bluuebunny/crossref_metadata_2025 huggingface dataset:
Tibial Nerve Grafting for Restoration of Plantar Sensation
Authors: Nunley James A. , Gabel Gerard T.
Published: March 2013

Five patients with a segmental loss of the tibial nerve and insensate plantar aspect of the foot were evaluated at an average of 5 years (2.5–9.5) postsural nerve grafting of the tibial nerve. Free-tissue transfer was required in three patients. The results as graded by restoration of superficial sensation, healing of plantar ulceration, and absence of neurogenic pain were four good and one fair at follow-up over 2 years. Assessment at 2 years or less yielded one good and four poor results, indicating a prolonged recovery period. Nerve grafting may be indicated in segmental injuries of the tibial nerve to restore plantar sensation, but ultimate recovery may require up to 4 years.
Deformity Correction and Arthrodesis of the Midfoot with a Medial Plate*
Authors: Horton Greg A. , Olney Brad W.
Published: March 2013

Nine feet in eight patients undergoing tarsometatarsal (Lisfranc) or other midfoot arthrodeses for posttraumatic or degenerative arthritis were reviewed retrospectively. All patients were treated using a medial one-third tubular plate spanning the midfoot joints to be fused. Three feet underwent fusion in situ while six feet underwent correction of residual planus, planovalgus, or cavovarus deformity at the time of fusion. All patients achieved fusion within 12 weeks. A good or excellent result was achieved in seven of nine feet. There was no radiographic or clinical evidence of pseudarthrosis or medial hardware failure in any patient. No patient to date has required hardware removal for a painful or prominent implant. The talus first metatarsal angle was improved an average of 15.5° in the lateral plane and 10° in the AP plane in patients undergoing deformity correction. The technique of using a medial plate for midfoot arthrodesis allows for reliable fusion in patients who require salvage for midfoot arthritis. This technique also allows for correction of deformity in patients with residual midfoot deformity.
Nonsurgical Treatment of Lateral Ligament Injury of the Ankle Joint
Authors: Yamamoto Haruyasu , Ishibashi Toshiro , Muneta Takeshi , Furuya Kohtaro
Published: March 2013

Between 1986 and 1989, 40 patients with acute lateral ligament injury of the ankle joint were treated by immobilizing their affected feet in a plaster cast with a heel for 4 weeks, followed by a brace for the next 2 months. The average follow-up time was 29 months. Ninety-eight percent of the patients were rated as having satisfactory functional results. Stress radiographs at the latest follow-up showed good stability even in ankles that were severely unstable at injury. Posttreatment stress radiographs taken periodically showed that stability was maintained 6 months after treatment.
In-Shoe Plantar Pressure Measurement of the First Metatarsophalangeal Joint in Asymptomatic Patients
Authors: Corbett Michael L. , Abramowitz Andrew J. , Fowble Coleman D. , Rask Bart , Whitelaw George P.
Published: March 2013

Using an in-shoe plantar pressure sensor, the pressure under the first metatarsophalangeal (MTP) joint was measured in 20 asymptomatic control subjects during their normal gait. A 7-micron in-shoe pressure sensor recorded the pressure under the first MTP joint in the 20 volunteers while they were wearing their normal footwear (athletic footwear), a wooden postoperative shoe, a fiberglass short leg walking cast, and a postoperative shoe with a first MTP joint cutout orthotic device. The results showed both casting, and the postoperative shoe with the first MTP joint cutout orthotic device significantly reduced pressure under the first MTP joint compared with normal footwear, with an average decrease of 31% and 43%, respectively. However, the standard postoperative shoe did not significantly reduce first MTP pressure compared with normal footwear. Certain surgeries performed on the distal first metatarsal may benefit from a diminution of loading forces encountered during normal gait. The results of this study indicate that a reduction in first MTP pressures can best be accomplished with either a postoperative shoe with a cutout orthotic device or a short leg walking cast. A standard postoperative shoe showed inconsistent results and had no statistically significant effect on decreasing the pressure under the first MTP joint.
Cuboid Stress Fractures: A Report of Two Cases
Authors: Beaman Douglas N. , Roeser Waldomer M. , Holmes James R. , Saltzman Charles L.
Published: March 2013

Stress fractures of the tarsal cuboid are rare. The literature contains three reported cases. This report presents two additional cases. These two occurred in collegiate athletes, and mimicked peroneal tendonitis on presentation. History, physical examination, plain radiographs, and bone scan were used for diagnosis. Treatment consisted of immobilization and activity modification, with complete resolution of symptoms in both cases.
Congenital Brachymetatarsia: Three Cases
Authors: Ferrández L. , Yubero J. , Usabiaga J. , Ramos L.
Published: March 2013

We report on three cases with congenital brachymetatarsia, one with bilateral affectation, together with the results of a lengthening of the short metatarsal bones by progressive axial distraction using an external minifixator.

The method proved to be easy to implement, permitting immediate functionality of the ankle and early load bearing. The immediate results (cosmetic) and later findings (functional) were excellent in all three cases.
Intraosseous Ganglion Cyst of the Talus: Case Report
Authors: Patterson Ronald H. , Jones Mark , Tuten Robert
Published: March 2013

A case of an intraosseous ganglion cyst 1 , 6 of the talus is described. 1 , 9 Ganglion cysts within bone are not rare but are usually found within long bones located in metaphyseal areas. 7 , 10 This lesion of the talus produced significant pain and was successfully treated with curettage and iliac crest bone graft. 3
Tarsal Coalition Presenting As A Pes Cavo-Varus Deformity: Report Of Three Cases and Review Of the Literature
Authors: Stuecker Ralf D. , Bennett James T.
Published: March 2013

The diagnosis of idiopathic pes cavo-varus is one of exclusion. Typically a neuropathic etiology is sought. Equally well known is the association of rigid flatfoot deformity with calcaneonavicular and subtalar coalition. Less well known is the association of pes cavo-varus with tarsal coalition. This is a report of three patients who presented with cavo-varus deformities without underlying neurologic abnormalities, one with a calcaneonavicular coalition and two with subtalar coalitions, the latter an entity not previously described in association with pes cavo-varus, to our knowledge.
Posterior Ankle Impingement
Authors: Hedrick Mark Raymond , McBryde Angus Murdoch
Published: March 2013

Thirty cases of posterior ankle impingement in 28 patients were treated over a 10-year period (1982–1992). All conditions were caused by forced plantar flexion. An os trigonum or posterior process fracture was demonstrated radiographically in 63% of these cases, and an intact posterior process was demonstrated in 33%. Ten cases were lost to follow-up. Of the remaining 20 cases, in 18 patients 12 (60%) improved with nonoperative treatment; 8 (40%) required operative excision. The results were good to excellent in 7 patients and fair in 1 patient. Operative excision for the treatment of recalcitrant posterior ankle impingement can relieve symptoms and allow a return to full preinjury activities.
Arthrodesis of the First Metatarsophalangeal Joint with Vitallium Plate Fixation
Authors: Coughlin Michael J. , Abdo Richard V.
Published: March 2013

Forty-seven patients (58 feet) underwent first metatarsophalangeal joint fusion with a small Vitallium plate (Howmedica, Inc., Rutherford, NJ). Congruous joint surfaces were prepared with either cone-shaped or cup-shaped reamers. At an average follow-up of 19.2 months, 98% (57 feet) were successfully fused. Ninety-three percent (54 feet) noted good or excellent results. Plate removal was necessary in only 7% (4 feet) of cases. Complications included nonunion with plate breakage in 2% (1 foot) and delayed union in 2% (1 foot) of cases. This technique was useful and predictable in achieving successful fusion of the first metatarsophalangeal joint.
Severe Obesity: Effects on Foot Mechanics During Walking
Authors: Messier Stephen P. , Davies Angela B. , Moore Dominic T. , Davis Shala E. , Pack Robert J. , Kazmar Scott C.
Published: March 2013

The purpose of our study was to determine the effects of severe obesity on the foot mechanics of adult females. Twenty-nine adult females between the ages of 20 and 48 years volunteered as subjects for this investigation. The subjects were separated into a severely obese (O) group (body mass index = 41.14 ± 2.61; N = 16) and a normal weight control group (body mass index = 20.84 ± 0.47; N = 13). A Locam camera (100 Hz) positioned perpendicular to the subjects’ posterior aspect was used to film the rearfoot movement of the subjects during the final 15 sec of a 10 min treadmill walk. The O group had a significantly greater touchdown angle ( P = .05), more total eversion range of motion ( P = .001), and a faster maximum eversion velocity ( P < .001). Moreover, analysis of dynamic foot angles indicated that the O group had significantly ( P = .003) more forefoot abduction. Finally, anthropometric data revealed statistically different ( P < .001) Q angle measurements between the O and control groups. The results of this study suggest that severely obese females have significantly greater rearfoot motion, foot angle, and Q angle values than normal weight females.
Plantar Pressure Distribution Patterns of Young School Children in Comparison to Adults
Authors: Hennig Ewald M. , Staats Anke , Rosenbaum Dieter
Published: March 2013

Peak pressures and relative loads were determined under the feet of 125 children between 6 and 10 years of age. These results were compared with previously published data from 111 adults. A capacitive pressure distribution platform with a resolution of 2 sensors/cm 2 was used for data collection during walking. As compared with the group of adults, the school children showed considerably lower peak pressures under all anatomical structures. Larger foot dimensions with respect to body weight result in reduced foot pressures for the children by distributing the ground reaction forces across larger contact areas. With increasing age, a medial load shift in the forefoot could be observed for the older children. Data analysis of the pressures under the midfoot revealed that the longitudinal foot arch development is almost complete before the age of 6. Contrary to the findings in adults, body weight was identified to be of major influence on the magnitude of the pressures under the feet of school children. No differences were found for the foot pressures between boys and girls.
Intraosseous Hemangioma of the Talus: A Case Report
Authors: Sheth Dhiren , Marcove Ralph C. , Healey John , Wilson Mary , Huvos Andrew G.
Published: March 2013

A 35-year-old female patient presented to us with a lesion in the talus that on AP-roentgenographic view simulated an osteoid osteoma. Final pathology revealed it to be an intraosseous hemangioma. An intraosseous hemangioma at this site is extremely uncommon and has not been previously reported.
Ossification of the Achilles Tendon: A Case Report
Authors: Hatori Masahito , Kita Atsushi , Hashimoto Yoshinori , Watanabe Nikichi , Sakurai Minoru
Published: March 2013

Ossification of the Achilles tendon is a rare condition. We recently treated a patient with ossification of bilateral Achilles tendons. The patient was a 50 year old male whose chief complaint was discomfort around the Achilles tendon. He had a previous history of treatment of bilateral club feet On the roentgenograms, the length of the bony mass in the Achilles tendon was 5.5 cm on the right side and 1.5 cm on the left side. The left side was treated by surgical removal of a bony mass and suture of the tendon. Microscopic examination of the extirpated specimen revealed bone formation through enchondral and intramembranous ossification in the Achilles tendon.
Intramural Leiomyosarcoma of the Dorsal Pedal Vein: A Clinical Mimicry of Ganglion
Authors: Bégin Louis R. , Guy Pierre , Mitmaker Benjamin
Published: March 2013

A 75-year-old woman presented with a ganglion-like nodule on the dorsal aspect of the right foot. A 2.5 × 1.5 cm, saccular and malleable tumor, that was in continuity with the dorsal venous arch, was completely resected. It was characterized by a diffuse intramural and circumferential, low grade, malignant, smooth muscle proliferation with an aneurysmal-like luminal space. No endoluminal or periadventitial invasive neoplastic component was present. The patient had no evidence of disease at 58-month follow-up. This is the first reported case of venous leiomyosarcoma in the foot. Furthermore, the intramural confinement of neoplastic growth is a unique observation.
Cigarette Smoking and Nonunion after Ankle Arthrodesis
Authors: Cobb Tyson K. , Gabrielsen Timothy A. , Campbell Donald C. , Wallrichs Steven L. , Ilstrup Duane M.
Published: March 2013

The relative risk of nonunion in smokers versus nonsmokers after ankle arthrodesis was determined in a case control study. Twenty-two patients were matched to 22 controls by age, sex, surgeon, surgical technique, and preoperative diagnosis. Information on duration, amount, and past history of smoking was obtained for these 44 patients. Ten of the patients were actively smoking at the time of surgery compared with four of the controls. Six of the patients had no history of smoking and six had stopped smoking before surgery. Eleven of the controls had no history of cigarette smoking and 7 had stopped smoking before surgery. The relative risk of nonunion was increased 3.75 times for active smokers. When patients did not have any known risk factors for nonunion, the risk of nonunion for smokers was 16 times the risk of nonunion for nonsmokers
The Modified Robert Jones Tendon Transfer in Cases of Pes Cavus and Clawed Hallux
Authors: Tynan Martin C. , Klenerman L. Ch.M.
Published: March 2013

This is a retrospective study of the modified Robert Jones tendon transfer in 24 patients and 28 feet. The main indication for the procedure was to correct symptoms related to clawing of the hallux in seven patients, relieve pressure under the head of the first metatarsal in 13 patients, and treat for both symptoms in three patients. One patient had diffuse ache in the arch. Fifteen patients had idiopathic cavus feet, of whom five had associated spina bifida occulta. The remainder had a variety of different etiologies including cerebral palsy, head injury, brain abscess, and spinal cord tethering. Postoperative follow-up ranged from 7 months to 33 years with an average of 5 years and 6 months. The modified Robert Jones tendon transfer was shown to be effective in relieving symptoms related to clawing of the hallux in 90% of patients but was not reliable in curing pain under the first metatarsal head, with success in only 43% of patients. In three patients, pain under the metatarsal head was relieved initially but recurred by 18 months. Complications were frequent. Six patients developed pain under the tip of the hallux postoperatively
Epidemiology of Sprains in the Lateral Ankle and Foot
Authors: Hølmer Per , Søndergaard Lars , Konradsen Lars , Nielsen Poul Torben , Jørgensen Lars Nannestad
Published: March 2013

The epidemiology of sprains in the lateral ankle and foot was investigated in a prospective study at the casualty ward at Hillerad County Hospital. During one year, 766 patients were registered. The overall sprain incidence was 7/1000 person-years. The incidence was highest for young males. After the age of 40 years, the incidence was higher for women than for men. Most sprains were sustained during sport, but, with increasing age, other activities became dominant. Sixty-one percent of the lesions were located around the lateral ankle, and 24% were located on the lateral midfoot.
The Use of Magnetic Resonance Imaging in the Diagnosis of Stress Fractures of the Foot and Ankle: Four Case Reports
Authors: Steinbronn David J. , Bennett Gordon L. , Kay David J.
Published: March 2013

Stress fractures result when bone is subjected to repeated loading which causes fatigue, cracking of the bone, and, eventually, a complete fracture. Stress fractures of the foot and ankle are common injuries affecting a broad range of the population, from the young to the elderly, the fitness enthusiast to the chronically debilitated. The diagnosis of stress fracture is not always obvious because radiographs are often negative, especially on initial presentation. In this report, we present four cases in which, after appropriate initial studies proved inconclusive, magnetic resonance imaging (MRI) was used to establish the diagnosis of stress fracture. We propose that MRI is a useful diagnostic modality in a select group of patients with suspected stress fractures of the foot and ankle.
Conservative Treatment of Plantar Heel Pain: Long-Term Follow-Up
Authors: Wolgin Mark , Cook Charles , Graham Charles , Mauldin Don
Published: March 2013

In order to evaluate the long-term results of patients treated conservatively for plantar heel pain, a telephone follow-up survey was conducted. After eliminating those patients with worker's compensation-related complaints and those with documented inflammatory arthritides, data on 100 patients (58 females and 42 males) were available for review. The average patient was 48 years old (range 20–85 years). The average follow-up was 47 months (24–132 months). Clinical results were classified as good (resolution of symptoms) for 82 patients, fair (continued symptoms but no limitation of activity or work) for 15 patients, and poor (continued symptoms limiting activity or changing work status) in 3 patients. The average duration of symptoms before medical attention was sought was 6.1, 18.9, and 10 months for the three groups, respectively. The three patients with poor results all had bilateral complaints, but had no other obvious risk factors predictive of their poor result. Thirty-one patients stated that, even with the understanding that surgical treatment carries significant risk, they would have seriously considered it at the time medical attention was sought; twenty-two of these patients eventually had resolution of symptoms. Although the treatment of heel pain can be frustrating due to its indolent course, a given patient with plantar fasciitis has a very good chance of complete resolution of symptoms. There is a higher risk for continued symptoms in overweight patients, patients with bilateral symptoms, and those who have symptoms for a prolonged period before seeking medical attention.
The Modified Mitchell Osteotomy-Bunionectomy: Indications and Technical Considerations
Authors: Blum Jerald Leonard
Published: March 2013

A total of 204 modified Mitchell osteotomy-bunionectomy procedures with Steinmann pin fixation were evaluated by radiograph, history, and physical examination with longterm personal follow-up. The specific surgical technique modifications used in this series are discussed. This modified procedure produced 91% good or excellent results in this series. The complications or unsatisfactory results were due to partial avascular necrosis, lateral metatarsalgia, incomplete correction of hallux valgus, or late stress fractures. These unsatisfactory results led to the development of specific preoperative surgical criteria for the procedure in addition to the technical modifications.
A Comprehensive Study of Pressure Distribution in the Ankle Joint with Inversion and Eversion
Authors: Calhoun Jason H. , Li Fan , Ledbetter Billy R. , Viegas Steven F.
Published: March 2013

The understanding of load transfer characteristics is the baseline for biomechanics of the ankle joint. Changes in contact patterns of the articular cartilage from the norm may indicate pathologic conditions. Measurement of the contact in human cadaver ankles provides a direct measurement for this understanding.

The force transfer characteristics of the three facets of the ankle joint were investigated. Five fresh-frozen cadaver lower extremities were tested in 12 positions under three axial loads of 490, 686, and 980 N. Fuji film served as the pressure transducer and the prints were analyzed by a computerized video digitizer. The results demonstrated that as the foot was moved into inversion or eversion with the ankle in neutral flexion or dorsiflexion, there was a decrease in total contact area and an increase in the average high pressure. In plantarflexion, the contact area was lower and the average high pressure was higher, indicating a greater force per unit area as compared with dorsiflexion and neutral flexion. In plantarflexion, however, little change was noted with inversion or eversion. In dorsiflexion, the total contact area was higher and the average high pressure slightly lower as compared with neutral flexion. With inversion, the contact area of the medial facet of the ankle increased and with eversion it increased on the lateral facet, especially in dorsiflexion. With an increase in loading, the pressure did not significantly increase but the contact area did increase. The centroid of the contact moved anteriorly to posteriorly on the talus as the joint moved from dorsiflexion to plantarflexion. The talar dome facet sustained 77% to 90% of the load, while the medial facet was loaded more during inversion (up to 22%) and the lateral facet was loaded more during eversion (up to 10.5%).

No previous study has examined the relative contributions of the three main talar joint surfaces in multiple positions. The new information in this study includes the fibular and medial facet contribution and the variation of the load with position changes and loading increase. This study also provides a comprehensive evaluation of the pressure, contact area, and centroid of the ankle joint in its normal ranges of motion.
Ankle Instability: In Vitro Kinematics in Response to Axial Load
Authors: Cass Joseph R. , Settles Harry
Published: March 2013

This study was undertaken to elucidate the kinematics of hindfoot instability. An axial load was applied to the inverted hindfoot. Unlike prior studies, axial rotation was not constrained. Using computerized tomography, measurements were made on the axial views of external or internal rotation of the leg, talus, and calcaneus. On the coronal views, tilting of the talus at the ankle and subtalar joints was assessed. No tilting of the talus in the mortise occurred with isolated release of the anterior talofibular (ATF) or calcaneofibular (CF) ligament. In every specimen, talar tilt occurred only after both ligaments were released, averaging 20.6°. External rotation of the leg occurred with inversion averaging 11.1° in the intact specimen. The leg averaged a further external rotation of 4.9° after ATF release and 12.8° further than the intact inverted specimens when both ligaments (ATF-CF) had been released. In earlier reports on the subject, the articular surfaces were believed to be the main constraint against tilting of the talus. In those studies, either axial rotation was constrained while inversion was allowed, or vice versa. Based on the data reported here, the ATF and the CF work in tandem to prevent tilting of the talus, and the articular surfaces do not seem to prevent tilting of the talus in the mortise.
Relationship Between Neutral Subtalar Joint Position and Pattern of Rearfoot Motion During Walking
Authors: McPoil Thomas , Cornwall Mark W.
Published: March 2013

The purpose of this study was to determine the relationship between the angle formed by the rearfoot when the subtalar joint is positioned in neutral and the pattern of rearfoot motion during walking. Each lower extremity for 50 healthy young adult subjects (mean age 25.5 years) was videotaped and the pattern of rearfoot motion was assessed using two-dimensional analysis. The results indicate that the rearfoot is slightly inverted before heel strike and that the average time to maximum pronation occurs at approximately 37.9% of the stance phase duration. Contrary to a previously published theory, the “neutral” position of the rearfoot for the typical pattern of rearfoot motion during the walking cycle was found to be resting standing foot posture rather than subtalar joint neutral position.
Magnetic Resonance Imaging for the Diagnosis of Osteomyelitis in the Diabetic Patient with a Foot Ulcer
Authors: Levine Stuart Eric , Neagle Charles E. , Esterhai John L. , Wright Douglas Gregory , Dalinka Murray K.
Published: March 2013

Twenty-seven diabetic patients (12 males and 15 females) with clinically suspected osteomyelitis complicating soft tissue infection of the foot underwent 29 magnetic resonance imaging studies of the suspected lesion. Of these patients, 26 had plain film radiographs, 11 had technetium bone scanning, and 12 had indium-labeled leukocyte scintigraphy performed within 2 weeks of the magnetic resonance imaging. Definitive diagnosis of the presence or absence of osteomyelitis was obtained on the basis of surgical findings, histological evidence, or resolution with nonoperative therapy.

Magnetic resonance imaging was 90% accurate (sensitivity 77%, specificity 100%) in the diagnosis of osteomyelitis in this patient population. Technetium bone scan was 45% accurate (sensitivity 100%, specificity 25%); indium-labeled leukocyte scintigraphy was 50% accurate (80% sensitivity, 29% specificity); and plain film roentgenography was 73% accurate (60% sensitivity, 81% specificity). Magnetic resonance imaging is a powerful, noninvasive tool for determining the presence or absence of osteomyelitis in the patient with a diabetic foot ulcer.
Tuberculosis of the Foot: A Case Report
Authors: Dalldorf Peter G. , Banas Michael P. , Marquardt John D.
Published: March 2013

A case of tuberculosis of the foot that was delayed in diagnosis is presented. Common pitfalls of diagnostic evaluation as well as pathogenesis and recent epidemiologic trends are discussed. It is hoped that such reports will serve to heighten awareness of the return of this mighty pathogen.
Radiographic Diagnosis of Ankle Fractures: Are Three Views Necessary?
Authors: Vangsness C. Thomas , Carter Vincent , Hunt Timothy , Kerr Rodger , Newton Edward
Published: March 2013

One hundred and twenty-three sets of emergency room ankle x-rays (anteroposterior lateral and mortise) were retrospectively reviewed to determine whether all three views were necessary to diagnose the presence of an ankle fracture. Four physicians (two orthopaedic surgeons, one musculoskeletal radiologist, and one emergency room physician) reviewed all randomly ordered sets of films twice—once with all three views and once with only the lateral and mortise views. The overall accuracy of two views was within the 95% expected threshold of accuracy using three views. The lateral and mortise views alone appear sufficient for ankle fracture diagnosis, and imply a substantial decrease in radiation and cost savings to the patient.
Gait Analysis and Dynamic Foot Pressure in the Assessment of Treated Clubfoot
Authors: Widhe Torulf , Berggren Lotta
Published: March 2013

Gait analysis and dynamic foot pressure were used in a follow-up study of 42 children with idiopathic clubfeet. Mean age at follow-up was 9 years (range 4–15 years). Twenty-four of the 62 clubfeet were treated conservatively and 38 had at least one operative intervention. Gait analysis showed that the vertical and posterior ground forces were significantly lower from the clubfoot compared with the normal foot. Dynamic foot pressure demonstrated a significant shift of the center of pressure to the lateral side in the affected compared with the normal side. In bilateral clubfeet, a relationship between center of pressure and subjective complaints was observed.
Arthroscopic Visualization of the Tibial Plafond During Posterior Malleolar Fracture Fixation
Authors: Holt Edward S.
Published: March 2013

Fracture of the tibial plafond, such as in a trimalleolar fracture, with a large posterior tibial (posterior malleolus) fragment may require open reduction and internal fixation. Anatomic reduction of the articular surface can be ensured by visualizing the articular surface using an arthroscope during reduction. Four cases wherein this technique has proven effective are described.
Use of Skin Z-Plasty for Management of Extension Contracture in Recurrent Claw- and Hammertoe Deformity
Authors: Myerson Mark S. , Fortin Paul , Girard Pierre
Published: March 2013

Nine patients with recurrent metatarsophalangeal joint extension contracture after clawtoe or hammertoe procedures were treated with Z-plasty skin closures as part of the revision surgical procedure. The indication for performing the Z-plasty was the presence of scar contracture in the skin that prevented satisfactory correction of the toe. Soft tissue release of the metatarsophalangeal joint was followed by a simple dorsal skin Z-plasty transposition. Patients were evaluated 1 1/2 to 6 years after revision surgery. No recurrence of the extension contracture had occurred.
Consistency of Visual Assessments of Arch Height among Clinicians
Authors: Cowan David N. , Robinson John R. , Jones Bruce H. , Polly David W. , Berrey B. Hudson
Published: March 2013

Flat feet and high-arched feet have been cited as risk factors for musculoskeletal injury and functional problems among runners and other active individuals, although there are no established quantitative definitions or measures for assessing either condition. As part of a larger study, four-plane photographs were made of the weight-bearing right foot of 246 young male Army trainees. These photographs were independently evaluated by six clinicians and rated on a scale of clearly flat-footed (category 1) to clearly high arched (category 5). There was much interclinician variability in the assessments, even for extremes of foot type. The probability of a clinician assessing a foot as clearly flat, given that another clinician had rated the foot as clearly flat, ranged from 0.32 to 0.79, with a median probability of 0.57, while for clearly high-arched feet, probabilities ranged from 0.0 to 1.00, with a median of 0.17. These findings demonstrate the need for objective standards and quantitative methods of evaluating foot morphology.
Recurrent Medial Ankle Instability: The Result of Distal Fibular Growth Arrest
Authors: Berg Eugene E.
Published: March 2013

Recurrent medial ankle instability is an uncommon clinical entity. A case that resulted from a distal fibular physeal arrest is described. Symptoms resolved after a one-stage fibular lengthening.
Management of Midfoot Diabetic Neuroarthropathy
Authors: Myerson Mark S. , Henderson Michael R. , Saxby Terence , Short Kelly Wilson
Published: March 2013

Between 1986 and 1990, we treated 68 patients with diabetes and neuroarthropathy of the midfoot, 21 of whom had bilateral involvement. Patients were managed according to a strict protocol defined by activity of the neuroarthropathy, instability, ulceration, infection, and ischemia. Initial management of acute neuroarthropathy (18 feet) was open reduction and arthrodesis (8), a total-contact cast or brace (9), and amputation (1). All patients with subacute neuroarthropathy (30 feet) were initially treated in a total contact cast. Four of these feet subsequently required amputation, two required arthrodesis, and one required exostectomy. For chronic neuroarthropathy (41 feet), a total-contact cast or a molded orthotic insert with or without bracing was used initially in all feet. Subsequent surgical salvage for this group included arthrodesis (9), plantar exostectomy (6), amputation (2), and abscess drainage (2). Four patients died during this treatment period and 64 patients (85 feet) were evaluated at a mean interval of 3 years (range 1–6 years) after initiation of treatment. This treatment program was found to be successful in 82 of 85 feet treated.
Ankle Resection Arthrodesis in Patients with Bone Tumors
Authors: Casadei Roberto , Ruggieri Pietro , Giuseppe Tella , Biagini Roberto , Mercuri Mario
Published: March 2013

The authors report 12 cases of bone tumors localized in the distal tibia treated by resection and reconstruction with ankle arthrodesis, using bone grafts and fixation with Kuntscher or Grosse-Kempf nail or plate. In seven cases autografts were used, and in five cases autografts combined with allografts were used. In three of these five patients, a vascularized fibula combined with a “gutter-like” allograft was used to reconstruct the bone defect. In all cases, the functional and oncologic results were good and all patients were disease free at an average follow-up of 68 months.
Outcome after Free Flap Reconstruction of the Heel
Authors: Durham John W. , Saltzman Charles L. , Steyers Curtis M. , Miller Bruce A.
Published: March 2013

We reviewed six free flap reconstructions of the weightbearing surface of the heel. Patients were seen for clinical evaluation at a mean follow-up of 4.7 years (range 2.7–6.0 years). Functional results using a modified Boston Children's Hospital Ankle Score were 33% excellent, 33% good, 17% fair, and 17% poor. The excellent functional results were related to the absence of chronic draining flap ulcers.

All flaps lacked protective sensation by Semmes-Weinstein monofilament testing. Weightbearing plantar pressures in the flaps were elevated in all patients. Sequential radiographs from the time of flap coverage revealed the development of a bony protuberance (stalactite) projecting from the undersurface of the calcaneus in all patients with injuries to the plantar cortex of the calcaneus. In patients with flap ulceration, these stalactites projected into the ulcer at the site of maximum plantar pressure. A combination of loss of plantar calcaneal integrity, elevated pressure concentrations, and flap insensitivity appear causally related to the development of heel free flap ulceration and outcome.
Comparison of Stability of Proximal Crescentic Metatarsal Osteotomy and Proximal Horizontal “V” Osteotomy
Authors: McCluskey Leland C. , Johnson Jeffrey E. , Wynarsky George T. , Harris Gerald F.
Published: March 2013

Proximal metatarsal osteotomies are often performed in patients with hallux valgus and significant metatarsus primus varus. The crescentic osteotomy is popular; however, some authors have reported malunion of the metatarsal shaft caused by dorsal angulation of the osteotomy in a significant number of cases. Recently, proximal transverse “V” osteotomies have been reported to have good results, with rapid healing and no dorsal malunions.

We compared the stability of a transverse, proximal “V” osteotomy, using two 0.062-inch K-wires or a 3.5-mm cortical screw for fixation, with that of the proximal crescentic osteotomy, using a 3.5-mm cortical screw fixation. The three osteotomy/fixation techniques were performed on 30 fresh-frozen cadaver feet. The specimens were loaded to failure at the fixation site by applying a load through the plantar surface of the first metatarsal head. Force versus displacement curves were obtained to calculate the failure load and stiffness. Statistical differences among the three groups were determined by the nonparametric Mann-Whitney U-test and the standard t-test.

The “V” osteotomy/screw group was more stable than either the “V” osteotomy/pin group or the crescentic osteotomy/screw group. Differences in failure strength between the “V”/screw group and the other two groups were significant at the P < .01 level and the differences in stiffness were significant at the P = .05 level. No statistical differences were found between the “V”/pins and the crescentic/screw groups.
The Superior Peroneal Retinaculum: An Anatomic Study
Authors: Davis W. Hodges , Sobel Mark , Deland Jonathan , Bohne Walter H.O. , Patel Manoj B.
Published: March 2013

The superior peroneal retinaculum is thought to be the primary restraint to subluxation and/or dislocation of the peroneal tendons as they pass posterior to the distal fibula. The descriptions in anatomy texts vary widely. This anatomical study describes the different patterns of insertions for the superior peroneal retinaculum and its relationship to the peroneal tendons and the ligaments of the lateral ankle.
The Plantar Plate of the Lesser Toes: An Anatomical Study in Human Cadavers
Authors: Johnston Richard B. , Smith Judith , Daniels Timothy
Published: March 2013

The purpose of this study was to evaluate the anatomic structure and biochemical composition of the plantar plate of the lesser toes. Fresh frozen-human cadaveric feet were used to study 20 metatarsophalangeal and proximal interphalangeal plantar plates. The observations of foot dissections were compared with the finger volar plate.

The plantar plate of the toe is a rectangular structure with a stout distal insertion and relatively flimsy proximal origin. The anatomic relationships to adjacent structures and composition are similar between the volar plates of the fingers and plantar plates of the toes. The plantar plate is known to experience extension forces that the volar plate does not experience. The weightbearing nature of the foot and forces imposed by toe-off may create chronic hyperextension of the metatarsophalangeal joint and predispose the plantar plate to attenuation or rupture, thus leading to instability of the metatarsophalangeal joint. These findings may explain in part the clinical condition of spontaneous metatarsophalangeal joint dislocation, most commonly found in the second toe.
Primary Union of Ankle Arthrodesis: Review of a Single Institution/Multiple Surgeon Experience
Authors: Dohm Micheal , Purdy Beth Ann , Benjamin James
Published: March 2013

A review of 37 ankle arthrodesis procedures done over a 12-year period by multiple surgeons at a single institution was performed. Six different techniques were used during the study period. The initial success rate, defined as cases achieving a solid union after the index procedure, was 65%. Seven additional patients went on to a solid arthrodesis after subsequent surgical procedures, for an ultimate success rate of 84%. The initial success rate varied considerably depending on the surgical technique used, and ranged from 29% with the RAF fibular strut technique to 100% with T-plate fixation. Although there are many variables that influence the success or failure of ankle arthrodesis, in our hands rigid internal fixation gave the most predictable rate of primary union.
A Biomechanical Evaluation of Three Forms of Internal Fixation Used in Ankle Arthrodesis
Authors: Dohm Michael P. , Benjamin James B. , Harrison Jeffrey , Szivek John A.
Published: March 2013

A biomechanical study was undertaken to evaluate the relative stability of three types of internal fixation used for ankle arthrodesis. Crossed screw fixation, RAF fibular strut fixation, and T-plate fixation were tested in 30 cadaver ankles using an MTS machine. T-plate fixation consistantly provided the stiffest construct when compared with the other types of fixation. Failure occurred by distraction of bony surfaces, posterior to the plane of fixation, in the crossed screw and RAF groups. In contrast, failure in the T-plate group occurred through compression of bone anterior to the midcoronal plane of the tibia. Although the stability of fixation is only one factor in determining the success or failure of ankle arthrodesis, the results of this study would support T-plate fixation over the other forms tested.
A Biomechanical Comparative Analysis of Two Techniques for Tibiotalar Arthrodesis
Authors: Friedman Robert L. , Glisson Richard R. , Nunley James A.
Published: March 2013

Two commonly used techniques for tibiotalar fusion were quantitatively compared using instrumented testing of the strength of the construct. The tibiae and tali from 10 pairs of fresh-frozen cadaveric limbs were used. One joint of each pair was fused using two 6.5-mm crossed cancellous screws from proximal to distal while the contralateral joint was fused using two 6.5-mm parallel cancellous screws from distal to proximal. Each specimen was subjected to cantilever bending and torsional testing by servohydraulic actuators. The bending tests included plantarflexion, dorsiflexion, inversion, and eversion, and measured the load during deflection applied 10 cm distal to the fusion site. The rigidity was expressed as newtons per millimeter of deflection. The torsional tests measured construct stiffness in external and internal rotation, and were expressed as newton-meters per degree of rotation. For the bending tests, the crossed screw construct was more rigid in eversion (23.1 N/mm, P = .0004) and dorsiflexion (16.9 N/mm, P = .02), while the parallel screw construct was more rigid in inversion (22.8 N/mm, P = .02) and plantarflexion (22.3 N/mm, P = .0007). In torsional testing, the crossed screw construct was at least 1.5 times stiffer than the parallel screw construct in resisting internal (1.7 N-m/deg versus 0.9 N-m/deg, P = .0001) and external (1.4 N-m/deg versus 0.9 N-m/deg, P = .02) rotation.

In laboratory testing, the crossed screw technique is more rigid than the parallel screws, especially in resisting torsional stresses. Assuming that a stronger construct is desirable, and given that short leg casts commonly used after such fusions do not completely restrict torsional motion, this biomechanical analysis suggests that the crossed screw technique improves the likelihood of a successful arthrodesis.
Intra-articular Radiation Treatment of Rheumatoid Synovitis of the Ankle with Dysprosium-165 Ferric Hydroxide Macroaggregates
Authors: Barnes C. Lowry , Shortkroff Sonya , Wilson Michael , Sledge Clement B.
Published: March 2013

Intra-articular radiation treatment using dysprosium-165 ferric hydroxide macroaggregate has been performed on eight patients with refractory synovitis of the ankle. Seventy-five percent (six patients) responded well to the treatment, and there were no complications from the injection. Although ankle synovectomy is not often indicated, those patients with rheumatoid synovitis without significant joint destruction respond favorably to radiation treatment.
Dynamic Study of Insole Materials Simulating Real Loads
Authors: Garcia Ana-Cruz , Durá Juan-Vicente , Ramiro José , Hoyos Juan-Victor , Vera Pedro
Published: March 2013

A new methodology of biomechanical analysis of materials for shoe inserts is presented. This methodology is based on the determination of the loads applied to the materials in real situations and its simulation by means of a dynamic testing machine. Both the rigidity and the energy-absorbing characteristics of the materials are investigated as a function of frequency. This methodology is applied to the study of several commercially available viscoelastic materials intended for shoe inserts in the treatment and prevention of degenerative joint diseases. The influence of thickness is investigated as well as the frequency-dependent behavior of the materials studied. Significant differences between materials and different behavior as a function of thickness and frequency were found. Poron materials were found to have the lowest rigidity, good for adequate pressure distribution, while Noene showed the highest energy absorption. A careful selection of the thickness of Sorbothane was found to be necessary for avoiding flattening of the material.
Plantar Pressures During Level Walking Compared with Other Ambulatory Activities
Authors: Lundeen Steve , Lundquist Kurt , Cornwall Mark W. , McPoil Thomas G.
Published: March 2013

This study was designed to determine the magnitude of plantar pressures during level walking in comparison to other activities. These activities included climbing up stairs, going down stairs, a simple pivot while walking, and a crossover pivot while walking in normal individuals. Twelve volunteers, six men and six women, mean age 28 years, served as subjects. Data were collected on the dominant foot with an EMED-SF pressure sensor platform as each subject walked barefoot and did each of the five activities. Maximum plantar pressure (MPP) and pressure-time integral (PTI) was found in the metatarsal and heel regions. The results of repeated-measures analysis of variance tests showed that the five experimental conditions were statistically different for both MPP and PTI in the metatarsal and heel regions. Post hoc analysis indicated that MPP and PTI were decreased during the going down stairs condition in the heel and increased during the crossover pivot while walking and pivot while walking conditions for the metatarsal region.
Case Report: An Unusual Cutaneous Myiasis of the Foot
Authors: Callahan Dennis J.
Published: March 2013

A case of rare cutaneous myiasis, which has not heretofore been described in the foot, is presented. The unusual life cycle is described in order to understand the clinical presentation. The treatment options are discussed and recommendations are made to avoid treatment pitfalls.
Management of the Adult, Spastic, Equinovarus Foot Deformity
Authors: Lawrence Steven J. , Botte Michael J.
Published: March 2013

Management of the persistent, acquired, neurogenic equinovarus foot may be a confounding rehabilitative dilemma. Victims of cerebrovascular accidents and traumatic brain injury commonly develop this neurogenic deformity. The plantarflexed and inverted foot position results from an imbalance of forces about the hindfoot due to exaggerated muscle tone and hyperactive stretch reflexes. Significant functional impairment may ensue if a plantigrade foot position cannot be achieved and maintained. Surgical correction may be necessary if conservative measures fail. Determination of the dynamic and static components contributing to the equinovarus deformity is difficult. Gait analysis and dynamic electromyographic studies are valuable adjuncts for operative planning. The wide-ranging goals of surgery vary from improving transfer and ambulation skills, to assisting wheelchair positioning, to facilitating use of braces and/or shoe wear.
Tibiocalcaneal Arthrodesis for Nonbraceable Neuropathic Ankle Deformity
Authors: Alvarez Richard G. , Barbour Thomas M. , Perkins Thornton D.
Published: March 2013

Seven patients with nonbraceable, neuropathic ankle joints have been successfully treated by tibiocalcaneal arthrodesis utilizing an adolescent condylar blade plate, large cannulated AO screws, and a special cancellous allograft mixture. All patients had fragmentation and partial resorption of the talus. This procedure was considered as an alternative to below-knee amputation. Goals were limb salvage and limited community ambulation.
Plantar Fascia Rupture Associated with Corticosteroid Injection
Authors: Sellman John Robert
Published: March 2013

A series of 37 patients, all with a presumptive diagnosis of plantar fascia rupture, is presented. All had had prior heel pain diagnosed as plantar fasciitis, and all had been treated with corticosteroid injection into the calcaneal origin of the fascia. One third described a sudden tearing episode in the heel, while the rest had a gradual change in symptoms. Most of the patients had relief of the original heel pain, which had been replaced by a variety of new foot problems, including dorsal and lateral midfoot pain, swelling, foot weakness, metatarsal pain, and metatarsal fracture. In all 37 patients, there was a palpable diminution in the tension of the plantar fascia on the involved side, and footprints often showed a flattening of the involved arch. Magnetic resonance imaging done on one patient showed attenuation of the plantar fascia. From these observations and data, the author concluded that plantar fascia rupture had occurred. Treatment following rupture included supportive shoes, orthoses, and time. The majority had resolution of their new symptoms, but this often took 6 to 12 months to occur. In the remainder, there were persisting symptoms. Corticosteroid injections, although helpful in the treatment of plantar fasciitis, appear to predispose to plantar fascia rupture.