bluuebunny/crossref_metadata_2025 huggingface dataset:
The High Incidence of Mismated Feet in the Population
Authors: Rossi William A.
Published: March 2013

All Americans, and most likely all individuals in all societies, have mismated feet; that is, the two feet of probably no individual are exactly alike in size, shape, or proportions. This conclusion was based on the findings of a demographic foot-measurement survey embracing 6800 adults (4000 females, 2800 males), conducted in 1981–1982 by the Prescription Footwear Association. The findings may explain why the ideal or expectation of “perfect” shoe fit is virtually impossible, although they do not suggest that adequate or satisfactory shoe fit is not attainable in most instances involving so-called “normal” feet. They also indicate that a mild degree of “breaking in” is required with most new footwear, although never necessitating any distress.

This article presents the methodology of the survey and foot measurements, along with the found data and their significance regarding the traditional processes of search of “proper” shoe fit and the obvious need for higher levels of professional shoe-fitting skills and service. The article also analyzes and discusses some little known or seldom considered complexities of shoe fit and the foot-shoe relationship that surfaces from this study, for example, the role of shoe design, shoe-sizing systems, consumer shoe-buying attitudes, and shoe materials, the four variable phases of shoe fit (static, weightbearing, functional, and thermal), and the availability of shoe sizes in stores.
Postural Impositions on the Foot and Ankle from Trunk, Pelvis, Hip, and Knee in Cerebral Palsy
Authors: Samilson Robert L. , Dillin Linden
Published: March 2013

Postural impositions on the foot and ankle in cerebral palsied patients may be due to neurological or biomechanical causes. Neurological etiology is related to retained neonatal automatisms, mass reflexes, lack of phasic muscle activity, and lack of voluntary control. Biomechanical impositions on the foot and ankle of superincumbent deformities in the transverse, sagittal, and coronal planes are analyzed and specific examples are cited. It is important to be able to differentiate those problems of the foot and ankle which are primary from those imposed by superincumbent structures. Some iatrogenic problems may be prevented by careful analysis.
Examination of the Cerebral Palsy Patient with Foot and Ankle Problems
Authors: Kasser James R. , MacEwen G. Dean
Published: March 2013

In this review of the examination of the foot and ankle in the cerebral palsy patient, we attempt to identify the findings important in orthopaedic decision making. This discussion is based upon personal experience of the authors and review of the literature. We stress the need for careful examination and observation in these often confusing patients.
Equinus and Cerebral Palsy—Its Management
Authors: Banks Henry H.
Published: March 2013

Orthopaedic procedures for the correction of equinus deformity are effective in the treatment of spastic cerebral palsy. The best operative procedure for the correction of fixed equinus deformity in our series was the sliding lengthening of the heel cord. Adequate postoperative management of these patients is essential in order to obtain a good result. Long-term support at night during the growing period is necessary to prevent recurrent equinus. An exercise regimen to develop balanced muscle function is essential for a satisfactory result.
Conservative Management of Cerebral Palsy in the Growing Child
Authors: Westin G. Wilbur , Dye Scott
Published: March 2013

Judicial use of long leg walking casts in the treatment of mild to moderate cerebral palsy involving the lower extremities has been adequate to control contractures throughout growth in a majority of our patients. Surgery has been performed on the patients who have not been controlled by casting alone. The use of corrective casts has given us a means of measuring the magnitude of spasticity in each individual and has helped in the selection of the proper surgical procedure for maximum benefit to the patient. Only if we cannot stretch the muscle with casting do we surgically lengthen it.
Cone Arthrodesis of the First Metatarsophalangeal Joint
Authors: Johansson J. E. , Barrington T. W.
Published: March 2013

The reliability and effectiveness of the treatment of hallux rigidus and sympomatic arthritis of the first metatarsophalangeal joint by the technique of cone arthrodesis are discussed. The authors reviewed the long-term results of cone arthrodesis in 51 patients with 60 operated feet. The average age was 55 years (range, 28 to 75 years) and the average length of follow-up was 39 months (range, 1 to 12 years). On questioning the patients regarding function, cosmesis, and pain, 41 of 51 patients were happy, eight of 51 patients were satisfied, and two of 51 were unhappy with their feet. No patient complained of persistent or recurrent hallux valgus deformity. Radiologically and clinically 58 of 60 first metatarsophalangeal joints were solidly fused. Two patients had a fibrous ankylosis which was functional and painless. Function with respect to gait and ability to walk on tiptoe and run was normal in all patients. In summary, the authors feel that this procedure is a reliable, effective treatment of painful arthritis of this joint.
Total Joint Prosthetic Arthroplasty of the Great Toe—A 12-Year Experience
Authors: Kampner Stanley L.
Published: March 2013

This report describes the use of a double-stemmed flexible hinge silicone elastomer implant for use as a total joint replacement for the metatarsophalangeal joint of the great toe. Experience with this prosthesis has been since 1971 with 103 prostheses implanted in 71 patients with a minimum follow-up of 12 months and an average follow-up of 7.4 years. Of the 71 patients, 40 had osteoarthritis with 64 joints replaced, 22 had rheumatoid arthritis with 29 joints replaced, four patients were revised from a failed excisional hemiarthroplasty, three patients with four joints involved were revised from a failed silicone implant hemiarthroplasty, and two patients had a surgically arthrodesed metatarsophalangeal joint taken down and revised to a total joint arthroplasty. Of the total number of patients involved, eight were men, 63 were women, and the average age per joint was 56 years.

The results were graded as excellent, good, fair, and poor on two bases: relief of pain and the cosmetic result. Overall results were good. On the basis of these results over a 12-year period, it was concluded that there is a place for total joint prosthetic replacement in the surgical reconstruction of the painful, destroyed metatarsophalangeal joint of the great toe.
A Complication of Silastic Hemiarthroplasty in Bunion Surgery
Authors: Lemon Richard A. , Engber William D. , McBeath Andrew A.
Published: March 2013

Seven cases of painful reactive synovitis following great toe Silastic hemiarthroplasty have been observed. All cases were treated successfully with synovectomy and removal of the implant. Microscopic examination of the synovium uniformly demonstrated a chronic foreign-body giant-cell reaction with intracellular and extracellular silicone elastomer particles. Gross examination of the implants showed varying degrees of erosion of the articulating surface. Abrasion of a Silastic implant creates tree-floating silicone elastomer particles that can precipitate a reactive synovitis. The authors believe an irregular, degenerated first metatarsal head is a contraindication to an interpositional Silastic hemiarthroplasty.
Surgery in Advanced Charcot-Marie-Tooth Disease
Authors: Gould Nathaniel
Published: March 2013

Crippling equinocavovarus position of the foot in advanced Charcot-Marie-Tooth disease with its attendant metatarsalgia tender calluses and rigidity creates painful, limited, hobbling ambulation with lowered work and general activity tolerance. The object of the surgeries is to convert this foot into a plantigrade, more flexible, painless unit. Surgery consists of plantar fasciotomies off the tubercle of the os caleis and also transversely through the middle of the longitudinal arch. Dorsally angulated green-stick osteotomies are performed at the bases of all the metatarsals. A Jones operation with transfer of the long extensor great toe tendon through the neck and head of the first metatarsal and arthrodesis of the IP joint of the great toe complete the surgery. Often it is necessary to do Bunnell repair lengthening of the flexor hallucis longus tendon. Occasionally, the first metatarsophalangeal joint needs dorsal capsulotomy and lengthening of the short extensor tendon. Variations in and simplicity of techniques are demonstrated with a case report. Ten patients (eight men and two women: 18 feet), ranging in age from 18 to 46 years (average age, 29 years), with a 3- to 6-year follow-up are herein reported. Correction has been maintained in the oldest case.
Anterior Calcaneal Osteotomy for Symptomatic Juvenile Pes Planus
Authors: Anderson Allen F. , Fowler S. Benjamin
Published: March 2013

Five patients with symptomatic flexible pes planus unresponsive to conservative therapy underwent nine open wedge anterior calcaneal osteotomies and advancement of the posterior tibial tendon. The average follow-up was 6 years, 8 months. Three patients exhibited medial and plantar talonavicular subluxation and naviculocuneiform sag. There were three excellent results, three very good, two good, and one poor. The patient with a poor rating was asymptomatic, had normal foot motion, and was satisfied with the procedure.
Dynamic Assessment of the Load Distribution on the Plantar Surface of the Foot Using the University of Cape Town Walkway and Its Clinical Application
Authors: Dall George
Published: March 2013

The dynamic assessment of the plantar pressure profile is now possible, and an immediate visual display without the necessity for complicated computer-assisted analysis has been developed using a walkway designed at the University of Cape Town. Using the walkway, the author assessed the feet of 10 normal children and 10 normal adults. They showed consistently similar profiles with very minor variations. Using the walkway, the author also showed in four abnormal cases the effects of corrective surgical procedures and of an orthotic device.
Ankle Joint Load and Leg Muscle Activity during Lifting
Authors: Ekholm J. , Svensson O. , Arborelius U. P. , Nemeth G.
Published: March 2013

The load on the talocrural joint during three different ways of lifting was compared and discussed with biomechanical and ergonomical aspects. Healthy subjects lifted a 12.8kg box from floor to table-level with bent and straight knees. The loading moment of force about the bilateral ankle axis was calculated by means of a computerized static sagittal plane model. Electromyography was recorded from the tibial anterior, gastrocnemius, and soleus muscles. The mean maximum loading moment was found to be 68 newton-meters with an estimated joint compressive force of 2.9 times body weight. The lowest loading moments obtained were associated with lifting the burden between bent knees and close to the pelvis.
The Role of the Interosseous Membrane on Tibiofibular Weightbearing
Authors: Skraba J. S. , Greenwald A. S.
Published: March 2013

Three in vitro, strain gauge instrumented lower legs were loaded in positions ranging from 10 degrees dorsiflexion to 10 degrees plantarflexion with loads corresponding to those seen in normal gait. The interosseous membrane was found to play a critical role in the load-sharing ability of the fibula. After incision of the membrane, fibular strains decreased to essentially zero, thus supporting the hypothesis that the interosseous membrane acts as a conduit for stress transmission to the fibula. An intact membrane keeps the fibula active during the loads and motions of normal gait.
Symptomatic Incisional Neuromas on the Dorsum of the Foot
Authors: Kenzora John E.
Published: March 2013

In a 2-year period, 17 patients presented with 25 highly symptomatic neuromas which followed routine orthopaedic procedures on the dorsum of the foot. Most of the neuromas followed incisions made on the dorsomedial two-thirds or so of the midfoot. Three of the patients who refused surgery and were treated nonoperatively had mediocre results. Fourteen patients underwent surgery. Two early cases underwent neurolysis of spindle neuromas with satisfactory results but with some persistent pain and dysfunction. Spindle and bulb neuromas in the remaining 12 patients were widely excised with highly satisfactory results in 10 and unsatisfactory results in two. A functional anatomic study was carried out to determine the area of sensation supplied by the deep peroneal nerve. The results of this study along with a review of anatomical references was used to diagram the sensory distribution to the dorsum of the foot. These diagrams proved helpful in making accurate anatomic diagnoses of the nerves involved with neuromas prior to treatment. The incidence of incisional neuromas is higher than anticipated, and the disability from them can be as severe as those reported in the hand and wrist. Proper diagnosis and treatment are essential to relieve this disability.
Duplication of the Hallux
Authors: Jahss Melvin H. , Nelson John
Published: March 2013

Sixteen patients with duplication of the hallux were reviewed. Follow-up averaged 21 years. Duplication may be classified into three groups: simple hallucal duplication, a transitional type with a short thick first metatarsal, and complete first ray duplication. Routine removal of the most medial hallux or ray is to be avoided. Careful preoperative assessment is necessary to compare hallucal function, cosmesis, and metatarsal weightbearing. Surgery should also correct the associated congenital hallux varus. Surgical complications include functionless hallucis from inappropriate selection and medial soft tissue contractures with either recurrence of the hallux varus or the gradual development of a hallux varus interphalangeus.
Surgical Correction of Spastic Equinovarus Deformity in the Adult Head Trauma Patient
Authors: Keenan Mary Ann , Creighton James , Garland Douglas E. , Moore Thomas
Published: March 2013

The results of 59 surgical procedures for correction of spastic equinovarus deformity of the foot using the split anterior tibial tendon (SPLATT) were reviewed in 54 adults with traumatic head injury. The mean time of follow-up was 49.7 months. Thirty-nine individuals had hemiplegic involvement, three had triplegic involvement, and 12 were quadriplegic. Evaluation of the patterns of lower extremity muscle activity preoperatively by dynamic electromyography in 33 patients showed no significant difference from that seen in the hemiplegic stroke population, namely, spastic calf muscles with overactive toe flexors and anterior tibial muscle. At follow-up all feet were in a plantigrade position. The only complication was a superficial skin slough on the dorsum of the foot which healed uneventfully. Postoperatively, 18 extremities (31%) were brace-free. Forty-one extremities required support because of calf weakness, ataxia, or proprioceptive deficits. Of the 15 patients who were nonambulatory prior to surgery, nine (60%) became ambulatory. At follow-up 36 patients (67%) were independent ambulators, four (7%) required supervision assistance, two (4%) required standby assistance, and six (11%) required minimal assistance. The six individuals (11%) who remained maximally assisted or nonambulatory had improved wheelchair positioning and shoe wear. These results show that the split anterior tibial tendon transfer is a safe and effective procedure for the head trauma patient since it corrects the equinovarus deformity, allowing for improved shoe wear and wheelchair positioning in the nonambulatory individual and improved ambulation with decreased brace wear in the more functional patient.
Dolorous Calcification of the Lateral Sesamoid Bursa of the Great Toe
Authors: Kernohan James , Dakin P. K. , Helal B.
Published: March 2013

A case of painful calcification within a sesamoid bursa of the great toe is presented. This may be the first description of painful calcification of this site.
Achilles Tendon Repair with an Absorbable Polymer-Carbon Fiber Composite
Authors: Parsons John Russell , Rosario Antonio , Weiss Andrew B. , Alexander Harold
Published: March 2013

Twenty-seven patients were surgically treated for Achilles tendon rupture using a composite implant. The implant is ribbon-like in configuration and composed of filamentous carbon fiber coated with an absorbable polymer. When used to secure an Achilles repair, the implant acts as a scaffold for the regrowth of collagenous tissue. Rapid attachment of host tissue assures good, early repair strengths which allows for a more vigorous rehabilitation program. Fourteen patients have at least 9 months of follow-up (average follow-up, 14.4 months) and have been objectively and subjectively evaluated on a temporal basis for return of function. To date, complications have been minimal. Results have been very encouraging with 90% return of function at 18 months.
Correction of Clawtoes by the Girdlestone-Taylor Flexor-Extensor Transfer Procedure
Authors: Barbari Stephan G. , Brevig Knut
Published: March 2013

Several techniques have been suggested for correction of clawtoe deformities in the lateral toes, ranging from multiple arthrodesis of the interphalangeal joints to phalanx resections, partial or total amputation of the impaired toes. An evaluation of the flexor-extensor transfer procedure is the basis of this study.

Between 1977 and 1983, 39 feet were operated on in 31 patients, presenting a wide variation in etiology, degree of deformity, and symptoms. Average age at the time of surgery was 57.5 (16 to 80). All of the patients were available for recall and were able to return for an interview and examination. Average length of follow-up was 38 months (range, 10–80 months). The report includes a general discussion of the deformities, description of the operative technique, and the results obtained in our series. Assessment emphasized a subjective report including patient satisfaction, cosmetic result, relief of pain, and objective examination to evaluate the presence of recurrent callosities, range of movement at the metatarsophalangeal joint, and degree of residual passive mobility of the toes. Reduction of metatarsalgia and callosities with improved shape of the toes was achieved in most cases. Our experience indicates that the treatment can be recommended for use in the elderly, too, in appropriate cases. Radical procedures are rarely accepted for cosmetic as well as for functional reasons.
Myxoid Chondrosarcoma of the Os Calcis: A Case Report
Authors: Steiner German , Greenspan Adam , Jahss Melvin , Norman Alex
Published: March 2013

This case report of a myxoid chondrosarcoma of the oscalcis is presented because of its rarity. The clinical, roentgenographic, and pathological features are discussed, and the difficulty in diagnosis is elaborated
Congenital Vertical Talus: The Riley Experience
Authors: DeRosa G. Paul , Ahlfeld Steven K.
Published: March 2013

This is a retrospective study of seven patients with 10 feet displaying nonparalytic congenital vertical talus treated at Riley Children's Hospital in Indianapolis by open reduction without naviculectomy. Each of the 10 feet underwent an operation for open reduction of congenital vertical talus. The procedure included a peritalar soft tissue release, posterior release of the hindfoot with Achilles tendon lengthening, and transfer of the tibialis anterior tendon into the talar neck. Length of follow-up ranged between 2 and 11 years. Average follow-up time was 6 years and 9 months. Age at time of open reduction ranged from 8 months to 3 years. The clinical follow-up evaluation revealed three excellent, three good, and four fair results. Only one patient underwent a subsequent surgical procedure.
Foot Deformity in Myotonic Dystrophy
Authors: Ray Suzanne , Bowen J. Richard , Marks Harold G.
Published: March 2013

Myotonic dystrophy is a progressive multisystem disorder that may be inherited from either parent, although only children with affected mothers usually show the more severe congenital form of the condition; others are classified as having adult myotonic dystrophy. Since 1940, 29 patients with myotonic dystrophy (10 adult, 17 congenital, two unclassifed) have been followed at the Alfred I. duPont Institute. Treatment protocols have been established for the treatment of talipes equinovarus deformity commonly seen in the congenital form of myotonic dystrophy, as well as the progressive dropfoot gait more commonly seen in the adult form.
Three-Dimensional Kinematics of Ankle Instability following Serial Sectioning of Lateral Collateral Ligaments
Authors: Cass Joseph R. , Morrey Bernard F. , Chao Edmund Y. S.
Published: March 2013

Triaxial kinematics of ankle instability were studied in vitro by applying an inversion force to seven nonaxially loaded cadaveric ankle-foot specimens. In intact specimens, mean maximal adduction of the tibia with respect to the calcaneus was 38° and mean maximal external rotation was 24°; maximal displacement occurred near full plantar flexion. Increases after release of ligaments were as follows: calcaneofibular, maximal adduction 10%, external rotation 3% near 15° of plantar flexion; anterior talofibular, adduction 30%, external rotation 8% at 30° of plantar flexion; both, adduction 41%, external rotation 65% near 0° of flexion; all three lateral collateral, adduction 42%, external rotation 240% in slight dorsiflexion. Regardless of the status of the lateral collateral ligaments, the talus adducted and externally rotated 18° ± 1° with respect to the calcaneus. Hence, collateral ligament release had no effect on subtalar motion.
Survey of Foot Deformities among 166 Geriatric Inpatients
Authors: Hung L. K. , Ho Y. F. , Leung P. C.
Published: March 2013

A clinical survey on foot deformities among 166 geriatric inpatients was carried out. Direct measurements on hallux valgus, great toe movements, great toe deformities, lesser toe deformities, arch of the foot, callosities, ankle movements, inversion, and eversion were done by using the goniometer. A specially designed goniometer was created to measure inversion and eversion. The Harris Mat was used to study foot prints in correlation with the various deformities. About 50% of geriatric patients were found to have foot deformities of various types. This compared well with available data in literature. The target population was also checked for their symptomatology which, amazingly, was found to be really insignificant compared with the deformities present. This finding was found to be very much unlike data for Caucasian individuals with foot deformities, 50% of whom had symptoms related to pain and footwear. This major difference in the clinical presentation encourages the authors to carry on their study and, perhaps, direct cross-cultural studies in the future.
Congenital Vertical Talus
Authors: Oppenheim William , Smith Chadwick , Christie Wayne
Published: March 2013

This series consisted of 15 congenital vertical tali in 12 patients, 11 of which were treated surgically and the remainder conservatively. Conservative treatment (casting alone) yielded poor results in three of four feet, while the results in the surgical group were four good, six fair, and one poor at an average follow-up of 8 years. The surgical procedures included a one-stage release with transfer of the anterior tibial tendon to support the neck of the talus. A Grice arthrodesis was performed either concurrently or within 2 to 4 years. The best results were obtained with early subtalar arthrodesis (Grice) and biplanar K wire fixation. Complications included skin sloughs, avascular necrosis of the talus, and pin tract drainage. Attempts to augment push-off power with tendon transfers were unrewarding.
The Appearance of the Tarsal Navicular after Posteromedial Release for Clubfoot
Authors: Schlafly Bruce , Butler James E. , Siff Sherwin J. , Criswell Allen R. , Cain Thomas E.
Published: March 2013

Sixty-one idiopathic clubfeet in 46 patients of an older population were treated by one-stage posteromedial release. Follow-up roentgenograms revealed dorsal subluxation of the tarsal navicular in 43% of the clubfeet. This abnormality is probably due to both closed manipulation and casting, and improper positioning of the navicular during posteromedial release. However, dorsal navicular subluxation did not adversely affect the results of treatment observed over the follow-up period that averaged nearly 6 ½ years. Medial subluxation of the navicular was associated with unsatisfactory results, whereas a centrally located or laterally subluxed navicular generally produced good or excellent results. Other abnormalities of the navicular noted included wedging and avascular necrosis. The long-term consequences of these various abnormalities of the roentgenographic appearance and position of the navicular are not known.
Local Treatment for Neuropathic Foot Ulceration and Osteoarthropathy
Authors: Brindley George W. , Cofield Robert H.
Published: March 2013

Forty-one patients with 42 involved feet received local care for neuropathic foot disease. Thirty-one patients had ulcers (nine with associated fractures), and 10 did not (eight with fracture and two with severe ligamentous injury). Patients were examined at least 1 year after initiation of treatment, and follow-up averaged 3 years (range, 1 to 9). Treatment included ulcer cleansing, debridement, local bone excision, molded plaster casts, and antibiotics for patients with significant infection. Most patients used special shoes. Of the 42 involved extremities, 39 (93%) healed with treatment, 21 extremities (50%) remained healed at follow-up examination, and 16 patients (39%) continue to have difficulty with recurrent foot ulceration or osteoarthropathy. Thirty-nine patients (95%) have avoided the need for a major amputation.
Diaphyseal Lengthening for Shortness of the Toe
Authors: Urbaniak James R. , Richardson William J.
Published: March 2013

A method of bone lengthening for bilateral shortness of the fourth toe in a 23-year-old woman is described. The symptomatic short fourth toes were successfully treated by metatarsal and phalangeal diaphyseal lengthenings with metatarsophalangeal joint preservation.
The Intrinsic and Extrinsic Arterial Supply to the Proximal Phalanx of the Hallux
Authors: Vega Michael , Resnick Donald , Black James D. , Haghighi Parviz
Published: March 2013

The hallux is subject to numerous surgical procedures and very little is known about its blood supply. Arteriographic studies were performed in six cadaver specimens to identify the major arterial supply to the hallux. Discrepancies with now known anatomical models were discovered. In this study, the major arterial supply to the hallux appeared to originate from the lateral digital artery. In addition, two transverse digital arteries were noted to emit the nutrient arteries of the phalanges. Examination of other arteriographic studies sustained our results.
A Method of Predicting the Degree of Functional Correction of the Metatarsus Primus Varus with a Distal Lateral Displacement Osteotomy in Hallux Valgus
Authors: Sarrafian Shahan K.
Published: March 2013

Metatarsus primus varus may be an important pathologic component in hallux valgus deformity. The correction of the pathologic intermetatarsal angle M1 M2 is essential for providing an acceptable alignment of the hallux. The distal lateral displacement osteotomy of the first metatarsal (Chevron or Mitchell) provides correction of the intermetatarsal angle M1 M2. The present paper describes a simple method of calculating preoperatively the maximum possible correction through such osteotomies. This method, based on the measurement of the length of the first metatarsal and the width at the osteotomy site, projects the amount of correction and, furthermore, provides the limits of angular correction through such osteotomies performed distally.
Three-Dimensional Imaging of the Ankle Joint from Computerized Tomography
Authors: Woolson Steven T. , Dev Parvati , Fellingham Linda L. , Vassiliadis Arthur
Published: March 2013

A computer system was developed to rapidly reconstruct three-dimensional (3D) images of bone from computerized tomography scans of the ankle joint. Solid models of the bones were produced from the 3D image data through the use of a computer numerically controlled milling machine. A cadaver ankle joint was scanned, and models of the distal tibia and fibula and dome of the talus were made and compared to the actual bone specimens. The measurements of the models were within 3 mm or less of the bones in all three planes (average, 1.2 mm or 5.5%). These 3D images and models of bone should allow better visualization of joint pathology and a system for preoperative planning on exact bone models to optimize the results of surgery.
The Risks and Benefits of Distal First Metatarsal Osteotomies
Authors: Meier Peter J. , Kenzora John E.
Published: March 2013

From a total of 138 patients who initially underwent either Chevron or Mitchell distal metatarsal osteotomies, 50 were available with complete pre- and postoperative data for study. Chevron osteotomies were performed on 60 feet (41 patients) and Mitchell osteotomies on 12 (nine patients). The results indicate that both procedures provide good or excellent subjective and objective results in about 90% of cases. There was no statistically significant difference between the procedures as regards the results. Age did not influence the outcome. Complications included damage to the proper digital nerve of the great toe in 30% indicating either direct injury to the nerve with subsequent neuroma formation or indirect injury by nerve entrapment. Osteonecrosis of the first metatarsal head occurred following Chevron osteotomies in 12 feet (12 of 60 or 20%) and following a Mitchell in one (one of 12 or 8%). However, four of the 10 (40%) patients who had a Chevron osteotomy plus a lateral adductor release developed osteonecrosis. Osteonecrosis is described and classified into three stages: stage I, the precollapse condition; stage II, the collapsed condition; and stage III, the osteoarthritic condition.

The major causes of failure were preexisting osteoarthritis, injury to the dorsal proper digital nerve, and osteonecrosis. Theoretically, most of these should be avoidable. Significant metatarsus primus varus and MTP osteoarthritis are contraindications to distal metatarsal osteotomies. A tourniquet should be routine and the nerve, visualized and protected. If a distal osteotomy is performed, a concomitant lateral adductor release is contraindicated and stripping of the distal soft tissues should be minimal.
The Sprained Ankle: Current Therapy
Authors: Kay David B.
Published: March 2013

The sprained ankle is one of the most common musculoskeletal injuries. Three treatments for severe acute sprain are advocated: immobilization, protected mobilization, and primary surgical repair. These injuries are cared for by different medical and paramedical specialties, each with varying skills and interests. In order to define the current preferred treatment, a survey was randomly distributed to 500 physicians. These data indicate that the treatment is generally conservative: cast immobilization was the preferred treatment for the moderate and severe sprain. These data also demonstrated that basic care (e.g., ice and elevation) and rehabilitation were often neglected. Significant differences were noted between the specialties of orthopaedic surgery, family practice, and emergency medicine.
Arthroscopy of the Ankle: Technique and Normal Anatomy
Authors: Andrews James R. , Previte William J. , Carson William G.
Published: March 2013

The authors present a modified technique of ankle arthroscopy and describe the intra-articular anatomy of the ankle joint as it relates to the establishment of arthroscopic portals. Cadaveric dissection was used to demonstrate the relationship of the tendons and neurovascular structures to the placement of the arthroscope. Diagnostic arthroscopy of the ankle can be systematic and reproducible when the surgeon is knowledgeable of the intra-articular and extra-articular anatomy of the ankle and when attention is given to accurate placement of the arthroscopic portals and to consistent surgical technique.
Treatment of Symptomatic First Metatarsal Shortened by Surgery
Authors: Chiappara Pietro
Published: March 2013

There are several complications that can result from shortening of the first metatarsal in the treatment of bunion. Metatarsalgia and recurrent deformity can be quite disabling. The surgical technique described in this brief report provides improved support of the metatarsal heads in walking while decreasing pain and enables the patient to stand for longer periods of time. The procedure is reserved for salvage of those patients with severe pain and deformity and in whom other salvage procedures have failed.
Calcaneal Osteomyelitis following Steroid Injection: A Case Report
Authors: Gidumal Ramesh , Evanski Phillip
Published: March 2013

A 71-year-old male presented with unremitting heel pain in the region of his calcaneal tuberosity. He had been previously treated with steroid injections for plantar fasciitis. Diagnostic workup revealed a calcaneal osteomyelitis which was treated with a partial calcanectomy. This case underlines the need to rule out this expected but previously unreported complication.
Primary Mycetoma Infection of the Distal Tibia Secondary to an Occult Foreign Body
Authors: Burkus J. Kenneth
Published: March 2013

Mycetoma infections of the extremities usually present with characteristic cutaneous manifestations of a locally invasive chronic infection. Primary mycetoma infection of bone can occur by direct inoculation of the fungus to a bony prominence from a penetrating injury. The clinical presentation, the surgical management, and the use of oral antifungal agents differentiate primary mycetoma of bone from chronic mycetoma infections.
Post-Fracture, Late Debridement Resection Arthroplasty of the Ankle
Authors: Gould Nathaniel , Flick A. Bart
Published: March 2013

Seven patients (three male and four female), aged 10 to 45 years (average, 36 years), who suffered fractures at the ankle (three right and four left) from 6 months to 20 years ago (average, 7.6 years), underwent late debridement resection arthroplasty. Follow-up ranged from 3.5 to 7 years (average, 5 years).

Six patients improved in range of motion, endurance, and freedom from pain and swelling and were able to engage thereafter in increased activities, including sports. The oldest female (aged 45), because of continual pain 15 months later, had an ankle arthrodesis.

No “normal” ankles resulted, but final rating determinations based on range of motion, endurance, swelling, pain, and subjective analyses were: excellent (1), good (3), fair (2), poor (1) (arthrodesis patient).

Results of the 5-year follow-ups suggest that this type of surgery in selected cases is a feasible, at least interim, alternative to more radical total ankle arthroplasty or ankle arthrodesis.
Cybex Evaluation of the Relationship between Anterior and Posterior Compartment Lower Leg Muscles
Authors: Scranton Pierce E. , Whitesel James P. , Farewell Vern
Published: March 2013

Twenty adult males were tested with the Cybex II isokinetic dynamometer, comparing in each leg the torque produced by the anterior and posterior muscle compartments. Significant torque is produced by the gastroc soleus muscle group, even when the knee is bent 90°. There is a significant increase in anterior compartment dorsiflexion torque produced with the knee in extension as compared to flexion. There is no difference in right or left handedness in comparing the results of torque generation in the lower extremity. On the average, dorsiflexion torque is approximately one-third of plantarflexion torque at slow speeds and half that of plantarflexion at fast speeds.
A Prospective Study of the Effect of a Shock-Absorbing Orthotic Device on the Incidence of Stress Fractures in Military Recruits
Authors: Milgrom C. , Giladi M. , Kashtan H. , Simkin A. , Chisin R. , Margulies J. , Steinberg R. , Aharonson Z. , Stein M.
Published: March 2013

In a prospective study of stress fractures the hypothesis that a shock-absorbing orthotic device worn within military boots could lessen the incidence of stress fractures was tested. The incidence of metatarsal, tibial, and femoral stress fractures was lower in the orthotic group, but only the latter difference was statistically significant. The time of onset and the location of stress fractures between orthotic and nonorthotic users did not differ. These findings suggest that the incidence of femoral stress fractures, which are the most dangerous type of stress fracture because of their high risk of developing into displaced fractures, can be reduced by an orthotic device.
Shoes versus Sneakers in Toddler Ambulation
Authors: Gould Nathaniel
Published: March 2013

The purpose of this study was to determine the relative values and differences between shoes and sneakers for young children just learning to walk.

In phase 1 of the study, 79 toddlers (47 females and 32 males), ranging in age from 11 months to 3 years, were carefully measured for footwear. Only 15 toddlers (19%) could be properly fitted in the medium-width sneakers that are currently available on the market. The majority of the measured toddlers required widths greater than D, and to accommodate these wider feet, it was necessary to fit them with longer sneakers than they actually needed otherwise, thus making ambulation a bit more difficult and clumsy.

In phase 2, eight toddlers, randomly selected except for sex (four male and four female), ranging in age from 11 to 16 months who had been ambulating 2 weeks to 5 months, were tagged with an identifying letter and videotaped in four walking situations: sneakers on tile, shoes on tile, sneakers on rugging, and shoes on rugging. Four hours of video taping was edited down to one-half hour. Twenty-three observers (orthopaedic surgeons, pediatricians, and shoe fitters) carefully reviewed the tape on multiple occasions and came to the following conclusions: better fit, stance, gait, cadence, and stability were noted with shoes in all the toddlers and in all situations. Falls were three times more frequent in sneakers as compared to shoes on tile surfaces and five times more frequent on rugging.

It was concluded that the slight economic advantage of sneakers over shoes was not that great to warrant jeopardizing the capabilities of the toddler in the earliest stages of ambulation.
The Forces of Ankle Joint Structures during Ergometer Cycling
Authors: Ericson M. O. , Ekholm J. , Svensson O. , Nisell R.
Published: March 2013

The ankle joint moment, joint compressive force, and Achilles tendon force obtained during ergometer cycling were calculated by using a quartz force-measuring transducer mounted on the pedal. Six healthy subjects rode in 11 different ways at different workloads, pedalling rates, saddle heights, and pedal foot positions. The mean maximum dorsiflexing load moment about the ankle joint during standardized ergometer cycling was calculated to 30.9 nm. The mean ankle joint compressive force and mean Achilles tendon force measured 1008 N (1.4 times body weight) and 762 N (1.1 times body weight), respectively. The ankle joint moment was significantly changed by a change of workload or pedal foot position.
The Tarsal Tunnel Syndrome: A Report of Eight Cases
Authors: Ricciardi-Pollini P.T. , Moneta M.R. , Falez F.
Published: March 2013

The authors report eight cases of tarsal tunnel syndrome, pointing out the difficulty of a differential diagnosis and the possibility of a complete restoration to normality by surgery in those cases which were resistant to local conservative treatment. Tight laciniate ligament, varices, exostosis, and adhesions were noted as the causative factors.
Molded Foot Orthosis after Great Toe or Medial Ray Amputations in Diabetic Feet
Authors: Due Thomas M. , Jacobs Richard L.
Published: March 2013

Necrosis of the tip of the next lateral remaining toe has been found to be a late complication of great toe and medial ray amputations in diabetic feet. The use of custom-molded insert foot orthoses helps avoid this complication.
Computerized Tomographic Analysis of Acute Calcaneal Fractures
Authors: Gilmer Peter W. , Herzenberg John , Frank J. Lawrence , Silverman Paul , Martinez Salutario , Goldner J. Leonard
Published: March 2013

Computerized tomography (CT) of the hindfoot is introduced as an effective technique in the evaluation of acute, intra-articular calcaneal fractures. Thirty-two fractures in 30 patients have been reviewed, and common fracture characteristics identified. These included (1) the presence of a sustentacular fragment, (2) displacement and comminution of the lateral weightbearing surface, and (3) lateral spread with loss of calcaneal height. Based on the improved understanding of fracture anatomy provided by the CT scan, treatment often can be determined more accurately.
Neurilemoma of the Lower Extremity
Authors: Spiegl Paul V. , Cullivan W. Timothy , Reiman Herbert M. , Johnson Kenneth A.
Published: March 2013

A series of 76 patients with 85 neurilemomas of the lower extremity was reviewed. The tumors were located throughout the lower extremity and had varied clinical presentations, which often posed problems in diagnosis. Pain, however, was a consistent symptom, and 63 (83%) of the patients presented with local or radiating (or both) pain. Electromyography was done in seven cases, but the results were abnormal in only two. When evaluating a painful mass or an atypical pain in the lower extremity, the clinician should have a high index of suspicion for neurilemoma.
Granulomatous Inguinal Lymphadenopathy after Bilateral Metatarsophalangeal Joint Silicone Arthroplasty
Authors: Shiel William C. , Jason Mark
Published: March 2013

Silicone elastomer arthroplasties for joint diseases involving the small joints of the hands and feet have been used worldwide since the late 1960s. While reports of axillary lymphadenopathy exist, the exact incidence of subclinical adenopathy and its relationship to arthroplasty integrity have been difficult to determine. We report a patient who developed bilateral inguinal granulomatous adenopathy as a foreign body response to regionally disseminated silicone particles from bilateral metatarsophalangeal joint prostheses.
Arthroscopy of the Posterior Subtalar Joint: A Preliminary Report
Authors: Parisien J. Serge
Published: March 2013

The technique of arthroscopy is, at the present time, available for the investigation of the subtalar joint. In this preliminary report, the relevant anatomy and technique are reviewed. Illustrative cases are presented to review some of its applications. It is the conclusion of the author that arthroscopy of the subtalar joint may be of value in the following situations: (1) assessment of the articular cartilage in suspected cases of degenerative, rheumatoid, or infectious arthritis; (2) evaluation of chronic pain syndrome in the hindfoot after injuries; and (3) biopsy of the synovial lining, breakage of adhesions, joint lavage, and removal of loose bodies.
Fracture Dislocations of the Tarsometatarsal Joints: End Results Correlated with Pathology and Treatment
Authors: Myerson Mark S. , Fisher Robert T. , Burgess Andrew R. , Kenzora John E.
Published: March 2013

Seventy-two patients with 76 fracture-dislocations of the Lisfranc tarsometatarsal joint complex were evaluated. Fifty-eight (81%) were polytrauma patients and the remainder suffered isolated injuries. Sixty of the original 72 patients were available for long-term study. Eight of these had an amputation at or shortly after the original admission, leaving 52 patients with 55 Lisfranc injuries for analysis. The average length of follow-up was 4.2 years (range, 20 months to 11 years). According to the Painful Foot Center scoring system, 27 feet (49%) achieved an excellent or good result and 28 (51%), a fair or poor result. Direct crush injuries did poorly with only one of eight scoring good or excellent. Of the various treatment modalities, open reduction and internal fixation with Kirschner wires yielded the best results.

The major determinant of unacceptable results was identified as the quality of the initial reduction. Tarsal instability and late degenerative joint disease caused most of the symptoms. Twenty-three of the 52 patients (44%) have had or should have further mid-foot surgery to improve function and comfort.

Because our results were often poor, our present protocol includes closed or open reduction and Kirschner wire internal fixation. Displacement greater than 2 mm or a talometatarsal angle greater than 15° on radiographs following a closed reduction mandates open reduction.
Predictive Value of Manual Muscle Testing and Gait Analysis in Normal Ankles by Dynamic Electromyography
Authors: Perry Jacquelin , Ireland Mary Lloyd , Gronley Jo , Hoffer M. Mark
Published: March 2013

Eight muscles about the ankle of seven normal subjects were assessed by electromyography (EMG) during manual muscle testing (MMT) and walking. Three strength levels (normal, fair, trace) and three gait velocities (free, fast, slow) were tested. The muscles studied included the gastrocnemius, soleus, posterior tibialis, flexor digitorum longus, flexor hallucis longus, anterior tibialis, extensor digitorum longus, and extensor hallucis longus. Relative intensity of muscle action was quantitated visually (using an eight-point scale based on amplitude and density of the signal). The data showed that EMG activity increased directly as more muscle force was required during the different manual muscle test levels and increased walking speeds. No MMT isolated activity to the specific muscle thought being tested. Instead, there always was a synergistic response. Both the gastrocnemius and soleus contributed significantly to plantarflexion regardless of knee position. The intensity of muscle action during walking related to the manual muscle test grades. Walking at the normal free velocity (meters/min) required fair (grade 3) muscle action. During slow gait the muscle functioned at a poor (grade 2) level. Fast walking necessitated muscle action midway between fair and normal, which was interpreted as good (grade 4).
Isolated Avulsion of the Tibial Origin of the Anterior Tibiofibular Ligament
Authors: Perry Clayton Richard , Ritterbusch James Karl , Burdge Robert Edward
Published: March 2013

A case report of a patient with an isolated avulsion of the anterior tubercle of the tibia is presented. This is the origin of anterior tibiofibular ligament, and this injury is the first stage of a supination external rotation injury of the ankle. It can be easily missed and, if not treated properly, can result in an unstable ankle. The patient was not treated initially and the result was an unstable ankle.
Burn Contractures of the Foot
Authors: Leung P. C. , Cheng J. C. Y.
Published: March 2013

Four different types of post-burn contractures of the foot, mild, moderate, severe, and mutilated, are described. The varying degrees of involvement require different methods of treatment, which are described in detail
Coccidioidomycosis of the First Cuneiform: Successful Treatment Utilizing Local Debridement and Long-Term Ketoconazole Therapy
Authors: Buckley Steven L. , Burkus J. Kenneth
Published: March 2013

Although intravenous amphotericin B is generally considered to be the standard treatment for coccidioidomycosis, the treatment of monostotic coccidioidomycosis is controversial. Long-term intravenous and oral antifungal chemotherapy has been utilized alone and in conjunction with local surgical debridement. We present a case of coccidioidal osteomyelitis of a tarsal bone successfully treated with local surgical debridement and oral ketoconazole and propose clinical guidelines for selecting the proper chemotherapeutic agent and for following the efficacy of the treatment regimen