Phalangeal Epiphysiodesis in the Treatment of Macrodactyly
Authors: Topoleski Tamara A. , Ganel Abraham , Grogan Dennis P.
Published: March 2013

The recommended treatment for macrodactyly of the foot will often include epiphysiodesis of the proximal phalanx in an attempt to halt further longitudinal growth of the toe. Nine patients who underwent open epiphysiodesis and debulking of the excess soft tissue involving 11 toes were reviewed to evaluate the effectiveness of this procedure. In 9 of 11 toes, overall length of the proximal phalanx did not change after surgery. Two toes demonstrated continued growth; one of these toes underwent a repeat epiphysiodesis of the phalanx, and the other foot underwent epiphysiodesis of the affected metatarsal. Overall, this surgical approach led to radiographic results that satisfied the surgical goals.
Pigmented Villonodular Synovitis in the First Metatarsophalangeal Joint: Arthroscopic Treatment of an Unusual Condition
Authors: Borton David C. , Peereboom Jeffrey , Saxby Terence S.
Published: March 2013

Pigmented nodular synovitis is an uncommon condition of the foot. In this case history, we report a case of pigmented nodular synovitis in the first metatarsophalangeal joint, treated by arthroscopic synovectomy. Pigmented nodular synovitis to our knowledge has not been described in the first metatarsophalangeal joint. We report successful treatment of the condition by arthroscopic removal of the tissue, with the patient being asymptomatic 2 years after surgery.
Achilleo-Calcaneal Vascular Network
Authors: Sanz-Hospital F.J. , Martín C.M. , Escalera J. , Llanos L.F.
Published: March 2013

This study investigates the vascularization of the Achilles tendon in 32 lower limbs of human neonates by injecting colored latex with subsequent microdissection. Because of its biomechanical significance (achilleo-calcaneal-plantar system) and the lack of descriptions in the literature, we analyzed the vascularization of the attachment area in the calcaneus, describing the achilleo-calcaneal vascular network, which is always well supplied in contrast to other tendinous areas.
Hallucal Rotation: A Method of Measurement and Relationship to Bunion Deformity
Authors: Talbot Kyle D. , Saltzman Charles L.
Published: March 2013

A method for measuring hallucal rotation on weightbearing tangential radiographs is described. Under controlled conditions using cadaver specimens, 10° changes in hallucal rotation were associated with a mean change in radiographically measured rotation of 10.6° (S.D. = 2.3°). A clinical study of 30 control patients and 39 patients presenting with a chief complaint of a bunion deformity was undertaken to assess the reliability of the measurement method. The overall reliability was high for both groups ( r = 0.98). A significant difference was found between mean values for hallucal rotation in the two groups ( P < 0.005). There is a modest association between increasing valgus deviation and increasing rotation of the hallux ( r = 0.43, P < 0.01). This study suggests that bunion deformities involve variable degrees of axial and coronal plane rotations of the first metatarsophalangeal joint and that the concept of a planar “hallux valgus” deformity may insufficiently describe this three-dimensional clinical condition.
Etiology, Histopathology, and Outcome of Surgery in Achillodynia
Authors: Rolf Christer , Movin Tomas
Published: March 2013

Fifty-eight patients suffering from achillodynia for a median of 12 months (range, 4–240 months) were analyzed using history, clinical findings, ultrasound findings, histopathology, and surgical outcome. Surgical criteria were daily pain or inability to perform sports activity and failure of nonoperative treatment. There were 34 men and 24 women, 31% (18 of 58 patients) of whom had no direct association with sports or vigorous physical activity. Ultrasonography was performed in all cases and showed low echogenous areas (N = 48), increased tendon diameter (N = 40), and/or peritendinous fluid (N = 11). Histopathological evaluation of tendon biopsies, obtained from regions showing pathology at surgery (N = 35), revealed altered fiber structure and arrangement, focal variations in cellularity, extracellular glycosaminoglycans, neovascularization, and/or hyalinization. In no case was inflammatory cell infiltration observed. At a median clinical follow-up of 25 months after surgery, symptoms were decreased in 86% of patients, and 76% had reached a higher activity level compared with the level before surgery. Complications occurred in 13% of operations.

In conclusion, achillodynia is not always associated with excessive physical activity. Macroscopic pathologic tendons showed marked histopathologic changes, correlating well with ultrasound findings. Surgical treatment was beneficial in most cases, despite a relatively high complication rate. The etiology and reason for the lack of healing response to rest and nonoperative treatment are unclear.
Chronic Disorders of the Achilles Tendon: Results of Conservative and Surgical Treatments
Authors: Johnston Eric , Scranton Pierce , Pfeffer Glenn B.
Published: March 2013

We reviewed our results of nonoperative and operative treatment of chronic Achilles tenosynovitis to further define outcomes and treatment parameters. Forty-one patients presented with an average of 14 weeks of Achilles tendon symptoms. All patients received nonsurgical treatment initially, and 21 patients (51%) recovered after an average of 18 weeks of therapy. Three additional patients improved after brisement of the tendon/peritenon interspace. Seventeen of 41 patients eventually underwent soft tissue tenolysis and/or excision of degenerative tendon cysts.

Those patients who responded to nonoperative therapy tended to be younger (average age, 33 years) than those who had degenerative tendon changes requiring surgery (average age, 48 years). All surgical patients were able to return to unrestricted activity after 31 weeks (range, 27–48 weeks). We believe 4 to 6 months of nonsurgical therapy is appropriate for middle aged patients or athletes with chronic Achilles tenosynovitis. Those that fail this treatment will improve with a limited debridement of diseased tissue without excessive soft tissue dissection of the tendon.
Calcaneal Osteomyelitis Caused by Nail Puncture Wounds
Authors: Laughlin Richard T. , Reeve Fredrick , Wright Douglas G. , Mader Jon T. , Calhoun Jason H.
Published: March 2013

Plantar puncture wounds to the foot are a common injury. A small number (1.8%) of these puncture wounds become infected and progress to osteomyelitis. The purpose of this article is to report the cases of six patients who developed osteomyelitis of the calcaneus after a puncture wound to the heel caused by a nail. The characteristics of the patients, the pathogenic organism, and the outcome were studied. Patients who were healthy and had no systemic illness (N = 4) had only one pathogenic organism cultured, whereas patients who had systemic illness (diabetes mellitus, N = 2) had more than one pathogenic organism cultured. The only amputation in this group occurred in a patient with diabetes mellitus. It was concluded that diabetic patients who develop calcaneal osteomyelitis from a nail puncture wound are more likely to have multiple pathogens cultured. Furthermore, if a diabetic neuropathy is also present, the nail puncture wound may be the initial injury leading to a chronic ulceration, increasing the risk of amputation.
Salvage of Pseudoarthrosis After Tibiotalar Arthrodesis
Authors: Levine Stuart E. , Myerson Mark S. , Lucas Paul , Schon Lew C.
Published: March 2013

We retrospectively reviewed the treatment of a selected group of 23 patients with pseudoarthrosis after ankle arthrodesis who underwent revision arthrodesis at an average of 1.7 years (range, 0.3–17.0 years) after the initial, unsuccessful procedure. Fourteen patients underwent isolated revision tibiotalar arthrodesis, and 9 had an additional hindfoot arthrodesis (7 tibiotalocalcaneal, 2 pantalar) performed at the time of the procedure. Rigid internal fixation with screws was performed when possible, and, in patients with poor bone quality, an external fixator was used. Autogenous bone grafting was used in 14 patients where bone loss was present. Twenty-one of 23 patients had successful union (average, 14 weeks; range, 6–48 weeks). Two patients had persistent ankle nonunions; one was asymptomatic, and one had symptomatic subtalar arthritis. Two patients underwent successful arthrodesis but had persistent pain from reflex sympathetic dystrophy. Overall, 19 of 23 patients were satisfied with the surgery. We conclude that revision arthrodesis for tibiotalar pseudoarthrosis is a worthwhile procedure.
Acquired Hallux Varus
Authors: Donley Brian G.
Published: March 2013

Acquired hallux varus most commonly occurs after hallux valgus surgery. Sagittal plane, coronal plane, and varus deformities are present at the metatarsophalangeal joint. Evaluation of both the metatarsophalangeal and interphalangeal joints for mobility is necessary in surgical decision making. Not all patients require surgery. The anatomy, incidence, pathogenesis, evaluation, classification, and treatment of acquired hallux varus are discussed in this review.
Subtalar Arthrodesis with Interposition Tricortical Iliac Crest Graft for Late Pain and Deformity After Calcaneus Fracture
Authors: Chan Samson C.F. , Alexander Ian J.
Published: March 2013

We are reporting our experience using tricortical interposition iliac crest grafting in the management of late pain and deformity after calcaneus fracture. Ten patients underwent this procedure, which was performed by the senior author. All but one were followed up with a questionnaire, physical examination, and repeat x-rays. The technique failed in one severely osteoporotic individual because of the graft sinking into the calcaneus. The experience led to two technique modifications that were evaluated in this study.
Treatment of Osteochondritis Dissecans of the Talus: Use of the Mosaicplasty Technique—A Preliminary Report
Authors: Hangody L. , Kish G. , Kárpáti Z. , Szerb I. , Eberhardt R.
Published: March 2013

A one-stage autogenous osteochondral grafting technique for the treatment of talar dome osteochondritis dissecans is described. Eleven patients with osteochondritis dissecans lesions, 10 mm or greater in diameter, were operated on using the mosaicplasty autogenous osteochondral transplantation technique. Osteochondral cylindrical grafts from the ipsilateral knee were delivered into the talar defect using specially designed tube chisels. These procedures were done by arthrotomy. With follow-up of 12 to 28 months (mean, 16 months), the patients returned to full activities and the results, using the Hannover scoring system, have been excellent.
Walking Pattern of Midfoot and Ankle Disarticulation Amputees
Authors: Pinzur Michael S. , Wolf Brian , Havey Robert M.
Published: March 2013

Measurements of the vertical component of ground reaction force (GRF) and dynamic center of pressure (COP) were recorded for five subjects with midfoot level amputations and six with Syme's ankle disarticulation amputations. All of the subjects underwent amputation surgery as a consequence of peripheral vascular disease and diabetes. GRF measurement was accomplished with the F-Scan system (Tekscan, Boston, MA).

Each group exhibited a consistent, reproducible pattern of gait. Subjects with Syme's ankle disarticulation initiated initial loading response, i.e., heel strike, with a concentration of GRF in the center of the anatomic heel. COP progressed along the midline to the center of the anatomic forefoot, where GRF was concentrated at push-off. Midfoot amputees initiated loading at the lateral-posterior heel. COP progressed medially to the midline, where it progressed distally to the level of the distal residual limb (proximal metatarsal metaphyses). It then shifted medially under the base of the first metatarsal, where a small concentration of GRF occurred at push-off, similar to the normal foot.

These findings explain the decreased magnitude of propulsion seen in midfoot level amputees and may explain the seemingly paradoxical increased metabolic cost of walking observed in midfoot amputees as compared with Syme's ankle disarticulation amputees.
Morphology of the Plantar Calcaneocuboid Ligaments
Authors: Ward Kathryn Anna , Soames Roger William
Published: March 2013

The plantar calcaneocuboid ligaments have various configurations and are referred to in the literature by different names. The aims of this study were to classify the form and attachments of the plantar calcaneocuboid ligaments and to determine their dimensions to describe their morphology. The plantar aspects of 59 cadaver feet were dissected to expose the associated ligaments. The long and short plantar ligaments showed several structural variations of shape, band number, and attachments. The variations that were seen have led to confusion in the literature, which needs to be resolved. A new nomenclature is suggested based on the observed morphology. These findings agree with previous reports, and data are also presented that describe the shapes of the ligaments.
Valgus Stress Radiography in Normal Ankles
Authors: Leith Jordan Michael , McConkey J.P. , Li David , Masri Bassam
Published: March 2013

Deltoid ligament injury is thought to be rare. Signs of complete rupture of the deltoid ligament may be subtle or interpreted as another injury condition and thus are often missed acutely. No standardized method has been created to evaluate medial ligament insufficiency in acute or chronic laxity.

To establish a diagnostic test for suspected isolated ruptures of the deltoid ligament, 32 subjects with no previous ankle injury underwent valgus stress radiography and nonstressed radiography of both ankles. Stress radiography in this study showed that there is a measurable but minimal range of talar tilt on valgus stress in previously uninjured ankles. This study provides the basis for diagnosis of the rare isolated rupture of the deltoid ligament of the ankle.
Alterations in Talar Morphology Associated with Adult Flatfoot
Authors: Anderson John G. , Harrington Richard , Ching Randal P. , Tencer Allan , Sangeorzan Bruce J.
Published: March 2013

To gain a better understanding of the anatomy of the factors contributing to symptomatic flatfoot, we compared the shape of the talus in feet that were flat to that in control tali from feet with a normal arch. Computed tomographic (CT) scans were performed on 9 adult patients with 10 symptomatic flatfoot deformities. CT scans of 10 feet being evaluated for acute trauma not involving the talus were randomly selected as controls. Flatfoot tali tended to be of greater overall length than the control tali, and this difference was not statistically significant. Statistically significant differences were found when comparing ratios of talar length with talar width ( P = 0.011), talar length with talar height ( P = 0.001) (they were long relative to their height and width), and head length with head width ( P = 0.001) for individual tali from the two groups.

The tali from the flatfoot group were narrower in width and shorter in height when compared with overall length and had heads that were more elongated in the transverse plane than tali in feet with a normal appearance. Clinical correlation: When performing surgical correction of a flatfoot in an adult, appearance of the foot rather than standard radiographic parameters should be used to judge the reduction. The altered shape of the bone may alter the standard radiographic parameters.
Subtalar Arthrodesis Versus Flexor Digitorum Longus Tendon Transfer for Severe Flatfoot Deformity: An in Vitro Biomechanical Analysis
Authors: Kitaoka Harold B. , Luo Zong Ping , An Kai-Nan
Published: March 2013

We defined the mechanical behavior of the foot after an operation for treatment of the flatfoot deformity, subtalar arthrodesis, and compared results with those from flexor digitorum longus tendon transfer. Twelve fresh-frozen human foot specimens were used. Supporting elements were sectioned to create a flatfoot deformity. To simulate midstance phase of gait, loads were applied axially to the plantar foot and to five tendons. Reduction of deformity in metatarsal-talar, calcaneal-talar, and talar-tibial positions was achieved and was significantly greater after subtalar arthrodesis operation than after flexor digitorum longus transfer.
Clinical Characteristics and Outcome in 223 Diabetic Patients with Deep Foot Infections
Authors: Eneroth Magnus , Apelqvist Jan , Stenström Anders
Published: March 2013

Clinical characteristics and outcome in 223 consecutive diabetic patients with deep foot infections are reported. Patients were treated by a multidisciplinary diabetic foot-care team at the University Hospital, Lund, Sweden, and were prospectively followed until healing or death. About 50% of patients lacked clinical signs of infection, such as a body temperature > 37.8°C, a sedimentation rate > 70 mm/hour, and white blood cell count (WBC) > 10 × 10 9 /liter. Eighty-six percent had surgery before healing or death. Thirty-nine percent healed without amputation; 34% healed after a minor and 8% after a major amputation. Sixteen percent were unhealed at death, and 3% were unhealed at the end of the observation period. Of those unhealed at death or follow-up, 4 patients had had a major and 11 a minor amputation.

After correction for age and sex, duration of diabetes < 14 years, palpable popliteal pulse, a toe pressure > 45 mmHg, and an ankle pressure > 80 mm Hg, absence of exposed bone and a white blood cell count < 12 × 10 9 /liter were all related to healing without amputation in a logistic regression analysis. We conclude that although only 1 in 10 had a major amputation, nearly all diabetic patients with a deep foot infection needed surgery and more than one third had a minor amputation before healing or death in spite of a well-functioning diabetic foot-care team responsible for all included patients.
A Kinematic Study of Ankle Joint Instability Due to Rupture of the Lateral Ligaments
Authors: Hashimoto Takeshi , Inokuchi Suguru
Published: March 2013

Kinematic analysis of patients who have ruptured the ligaments of the ankle joint was performed to evaluate the function of those ligaments. Ten patients with ruptured lateral collateral ligaments and 10 normal volunteers were examined. Patients’ ages ranged from 17 to 29, averaging 20.9 years old. We performed kinematic evaluation by a three-dimensional optical analytic technique using surface markers. According to our results, the ankles with lateral ligament injury abnormally pronated and rotated externally at the time of heel strike and abnormally supinated and rotated internally during the acceleration phase.
Isolated Dislocation of the Middle Cuneiform in a Farmer: A Case Report and Review of the Literature
Authors: Maitra Ranjan , DeGnore Lisa Tiffany
Published: March 2013

Isolated dislocations of the middle cuneiform are uncommon. There have been four reported previously. Significant force is required to produce these injuries, and they can have serious neurovascular consequences. In this case report and review of the literature, we present an isolated middle cuneiform dislocation in a 69-year-old farmer with impending skin and soft tissue loss over the dislocated bone.
Metatarsal Lengthening: Case Report and Review of Literature
Authors: Choudhury Sambhu N. , Kitaoka Harold B. , Peterson Hamlet A.
Published: March 2013

Shortening of one or more metatarsals may be a cause of metatarsalgia and painful toe deformity. Usually, symptoms are limited and may be successfully addressed with nonoperative treatment. Rarely, operation is indicated. This report reviews the surgical techniques, results, and complications. These operations include osteotomy and one-stage distraction with bone grafting, osteotomy and one-stage distraction without bone grafting, osteotomy with gradual distraction and bone grafting, and osteotomy with gradual distraction without bone grafting.
Adamantinoma Arising in the Distal Fibula Treated with Distal Fibulectomy: A Case Report and Review of the Literature
Authors: Mohler David Glenn , Cunningham David Charles
Published: March 2013

Adamantinoma is a rare primary bone tumor occurring in the mandible and the long tubular bones. The diaphysis of the tibia is the most common site of extragnathic presentation. Fibular involvement is rare and usually has coexisting tibial involvement. Adamantinoma arising in the distal fibular metaphysis has not been previously reported. This is a case of a teenage boy presenting with a cystic lesion of the distal fibula, initially diagnosed and treated as a unicameral bone cyst. Aggressive behavior ultimately led to a diagnosis of adamantinoma. He was treated with distal fibulectomy without surgical reconstruction with good functional outcome.
Functional Evaluation of the 10-Year Outcome after Modified Evans Repair for Chronic Ankle Instability
Authors: Rosenbaum Dieter , Becker Horst-Peter , Sterk Jürgen , Gerngross Heinz , Claes Lutz
Published: March 2013

The Evans tenodesis is an operative treatment for chronic ankle instability with good short-term results. 18 , 24 , 25 The disadvantage of impaired hind foot kinematics and restricted motion has been described, 6 , 16 and only few reports of long-term results can be found. 14 No techniques have been used to assess the outcome objectively. We wanted to determine whether a modified Evans procedure 33 led to a satisfactory clinical and functional outcome. Nineteen patients were available at a 10-year follow-up. The clinical examination included a detailed questionnaire and stress radiographs. Foot function was evaluated with plantar pressure distribution measurements during walking and peroneal reaction time measurements elicited on a rapidly tilting platform (recorded with surface electromyography). High subjective patient satisfaction was contrasted with a high rate of residual instability, pain, and swelling. The radiographs showed an increased number of exostoses. The gait analysis revealed reduced peak pressures under the lateral heel and increased values under the longitudinal arch. The reaction times of the peroneal muscles were shorter on the operated side (significant: peroneus longus). The persistent clinical problems as well as the functional changes indicate that the disturbed ankle joint kinematics permanently alter foot function and may subsequently support the development of arthrosis. Therefore, the Evans procedure should only be applied if anatomical reconstruction of the lateral ankle ligaments is not feasible.
A Review of Selected Noncontact Anterior Cruciate Ligament Injuries in the National Football League
Authors: Scranton Pierce E. , Whitesel James P. , Powell John W. , Dormer Stephen G. , Heidt Robert S. , Losse Gary , Cawley Patrick W.
Published: March 2013

During five football seasons, from 1989 through 1993, 61 surgically proven, noncontact, anterior cruciate ligament injuries, were identified from among 22 National Football League teams. The variables of surface, shoe type, playing conditions, and whether or not the shoe was spatted were identified for each reported injury. Forty noncontact injuries occurred in conventional cleated shoes on natural grass, and 21 occurred on an artificial surface. Almost half of all injuries (47.5%) occurred during game-day exposures despite the fact that the practice versus game-day exposure rate was 5:1. Of these injuries, 95.2% (N = 58) occurred on a dry field. The factors of cleat and shoe type, type of surface (natural versus artificial), surface conditions (wet/dry), and the effect of “spatting” a shoe are presented. The significance of these factors and their likelihood to be associated with injury is analyzed by use of a statistical tool, the incidence density ratio.
Arthroscopic Excision of the Os Trigonum: A New Technique with Preliminary Clinical Results
Authors: Marumoto Jay M. , Ferkel Richard D.
Published: March 2013

Open excision of a painful os trigonum can be associated with prolonged recovery. An arthroscopic technique has been developed to decrease scarring, diminish surgical morbidity, and promote a faster recovery. Eleven patients were retrospectively evaluated after removal of the os trigonum after a mean follow-up of 35 months. Small joint arthroscopy equipment was utilized in a supine position with a distraction device. Average patient scores improved on the AOFAS Ankle/Hindfoot Scale from 45 to 86 points. All patients went home the same day, and no complications occurred during the procedure. All patients reached maximum recovery level within the first 3 months after surgery. Arthroscopic excision of a painful os trigonum yields good results with minimal surgical morbidity and shorter recovery time.
The Relationship Between the Use of Tourniquet and the Intensity of Postoperative Pain in Surgically Treated Malleolar Fractures
Authors: Ömeroĝlu Hakan , Günel Uĝur , Biçimoĝlu Ali , Tabak A. Yalçin , Uçaner Ahmet , Güney Ömer
Published: March 2013

The purpose of this study was to examine whether application of a pneumatic tourniquet to the lower extremity during open reduction and internal fixation of malleolar fractures had an effect on the intensity of postoperative pain or not. It was found in males and patients older than 30 years of age that postoperative pain with tourniquet use was harder to control compared with others not in these groups.
The Effects of Cheilectomy on Dorsiflexion of the First Metatarsophalangeal Joint
Authors: Heller William A. , Brage Michael E.
Published: March 2013

Our purpose in this study was to determine the effects of cheilectomy on the mechanics of dorsiflexion of the first metatarsophalangeal (MTP) joint. Ten fresh-frozen cadaver feet were utilized, of which two demonstrated radiographic evidence of hallux rigidus. Each specimen was rigidly mounted on a custom-made slide tray that was articulated with a hinge mechanism designed to dorsiflex the first MTP joint. Range-of-motion measurements were made on the first MTP joint. Cheilectomy of 30% of the metatarsal head diameter was performed. Lateral radiographs with the beam centered on the MTP joint were taken with the joint at neutral, 20°, 40°, and at the limits of dorsiflexion. This process was repeated after a 50% cheilectomy was performed. The radiographs were examined for changes in joint congruence and in patterns of surface motion as the hallux moved from neutral to full dorsiflexion. Instant centers of rotation were determined by a method first described by Rouleaux. We constructed surface velocity vectors to describe patterns of motion of the first MTP joint.

The mean dorsiflexion of the first MTP joint was 67.9° and increased to 78.3° after 30% cheilectomy. The increase in dorsiflexion was significantly greater in the two specimens with hallux rigidus (33%) than in the other specimens (12.1%). After both levels of cheilectomy, the proximal phalanx demonstrated pivoting at the resection site on the metatarsal head. This pivoting resulted in abnormal motion patterns across the MTP joint. Normal sliding motion predominated in early dorsiflexion, with compression peaking at the end stage of dorsiflexion, producing jamming of the articular surfaces.

Cheilectomy significantly increased dorsiflexion of the MTP joint, but resulted in abnormal motion patterns. The increase in dorsiflexion resulted from pivoting of the proximal phalanx on the metatarsal head, resulting in anomalous velocity vectors and compression across the MTP joint.
The Mechanism of Plantar Unloading in Total Contact Casts: Implications for Design and Clinical Use
Authors: Shaw Jonathan E. , Hsi Wei-Li , Ulbrecht Jan S. , Norkitis Arleen , Becker Mary B. , Cavanagh Peter R.
Published: March 2013

Although the total contact cast (TCC) has been shown to be an extremely effective treatment for the healing of plantar ulcers in diabetic patients, little is known about the biomechanics of its action. In this study, plantar pressure and ground reaction force measurements were obtained from over 750 foot contacts as five subjects with known elevated plantar forefoot pressures walked barefoot, in a padded cast shoe, and a TCC. Peak plantar pressures in the forefoot were markedly reduced in the cast compared with both barefoot and shoe walking (reductions of 75% and 86% respectively, P < 0.05). Peak plantar pressures in the heel were not, however, significantly different between the shoe and the TCC, and the longer duration of heel loading resulted in an impulse that was more than twice as great in the cast compared with the shoe ( P < 0.05). An analysis of load distribution indicated that the mechanisms by which the TCC achieves forefoot unloading are (1) transfer of approximately 30% of the load from the leg directly to the cast wall, (2) greater proportionate load sharing by the heel, and (3) removal of a load-bearing surface from the metatarsal heads because of the “cavity” created by the soft foam covering the forefoot. These results point out some of the “essential design features” of the TCC (which are different from what had been previously supposed), support the use of the TCC for healing plantar ulcers in the forefoot, but raise questions about its utility in the healing of plantar ulcers on the heel.
Gout: Rare Cause of Hallucal Sesamoid Pain: A Case Report
Authors: Reber Peter U. , Patel Ameet G. , Noesberger Bruno
Published: March 2013

Tophaceous gout is commonly encountered and is amenable to effective medical management. A rare case of tophaceous gout in a tripartite medial sesamoid bone of the great toe is presented. Clinical presentation, differential diagnosis, and treatment of hallucal sesamoid pain are discussed.
Effective Treatment of Chronic Plantar Fasciitis with Dorsiflexion Night Splints: A Crossover Prospective Randomized Outcome Study
Authors: Powell Mark , Post William R. , Keener Jay , Wearden Stanley
Published: March 2013

Chronic plantar fasciitis frustrates patients and treating physicians. Our hypothesis was that use of a dorsiflexion night splint for 1 month would effectively treat patients with recalcitrant plantar fasciitis. A 6-month randomized crossover study included 37 patients with chronic plantar fasciitis. Patients were treated with dorsiflexion night splints for 1 month. Group A wore splints for the 1st month and group B for the 2nd month. No splints were used in either group for the final 4 months of the study. No other medications, stretching, or strengthening exercises were prescribed.

Eighty-eight percent of patients who completed the study improved. Eighty percent of the involved feet improved subjectively. Results of the AOFAS Ankle-Hindfoot Rating System 17 and the Mayo Clinical Scoring System 7 demonstrated significant improvement for both groups during the period of splint wear. Improvements were maintained at study completion. Response to splinting did not correlate with foot type, degree of obesity, or the presence of heel spur on radiographs. We believe dorsiflexion splints provide relief from the symptoms of recalcitrant plantar fasciitis in the majority of patients.
Effect of Variations in Calcaneocuboid Fusion Technique on Kinematics of the Normal Hindfoot
Authors: Sands Andrew , Early John , Harrington Richard M , Tencer Allan F , Ching Randal P , Sangeorzant Bruce J.
Published: March 2013

Calcaneocuboid fusion with lengthening of the lateral column of the foot has been advocated as a method of treating flatfoot deformity. This study was designed to determine how the length of the lateral column chosen or the position of the foot selected when performing this fusion affect hindfoot kinematics in normal cadaver feet. An electromagnetic tracking system was used to monitor the positions of the talus, calcaneus, navicular, and cuboid while the intact cadaver feet were moved passively and then under reproducible loads. Calcaneocuboid fusion was then performed on these feet first with the feet in neutral position and the lateral column of normal length, then lengthened 10 mm or shortened 5 mm, and then with the lateral column lengthened 10 mm and the feet positioned in plantar flexion and eversion or dorsiflexion and inversion. Kinematic measurements were made at each stage using the same loads. Fusing the calcaneocuboid joint with lengthening or shortening the lateral column and the feet in neutral position did not affect hindfoot joint motion compared with intact. Changing the position of the foot for fusion, however, resulted in significant decreases in motion in the talocalcaneal and talonavicular joints. Tibiotalar joint motion was unaffected. This study, therefore, demonstrates that when fusing the calcaneocuboid joint, attention should be paid to maintaining a neutral position of the foot.
The Influence of Foot Abduction on Differences between Two-Dimensional and Three-Dimensional Rearfoot Motion
Authors: McClay Irene , Manal Kurt
Published: March 2013

The advantage of a three-dimensional over a two-dimensional approach to rearfoot analysis has been questioned in the past. The purpose of this study was to examine differences in typical rearfoot variables obtained using a two-dimensional analysis compared with a three-dimensional approach. In addition, the influence of foot placement angle on these differences was assessed. Two- and three-dimensional rearfoot kinematics were collected from 18 recreational runners. Two-dimensional values for eversion at toe-off and time to peak eversion were found to be significantly different from the three-dimensional results. Differences between two-dimensional and three-dimensional variables were magnified with increased toe-out. Differences between eversion values were found to be minimal when the foot was abducted between 7 and 10°. The premise that excessive pronators have more pronounced toe-out was not supported by this study. Results suggest that caution should be exercised when assessing two-dimensional rearfoot motion in subjects with excessive toe-out.