bluuebunny/crossref_metadata_2025 huggingface dataset:
Magnetic Resonance Imaging of the Lisfranc Ligament of the Foot
Authors: Potter Hollis G. , Deland Jonathan T. , Gusmer Peter B. , Carson Eric , Warren Russell F.
Published: March 2013

Early recognition of subtle Lisfranc injuries is important, because deformity and disability may develop after initially unremarkable radiographs. The authors studied 23 patients (mean age, 25.4 years) with a history of midfoot trauma with both radiographs and magnetic resonance imaging (MRI). When compared with the uninjured side, diastasis on radiographs ranged from 0 to 2 mm. The MRI revealed 2 intact ligaments, 3 complete tears, and 18 partial tears. All patients with complete tears had at least 2 mm more displacement between the second metatarsal and medial cuneiform, compared with the unaffected side. Because of the presence of complete or near complete rupture, seven patients underwent surgery, and the degree of rupture was confirmed. MRI of five cadaver specimens was also performed, disclosing discrete dorsal and plantar components. MRI was found to be useful in identifying Lisfranc ligament tears. If there is clear diastasis on weightbearing radiographs, MRI is not indicated. Whereas radiographic findings may be equivocal, however, MRI may accurately disclose the degree of ligament disruption.
Three-Dimensional Analysis of Flatfoot Deformity: Cadaver Study
Authors: Kitaoka Harold B. , Luo Zong-Ping , An Kai-Nan
Published: March 2013

Eleven fresh-frozen cadaver foot specimens were tested to define changes in tarsal alignment associated with flatfoot, or pes planus, a common clinical problem. The three-dimensional position of four bones (talus, calcaneus, navicular, and first metatarsal) relative to the fixed tibia was determined with a magnetic tracking system in the intact foot and flatfoot conditions. In the flatfoot, the average metatarsal-to-talar position difference was 11.7° ± 4.4° in abduction ( P < 0.0001), 10.4° ± 3.6° in dorsiflexion ( P < 0.0001), and 10.9° ± 6.0° in eversion ( P < 0.0001) compared with the intact foot. The average calcaneal-to-talar position difference was 2.2° ± 2.6° in abduction ( P = 0.0171) and 2.7° ± 2.0° in eversion ( P = 0.0012) compared with the intact foot. The average navicular-to-talar position difference was 13.6° ± 5.0° in abduction ( P < 0.0001), 10.5° ± 6.6° in dorsiflexion ( P = 0.0004), and 8.1° ± 3.8° in eversion ( P < 0.0001) compared with normal. The average talar-to-tibial position difference was −8.2° ± 3.2° in dorsiflexion ( P < 0.001) compared with the intact foot. The average arch height difference was 6.0 ± 2.7 mm ( P < 0.0001) less than the normal condition. The deformity associated with flatfoot is complex and occurs in multiple joints and in all three planes. An understanding of the normal and pathologic (flatfoot) conditions is necessary to surgically restore appropriate alignment and function in hindfoot reconstruction operations.
Two Reconstructive Techniques for Flatfoot Deformity Comparing Contact Characteristics of the Hindfoot Joints
Authors: McCormack Anne P. , Niki Hisateru , Kiser Patti , Tencer Allan F. , Sangeorzan Bruce J.
Published: March 2013

The effect of two different methods of reconstruction of flatfoot deformity and the role of the posterior tibial tendon on the contact characteristics of the hindfoot joints were quantified using pressure-sensitive film. Each of 10 cadaver feet was loaded quasi-statically by an axial compressive force to simulate varying loads. First, a specimen was tested intact, then it was tested after sectioning the spring ligament and loading the specimen cyclically to create one type of flatfoot deformity. It was then tested again after reconstructing the deformity. Reconstructions used were the Dillwyn-Evans procedure (bone graft in osteotomy of the calcaneus) or the calcaneocuboid distraction arthrodesis (CCDA). We found that surgically produced flatfoot deformity altered mainly the talonavicular joint, by decreasing its contact area. The Dillwyn-Evans method had less effect on the talonavicular joint (altering 2 of 6 measured parameters) than the CCDA (3 of 6) and more effect on the anteriomedial facet (altering 3 of 6 parameters) than the CCDA (1 of 6). The Dillwyn-Evans method had more effect on the posterior facet (altering 2 of 6 measured parameters) than the CCDA (1 of 6). Function of the posterior tibial tendon had no effect on contact characteristics of the hindfoot joints after either type of reconstruction. These findings are based on measurements using a quasi-statically-loaded foot model at three selected positions, and results may be different with dynamic loading.
“Os Post Peronei” and the Posterolateral Nutcracker Impingement Syndrome
Authors: Callanan Ian , Williams Lloyd , Stephens Michael
Published: March 2013

Impingement syndromes have been described in relation to accessory or anomalous bony additions to the foot skeleton. We describe a hitherto undescribed accessory bone in the hindfoot causing posterolateral impingement in a 28-year-old woman.
Local Bone Deformation at Two Predominant Sites for Stress Fractures of the Tibia: An In Vivo Study
Authors: Ekenman Ingrid , Halvorsen Kjartan , Westblad Pär , Fellãnder-Tsai Li , Rolf Christer
Published: March 2013

Local bone deformation was registered at two predominant injury sites for tibial stress fractures in a healthy female volunteer. Two instrumented strain gauge staples were inserted under local anesthesia to the anterior middiaphysis (AM) and to the posteromedial part of the distal tibia (PD). Calibration and reliability of the instrumented staple system have previously been demonstrated in vitro. Concomitant ground reaction forces were registered with a Kistler force plate. Studying peak values, it was shown that during a voluntary 30-cm forward jump, PD deformation was greater during forefoot landing (2700–4200 microstrain) than during a heel strike landing (1200–1900 microstrain) and also compared with the concomitant AM deformation under both above testing conditions (1300–1900 microstrain). The stance phase during walking resulted in PD deformation of 950 microstrain, whereas the concomitant AM deformation was 334 microstrain. The greatest AM deformation (mean, 2128 microstrain) was registered during ground contact after a voluntary vertical drop from a height of 45 cm, concomitant with a PD deformation of 436 microstrain. These data are the first to show different local deformations at various sites of the tibia in vivo. The PD deformation was larger than previously noted from other parts of the tibia, whereas the middiaphysis data are consistent with other reports. The results may support the clinical assumption of different etiologies for stress fractures at these predominant sites.
Midfoot Fusion Technique for Neuroarthropathic Feet: Biomechanical Analysis and Rationale
Authors: Marks Richard M. , Parks Brent G. , Schon Lew C.
Published: March 2013

To test the hypothesis that a plate applied to the plantar (tension) side of the medial midfoot provides stronger fixation than midfoot fusion with screw fixation, we biomechanically compared the two constructs for midfoot fusion. We created a model of midfoot instability in eight matched pairs of cadaver legs by section of joint capsule, ligaments, and tendons about Lisfranc's joints, and then performed a load-to-failure study to compare the fixation provided by a plantarly applied third tubular plate with that by cortical screws. After an initial load deformation curve to 1000 N was obtained, specimens were cyclicly loaded at 200 to 750 N for 3000 cycles and then loaded to failure (screw pullout, fracture, or deformation >3 mm). Comparing the plantar plate and midfoot fusion with screw fixation constructs, a plate applied to the plantar (tension) aspect of the medial midfoot provides a stronger, sturdier construct than does midfoot fusion with screw fixation.
Pathology of the Posterior Tibial Tendon in Posterior Tibial Tendon Insufficiency
Authors: Mosier Susan M. , Lucas David R. , Pomeroy Gregory , Manoli Arthur
Published: March 2013

Gross and histologic examinations of 15 normal cadaver and 15 surgical posterior tibial tendons from patients with posterior tibial tendon insufficiency were performed. All surgical specimens were abnormal with enlargement distal to the medial malleolus and a dull white appearance. At histologic examination, 12 of 15 cadaver tendons displayed normal tendon structure characterized by linear orientation of collagen bundles, normal fibroblast cellularity, low vascular density, and insertional chondroid metaplasia. The surgical specimens displayed a degenerative tendinosis characterized by increased mucin content, fibroblast hypercellularity, chondroid metaplasia, and neovascularization. This resulted in marked disruption of the linear orientation of the collagen bundles.
Metatarsophalangeal and Intermetatarsal Angle: Different Values and Interpretation of Postoperative Results Dependent on the Technique of Measurement
Authors: Schneider Wolfgang , Knahr Karl
Published: March 2013

For measurement of the first metatarsophalangeal angle and intermetatarsal angle I-II, five different methods for drawing the axis of the first metatarsal have been published. This study aimed to evaluate differences in the resulting angles that depend on the method of drawing this axis. Using pre- and postoperative radiographs of 20 patients who had surgery on the hallux (chevron procedure), highly significant differences were found: mean values for the preoperative metatarsophalangeal angle ranged from 27.3° to 31.9° the mean postoperative values were calculated at 8.6° to 20.3°. The preoperative mean of intermetatarsal angle I-II showed values from 13.0° to 17.6° the postoperative mean ranged from 5.2° to 16.7°. These differences-especially in the postoperative evaluation-resulted in a postoperative improvement between 11.6° and 20.8° for the metatarsophalangeal angle and between 0.9° and 10.0° for the intermetatarsal angle. These wide differences seem to be unacceptable for angles as a criterion of success in surgery on the hallux. The reason for these discrepancies can be found in the different relations of the points of reference to the anatomical outline of the metatarsal and the site of osteotomy. As a consequence of this study, defining the axis of the first metatarsal as a line connecting the center of the articular surface of the metatarsal head and the center of the proximal articulation can be recommended as the most appropriate method. The resulting angles are independent of the type of surgery performed on the hallux.
Measurement of Dorsal Mobility in the First Ray: Elimination of Fat Pad Compression as a Variable
Authors: Glasoe Ward Mylo , Allen Mary Kay , Yack H. John
Published: March 2013

Previous designs for a device to measure first ray mobility have included compression of the first metatarsal fat pad as part of the measurement of displacement or have failed to standardize the force applied to the head of the first metatarsal. In this investigation, assessment of vertical mobility of the first ray of both feet in 14 volunteers was determined using a device that applied dorsiflexing force to the first metatarsal. First ray displacement was measured initially from the plantar surface and then from the dorsal aspect of the head of the first metatarsal. The difference between plantar- and dorsal-surface-measured vertical displacement was highly significant. This study suggests that mobility of the first ray measured from the dorsal aspect of the first metatarsal head eliminated compression of the plantar fat pad from being interpreted as part of the measurement of displacement.
The Effect of Musculus Extensor Digitorum Brevis Transfer for Chronic Lateral Ankle Instability
Authors: Vammen Sten , Petersen Lars Gorm , Kaalund Søren , Jørqensen Torben Ejsing
Published: March 2013

Thirty-eight patients who had undergone surgery for instability of their ankles between 1980 and 1994 answered questionnaires regarding the results. In 32 of the 38 patients, clinical examinations were performed including practice on a balancing board, circle-running tests, and active and passive electromyographic measurements on the musculus extensor digitorum brevis (MEDB). The questionnaires showed that 90% of the patients with a median observation time of 9 years (range, 16 months-14 years) were content with the results of their operations, and the number of painful distortions of the ankle were reduced considerably in 96% of the patients. Within the group of active sportspersons with more than 4 hours of weekly exercise, 42% returned to their previous levels of sports activity. The tendency to have ankle pain disappeared in 90% of the patients. At the clinical examination, the time spent on the balancing board was reduced by 25% for the operated foot. When the patient ran in a circle with the operated leg toward the center, as compared with running with the nonoperated leg toward the center, the time was enhanced by 8%. We found electromyographic activity in the MEDB during active movement of the toes and with passive supination of the talocrural joint but not during passive pronation of the foot. The MEDB transfer procedure not only strengthens the lateral ligaments but also seems to add proprioceptive protection to the ankle to prevent distortions.
Hypertrophic Extensor Digitorum Brevis Muscles Simulating Pseudotumors: A Case Report
Authors: Montgomery Fredrik , Miller Robert
Published: March 2013

Pseudotumors can involve soft tissue or bone, and can lead to difficulty or uncertainty in diagnosis and treatment. The authors describe bilateral hypertrophy of the belly of the extensor digitorum that simulated ganglia.
Biplanar Chevron Osteotomy
Authors: Chou Loretta B. , Mann Roger A. , Casillas Mark M.
Published: March 2013

We retrospectively reviewed the results of using a biplanar chevron osteotomy performed on patients who presented with hallux valgus deformities with an increased distal metatarsal articular angle (DMAA). The study included 17 feet (14 patients) of 12 women and 2 men. The average follow-up was 33 months. The average American Orthopaedic Foot and Ankle Society Hallux Metatarsophalangeal-lnterphalangeal Clinical Rating Score was 91. Ten of the 14 patients (13 of 17 feet) stated that they would choose to undergo the procedure again. The hallux valgus angle was improved from an average of 22° to 18°, the intermetatarsal angle from 11° to 9°, and the DMAA from 16° to 9°. We have demonstrated this procedure to be useful in the treatment of symptomatic bunion deformities with an increased DMAA.
Modified Mitchell Osteotomy for Hallux Valgus
Authors: Kuo Chung-Hung , Huang Peng-Ju , Cheng Yuh-Min , Huang Kuan-Yu , Chen Tai-Bin , Chen Ying-Wang , Lin Sen-Yuen
Published: March 2013

From 1988 to 1995, 96 patients (161 feet) underwent a modified Mitchell distal metatarsal osteotomy performed for mild-to-moderate hallux valgus. On AP x-rays of the standing foot, the average intermetatarsal angle was corrected from 15° to 9°, and the first metatarsophalangeal angles were corrected from an average of 41° to 15°. Criteria for evaluation of clinical results included relief of pain, appearance of foot, and shoe wear. After an average follow-up of 38 months, the overall satisfaction rate was 92.5%. Complications included 13 pin tract infections, two delayed unions, and two correction losses. The most common late sequela was transfer metatarsalgia of the lesser toes, which occurred in 20 feet (12.4%), leading to some dissatisfaction. The Mitchell osteotomy can be used on cases with less than 20° of intermetatarsal angle, offering a stable construct with easy postoperative care.
Traumatic Extrusion of the Talus (Missing Talus)
Authors: Papaioannou Nikolaos A. , Kokoroghiannis Constantine G. , Karachalios Georgios-Grigorios
Published: March 2013

Complete dislocation of the talus is an extremely rare injury. We report on a case that was treated according to a surgical technique described by Günal et al. According to this technique, a pseudarthrosis is created between the tibia and the calcaneus by transposing and fixing the medial malleolus laterally and displacing the entire foot anteriorly. The result was considered to be initially unsatisfactory. At the 2-year follow-up examination, the outcome was considered to be satisfactory. This was attributed to preservation of motion and stability in the new mortise.
Metastatic Prostate Carcinoma to the Foot with Magnetic Resonance Imaging and Pathologic Correlation
Authors: Schwartz Eric D. , Donahue Francis I. , Bromson Mark S. , Blaise Joseph F.
Published: March 2013

Metastases to the bones of the foot from prostate carcinomas are rare and usually are associated with diffuse metastatic disease. The authors encountered a patient who presented with prostate carcinoma metastases limited to the right foot. Magnetic resonance imaging correlation in this case demonstrated normal marrow signal in the surrounding bones of the foot and increased vascularity of the foot.
Use of Ultrasonography Versus Magnetic Resonance Imaging for Tendon Abnormalities Around the Ankle
Authors: Rockett Matthew S. , Waitches Gayle , Sudakoff Gary , Brage Michael
Published: March 2013

A prospective study was performed on 28 patients who underwent surgery for tendon disorders around the ankle. Preoperatively, all patients had real-time, high resolution ultrasonography performed with a 7.5 or 10 mHz transducer. Twenty of these patients also had a preoperative magnetic resonance imaging (MRI) examination of the ankle. A total of 54 tendons were inspected intraoperativey, revealing a total of 24 intrasubstance or complete tendon tears. These surgical findings were compared with the ultrasound and MRI findings, from which the sensitivity, specificity, and accuracy were calculated for both modalities. Ultrasound produced results with a sensitivity measurement of 100%, specificity of 89.9%, and accuracy of 94.4%. MRI produced results with a sensitivity measurement of 23.4%, specificity of 100%, and accuracy of 65.75%. Ultrasound results were more sensitive and accurate than MRI in the detection of ankle tendon tears in our study.
Charcot Restraint Orthotic Walker
Authors: Mehta Janak A. , Brown Christopher , Sargeant Naomi
Published: March 2013

Five patients (three with insulin dependent diabetes mellitus (IDDM), one with noninsulin dependent diabetes mettlitus (NIDDM), and one with hereditary sensorimotor neuropathy (HSMN)) with stage 1 Charcot's neuroarthropathy involving the midfoot and or subtalar and ankle joints were fitted with a Charcot restraint orthotic walker (CROW). The rationale for this orthotic management was to maintain a plantigrade foot for ambulation and to protect the joints and skin by the uniform transfer or distribution of weight over the foot until the time when the pathology reached the stage of coalescence. The patients were able to fully bear weight and to ambulate with the CROW. All patients noted varying measures of improvement in symptoms and function at an average 12-month follow-up. The CROW is a useful orthosis in the armamentarium for treating neuroarthropathy of the pedal joints.
Atypical Medial Dislocation of the First Metatarsophalangeal Joint
Authors: Massari Leo , Ventre Tommaso , lirillo Antonio
Published: March 2013

Medial dislocation of the great toe without fracture or sesamoid separation is an unusual event. We are reporting such a case which occurred in a man after a motor vehicle accident. The patient was treated with closed reduction and cast immobilization. The patient recovered all his activities after 30 days. Three-year follow-up showed a complete recovery, clinically and radiographically, with only slight radiographic signs of osteoarthritis, which was present also in the contralateral foot.
Great Toe Neuroarthropathy: A Report of Two Cases
Authors: Beals Timothy C. , Manoli Arthur
Published: March 2013

Two cases of diabetic neuroarthropathy of the great toe are presented. The differential diagnosis is emphasized, and the literature regarding this unusual site for symptomatic disease is reviewed.
Delayed Aseptic Swelling After Fixation of Talar Neck Fracture with a Biodegradable Poly-L-Lactide Rod: Case Reports
Authors: Yoshino Nobuyuki , Takai Shinro , Watanabe Yoshinobu , Kamata Keiji , Hirasawa Yasusuke
Published: March 2013

A 63-year-old woman complained of acute swelling and pain in her ankle at 15 months, after fixation of a talar neck fracture with poly-L-lactide rods. Roentgenographic and laboratory data revealed no abnormalities, but T1-weighted magnetic resonance imaging showed a diffuse area of low intensity in the talus. After nonweightbearing for 1 month, local findings had disappeared and the area of low intensity shown by magnetic resonance imaging had decreased without surgical treatment. Although there have been some reports of aseptic swelling or synovitis after fixation of a fracture with polyglycolide rods or screws, there has been no report of such cases with poly-L-lactide rods or screws.
Replantation of the Great Toe: Two Case Reports
Authors: Sakamoto Kazuaki , Kozuki Kenso , Maki Hiroshi
Published: March 2013

We performed two replantations of the great toe in children less than 4 years of age. Both cases were successful, and there was no complaint of pain or disturbance in gait, postoperatively. Good results seemed to be based on mobility of the metatarsophalangeal joint and on sensation in the replanted toe. In our opinion, all traumatic amputations of the great toe in children should be replanted, if the conditions of the foot and amputated toe allow vascular and neural reattachment.
Fractures of the Lateral Process of the Talus: Two Case Reports and a Comprehensive Literature Review
Authors: Tucker Daniel J. , Feder John M. , Boylan Joseph P.
Published: March 2013

Fractures of the lateral process of the talus are frequently overlooked and should be considered in the differential diagnosis of patients with acute and chronic ankle pain. Early diagnosis is emphasized in all series reviewed in the literature to prevent long-term complications. Thorough radiographic evaluation is necessary to determine the need for operative vs. nonoperative management. Small nondisplaced fractures are treated with cast immobilization, whereas large or displaced fractures usually require open reduction and internal fixation. Comminution of fragments may necessitate surgical excision. To achieve the best possible results, a timely diagnosis is required, and it is our belief that early treatment has better overall results.
Persistent Disability Associated with Ankle Sprains: A Prospective Examination of an Athletic Population
Authors: Gerber J. Parry , Williams Glenn N. , Scoville Charles R. , Arciero Robert A. , Taylor Dean C.
Published: March 2013

The purpose of this study was to examine a young athletic population to update the data regarding epidemiology and disability associated with ankle injuries. At the United States Military Academy, all cadets presenting with ankle injuries during a 2-month period were included in this prospective observational study. The initial evaluation included an extensive questionnaire, physical examination, and radiographs. Ankle sprain treatment included a supervised rehabilitation program. Subjects were reevaluated at 6 weeks and 6 months with subjective assessment, physical examination, and functional testing. The mean age for all subjects was 20 years (range, 17–24 years). There were 104 ankle injuries accounting for 23% of all injuries seen. There were 96 sprains, 7 fractures, and 1 contusion. Of the 96 sprains, 4 were predominately medial injuries, 76 were lateral, and 16 were syndesmosis sprains. Ninety-five percent had returned to sports activities by 6 weeks; however, 55% of these subjects reported loss of function or presence of intermittent pain, and 23% had a decrement of >20% in the lateral hop test when compared with the uninjured side. At 6 months, all subjects had returned to full activity; however, 40% reported residual symptoms and 2.5% had a decrement of >20% on the lateral hop test. Neither previous injury nor ligament laxity was predictive of chronic symptomatology. Furthermore, chronic dysfunction could not be predicted by the grade of sprain (grade I vs. II). The factor most predictive of residual symptoms was a syndesmosis sprain, regardless of grade. Syndesmosis sprains were most prevalent in collision sports. This study demonstrates that even though our knowledge and understanding of ankle sprains and rehabilitation of these injuries have progressed in the last 20 years, chronic ankle dysfunction continues to be a prevalent problem. The early return to sports occurs after almost every ankle sprain; however, dysfunction persists in 40% of patients for as long as 6 months after injury. Syndesmosis sprains are more common than previously thought, and this confirms that syndesmosis sprains are associated with prolonged disability.
Occult Osseous Injuries After Ankle Sprains: Incidence, Location, Pattern, and Age
Authors: Labovitz Jonathan M. , Schweitzer Mark E.
Published: March 2013

We retrospectively evaluated 109 magnetic resonance studies in patients with prior ankle sprains to investigate the frequency and pattern of bone bruises. Patterns of bone bruises were then correlated with the ligaments injured. In addition, the age of the injury was determined from medical records to correlate the presence of bone bruises with the temporal period from injury. Bone bruises occurred in 39% of ankle sprains. Multiple bone bruises were seen in 40% of those with bone bruises; they occurred more frequently in patients with multiple ligaments injured. The marrow changes may be secondary to impaction, rotary instability of the ankle, and microavulsion vectors. Bone bruise-like lesions were seen at an average of 8.4 weeks in age but were seen more than a year after the injury. We conclude that bone bruises frequently occur in patients with ankle sprains, and the marrow changes may be caused by one of the three proposed mechanisms.
Support of the Talus: A Biomechanical Investigation of the Contributions of the Talonavicular and Talocalcaneal Joints, and the Superomedial Calcaneonavicular Ligament
Authors: Reeck Jay , Felten Nancy , McCormack Anne P. , Kiser Patti , Tencer Allan F. , Sangeorzan Bruce J.
Published: March 2013

The goal of this study was to determine the magnitude of force transmission to the talus by its inferior articulations to provide insight into mechanisms involving acquired deformities of the hindfoot. Cadaver feet were mounted in a loading apparatus that applied axial force through the tibia and fibula as well as tensile loading of the tendons of extrinsic musculature. This also permitted positioning of the tibia in the sagittal plane. Eighteen specimens were tested in three selected positions of the gait cycle. In one series, pressure-sensitive film was inserted into the posterior and anteromedial facets of the talocalcaneal joint as well as into the talonavicular joint. In a second series, film was inserted between the talar head and the superomedial calcaneonavicular ligament. In stance position, the specimens were also tested without posterior tibial tendon (PTT) tension. Contact areas and force transmitted across the articulations were greatest in near toe-off position, in the posterior facet of the talocalcaneal joint. The talonavicular joint, the anteromedial facet of the talocalcaneal joint, and the calcaneonavicular ligament articulation showed sequentially decreasing amounts of contact area and force transmission. Mean pressures were similar across all articulations, except in the posterior facet in near toe-off position. From heel-strike to stance, to near toe-off, a trend to increasing contact area and force was noted. No difference in contact characteristics was found in the calcaneonavicular ligament articulation after PTT release. The contact force of the calcaneonavicular ligament against the talus was found to be much smaller than those of other talar articulations; however, its medially oriented direction must contribute to stabilization of the head of the talus against medial displacement. Loss of PTT tension was not found to alter the contact forces acting at the talar head in this model, which might indicate that it shares its talar stabilizing function with other structures.
Assessment Of Rearfoot Motion: Passive Positioning, One-Legged Standing, Gait
Authors: Torburn Leslie , Perry Jacquelin , Gronley JoAnne K.
Published: March 2013

Earlier studies that address assessment of the subtalar joint (STJ) by measuring rearfoot motion used a goniometer to evaluate intertester reliability. Few investigations have determined how positions of the rearfoot, assessed manually (passive range of motion) or statically in one-legged standing, compare with those occurring during walking. The purpose of this study was to determine the following: (1) the intertester reliability of positioning the STJ in neutral, maximum inversion, and maximum eversion; (2) the reliability of the rearfoot position during relaxed one-legged standing; and (3) how these positions compare to rearfoot motion during walking. An electrogoniometer attached to the lateral aspect of the lower leg and heel was used to record the position of the rearfoot during testing procedures. Ten healthy volunteers participated. Rearfoot position was recorded during relaxed one-legged standing and during free and fast walking. Additionally, rearfoot position was recorded while each of three physical therapists positioned the STJ in neutral, maximum inversion, and maximum eversion. Intertester reliability for positioning the STJ in neutral, maximum inversion, and maximum eversion yielded intraclass correlation coefficients of 0.76,0.37, and 0.39, respectively. Reliability of relaxed one-legged standing had an intraclass correlation coefficient of 0.92. The rearfoot position in relaxed one-legged standing and the maximum eversion position occurring during gait were not significantly different. These findings suggest that there is good intertester reliability in positioning the STJ in neutral. Additionally, the rearfoot position in relaxed one-legged standing may be used to approximate the maximum eversion position that occurs during gait.
Osteoblastoma of the Foot and Ankle
Authors: Temple H. Thomas , Mizel Mark S. , Murphey Mark D. , Sweet Donald E.
Published: March 2013

A total of 329 patients with osteoblastoma were retrospectively reviewed from the archives of the Armed Forces Institute of Pathology, of which 41 (12.5%) presented with tumors in the foot and ankle. This was the third most common site of disease after the spine and femur. Overall, the mean age was 22.5 years, which was the same for the foot and ankle subset of patients; however, there was a significant male predominance in foot and ankle patients compared with the whole group. The majority of patients were skeletally mature (85.4%). Clinically, most patients presented with pain (97.2%), although one-third of the total related a history of antecedent trauma. The interval between the onset of symptoms and biopsy was 84 days (range, 0–572 days). Radiographically, the majority of lesions were in the hindfoot (N = 18; 44%) of which 16 of 18 tumors (89%) were in the talus. Of these, one-half were subperiosteal and dorsally based and were associated with osseous tumor matrix and a soft tissue mass. Two osteoblastomas, both in the metatarsals, transitioned into sarcomas; the rest were histologically benign. For diagnostic purposes, it was essential to obtain clinical, radiographic, and histologic correlation.
Stress Fracture of the Fifth Metatarsal After Evans' Calcaneal Osteotomy: A Report of Two Cases
Authors: Davitt James S. , Morgan James M.
Published: March 2013

The Evans calcaneal lengthening osteotomy has gained popularity in recent years for the treatment of symptomatic flexible pes planus deformity. To our knowledge, the occurrence of a stress fracture of the fifth metatarsal has not been reported after this procedure. We report two such cases and discuss the probable mechanism of this problem, a relative overloading of the lateral aspect of the foot. Both cases were treated successfully with immobilization. Clinicians should be aware of this possible problem and treat it appropriately.
Brachymetatarsia: Congenitally Short Third and Fourth Metatarsals Treated by Distraction Lengthening—A Case Report and Literature Summary
Authors: Robinson Jon F. , Ouzounian Tye J.
Published: March 2013

Brachymetatarsia is an uncommon condition, and when present, it is usually asymptomatic. A case report demonstrating the use of distraction lengthening for symptomatic multiple congenital short metatarsals is presented. A 15-year-old female with congenital short third and fourth metatarsals was treated for painful transfer lesions under the second and fifth metatarsal heads and a secondary hallux valgus deformity. Surgical correction with a chevron osteotomy, soft tissue reconstruction of the second toe, and distraction lengthening of the third and fourth metatarsals was performed. Three years after treatment, the patient has an excellent clinical correction, with no evidence of recurrent transfer lesions. To our knowledge, this is the first report demonstrating the use of distraction lengthening without supplemental bone graft for multiple short metatarsals in a single extremity.
Operative Management of Haglund's Deformity in the Nonathlete: A Retrospective Study
Authors: Sammarco G. James , Taylor Alison L.
Published: March 2013

Haglund's deformity, or “pump bump,” is a common cause of posterior heel pain. Management of the condition usually consists of nonoperative therapy. This study presents a retrospective study of 65 cases (53 patients), with symptomatic Haglund's deformity in nonathletes (13 male and 40 female), who presented during a 4-year period (1989–1994). Sixty-five percent (39 heels) of these patients failed to respond to nonoperative therapy for an average of 62 weeks, (range, 4–260 weeks). This group of patients went on to operative treatment. Surgical management consisted of excision of the posterior calcaneal tuberosity through a medial longitudinal incision with debridement, r'eattachment of the Achilles tendon using bone anchors, and 4 weeks of postoperative immobilization. Thirty-nine patients (74%) were contacted for follow-up. The average follow-up period for these patients was 155 weeks, (range, 92–335 weeks). There were 50% excellent results, 47% good results, 3% fair results (1 patient), and no poor results. The Maryland Foot Score for operated heels was an average of 67/100 preoperative and an average of 92/100 postoperative. On unoperated heels the score was an average of 81/100 at first evaluation and an average of 86/100 at final evaluation. Complications included one recurrence of painful prominence, one wound infection, and one incisional neuroma. The outcome of these cases demonstrated that in those patients who fail nonoperative treatment, surgical treatment of Haglund's deformity produces a predictably good surgical result when performed using the technique described.
Acute Inversion Injury of the Ankle: Magnetic Resonance Imaging and Clinical Outcomes
Authors: Tochigi Yuki , Yoshinaga Katsunori , Wada Yuichi , Moriya Hideshige
Published: March 2013

This study was undertaken to compare the clinical and magnetic resonance imaging results of 24 patients who had sustained ligament injuries after acute inversion injury of the ankle. On magnetic resonance imaging, the following lesions were detected: anterior talofibular ligament tear in 23 patients, calcaneofibular ligament lesion in 15, posterior talofibular ligament lesion in 11, interosseous talocalcaneal ligament lesion in 13, cervical ligament lesion in 12, and deltoid ligament lesion in 8. Compared with the clinical outcome at the follow-up study, there was a statistically significant relationship between interosseous talocalcaneal ligament lesion and each of giving way, pain, and limitation of ankle motion; between cervical ligament lesion and both giving way and pain; and between deltoid ligament lesion and giving way ( P < 0.05).
Evans Osteotomy in the Adult Foot: An Anatomic Study of Structures at Risk
Authors: Raines Robert A. , Brage Michael E.
Published: March 2013

The Evans osteotomy has become an important option in the surgical treatment of adult pes planus deformity of multiple causes. Despite its increasing popularity, however, no single study, to our knowledge, has thoroughly examined the structures at risk when performing the Evans osteotomy on the adult foot. We performed the Evans osteotomy on 20 adult cadaver specimens to determine which soft tissues and bony structures were endangered by the procedure. We found that the optimal Evans osteotomy site should be exactly 10 mm proximal to the calcaneocuboid joint because this location best affords the opportunity of avoiding damage to the anterior or middle subtalar facets in those specimens with separate facets. In addition, we determined that the sural nerve, peroneus longus tendon, and peroneus brevis tendon were consistently at risk during the operative approach. Regarding the medial soft tissues, we found that these structures did, in fact, consistently pass in the line of the Evans osteotomy, and so are at risk.
Cutaneous Innervation of the Medial Ankle: An Anatomic Study of the Saphenous, Sural, and Tibial Nerves and their Clinical Significance
Authors: Aszmann Oskar C. , Ebmer Johannes M. , Dellon A. Lee
Published: March 2013

The distribution and variability of the nerves innervating the skin overlying the medial ankle were determined in 22 human anatomic specimens using × 3.5 loupe magnification for dissection. Five different types could be identified: (1) Type A received contributions from the saphenous (SP), sural (SR), and the tibial (TB) nerves (54%); (2) Type B received contributions from the SR and SP nerves (14%); (3) Type C received contributions from the TB and SP nerves (9%); (4) Type D was singularly innervated by the SP (14%); and (5) Type E received contributions only from the TB nerve (9%). In two specimens, an unusual connection between the SP and the medial plantar nerves was found. Based on these findings, an incision line for tarsal tunnel release is suggested to avoid injury to the small cutaneous branches of the SP, SR, and TB nerves.
Anatomy of the Collateral Ligaments of the Human Ankle Joint
Authors: Milner Clare Elizabeth , Soames Roger William
Published: March 2013

Damage to the collateral ligaments of the ankle is relatively common, particularly the lateral ligaments; therefore, it is important to be aware of the detailed anatomy and frequency of variation of the individual ligaments. Only two reports of collateral ligaments dimensions were found in the literature, neither of which considers all of the individual components of the collateral ligament complex. Osteoligamentous preparations of the collateral ligaments of 40 ankles from 20 cadavers of European Caucasian origin were studied, from which mean values for the length and width of the individual components were determined, together with their frequency of occurrence. For the collateral ligaments of the ankle as a whole, the ligamentous dimensions determined in this study are similar to those reported previously. The data presented in this study are, therefore, a valuable addition to the small pool of data that exists concerning the dimensions of the collateral ligaments of the human ankle joint. These data may be of value when considering surgical repair or reconstruction of traumatized collateral ligaments, especially because any undue foreshortening of the ligaments may reduce the range of motion possible at either the ankle or subtalar joints, or both. It is possible that in extreme cases, such a reduction in the range of motion may modify gait patterns and the transmission of stresses across the joints of the foot and lower limb.
Leg Stiffness and Foot Orientations During Running
Authors: Viale Fabrice , Dalleau Georges , Freychat Philippe , Lacour Jean-René , Belli Alain
Published: March 2013

This study was done to determine whether leg stiffness ( Kleg) during running was related to rearfoot-to-forefoot angle in standing (RFAst) and running (RFArun). Footprints obtained from 32 subjects were used to calculate RFAts, and RFArun' defined as positive when forefoot axis was abducted from rearfoot axis. A spring-mass model was used to calculate Kleg in running from ground reaction forces, measured by a force platform. The Kleg of runners (13.0 ± 2.7 kN m−1) was negatively correlated with RFAst (−8.4° ± 6.4°) and RFArun (−0.4° ± 7.2°). When runners were divided into opened foot (RFArun > 0; N = 19) and closed foot (RFArun < 0; N = 12) groups, the Kleg of opened foot runners was less than that of the closed runners. We suggest that foot structure is a factor responsible for the differences in leg stiffness observed in runners.
Histopathologic Findings in Autogenous Saphenous Vein Graft Wrapping for Recurrent Tarsal Tunnel Syndrome: A Case Report
Authors: Campbell John T. , Schon Lew C. , Burkhardt Linda D.
Published: March 2013

Autogenous saphenous vein graft wrapping of the tibial nerve has been described as an effective treatment option for failed tarsal tunnel decompression. Various theories have been proposed to explain how this method works, with little histologic evidence to date. A pathologic investigation of a sectioned nerve that had been previously wrapped provides some insight into these proposals.
Anterior Tibialis Tendon Ruptures: An Outcome Analysis of Operative Versus Nonoperative Treatment
Authors: Markarian Greory G. , Kelikian Armen S. , Brage Michael , Trainor Timothy , Dias Luciano
Published: March 2013

Ruptures of the anterior tibialis tendon are a rare clinical entity. Case reports in the literature reveal a total of 28 cases. Unfortunately, because of the limited discourse in the orthopaedic literature, there are few guidelines regarding the treatment for these injuries. This study analyzes the treatment of 16 anterior tibialis tendon ruptures. Eight patients in this group had operative treatment of their ruptures, and eight patients had nonsurgical treatment of their ruptures. The average follow-up for the operative and nonoperative patients were 6.68 years and 3.86 years, respectively. The Foot and Ankle Outcome questionnaire provided by the American Academy of Orthopaedic Surgeons and an outcome-based foot score described by Kitaoka et al. were used as the methods of analysis. Our outcome results show no statistically significant difference between operative and nonoperative treatment in anterior tibialis tendon ruptures. The lack of statistical difference between operative and nonoperative groups may be a reflection of the age bimodality present in this study. Elderly low demand patients were treated nonsurgically and young active patients were treated operatively. Therefore, despite a lack of statistical difference present in the outcome of both groups, we still maintain the need to repair/reconstruct anterior tibialis tendon ruptures in young active patients with high functional demands. The deficits present in the nonoperative group, we believe, would not be well tolerated in a young high functional demand patient. Nonsurgical management is an appropriate alternative in low demand elderly patients.
Optimal Computed Tomography Imaging of the Midfoot: An Improved Technique
Authors: Johnson Jeffrey E. , Timins Michael E.
Published: March 2013

A new protocol for computed tomography (CT) imaging of the midfoot is described. This imaging technique places the CT cuts parallel to and perpendicular to the talus-first metatarsal axis, as viewed on the lateral CT scout image. For imaging the midfoot, this technique is an improvement over previously described hindfoot or midfoot protocols.
Operative Treatment for Hallux Valgus in Children with Cerebral Palsy
Authors: Jenter Martin , Upton Glenn E. , Miller Freeman
Published: March 2013

All patients with cerebral palsy who had hallux valgus and bunion deformities surgically corrected between 1986 and 1995 were reviewed to determine whether techniques other than arthrodesis of the first metatarsophalangeal joint would adequately correct these deformities. Twenty-six feet of 17 patients were surgically corrected for their bunions and/or their hallux valgus deformity. The mean hallux valgus angle for all children was 30°, preoperatively, with 70% correction achieved. Four techniques of surgical correction were used. A first metatarsophalangeal joint arthrodesis on eight feet gave excellent outcomes for all using the duPont Bunion Rating Score and a mean of 89% correction of the hallux valgus angle. A proximal first metatarsal osteotomy, distal soft tissue release, and exostectomy of the bunion on five feet gave three excellent and two fair outcomes, with a mean of 83% correction of the hallux valgus angle. A distal soft tissue release and exostectomy on eight feet gave four excellent outcomes, two good outcomes, and two fair outcomes, with a mean of 53% correction of the hallux valgus angle. An osteotomy of the first proximal phalanx, metatarosphalageal soft tissue release, and exostectomy on five feet gave three excellent outcomes, one good outcome, and one fair outcome with a mean of 36% correction of the hallux valgus angle. All patients who met the criteria for the procedures were satisfied with the outcomes; however, the first metatarosphalageal joint arthrodesis gave the best results with the highest percent correction and bunion score.
Intra-articular Calcaneal Fractures: Effect of Open Reduction and Internal Fixation on the Contact Characteristics of the Subtalar Joint
Authors: Mulcahy David M. , McCormack Damien M. , Stephens Michael M.
Published: March 2013

Intra-articular calcaneal fractures are associated with significant long-term morbidity, and considerable controversy exists regarding the optimum method of treating them. The contact characteristics in the intact subtalar joint were determined at known loads and for different positions of the ankle and subtalar joint, using pressure-sensitive film (Super Low; Fuji, Itochu Canada Ltd, Montreal, Quebec). We measured the contact area to joint area ratio (pressure > 5 kg force/cm2 [kgf/cm2]) which normalizes for differences in joint size and the ratio of high pressure zone (>20 kgf/cm2) as a reflection of overall increase in joint pressure. Three simulated fracture patterns were then created and stabilized with either 1 or 2 mm of articular incongruity. Eight specimens were prepared with a primary fracture line through the posterior facet, eight with a joint depression-type fracture, and six with a central joint depression fracture. A measure of 1 to 2 mm of incongruity in the posterior facet for all three fracture patterns produced significant unloading of the depressed fragment, with a redistribution of the overall pattern of pressure distribution to parts of the facet that were previously unloaded.