bluuebunny/crossref_metadata_2025 huggingface dataset:
Keller Arthroplasty in Combination with Resection Arthroplasty of the Lesser Metatarsophalangeal Joints in Rheumatoid Arthritis
Authors: McGarvey Scott R. , Johnson Kenneth A.
Published: March 2013

We reviewed the results of the Keller arthroplasty in combination with resection arthroplasty of the forefoot in patients with rheumatoid arthritis. Of the 29 patients (49 feet) in the series, 20 had involvement of both feet and nine had involvement of a single foot. The average age of the patients was 55.4 years, and the average follow-up period was 4.9 years. All feet had resection of the lesser metatarsal heads, resection of the base of the proximal phalanges of the lesser toe, and a Keller arthroplasty of the first metatarsophalangeal joint. The results were satisfactory in 16 feet, satisfactory with some reservations in 21 feet, satisfactory with major reservations in seven feet, and unsatisfactory in five feet. For 40 of the 49 feet (82%), the patients stated that they would repeat the procedure, knowing the results achieved. The major causes of patient reservations and lack of satisfaction were return of the hallux valgus deformity and pain (53%), forefoot instability (27%), and continuing metatarsalgia (20%). Resection arthroplasty of the lesser metatarsophalangeal joints of the forefoot in rheumatoid disease is a satisfactory procedure. When used in combination with Keller resection arthroplasty of the first metatarsophalangeal joint, however, an increased number of unsatisfactory results occur, attributable to returning pain and deformity of that joint.
Subtalar Distraction Bone Block Fusion for Late Complications of Os Calcis Fractures
Authors: Carr James B. , Hansen Sigvard T. , Benirschke Stephen K.
Published: March 2013

The authors are presenting a new subtalar fusion technique for late complications of calcaneus fractures. These complications include pain, shoe wear difficulties, and foot deformity. The complex pathology includes incongruous subtalar joint, loss of calcaneal body height, and decreased lateral talocalcaneal angle. The latter two factors can result in tibiotalar neck impingement, a deformity that has received little attention in the literature. The subtalar fusion technique involves distraction of the subtalar joint, insertion of a bone block, and rigid screw fixation. The distraction allows correction of the talocalcaneal relationship and regains lost hindfoot height. The clinical series involved 16 feet with an average follow-up of 19 months. Results were satisfactory in 13 feet. Pre- and postoperative radiographic analysis for tibiotalar impingement, lateral talocalcaneal angle, and talonavicular subluxation was performed, with improvement to a normal range seen in the cases analyzed. The results are encouraging but should be considered preliminary based on the length of follow-up.
Arthroscopic Treatment of Sports-Related Anterior Osteophytes in the Ankle
Authors: Hawkins Richard B.
Published: March 2013

Osteophytes on the anterior aspect of the tibia and anterior talus are common in athletes such as dancers, runners, and high jumpers who impact with quick and forceful dorsiflexion to this area. This pathology is often confirmed easily on lateral x-ray films. Excision, debridement, and/or abrasion arthroplasty can be performed arthroscopically to remove osteophytic bone. The joint space is easily approached and managed using small joint or even regular-sized arthroscopic instruments. Care is taken to reshape the anterior tibia and/or talus to its original contour, thus avoiding impingement of the joint space and scuffing of adjacent articular cartilage. Proper abrasion depths and punch lesions may be needed to expose bleeding capillary bone. This allows a regeneration of a fibrocartilage covering that not only decreases pain but also permits a return to functional and athletic activities. Postoperative treatment, including physical therapy, is described. Three case studies are presented that adequately demonstrate this problem, along with the corrective measures taken. Each case concludes with a brief summary of follow-up.
Painful Heel Syndrome: Radiographic and Treatment Assessment
Authors: Amis Jim , Jennings Linda , Graham Dorcas , Graham Charles E.
Published: March 2013

From July 1980 to January 1986, 170 patients who had unilateral heel pain were examined, x-ray filmed, and treated in a similar fashion. Radiographs of painful and nonpainful heels were measured. There was a statistically significant increased thickness of the heel fat pad and subfascial area compared with that of the control subject (the nonpainful side). A tightness of the Achilles tendon and a new sign, which the authors are designating as the “saddle” sign, were other prominent features. A treatment program of stretching exercises and walking seemed to be effective in relief of symptoms.
Metastatic Sweat Gland Carcinoma in an Adolescent: A Case Report
Authors: Morrissey Kenneth , Ward Michelle Denise , Stadecker Miguel Jose , Zimbler Seymour
Published: March 2013

Sweat gland carcinomas are rare tumors that metastasize frequently. The diagnosis is seldom suspected prior to histologic examination. A long interval between onset of the disease and diagnosis is characteristic of the disorder. The benign clinical and histologic appearance of some of these tumors can obscure their full malignant potential. This report illustrates an unusual instance of sweat gland carcinoma metastatic to bone carcinoma in an adolescent. This case stresses the necessity for those involved in the care of the foot to be familiar with a condition of this type.
Treatment of Diabetic Foot Infections: Wagner Classification, Therapy, and Outcome
Authors: Calhoun Jason H. , Cantrell Jeff , Cobos Jose , Lacy Joe , Valdez Ray R. , Hokanson James , Mader Jon T.
Published: March 2013

A total of 850 cases of septic diabetic foot infections were reviewed in 355 patients. Age, sex, other chronic diseases, site, etiology, Wagner grade, treatment, and results were analyzed. One third of the patients were in their sixth decade of life. There were 180 women and 175 men. Chronic diseases included hypertension, congestive heart disease, and renal failure. Staphylococcus aureus was the most common bacteria. Treatment was considered to meet protocol standards if Wagner's algorithms and infectious disease principles were followed. Thirty-nine Wagner grade 0 infections were seen: only one was not treated appropriately. Eighty-eight percent treated per protocol healed and the one not treated appropriately failed. In grade 1, 79% of the 154 evaluable patients were treated appropriately with a 86% success rate versus a 53% success rate for those not treated per protocol. Of three quarters of the 64 patients with grade 2 infections treated according to protocol, 73% healed. One of those in grade 2 who was not treated according to protocol healed. In grade 3,64% of the 251 patients were treated per protocol with a 79% success rate versus a 12% success rate for those who were not treated per protocol. Most of the 189 patients with grade 4 cases were treated according to protocol with 88% success; the 20 not treated per protocol had a 15% success rate. Thirty of the 32 grade 5 patients were treated per protocol and all but one healed. Protocol therapy had a statistically significant effect by χ2 test in the treatment of all groups.
Objective Evaluation of Insert Material for Diabetic and Athletic Footwear
Authors: Brodsky James W. , Kourosh Sohrab , Stills Mel , Mooney Vert
Published: March 2013

Five of the most commonly used materials for shoe inserts (soft Plastazote, medium Pelite, PPT, Spenco, and Sorbothane) were objectively evaluated in the laboratory to characterize their behavior in the following three specific functions that correspond to clinical use: (1) the effect on the materials of repeated compression. (2) the effect of a combination of repetitive shear and compression. (3) the force-distribution (force-attenuation) properties of these materials, both when new and after repeated compression. The last function represents a model for relief of pressure beneath plantar bony prominences, a topic of special concern for the insensitive foot.
Tibial Nerve Branching in the Tarsal Tunnel
Authors: Havel Paul E. , Ebraheim Nabil A. , Clark Susan E. , Jackson W. Thomas , DiDio Liberato
Published: March 2013

Tarsal tunnel syndrome is an infrequent and probably underdiagnosed clinical condition. Diagnosis and treatment depend on understanding the tibial branching pattern within the tarsal tunnel. A total of 68 foot dissections were performed. Bifurcation into the medial and lateral plantar nerves occurred within the tunnel in 93% and proximal in 7%. Proximal bifurcation may predispose to tarsal tunnel syndrome, and its infrequent occurrence correlates with the infrequent clinical diagnosis. Nine different calcaneal branching patterns were noted; they provide an anatomical explanation for heel sparing. An understanding of anatomic variations should aid in providing complete surgical release and in avoiding accidental heel denervations.
Unrecognized Laceration of Tibialis Anterior Tendon: A Case Report
Authors: Crosby Lynn A. , Fitzgibbons Timothy C.
Published: March 2013

Surgical exploration of the traumatic wound is always important to allow full definition of the extent of injury. The authors report a case of a lacerated tibialis anterior tendon that was initially overlooked 8 years prior to presentation.
Isolated Dislocation of the Tarsal Navicular: A Case Report
Authors: Pathria Mini N. , Rosenstein Alex , Bjorkengren Ann G. , Gershuni David , Resnick Donald
Published: March 2013

Isolated dislocation of the tarsal navicular is a rare injury that is not mentioned in standard orthopedic textbooks and described only once in the English literature. Because of the rarity of this condition, the best means of treatment has not been established. A patient with this unusual dislocation was recently diagnosed and treated. Open reduction was eventually required, which was followed by the development of ischemic necrosis of the navicular.
First Tarsometatarsal Joint: Anatomical Biomechanical Study
Authors: Wanivenhaus A. , Pretterklieber M.
Published: March 2013

We studied the function of the first tarsometatarsal joint in 100 specimens of 53 cadavers. The study showed that an adduction and abduction movement described earlier was present only in approximately 10% of the specimens. Moreover, eversion of an average of 6.2° often only occurs as a result of dorsal displacement of the joint surfaces of the first metatarsal in relation to the first cuneiform by an average of 2.6 mm. All other movements in the frontal, horizontal, and sagittal plane can be disregarded or are the result of this movement. New conclusions may be drawn from these results, especially with regard to subcapital osteotomies of the first metatarsal and the adductor transfer according to McBride in metatarsus primus varus. These findings challenge the value of the McBride transfer.
Osteotomy of the First Metatarsal Base for Metatarsus Primus Varus
Authors: Limbird T. J. , DaSilva R. M. , Green N. E.
Published: March 2013

An opening wedge osteotomy of the first metatarsal base using either iliac crest bone or the removed exostosis as a graft was used to treat metatarsus primus varus in 22 feet of 15 patients. The preoperative intermetatarsal angle averaged 15°, with the final angle averaging 8°. All osteotomies healed in 3 months with excellent cosmetic and functional results and no difference between iliac crest and exostosis grafts. We conclude that an opening wedge osteotomy of the first metatarsal base is a satisfactory method for the correction of metatarsus primus varus.
Chronic Peroneus Brevis Tendon Lesions
Authors: Sammarco G. James , DiRaimondo Charles V.
Published: March 2013

Changes can occur in the peroneus brevis tendon following ankle injuries or sprains. A series of 14 tendon lesions is reported in the ankles of 13 patients. The duration of symptoms ranged from 8 months to 20 years. The predominant symptom in 12 ankles was lateral pain. In 11 ankles, lateral ankle instability was treated by a reconstruction with the split peroneus brevis graft, and in one ankle, by direct repair. The defects were found during harvest of the graft. One patient had previous fractures with bony impingement and one had a chronic tear of the tibialis posterior tendon with pes planus. All lesions were located in the segment of the tendon at or distal to the lateral malleolus. The lesions were 2 to 5 cm in length, single or multiple, and with a grossly degenerative appearance. No avulsions or anomalies of the tendon were found. In 11 patients, the defect in the peroneus brevis was incorporated into the portion of the tendon in ankle ligament reconstruction for use as a graft; in 2 cases it was repaired directly. On follow-up of eight months to four and one half years, twelve ankles had significant improvement in pain and function.
Surgical Treatment of Foot and Ankle Trauma: Use of Indirect Reduction Techniques
Authors: Carr James B. , Hansen Sigvard T. , Benirschke Stephen K.
Published: March 2013

A useful intraoperative technique to aid the surgical treatment of complex foot and ankle trauma is described. With mechanical distraction to help obtain bony reduction and improve exposure, it can be used in the acute or reconstructive situation. Indications and a step by step technique are outlined.
Crush Injuries of the Foot with Compartment Syndrome: Immediate One-Stage Management
Authors: Ziv I. , Mosheiff R. , Zeligowski A. , Liebergal M. , Lowe J. , Segal D.
Published: March 2013

Severe crush injuries with compartment syndrome were treated in five patients by an immediate one-stage procedure. This procedure included the assessment of skin flap viability with accurate debridement of devascularized tissues. It was performed according to the split-thickness skin excision technique. Compartment pressures were measured and the fasciotomies were performed through open wounds or separate medial and lateral incisions. The medial incision was extended to release the tarsal tunnel. Fractures were reduced and internally fixed and exposed bones were covered with locally transposed muscles. Skin grafts, taken earlier for the skin viability assessment, were meshed and applied to replace skin loss. All wounds and fractures healed uneventfully with no major functional loss. In multiple trauma, the physician should maintain a high index of suspicion for early diagnosis and treatment of severe foot injuries. Early treatment leads to more desirable results, shorter hospitalization, and faster rehabilitation.
Kinematics of the Ankle/Foot Complex: Plantarflexion and Dorsiflexion
Authors: Lundberg Arne , Goldie Ian , Kalin Bo , Selvik Göran
Published: March 2013

In an in vivo investigation of eight healthy volunteers, three dimensional ankle/foot kinematics were analyzed by roentgen stereophotogrammetry in 10° steps of motion from 30° of plantar flexion to 30° of dorsiflexion of the foot. The study included all of the joints between the tibia and the first metatarsal, as well as the talocalcaneal joint, and was performed under full body load. Although the talocrural joint was found to account for most of the rotation around the transverse axis occurring from 30° of plantar flexion to 30° of dorsiflexion, there was a substantial contribution from the joints of the arch. This was seen particularly in the input arc from 30° of plantar flexion to the neutral position, where the dorsiflexion motion of these joints amounted to 10% to 41% of the total transverse axis rotation.
The Heel of Achilles: Calcaneal Avulsion Fracture from a Gunshot Wound
Authors: Cooper Daniel E. , Heckman James D.
Published: March 2013

Greek mythology relates that the legendary warrior Achilles was made invincible by his mother Thetis, who dipped him in the River Styx while holding him by his heel. Because his heel was never immersed, it remained his one area of vulnerability. After the fall of Troy, Achilles met his demise when he was shot in the heel by Paris, whose arrow was guided by the Greek god Apollo. This is the derivation of the term “Achilles tendon.”

Avulsion fractures of the tuberosity of the calcaneus are rare injuries. 1 , 2 , 3 , 6 , 7 , 12 Schonbauer 14 reviewed a series of 870,000 accident cases treated at the Vienna Trauma Hospital and found only four such cases in addition to 151 cases of subcutaneous Achilles tendon rupture. In Bohler's 4 series of 182 calcaneal fractures, avulsion of the calcaneal tuberosity accounted for less than 1% of these injuries. Rowe 13 reported four Achilles avulsion fractures in his series of 154 calcaneal fractures. Three basic mechanisms of injury have been described: (1) dorsiflexion violence against the maximally plantarflexed foot, typically occurring in a fall from a height; (2) powerful contraction of the triceps surae muscle with simultaneous extension of the knee such as when a person is about to sprint in a race; (3) a direct blunt blow to the hindfoot. 1 , 2 , 8

We are describing a case of avulsion of the calcaneal tuberosity due to direct penetrating trauma from a gunshot wound, a mechanism not previously reported.
Dorsiflexion Osteotomy in Freiberg's Disease
Authors: Kinnard Patrick , Lirette Richard
Published: March 2013

A retrospective study of the postsurgical results of 10 patients who had dorsiflexion osteotomy was undertaken. Patient satisfaction, clinical findings, and roentgenographic measurements were all carefully evaluated after an average duration of follow-up of 36.5 months. The procedure gave excellent results for all patients, with minimal loss of metatarsophalangeal motion and an average radiological metatarsal shortening of 2.3 mm and no postoperative metatarsalgia. The authors believe that the dorsiflexion osteotomy is a reasonable treatment for symptomatic Freiberg's disease. The procedure is reliable and not destructive, should further treatment be necessary.
Kinematics of the Ankle/Foot Complex—Part 2: Pronation and Supination
Authors: Lundberg Arne , Svensson Ola K. , Bylund Carin , Goldie Ian , Selvik Göran
Published: March 2013

The influence of pronation and supination of the foot on the joints of the ankle/foot complex was analyzed three dimensionally by roentgen stereophotogrammetry in eight healthy volunteers. Radiopaque markers were introduced into the tibia, talus, calcaneus, navicular, medial cuneiform, and first metatarsal bones. The subjects stood on a platform that was tilted in 10°-steps from 20° of pronation to 20° of supination. Pairs of x-ray exposures were made in each position. Calculation of resulting joint deviations from the neutral position showed that the largest amounts of motion occurred in the talonavicular joint followed by the talocalcaneal joint, in the latter case mainly in supination. The joints proximal and distal to the medial cuneiform also participated substantially in the total motion registered. The tibia showed an average of 0.2° of external rotation for each degree of supination of the foot.
Heel Pain and Body Weight
Authors: Hill James J. , Cutting Paul J.
Published: March 2013

Body weight has been implicated as a factor in plantar heel pain. In this study, a statistically significant correlation between heel pain and increased body weight is documented in a series of consecutive plantar heel pain patients.
Carcinoma Cuniculatum (Verrucous Carcinoma) of the Foot
Authors: Fugate Douglas S. , Romash Michael M.
Published: March 2013

A patient with carcinoma cuniculatum of the foot, an uncommon tumor, is presented. This tumor, also reported as verrucous carcinoma and epithilioma cuniculatum, is a low-grade, squamous cell carcinoma of the skin that rarely metastasizes. The highly keratinizing lesion has a locally destructive course, but with treatment by excision, it has a low recurrence rate.
Modified Lapidus Procedure for Hallux Valgus
Authors: Sangeorzan Bruce J. , Hansen Sigvard T.
Published: March 2013

A modified Lapidus procedure was introduced at Harborview Medical Center in 1979 for the treatment of symptomatic hallux valgus with hypermobile first ray. The results of the procedures were reviewed retrospectively in 32 patients with 40 feet that were operated on between 1979 and 1984. Preoperative diagnosis was symptomatic hallux valgus complex with hypermobile first ray in 33 and failed bunion surgery in 7. Follow-up ranged from 30 months to 6 1/2 years. Union of the arthrodesis site occurred in 36 (90%). The average preoperative intrametatarsal angle was 14° (range 7.5 to 20°) and the hallux valgus angle was 26° (range 0 to 50°). At healing, the angles were as follows: intermetatarsal angle 6° (range 0 to 18°) and hallux valgus angle 11° (range −3 to 30°). The average change in the length of the first metatarsal was −5 mm for those without bone graft and +4 mm for those with bone graft. Of 33 feet operated on as a primary procedure, successful results were reported in 75% by our rating system. Of 7 feet operated on for failed previous surgery, all were improved. Best results were obtained in those with multiple screw fixation, use of bone graft, and attention to plantarflexion of the first metatarsal.
Prosthetic Replacement of the First Metatarsophalangeal Joint
Authors: Merkle Peter F. , Sculco Thomas P.
Published: March 2013

As an alternative to Keller bunionectomy, Silastic implant replacement, and cheilectomy of the first metatarsophalangeal joint, a custom implant was designed at the Hospital for Special Surgery. Between April 1985 and January 1987, 15 implants were placed in 12 patients. Of these patients, 9 were available for follow-up, 2 were lost to follow-up, and 1 patient had died. A high rate (54.5%) of loosening is observed. Subjective, good, and excellent results were seen in 4 of the 11 feet studied. Further modification of the prosthesis and its fixation method is currently being considered.
Mathematical Analysis of First Metatarsal Osteotomies
Authors: Kummer Frederick J.
Published: March 2013

The mathematical analysis of most first metatarsal osteotomy corrections for metatarsus primus varus is presented and interpreted with respect to metatarsal lengthening or shortening and changes in clinical reference angles (e.g., intermetatarsal or angle of declination). The critical parameters for each osteotomy such as location and angles of cuts and amount of displacement are defined and their theoretical effects on the final correction determined. Although exactitude in surgical methodology and an absolute prediction of final clinical results are impossible at the present time, even guidelines as to the potential effectiveness of various surgical techniques and quantitative methods for subsequent evaluation are lacking. This mathematical analysis can provide guidelines for prospective choices and a basis for retrospective interpretation as well as represent a critical component for biomechanical calculations.
Kinematics of the Ankle/Foot Complex—Part 3: Influence of Leg Rotation
Authors: Lundberg Arne , Svensson Ola K. , Bylund Carin , Selvik Göran
Published: March 2013

In an in vivo kinematical investigation, the movements of the ankle/foot complex induced by external rotation of the leg from an internally rotated position were analyzed by roentgen stereophotogrammetry. Radiopaque markers were introduced into the tibia, talus, calcaneus, navicular, medial cuneiform, and first metatarsal bones of eight healthy volunteers. Rotations occurring between these bones after 10° increments of leg rotation were calculated in three dimensions. Movement of the leg from an internally rotated position to the neutral was found to induce motion mainly as internal rotation of the talus in relation to the tibia. Further external rotation induced motion mainly in the talonavicular and talocalcaneal joints, whereas a smaller amount of motion was seen in the joint between the navicular and the medial cuneiform.
Lateral Supporting Ligament of the Distal Phalanx
Authors: Winter William G. , Iwersen Lawrence J. , Johnson Eric D.
Published: March 2013

A 49-year-old woman complained of 3 months of constant aching pain deep to the ingrown medial nail margin of her right hallux that was unaffected by shoe wear. Physical examination disclosed no purulence, discoloration, or obvious acute inflammation; an incurved medial nail plate was seen. There was mild chronic thickening of the medial nail fold. Tenderness was maximal 2 to 3 mm plantar to the medial edge of the nail.

By roentgenogram ( Fig. 1 ), bony projections were seen arcing from the distal phalangeal tuft and the proximal metaphyseal flare toward each other. This was considered to be a “normal” radiological variant.

A partial medial onychectomy and matricectomy (Winograd procedure) was performed. Further dissection 1 to 2 mm deeper along the medial phalangeal border revealed a 1-mm wide longitudinal ligament extending from the phalangeal distal tuft to the proximal metaphyseal flare. Bony projections and ligament were excised. The wound healed satisfactorily, and symptoms ceased.
Magnetic Resonance Imaging of the Hindfoot
Authors: Crim Julia R. , Cracchiolo Andrea , Bassett Lawrence W. , Seeger Leanne L. , Soma Charles A. , Chatelaine Anne
Published: March 2013

This article demonstrates normal anatomy of the foot and ankle as visualized with magnetic resonance imaging (MRI) in the sagittal, axial, and coronal planes. Additionally, selected cases chosen from our experience with more than 100 clinical scans are shown to highlight the primary areas in which we have found MRI to be clinically useful: bone marrow abnormalities, especially osteomyelitis and osteonecrosis, soft tissue injuries and masses, and cases in which metallic fixators make CT evaluation problematic.
Stabilizing Effect of the Tibiocalcaneal Fascicle of the Deltoid Ligament on Hindfoot Joint Movements: An Experimental Study
Authors: Kjærsgaard-Andersen Per , Wethelund Jon-Oddvar , Helmig Peter , Søballe Kjeld
Published: March 2013

The tibiocalcaneal fascicle of the deltoid ligament was studied in 10 lower leg amputation specimens to evaluate its stabilizing effect on movement in the tibiotalocalcaneal joint complex and the talocalcaneal joint complex. Cutting of the fascicle resulted in minor numerical increases in movement in all three planes in the tibiotalocalcaneal joint complex as well as in the talocalcaneal joint complex. The maximum median increase in the tibiotalocalcaneal joint complex was 6.1° in abduction, whereas the maximum median increase in the talocalcaneal joint complex was 3.6° in abduction. However, the percentage of increase in the total range of movement in a single plane was large for abduction-addition in both the tibiotalocalcaneal joint complex and the talocalcaneal joint complex, at 28% and 31%, respectively. The largest percentage of increase, 40%, was found in the total range of plantarflexion-dorsiflexion in the talocalcaneal joint complex. Our data suggest that the tibiocalcaneal fascicle is an important stabilizing structure of abduction, external rotation, and plantarflexion movements in the tibiotalocalcaneal joint complex, especially in the talocalcaneal joint complex.
Posterior Instability of the Talus: An Anatomic Evaluation
Authors: Harper Marion C.
Published: March 2013

A cadaver study was conducted to evaluate the role of the posterior tibial margin or posterior malleolus, as well as medial and lateral supporting structures, in providing posterior stability for the talus. Posterior malleolar fractures consisting of approximately 30%, 40%, and 50% of the articular margin on the lateral radiograph were created in specimens that were then subjected to posterior stressing. No posterior talar subluxation was noted in any specimen. Repeat stressing following removal of the medial malleolus again revealed no subluxation in any specimen. The lateral supporting structures, primarily the posterior fibulotalar and fibulocalcaneal ligaments, appeared to be the key structures providing posterior talar stability. If the fibula is stable in an anatomic position, feared posterior instability of the talus would not appear to be an indication for internal fixation of posterior malleolar fractures.
Fracture-Dislocation of the Articular Surface of the Third Metatarsal Head
Authors: Dutkowsky Joseph , Freeman Barney L.
Published: March 2013

Fracture of the metatarsal head is uncommon, and reports are rare of isolated osteochondral fracture of the articular surface of the metatarsal head, as occurred in the 18-year-old man reported here. Good results were obtained with closed reduction by manipulation and traction, followed by cast immobilization for 6 weeks.
Split-Thickness Skin Excision: Its Use for Immediate Wound Care in Crush Injuries of the Foot
Authors: Myerson Mark
Published: March 2013

Split-thickness skin excision (STSE) was used as an adjunctive modality in the treatment of eight crush injuries of the foot. Compartment syndromes were present in four feet and were treated with fasciotomy. Wound debridement, internal fixation of fractures, and STSE followed. This technique accurately determined the viability of the skin flap, simultaneously providing skin for local wound coverage. All flaps treated in this manner survived and all (100%) of the degloved STSE grafts healed. Additional procedures were performed in four patients (two free flaps and two split-thickness skin grafts) adjacent to the debrided flap for complete coverage. STSE proved to be an effective modality for skin coverage in crush injuries of the foot associated with degloving of skin.
Silastic Ball Spacer Arthroplasty in the Management of Hallux Valgus and Hallux Rigidus
Authors: Broughton N. S. , Doran A. , Meggitt B. F.
Published: March 2013

Sixty-two feet in 39 patients who were treated by insertion of a silastic ball spacer prosthesis into the first metatarsophalangeal joint for hallux valgus or hallux rigidus have been reviewed with a follow-up time of between 2 and 6 years. Twenty-one results (34%) were excellent, 27 (43%) were fair, 13 (21%) were poor, and one was revised. Seventeen feet (27%) had some metatarsalgia at followup. Results were disappointing in the young patients; in 19 cases of hallux valgus under the age of 45, 8 were either poor or had been revised. The original concept of the silastic ball spacer was to maintain great toe length and prevent proximal migration of the sesamoids. However 60% of these feet showed settling of the prosthesis or new bone formation around the prosthesis and 54% had more than 2 mm proximal migration of the sesamoid bones. The symptomatic results in these patients were similar to those in whom great toe length had been successfully maintained. The silastic ball spacer infrequently achieves its aims, however maintenance of hallux length does not seem to be important in the symptomatic result.
Intra-Articular Talar Fractures: Repair Using the Herbert Bone Screw
Authors: Mallon William J. , Wombwell Joseph H. , Nunley James A.
Published: March 2013

Intra-articular fractures of the talus remain a problem because of the difficulty in achieving and maintaining anatomic reduction, and because of the risk of degenerative arthritis of the hindfoot if such reduction is not achieved. We report our experience with three cases in which intra-articular talar fractures were repaired by use of the Herbert bone screw. In addition, we discuss the biomechanical features of the Herbert bone screw which make it particularly well suited for intra-articular fractures of the talus.
Selected Measures of Ankle Dorsiflexion Range of Motion: Differences and Intercorrelations
Authors: Bohannon Richard W. , Tiberio David , Zito Michael
Published: March 2013

The purpose of this investigation was to describe and compare ankle dorsiflexion range of motion (ADROM) measurements obtained using the heel, fifth metatarsal, and plantar surface of foot as distal surface landmarks while the ankle was dorsiflexed under three conditions. The conditions were: 1) passive ankle dorsiflexion with force adequate to encounter notable tension in the plantar flexor muscles, 2) passive ankle dorsiflexion with a maximal force, and 3) as in number 2 but actively assisted by the subject. Thirty-six women had their ankles dorsiflexed three times under each of the three conditions. Slide photographs were taken of the procedure. The photographs were projected and ADROM measured using the three distal landmarks. Analysis of variance demonstrated that ADROM measurements were significantly different ( p < 0.001) under the three conditions of measurement and when the different landmarks were used. The majority (83.3%) of the ADROM measurements were correlated significantly ( P < .01) with one another regardless of the condition or landmark of measurement. Clinicians should be aware that measurements of ADROM will differ depending on the conditions of measurement and the landmarks used. Despite the differences, measurements obtained using various combinations of conditions and landmarks will provide an indication of ADROM.
Laser Use in Foot Surgery
Authors: Bennett Gordon L.
Published: March 2013

Laser is an acronym for Light Amplification by the Stimulated Emission of Radiation. Laser surgery is rapidly gaining the interest of both the medical practitioner and the general public. Since the first reported use of laser surgery in podiatry in 1980, 23 a large number of laser surgery centers for treatment of foot and ankle disorders have appeared throughout the country. A relative paucity of literature exists about applications of lasers in foot and ankle surgery, and orthopaedic surgery as a whole. This is further compounded by the fact that very few of the existing studies are scientifically significant, either due to inadequate numbers, questionable study design, or a combination of these factors. At the present time, it appears that the only worthwhile application of lasers in foot and ankle surgery is for the treatment of plantar warts that are resistant to more conventional methods of treatment. As more well-controlled studies on the applications of lasers become available, the future of lasers in foot and ankle surgery will become more apparent.

The purpose of this study is to present a summary of the use of lasers in orthopaedic foot and ankle surgery. The current clinical applications will be presented, followed by an overview of basic laser physics, laser characteristics and effects on tissue, and laser safety. Because of the growing interest in laser surgery by the medical profession, and the increasing public awareness of this relatively new and exciting technology, it is important that orthopaedic surgeons have a good understanding of laser surgery.
Avascular Necrosis of Lesser Metatarsal Heads following Forefoot Surgery
Authors: Bayliss Neil C. , Klenerman Leslie
Published: March 2013

Three cases of avascular necrosis of the lesser metatarsal heads following forefoot surgery are presented. The variable blood supply of the metatarsal heads is described. Interruption of this delicate circulation at the time of surgery is thought to be a major etiological factor. Repeated trauma following transference of load to the lesser metatarsal heads after operation may also play an important role. Although not previously described this may be a cause of persistent pain following surgery to the forefoot which is easily overlooked.
Metatarsal Osteotomy Using a Double-Threaded Compression Scew: An Adjunct to Revision Forefoot Surgery
Authors: Sammarco G. James , Scioli Mark W.
Published: March 2013

A double-threaded compression screw (Herbert®) was used as internal fixation of metatarsal neck osteotomy and nonunion repair in 16 patients (18 feet). Fifteen patients had associated symptomatic conditions of the foot. Twelve patients had one or more previous surgical procedures on the involved foot. Fourteen patients (15 feet) underwent 20 primary or revision lesser metatarsal osteotomies. Four of these patients had undergone previous lesser metatarsal osteotomies and had developed recurrent pain beneath six metatarsals and transfer metatarsalgia in one case. The remaining two patients (three feet), with six nonunions from previous metatarsal osteotomies, had repair with screw fixation and bone grafting. Follow-up for the series averaged 14 months.
A Radiographic Evaluation of the Tibiofibular Syndesmosis
Authors: Harper Marion C. , Keller Tony S.
Published: March 2013

A radiographic evaluation of the normal as well as the progressively widened tibiofibular interval in the area of the syndesmosis was done using 12 fresh cadaver lower extremities. The width of the tibiofibular “clear space” and the amount of tibiofibular overlap was determined on accurately positioned anterior-posterior and mortise radiographs. Based on a 95% confidence interval, measurements obtained for the intact specimens would support the following criteria as consistent with a normal tibio-fibular relationship: (1) a tibiofibular “clear space” on the anterior-posterior and mortise views of less than approximately 6 mm; (2) tibiofibular overlap on the anterior-posterior view of greater than approximately 6 mm or 42% of fibular width; (3) tibiofibular overlap on the mortise view of greater than approximately 1 mm. The width of the tibiofibular “clear space” on both anterior-posterior and mortise views appeared to be the most reliable parameter for detecting early syndesmotic widening.
Ankle Extensor Tendon Synovitis Due to a Date Palm Thorn
Authors: Nyska Meir , Sperber Ami D. , Howard Charles B. , Nyska Abraham , Dekel Shmuel
Published: March 2013

Palm thorn injury to tendons and joints is characterized in most patients by an acute inflammatory stage followed by a relatively asymptomatic period and finally by chronic synovitis or tenosynovitis. Once the inflammatory process has begun, detection and localization of the thorn can be very difficult. We present an unusual case of palm thorn tenosynovitis of the ankle extensor tendon which was detected and localized preoperatively by ultrasound. Removal of the thorn and synovectomy were curative.
Distraction Lengthening for the Congenitally Short Metatarsal: A Case Report
Authors: Upton Joseph , Khouri Roger , Ramos Douglas , Micheli Lyle
Published: March 2013

Distraction lengthening has gained wide acceptance in general orthopedics and in upper extremity reconstructions. The application of this technique to the foot is presented. The congenitally short fourth metatarsal of a 16-yr-old girl was successfully lengthened by a two-stage procedure. At the first stage, an open diaphyseal osteotomy was performed and the distraction apparatus was secured. Over the ensuing 5 weeks, 36 mm of distraction was achieved. At the second stage, the distracted gap was filled with a fibular bone graft. Following uncomplicated healing, there was no gait, intrinsic muscle, or tendon abnormalities. Metatarsal distraction lengthening can be safely accomplished provided there is good bone stock, adequate soft tissue, and a cooperative patient.
Keller's Arthroplasty and Mitchell Osteotomy: A Comparison with First Metatarsal Osteotomy of the Long-Term Results for Hallux Valgus Deformity in the Younger Female
Authors: Broughton N.S. , Winson I.G.
Published: March 2013

We have made a retrospective comparison between the results of 37 Keller's arthroplasties and 36 distal transverse first metatarsal osteotomies performed in female patients between the ages of 25 and 50 years, for the treatment of hallux valgus. The choice of operation depended on the policy of the consultant responsible for treatment, but analysis of the preoperative findings showed that the two groups were similar, allowing comparative assessment of Keller's procedure in the younger middle-aged patient. All patients were assessed 3 to 5 years after operation using an objective scoring system of symptoms, clinical examination, anteroposterior standing radiographs and walking footprints from a Harris Beath mat. The results following a Keller's arthroplasty were excellent in 7 (19%), good in 22 (60%), poor in 6 (16%), and needed revision in 2 cases (5%). In the osteotomy group, 11 (30.5%) were excellent, 19 (52.5%) were good, 5 (14%) were poor, and 1 (3%) required revision
Subtalar Arthrodesis in Children with Cerebral Palsy: Results Using Iliac Bone Plug
Authors: Guttmann Gad G.
Published: March 2013

Twenty-six extra-articular subtalar arthrodeses were performed on 15 patients with flexible planovalgus feet due to cerebral palsy. Following muscle balancing procedures, an iliac bone plug was used to stabilize the sinus tarsi. A review of the results up to 12 years, average 6.8, is presented. Overall satisfactory results were achieved in 88.4% of the patients, unsatisfactory in 11.6%. All children were immobilized in short-leg walking casts for 6 to 8 weeks. The surgical technique is described. The procedure gave good stability to the subtalar joint and was found to be reliable. Graft acquisition was simple and there were no complications.
Normal Magnetic Resonance Anatomy of the Tarsal Tunnel
Authors: Zeiss Jacob , Fenton Paul , Ebraheim Nabil , Coombs Robert J.
Published: March 2013

Images of five cadaver ankles and three normal volunteers were obtained in an attempt to delineate magnetic resonance (MR) anatomy of the tarsal tunnel. Multiplanar T1-weighted (TE 20 msec, TR 600 msec) scans were obtained of the cadaver specimens while T1 and T2 weighted (TE 20, 80 msec, TR 2000 msec) scans were obtained of the volunteer ankles. After imaging, the cadaver ankles were frozen, sectioned, photographed, and compared to the MR images in the transverse plane. The anatomical structures seen on the MR images correlated closely with the cadaver sections. The bony and soft tissue boundaries and contents of the tarsal tunnel could be imaged with detail easily sufficient to delineate all the major structures within it, including the posterior tibial nerve and its branches
Silastic Implant Arthroplasty with Proximal Metatarsal Osteotomy for Painful Hallux Valgus
Authors: Myers Steven R. , Herndon James H.
Published: March 2013

First metatarsophalangeal joint arthrosis may be associated with hallux valgus deformity. In an attempt to address the pain and deformities of this disorder, silastic implant arthroplasty combined with soft tissue balancing and proximal first metatarsal osteotomy has been performed on 17 feet in 11 patients. A retrospective review of the results at an average followup of 29.5 months is presented. Subjective pain relief has been satisfactory, and loss of correction of deformity has been minimal. Infection remains as a significant postoperative complication. This technique may be a treatment option in the low demand patient with a hallux valgus deformity, painful arthritis of the first metatarsophalangeal joint, and a wide first intermetatarsal angle
An Anatomic Study Of Subtalar Instability
Authors: Heilman Alan E. , Braly W. Grant , Bishop John O. , Noble Philip C. , Tullos Hugh S.
Published: March 2013

Subtalar instability has been recognized as a cause of ankle symptoms. The purpose of this anatomic study is to determine the ligament damage required to produce subtalar instability, and to define a radiographic technique to demonstrate it. Ten fresh adult cadaver ankles were dissected. Selective sectioning of the calcaneofibular ligament, capsule, and interosseous ligaments of the subtalar joint were done. Radiographic documentation of subtalar opening was recorded, using a lateral and Brodan's view. Sectioning of the calcaneofibular ligament alone produced a 5-mm opening of the subtalar joint. When combined with sectioning of the interosseous ligament, a 7-mm opening was produced. This was reproduced with a plantar flexionsupination load to the foot. Instability of the ankle joint (talar tilting) was produced only when loading caused additional tearing of the anterior talofibular ligament. This study suggests that surgical repairs to correct lateral ankle instability should include repair or substitution of the calcaneofibular ligament if subtalar instability is a consideration
Use of Isolated Cold Stress Testing in Determining Normal Lower Extremity Thermoregulation
Authors: Pollock F. Edward , Koman L. Andrew , Neal M. Bryan , Brockschmidt Joni K. , Jennings Roger , Poehling Gary G.
Published: March 2013

Isolated cold stress testing was performed on 72 healthy subjects in order to evaluate the normal thermoregulatory potential of vessel beds in the acral areas of the lower extremity. Two patterns of response were demonstrated: a cool response in approximately 80% of subjects, and a warm pattern in approximately 20%. In the former, the responses to cold stress were more active and the temperatures lower; in the latter, there was little change in temperature in response to the cold stress. Both patterns correlated strongly with initial temperature, and neither pattern correlated with age, sex, or smoking habits. No subjects reported pain, numbness, or discomfort during the test. This study demonstrated that wide variations in thermoregulatory flow were possible without clinical symptoms, and suggested that nutritional blood flow was adequate to meet metabolic demands despite thermoregulatory modulation.
Leiomyosarcoma of the Os Calcis
Authors: Marymont John V. , Clanton Thomas O.
Published: March 2013

A primary leiomyosarcoma of the os calcis, occurring in a 68-year-old woman and treated by below-the-knee amputation, is reported. The diagnosis was confirmed by electron microscopy, and supported by immunochemistry. These techniques can be performed in a primary spindle cell osseous neoplasm to distinguish leiomyosarcoma from fibrosarcoma and malignant fibrous histiocytoma. A total of 28 cases of primary leiomyosarcoma of extragnathic bones have been reported in the literature with one occurring in the foot. This is the first reported case involving the os calcis and the first reported leiomyosarcoma of the foot in the English literature
Distal Metatarsal Osteotomy for Intractable Plantar Keratoses
Authors: Leventen Edward O. , Pearson Steven W.
Published: March 2013

A relatively simple distal osteotomy of the metatarsal necks is presented. Twenty-one feet were followed for an average of 31 months with a diagnosis of intractable plantar keratosis causing metatarsalgia. A treatment plan is given that indicates which metatarsals to osteotomize, depending on location of the keratosis. Results and complications are discussed.
Ankle Arthrodesis in the Rheumatoid Patient
Authors: Smith Evert J. , Wood Peter L.R.
Published: March 2013

We studied 11 patients with severe rheumatoid arthritis of the ankle joint who underwent arthrodesis employing the Charnley technique. Results of the procedure were assessed using the Fries score and the ankle evaluation grading system of Mazur et al. Four patients (36%) suffered pin-track sepsis. Three patients also showed delayed union, but sound bony fusion was eventually achieved in all patients.
Complications of Ankle Arthroscopy
Authors: Barber F. Alan , Click James , Britt Bradley T.
Published: March 2013

Of over 4500 ankle arthroscopies recently surveyed by the Arthroscopy Association of North America, only one complication (an infection) was reported. Nerve injury, vascular injury, or reflex sympathetic dystrophy were not reported. The ankle's anatomy is complex and there are many structures that can be damaged by imprecise portal placement. A review of our experience with 53 consecutive ankle arthroscopies found nine complications for a rate of 17%. There were three permanent dorsal sensory nerve injuries, two synovial fistulas, three wound infections, and one reflex sympathetic dystrophy. A literature review found other reported complications to include instrument breakage, synovitis, painful scars and nodules, and fibula fracture. Complications occur with ankle arthroscopy more frequently than previously reported, and the average or beginning ankle arthroscopist should expect a higher rate of surgical complication than has been previously reported.