bluuebunny/crossref_metadata_2025 huggingface dataset:
An Office-based Orthotic System in Treatment of the Arthritic Foot
Authors: Glass MacEllis K. , Karno Martin L. , Sella Enzo J. , Zeleznik Reivan
Published: March 2013

Patients with inflammatory arthritic disease of the feet invariably require conservative office management. The simplest method of obtaining relief has been to use commercially available extra-depth shoes combined with cus-tommade, removable, closed-celled polyethylene foam arch supports. These supports are soft, light, and can be accurately adjusted to each patient's pathology. The technique and modifications used for relieving the commonest problems, such as anterior metatarsalgia and plantar heel pain, are discussed.
Ganglia of the Foot and Ankle
Authors: Kliman Michael E. , Freiberg Arnis
Published: March 2013

This report documents the treatment of 33 foot and ankle ganglia. The average patient age was 3d years ( versus 25 years for patients with ganglia about the wrist joint). Twenty-one ganglia were treated operatively and nine recurred. Three patients suffered cutaneous nerve injury. The other 12 ganglia were treated by aspiration and steroid injection. There were four recurrences, one of which was cured by a second injection. Two of the four recurrences were small and asymptomatic and required no treatment. There were no complications with aspiration and injection.

In view of the high recurrence rates and inconvenience of ganglionectomy in the foot, aspiration and steroid injection is a more safe, simple, and effective treatment. We feel that surgery should generally be reserved for failures of nonoperative treatment.
Parosteal Osteosarcoma of the Fourth Metatarsal Bone
Authors: Kliman Michael E. , Fornasier Victor L. , Hastings David E.
Published: March 2013

The authors present a case of a parosteal osteosarcoma of the fourth metatarsal in a 19-year-old male. This location has never been previously reported. The periosteal new bone formation without bone destruction must be differentiated from foreign body reaction and stress fractures. En bloc resection of the fourth and fifth rays was done. There has been no evidence of recurrence to date, 1 year and 10 months following the surgery. There has been an excellent functional result.
Anterior Tibiotalar Impingement Syndromes in Dancers
Authors: Kleiger Barnard
Published: March 2013

A common ankle problem among dancers is impingement of the tibia on the talar neck. Two syndromes are described. One results in the development of exostoses on the anterior tibia and talus. The other results in plantar fascial sagging and chronic foot strain. The treatment and prognosis are presented along with representative cases.
Posterior Block of the Ankle Joint in Dancers
Authors: Howse A.J.G.
Published: March 2013

A posterior block of the ankle joint caused by an os trigonum, a large posterior tubercle of the talus, or prominence on the dorsum of the posterior part of the os calcis is described. The presenting symptoms are listed, the most important being Achilles tendonitis anterolateral ankle pain, recurrent calf strain, and pain under the plantar aspect of the foot. All these can be associated with difficulty in pointing the foot. Details are given of the operation and the after care.
Forefoot Conditions in Dancers—Part I
Authors: Sammarco G. James , Miller Edward H.
Published: March 2013

The conditions occurring in the dancer's forefoot can be divided into five categories. The three categories presented in Part I of our study include those conditions occurring from poor training, those from chronic forefoot stresses, and those of static deformity. Five hundred dancers were observed for both symptomatic and asymptomatic forefoot conditions. It is most important that a young dancer have at least three years training before dancing en pointe. Many skeletal changes in a dancer's foot occur from use and should not be interpreted as injuries. Static forefoot deformities tend to appear in dancers at a younger age than the general population but seldom require corrective surgery.
Hoffman Procedure in the Ulcerated Diabetic Neuropathic Foot
Authors: Jacobs Richard L.
Published: March 2013

Twelve diabetic patients with varying degrees of insen-sitivity of the foot presented with problems of forefoot ulceration beneath one or more metatarsal heads. This was associated with local abscess formation. Some of these patients had previously been subjected to surgical procedures such as ray resection or single metatarsal head resection for earlier problems and were left with areas of increased pressure in the weightbearing surface of the forefoot.

Appropriate antibiotic therapy was started by the Infectious Diseases service in each case. Blood flow to the extremity was evaluated by pulse volume recordings and measurement of Doppler pressures at various levels down the extremity. Vascular reconstruction was indicated in two of these patients. After this reconstruction, circulation was deemed adequate to perform the Clayton (Clayton, M.L.: Surgery of the forefoot in Rheumatoid Arthritis. Clin. Orthop. 16:136–140, 1960) modification of the Hoffman (Hoffman, P.: An operation for severe grades of contracted or clawed toes. Am. J. Orthop. 9:441–449, 1911) procedure.

This procedure was also done on 10 other patients with more adequate circulation. Although the time of healing was prolonged in some instances, all feet healed and the patients were successfully graduated to full weightbearing with extra depth shoes with soft neoprene rubber insoles. This procedure should be considered instead of transmetatarsal amputation in some patients with problems of ulceration and abscess formation of the forefoot if circulation is adequate, or can be restored to adequate levels by vascular reconstruction.
The Use of Skin Temperature Determinations in Lower Extremity Amputation Level Selection
Authors: Golbranson Frank L. , Yu Eric C. , Gelberman Richard H.
Published: March 2013

Skin temperatures were recorded preoperatively with a surface temperature probe in 30 limbs of 26 patients undergoing amputations for peripheral vascular disease. A significant correlation was established between the temperature readings and stump survival at the selected levels. All amputation levels with temperature readings above 32° C healed, and all those with readings below 30.5° C failed to heal. If the difference between skin temperature and room temperature was less than 5° C the amputation generally failed.
Lower Limb Replantation: A report of nine cases
Authors: Kutz Joseph E. , Jupiter Jesse B. , Tsai Tsu-Min
Published: March 2013

An analysis of nine replantations of completely amputated lower limbs is presented in this paper. Four cases were successful, including two at the level of the distal third of the tibia, one through the midfoot, and one at the proximal third of the tibia. The latter case involved the replantation of the shortened limb followed by a Syme's amputation of the foot to preserve a functional below-knee amputation level. In each successful case protective sensibility, bony union, and a stable stance and functional gait has been achieved, thereby eliminating a prosthetic requirement.
Total Astragaloplasty
Authors: Neches A. Crespo , Neches S. Crespo
Published: March 2013

Four cases are presented of astragular arthrosis treated with substitution of the entire astragalus with a prosthesis identical in form to that bone. The four cases were due to severe fracture, avascular necrosis, and degenerative joint disease. One patient died of a heart attack 6 months after the operation, the other three cases, one of them with a 6-year follow-up, present a good result. The presentation is made to illustrate the clinical progress of treatment of talar arthroses.
Treatment of Ingrown Toenail
Authors: Dixon George L.
Published: March 2013

A plan is presented which brings together three elements: the clinical stage of disease, the age of the patient, and the treatment regimes available. It is a practical and systematic yet flexible approach to the successful treatment of a given ingrown toenail. A general outline and specific detail of conservative and surgical technique are offered.
Bilateral Tarsal Tunnel Syndrome Caused by Varicosities
Authors: Gould Nathaniel , Alvarez Richard
Published: March 2013

The authors present a case report of bilateral tarsal tunnel syndrome occurring in a 39-year-old, slightly overweight female with a long history of varicose veins of her legs. Symptomatology suggestive of tarsal tunnel syndrome was present over the left heel. Vein stripping was done on both legs. When the burning discomfort at the inner aspect of the left heel continued in spite of the strippings, she presented at our Foot Clinic. Surgery on the left heel revealed varicosities overlying the medial and lateral plantar nerves near their origin, and removal of these resulted in prompt relief of her complaints. Nine months later and 10 months following the venous stripping of her right leg, medial right heel pain, burning, paresthesias, and a positive Tinel sign appeared over the inner aspect of her right heel. There was prompt subsidence of these complaints when again varicosities were found and removed.
The Development of the Human Foot As a Résumé of Its Evolution
Authors: Crelin Edmund S.
Published: March 2013

The changes the human foot undergoes during its development are described as indications of structural and functional changes which might have occurred during the evolution of the vertebrate hind foot. The human foot, when compared to other vertebrate feet, appears to be a relatively minor modification of the plantigrade hind foot of the shrew-like insectivores that gave rise to all of the mammals. There is no developmental evidence to indicate that the first toe of the human foot was ever prehensile. Thus, the generally accepted evolutionary view, which depicts the feet of the early ancestors of modern human beings as having ape-like prehensile first toes, is seriously questioned.
The Evolutionary Basis of Some Clinical Disorders of the Human Foot: A Comparative Survey of the Living Primates
Authors: Olson Todd R. , Seidel Michael R.
Published: March 2013

The living primates are a highly diverse group of essentially arboreal animals whose feet are variously adapted for grasping, climbing, and leaping in trees. One of the most remarkable aspects of the anatomical variation in the feet of the extant primates is that this diversity can be arranged in a graduated sequence ranging from the primitive transtarsal-opposition type of grasping foot found in the lemurs, through the specialized transmeta-tarsal-adduction type that characterizes the higher primates, to'the unique nongrasping foot of humans. The comparative study of this graded series makes it possible, without recourse to the fossil record, to appreciate the adaptive and functional stages through which the human foot passed in its evolution. It is hypothesized that the initial stage of human erect posture was characterized by a foot which was adapted to both hallucial grasping and short distance bipedal walking. In many respects, the structure of the foot of this primitive human was probably similar to that of the living highland gorilla.

When compared with the feet of our closest living relatives, the African apes, the human foot is characterized by two major evolutionary specializations: the longitudinal and transverse arches, and the parallel first and second metatarsals. These two morphological adaptations, together with several associated specializations, are the structural basis of the bipedal human foot. Reconstructing the evolutionary and adaptive history of these specializations creates a better understanding of some of the more common clinical podiatric disorders. The modern human foot is structurally so well adapted to prolonged bipedal walking and standing that even slight deviations from its evolutionarily established pattern will produce debilitating clinical manifestations. In most cases, successful treatment of such disorders involves restoration of the foot's basic adaptive configuration.
The Evolution of the Primate Foot from the Earliest Primates to the Miocene Hominoids
Authors: Conroy Glenn C. , Rose M. D.
Published: March 2013

The fossil evidence relating to the evolution of the primate foot is reviewed and evaluated. Many of the characteristic features of the primate foot had evolved by the early Tertiary over 40 million years ago. Probably the most significant of these developments was the progressive migration of the talus to a position over the calcaneum. These morphological features are followed through the Miocene hominoid genera from East Africa, Europe, and South Asia. While some features of Miocene hominoids, especially those relating to climbing abilities, are still evident in the predominantly bipedal earliest hominids of the Plio-Pleistocene, there is no evidence yet from the Miocene of the first stages in the evolution of that bipe-dalism.
Scleroderma of the Foot: Orthopaedic Treatment
Authors: Bernstein Saul M. , Bernstein Bram H. , Isaacson Joseph
Published: March 2013

Four patients with scleroderma involving the feet have been treated at Childrens Hospital of Los Angeles by the authors. All children had severe deformity of the feet secondary to the scleroderma. A review of the literature reveals little past mention of indications or treatments of this deformity in the past with the exception of the use of local steroids. Six feet in four children underwent orthopedic treatment. Treatment was primarily by casting to stretch soft tissues and gain as much correction as possible. Surgical correction of the remaining deformity by releasing the soft tissue contractures was then accomplished. Internal fixation of the foot in the corrected position was carried out in four cases. Three of the four patients showed significant improvement following soft tissue surgery and one patient was unchanged. Surgical treatment of the patient with scleroderma can be carried out safely as long as careful attention is paid to circulatory status and extensive preoperative casting and stretching of “soft” tissues is utilized.
Biomechanics in Cerebral Palsy
Authors: Mann Roger
Published: March 2013

Normal gait is dependent upon a coordinated series of events which moves the body through space with the minimal energy expenditure. Any neuromuscular abnormality which interferes with this pattern and results in loss of coordination will give rise to increased energy requirements. When energy requirements become too great, the patient becomes nonambulatory. This article presents the basic patterns present during normal bipedal gait and discusses the manner in which they are altered in the patient with cerebral palsy.
Pathodynamics of Gait Alterations in Cerebral Palsy and the Significance of Kinetic Electromyography in Evaluating Foot and Ankle Problems
Authors: Hoffer M. Mark , Perry Jacqueline
Published: March 2013

Normal gait involves a well-defined sequence of joint motion and muscle activity. In cerebral palsy there are significant alterations. Surgical and orthotic plans should be made with the aid of the knowledge of these deviations.
Role of Nerve Blocks in the Foot and Ankle in Cerebral Palsy: Therapeutic and Diagnostic
Authors: Carpenter Earnest B.
Published: March 2013

Dilute absolute alcohol (45%) injected into quadrants of the gastocnemius or gastrocsoleus in children with cerebral palsy of the spastic type who have an equinous gait but without contractures offers the clinician diagnostic information in determining therapeutic surgery or treatment. Similarly, Marcaine 0.25% (or similar anesthetic agents) injected into the nerve at the ankle or foot will assist in determining surgical procedures to correct foot deformities. The use of dilute alcohol or local anesthetic agents gives additional information to therapists treating these children.
A Comparison between Chevron and Mitchell Osteotomies for Hallux Valgus
Authors: Kinnard Patrick , Gordon Douglas
Published: March 2013

A retrospective study of 15 Mitchell and 15 Chevron osteotomies was undertaken in order to compare the efficacy of these two procedures in the correction of hallux valgus. Patient satisfaction, clinical findings, and roentgenographic measurements were all carefully evaluated after follow-up periods of 21 ± 5 months for the Chevron and 34 ± 8 months for the Mitchell procedures. Differences observed were a better correction of the angle between the first and second metatarsals by the Mitchell osteotomy (2.3 vs 5.5 degrees) and a tendency to loose the correction in the immediate postoperative period for the Chevron osteotomy. However, no clinical superiority could be demonstrated, nor did patient satisfaction differ in the two techniques. The authors conclude that these procedures give essentially equivalent results. Although the outcome was generally considered satisfactory by the patient, nearly 40% of both groups had metatarsalgia in the lateral rays, which stresses the importance of carefully considering load distribution across the foot in planning any corrective surgery.>
Ankle Diastasis without Fracture
Authors: Edwards George S. , DeLee Jesse C.
Published: March 2013

Ankle diastasis without associated fracture occurs in a latent form in which the diastasis is detected only by stress radiographs, and in a frank form with the diastasis visible on routine, unstressed radiographs. Whereas latent ankle diastasis requires no reduction and can be treated by cast immobilization, frank diastasis requires anatomical reduction of the ankle mortise. The method of reduction depends upon the particular type of frank diastasis. We have identified four types of frank ankle diastasis without fracture. Type I injuries demonstrate straight lateral fibular subluxation without plastic deformation of the fibula and are best treated by open reduction, removal of any interposed soft tissue, and stabilization with a tibiofibular screw. Type II injuries present with straight lateral subluxation of the fibula due to plastic deformation of the distal fibula and may require a fibular osteotomy for reduction prior to internal fixation. Plastic deformation of the fibula as a cause of ankle diastasis has not been previously reported.

The uncommon type III injury consists of posterior rotatory subluxation of the fibula. In type IV injuries the talus is dislocated superiorly, resulting in divergence of the tibia and fibula. Type III and IV injuries can usually be treated by closed manipulation and plaster immobilization.

The authors treated four type I and two type II patients by open reduction and internal fixation. Both type II injuries required fibular osteotomy to restore the normal tibiofibular relationship. Good results were obtained in four patients. Fair results secondary to stiffness and pain on activity were present in two patients. All patients maintained anatomical reduction of the ankle mortise following removal of the tibiofibular screw.
Occult Injuries of the Talus Diagnosed by Bone Scan and Tomography
Authors: Burkus J.K. , Sella E.J. , Southwick W.O.
Published: March 2013

Five patients, four women and one man, were found to have an osteochondral lesion of one of the talar joints. All patients had normal plain radiographs of the ankle and foot and were referred to us as a second or third consultation for undiagnosed ankle and hindfoot pain. Bone scans of the tali demonstrated the specific talar joint that was injured, and tomography confirmed the presence of an osteochondral lesion. The average delay in the diagnosis between the onset of symptoms and the initiation of treatment was over 10 months. Bone scanning is an effective diagnostic tool in locating injuries of the talus not appreciated on routine x-ray.
A Rerouting Operation for Dislocation of Peroneal Tendons: Operative Technique and Case Report
Authors: Pozo Joseph L. , Jackson Andrew M.
Published: March 2013

An osteotomy of the lateral malleolus for rerouting the peroneal tendons in cases of acute or recurrent dislocation is described. This technique, which does not compromise the stability of the ankle joint or the excursion of the peroneal tendons, allows an early return to full activity with no loss of function.
Plantar Fascitis–Early Blood Pool Images in Diagnosis of Inflammatory Process
Authors: Vasavada Prasan J. , DeVries Donald F. , Nishiyama Hiroshi
Published: March 2013

Bone scintigraphy is of diagnostic value in stress fractures where radiography may not be helpful. Obtaining early blood pool images during scintigraphy for suspected stress fractures may help to identify soft tissue inflammation (plantar fascitis) when delayed images are normal.
A New Radiological Technique for the Forefoot
Authors: Chang Julian W. , Griffiths Harry , Chan Donald P. K.
Published: March 2013

Based on a study of 50 subjects seen at the University of Rochester Medical center, a new axial weightbearing radiological technique of the forefoot is described. The technique is simple, inexpensive, and easily reproducible. It has the advantage of not distorting the forefoot, relationships, unlike currently employed techniques. Since it is performed under weightbearing conditions, the results correlate closer to clinical situations. The SUbjects under this study, which excluded those with neuromuscular or malalignment problems, were found to fall into two categories: the pain-free and callous-free feet group, who have a well defined arch in the forefoot, and the group of subjects with pain and/or callous under the forefoot, who have a depressed arch. There is also a statistical significance between the relative heights of the tibial and fibular sesamoids. A new classification for hallux valgus based on observations of this technique is proposed.
The Effect of Simulated Tibial Deformities on the Ankle Joint during the Gait Cycle
Authors: Wagner Kendall S. , Tarr Richard R. , Resnick Charles , Sarmiento Augusto
Published: March 2013

The effect of angular deformities of the tibial shaft on the area, location, and shape of the ankle joint contact during the normal extremes in the gait cycle was studied with the use of a cadaveric model. Six lower limbs were first examined radiographically and found to be free of pathology. These specimens were then stripped of soft tissues proximal to the ankle joint and had a custom-designed universal joint-plate inserted into the tibia at the proximal, middle, or distal third level. An anterior ankle arthrotomy was performed, and pressure sensitive film was inserted into the tibiotalar joint. Load was then applied with the ankle set in dorsiflexion or plantarflexion via metal wedges, and tibial deformities of 5, 10, and 15° were simulated in varus, valgus, anterior bow, and posterior bow.

Contact area and location changes were noted to be of greater magnitude with proximal and distal third tibial deformities than with middle third deformities. Varus and valgus deformities showed smaller contact area changes than anterior or posterior bow deformities. Contact area changes tended to be larger in dorsiflexion compared to plantarflexion for each level and degree of tibial angulation. Posterior bow deformities at all levels resulted in greater changes in contact area and shape than other deformities. The role of subtalar compensation, stiffness of the foot-ankle complex, and geometric factors are all thought to influence the changes noted. On the basis of this experimental study it would appear that angular deformity of the tibia less than 10° would not significantly alter ankle joint contact.
Treatment of Symptomatic Foot and Ankle Deformities in the Nonambulatory Neuromuscular Patient
Authors: Hsu John D. , Jackson Richard
Published: March 2013

Thirteen nonambulatory patients, aged 7 to 15 years and with neuromuscular disease, had residual foot and ankle deformities secondary to persistent and continued muscular imbalance around the ankle and foot. Surgical procedures were done to correct these fixed contractures so that the ankle was neutral and the foot plantigrade at the conclusion of the procedures. Despite successful attainment of the preoperative objectives, surgery should not be performed unless the following indications are present: (1) severe pain, (2) skin breakdown and/or ulceration, and (3) the inability for the foot and ankle to accept reasonably costing and available shoe wear. Recurrence occurs if AFOs (ankle-foot orthoses) are not used after the surgical releases.
Roentgenographic and Mathematical Analysis of First Metatarsal Osteotomies for Metatarsus Primus Varus: A Comparative Study
Authors: Jahss Melvin H. , Troy Allen I. , Kummer Frederick
Published: March 2013

The operative effectiveness of five different first metatarsal osteotomies for nonarthritic hallux valgus and metatarsus primus varus were objectively evaluated roentgenographically. The series consisted of 120 feet (75 patients) seen over a 5-year period. The osteotomies were biplanar neck, Chevron, biplanar basilar, basilar concentric, and basilar concentric combined with a lateral closing wedge. All the osteotomies except for the Chevron had varying degrees of plantar displacement of the distal fragment and crossed Kirschner wire fixation.

The operative techniques and failures are discussed. Special x-ray studies confirmed misleading pseudocorrections caused by bandage compression and intraoperative and early postoperative roentgenographic distortion. The Chevron gave the least correction, 2°, and did not permit plantar displacement to obviate late metatarsal transfer lesions. The biplanar neck osteotomies were technically the simplest, giving 86% satisfactory corrections, averaging 4.3°. The biplanar basilar osteotomies yielded the most erratic results. The poor results were due to medial tilt during fixation, thereby negating any correction. The technical difficulties with the basilar concentric osteotomy were overcome by the addition of a small lateral closing wedge. This procedure gave by far the most consistently good results with corrections of up to 12°, averaging 7.9°.
Monarticular Nontraumatic Synovitis of the Metatarsophalangeal Joint: A New Diagnosis?
Authors: Mann Roger A. , Mizel Mark S.
Published: March 2013

Seven patients presented with forefoot pain in the metatarsal head region, with an average age of 57 years, and no history of trauma. Six had pain in the second metatarsophalangeal joint, while one patient had pain in the third. Physical examination demonstrated generalized thickening of the involved metatarsophalangeal joint along with warmth and tenderness to compression. Range of motion was decreased in flexion and two patients had a subluxed metatarsophalangeal joint. All patients demonstrated some instability of the joint with dorsoplantar stress. Palpation of the intermetatarsal space demonstrated some evidence of irritation of the common digital nerve. The toe demonstrated some thickening. Roentgenograms demonstrated some widening of the metatarsophalangeal joint in four of these patients.

One patient responded to conservative treatment, and the remaining six patients underwent synovectomy. In three cases the common digital nerve was resected.

Follow-up was 16 months, and four of the six patients operated on felt their symptoms were completely relieved, one patient felt that the symptoms were improved, and one patient believed her surgery was of no benefit. Synovial tissue in all cases revealed pathologic changes of chronic synovitis.

The etiology of this synovitis is unknown. The excessive synovium resulted in the joint thickening, which probably accounts for the neuritic symptoms, the generalized thickening of the toe, and the instability of the joint. Because of the poor response to conservative treatment, perhaps earlier synovectomy is the treatment of choice for this entity.
A Review of Ruptures of the Achilles Tendon
Authors: Hattrup Steven J. , Johnson Kenneth A.
Published: March 2013

Rupture of the Achilles tendon is a relatively infrequent injury that is often missed by the initial treating physician. The diagnosis can be established on the basis of the physical examination with weakness of plantarflexion, a palpable gap in the tendon, and a positive squeeze test. Special diagnostic studies are rarely necessary. In the majority of cases, the etiologic basis for the rupture appears to be a combination of intratendon degeneration and mechanical stress. Conservative treatment of an acute rupture by immobilization with a cast provides satisfactory results. For the younger, more athletic patient, surgical repair should be considered.
Osteochondrosis Dissecans Occurring in the Knee and Ankle of the Same Patient
Authors: Smith Purcell , Coker Tom P.
Published: March 2013

Osteochondrosis dissecans is a disease that is known to present in multiple joints. A literature search revealed no reports of this lesion appearing in the knee and ankle of the same patient. Such a clinical presentation is the basis for this report, which is intended to alert clinicians to include osteochondrosis dissecans in their differential diagnosis of knee and ankle pain. A short review of the literature and treatment alternatives is included.
The Normal Range of Subtalar Inversion and Eversion in Young Males as Measured by Three Different Techniques
Authors: Milgrom C. , Giladi M. , Simkin A. , Stein M. , Kashtan H. , Margulies J. , Steinberg R. , Aharonson Z.
Published: March 2013

In a prospective study, 272 males aged 18 to 20 had goniometric measurement of their subtalar inversion and eversion by three different methods. Placing the ankle in dorsiflexion while performing the measurements decreased the mean inversion from 32 to 22 degrees but had little effect on eversion. The neutral position of the subtalar joint was found to have a mean value of 3 degrees of varus from the midpoint of the tibia. The technique for measuring subtalar motion as described by the Committee for the Study of Joint Motion of the American Academy of Orthopaedic Surgeons has less subjective variables than the other two methods used in this study. Its use is therefore recommended if comparisons are to be made between series.
The Roentgenographic Appearance of the “Corrected Clubfoot”
Authors: Miller John H. , Bernstein Saul M.
Published: March 2013

Roentgenographic changes associated with a corrected clubfoot may not be readily apparent. In some individuals with minimal residual deformity, these roentgenographic changes are quite subtle. The roentgenographic abnormalities of the corrected clubfoot are described.
Osteomyelitis of the Heel with Pasteurella pneumotropica: A Case Report
Authors: Sammarco G. James , Leist Phyllis A.
Published: March 2013

A rare case of Pasteurella pneumotropica occurring in a polymicrobial anaerobic osteomyelitis of the heel is presented. The natural history, predisposing conditions, treatment, and postoperative care are presented. Surgical excision of the infected portion of the calcaneus, appropriate antibiotics, and lift with proper supporting heel cup all aided in returning the patient to her normal daily activities.
External Fixation of the Foot and Ankle
Authors: DeCoster Thomas , Alvarez Richard , Trevino Saul
Published: March 2013

The use of Hoffmann external fixation in the treatment of ankle and foot trauma in 26 patients is reviewed. There were 21 males and five females, ranging in age from 14 to 56 years. There were 22 fresh fractures and four arthrodeses. Fourteen of the 22 injuries were open fractures. Eight of 22 involved foot joint disruptions. This form of treatment required a complete set of external fixation equipment, sound knowledge of foot and ankle anatomy, and technical skill in frame construction and application. This fixateur allowed three plane stabilization of complex fractures, mobilization of unaffected joints, and access to wounds for soft tissue care. Follow-up evaluations from 24 to 48 months demonstrated good clinical results. The fractures healed and soft tissue and joint function were preserved. The arthrodeses fused. There were no neurovascular complications, pin tract infections, or equipment breakage. Foot trauma frequently combines soft tissue injury and complex skeletal instability, which makes external fixation particularly attractive. Although ideal indications for the use of this technique have not yet been determined, the theoretical advantages and initial results are encouraging. External fixation is a useful addition to the treatment armamentarium of the foot surgeon.
Evaluation and Therapy After Injury to Peripheral Nerves
Authors: Lusskin Ralph , Battista Arthur
Published: March 2013

Peripheral nerve injuries from whatever cause should be classified according to the degree of axon, fascicle, and main nerve trunk damage. This approach is useful in assessing the chances for spontaneous recovery and planning for surgery directed at improving neural recovery. Evaluation over time may be required to better classify the degree of injury. Once recovery slows or ceases, the surgical approaches available include neurolysis, nerve repair, nerve transposition, autograft reconstruction, and various procedures directed at painful neuromata. With proper mobilization and protection of neural and vascular structures, even extensive orthopaedic reconstructive procedures may be performed. Ischemic neuritis and myopathies may be improved by such combined approaches.
Sensory Reinnervation in Reconstruction of the Foot
Authors: Ning Chang K. , Buncke Harry J.
Published: March 2013

Intact sensation constitutes an important protective mechanism for the plantar surface of the foot. For optimal functional results, sensory reinnervation in reconstruction of the heel of the plantar foot would appear to be helpful. Various techniques are presented in which both intact local tissue and distant tissue are used. The design of neurosensory fasciocutaneous flaps and musculocutaneous flaps from the foot, sensory-innervated full thickness skin grafts, and microsurgically transferred skin flaps, muscle flaps, and musculocutaneous flaps are presented. Free tissue transfer techniques can be used in combination with various sensory reinnervation techniques.
Injuries to the Metatarsophalangeal Joints in Athletes
Authors: Clanton Thomas O. , Butler James E. , Eggert Allen
Published: March 2013

Injury to the metatarsophalangeal joints in sports has become an increasing problem with the advent of more flexible shoewear and artificial playing surfaces. These injuries vary from mild sprains to severe tearing of the capsuloligamentous complex including avulsion fractures. This may include a compression fracture of the metatarsal head in the more severe cases. At the extreme, dislocation or fracture-dislocation of the metatarsophalangeal joint occurs. The findings in 62 cases of these injuries in Rice University athletes from 1971 to 1985 are presented. Treatment follows a standard regimen of ice, taping and anti-inflammatory medication with gradual return to sports activity as symptoms allow. Recommendations for preventive therapy include stiffening the forefoot in athletic shoes or the use of an orthotic device. This should reduce the incidence of long-term sequelae.
Osteochondritis Dissecans of the Midfoot
Authors: Lehman Richard C. , Gregg John R.
Published: March 2013

Osteochondritis dissecans of the midfoot is described with discussion focusing on its etiology, classification, and treatment. Two cases are presented in which work-up, treatment, and follow-up are described. Difficulty in making the diagnosis is caused by a lack of awareness of this entity and the specific studies needed to identify the lesion.
The Biomechanics of Lower Extremity Action in Distance Running
Authors: Cavanagh Peter R.
Published: March 2013

The role of quantitative biomechanical measurements in the evaluation of the running patient is discussed. Many techniques are now available to provide insight into the external mechanics of lower extremity action during running, and results from such measurements are presented for symptom-free subjects at distance running speeds. Details of stride length, stride time, and foot placement are first presented followed by a discussion of kinematic data, including stick figures, angle-time graphs, and angle-angle diagrams for the sagittal plane motion of the hip, knee, and ankle joints. The measurement of rearfoot motion, as an approximation of coronal plane subtalar joint movements, is also discussed. Results from acceleration, force, and pressure measurements are considered, and the assertion is made that bilateral asymmetry in many of these measures is a fairly common finding. There are, at present, few reports in the literature of the application of biomechanical techniques to the evaluation of patients with running injuries. It is anticipated that there will be rapid developments in this area in the future and that this will provide considerable insight into the etiology, diagnosis, and treatment of running injuries.
Imaging Study of the Painful Heel Syndrome
Authors: Williams P L. , Smibert J G. , Cox R. , Mitchell R. , Klenerman L.
Published: March 2013

A total of 45 patients with the painful heel syndrome without evidence of an associated inflammatory arthritis, seven of whom had pain in both heels, were studied using technetium-99 isotope bone scans and lateral and 45° medial oblique radiographs of both feet. Of the 52 painful heels 31 (59.6%) showed increased uptake of tracer at the calcaneum. Patients with scans showing increased uptake tended to have more severe heel pain and responded more frequently to a local hydrocortisone injection. On plain x-ray, 39 of 52 painful heels (75%) and 24 of the 38 opposite nonpainful heels (63%) showed plantar spurs, compared with five of 63 (7.9%) heels in 59 age- and sex-matched controls. No evidence of stress fractures was seen.
Lateral Talocalcaneal Instability Following Section of the Calcaneofibular Ligament: A Kinesiologic Study
Authors: Kjaersgaard-Andersen Per , Wethelund Jon-Oddvar , Nielsen Strange
Published: March 2013

In the evaluation of the role of the calcaneofibular ligament in stabilizing the talocalcaneal joint, an experimental set-up was prepared. In 10 osteoligamentous specimens, the talocalcaneal motion was measured under a constant well defined moment by using a specially constructed apparatus. By using a moment of 1.5 Nm, increment in adduction in the talocalcaneal joint after section of the calcaneofibular ligament was found between 3.1° and 4.6°, still increasing with dorsiflexion. This increment, shown to constitute 61 to 77% of the total increment in adduction in the hindfoot after section of the calcaneofibular ligament, was found to increase gradually with dorsiflexion. The study has shown the calcaneofibular ligament as an important structure in stabilizing the talocalcaneal joint. Increment in adduction in the hindfoot after section of the calcaneofibular ligament was shown primarily to take place in the talocalcaneal joint.
Keller Arthroplasty: A Prospective Review
Authors: Love T. R. , Whynot A. S. , Farine I. , Lavoie M. , Hunt L. , Gross A.
Published: March 2013

A prospective study of the Keller procedure for hallux valgus was carried out on 44 female patients (75 feet) with an average age of 66 years. The average follow-up was 31 months (range, 12–64 months). The operation was effective in improving symptoms (joint pain and bunion tenderness), cosmesis, function (footwear and level of activity) and in decreasing the deformity. The operation did not have an influence on metatarsal calluses. Cock-up deformity was common postoperatively but did not affect the results. The overall patient satisfaction rate was 77%.
Extraosseous and Intraosseous Arterial Supply to the First Metatarsal and Metatarsophalangeal Joint
Authors: Shereff Michael J. , Yang Quing Ming , Kummer Frederick J.
Published: March 2013

The extraosseus and intraosseous circulation to the first ray was evaluated by means of vascular injection techniques. The first metatarsal and metatarsophalangeal joint receive their blood supply from the first dorsal metatarsal artery, the first plantar metatarsal artery, and the superficial branch of the medial plantar artery. These three source arteries provide variable numbers of branches to the base, shaft, and head of the first metatarsal. Ramifications of branches to the head form an extensive capsular network that is more consistent and abundant on the dorsal and lateral aspects of the joint.

The source of intraosseous vascularity consists of a diffuse network of fine periosteal arteries enveloping the diaphysis of the metatarsal, a single nutrient artery that perforates the first metatarsal at the lateral aspect of the shaft distally, and a system of metaphyseal and capital arteries that appear to constitute a major source of blood supply to the metatarsal head.
Foot Breadth in Children—Its Relationship to Limb Dominance and Age
Authors: Didia B.C. , Nyenwe E.A.
Published: March 2013

A total of 996 school pupils between the ages of 5 and 12 yr were studied for the relationship between foot breadth and limb dominance. The test of significance and chi-square analysis were used in the calculation. Limb dominance is divided into upper limb dominance (handedness) and lower limb dominance (footedness). No asymetry or difference was found between the right and left foot ( P < 0.69) in terms of foot breadth. A significant correlation between limb dominance and foot breadth was not found ( P < 0.01). An ipsolateral relationship exists between the two forms of limb dominance—92.37% of right handers are right footed while 51.85% of left handers are left footed.

As an offshot of this work an equation for the estimation of a child's age from his foot breadth is given.
Limb Salvage in Infected Lower Extremity Gangrene
Authors: Pinzur Michael S. , Sage Ronald , Abraham Malik , Osterman Helen
Published: March 2013

Four diabetic patients with gangrene of the forefoot and infection ascending above the ankle were treated with open amputation of the foot combined with open fasciotomy and debridement of the involved proximal muscle compartments. All four patients healed their wounds and returned to their premorbid community ambulation status. The management and indications in these unusual patients are discussed.
Use of the Medial Plantar Flap in Soft Tissue Replacement Around the Heel Region
Authors: Leung Professor P. C. , Hung Dr. L. K. , Leung Dr. K. S.
Published: March 2013

Large ulcers around the heel region are common but difficult problems because the usual methods of resurfacing are unsatisfactory. Twelve cases of such ulcers were covered with medial plantar vascular pedicled flaps and the results had been excellent. The operative procedures were simple and the quality of skin supplied was perfect. Different sizes of medial plantar flaps may be used, based on the available branches of the posterior tibial vessels.
Postoperative Pain Relief Using Local Anesthetic Instillation
Authors: Bourne Michael H. , Johnson Kenneth A.
Published: March 2013

Effective pain control following surgery is a concern. Oral narcotic agents may be effective yet have many side effects. Parenteral agents are impractical in outpatient procedures. Local blocks may distort tissue planes and require additional time and technical skill to administer. We have found that instillation of local anesthetic (0.5% bupivacaine [Marcaine, Sensorcaine]) into the wound prior to closure is a safe and effective means of providing significant reduction in postoperative foot pain.
The Influence of Dorsiflexion in the Treatment of Severe Ankle Sprains: An Anatomical Study
Authors: Smith Ronald W. , Reischl Stephen
Published: March 2013

Cadaver studies were performed to examine the applicability of ankle position to the treatment of ruptured fibulo-collateral ligaments. Nonembalmed cadaver specimens were studied with anterior drawer and talar tilt stresses before and after division of the ligaments to simulate the sprained ankle. Dorsiflexion completely reduced the anteriorly subluxed talus and apposed the ends of the anterior talofibular ligament in specimens with divided lateral collateral ligaments. The dorsiflexion angle required to reduce the unstable ankle varied from 5° to 15°. These studies suggest that positioning the ankle in dorsiflexion instead of neutral or plantar flexion may have advantages in promoting a stable ankle if immobilization is chosen for treating a grade III sprain.
Subtalar and Intertarsal Joint Involvement in Hemophilia and Juvenile Chronic Arthritis: Frequency and Diagnostic Significance of Radiographic Abnormalities
Authors: Morgante Daniela , Pathria Mini , Sartoris David J. , Resnick Donald
Published: March 2013

Because radiological distinction between hemophilia and juvenile chronic arthritis can be difficult, the ankle and foot radiographs of patients affected by these two disorders were evaluated to compare the frequency and pattern of joint involvement. No statistical difference was noted between the frequency of posterior subtalar joint involvement in the two disorders, but, in the juvenile chronic arthritis group, more than 90% of the abnormal posterior subtalar joints were associated with intertarsal involvement. This association was never found in patients with hemophilia. Isolated tibiotalar joint involvement without subtalar abnormalities was significantly more frequent in hemophilia than in juvenile chronic arthritis. Although clinical differentiation between the two disorders is easily made, intertarsal joint involvement could be a useful feature in the radiological distinction of hemophilia and juvenile chronic arthritis.
Hemangiosarcoma of the Left Foot and Tibia: Case Report
Authors: Castillo Mauricio , Tehranzadeh Jamshid , Ghandur-Mnaymneh Latifa , Mnaymneh Walid
Published: March 2013

A case of a hemangiosarcoma involving the bones of the foot in a diabetic patient who had swelling of the left foot is reported. Radiographs demonstrated multiple lytic areas throughout the bones of the foot. Clinically and radiographically, infection was suspected, but the biopsy revealed the presence of tumor. Metastases to the tibia were found and an above the knee amputation was performed. Chemotherapy was given, but 6 months later the patient died. Hemangiosarcoma is known to involve the different bones of the foot in a “multicentric” fashion and should be considered in the differential diagnosis of lytic lesions of multiple bones of the lower extremities.
Weightbearing Roentgenograms in Arthritis of the Ankle: A Case Report
Authors: Innis Peter C. , Krackow Kenneth A.
Published: March 2013

In specific situations the nonweightbearing roentgenograms of the ankle do not correlate with clinically suspected ankle malalignment or arthrosis, and weightbearing roentgenograms of the ankle joint can be quite helpful. The nature and severity of ankle arthrosis may not be detected with standard x-rays alone. A case is described in which these views contributed significantly to the clinical treatment of a rheumatoid patient.
Long-Term Follow-up of Syme Amputations for Peripheral Vascular Disease Associated with Diabetes Mellitus
Authors: Jany Richard S. , Burkus J. Kenneth
Published: March 2013

Ten patients underwent Syme amputation for diabetic peripheral vascular disease between 1980 and 1986 and were observed postoperatively for an average of 5 years. Surgical wounds healed in only five of the 10 patients; they were then fitted for a permanent Syme's prosthesis. All failures resulted from the inability to heal the surgical incisions primarily. The clinical records of these patients were retrospectively analyzed for predictors of successful clinical outcome. The ischemic index, grade of the lesion, initial wound treatment, and presence of the infection at the time of amputation were not found to be reliable predictors of a successful level of amputation. Clinical assessment of both the vascular and nutritional status of the patient was necessary to predict a successful result at this level of amputation.