bluuebunny/crossref_metadata_2025 huggingface dataset:
Fractures of the Calcaneus Part II: Treatment
Authors: Lowery Robert B.W. , Calhoun Jason H.
Published: March 2013

Extra-articular fracture management of the calcaneus is well accepted. Despite advancements, there is still no consensus on the treatment of intra-articular calcaneal fractures. Although the results of open reduction and internal fixation appear promising, evaluation is difficult because there is no universally accepted classification system. We believe that a consensus is developing for the evaluation, staging, and treatment of the acute calcaneus fracture and its chronic problems. Advancements in the understanding of the anatomy, injury mechanism, and classification of calcaneal fractures were presented in Parti ( Foot & Ankle International, 17(4):230–235, 1996). Treatment of displaced intra-articular fractures gives superior results when anatomic reduction of the subtalar joint is achieved.
Trochanteric Bone Grafts in Foot and Ankle Surgery
Authors: Hayes W. Richard , Smith Ronald W.
Published: March 2013

Eighty-five patients who underwent trochanteric bone graft harvest in association with foot and ankle surgery were studied retrospectively by patient questionnaire. The average follow-up was 49 months (range, 14–101 months). Ninety-five percent of the patients expressed satisfaction with the procedure, in that they would choose to accept the trochanteric bone graft again if required to make the choice. However, 31 % of the patients acknowledged some degree of hip discomfort and 4% reported some daily pain.

Nineteen of 85 patients (22%) were treated for trochanteric pain. Most patients responded to strengthening/stretching and heat/ice. Four patients (5%) had failed or delayed union of the arthrodesis in which trochanteric bone graft was utilized.

The greater trochanter may be considered as an alternative for major bone graft when the iliac bone is not available and when weightbearing is restricted for at least 6 weeks after surgery. As with the use of iliac bone graft, patients should be alerted to the possibility of postoperative discomfort. Surgical details should be followed to minimize the risk of peritrochanteric fracture.
Dorsal Neuroma of the Feet: A Case Report
Authors: Samimi Soheil , Enyati Ali
Published: March 2013

A patient presented with bilateral neuromas of medial dorsal nerves of the great toes. She had a 3-year history of localized tenderness and an “electric” type of pain. At surgery, neuromas of the dorsal medial digital nerves were identified and removed. The patient's symptoms resolved completely.
Distal Soft Tissue Release Using Direct and Indirect Approaches: An Anatomic Study
Authors: Lin Ian , Bonar Susan K. , Anderson Robert B. , Davis W. Hodges
Published: March 2013

Two surgical approaches for distal soft tissue release in the correction of hallux valgus, one using a dorsal first web space incision and the other a longitudinal medial capsulotomy incision (used also for medial eminence resection), were studied to compare and delineate the structures actually incised. Anatomic dissections were performed on six fresh-frozen amputation specimens using each of the approaches. The adequacy of release of the adductor hallucis, transverse and oblique heads, first metatarsophalangeal lateral capsule, and suspensory ligament was reviewed. Any inadvertent damage to the first metatarsal head cartilage, second metatarsophalangeal capsule, and lateral head of the flexor hallucis brevis tendon was also noted. Distal soft tissue release is thought to be an important part of hallux valgus surgery. Based on our anatomic dissections, the actual extent of the release may be inconsistent and unpredictable, and may have implications for the predictability of results after hallux valgus surgery.
Plantar Pressure Analysis of Diabetic Rockerbottom Deformity in Total Contact Casts
Authors: Martin Rob L. , Conti Stephen F.
Published: March 2013

In a previous study, we examined plantar pressures under normally arched individuals in casts. The investigation described in this article was designed to assess plantar pressure distribution in subjects with Charcot midfoot collapse and rockerbottom deformity in standard short leg casts and total contact casts. Our results show that both types of casts significantly reduced midfoot pressures. No significant differences were noted between the two casting groups.
A Study of Intrinsic Factors in Patients with Stress Fractures of the Tibia
Authors: Ekenman Ingrid , Tsai-Felländer Li , Westblad Pär , Turan Ibrahim , Rolf Christer
Published: March 2013

We aimed to study intrinsic factors in 29 consecutive patients with well-documented unilateral stress fractures of the tibia. Anthropometry, range of motion, isokinetic plantar flexor muscle performance, and gait pattern were analyzed. The uninjured leg served as the control. A reference group of 30 uninjured subjects was compared regarding gait pattern. Anterior stress fractures of the tibia (N = 10) were localized in the push-off/ landing leg in 9/10 athletes, but were similarly distributed between legs in posteromedial injuries (N = 19). Ten (30%) of the stress fracture subjects had bilateral high foot arches, similar to those found in the reference group. There were no other systematic differences in anthropometry, range of motion, gait pattern, or isokinetic plantar flexor muscle peak torque and endurance between injured and uninjured legs. No other differences were found between anterior and posteromedial stress fractures. We conclude that anterior stress fractures of the tibia occur mainly in the push-off/landing leg in athletes. Within the limitations of our protocol, no registered intrinsic factor was found to be directly associated with the occurrence of a stress fracture of the tibia.
Outcome of Nonsurgical Treatment for Plantar Fasciitis
Authors: Gill Lowell H. , Kiebzak Gary M.
Published: March 2013

Four hundred eleven patients with a clinical diagnosis of plantar fasciitis were assessed for predisposing factors. Each patient completed an outcomes assessment survey instrument that ranked effectiveness of various nonsurgical treatment modalities. Listed in descending order of effectiveness, the treatment modalities assessed were short leg walking cast, steroid injection, rest, ice, runner's shoe, crepe-soled shoe, aspirin or nonsteroidal anti-inflammatory drug, heel cushion, low-profile plastic heel cup, heat, and Tuli's heel cup. Treatment with a cast ranked the best. The Tuli's heel cup ranked the poorest. Most of the treatments were found to be unpredictable or minimally effective. The ineffectiveness of nonsurgical treatments noted in this outcomes study is at variance with most published clinical studies in which generally favorable results are reported after nonsurgical treatment for plantar fasciitis.
Control of the Residual Tibia in Transtibial Amputation
Authors: Pinzur Michael S. , Reddy Narayn , Charuk George , Osterman Helen , Vrbos Lori
Published: March 2013

Eight transtibial amputees had localized unremitting discomfort and pain in the distal anterior residual limb during prosthetic wear while weightbearing. Modification of the prosthetic socket did not change this pain. It was not consistent with “phantom limb” or causalgia/reflex sympathetic dystrophy-type etiologies. Thirteen randomly selected, pain-free, transtibial amputees were selected for comparison. The subjects in both groups used similar total-contact, “patellar tendon-bearing” prosthetic sockets fabricated and aligned with similar technique. The angles formed between the femur and tibia, femur and prosthetic socket, and tibia and socket were measured. Significant differences were found at each angle measurement between those patients who experienced pain and those who did not. The variable of tibia length had no effect. We conclude that bone alignment within the transtibial total-contact prosthetic socket may be partially dependent on surgical technique and not solely on prosthetic socket configuration.
Geometric Data of Hallux Valgus Feet
Authors: Lamur Kenneth S. , Huson Anton , Snijders Chris J. , Stoeckart Rob
Published: March 2013

The aim of this study is to find basic quantitative geometric data that may contribute to the understanding of the etiology of hallux valgus. Embalmed specimens with existing hallux valgus (N = 39) were dissected; 28 variables were measured with a Vernier caliper gauge and toe goniometer. Correlations between pairs of independent variables were calculated. Linear dependency of the hallux angle, varus angle, and the width of the forefoot on a number of independent variables was analyzed by multiple linear regression. A least squares method and a stepwise procedure were used. The distance from the tendon of the flexor hallucis longus muscle to the head of the first metatarsal bone explains more than other variables the variation in hallux angle and width of the forefoot. A widened forefoot is significantly correlated with both hallux and varus angles. The interrelation of the predictor parameters illustrates the complicated hallux valgus phenomenon.
Clinical Safety and Efficacy of Calf Tourniquets
Authors: Michelson James D. , Perry Mark
Published: March 2013

A clinical study was undertaken to ascertain the utility and complication rate of proximal calf tourniquet use for foot and ankle surgery. The surgical and clinical records of 446 patients undergoing foot and ankle surgery between March 1992 and December 1994 were examined for details pertaining to intraoperative tourniquet use and postoperative evidence of neurologic or vascular complications. All patients who had surgery performed under tourniquet control were included in the study.

A total of 454 limbs were operated on: 8 patients underwent bilateral surgical procedures. The patients comprised 172 men and 274 women. The average age was 48.9 (±16.0 SD) years. Surgery was completed in one tourniquet period in 435 cases (95.8%) and in two periods of tourniquet inflation in 19 cases (4.2%). The average duration of tourniquet ischemia was 49.2 minutes (±30.7 SD) for one tourniquet period and 131.1 minutes (±46.0 SD) for two tourniquet periods.

No postoperative compromise to either neurologic or vascular function was detected. Specifically, no alteration in peroneal nerve function was seen.

We conclude that a calf tourniquet placed proximally with adequate cast padding is a safe and effective method to achieve a bloodless surgical field for foot and ankle surgery.
Comparison of Bioabsorbable Pins and Kirschner Wires in the Fixation of Chevron Osteotomies for Hallux Valgus
Authors: Winemaker Mitchell Jeffrey , Amendola Annunziato
Published: March 2013

A retrospective review of the medical records and radiographs of 32 consecutive patients, totaling 52 extremities with chevron osteotomies for hallux valgus, was conducted to compare K wire fixation with absorbable (poly- p-dioxanone) pin fixation. Each group comprised 21 feet, with a mean clinical follow-up of 35.6 months (25.6–50.5 months) in the K wire group and 23.1 months (13.7–28.8 months) in the absorbable pin group. Demographics as well as final clinical follow-up scores (hallux-metatarsophalangeal-interphalangeal scale and visual analogue scores) were similar in both groups. Postoperative hallux valgus and intermetatarsal angles were similar in both groups. No complications, such as osteolysis or inflammatory sinus formation, occurred in the absorbable pin group. Two patients in the K wire group had a malunited osteotomy and two patients had a retained K wire at final follow-up. Our experience suggests that poly- p-dioxanone pins are at least as effective as K wires, and the previous reports of inflammatory sinus formation and osteolysis are not a significant concern in the fixation of chevron osteotomies for hallux valgus.
Classification of Fractures of the Talus: Clear Differentiation Between Neck and Body Fractures
Authors: Inokuchi Suguru , Ogawa Kiyohisa , Usami Norio
Published: March 2013

The treatment and prognosis of neck fractures (extra-articular) and body fractures (intra-articular) of the talus are different. Ratios between neck fractures and body fractures reported by different investigators vary widely (from 6:1 to 1:1), because it is difficult to differentiate fractures crossing the anteromedial aspect of the trochlea. We examined 215 fractures of the talus. By examining the inferior surface fracture line, we found that the 61 fractures crossing the anteromedial aspect of the trochlea could be differentiated into 28 neck fractures and 33 body fractures. We suggest classifying fractures of the talus based on the inferior, not superior, surface fracture line.
Components of the Posterior Calcaneal Facet: Anatomic and Radiologic Evaluation
Authors: Ebraheim Nabil A. , Mekhail Anis O. , Yeasting Richard A.
Published: March 2013

The calcaneal facet of the posterior subtalar joint can be divided into two portions: an anterolateral portion and a posteromedial portion. The importance of this consideration is that the two portions of the facet do not lie in the same plane. This should be taken into consideration when interpreting radiographs of the subtalar joint. Measurements from 50 dry-bone specimens and radiographs of 10 cadaver specimens were taken. The radiographs were obtained after marking the posterior subtalar joint to demonstrate the corresponding site of each facet portion on radiographs. The posteromedial portion lies almost in the transverse plane, making an angle of approximately 40° with the anterolateral portion. Each radiographic projection was explained by demonstrating the orientation of markings applied to the specimens and correlated to the data derived from the angular measurements. A protocol of sequential radiographs that can be used to evaluate the posterior subtalar joint is proposed.
Triple Arthrodesis: A Biomechanical Evaluation of Screw Versus Staple Fixation
Authors: Meyer Mark S. , Alvarez Brian E. , Njus Glen O. , Bennett Gordon L.
Published: March 2013

The subtalar, talonavicular, and calcaneocuboid joints were internally fixed to simulate triple arthrodesis was performed on eight matched pairs of human cadaver feet. Feet were randomly assigned such that one specimen in each pair was internally fixed with cobalt-chrome staples and one specimen with stainless steel screws. Liquid metal strain gauges were placed in a perpendicular fashion across the three joints of each specimen. Each foot was then secured to the Shore Western Materials Test System where a series of 10 increasing eversion stresses across the foot was created. Displacement was measured at each joint with every increase in eversion stress.

Our results show that there is no statistical difference in fixation strength between screws and staples at the talonavicular, calcaneocuboid, or subtalar joints ( P = 0.862). Although many studies determining the strength to failure of different implants have been performed, shear stress and micromotion at the joint surfaces have not been evaluated, to our knowledge, and no single implant in this study has shown superior immobilization characteristics to recommend its use as the implant of choice in triple arthrodesis.
Lengthening the Terminal Portion of a Tendon
Authors: Botte Michael J. , Santi Mark D. , Abrams Reid A.
Published: March 2013

In the operative reattachment of an avulsed or lacerated tendon, additional tendon length is occasionally needed to reach the proposed reinsertion site. This is encountered when there is loss of distal tendon substance or when muscle shortening and tendon retraction has occurred. The following describes a technique of lengthening the terminal portion of the tendon to facilitate reattachment.
Nonunion of a Fracture of the Lateral Malleolus: A Case Report and Review of the Literature
Authors: Rand Nahshon , Mosheiff Ram , Liebergall Meir
Published: March 2013

Nonunion of a fracture of the lateral malleolus is a rare condition. We present a case of established nonunion of a fracture of the lateral malleolus confirmed and treated surgically, using debridement and internal fixation with autologous bone graft. At 5-year follow-up, the fracture was united but the patient still showed clinical signs of reflex sympathetic dystrophy. Male gender, supination fractures, Weber type C fractures, and primary internal fixation are cited as possible risk factors. Prognosis is variable.
Treatment of Established Nonunions of Mitchell Osteotomies
Authors: O'Malley Martin J. , Chao Wen , Thompson Francesca M.
Published: March 2013

The Mitchell distal metatarsal stepcut osteotomy for the treatment of hallux valgus is a technically demanding procedure with a high complication rate. Reported complications include metatarsal shortening with lateral metatarsalgia, partial avascular necrosis of the distal fragment, and loss of position with incomplete correction. Nonunion, however, has only rarely been reported. We describe our experience with the treatment of three nonunions of Mitchell osteotomies reconstructed using a tricortical iliac crest bone graft.
Achilles Tendon Insertion: An In Vitro Anatomic Study
Authors: Chao Wen , Deland Jonathan T. , Bates James E. , Kenneally Sharon M.
Published: March 2013

Seventeen adult fresh-frozen below-knee amputation cadaver specimens were studied. Calcific Achilles tendinitis was present in three specimens. After exposing the Achilles tendon insertion on the calcaneus, the insertion was outlined with waterproof paint. The specimens were photographed on a special plexiglass apparatus to highlight important findings. For the purpose of showing the length of insertion on lateral radiographs, lead beads were placed on the most superior and most inferior aspects of the insertion.

All specimens showed that the tendon terminated at the medial and lateral bone borders of the calcaneus without significant extension around the medial or lateral wall. All specimens revealed a greater distance of insertion on the medial calcaneus than on the lateral side. In the specimens that had calcific Achilles tendinitis, the posterior bone surface of the spurs was devoid of tendinous insertion. Instead, the insertion occurred between the spur and the posterior wall of the calcaneus. All spurs were located laterally at the most inferior border of the tendon insertion.
Macrodystrophia Lipomatosa of the Foot: A Report of Three Cases and Literature Review
Authors: Bailey Erroll J. , Thompson Francesca M. , Bohne Walther , Dyal Cherise
Published: March 2013

Macrodystrophia lipomatosa is a distinct clinical entity often misdiagnosed as other forms of macrodactyly. The most specific finding is an overabundance of fibrofatty tissue on the plantar aspect of the foot. Three cases, with the diagnoses made from tissue specimens, are presented in this article. The clinical, pathologic, and roentgenographic findings are discussed and a review of the literature is provided.
Chronic Ankle Pain Caused by Osteoid Osteoma of the Neck of the Talus
Authors: Snow Stephen W. , Sobel Mark , DiCarlo Edward F. , Thompson Francesca M. , Deland Johnathan T.
Published: March 2013

Five patients with osteoid osteomas of the talar neck were treated at the Hospital for Special Surgery between 1981 and 1992. The course of care leading to definitive diagnosis and treatment was reviewed.

All five of the patients had night pain relieved by aspirin or nonsteroidal anti-inflammatory drugs. One of the five reported associated trauma. The average time from onset of symptoms to correct diagnosis was 2.5 years. Juxta-articular osteoid osteoma can cause a small spur that resembles a traction spur on the neck of the talus. Anterior ankle impingement was the most common misdiagnosis. Initial treatments included arthroscopic spur debridement or synovectomy, casting for fracture, and repeated nerve blocks for reflex sympathetic dystrophy. The five patients were cured by en bloc excision of the lesion.

In the diagnosis of osteoid osteoma, a history of relief of pain with aspirin is important. Plain radiographs and a bone scan are useful. Fine cut computed tomography scanning or magnetic resonance imaging are the best studies for making a definitive diagnosis. Localization by computed tomography guided needle placement or intraoperative radionuclide scanning are recommended to find the lesion for excision. Intraoperative radiographs of the excised lesion should be used to confirm complete removal.
The Chevron Osteotomy: A Clinical and Radiographic Analysis
Authors: Mann Roger A. , Donatto Keith C.
Published: March 2013

This is a retrospective study of the chevron osteotomy for hallux valgus. Subjective and objective postoperative results were evaluated. Differences in the postoperative correction of the intermetatarsal 1–2 angle and the first metatarsophalangeal angle were noted using two accepted measurement methods. Seventeen patients (23 feet) with an average age of 39 years (range, 15–51 years) and an average follow-up of 3 years (range, 1–5 years) were studied. The average preoperative intermetatarsal 1–2 angle was 11° (range, 8° to 14°), and the average hallux valgus angle was 23° (range, 7° to 39°). The apparent postoperative correction differed depending on the method of measurement used. One method consistently indicated a greater amount of correction in both the intermetatarsal and metatarsophalangeal angles.

The chevron procedure resulted in an overall satisfactory improvement of symptoms, function, and cosmesis. Four feet exhibited postoperative radiographic changes that could be construed as avascular changes, but there was no collapse noted, nor were there clinical symptoms of avascular necrosis. No nonunions, malunions, or infections developed, and no cases of hallux varus occurred.
Intrachondral Microvasculature in the Human Fetal Talus
Authors: Cheng Xiaoguang , Wang Yunzhao , Qu Hui
Published: March 2013

The intrachondral microvasculature of the growing talus of human was studied in 16 fetuses aged from 15 to 44 weeks of gestation, using interrupted serial sections and vascular injection of ink. The cartilage model of the talus was shown to be well vascularized throughout by cartilage canals. The cartilage canal contained blood vessels and connective tissue, with vessels originating from the perichondrial vessels. They were covered by a thick connective tissue wall that was continuous with the perichondrium. The functions of the cartilage canals were mainly to nourish the large masses of cartilage and to supply osteogenic tissue, which initiates the primary ossification center. As in the adult, the fetal talus was supplied with four to five main branches originating from the sinus tarsi and the tarsal canal; there were no anastomoses between the vessels of the adjacent cartilage canals and between the branches within the cartilage canal. This type of microvasculature is vulnerable to injury and, if impaired, may cause serious complications.
Prevalence of Radiographic Foot Abnormalities in Patients with Diabetes
Authors: Smith Douglas G. , Barnes Brett C. , Sands Andrew K. , Boyko Edward J. , Ahroni Jessie H.
Published: March 2013

Clinicians are increasingly aware that mechanical aspects of foot deformities, such as Charcot changes, clawtoes, bunion deformities, or cavus or planus foot deformities, might have an impact on the occurrence, potential healing, and recurrence of foot ulcers. We report the prevalence of plain radiographic changes and attempt to rate the severity of those deformities in the feet of 456 diabetic veteran medicine clinic enrollees. All 456 radiographs were reviewed by orthopaedic surgeons to specifically identify Charcot changes, presence of arterial calcification, dislocation of the lesser toe metatarsophalangeal joints, hallux interphalangeal joint dislocation, and radiographic evidence of previous surgery. Radiographs of 428 patients were taken while weightbearing, and these were reviewed to quantify hallux valgus angles, intermetatarsal 1–2 angles, fifth metatarsalproximal phalangeal angles, second metatarsal lengths, lateral talocalcaneal and talar-first metatarsal angles, and claw toe deformities. The prevalence of Charcot changes was 1.4% (six subjects), and all had radiographic evidence of midfoot Charcot changes. Other deformities, such as clawtoes, hallux valgus, lesser toe joint dislocations, and alterations in arch height, are more common in veterans with diabetes.
Osteochondritis Dissecans of the Head of the Talus
Authors: Dolan A. Mark , Mulcahy David M. , Stephens Michael M.
Published: March 2013

We present a case of osteochondritis dissecans of the head of the talus, without a history of trauma. The clinical and radiological features and a 2-year and 3-month follow-up are discussed.
Plantar Pressure Distribution After Resection of the Metatarsal Heads in Rheumatoid Arthritis
Authors: Bitzan Peter , Giurea Alexander , Wanivenhaus Axel
Published: March 2013

Surgical correction of the forefoot in rheumatoid arthritis by resection of all metatarsal heads in combination with a resection arthroplasty of the first metatarsophalangeal joint showed excellent and good results in 20 (77%) of 26 cases and satisfactory and fair results in 6 (23%) of 26 cases. Twenty-six feet in 16 patients were operated on by a plantar approach and examined after a mean follow-up period of 50 months (range, 24–90 months). Seventy-three percent of the patients were free of pain. In 75 (58%) of all 130 investigated toes, complete absence of load distribution was noted. In the remaining 55 (42%) toes, we observed a variable extent of function, depending on the length of resection. Although toe function is better in minimal metatarsal resection, single excessive length or plantar spike formation revealed pressure peaks in the metatarsal area. Metatarsal head resection provided reduction of pain and correction of severe deformities, and permitted the patients to wear ordinary shoes in 24 (93%) of 26 cases.
Arthroscopic Treatment of Anterior Ankle Impingement
Authors: Branca Alberto , Di Palma Luigi , Bucca Carmelo , Visconti Camilla Sagarriga , Di Mille M.
Published: March 2013

Ankle arthroscopy has recently allowed the elaboration of less invasive techniques for the treatment of anterior impingement. Its indications, advantages, and drawbacks in this application are discussed.

Between 1987 and 1994, 133 patients were treated for ankle impingement. Among them, 58 patients, 37 men and 21 women (mean age, 28.5 years), who had failed a trial of conservative treatment were treated by means of tibiotalar arthroscopy. Twenty-seven were athletes engaged in sports with abnormal stressing of the ankle. According to McDermott's radiological classification, there were 15 stage I cases, 23 stage II, 13 stage III, and 7 stage IV. Preoperative evaluation with a modified version of McGuire's scoring system gave 50 cases rated as “poor” (<60 points) and 8 cases rated as “fair” (60–67 points). Treatment consisted of removal of adhesions, cartilage shaving, and removal of the bone impingement with powered instruments, curettes, or small osteotomes. Follow-up was from 8 to 62 months (mean, 21.5 months). The postoperative McGuire ratings were 37 good, 13 fair, and 8 poor. There were no major complications. Recurrence of impingement was observed in four cases of stage III and IV. The conclusion is drawn that ankle arthroscopy is a sound method for the treatment of anterior impingement. Even in cases with severe joint cartilage impairment, it plays a therapeutic role as a means of postponing a possible arthrodesis.
A Comparison of Two Motion Analysis Systems for the Measurement of Two-Dimensional Rearfoot Motion During Walking
Authors: Mannon Kori , Anderson Tonya , Cheetham Phil , Cornwall Mark W. , McPoil Thomas G.
Published: March 2013

The purpose of this study was to compare two-dimensional rearfoot motion during walking measured by a traditional video-based motion analysis system to that of an electromagnetic analysis system. Twenty-five individuals (15 men, 10 women) with a mean age of 29.8 years served as subjects for this study. The results of the study showed that there was a high correlation ( r = 0.945) between the mean motion paths produced by the two systems, indicating that they were very similar. The electromagnetic motion analysis system was able to produce these similar results in a fraction of the time required by the video-based system.
Intraosseous Gouty Invasion of the Talus
Authors: Raikin Steven , Cohn Bruce T.
Published: March 2013

A 34-year-old man presents with a cystic lesion of the talus that has developed over the last 3 years and a history of a single first metatarsophalangeal attack of gout. Radiodiagnostic studies confirmed the cyst and an associated osteochondritic lesion but showed no evidence of avascular necrosis. At arthroscopy, chalk-like material was removed from the cyst, which was histologically compatible with tophaceous gout. The lesion was debrided, and the patient was then treated with antihyperuricemic medication; radiographic evidence of cyst resorption was seen after 9 months of treatment.
Early One-Stage Reconstruction of Congenital Vertical Talus
Authors: Stricker Stephen J. , Rosen Eileen
Published: March 2013

A simple, one-stage surgical reconstruction was performed on 20 feet with congenital vertical talus in 13 consecutive children. A newly devised outcome scoring system with seven clinical and eight radiographic parameters was utilized to determine correction of all feet at average follow-up of 41 months. There were no excellent, 17 good, 3 fair, and no poor results, with few associated perioperative complications. Clinically, mild postoperative stiffness of ankle and subtalar motion was occasionally noted. Radiographically, many feet had mild residual forefoot abduction with midfoot sagging at the talonavicular joint. Despite these mild postoperative abnormalities, good correction with plantigrade, painless feet was generally obtained when this procedure was performed in children younger than 27 months of age.
Acquired Hallux Varus and Clinical Tolerability
Authors: Trnka H.-J. , Zettl R. , Hungerford M. , Mühlbauer M. , Ritschl P.
Published: March 2013

This retrospective study was undertaken to determine the long-term clinical problems, residual disability, and need for further surgery in patients with iatrogenic hallux varus. Between 1975 and 1985, in 16 (19 feet) of 83 patients who underwent foot surgery for hallux valgus or metatarsus primus varus, hallux varus deformity was noted at 1-year follow-up on dorsoplantar roentgenograms obtained with the patients bearing weight. Thirteen of those patients (16 feet) were reexamined at an average of 18.3 years (220 months) after surgery. The average hallux varus deformity in this group was 10.1°. Eleven patients (12 feet) rated their results as excellent. The average hallux metatarsophalangeal interphalangeal score for all patients was 91.5 points. Only those with extreme hallux varus deformity were dissatisfied or required further surgery.
Biomechanical Evaluation of Polylactide Absorbable Screws Used for Syndesmosis Injury Repair
Authors: Thordarson David B. , Hedman Thomas P. , Gross Dominic , Magre George
Published: March 2013

Simulated syndesmosis injuries were created in 12 fresh-frozen, below-knee cadaver specimens. Six specimens were repaired with a 4.5 mm stainless steel screw, and six were repaired with a 4.5 mm polylactide screw. Three specimens of each group were tested in load to failure by axially loading with 1400 N and externally rotating to 90°. Three specimens in each group underwent fatigue testing by axially loading with 700 N and applying 2.5 N-m of torque for 57,700 cycles. Radiographs and computed tomography scans were evaluated. None of the screws broke or failed. Similar load to failure was noted in polylactide and control groups. Fatigue testing revealed no significant change in stiffness. No significant screw damage was evident on radiographic or computed tomography evaluation. The data suggest that a polylactide screw has sufficient fatigue and failure strength to allow for healing of this injury in a clinical situation.
Stability of the Arch of the Foot
Authors: Kitaoka Harold B. , Ahn Tae-Kun , Luo Zong Ping , An Kai-Nan
Published: March 2013

We defined the relative contributions of six ligaments in stabilizing the arch of the foot: plantar aponeurosis, long-short plantar ligaments, plantar calcaneonavicular ligament (spring ligament), medial talocalcaneal ligament, talocalcaneal interosseous ligament, and tibionavicular portion of the deltoid ligament. Nineteen fresh-frozen human foot specimens were used. A load of 445 N was applied axially to simulate standing-at-ease posture. Three-dimensional positions of tarsal bones before and after ligament sectioning were determined with the use of a magnetic tracking device. The motions were presented in the form of screw axis displacements, quantitating rotation, and axis of rotation orientation. After sectioning one structure, the arch did not collapse on any specimen and there was no obvious change by visual inspection. There were, however, measurable changes in tarsal bone position. Metatarsal-to-talus total rotation difference was greatest with spring ligament and deltoid ligament sectioning, with an average of 2.1° ± 1.7° and 2.0° ± 0.2° difference, respectively. Calcaneus-to-talus rotation difference was greatest with talocalcaneal interosseous ligament sectioning, with an average of 1.7° ± 1.5°. The spring ligament, deltoid ligament, and talocalcaneal interosseous ligament were most important for arch stability.
Reconstruction of the Lateral Ankle Ligaments Using an Inferior Extensor Retinaculum Flap
Authors: Saragaglia D. , Fontanel F. , Montbarbon E. , Tourné Y. , Picard F. , Charbel A.
Published: March 2013

The aim of this study was to assess the results of 32 cases of chronic ankle instability. These were treated by ligament shortening and reinforced with an inferior extensor retinaculum flap. All patients complained of persistent functional instability unrelieved with proprioceptive exercises.

Results were assessed clinically (pain, instability, recovery of sports activity, mobility) and radiologically (correction of laxity on stress x-rays). This enabled us to draw up a revision score on a scale of 100 points. We obtained a mean score of 86.7 points (45–100 points), and subjective results showed that 88% of the patients were satisfied with the surgery.
Subtalar Distraction Bone Block Fusion: An Assessment of Outcome
Authors: Bednarz Paul A. , Beals Timothy C. , Manoli Arthur
Published: March 2013

Twenty-nine feet in 28 patients who underwent subtalar distraction bone block fusion for the treatment of subtalar deformities associated with symptomatic arthrosis were evaluated. All patients were assessed with the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale score. Eighteen men and 10 women with a mean age of 44 years were evaluated. The mean follow-up was 33 months. Subtalar arthrosis was secondary to trauma in 27 of 29 feet (93%) with os calcis fractures in 19, subtalar dislocations in 5, and talus fractures in 3. Eighteen of the 28 patients (64%) returned to either full- or part-time work. The change in the mean AOFAS Ankle-Hindfoot Scale score from 25 preoperatively to 75 postoperatively was statistically significant ( P < 0.0001). The radiographic analysis of the pre- and postoperative standing lateral radiographs showed an average increase of 8 mm in hindfoot height, 9° in lateral talocalcaneal angle, and 11° in lateral talar declination angle that were statistically significant ( P < 0.0001). All patients but one (96%) were satisfied. Complications included four nonunions, two varus malunions, one metatarsal stress fracture, and one medial plantar nerve paresthesia. Each nonunion occurred in patients who smoked.
The Effect of Tibiotalar Fixation on Foot Biomechanics
Authors: Wayne Jennifer S. , Lawhorn Keith W. , Davis Kenneth E. , Prakash Karanvir , Adelaar Robert S.
Published: March 2013

Contact areas and peak pressures in the posterior facet of the subtalar and the talonavicular joints were measured in cadaver lower limbs for both the normal limb and after fixation of the tibiotalar joint. Six joints were fixed in neutral, in 5–7° of varus and of valgus. Ten degrees of equinus angulation was also studied. Each position of fixation was tested independently. Neutral was defined as fixation without coronal or sagittal plane angulation compared with prefixation alignment of the specimen. When compared with normal unfused condition, peak pressures increased, and contact areas decreased in the subtalar joint for specimens fixed in neutral, varus, and valgus. However, the change in peak pressure for neutral fusion compared with normal control was not statistically significant ( P > 0.07). Peak pressures for varus and valgus fixation were significantly different from normal ( P < 0.001). Contact areas for all positions of fixation were significantly different from normal ( P < 0.001). Coronal plane angulation, however, also resulted in significantly lower contact areas compared with neutral fixation ( P < 0.001). Contact areas and peak pressures in the talonavicular joint did not appear to be substantially affected by tibiotalar fixation with coronal plane angulation. Equinus fixation qualitatively increased contact areas and peak pressures in the talonavicular and posterior facet of the subtalar joint.

Neutral alignment of the tibiotalar joint in the coronal and sagittal planes altered subtalar and talonavicular joint contact characteristics the least compared with normal controls. Therefore, ankle fusion in the neutral position would be expected to most closely preserve normal joint biomechanics and may limit the progression of degenerative arthrosis of the subtalar joint.
Acute Disruption of the Posterior Tibial Tendon Associated with Open-Fracture Dislocation of the Ankle
Authors: Bos Mary , Lusskin Ralph
Published: March 2013

A 27-year-old man with a high-energy, open-fracture dislocation of the ankle underwent debridement and open reduction of his injuries. During surgery a disruption-laceration of the posterior tibial tendon at the level of the fracture of the medial malleolus was found. Repair required location of the proximal muscle and tendon and controlled traction of the musculotendinous unit from its retracted position. Common aspects in the nine previously reported instances of this lesion include relatively high energy of the injury and the fracture type, a transverse fracture in the medial malleolus. Unique to this case was the open injury.
Fixation Comparison for Chevron Osteotomies
Authors: Crosby Lynn A. , Bozarth Gordon R.
Published: March 2013

A comparison study of temporary K-wire fixation, permanent Herbert Whipple screw fixation, versus no osteotomy fixation was performed on distal chevron osteotomies for hallux valgus deformities. Nineteen chevron osteotomies were performed on 17 patients. Six patients received a Herbert Whipple screw for fixation, seven patients received temporary K-wire fixation, and six patients received no fixation for the chevron osteotomy. The average postoperative hallux valgus (HV) angle improved by 7.1° with no fixation, 6.3° with temporary K-wire fixation, and 9.5° with Herbert Whipple screw fixation. Comparison of the three groups using the Student's t-test revealed no statistical difference between the three groups ( P = 0.6). The increased anesthesia time and operative costs for Herbert Whipple screw fixation was found to be statistically significant in comparison with the use of no fixation ( P = <0.001). Time and cost studies were not significantly different for the K-wire and no fixation groups. Follow-up averaged 3.3 years. All patients reported satisfaction with the procedure and an improvement of their preoperative complaints. No significant difference in patient satisfaction was found to exist between the groups receiving fixation and those who did not have fixation. The results of this study can find no long-term benefit when comparing costs and patient satisfaction with the use of any temporary or permanent fixation of osteotomy sites when performing chevron osteotomies.
Ultrasonographic Diagnosis of Recurrence after Excision of an Interdigital Neuroma
Authors: Levine Stuart E. , Myerson Mark S. , Shapiro Patricia P. , Shapiro Steven L.
Published: March 2013

We retrospectively reviewed the records of 20 patients (21 feet) with previous interdigital neuroma resections and symptoms suggestive for, but not diagnostic of, recurrent neuroma. Sonography was performed when clinical findings supplemented by local anesthetic block did not conclusively confirm the presence of recurrent neuroma. Studies performed in 13 patients (14 feet) were positive for recurrent neuromas. Three studies were indeterminate. The remaining four studies were negative for recurrent neuroma. The ultrasound studies were performed at an average of 19.2 months (range, 2–82 months) after the resection. Nine patients with 11 previous interdigital neuromas underwent ultrasonographic examination of the forefoot and subsequent revision neuroma resection. At surgery, gross and histologic findings were consistent with recurrent neuroma in 10 of 11 cases; one patient was found to have metatarsal-phalangeal synovitis. Ultrasonography appears to be a useful means for confirming neuroma recurrence in patients with symptoms after interdigital neurectomy when the diagnosis is not clear on physical examination.
Duplication of the Medial Column Presenting as a Fixed Equinus Deformity: A Case Report
Authors: Feeney Micheál S. , Devitt Aiden T. , Stephens Michael M.
Published: March 2013

A case of accessory talus is described in which a large ossicle on the medial aspect of the talus had formed an articulation with the distal tibial epiphysis and had produced a fixed equinus deformity of the ankle. We propose that this ossicle, in association with a previously excised accessory toe at the level of the base of the first metatarsal, represents a partial duplication of the medial column of the foot.
Results of Preprocedure and Postprocedure Toe Cultures in Orthopaedic Surgery
Authors: Zacharias Jeffrey , Largen Pamela S. , Crosby Lynn A.
Published: March 2013

This study was to determine whether there is any benefit to wrapping the toes sterilely during orthopaedic procedures not involving the foot but performed on the lower extremity. The group studied consisted of 12 patients who had an orthopaedic procedure performed in which the foot and toes were included in the surgical prep, but not involved in the surgical procedure. Nine of the 12 patients (75%) had positive results from preprocedural aerobic cultures and two of the 12 (16.6%) had positive results from preprocedural fungal cultures. Recolonization of the bacteria between the toes was also demonstrated. Sterile draping of the toes would minimize the risk of infection and also protect against bacteria that recolonize during the procedure.
Operative Management of Foot and Ankle Equinovarus Associated with Focal Dystonia
Authors: Moore Thomas J. , Evans William , Murray Douglas
Published: March 2013

Six surgical procedures, consisting of tendon transfers and releases, were performed in five patients with idiopathic focal dystonia involving the lower extremity. All patients were female. Surgical management was performed to correct clinically significant foot abnormalities. The goal of each procedure was functional improvement and obtaining a plantigrade foot. The SPLATT (split anterior tibial tendon transfer) procedure was performed in each foot with a flexible equinovarus foot abnormality. Follow up at a mean of 27.2 months (range, 8–40 months) yielded satisfactory clinical results without significant complications. Clinical equinovarus has not recurred after this procedure. All patients remain brace-free ambulators.
Relationship Between Foot Pressure Pattern and Foot Type
Authors: Walker Martha , Fan Hui-Ji
Published: March 2013

Foot type and location of area of peak pressure under the metatarsal heads were determined for 54 healthy adults between the ages of 21 and 39 years. Feet were classified as neutral, pronated, or supinated. Each subject walked barefoot over a pedobarograph, and the area of peak pressure was identified as being either medial, central, or lateral under the metatarsal heads. A Fisher's exact test determined that there was a significant relationship between the area of peak pressure and foot type. A post hoc λ asymmetric test showed that the relationship was very weak. Nearly half (49%) of the feet were classified as neutral, 36% were pronated, and 15% were supinated. Pressure patterns were as follows: 62% central, 26% medial, and 12% lateral. Other factors besides foot type influence the area of peak pressure under the metatarsal heads.
Complete Atraumatic Rupture of the Flexor Hallucis Longus Tendon: A Case Report and Review of the Literature
Authors: Wei Steven Y. , Kneeland J. Bruce , Okereke Enyi
Published: March 2013

A complete atraumatic rupture of the flexor hallucis longus tendon in a patient without systemic disease is a rare occurrence. Although four cases of complete traumatic ruptures have been cited in the literature, only one case of a complete atraumatic rupture has been previously reported. Presented here is a second case with a review of the literature and a discussion of the surgical indications.
Isolated Subtalar Arthrodesis
Authors: Mann Roger A. , Beaman Douglas N. , Horton Greg A.
Published: March 2013

Forty-eight isolated subtalar arthrodeses in 44 patients with an average follow-up of 59.5 months were retrospectively reviewed. Original diagnoses included talocalcaneal coalition, healed calcaneal fracture with subtalar arthrosis, acquired flatfoot because of posterior tibial tendon dysfunction, degenerative subtalar arthrosis, subtalar instability, and psoriatic arthritis. Ninety-three percent of patients were very satisfied or satisfied with their treatment. Pain and function improved significantly, and the American Orthopaedic Foot and Ankle Society ankle-hindfoot score at follow-up was 89. There were six unsatisfactory results: three feet had calcaneal fractures and three were malpositioned. Union was achieved in all cases. Transverse tarsal motion was diminished by 40%, dorsiflexion by 30%, and plantarflexion by 9%. There was a 36% and 41% incidence of mild radiographic progression of arthrosis in the ankle and transverse tarsal joint, respectively. Isolated subtalar arthrodesis provided a highly successful result in the disease presented, and this study provides support for the use of a selected hindfoot fusion procedure for specific indications.
Ankle Fracture Classification: A Comparison of Reliability of Three X-ray Views Versus Two
Authors: Brage Michael E. , Rockett Matthew , Vraney Robert , Anderson Robert , Toledano Alicia
Published: March 2013

Our hypothesis was that malleolar ankle fractures could be classified with two radiographic views as reliably as with three views. Four different observers independently evaluated 99 sets of ankle radiographs. The examiners classified the ankle fractures by using both the Lauge-Hansen and Danis-Weber systems. The interobserver and intraobserver variations were analyzed by kappa statistics. With regard to intraexaminer reliability, the examiners demonstrated excellent accord in classifying the fractures in the Danis-Weber system with either three views or two views. The kappa values were comparable. In the Lauge-Hansen system, three examiners demonstrated excellent accord and one examiner demonstrated good accord in classifying the fractures. Similar kappa values were generated when examiners classified fractures with either three views or two views. With regard to interexaminer reliability, good to excellent accord was demonstrated overall among the four examiners when they used the Danis-Weber system with either three views or two views. The examiners were in good agreement when they used the Lauge-Hansen system. Similar kappa values were generated whether the examiners used three views or two views. Three radiographic views are usually ordered for evaluation of an acute ankle injury. Previous studies have shown that only two views are needed for diagnosis of a malleolar ankle fracture. This study demonstrates that malleolar ankle fractures can be classified with two views, lateral or mortise, with a reliability as good as that achieved with three views. The best agreement is achieved with lateral and mortise views.