bluuebunny/crossref_metadata_2025 huggingface dataset:
Kidner Procedure for Symptomatic Accessory Navicular and Its Relation to Pes Planus
Authors: Prichasuk Somchai , Sinphurmsukskul Opas
Published: March 2013

The role of relocation of tibialis posterior tendon insertion in the treatment of symptomatic accessory navicular and its relation to the pes planus was studied in 28 patients with symptomatic accessory navicular. Two hundred non-affected individuals were used as control. The calcaneal pitch angle measured radiographically, was used as an indicator of pes planus. All patients had had an excision of the accessory navicular and relocation of the tibialis posterior tendon insertion (Kidner procedure). The average follow-up was 3.2 years. The results were good in 27 patients, and fair in 1 patient, and there were no poor results. Most of the patients demonstrated that the pain and the fatigue signs of the foot and the leg have been improved. Only 3 of 25 patients clinically showed an improvement of the medial longitudinal arch. The calcaneal pitch angle in patients with symptomatic accessory navicular was significantly (14.8°) lower than that in normal subjects (21.4°). An association of pes planus and symptomatic accessory navicular was shown. The Kidner procedure gave good results in the relief of pain and fatigue in patients with symptomatic accessory navicular. The procedure did not significantly restore the height of the medial arch.
Kirschner Wire Breakage after Surgery of the Lesser Toes
Authors: Zingas Christopher , Katcherian David A. , Wu Kent K.
Published: March 2013

A retrospective review was made of all patients operated on by the two senior authors from January 1985 to January 1993 for problems with Kirschner wire breakage following forefoot surgery. Thirty-three broken K-wires in 27 patients were encountered. All of these were 0.045-inch K-wires that had been placed across the metatarsophalangeal (MTP) joint of the lesser toes. In no case was there breakage of a K-wire that was larger than 0.045 inches or that did not cross the MTP joint.

The medical records and radiographs of 565 consecutive patients having fixation with 0.045-inch K-wires that crossed the MTP joints of the lesser toes were then reviewed. A total of 1002 K-wires were used with an overall failure rate of 3.2% (4.8% of the patients). All of these K-wires failed just proximal to the point of entry into the metatarsal head. No intra-articular retained fragments were noted. Twenty-five of the retained fragments were completely within the metatarsal head and shaft, and eight of these fragments pierced the cortex of the metatarsal proximally.

Twenty-three patients with retained fragments were examined in follow-up and in no case could the retained fragment be palpated or directly related to postoperative symptoms. Of the three patients who complained of persistent pain, two had mild pain with persistent MTP synovitis and one had severe pain due to lateral deviation of the toe after surgery.

Patients with rheumatoid arthritis who underwent metatarsal head excision were noted to have a higher rate of failure (10.3% of patients, 4.0% of K-wires) than those without rheumatoid arthritis or metatarsal head excision (3.3% of patients, 2.3% of K-wires). Also four of the six cases with multiple K-wire breakage in the same foot had rheumatoid arthritis.
In Vitro Kinematics of the Axially Loaded Ankle Complex in Response to Dorsiflexion and Plantarflexion
Authors: Hintermann Beat , Nigg Benno M.
Published: March 2013

The rotational movements of the tibia and calcaneus that occur with dorsiflexion-plantarflexion and axial loading were studied in cadaver foot-leg specimens using an unconstrained testing apparatus. Independent of the foot flexion position, significant internal rotation of the tibia and eversion of the calcaneus were noted after the ankle complex was axially loaded. Independent of loading, 10° of dorsiflexion resulted in 0.1° of eversion and 2.1° of internal rotation of the tibia. Conversely, 10° of plantarflexion resulted in 1.6° of inversion and 1.3° of external rotation of the tibia. The induced rotational movements of the tibia and the calcaneus differed significantly between the specimens. These results suggest that the foot “axes” did not change by axially loading the ankle complex and they support previous reports that the ankle complex uses different axes for dorsiflexion and plantarflexion.
The Hindfoot Alignment View
Authors: Saltzman Charles L. , El-Khoury Georges Y.
Published: March 2013

A modification of Cobey's method for radiographically imaging the coronal plane alignment of the hindfoot is described. Using this view, we estimated the moment arm between the weightbearing axis of the leg and the contact point of the heel. Normative data on 57 asymptomatic adult subjects are presented. The weightbearing line of the tibia falls within 8 mm of the lowest calcaneal point in 80% of subjects and within 15 mm of the lowest calcaneal point in 95% of subjects. The technique for measuring coronal plane hindfoot alignment is reliable, with an interobserver correlation coefficient of 0.97. This radiographic technique should help in the evaluation of complex hindfoot malalignments.
Gout as a Source of Sesamoid Pain
Authors: Mair Scott D. , Coogan Alice C. , Speer Kevin P. , Hall Reginald L.
Published: March 2013

Isolated gout of a great toe sesamoid has not been described previously. We present a case of gout of the medial sesamoid in a young athlete. Because a diagnosis is often elusive in patients with sesamoid pain, it is possible that other cases of gout of a hallucal sesamoid have gone unrecognized. Consideration of this diagnosis might lead to curative medical therapy precluding the need for surgical intervention.
Influence of Malalignment of Feet on the Plantar Pressure Pattern in Running
Authors: Sneyers Claire Jeanne Louise , Lysens Roeland , Feys Hilde , Andries Ruoli
Published: March 2013

When overuse injuries of the lower limbs are diagnosed in athletes, the architecture and function of the foot should be examined. Foot structure was evaluated in 10 male and 14 female athletes. Based on this examination, the subjects were classified into three groups: pes planus, pes cavus, and pes rectus. While running, the plantar pressure pattern of these athletes was assessed with pressure-measuring insoles. Using these measurements, peak pressures and impulses were calculated for different foot anatomical locations.

The plantar heel load was distributed significantly ( P < 0.05) more toward the anterior part of the calcaneus in the pes planus group compared with the normal group. The relative load under the midfoot region was significantly ( P < 0.05) lower in the pes cavus group compared with the other foot types. The relative load of the forefoot was significantly ( P < 0.05) higher in the pes cavus group and lower in the pes planus group. Both feet of an athlete showed a similar plantar pressure pattern. Three successive steps were comparable in terms of impulses, but the peak pressures varied significantly from step to step. The local impulse and peak pressure values obtained in barefoot running differed significantly from the values obtained in running with sport shoes.
Influence of Arthrodeses on Kinematics of the Axially Loaded Ankle Complex during Dorsiflexion/Plantarflexion
Authors: Hintermann Beat , Nigg Benno M.
Published: March 2013

The purpose of this study was to quantify the effect of selective arthrodesis (stabilization) of the ankle, subtalar, and talonavicular joints on the rotational movement of the tibia and the calcaneus occurring with dorsiflexion/plantarflexion. Six cadaver foot-leg specimens were investigated using an unconstrained testing apparatus. Simulated ankle joint arthrodesis caused a large increase in tibial rotation and calcaneal eversion-inversion. Subtalar and talonavicular stabilization did not cause as large a rotation.
Nonoperative Treatment of Metatarsophalangeal Joint Synovitis
Authors: Trepman Elly , Yeo Seng-Jin
Published: March 2013

The results of nonoperative treatment of metatarsophalangeal (MP) joint synovitis in 13 patients without known rheumatologic conditions (15 joints) were reviewed. Average duration of forefoot pain was 4 ± 3 months (range 0.5–12 months), except for one patient who had pain for 30 months. The second MP joint was involved in nine cases (60%), and the third was involved in six cases (40%). Examination revealed tenderness and palpable fullness of the MP joint in all cases; painful dorsal drawer sign was present in 10 cases (67%), adjacent interdigital tenderness in six cases (40%), and hammertoe deformity in eight cases (53%). Treatment included intra-articular corticosteroid injection and rocker-sole shoe modification to limit MP joint dorsiflexion. At follow-up evaluation (18 ± 9 months, range 4–26 months), the involved MP joint was asymptomatic in nine joints (60%), improved or almost asymptomatic in five joints (33%), and operated in one (7%) joint. Two of seven (29%) joints not initially associated with hammertoe developed a mild hammertoe deformity from time of diagnosis to follow-up. In conclusion, nonoperative treatment can be effective for MP joint synovitis, and the incidence of progressive hammertoe deformity in successfully treated cases is low.
Prospective Study of Bone, lndium-111-Labeled White Blood Cell, and Gallium-67 Scanning for the Evaluation of Osteomyelitis in the Diabetic Foot
Authors: Johnson Jeffrey E. , Kennedy E. Jeff , Shereff Michael J. , Patel Neetin C. , Collier B. David
Published: March 2013

Twenty-two adult diabetic patients with clinical suspicion of foot and/or ankle infection were prospectively evaluated using radiography, technetium-99m methylene diphosphonate bone scanning (99Tc), indium-111-labeled leukocyte scanning (111In), and gallium-67 scanning (67Ga) to determine the presence of clinically suspected osteomyelitis.

Biopsy for culture and histology was performed in 16 patients. The diagnosis of osteomyelitis was confirmed by biopsy in 12 patients. The remaining 10 patients had no evidence of osteomyelitis with long-term follow-up. 99mTc was snown to be of limited valued when used alone in these patients with peripheral neuropathy. 67Ga, either alone or in combination with 99mTc bone scanning, was of little diagnostic value and gave no additional information that was not available from 111In.

The combination of three-phase 99mTc and 111In had the highest diagnostic efficacy (100% sensitivity, 80% specificity, and 91% accuracy), followed closely by 111In alone (100% sensitivity, 70% specificity, and 86% accuracy).

We conclude that for adult diabetic patients with clinical suspicion of osteomyelitis but no radiographic findings of that disease, 111In alone is an appropriate nuclear medicine evaluation for ruling out infection if it is negative. However, if an area of 111In white blood cell uptake is present, a “simultaneous” 99mTc is often helpful in providing the anatomic correlation to differentiate osteomyelitis from infection that is limited to soft tissue.
Displaced Intra-Articular Calcaneus Fractures Treated with the Galveston Plate
Authors: Laughlin Richard T. , Carson J.G. , Calhoun Jason H.
Published: March 2013

From January 1992 to August 1993, 59 calcaneal fractures in 48 patients were treated. Thirty-three fractures in 31 patients were displaced intra-articular fractures and were treated with open reduction and internal fixation through an extensile lateral approach with the Galveston plate (Smith and Nephew, Richards, Memphis, TN).

Complete radiographs and CT scans were available for 32 of the fractures. The CT scan classification of Sanders was used. The distribution of the fractures was: IIA, N = 17; IIB, N = 2; IIC, N = 2; IIIAB, N = 7; IIIAC, N = 2; IV, N = 2. Sixteen (50%) had calcaneocuboid joint involvement. Preoperative and postoperative radiographic measurements of Bohler's angle, Gissane's angle, talocalcaneal angle, and Achilles tendon fulcrum distance were made. Clinical follow-up on 23 fractures in 22 patients at an average of 21 months is presented. Seventy percent of the patients have no pain or only occasional pain not requiring medication. Using the Maryland Foot Score for assessment, 78% of the patients had a good or excellent result. The Galveston plate was useful for maintaining reduction of intra-articular calcaneus fractures treated operatively and provided results comparable to other reported series.
Surgical Excision of Pseudotumorous Pretibial Myxedema
Authors: Pingsmann A. , Ockenfels H. M. , Patsalis Th.
Published: March 2013

Pretibial myxedema is a well-known clinical feature of autoimmune thyroid malfunction and is classically associated with Graves’ disease. Its clinical course is frequently not related to the clinical control of the underlying thyroid disease. Treatment is primarily medical, consisting of oral and topical corticosteroids.

We present a case of successful local excision of a pseudotumorous manifestation at the dorsum of the foot recalcitrant to multimodal medical and dermatological therapy.
Tarsal Fracture Dislocation with Plantar Dislocation of the Navicular: A Case Study
Authors: Puente C. A. , Alaez J. P. , Marti D. G.
Published: March 2013

A rare case of fracture-dislocation of the midtarsal bones with plantar dislocation of the navicular, the latter not being fractured, is described in this article. The working mechanism produced is discussed in accordance with previously described classifications. Open reduction and osteosynthesis are necessary.
Measurement of Dynamic Pressures at the Shoe-Foot Interface During Normal Walking with Various Foot Orthoses Using the FSCAN System
Authors: Brown Melanie , Rudicel Sally , Esquenazi Alberto
Published: March 2013

Foot orthoses are routinely used in clinical practice to redistribute pressure at the shoe-foot interface, although there is very little scientific evidence to support the efficacy of their use. In this study, the FSCAN sensor (an ultrathin in-shoe transducer) was used to determine the efficacy of pressure redistribution with a Plastizote, Spenco, cork, and a plastic foot orthosis as compared with control (no orthosis). Measurement variations of up to 18% occurred between sensors, and changes in stance time of up to 5% occurred between the orthoses and the control conditions. In spite of these potentially confounding variables, statistically significant differences in peak pressure between the orthotic types and the control condition (range, 9–146%) were noted. We conclude that Plastizote, cork, and plastic foot orthoses can be beneficial in relieving pressure in certain regions of the shoe-foot interface, but that they may do so at the cost of increasing pressure in other areas of the plantar surface.
In-Shoe Plantar Pressures During Activities of Daily Living: Implications for Therapeutic Footwear Design
Authors: Rozema Annet , Ulbrecht Jan S. , Pammer Scott E. , Cavanagh Peter R.
Published: March 2013

Pressures on the plantar surface of the foot during activities of daily living were measured in 12 young, healthy subjects using an in-shoe pressure-measuring device. The tasks chosen were standing, slow and fast walking, slow running, walking up and down stairs, rising from and sitting in a chair, and walking in a circle. All except the sitting tasks showed significantly higher pressures in all regions of the foot compared with standing, with the exception of walking up stairs and walking down stairs in the heel region. Both running and walking in a circle led to higher pressures (up to 1.42 times greater) in the total foot compared with “normal” walking. Furthermore, pressures during other activities were not always well predicted by walking pressures ( r 2 = 0.10–0.77). Therefore, measurement during level walking alone cannot be considered to fully define the plantar pressure affecting a foot in a particular shoe during activities of daily life.
Clinical and Radiographic Evaluation of Wilson Osteotomy for Hallux Valgus
Authors: Pouliart Nicole , Haentjens Patrick , Opdecam P.
Published: March 2013

Thirty-two Wilson osteotomies (26 patients) were evaluated after a mean follow-up time of 20 months. According to the classification of Bonney and MacNab, there were 90% good and excellent results. There was no correlation between the patient's appraisal of the result and the clinical result based on objective, functional, and radiographic data. The occurrence of metatarsalgia or callosities did not correlate with shortening or angulation. If there was a tendency to recurrence, there was a greater loss of correction with a longer duration of follow-up. In addition, patients over 50 seemed to have a greater tendency to recurrence than younger patients.
Rear Foot Inversion/Eversion During Gait Relative to the Subtalar Joint Neutral Position
Authors: Pierrynowski Michael Raymond , Smith Steve Barry
Published: March 2013

Clinicians often fabricate foot orthotic devices at the subtalar joint neutral position (STNP) to mimic the position of the rear foot during midstance. However, rear foot motion during gait, relative to the resting standing foot position, not the STNP, is often reported in the literature. The motion of the rear foot relative to a valid estimate of the STNP is unknown. In this study, six experienced foot care specialists manually placed the rear part of the feet of nine subjects at the STNP seven or eight times to obtain a valid estimate of each subject's STNP. The worst-case mean and 95% confidence interval of the STNP estimate for any one subject was 0.0° ± 0.7°. These nine subjects then walked on a motor-driven treadmill, set at 0.89 meters/sec, and three-dimensional estimates of each subject's rear foot inversion/eversion motion were obtained, then averaged over 6 to 26 strides. For most subjects, the rear foot was always everted during stance with mean and standard deviation maximal eversion (7.2° ± 1.2°) occurring at 44% of the total gait cycle. The inversion/eversion orientation during swing was characterized by 1 ° to 2° of eversion, with a small amount of inversion in early swing. These findings have implications for the fabrication of foot orthoses, since the rear foot is rarely near the STNP during stance.
Extra-Articular Localized Nodular Synovitis (Giant Cell Tumor of Tendon Sheath Origin) Attached to the Subtalar Joint
Authors: Villani Ciro , Tucci Gabriele , Di Mille Mariantonietta , Di Gennaro Stefano , Corsi Alessandro
Published: March 2013

A large soft tissue mass of the left ankle was documented by ultrasonography in a 24-year-old man. Histologic examination of biopsy samples was consistent with pigmented villonodular synovitis. Magnetic resonance, performed to establish the extension of the mass, revealed an extra-articular lesion involving the posteromedial extra-articular soft tissues, which, by means of a thin peduncle, extended into the subtalar joint space. The mass was excised; gross and microscopic examinations were characteristic of localized nodular synovitis. Bone and cartilage abnormalities were not revealed by either preoperative imaging or surgery. At 15-month follow-up, the patient was free of recurrences. This case is an uncommon example of localized nodular synovitis of the subtalar joint, characterized by the absence of bone and articular cartilage abnormalities. In addition, this case reveals that the pattern of growth (i.e., the shape of the lesion) is an important factor in determining secondary lesions of bone and cartilage.
Analysis of Failed Surgical Management of Fractures of the Base of the Fifth Metatarsal Distal to the Tuberosity: The Jones Fracture
Authors: Glasgow Michele T. , Naranja R. John , Glasgow Steven G. , Torg Joseph S.
Published: March 2013

Failure of surgical management of fractures of the base of the fifth metatarsal distal to the tuberosity is uncommon. Only one such failure has been reported in the literature to date. The purpose of this article is to present the clinical course of 11 patients with failure of surgically managed Jones fractures reviewed by the senior author (J.S.T.). Surgical management was complicated by delayed union in three patients, refracture in seven patients, and nonunion in one patient. The 11 procedures were divided between two established techniques: (1) intramedullary screw fixation (N = 6) and (2) inlaid corticocancellous bone graft (N = 5).

In the six intramedullary fixation procedures, using other than a 4.5-mm ASIF malleolar screw for internal fixation correlated with failure. In the five inlaid bone graft procedures, undersized corticocancellous grafts and incomplete reaming of the medullary canal correlated with failure. Also, after both procedures, early return to vigorous physical activity is believed to have played a role in delayed union and refracture.
Parent Satisfaction Comparing Two Bandage Materials Used During Serial Casting in Infants
Authors: Coss H. Steven , Hennrikus William L.
Published: March 2013

Plaster of Paris was compared with semirigid fiberglass casting material during serial casting in 17 infants with clubfoot or rigid metatarsus adductus. Semirigid fiberglass was statistically superior in its durability, convenience, performance, and ease of removal. The average amount of time for home cast removal by the parents was 55 minutes for plaster of Paris and 21 minutes for semirigid fiberglass. Complications such as skin abrasions and cast slip-off were similar for both casting materials. Ninety-four percent of parents strongly preferred semirigid fiberglass rather than plaster of Paris for their child's serial casting.
Aneurysmal Bone Cyst and Giant Cell Tumor of the Foot
Authors: Casadei Roberto , Ruggieri Pietro , Moscato Manuela , Ferraro Andrea , Picci Piero
Published: March 2013

From 1950 to 1994, 257 cases of benign bone tumors of the foot were treated at the Bone Tumor Center of the Rizzoli Institute. Aneurysmal bone cysts (ABC) and giant cell tumors (GCT) are rare and often they are misdiagnosed. To define the clinical and radiographic features useful for diagnosis, x-rays of 24 ABCs and 21 GCTs of the foot were reviewed. Adding our series to the cases reported in the literature, the only important clinical data that emerged was the average age of patients affected by ABC and GCT (15 and 27 years, respectively). ABCs localized in small tarsal bones were rare (6%), whereas 19% of GCTs were found in this site. The eccentric, round shape of a lytic lesion was more characteristic of GCT. An aggressive pattern of radiographic bone destruction was observed more frequently in GCT than in ABC ( P = 0.01). Septation was seen in both tumors. Typical of ABC was a sharp and trabeculated margin, whereas GCT had an ill-defined edge with normal cancellous bone ( P = 0.007). The growth of ABCs often expanded the cortex, while GCTs eroded, thinned, and broke the cortical bone ( P = 0.001). A saucerized cortex was observed only in ABCs. A bony shell was more characteristic of ABC than of GCT ( P = 0.002). Pathologic fractures (67%) and joint involvement, evaluated by computed tomography and magnetic resonance imaging (83%), were more frequent in GCTs, whereas fluid levels were more frequently observed in ABCs (47%). The majority of the tumors were stage 2, but GCTs represented 70% of stage 3 aggressive lesions.
A Pitfall of Coronal Computed Tomographic Imaging in Evaluation of Calcaneal Fractures
Authors: Ebraheim Nabil A. , Biyani Ashok , Padanilam Thomas , Paley Kevin
Published: March 2013

Computed tomographic (CT) coronal images of the posterior talocalcaneal joint were compared with lateral radiographic views and intraoperative findings in 35 patients with 36 intra-articular calcaneal fractures. The severity of articular incongruity and rotational displacement of the posterior facet fragment were not well appreciated in coronal CT images of nine patients, although Bohler and Gissane angles were significantly decreased in lateral radiographs. This disparity between the radiographic and coronal CT scans can be explained by the intraoperative finding of rotation of the fractured central or lateral portion of the convex posterior calcaneal facet along a horizontal axis in the coronal plane.
Surgical Treatment of Recalcitrant Plantar Fasciitis
Authors: Sammarco G. James , Helfrey Richard B.
Published: March 2013

Twenty-six patients (35 feet) underwent partial plantar fasciectomy with neurolysis of the nerve to the abductor digiti quinti muscle. Nonsurgical treatment for plantar fasciitis had been unsuccessful in these patients. Patients were followed after surgery for an average of 37.5 months. Six patients were male and 20 patients were female; the average age was 49 years. All patients had failed to respond to nonsurgical treatment for an average of 21.5 months. In addition to routine history and physical examination patients were evaluated before and after surgery with a subjective foot rating system, and a detailed questionnaire was used to assess postoperative functional outcome.

Thirty-two patients (92%) had a satisfactory functional outcome, and three patients (8%) had an unsatisfactory result (21 excellent, 11 good, 3 fair, 0 poor). The Maryland Foot Score increased from a preoperative average of 74.8/100 points to a postoperative average of 90.6/100 points. Four patients (11%) had postoperative complications, including superficial wound infection (two patients), deep venous thrombosis (one patient), and superficial phlebitis (one patient), all of which resolved uneventfully with treatment. Ten patients (28.6%) reported some degree of heel pain after surgery. All 10 patients denied limitation in activity related to postoperative pain. The average period before return to daily activity and restricted work duty was 5.6 weeks and to full work duty without restriction was 8.7 weeks. Although the length of time for partial or complete resolution of symptoms is variable, a successful treatment outcome can be expected in most patients who are treated for recalcitrant plantar fasciitis.
A Comparison of MRI and Clinical Examination of Acute Lateral Ankle Sprains
Authors: Frey Carol , Bell James , Teresi Louis , Kerr Roger , Feder Keith
Published: March 2013

Because of its excellent soft tissue contrast and ability to demonstrate soft tissue structures, magnetic resonance imaging is ideally suited to the evaluation of the soft tissues surrounding the ankle, including the lateral collateral ligaments. This study was undertaken to compare the clinical evaluation of 15 patients who suffered inversion injuries of the ankle with the results found on magnetic resonance imaging within 48 hours of the injury. Physical examination was found to be 100% accurate in the diagnosis of grade III ligament injuries but only 25% accurate in the diagnosis of grade II injuries. Clinicians most often underestimate the damage with a grade II ligament tear. Furthermore, other associated injuries, such as significant capsule ruptures and tendon damage, were often overlooked at physical examination.
The Role of Internal Fixation in the Treatment of Jones Fractures in Diabetics
Authors: Yue James J. , Marcus Randall E.
Published: March 2013

The purpose of this study was to evaluate the treatment of fractures of the proximal fifth metatarsal at the junction of the metaphysis and diaphysis (i.e., Jones fracture) in diabetics. Open reduction and internal fixation with bone grafting resulted in clinical and radiographic union 8 weeks after surgery in patients treated with either immediate or delayed open reduction and internal fixation. Open reduction and internal fixation with autologous bone grafting is an effective treatment regimen in the diabetic patient with a Jones fracture. An initial trial of casting can be attempted without any apparent deleterious effects on secondary open reduction and internal fixation.
Calcaneocuboid Joint Involvement in Calcaneal Fractures
Authors: Ebraheim Nabil A. , Biyani Ashok , Padanilam Thomas , Christiensen Greg
Published: March 2013

The charts and radiographs of 48 surgically treated patients who underwent surgery for calcaneal fractures (right in 25 patients, left in 22, and bilateral in 1) between 1987 and 1994 were retrospectively reviewed. Coronal computed tomographic scans alone were obtained in 33 patients, and both coronal and axial computed tomographic scans were obtained in 9 patients. Three fractures exiting close to the calcaneocuboid joint (CCJ), but not involving the joint, were excluded.

Nineteen patients (38.7%) had involvement of the CCJ. The extension of the fracture to the CCJ was apparent in anteroposterior or oblique radiographs or both in 18 patients. There was intra-articular fracture displacement of ≤1 mm in 6 patients, and 13 patients had a step or a gap of ≥2 mm with or without angulation. Eleven patients had joint depression type fractures, 6 had tongue type fractures, and 2 had comminuted fractures. Extension of the calcaneal fracture into the CCJ was significantly more common with the joint depression type calcaneal fractures (chi-square test; P = 0.008). The coronal computed tomographic images showed significant lateral subluxation of posterior facet fragments in 8 patients and considerable comminution of the lateral calcaneal wall with or without lateral subluxation of posterior facet fragment in 10 patients. These patients also had CCJ involvement, thus establishing a strong correlation between lateral subluxation of the posterior facet fragment or comminution of the lateral calcaneal wall and CCJ involvement.

CCJ involvement is more common with joint depression type fractures. Extension of the fracture line into the CCJ should be suspected in presence of significant lateral column comminution or lateral talar subluxation.
Talonavicular Arthrodesis for the Painful Adult Acquired Flatfoot
Authors: Harper Marion C. , Tisdel Christopher L.
Published: March 2013

Twenty-seven consecutive patients with posterior tibial tendon insufficiency were treated with talonavicular arthrodesis as the primary stabilizing procedure. Twenty-six patients were followed a minimum of 12 and an average of 27 months. Twenty-four patients had either no pain or pain only after heavy usage. Eleven patients were completely satisfied with postoperative foot function, 13 were satisfied, with minor reservations, and 2 were satisfied, with major reservations. Results were rated as excellent in 10 patients, good in 14 patients, and fair in 2 patients. Successful arthrodesis was achieved in all patients, although one patient required two additional bone grafts. Progressive arthrosis in adjacent joints was noted in five patients, four of whom had arthrosis preoperatively. No deterioration of foot position was seen in any patient with follow-up as long as 5 years. An isolated talonavicular arthrodesis seems to offer patients with this disorder both reliable pain improvement and lasting stability.
The Effect of Shoe Gear on Human Tibial Strains Recorded During Dynamic Loading: A Pilot Study
Authors: Milgrom Charles , Burr David , Fyhrie David , Forwood Mark , Finestone Aharon , Nyska Meir , Giladi Miki , Liebergall Meir , Simkin Ariel
Published: March 2013

The study was conducted to test the hypothesis that alterations in shoe gear can affect tibial strains in the human during dynamic loading. Rosette strain gauges were mounted on the medial border of the mid-diaphysis in two human subjects with a new strain gauge bonding technique using methyl methacrylate. Strain measurements were made at this site, the most frequent location for stress fractures in the Israeli Army during treadmill walking and free running while wearing various sport shoes (Rockport ProWalkers and New Balance NBX 900) and army boots (light Israeli infantry, double layered sole Israeli infantry, and Zohar infantry boots). Data were analyzed for only one of the subjects because strain gauge bonding was found to be inadequate at the time of surgical removal in the other subject. No single shoe lowered both the principal tibial compression and tensile strains, and the shear strains. The Zohar boot had the lowest principal compression strains during treadmill walking and mobile running, despite its relatively higher weight and sole durometry.
Repair of Talar Neck Nonunion with Indirect Corticocancellous Graft Technique: A Case Report and Review of the Literature
Authors: Migues Atilio , Solari Gabriel , Carrasco Nelly Marina , Valle Alejandro González Della
Published: March 2013

In this article, a case of talar neck fracture nonunion is presented. Union was accomplished with an indirect placement of a corticocancellous fibular graft through a posterolateral approach. The advantages and indications for this method of the treatment of talar neck nonunion are discussed, together with a review of the literature.
The Calcaneus: Applications of Magnetic Resonance Imaging
Authors: Yu Joseph S. , Vitellas Kenneth M.
Published: March 2013

The calcaneus is the largest bone in the foot and is an important primary weightbearing structure. Pathologic processes that affect this bone may manifest in a variety of clinical presentations, including pain, abnormal motion, instability, or fracture. The purpose of this article is to present a pictorial essay of the wide spectrum of pathologic entities that may affect the calcaneus, emphasizing applications of magnetic resonance imaging and characteristic magnetic resonance features of these processes.
Effect of Partial Versus Complete Plantar Fasciotomy on the Windlass Mechanism
Authors: Thordarson David B. , Kumar Pradeep John , Hedman Tom P. , Ebramzadeh Edward
Published: March 2013

Eight adult below-knee cadaver specimens were placed in a testing machine and loaded to 350 newtons according to a strict protocol. Arch height and length measurements were obtained in each specimen with the toes resting on the foot plate, dorsiflexed to 30°, and maximally dorsiflexed manually. The plantar fascia was then divided from medial to lateral in one-quarter increments, and the effect on arch height and length measurements was assessed using the same loading protocol. A consistent decrease in the arch-supporting function on sequential sectioning of the plantar fascia was encountered. A less consistent decrease in the arch-supporting function was reflected by the increase in the height of the arch with sequential sectioning of the plantar fascia. The study demonstrates that partial plantar fasciotomy decreases the arch-supporting function of the plantar fascia in addition to weakening the structure. Strict surgical indications for this type of procedure should be maintained.
A Comparison Study of Plantar Foot Pressure in a Standardized Shoe, Total Contact Cast, and Prefabricated Pneumatic Walking Brace
Authors: Baumhauer J.F. , Wervey R. , McWilliams J. , Harris G.F. , Shereff M.J.
Published: March 2013

Total contact casting is the current recommended treatment for Wagner Stage 1 and 2 neuropathic plantar ulcers. The rationale for this treatment includes the equalization of plantar foot pressures and generalized unweighting of the foot through a total contact fit at the calf. Total contact casting requires meticulous technique and multiple cast applications to avoid complications before ulcer healing. An alternative to total contact casting is the use of a prefabricated brace designed to maintain a total contact fit. This study compares plantar foot pressure metrics in a standardized shoe (SS), total contact cast (TCC), and prefabricated pneumatic walking brace (PPWB).

Five plantar foot sensors (Interlink Electronics, Santa Barbara, CA) were placed at the first, third, and fifth metatarsal heads, fifth metatarsal base, and midplantar heel of 10 healthy male subjects. Each subject walked at a constant speed over a distance of 280 meters in a SS, PPWB, and TCC. A custom-made portable microprocessor-based system, with demonstrated accuracy and reliability, was used to acquire the data.

No significant differences in peak pressure or contact duration were found between the initial and repeat SS trials ( P > 0.05). Peak pressures were reduced in the PPWB as compared to the SS for all sensor locations ( P < 0.05). Similarly, peak pressures were reduced in the TCC compared to the SS for all sensor locations ( P < 0.05) with the exception of the fifth metatarsal base ( P = 0.45).

Our results are summarized as follows: (1) the methods used in the current study were found to be reliable through a test-retest analysis; (2) the PPWB decreased peak plantar foot pressures to an equal or greater degree than the TCC in all tested locations of the forefoot, midfoot, and hindfoot; (3) compared to a SS, contact durations were increased in both the TCC and PPWB for most sensor locations; and (4) the relationship of peak pressure over time, the pressure-time integral, is lower in the brace compared to the shoe at the majority of sensor locations. The values are not significantly different between the cast and shoe. These findings suggest an unweighting of the plantar foot and equalization of plantar foot pressures with both the PPWB and TCC. Based on these findings, the PPWB may be useful in the treatment of neuropathic plantar ulcerations of the foot.
Capsular Interposition Arthroplasty for Severe Hallux Rigidus
Authors: Hamilton William G. , O'Malley Martin J. , Thompson Francesca M. , Kovatis Paul E.
Published: March 2013

Thirty patients (37 feet) with severe hallux rigidus underwent resection arthroplasty of the first metatarsophalangeal joint with our modification (reattachment of the extensor hood and extensor brevis to the flexor hallucis brevis as a capsular interposition arthroplasty, with minimal bone resection). Pain and function were significantly improved. Transfer metatarsalgia was not seen. All patients had at least 4/5 plantarflexion strength and averaged 50° of dorsiflexion. In patients with severe hallux rigidus and nearly equal length of first and second metatarsals, capsular interpostion arthroplasty offers a surgical option that relieves pain without sacrificing motion or strength.
Proximal Metatarsal Osteotomy in Hallux Valgus Correction: A Comparison of Crescentic and Chevron Procedures
Authors: Markbreiter Lance A. , Thompson Francesca M.
Published: March 2013

We retrospectively evaluated the results of 50 hallux valgus reconstructions in 36 patients for moderate to severe deformities, performed by the senior author (F. M. T.). All feet were treated at the metatarsophalangeal joint with a distal soft tissue realignment. The first 25 feet were corrected proximally with a crescentic osteotomy fixed with an AO screw; these cases had an average follow-up of more than 5 years (range, 40–141 months). The second 25 feet underwent a basal osteotomy with a proximally directed chevron osteotomy; these cases had an average follow-up of 21.4 months (range, 12–33 months). The average hallux valgus correction in the crescentic osteotomy group went from 37.6° to 11.4°, and in the chevron osteotomy group, the hallux valgus angle was reduced from 31.3° to 11.6°. The intermetatarsal angle in the crescentic group was corrected from 16.2° to 6°, and in the chevron group the intermetatarsal angle was reduced from 15.1° to 5.4°. The fibular sesamoid subluxation was reduced from 92% to 24% in the crescentic group and from 88% to 18% in the chevron group. All patients were assessed using the American Orthopaedic Foot and Ankle Society scale, in which 100 points are used to compare pre- and postoperative pain, function and range of motion, shoewear comfort and activity levels, and alignment. In the crescentic group, the score improved from 46.8 points to 93.1 points; in the chevron group, the score changed from 53.4 points to 92.7 points. In all parameters studied, there were no statistically significant differences using the Student's t-test. We conclude that the two operative techniques offer equivalent results, which are excellent and predictable. The proximal chevron osteotomy is technically easier, eliminates the proximal dorsal scar, and does not require postoperative metal removal.
Clinical Evaluation of the Ruiz-Mora Procedure: Long-term Follow-up
Authors: Dyal Cherise M. , Davis W. Hodges , Thompson Francesca M. , Bonar Susan K.
Published: March 2013

The Ruiz-Mora procedure has been advocated for treatment of congenital overlapping fifth toes, fifth hammertoe, and clavus deformities. This study evaluated the results of the Ruiz-Mora procedure in 12 patients with an average follow-up of more than 4 years. The data indicate the majority of patients are satisfied with the results of the procedure. Unacceptable cosmesis was the primary complaint of all dissatisfied patients. Assessment of preoperative versus postoperative symptoms indicate an improvement in symptoms as well as maintenance of stability and function. The average shortening of the toe was 12.8 mm. This presented no functional problems to the patients. Three patients had transient skin healing problems which resolved with local care. Based on this series, the Ruiz-Mora procedure is effective in dealing with the problem of the cock-up fifth hammertoe and is associated with few complications. Because of patient dissatisfaction with cosmesis, consideration should be given to showing patients postoperative photographs of the procedure before surgery and reserving this procedure for salvage of iatrogenic cock-up deformities, recalcitrant hard corns, and congenital cock-up deformities.
Foot Orientation and Lower Limb Kinematics During Running
Authors: Viale Fabrice , Belli Alain , Lacour Jean-Rene , Freychat Philippe
Published: March 2013

The purpose of this study was to determine the possible mechanisms explaining the interindividual differences in foot orientations observed during running. Foot orientations, foot pressures, and ankle dorsiflexion and plantarflexion were simultaneously recorded on 12 male subjects running barefooted at 3.9 ± 0.6 m · sec−1. The abduction of the forefoot was significantly related to the ankle dorsiflexion and plantarflexion velocities ( P < 0.01 and P < 0.05, respectively). Because it was not possible, from pressure measurements, to determine differences in foot lever arm of runners, it is suggested that the interindividual variability of foot kinematics could not be explained by Bojsen-Moller's model, but could reflect differences in the lower limb stiffness control.
A New Operative Approach for Flatfoot Secondary to Posterior Tibial Tendon Insufficiency: A Preliminary Report
Authors: Pomeroy Gregory C. , Manoli Arthur
Published: March 2013

The treatment of Johnson stage 2 posterior tibial tendon insufficiency remains controversial. Because the deformities remain flexible in stage 2, bony osteotomies are preferable over fusion operations. It is our contention that operative intervention should address all of the components of the pes planovalgus deformity that exists in stage 2 disease. Seventeen patients with 20 cases of stage 2 posterior tibial tendon insufficiency were treated with heel cord lengthening, flexor digitorum longus to medial cuneiform tendon transfer, lateral column lengthening, and medial displacement calcaneal osteotomy. Preoperative, postoperative, and final radiographs while standing were analyzed to determine radiographic correction of the deformities. In addition, the American Orthopaedic Foot and Ankle Society's ankle/hindfoot rating scale was applied to all patients before surgery and at 6-month intervals after surgery. Currently, the average follow-up is 17.5 months. The average foot rating score preoperatively was 51.4 and has improved to 82.8.

Radiograph measurements have demonstrated statistically significant correction of the pes planovalgus deformity, as well as maintenance of the correction to date.

It is our conclusion that this combination of surgical procedures provides correction of the symptomatology and deformity associated with stage 2 posterior tibial tendon insufficiency. The long-term result of the procedure is unknown.
Tendon Arthroplasty of the First Metatarsophalangeal Joint in Hallux Rigidus: Preliminary Communication
Authors: Barca Francesco
Published: March 2013

A biological arthroplastic interposition is described for hallux rigidus, in which the rolled plantaris tendon is positioned at the base of the first phalanx. Eleven patients, for a total of 12 feet, underwent surgery using this technique. The average follow-up was 21 months. In all patients, pain and supination gait disappeared. The average metatarsal motion increased 44° in dorsiflexion. The tendon packet seems to be a good biological spacer, because it adapts and models itself to the new joint function.
Chondroblastoma of the Foot
Authors: Fink Lcdr Brett R. , Thomas Maj H. , Chiricosta Maj Francis M. , Mizel Mark S. , Murphey Mark D.
Published: March 2013

A total of 322 cases of chondroblastoma were referred to the Armed Forces Institute of Pathology between 1960 and 1990. Ten additional cases of chondroblastoma were treated at Walter Reed Army Medical Center between 1985 and 1993. Forty-two of these involved the foot, two of which were treated at Walter Reed Army Medical Center. Patients with chondroblastoma of the foot were male in 35 (81%) cases, with a mean age of 25.5 years, which was significantly different from the mean age of 17.3 years in patients with chondroblastoma of the long bones (P < 0.0001). Chondroblastoma of the foot is most commonly found in the posterior subchondral areas of the talus and calcaneus as well as in the calcaneal apophysis. Radiographically, the lesion was associated with an articular surface or apophyseal area in all cases and appeared radiolucent, with little to no matrix production. The margins were generally well defined. Cystic features were noted grossly and histologically in 24 (57%) specimens, a feature seen in only 21% of all chondroblastomas overall. Treatment consists of thorough curetting and bone grafting with good oncologic and functional results.
Physiological Elongation of Ligamentous Complex Surrounding the Hindfoot Joints: In Vitro Biomechanical Study
Authors: Luo Zong-Ping , Kitaoka Harold B. , Hsu Horng-Chaung , Kura Hideji , An Kai-Nan
Published: March 2013

Ligaments surrounding the hindfoot joints play an important role in hindfoot stability. This in vitro study investigated anatomical and biomechanical characteristics of nine major ligamentous structures, including length and orientation at neutral position and physiological elongation with the foot in five different positions relative to the neutral position. The results showed that ligament elongation depended on the ligament length, orientation in neutral position, and movement of bones to which they were attached.
Vascular Supply of Nerves in the Tarsal Tunnel
Authors: Flanigan David C. , Cassell Martin , Saltzman Charles L.
Published: March 2013

The normal vascular supply of nerves in the tarsal tunnel was studied by intra-arterial injection of latex. In general, the blood supply to the tibial nerve and its branches came directly from corresponding arteries. Each nutrient artery to the tibial nerve bifurcated on the surface of the lateral plantar nerve fasciculus to create longitudinal vessels that made anastomoses with bifurcating nutrient vessels proximally and distally. This primary longitudinal system supplied intersubfascicular vessels to the medial plantar fasciculus. The last nutrient artery from the posterior tibial artery usually supplied the terminal branching point of the tibial nerve midway through the tarsal tunnel. The lateral and medial plantar nerves received most of the nutrient vessels from their corresponding arteries in shorter intervals. In 65% of cases, the lateral plantar nerve received a nutrient vessel from the medial plantar artery. Potential anatomical areas of vascular compromise in the etiology or surgical release of tarsal tunnel syndrome are discussed.
Pathology of the Achilles Tendon in Association with Ciprofloxacin Treatment
Authors: Movin Tomas , Gad Adel , Güntner Peter , Földhazy Zoltan , Rolf Christer
Published: March 2013

Achilles tendon pain or rupture after fluoroquionolone treatment has been described as an uncommon adverse effect. We report two patients with ciprofloxacin-associated Achilles tendon disease, one with histopathological examination. Microscopic evaluation showed irregular collagen fiber arrangement, hypercellularity, and increased interfibrillar glycosaminoglycans. These pathological features are also seen in tendon overuse injuries in athletes.