bluuebunny/crossref_metadata_2025 huggingface dataset:
Hallux Valgus Correction Using a Modified Hohmann Technique
Authors: Christensen Poul Hedevang , Hansen Torben Bæk
Published: March 2013

In 181 patients presenting with hallux valgus (247 toes), we performed a modified Hohmann procedure with Kirschner wire fixation of the osteotomy. Follow-up by a questionnaire was possible in 159 patients representing 217 operated toes (21 reoperations), and roentgenograms of bony healing were assessed in all these patients. The questionnaire was returned by 91% (145/159) of the patients. The average observation time was 52 months (25–97 months). The average correction of the hallux valgus angle was 10°, ranging from 31.4° before surgery to 21.4° after surgery. Eighty-eight percent of the patients stated that they had an excellent or good/fair result, and 12% had pain or problems with footwear.

We found a positive correlation among the correction of the valgus angle, the lateral displacement, shortening of the first metatarsal, and the overall result. No correlation was found among the plantar displacement, correction of the intermetatarsal angle and the result.

The modified Hohmann procedure is, in our opinion, a safe and reliable procedure for treating hallux valgus deformity of the foot.
Distal Tibia Bone Graft for Arthrodesis of the Foot and Ankle
Authors: Danziger Marc B. , Abdo Richard V. , Decker J. Elliot
Published: March 2013

Forty patients since 1988 have had distal tibial bone grafting for 41 arthrodeses of the foot and ankle. Bone graft is obtained through a cortical window made just above the medial metaphyseal distal tibial flare.

Average follow-up was 23.3 months. Forty of 41 arthrodesis sites fused; there was only one nonunion. There were no delayed unions. There were no complications at the donor site based on patient examination and radiographs. Ipsilateral ankle motion was not affected by the bone graft procedure.

Cited complications from iliac crest bone graft include donor site pain, blood loss, heterotopic bone formation, pelvic instability, iliac hernia, infection, fracture, and deformity. Complications with allografts include disease transmission and immune response. These are avoided by using locally obtained distal tibia autograft for arthrodeses in the foot and ankle.
The Strength of Achilles Tendon Repair: An In Vitro Study of the Biomechanical Behavior in Human Cadaver Tendons
Authors: Watson Thomas W. , Jurist Kenneth A. , Yang King H. , Shen Kun-Ling
Published: March 2013

Eighteen fresh frozen human Achilles tendons were used to test the ultimate strength of repaired tendon “ruptures.” Three methods, the Kessler, the Bunnell, and the locking loop, were used to test the initial strength of Achilles tendon repair. The Kessler and Bunnell methods are current standard clinical configurations described for Achilles tendon repair. Under uniform and standardized laboratory conditions, the specimens were loaded to failure. The locking loop suture method was substantially stronger than either of the other two standard configurations. The latter two did not differ significantly from each other. The results of this study may be clinically relevant in terms of the choice of the repair method for surgically treated Achilles tendon ruptures.
Fibular Osteochondroma Presenting as Chronic Ankle Sprain
Authors: Montella Bruce J. , O'Farrell Dermot A. , Furr Wm. Stephen , Harrelson John M.
Published: March 2013

A 19-year-old baseball player was referred for assessment of recurrent sprains of the right ankle. This was found to be secondary to a palsy of the common peroneal nerve that was compressed by an osteochondroma of the fibular neck. The lesion was resected from the fibula and the patient made a complete recovery. We present this case as an example of a rare underlying problem in a patient who was initially diagnosed as having a sports-related ankle injury.
Arthroscopic Removal of an Osteoid Osteoma of the Talus: A Case Report
Authors: Resnick Ronald B. , Jarolem Kenneth L. , Sheskier Steven C. , Desai Panna , Cisa Jordi
Published: March 2013

This article describes a patient with a 10-year history of persistent ankle pain. Differential diagnosis included osteoid osteoma and anterior ankle impingement. This patient subsequently underwent arthroscopic excision of a lesion on the talar neck following a complete radiographic work-up, which was nondiagnostic. The diagnosis of osteoid osteoma was finalized upon pathologic study of the arthroscopic shavings. The use of a motorized instrument for excision did not preclude pathologic evaluation of the specimen. Therefore, in an accessible location on the talar neck, arthroscopic excision of an osteoid osteoma can be performed.
Salter-Harris Type IV Epiphyseal Fracture of the Proximal Phalanx of the Great Toe: A Case Report
Authors: Buch Barbara D. , Myerson Mark S.
Published: March 2013

Epiphyseal fractures account for about one fifth of pediatric fractures. Approximately 10% cause major growth disturbances, depending on the location and type of the fracture and the skeletal maturity of the child. Intra-articular Salter-Harris type IV fractures are rare, carry a poor prognosis, and almost always need surgical reduction to prevent deformity. We present a case report of a pediatric patient who returned to normal function after the successful surgical reduction of a Salter-Harris type IV fracture in the proximal phalanx of the great toe.
Hallux Flexion Deformity Secondary to Entrapment of the Flexor Hallucis Longus Tendon after Fibular Fracture
Authors: Leitschuh Paul H. , Zimmerman Jeffrey P. , Uhorchak John M. , Arciero Robert A. , Bowser Lloyd
Published: March 2013

This article presents a case of entrapment of the flexor hallucis longus tendon after open reduction and internal fixation of a Weber C ankle fracture resulting in interphalangeal joint contracture of the hallux. Pathology involving other tendons at the foot and ankle associated with ankle fractures is reviewed. Other scenarios of flexor hallucis longus pathology are discussed. Flexor hallucis longus anatomy, as related to distal fibular fractures, is outlined, and a recommendation is made to consider flexor hallucis longus entrapment as a cause of hallux dysfunction after open reduction and internal fixation of an ankle fracture.
A Modified Chrisman-Snook Procedure for Reconstruction of the Lateral Ligaments of the Ankle: Review of 18 Cases
Authors: Smith Patrick A. , Miller Stephen J. , Berni Anthony J.
Published: March 2013

The outcome of 18 ankles of 16 patients who underwent a modification of the Chrisman-Snook lateral ligamentous reconstruction was analyzed. The modification described herein attempts a more anatomic reconstruction of the calcaneofibular ligament, while the anterior talofibular ligamentous reconstruction remains unchanged. All patients were evaluated before and after surgery by physical examinations and stress inversion radiographs were taken to measure the degree of talar tilt. Additional postoperative assessment consisted of a questionnaire, inversion and eversion isokinetic strength measurements, subtalar joint inversion stress radiographs (stress Brodén's views), and a hop test to assess ankle confidence. An average preoperative talar tilt of 13.7° was reduced to an average of 2.3° after surgery. Postoperative subtalar stress radiographs revealed an average of 2.8° of subtalar tilt compared with the “normal” average of 7.2° in the nonoperative ankles. While no ankles were found before surgery to have a 3+ anterior drawer sign, 11 ankles had 3+ inversion laxity. Excessive inversion laxity, which can occur through both the ankle and subtalar joints, more than anterior drawer laxity, may appear to be the primary determinant of functional ankle instability in the chronic setting. We recommend subtalar stress radiographs, in addition to routine talar stress radiographs, to quantify the relative contributions of each of these joints to inversion laxity in a symptomatic patient to guide appropriate treatment. The described procedure will anatomically stabilize both joints to inversion stress.
Measuring Hallux Valgus: A Comparison of Conventional Radiography and Clinical Parameters with Regard to Measurement Accuracy
Authors: Resch Sylvia , Ryd Leif , Stenström Anders , Johnsson Kjell , Reynisson Kristbjörn
Published: March 2013

To assess the repeatability and error of conventional x-ray measurements, intra- and interobserver evaluations of measurement accuracy were done on 20 preoperative and 40 postoperative (20 chevron and 20 proximal osteotomy) x-rays of hallux valgus patients. Standard x-rays showed an average interobserver error of measurement of 6.4° for the hallux valgus angle, 5.4° for the intermetatarsal angle, and 2.0 mm for the intermetatarsal distance. The intraobserver error did not differ greatly. The repeatability and error of two clinical measurements, ball circumference, and dorsal to plantar range of motion of the first metatarsophalangeal joint were evaluated for 20 healthy volunteers. The ball circumference had an average measurement error of 1.1 cm, whereas the dorsal and plantar range of motion of the great toe had an average measurement error of 12° in dorsiflexion and 16° in plantarflexion. In both clinical and radiographic parameters, linear measurements were more accurate than angular measurements. Although x-rays are of value in hallux valgus surgery, standard x-rays are less accurate than previously assumed. Small changes produced by osteotomies may be hidden by the postoperative measurement error. The results of hallux valgus surgery should primarily be evaluated clinically. When clinical and radiological evaluations are made, linear measurements may be preferable.
Bone Scintigraphy in the Assessment of the Hallucal Sesamoids
Authors: Chisin Roland , Peyser Amos , Milgrom Charles
Published: March 2013

Bone scintigraphy is frequently used to evaluate suspected hallucal sesamoid pathology. Increased scintigraphic activity of the hallucal sesamoid is assumed to corroborate clinical suspicion of pathology, but the incidence of such increased uptake has not been studied in an asymptomatic population. Using a 0 to 2 bone scintigraphic rating system, 25 of 86 (29%) asymptomatic infantry recruits and 7 of 27 (26%) asymptomatic sedentary adults were found to have grade 1 or grade 2 activity. When using scintigraphy to evaluate hallucal sesamoid pathology, caution should be used in interpreting the meaning of increased scintigraphic activity.
Plantar Medial Subluxation of the Medial Cuneiform: Case Report of an Uncommon Variant of the Lisfranc Injury
Authors: Lynch James Robert , Cooperstein Lawrence Alan , DiGioia Anthony Michael
Published: March 2013

An uncommon injury of plantar medial subluxation of the medial cuneiform as a variant of the Lisfranc fracture subluxation is presented. The mechanism of injury is discussed and a comparison is made to previous case reports of variants of medial cuneiform injury.
Surgical Management for Intractable Metatarsalgia
Authors: Mann Roger A. , Chou Loretta B.
Published: March 2013

We reviewed the results of arthrodesis of the first metatarsophalangeal joint and excisional arthroplasty of the lesser metatarsophalangeal joints performed on patients who presented intractable metatarsalgia and forefoot deformities. The study included 18 feet (15 patients) in 12 women and 3 men. The follow-up averaged 5.2 years. A good to excellent result was achieved in 15 (83%) feet; pain, which had been moderate to severe before surgery, was reduced to none to mild, and function, which had been severely limited before surgery, was improved to virtually unlimited. The fusion rate of the first metatarsophalangeal joint was 94% (17 of 18 feet). Thirteen of the 15 patients (87%) stated they would have the procedure again. This repair has been demonstrated to be a useful salvage procedure in nonrheumatoid patients with severe metatarsalgia secondary to failed forefoot surgery.
Update on Women's Footwear
Authors: Frey Carol , Thompson Francesca , Smith Judith
Published: March 2013

Shoes have been implicated as being responsible for the majority of foot deformities and problems that physicians encounter in women. In our original study of 356 women, the majority of women studied wore shoes that were too small for their feet, had foot pain and deformity, and had increased in shoe size since the age of 20. The women without foot pain or deformities also wore shoes that were smaller than their feet but to a lesser degree. In the present study, data on 255 of the original 356 women are evaluated. Tracings were made of the standing foot and the shoe. Measurements were made of forefoot and the heel width. An index of forefoot width to heel width was developed. The indices do not vary much among women. Based on linear measurements, as forefoot width increases, so does heel width. As foot length increases, forefoot width increases to a greater extent than heel width.
Triple Arthrodesis for Diabetic Peritalar Neuroarthropathy
Authors: Tisdel Christopher L. , Marcus Randall E. , Heiple Kingsbury G.
Published: March 2013

From 1963 to 1990, the senior authors (R.E.M. and K.G.H.) performed eight triple arthrodeses in seven patients with diabetes mellitus with sensory loss in the lower extremities. By clinical and roentgenographic examination, all patients were diagnosed with peritalar neuroarthropathy before surgery. All patients underwent a two-incision triple arthrodesis with internal fixation. Patient follow-up averaged 44 months and included repeat physical examinations and radiographs. All patients went on to clinical union and were satisfied with the procedure. One patient had prolonged wound drainage that resolved with antibiotic therapy; another had a residual rocker-bottom deformity and plantar ulceration that resolved after modification of custom shoe wear.

We believe comprehensive management of diabetic peritalar neuroarthropathy can include surgical arthrodesis of the involved joints. The disease process and surgical indications are discussed.
Treatment Outcome of Major Fractures of the Talus
Authors: Frawley Philip A. , Hart John A. L. , Young David A.
Published: March 2013

Twenty-six patients with major fractures of the talus were studied to assess the long-term outcome. The patients were admitted to a university teaching hospital and major trauma center from 1983 to 1991. The study excluded isolated fractures of the talar dome and posterior tubercle.

Fifteen patients were treated using internal fixation and 11 patients were treated using nonsurgical methods. Avascular necrosis was detected in only four of the 26 patients. Subtalar osteoarthritis was a significant problem in 61%. Seven of these patients have come to secondary fusion procedures, with another three contem-plating fusion procedures at the time of review. Only one patient developed significant avascular necrosis requiring a fusion procedure. Only three of 26 patients had not returned to work at a mean 6 years after their injury. Eleven of the 26 (42%) had not returned to their premorbid activity level.

The majority of these patients (25/26) had sustained multiple injuries, which compromised the functional recovery from the talar injury.

Early accurate diagnosis and anatomical reduction gave the best results. The low incidence of avascular necrosis in this study has been attributed to early anatomical stabilization of the fracture. We believe an early CT scan can more accurately assess the severity of the talar fracture and offers the best information for an appropriate treatment plan.
Potential for Recurrence of Hallux Valgus after a Modified Hohmann Osteotomy: A Biomechanical Analysis
Authors: Sanders Antal Petrus , Snijders Christiaan Johannes , Linge Bert V.
Published: March 2013

On the basis of a biomechanical model the present study investigates whether a foot-widening effect, which may result in recurrence of bunions, can be demonstrated in operated patients. Therefore, the medial deviation of the first metatarsal head as a result of flexion forces on the hallux was measured in eight patients with clinical idiopathic hallux valgus, who underwent a modified Hohmann osteotomy, and in eight “normal” persons. We found that (1) before osteotomy, all forefeet broadened while pressing the big toe downward, and (2) after surgery, widening of the forefeet on average had significantly diminished, but still existed, which might explain the development of recurrences. (3) After surgery, the patients showed a slight, but statistically nonsignificant, decrease (from 37 N to 25 N) of the isometrically determined average maximal applicable flexion force. These abnormal hallux loads may cause, or result from, a deviation in gait pattern.
Volkmann's Ischemic Contracture of the Foot and Ankle: Evaluation and Treatment of Established Deformity
Authors: Santi Mark D. , Botte Michael J.
Published: March 2013

Fibrotic contracture of skeletal muscle can follow weeks or months after the severe ischemic insult of compartment syndrome. Commonly known as Volkmann's ischemic contracture, the affected limb often becomes dys-functional and painful, and may lose sensibility. The pathogenesis of the muscle contracture includes prolonged ischemia, myonecrosis, fibroblastic proliferation, contraction of the cicatrix, and myotendinous adhesion formation. Resultant shortening or overpull of involved muscles leads to stiffness and deformity. Simultaneously, nerve injury from initial ischemia or subsequent soft tissue fibrotic compression leads to muscle paresis or paralysis of the involved compartment and of those muscles more distally innervated. The resultant deformity is thus a combination of varying degrees of contracture and weakness depending on which muscles and nerves are affected. Deformity and functional impairment in the foot and ankle secondary to ischemia are determined by many factors, including: (1) which leg compartment, if any, has been affected and to what degree extrinsic flexor or extensor overpull is exhibited, (2) degree of nerve injury sustained causing weakness or paralysis of extrinsic or intrinsic foot and ankle muscles, (3) which foot compartment, if any, has been affected and to what degree intrinsic overpull is exhibited, and (4) degree of sensory nerve injury leading to anesthesia, hypoesthesia, or hyperesthesia of the foot. Therefore, a variety of clinical presentations can be encountered following compartment syndrome of the leg and foot. Treatment is based on an appreciation of the patho-anatomy of the deformity. Nonoperative therapy is aimed at obtaining or preserving joint mobility, increasing strength, and providing corrective bracing and accom-modative footwear. Operative management is usually reserved for treatment of residual nerve compression or severe and problematic deformities. Established surgical protocols are performed in a stepwise fashion, to include: (1) release of residual or secondary nerve compression, (2) release of fixed contractures, using infarct excision, myotendinous lengthening, muscle recession, or tenotomy, (3) tendon transfers or arthrodesis to increase function, and (4) ostectomy or amputation for severe, refractory deformities.
Anterior Tibial Tendon Rupture
Authors: Ouzounian Tye J. , Anderson Robert
Published: March 2013

Twelve patients with rupture of the anterior tibial tendon are presented. Nine patients were aware of an acute event prior to their symptom onset and three were not aware of any acute event. Complete rupture of the tendon was noted in 10 patients and incomplete rupture was seen in two patients. Treatment was individualized based on age, etiology, preinjury function, patient health, and personal considerations. Five patients were treated without surgery. Three preferred no orthotic devices, and two believed their function was improved with an ankle-foot orthosis. Seven patients were treated operatively using a variety of individualized reconstructive techniques. All operatively treated patients demonstrated increased function and strength. Based on our findings, operative reconstruction is recommended in appropriate patients.
Arthroscopy of the Subtalar Joint: Establishing a Medial Portal
Authors: Mekhail Anis O. , Heck Bruce E. , Ebraheim Nabil A. , Jackson William T.
Published: March 2013

One of the recently introduced procedures for studying the posterior subtalar joint is subtalar arthroscopy. There is no reference in the literature to the possibility of a medial portal that might be used either for arthroscopic insertion, probing, or instrumental manipulation. The two portals mentioned in the literature are the anterolateral and the posterolateral portals. For evaluating the possibility of establishing a medial portal, six embalmed adult cadaver feet were used to study the anatomical relations to the proposed medial portal. The subtalar joints of another six fresh adult cadaver feet were then arthroscoped, after distraction of the joint, using the anterolateral, posterolateral, and medial portals. Findings indicated that the medial portal gives good visualization of the posterior subtalar joint. Clinical application has not yet been assessed.
Retrograde Intramedullary Nailing for Ankle Arthrodesis
Authors: Moore Thomas J. , Prince Robert , Pochatko David , Smith Judith W. , Fleming Samuel
Published: March 2013

This is a retrospective study of retrograde intramedullary rodding for ankle arthrodesis in 19 ankles in 16 patients. The preoperative diagnosis of 16 patients was diabetic neuropathic arthropathy in seven patients, rheumatoid arthritis in three patients, post traumatic arthrosis in three patients, paraplegia with fixed equinovarus of the foot in two patients, and avascular necrosis of the talus in one patient. Retrograde intramedullary rodding for ankle arthrodesis was done as a salvage procedure in each patient. Fourteen of the 19 ankles had radiographic evidence of solid arthrodesis. In the four patients with five ankles with pseudarthrosis, no case was clinically significant. There was one deep infection and one broken rod. Thirteen of the 16 patients are ambulatory, and nine required either an ankle-foot orthosis or shoe modification.

The standard method of ankle fusion using crossed cancellous screws is the procedure of choice because it preserves the subtalar joint. Retrograde intramedullary rodding for ankle arthrodesis should be considered for patients with significant posttraumatic arthrosis and bone loss following distal tibial plafond fractures, concomitant subtalar arthrosis, severe osteopenia, such as in patients with rheumatoid arthritis, or neuropathic arthropathy.
Comparison of Two Fixation Methods of Oblique Lesser Metatarsal Osteotomies: A Biomechanical Study
Authors: Slovenkai Mark P. , Linehan Daniel , McGrady Linda , Lim Tae-Hong , Harris Gerald F. , Shereff Michael J.
Published: March 2013

Two methods of internal fixation of oblique lesser metatarsal osteotomies were compared biomechanically using fresh-frozen human cadaver bones. Osteotomies were made obliquely through the metatarsal shafts and fixed with either crossed Kirschner wires or a single AO screw using the lag technique. The specimens were then fixed at their proximal end and loaded to failure using an axial torsion material testing system (MTS, Minneapolis, MN). Load displacement curves were obtained and the stiffness of the constructs was determined. Single-screw fixation was found to be significantly stiffer than the crossed wire configuration ( P < .01). Single-screw fixation resulted in a stiffness of 211.2 ± 111.7 N/cm (mean ± SD), while stiffness of the crossed wire configuration averaged 56.9 ± 25.1 N/cm.
Ipsilateral Peroneus Brevis Tendon Grafting in a Complicated Case of Traumatic Rupture of Tibialis Anterior Tendon
Authors: Forst Raimund , Forst Jürgen , Heller Karl D.
Published: March 2013

Ruptures of tibialis anterior tendon can be caused by open, closed, direct, or indirect trauma, as well as spontaneously. Sixty-three cases of tibialis anterior tendon ruptures have been reported in the international literature. The treatment of choice is the surgical end-to-end or side-to-side anastomosis after previous Z-lengthening. The case of a 28-year-old world-class female triathlete who sustained an open laceration of the tibialis anterior tendon from the bicycle chain guard is reported. The primarily applied tendon suture became infected and a wound revision with wide resection of the tendon stumps was necessary. This lead to an extensive defect of the tendon combined with a deep-seated keloidal scar reaction of the skin. The surgical closure was performed using free ipsilateral peroneus brevis tendon grafting. Four months after the operation the patient was completely rehabilitated. Eight months later she became the second European triathlon champion.
Influence of Extrinsic Plantar Flexors on Forefoot Loading During Heel Rise
Authors: Ferris Linda , Sharkey Neil A. , Smith Tait S. , Matthews Donald K.
Published: March 2013

This investigation studied the effects of simulated plantar flexor muscle activity on forefoot loading using a static cadaver model. Nine cadaver feet were mounted in an apparatus in the heel rise position. Using computer-controlled and pneumatic actuators, forces were simultaneously applied to the tendons of the triceps surae, flexor hallucis longus, flexor digitorum longus, peroneus brevis and longus, and tibialis posterior until 750 N of ground reaction force was achieved, at which time forefoot plantar pressure patterns were captured immediately with a pedobarograph. Second metatarsal bending moments were calculated from strain gauge data collected concurrently. Consecutive loading cycles were performed with sequential elimination of simulated muscle force from each tendon except the Achilles. Loss of simulated flexor hallucis longus activity significantly decreased great toe contact forces and significantly increased forces under the forefoot. Simulated loss of both the flexor hallucis longus and flexor digitorum longus caused significant decreases in contact area, pressure, and force beneath the toes and significant increases in contact area and force under the forefoot. Bending moments in the second metatarsal were shown to vary directly with peak pressure under the second metatarsal head (r = 0.801). These findings demonstrate the load distributing function of the extrinsic plantar flexors during heel rise.
Cylindrical Cemented Ankle Arthroplasty: A Prospective Series with Long-Term Follow-Up
Authors: Kofoed Hakon
Published: March 2013

From 1981 to 1985 28 ankle arthrop! lasties were performed using a congruent and cylindrical ankle design. The talus component was an anatomically shaped cap to cover the talus dome and the facets. The tibial component was congruent toward the talus and had two parallel bars on the back for fixation into the distal tibia. The diagnosis was osteoarthritis in 15 cases and rheumatoid arthritis in 11 cases (two bilateral cases). There were seven failures, giving a cumulative estimated survival rate of 70% for the prosthesis at 12 years.
Anatomy of the Plantar Plate and Its Attachments in the Lesser Metatarsal Phalangeal Joint
Authors: Deland Jonathan T. , Lee Kyung-Tai , Sobel Mark , DiCarlo Edward F.
Published: March 2013

The plantar plate is a rarely seen, yet central structure to the lesser metatarsal phalangeal (MP) joint. Thirty cadaver lesser MP joints were studied to obtain a detailed description of the plate, including its dimensions, connections, and histology. The plate was found to be made of fibrocartilage with fiber orientation which suggests that it withstands tensile loads in line with the plantar fascia as well as the compressive loads from the metatarsal head. The plantar plate was the most substantial distal insertion of the plantar fascia. Impressive plantar plate attachments were noted to the proximal phalanx, the major longitudinal bands of the plantar fascia, and the collateral ligaments. The plate and collateral ligaments formed a substantial soft tissue box connected to the sides of the metatarsal head. From the dissections, it is apparent that malposition of the toe at the MP joint is likely over time to be associated with pathology in both the collateral ligaments and the plate. Because of these attachments and a close association with the flexor tendons to the lesser toe, the plate can be compared with the sesamoid mechanism of the first MP joint.
Silastic Single-Stem Implants in the Treatment of Hallux Rigidus
Authors: Shankar N. S.
Published: March 2013

Forty cases of hallux rigidus treated by Silastic hemiarthroplasty over an average period of 110 months have been reviewed here. As many as 36% (14 feet) of the patients were unhappy with the results of their operation. Six implants had to be removed because of increasing pain and fragmentation of the prosthesis. These patients improved after the prosthesis was removed. It is concluded that Silastic hemiarthroplasty does not give an acceptable level of good results when compared with published reports of other forms of treatment. The probable causes of the high dissatisfaction rate are discussed.
Kinematics of the Normal Arch of the Foot and Ankle Under Physiologic Loading
Authors: Kitaoka Harold B. , Lundberg Arne , Luo Zong Ping , An Kai-Nan
Published: March 2013

We studied 15 cadaver feet to determine three-dimensional motion of selected tarsal bones under axial loading at three different loading levels. We determined the motion of individual joints and also the rotation of the tarsal bones in relation to the tibia. Joint rotations increased consistently with higher loads. The navicular-talar joint had the greatest total screw axis rotation, which averaged 9.4° ± 2.2° at 667 N of load, followed by the first metatarsal-navicular (mean, 7.2° ± 1.5°), talar-tibial (mean, 5.2° ± 1.6°), and calcaneal-talar (mean, 4.4° ± 1.7°) joints. The observed changes indicate the need for assessment of foot and ankle alignment clinically and radiologically while the patient is weightbearing.
Ground Reaction Torque and Pathway of Point of Application of Ground Reaction Force During Gait of Intoeing Children
Authors: Xue-Cheng Liu , Fabry G. , Van Audekercke R. , Molenaers G.
Published: March 2013

One hundred twenty-four children with intoeing and 80 age-matched controls were investigated with the Kistler force plate. Tr2, reflecting the maximum external rotational ground reaction torque, is reduced by 30% to 40% in all intoeing children. There also is an appreciably shorter pathway of the point of application of the ground reaction force in the Y-direction (from 20% to 25%) and an obvious medial shift of the point of application of the ground reaction force in the X-direction (from 105% to 290%), from heel strike to toe-off as compared with controls. In spontaneous correction of intoeing, point of application of the ground reaction force in the X-direction becomes more close to normal. The “foot progression angle,” which can easily be calculated from the force plate measurements to judge the degree of intoeing, is different from the values in the literature.
Late Flexor Digitorum Longus Tendon Rupture after Transfer for Posterior Tibial Tendon Insufficiency: A Case Report
Authors: Ouzounian Tye J.
Published: March 2013

A 64-year-old woman was treated for an idiopathic complete rupture of the posterior tibial tendon with transfer of the flexor digitorum longus tendon to the navicular. After an initial excellent result, she returned 41 months later after experiencing a sudden pop in the medial retromalleolar area, followed by progressive medial ankle pain. At reoperation, a complete rupture of the flexor digitorum longus tendon was noted at its insertion into the navicular. Reconstruction was performed utilizing a sliding lengthening of the flexor digitorum longus tendon and reattachment to the navicular with a suture anchor. Clinical improvement was noted at the 12-month follow-up evaluation. This case presentation is of clinical interest, as late acute failure of a flexor digitorum longus tendon transfer for posterior tibial tendon rupture has not been reported previously.
Treatment of Symptomatic Hammertoe with a Proximal Interphalangeal Joint Arthrodesis
Authors: Lehman Daniel E. , Smith Ronald W.
Published: March 2013

This study examined 76 consecutive patients (100 feet) treated by a single surgeon for both flexible and rigid hammertoes with a PIP arthrodesis using custom-machined drills, a peg cutter, and hole cutter, combined with an extensor tenotomy and dorsal capsulotomy. Forty-eight percent of patients were defined as satisfied without reservation, 37% were defined as satisfied with reservations, and 15% were defined as dissatisfied. The incidence of radiographic fusion was 95% (130/137 toes). The most common reasons for either reservation or dissatisfaction included incomplete pain relief, residual toe angulation, and prolonged shoe wear restriction in the postoperative period.

Based upon the results of this study, the authors suggest that when using a peg and socket arthrodesis for hammertoe correction (1) there is a 95% rate of radiographic fusion, (2) patients over 65 years old be alerted to a diminished rate of satisfaction, and (3) a distal flexor tenotomy be considered in patients with a preoperative DIP flexion contracture.
Anatomic Structures at Risk: Combined Subtalar and Ankle Arthrodesis with a Retrograde Intramedullary Rod
Authors: Pochatko David J. , Smith Judith W. , Phillips Ruth Ann , Prince Bobby D. , Hedrick Mark R.
Published: March 2013

Retrograde intramedullary rodding from the calcaneus, through the talus, and into the tibia is currently an evolving procedure being used for salvage of severe foot/ankle deformity, arthritis, tumor, and instability. In this study, retrograde rodding was performed on six cadaver specimens. The specimens were then dissected to determine the subcalcaneal structures at risk and the optimal insertion point for the rod. This study elucidated the structures most at risk and showed the optimal insertion site to be at the junction of the sustentaculum tali and the body of the calcaneus.
Plantar Fibromatosis: A Review of Primary and Recurrent Surgical Treatment
Authors: Wapner Keith L. , Ververeli Prodromos A. , Moore John H. , Hecht Paul J. , Becker Carl E. , Lackman Richard D.
Published: March 2013

Plantar fibromatosis can be quite disabling to the patient, as well as a technical challenge to the surgeon. Patients who undergo previous local excisions and in whom aggressive recurrences develop are difficult to manage successfully. We present a consecutive series of five primary procedures on patients with painful plantar fibroma and seven revision operations on patients with recurrent plantar fibroma. The average follow-up was 47 months (range, 22–66 months) in the primary group and 40 months (range, 21–78 months) in the revision group. The overall results were satisfactory in four of the five primary operations, with only one recurrence. In the revision group, five of seven results were satisfactory with no recurrences. The major complication that led to unsatisfactory results was the development of a postoperative neuroma. In this article, we outline our present surgical techniques of wide primary excision and a staged revision procedure with delayed split-thickness skin graft closure. These techniques can be used successfully to manage this disabling, progressive disease.
An Anatomic Analysis of Endoscopic Plantar Fascia Release
Authors: Hawkins Bryan J. , Langermen Richard J. , Gibbons Timothy , Calhoun Jason H.
Published: March 2013

Eighteen fresh-frozen cadaver foot specimens underwent release of the plantar fascia via a newly described endoscopic technique. A 75% release was attempted on each specimen in order to represent a partial fascial release. Each specimen was then dissected to assess the success of the procedure. Five separate measurements were recorded evaluating the reproducibility of the procedure, adequacy of the release considering accepted etiologies for chronic heel pain, and the possibility of damage to local structures. Partial release was noted to be possible, but controlling the exact percentage of the incision was difficult. The release averaged 82% of the width of the fascia, with a range of 53% to 100%. There was no damage in any specimen to the first branch of the lateral plantar nerve, the structure considered most at risk during the procedure. Release of the deep fascia of the abductor hallucis muscle was not possible with this approach.
A Comparison of the Dynamic Pedobarograph and EMED Systems for Measuring Dynamic Foot Pressures
Authors: Quaney Barbara , Meyer Katja , Cornwall Mark W. , McPoil Thomas G.
Published: March 2013

The purpose of this study was to compare the peak pressure and peak force values obtained from two pressure assessment systems, the Dynamic Pedobarograph and the EMED SF. Twenty-one individuals with a mean age of 31.6 years walked barefoot over both systems using a two-step data collection protocol. Peak plantar pressures and peak vertical force values were measured under the heel, central forefoot, hallux, and entire foot for both systems. The results of this study demonstrated that the EMED SF system produced larger peak pressures under the central forefoot and hallux. The Pedobarograph, on the other hand, produced greater pressures under the heel and entire foot. With respect to peak vertical forces, the Pedobarograph showed significantly greater values under the heel and central forefoot compared with the EMED SF, but were significantly lower under the hallux and entire foot.
Influence of Ligament Transection on Tibial and Calcaneal Rotation with Loading and Dorsi-Plantarflexion
Authors: Hintermann Beat , Sommer Christian , Nigg Benno M.
Published: March 2013

The purpose of this study was to quantify the effect of sequential ligament transection (anterior talofibular, calcaneofibular, posterior talofibular, deltoid, and subtalar interosseous ligaments) on the rotational movement of the tibia and the calcaneus as associated with axial loading and dorsi-plantarflexing the foot. Eight cadaver foot-leg specimens were investigated using a unconstrained testing apparatus. As the ankle complex was axially loaded, almost the same internal rotation of the tibia and the same calcaneus eversion was found with and without the various degrees of lateral and medial ligament release; additional sectioning of the subtalar interosseous ligament tremendously increased the resulting tibial and calcaneal rotation. While tibial and calcaneal rotation from foot dorsi-plantarflexing did not alter significantly with transection of the lateral ligaments, almost no tibial and calcaneal rotation occurred after additional sectioning of the deltoid and subtalar interosseous ligament. These results indicate that, after release of the lateral ligaments, the foot becomes partially mechanically disconnected from the tibia by additional transection of the medial ligaments and even further disconnected after transection of the subtalar interosseous ligament.
Kinematics of the Axially Loaded Ankle
Authors: Michelson James D. , Helgemo Stephen L.
Published: March 2013

An apparatus that allowed the application of a 900 N axial load and the simultaneous measurement of rotation in the sagittal, coronal, and axial planes was used to study the normal kinematics of the ankle in 13 below-knee amputation specimens. Two testing routines were done on all specimens.

In the first sequence, specimens were moved through a dorsiflexion (DF) and plantarflexion (PF) arc of 60° (25° DF and 35° PF). DF was associated with an average of 2.5° of external rotation, and PF was associated with an average of <1° of internal rotation. In the coronal plane, PF and DF were both associated with <1° of varus.

In the second part of the testing, the ankle position in the sagittal plane (DF/PF) was fixed and the axial load was increased from 50 N to 750 N in 100-N intervals. Increasing the axial load caused an increase in external rotation and valgus of 1° to 2°. For axial rotation, external rotation was more pronounced in PF than DF. The effect of load on the increase on valgus was not affected by sagittal ankle position. The effect of increasing axial load on sagittal rotation was to increase DF or PF <2° over the entire range of loads and sagittal positions.

The understanding of ankle biomechanics is essential to the formulation of rational guidelines for the treatment of ankle pathology and the prediction of the long-term consequences of ankle injuries. The incomplete understanding of this subject is evident when the disparate recommendations for a number of common conditions are considered. By examining the three-dimensional motion of the stable ankle, a more precise understanding of the abnormal three-dimensional motions associated with instability can be achieved. This knowledge will permit a logical approach to treatment of ankle fractures.
Sonographic Evaluation of Interdigital Neuromas
Authors: Shapiro Patricia P. , Shapiro Steven L.
Published: March 2013

Fifty surgical patients with symptoms suggestive of Morton's neuroma underwent preoperative ultrasound examination of the forefoot using a 7.5 MHz transducer. Fifty-five neuromas were excised. Of these, one neuroma had a ganglion associated with it and five neuromas were recurrent. Four feet had adjacent neuromas. Ultrasound accurately predicted the presence, location and size of the neuromas in 98% of the cases. There were no false positives. In all cases in which a neuroma was predicted by ultrasound, it was confirmed grossly at the time of surgery and later by histological exams. We conclude that ultrasound is an accurate technique in the diagnosis of interdigital neuromas.
Clawtoe Deformity Following Vascularized Fibula Graft
Authors: Bohay Donald R. , Manoli Arthur
Published: March 2013

The free vascularized fibula graft has been an increasingly useful tool in orthopaedic surgery. In addition to its many applications, the reported low donor site morbidity has helped make this a popular treatment modality. Isolated flexor hallucis longus flexion contracture has been reported in the literature; however, multiple ipsilateral clawtoe deformity has not been reported. We describe two cases of multiple clawtoe deformity following ipsilateral harvest of a free vascularized fibula graft.
Efficacy of First-Time Steroid Injection for Painful Heel Syndrome
Authors: Miller Richard A. , Torres John , McGuire Michael
Published: March 2013

The purpose of this study was to evaluate the results of a single injection of corticosteroids in patients with painful heel syndrome. Twenty-seven heels in 24 patients were injected with a combination of 1 ml of lidocaine and 1 ml of betamethasone (6 mg). These patients had never previously received an injection to their heels and had continued symptoms of pain after a trial of other nonoperative treatment modalities. After the injection, patients were seen and surveyed periodically for a period of 5 months to 8 months. The amount of pain relief that they obtained, the length of time this lasted, and the amount of heel pain present at the final follow-up were recorded.

Based on the results of our study, we believe that a steroid injection is a reasonable adjunct in the treatment of painful heel syndrome, but that it is unlikely to provide permanent pain relief.
Giant Cell Tumor of Bone in the Foot and Ankle
Authors: O'Keefe Regis J. , O'Donnell Richard J. , Temple H. Thomas , Scully Sean P. , Mankin Henry J.
Published: March 2013

Giant cell tumor of bone has been shown to behave more aggressively when located in the wrist and hand. Although nearly 4% of giant cell tumors arise in the foot and ankle, biological features specific to this location have not been identified. In our experience with more than 300 cases of giant cell tumor, 12 arose in the foot and ankle and were followed for more than 2 years. These included nine females and three males ranging in age from 15 to 52 years (mean age, 29.5 years). All patients presented with pain of 5.0 months’ mean duration and 9 of 12 tumors demonstrated aggressive radiographic features, including bone erosion and destruction; five had either invasion of a joint or a soft tissue mass present. Unlike the hand, where metacarpal and phalangeal lesions are common, no tumors arose in the forefoot and nine of the tumors were present in the ankle region. Four patients were treated with resection (no recurrence), two with curettage and cement packing (one recurrence), and six with curettage and autologous bone graft (two recurrences), which resulted in an overall recurrence rate of 25%. None of the recurrent tumors have returned after additional treatment, which consisted of curettage and cement packing in two cases and resection in one case. Five tumors (four primary, one recurrent) were treated with local resection and reconstruction with no major complications and with no amputations performed. Thus, giant cell tumors of the foot and ankle can be treated with local procedures, which result in recurrence rates similar to those found in more common locations.
Comparative Evaluation of Bone Suture Anchor to Bone Tunnel Fixation of Tibialis Anterior Tendon in Cadaveric Cuboid Bone: A Biomechanical Investigation
Authors: Fennell Colin W. , Ballard John M. , Pflaster Daniel S. , Adkins Rodney H.
Published: March 2013

A multiphase biomechanical study was performed using human tibialis anterior tendons and cuboid bones, comparing the fixation of the tendon to the bone using bone anchors and bone tunnels. Twenty-six specimens were tested for ultimate load to failure comparing Mitek Superanchor fixation with no. 1 and no. 5 braided polyethelyne suture to bone tunnel fixation. Mitek Superanchor with no. 5 suture failed at 223 N, compared with Mitek Superanchor with no. 1 suture at 134 N and bone tunnel at 143 N ( P = 0.033). Mitek with no. 1 suture versus bone tunnel was not significantly different. The Mitek with no. 5 suture failed at the tendon/suture interface (75%), the Mitek with no. 1 suture failed at the suture/anchor interface (56%), and bone tunnel fixation failed most commonly by fracture of the tunnel (76%). This study is the first biomechanical analysis of the pullout strengths of bone tunnels or suture anchors in the cuboid bone. We have shown that the suture anchor has a pullout strength comparable or superior to a conventional bone tunnel in an in vitro situation. We believe it is a viable alternative to fixation of the tibialis anterior tendon to the cuboid when there is insufficient tendon length or failure of the bone tunnel.
Accessory Calcaneus: A Case Report and Literature Review
Authors: Krause John O. , Rouse Andrew M.
Published: March 2013

A case of bilateral accessory calcanii is presented in which the accessory ossicle articulated with the talus and calcaneus at the lateral aspect of the posterior facet of the subtalar joint, causing premature subtalar degenerative changes in a 19-year-old man. Although rare and usually asymptomatic, accessory ossicles around the foot may need surgical excision if painful or if sufficient size is obtained to cause deformity and/or limitations in range of motion.
Accessory Soleus Presenting as a Posterior Ankle Mass: A Case Report and Literature Review
Authors: Travis Michael T. , Pitcher J. David
Published: March 2013

The accessory soleus muscle is a rare anatomic variant that may present as a mass in the posterior-medial aspect of the ankle in young adults. The presence of such a mass may result in pain and difficulty with running. We present a case of accessory soleus muscle in a 21-year-old soldier and review the literature. We present the first magnetic resonance imaging studies in the American literature, to our knowledge, of this unusual anomaly.