bluuebunny/crossref_metadata_2025 huggingface dataset:
Effects of Exercise on Achilles Tendon Healing in a Rat Model
Authors: Murrell George A.C. , Jang Daniel , Deng Xiang-Hua , Hannafin Jo A. , Warren Russell F.
Published: March 2013

The effects of motion, or lack of it, on Achilles tendon healing are not well defined. We have recently shown that immobilization has a detrimental effect on tendon healing in a rat model. The aim of this experiment was to determine whether enforced exercise had an additional beneficial effect on the mechanical and functional recovery of divided Achilles tendons in rats. Male Sprague-Dawley rats were randomly allocated into a nonexercise and an exercise group (N = 10 for each group). In both groups the right Achilles tendon was surgically transected. The left, uninjured lower limb served as an internal control. Both groups of animals were housed under identical conditions with the exception that the exercise group swam for 15 minutes per day. Functional performance was determined from the measurement of hindpaw prints of walking rats preoperatively and on alternate postoperative days. On day 15, the animals were killed and weighed, and biomechanical evaluations were performed on both the injured and uninjured Achilles tendon constructs. There were no differences in weight at time of death. All animals had an initial functional deficit that returned to near-normal by day 15. There were significant differences in the morphological and the mechanical properties of the healing Achilles tendon constructs at day 15 when comparing the injured with the uninjured Achilles tendon constructs. Supplemental exercise, however, had no effect on the functional or mechanical recovery of injured or uninjured Achilles tendons in the rat model.
Healing Times of Diabetic Ulcers in the Presence of Fixed Deformities of the Foot Using Total Contact Casting
Authors: Sinacore David Ft.
Published: March 2013

In a diabetic foot, ulcers can lead directly to the loss of a limb, and they may be life threatening if the patient is not provided effective intervention directed at healing. This study reports on the healing times of diabetic neuropathic plantar ulcers in the presence of fixed deformities of the foot using the ambulatory method of total contact casting (TCC). In this study, 21 subjects with chronic diabetes mellitus, plantar ulcers, and fixed deformities of the foot were put in casts, and their progress was followed until the ulcers were completely healed. Results indicated that all of the ulcers healed. The average time to healing was 67 ± 29 days. Ulcers located in the forefoot, midfoot, and rearfoot healed in an average of 35 ± 12 days, 73 ± 28 days, and 90 ± 12 days, respectively. The location of the ulcer and the presence and location of a fixed deformity of the foot strongly correlated with and was predictive of healing time using TCC. The location of the ulcers and the location of the fixed deformities of the foot should always be considered by providers of rehabilitation who treat diabetic neuropathic foot ulcers using TCC.
Posterior Tibial Tendon Tears in Young Competitive Athletes: Two Case Reports
Authors: Porter David A. , Baxter Donald E. , Clanton Thomas O. , Klootwyk Thomas E.
Published: March 2013

Unlike the Achilles tendon, the posterior tibial tendon does not typically undergo acute rupture. We report two cases of posterior tibial tendon tears occurring in young, athletic individuals (<30 years old) that required operative intervention before the patients could return to competitive sports. We believe that these are the first two reports of posterior tibial tendon tears occurring in this population without the patient having a prior history of steroid injections in the tendon. The tears we observed and described at surgical exploration were chronic and degenerative in nature. We also comment on our approach to treatment of posterior tibial tendon injuries in the athletic population.
Reliability of F-Scan In-Shoe Measurements of Plantar Pressure
Authors: Ahroni Jessie H. , Boyko Edward J. , Forsberg Ruby
Published: March 2013

Research by our group and others indicates that many amputations of the lower limb occur after foot ulceration in patients with diabetes. It has been proposed that diabetic foot ulcers are mainly caused by repetitive trauma in areas of high plantar pressure during walking. Recent technology permits in-shoe measurement of plantar pressure. We assessed the reliability of the F-Scan in-shoe system for measurement of plantar pressure (Tekscan Inc., Boston, MA) in 51 subjects from a cohort of 977 diabetic veterans enrolled in a prospective study of risk factors for foot ulceration and amputation (the Seattle Diabetic Foot Study). Subjects were tested twice, wearing their own shoes. We used the coefficient of variation (CV) and the intraclass correlation coefficient (ICC) to estimate the reliability of F-Scan measurements of pressure. Peak pressure over the metatarsal heads proved to have the best indices of reliability, with CVs of 0.150 and 0.155, and ICCs of 0.755 and 0.751. Coefficients of variation for the heel, whole foot, and hallux ranged from 0.148 to 0.240, with ICCs ranging from 0.493 to 0.832. By published standards, peak pressures over the metatarsal heads and right hallux met the criteria for excellent reliability. Our ICCs for high pressures under the foot, heel, metatarsal heads, and hallux, and for peak pressures under the heel and left hallux represented fair-to-good reliability. No F-Scan plantar measurements could be judged by these criteria as having poor reliability. This clinical study found that for elderly patients with diabetes who were wearing their own shoes and were tested on two different days with different insoles, the F-Scan insole system was generally reliable for measurements of high pressure and peak pressure.
Effect of Varying Arch Height with and Without the Plantar Fascia on the Mechanical Properties of the Foot
Authors: Arangio George A. , Chen Chaorong , Salathé Eric P.
Published: March 2013

A biomechanical model was used to calculate the mechanical properties of the foot at a load of 683 newtons, while changing arch height with and without the plantar fascia. An increase in arch height from 20 mm to 60 mm decreased predicted vertical displacement of the foot from 11.8 mm to 5.5 mm with the plantar fascia intact and from 13.5 mm to 7.5 mm without the plantar fascia. The amount of horizontal elongation decreased from 8.6 mm to 8.4 mm with the plantar fascia and increased from 9.8 mm to 11.7 mm without. A 60-mm arch height yielded a 40% increase in horizontal elongation and a 36% increase in vertical displacement when the plantar fascia was cut, whereas a 20-mm arch height yielded a 13% increase in horizontal elongation and a 14% increase in vertical displacement. A change in arch height from 20 mm to 60 mm increased stiffness of the foot with and without the plantar fascia.
How to Reduce the Cost of Hindfoot Fusion
Authors: Luber Martin J. , Nunley James A.
Published: March 2013

The purpose of this study was to determine whether modification of a surgical practice by using regional anesthesia and local bone grafting would yield the same surgical results as traditional anesthesia and iliac crest bone graft, with a cost reduction. All patients were matched by preoperative disease and were assessed to determine satisfaction and complications. The length of stay for the seven matched pairs of patients undergoing subtalar arthrodesis decreased significantly, as did blood loss, total operating room time, and tourniquet time. The average cost saving was $7844. Similar data were found for the nine matched pairs of patients who underwent triple arthrodesis, blood loss, and tourniquet time. Total cost was again found to be significantly lower by an average of $9302 in the study group. The most dramatic changes between the two groups were demonstrated in the patients who underwent ankle fusions. The 10 matched pairs showed a marked reduction in length of stay, with a decrease in estimated blood loss from 260 mL to 92 mL ( P < 0.05). The total operating room time and tourniquet time in these two groups were similar. There was a cost savings in the study group of $9888, with no increase in complications. The use of longacting regional anesthesia and local bone grafting enabled surgeons to perform hindfoot arthrodeses on an outpatient basis, with a significant reduction in cost to the patient and no increase in complications.
Effects of Tarsal Tunnel Release and Stabilization Procedures on Tibial Nerve Tension in a Surgically Created Pes Planus Foot
Authors: Lau Johnny T.C. , Daniels Tim R.
Published: March 2013

An in vitro study was performed on 11 cadaver legs to study the effects of tarsal tunnel release, distraction calcaneocuboid arthrodesis, and triple arthrodesis on tibial nerve tension in surgically created pes planus feet. Baseline tibial nerve tension was measured during maximal dorsiflexion, eversion, combined dorsiflexion-eversion, and cyclical load with varying degrees of internal rotation. These measurements were repeated on the same leg after each surgical procedure. This study demonstrated that a tarsal tunnel release significantly increased nerve tension during eversion, dorsiflexion-eversion, and cyclical load compared with the pes planus foot. Both triple arthrodesis and distraction calcaneocuboid arthrodesis were effective at decreasing tibial nerve tension; the former was more effective than the latter. Procedures producing skeletal instability, such as ligament release producing a pes planus deformity and a tarsal tunnel release, increased tibial nerve tension. Procedures that corrected deformity and increased stability decreased tibial nerve tension. If increased tibial nerve tension plays a role in the pathophysiology of tarsal tunnel syndrome, then this needs to be considered for treatment of patients with this syndrome.
Dislocation of Posterior Tibial Tendon
Authors: Loncarich David P. , Clapper Mark
Published: March 2013

Dislocation of the posterior tibial tendon has been reported rarely in the English literature. We report a case of traumatic dislocation of the posterior tibial tendon. The diagnosis was delayed for months and was ultimately made by magnetic resonance imaging, which accurately determined the location of the tendon. At the time of surgical exploration, no predisposing anatomic abnormalities were noted. A new pseudoretinaculum had developed that prevented recurrent subluxation or dislocation. Surgical relocation of the tendon and repair of the retinaculum resulted in a good outcome.
Fibromatosis of the Plantar Fascia: Diagnosis and Indications For Surgical Treatment
Authors: Dürr Hans R. , Krödel Andreas , Trouillier Hans , Lienemann Andreas , Refior Hans J.
Published: March 2013

Plantar fibromatosis is a rare, benign lesion involving the plantar aponeurosis. Eleven patients (13 feet) underwent 24 operations, including local excision, wide excision, or complete plantar fasciectomy. Clinical results were evaluated retrospectively. There were no differences among the subgroups in postoperative complications. Two primary fasciectomies did not recur. Three of six revised fasciectomies, seven of nine wide excisions, and six of seven local excisions recurred. Our results indicate that recurrence of plantar fibromatosis after surgical resection can be reduced by aggressive initial surgical resection.
Clinical Significance of Increased Mobility in the Sagittal Plane in Patients with Hallux Valgus
Authors: Ito Hiromu , Shimizu Akira , Miyamoto Toshihiro , Katsura Yoshiaki , Tanaka Kenji
Published: March 2013

Hallux valgus (HV) deformity is not always accompanied by pain. We compared roentgenograms of 32 feet of people with HV deformity and pain to roentgenograms of 22 feet of people with painless HV deformity. Twenty-three feet without HV deformity or pain were used as controls. Weightbearing and nonweightbearing roentgenograms of the lateral talar-first metatarsal angle showed a statistically significant difference between feet with deformity and pain compared with feet with painless HV, or compared with normal feet. Changes in the angles of HV between weightbearing and nonweightbearing situations showed significant differences between HV feet and normal feet, whether or not they had pain. In HV patients, increased mobility in the sagittal plane may play a considerable role in the development of pain.
Open Reduction and Internal Fixation of Fracture of the Posterior Process of the Talus: A Case Report and Review of the Literature
Authors: Nadim Yasser , Tosic Aleksandar , Ebraheim Nabil
Published: March 2013

A fracture of the posterior process of the talus is rare. In this report, we present a case of isolated displaced fracture of the posterior process of the talus, which was treated by early open reduction and internal fixation through a posteromedial approach. The fracture healed without evidence of avascular necrosis of either the posterior fragment or the talar body. The purpose of this article is to highlight the importance of early postoperative management of this uncommon type of fracture.
Biomechanical Consequences of Plantar Fascial Release or Rupture During Gait Part II: Alterations in Forefoot Loading
Authors: Sharkey Neil A. , Donahue Seth W. , Ferris Linda
Published: March 2013

With a model using feet from cadavers, we tested the hypothesis that plantar fascial release or rupture alters the loading environment of the forefoot during the latter half of the stance phase of gait. The model simulated the position and loading environment of the foot at two instants: early in terminal stance immediately after heel-off and late in terminal stance just preceding contralateral heel strike. Eight feet were loaded at both positions by simulated plantar flexor contraction, and the distribution of plantar pressure was measured before and after progressive release of the plantar fascia. Strain in the diaphysis of the second metatarsal was also measured, from which the bending moments and axial force imposed on the metatarsal were calculated. Cutting the medial half of the central plantar fascial band significantly increased peak pressure under the metatarsal heads but had little effect on pressures in other regions of the forefoot or on second metatarsal strain and loading. Dividing the entire central band or completely releasing the plantar fascia from the calcaneus had a much greater effect and caused significant shifts in plantar pressure and force from the toes to beneath the metatarsal heads. These shifts were accompanied by significantly increased strain and bending in the second metatarsal. Complete fasciotomy increased the magnitude of strain in the dorsal aspect of the second metatarsal by more than 80%, suggesting that plantar fascial release or rupture accelerates the accumulation of fatigue damage in these bones. Altered forefoot loading may be a potential complication of plantar fasciotomy.
Radiographic Evaluation of the Calcaneocuboid Joint: A Cadaver Study
Authors: Ebraheim Nabil A. , Haman Steve P. , Lu Jike , Padanilam Thomas G.
Published: March 2013

Eighteen cadaver feet were used for radiographic evaluation of the calcaneocuboid joint. The articular surface of the cuboid on all specimens was painted with a ra-diopaque material. Fractures and 1-mm step-off of the fractures were simulated in six specimens. The articular surface line and joint space could be visualized maximally on an oblique radiograph without overlapping structures. The oblique view is good for assessing the extent of the minor fracture-displacement, which is normally obscured by overlapping projections in dorsoplan-tar and lateral radiographs. If there is any doubt on the routine radiographs or any injury involving the calcaneocuboid joint, an oblique view of the foot should be performed. The early diagnosis and treatment of calcaneocuboid joint injuries may minimize development of posttraumatic degenerative arthritis.
Tarsal Tunnel Syndrome: A Review of the Literature
Authors: Lau John T.C. , Daniels Tim R.
Published: March 2013

Tarsal tunnel syndrome is an uncommon clinical entity. This article will review the published reports on tarsal tunnel syndrome with respect to its anatomy, cause, pathophysiology, clinical presentation, diagnosis, treatment, and results of treatment in an attempt to improve understanding of this problem.
Functional Properties of Adhesive Ankle Taping: Neuromuscular and Mechanical Effects Before and After Exercise
Authors: Alt Wilfried , Lohrer Heinz , Gollhofer Albert
Published: March 2013

The purpose of the study was to investigate effects of adhesive ankle taping. Using electromyographic, gonio-metric, and thermologic methods, different ankle tapes were tested before and after athletic exercise in simulated inversion trauma. Twelve subjects with stable ankle joints performed five trials: with two different materials, with two taping techniques, and one trial without tape as control. After the simulated inversion trauma, approximately 35% of the initial maximum inversion amplitude was decreased by ankle taping. Depending on the technique, there was a loss of tape stability £14% after 30 min of athletic exercise. Thermologic analysis revealed a postexercise 6°C temperature increase in the foot, especially under the tape.

Initially, interpreted as the primary effect, the improved joint stabilization is based on mechanical stiffness caused by the adhesive tape. Joint stability was influenced positively by neuromuscular proprioceptive and physiological processes, characterized by relatively increased electromyographic activation.
Clinical Evaluation of the Modified Brostrom-Evans Procedure to Restore Ankle Stability
Authors: Girard Pierre , Anderson Robert B. , Davis W. Hodges , Isear Jerome A. , Kiebzak Gary M.
Published: March 2013

The modified Brostrom procedure has become the standard for anatomic repair of symptomatic chronic lateral instability. However, it was our perception that this local tissue repair may fail eventually, particularly in patients that are overweight, hyperflexible, or are involved in strenuous work or athletic activity. This is a retrospective review of 21 lateral ankle reconstructions (20 patients) in which the modified Brostrom technique was augmented with a portion of the peroneus brevis tendon.

All patients were interviewed at an average of 29.5 months (range, 14–56 months postsurgery). Fourteen patients also agreed to be evaluated by a physical therapist. No surgical complications were identified. American Orthopaedic Foot and Ankle Society ankle-hindfoot scores averaged 98.2. There was no significant difference in passive or active range of motion of plantarflex-ion or dorsiflexion when compared to the contralateral ankle. However, a statistically significant loss of inversion (passive, P = 0.011; active, P = 0.018) and eversion (passive, P = 0.004; active, P = 0.007) was noted when compared to the contralateral ankle. Measurement of isometric eversion strength, using a Cybex 340 Isoki-netic device, and functional testing, using a lateral lunge test, revealed no significant loss of peroneal strength.

The authors conclude that chronic lateral ankle instability in the general population can be successfully managed with a modified Brostrom procedure augmented with a portion of the peroneus brevis. The procedure remains technically simple and provides a greater static restraint for inversion stress without evidence of dramatic overtightening or loss of peroneal strength.
Posterior Calcaneal Osteotomy with Wedge: Cadaver Testing of a New Procedure for Insufficiency of the Posterior Tibial Tendon
Authors: Deland Jonathan T. , Page Alexandra E. , Kenneally Sharon M.
Published: March 2013

Insufficiency of the posterior tibial tendon is challenging to treat. When the deformity is flexible, treatment options have included tendon transfer, often combined with a medial slide calcaneal osteotomy and/or a lengthening of the lateral column. Posterior calcaneal osteotomy has been shown to give correction, although not full correction. Lengthening of the lateral column also has been shown to give correction and has been used in the more severe flexible deformities, but it involves either fusion of the calcaneocuboid joint or risk of arthritis at this joint.

An osteotomy combining the calcaneal medial slide with a lengthening of the lateral column at the same osteotomy site has been tested in the laboratory. This combined osteotomy provides a lengthening of the lateral column, but it is positioned away from the calcaneocuboid joint. In this study, the osteotomy was compared with a medial slide calcaneal osteotomy and an Evans lengthening of the lateral column, using a cadaver flatfoot model. Radiographic measurements were made to evaluate correction of the planovalgus deformity after each of these procedures. There was statistically significant improved correction with the new osteotomy compared with that in a standard medial slide, and correction was comparable to that in the lengthening of the lateral column. This combined osteotomy may be a reasonable alternative when more correction is desired than can be obtained from a medial slide alone and when the surgeon wishes to avoid an osteotomy near the calcaneocuboid joint.
The Efficacy of Using Search Engines in Procuring Information About Orthopaedic Foot and Ankle Problems from the World Wide Web
Authors: Nogler Michael , Wimmer Cornelius , Mayr Eckart , Öfner Dietmar
Published: March 2013

This study has attempted to demonstrate the feasibility of obtaining information specific to foot and ankle orthopaedics from the World Wide Web (WWW). Six search engines (Lycos, AltaVista, Infoseek, Excite, Webcrawler, and HotBot) were used in scanning the Web for the following key words: “cavus foot,” “diabetic foot,” “hallux valgus,” and “pes equinovarus.” Matches were classified by language, provider, type, and relevance to medical professionals or to patients. Sixty percent (407 sites) of the visited websites contained information intended for use by physicians and other medical professionals; 30% (206 sites) were related to patient information; 10% of the sites were not easily classifiable. Forty-one percent (169 sites) of the websites were commercially oriented homepages that included advertisements.
Avulsion Fracture of the Great Toe: A Case Report
Authors: Rapoff Andrew J. , Heiner John P.
Published: March 2013

A case involving an isolated bony avulsion fracture of the extensor insertion on the distal phalanx of the great toe is described. The fracture was displaced 2 mm with 30° dorsal angulation; the joint was congruent and not subluxed. The patient was treated nonsurgically with a rigid-soled sandal. Bony healing at the fracture site was clearly evident at 16 weeks postinjury. The patient began using a normal shoe at 10 weeks and resumed his running activities without pain at 16 weeks. The nonsurgical treatment of this injury, similar to that of a mallet finger, was successful.
Triple Arthrodesis in Adults Using Rigid Internal Fixation: An Assessment of Outcome
Authors: Bednarz Paul A. , Monroe Michael T. , Manoli Arthur
Published: March 2013

The intermediate outcome of patients who underwent a triple arthrodesis for the treatment of adult foot disorders was evaluated with an outcome tool to determine if their pain and functional status were improved. We evaluated 63 feet in 57 patients who underwent a triple arthrodesis using rigid internal fixation for the treatment of hindfoot deformities associated with symptomatic arthrosis. Twenty-four men and thirty-three women, with an average age of 54 years, were evaluated. The average follow-up was 30 months. Multiple diagnoses contributed to hindfoot deformities with secondary arthrosis. Iliac crest bone graft was used in 56 of 63 cases (89%). Percutaneous heel cord lengthening was done in 53 of 63 cases (84%). Twenty-four of the thirty patients (80%) returned to work. Twenty-five patients were retired and two were unemployed before surgery. All patients except two (97%) were satisfied with the surgery and would have the surgery again. The average American Orthopaedic Foot and Ankle Society Ankle-Hindfoot preoperative score was 28 points, and the average postoperative score was 81 points ( P < 0.0001). In the radiographic measurements, there was an average improvement of 12° in the lateral talometatarsal angle, 7° in the lateral talocalcaneal angle, and 10° in the AP talometatarsal angle ( P < 0.0001). Complications experienced included two varus malunions, two valgus malunions, two nonunions, two deep vein thromboses, one distal fibula stress fracture, and one wound infection. Of the 26 feet in 22 patients with mortise views available, 10 feet (38%) had evidence of ankle arthrosis and 19 feet (73%) had some degree of talar tilt postoperatively.
Plantar Fascia Release Through a Transverse Plantar Incision
Authors: Brown Jeremy N. , Roberts Simon , Taylor Mark , Paterson Roger S.
Published: March 2013

A transverse plantar incision for plantar fascial release was assessed for pain relief, numbness, and subsequent heel pad symptoms. Twenty-seven feet in 26 patients who underwent plantar fascia release were reviewed with a minimum follow-up of 2 years after surgery (average, 37.6 months). Comprehensive data were obtained on 25 feet (24 patients) (93% response rate). The plantar fascia origin was completely transected in all cases. This led to complete resolution of symptoms in 19 feet and residual minor symptoms in six feet. After 2 years, four patients had developed recurrent symptoms, two in the area of surgery and two on the dorsum of the foot, in association with a pes planus foot. Two patients had some continued persistence of heel pain after surgery, although significantly less pain than preoperatively. Thus, 76% of patients had complete relieve of there symptoms, 12% of patients had mild symptoms not affecting daily activities, and 12% of patients had moderate symptoms that limited some activities. No patient suffered heel pad symptoms or numbness after surgery.

It is concluded that plantar fascia release through a transverse plantar incision is a successful procedure for long-term relief of symptoms which avoids unnecessary heel pad numbness and scar morbidity. The benefits of a transverse incision include greater intraoperative vision, to ensure adequate release and spur excision, and an incision parallel to the medial calcaneal branches of the tibial nerve.
Salvage of Tibial Pilon Fractures Using Fusion of the Ankle with a 90° Cannulated Blade-Plate: A Preliminary Report
Authors: Morgan Steven J. , Thordarson David B. , Shepherd Lane E.
Published: March 2013

Six patients with ankle joint destruction and delayed metaphyseal union after tibial plafond fracture were surgically treated with tibiotalar arthrodesis and metaphyseal reconstruction, using a fixed-angle cannulated blade-plate. The procedure was performed through a posterior approach in five cases and a lateral approach in one case. The subtalar joint was preserved in all cases. Metaphyseal union and a stable arthrodesis were obtained in all cases without loss of fixation and with no mechanical failure of the blade-plate. Union was obtained in an average of 26 weeks. No secondary procedures were required to obtain union. All six patients were ambulatory at last follow-up. Stable internal fixation for simultaneous tibiotalar fusion and metaphyseal reconstruction can be achieved with a cannulated blade-plate while preserving the subtalar joint in complex plafond fractures.
External Rotation-Lateral View of the Ankle in the Assessment of the Posterior Malleolus
Authors: Ebraheim Nabil A. , Mekhail Anis O. , Haman Steve P.
Published: March 2013

Demonstration of a posterior malleolar fragment on a radiograph of an ankle fracture is important in the diagnosis and evaluation of posterior malleolus fractures. The size and extent of displacement of a posterior malleolar fragment can be evaluated. The diagnosis of nonunion of the posterior malleolus is also important because it can lead to failure of reduction of ankle fractures. The authors present a case in which nonunion of the posterior malleolus was diagnosed by an external-rotation lateral view of the ankle. This could not be demonstrated on the AP or the lateral views. Thirteen cadaver feet were then used to study the external-rotation lateral view. A posterior malleolar fracture was created, and the borders of the fracture line were marked with solder wire. The average external rotation angle required to best demonstrate the posterior malleolar fracture was 50° (range, 43°–55°). The actual size of the posterior malleolus fragment was measured and compared to the x-ray measurement. There was a 0.10 correction for the determination of the actual size of the fragment. The unmarked fragment could not be demonstrated on AP and lateral views.
Osteoid Osteoma of the Lateral Talar Process Presenting as a Chronic Sprained Ankle
Authors: Monroe Michael T. , Manoli Arthur
Published: March 2013

Pathologic conditions of the lateral talar process may be difficult to diagnose using physical examination and roentgenographs. A computed tomography scan of the hindfoot is often useful to define lesions of the lateral process. We report a case of osteoid osteoma of the lateral talar process that defied diagnosis for 4 years. The patient had an antecedent history of an inversion injury, which had been treated as a chronically painful sprained ankle without resolution of symptoms. The tumor was ultimately identified on a computed tomography scan, best seen on a coronal section through the talus. The patient had complete relief of pain after excisional biopsy of the tumor.
Synovial Osteochondromatosis of the Retrocalcaneal Bursa: A Case Study
Authors: Giordano Vincenzo , Giordano Marcos , Knackfuss Irocy G. , Giordano José
Published: March 2013

A 42-year-old man presented with synovial osteochondromatosis (SO) of the retrocalcaneal bursa with intraosseous lesions in the calcaneum, leading to significant pain and consequent disability. Simple x-rays, computed tomography, and magnetic resonance imaging were performed preoperatively. The patient has remained asymptomatic, clinically and radiographically, without recurrent lesions for 18 months postoperatively.
Pigmented Villonodular Synovitis of the Foot and Ankle: A Report of Eight Cases
Authors: Rochwerger Alexandre , Groulier Pierre , Curvale Georges , Launay Franck
Published: March 2013

Eight cases of pigmented villonodular synovitis of the foot and ankle are reported. The purpose of this study was to analyze the manifestation of pigmented villonodular synovitis in the foot and to evaluate treatment options. There were four cases in the ankle and hindfoot, one in the first tarsometatarsal joint, and three in the toes. In seven of eight cases, diagnosis was confirmed by magnetic resonance imaging (MRI) scans. The tenosynovial form was found in the toes and the articular form in the hindfoot and ankle. Surgical treatment was performed in all cases: one arthroscopically assisted synovectomy in the ankle joint, two talocrural arthrodeses, one subtalar arthrodesis, one tarsometatarsal arthrodesis, and tumor removal on the toes with arthrodesis of the distal interphalangeal (DIP) joint in two cases. Average follow-up was 4 years. Recurrence occurred in one toe and led to partial amputation. Malunion in one ankle arthrodesis was operated on again with no sign of recurrence. In the toes, the lesion had a tumoral feature; the bone was infiltrated by soft tissue, and the surgical procedure was local removal of the tumor. In the hindfoot, the lesions were intra-articular and required synovectomy, usually with an arthrodesis. In the midfoot, there was a large extraosseous tumor surrounding tendons with destructive articular lesions.
Intercuneiform Instability and the “Gap” Sign
Authors: Davies Mark S. , Saxby Terence S.
Published: March 2013

We describe three cases of low-energy injuries to the midfoot resulting in rupture of Lisfranc's ligament without tarsometatarsal injury. Examination of the feet revealed an obvious physical sign only on weightbearing, and all three patients were noted at surgery to have intercuneiform instability in association with a rupture of Lisfranc's ligament.
Hindfoot Alignment of Hallux Valgus Evaluated by a Weightbearing Subtalar X-Ray View
Authors: Tanaka Yasuhito , Takakura Yoshinori , Fujii Tadashi , Kumai Tsukasa , Sugimoto Kazuya
Published: March 2013

A new radiographic view was proposed to evaluate alignment of the hindfoot under weightbearing condition. The ankle joint and the middle and posterior facets of the subtalar joint were clearly visualized in all radiographs.

A comparative study was made of 104 feet with hallux valgus in 58 female patients and 67 normal feet in 57 normal female subjects (control group). The mean value of the angle between the axis of the tibia and a line on the surface of the ankle joint on the talus was significantly larger in the group with hallux valgus than in the control group. Likewise, the mean value of the angle between the axis of the tibia and a line on the surface of the posterior facet of the subtalar joint on the calcaneus in the group with hallux valgus was 95.3°, significantly larger than the 87.9° in the control group. These findings showed that the ankle joint and the posterior facet of the subtalar joint in hallux valgus have valgus deviation. The hindfoot in a foot with hallux valgus has a tendency toward pronation. No previous study has measured the inclination of the posterior facet of the subtalar joint directly in weightbearing.
Comparison of the Reliability of Plantar Pressure Measurements Using the Two-step and Midgait Methods of Data Collection
Authors: Bryant Alan , Singer Kevin , Tinley Paul
Published: March 2013

The reliability of plantar pressure measurements obtained using the traditional midgait method compared with the two-step method was investigated. Using an EMED-SF system, the parameters of contact area, contact time, maximum force, and peak pressure at seven sites of the foot were assessed for reliability of measurement in 10 normal subjects. The results of the study indicate that the two-step method is as reliable as the midgait method and may be preferred for use in both research and clinical settings.
Guidelines for Diabetic Foot Care
Authors: Pinzur Michael S. , Slovenkai Mark P. , Trepman Elly
Published: March 2013

Foot infection is the most common reason for hospital admission of patients with diabetes in the United States. Foot ulceration leads to deep infection, sepsis, and lower extremity amputation. Prophylactic foot care has been shown to decrease patient morbidity, decrease the utilization of expensive resources, and decrease the risk for amputation and premature death. The Diabetes Committee of the American Orthopaedic Foot and Ankle Society has developed guidelines for implementing this type of prophylactic foot care.

The guidelines are arranged as follows:

Screening for Patients Who Are at Risk for Developing Diabetic Foot Complications Risk Factors Components of Screening and Examination Patient Education Basic Treatment Guidelines Risk Categories Nail Care Ulcer Care Referral Guidelines Vascular Surgery Consultation Orthopaedic Consultation Endocrinologist/Diabetologist Consultation Infectious Disease Consultation Radiologic Consultation Pedorthic Consultation Resources
Effect of Foot and Ankle Position on Tarsal Tunnel Compartment Pressure
Authors: Trepman Elly , Kadel Nancy J. , Chisholm Kathleen , Razzano Lynn
Published: March 2013

Tarsal tunnel intracompartment pressures were determined in 10 fresh-frozen normal human adult cadaver specimens. With the foot and ankle held in mild plantarflexion and neutral eversion-inversion, mean tarsal tunnel pressure was minimal (2 ± 1 mmHg). However, when the foot and ankle were positioned in full eversion, mean tarsal tunnel pressure increased to 32 ± 5 mmHg ( P ≤ 0.005); in full inversion, mean pressure increased to 17 ± 5 mmHg ( P ≤ 0.05). There was no significant difference in mean tarsal tunnel pressure between the everted and inverted positions. These results support the hypothesis that increased pressure within the tarsal tunnel when the foot is moved into the everted or inverted position may aggravate posterior tibial nerve entrapment. These findings may also provide an explanation for clinically observed aggravation of symptoms in these positions, night pain, and improvement of symptoms with neutral immobilization in some patients with tarsal tunnel syndrome.
Pseudoaneurysm of the Lateral Malleolar Artery After an Ankle Sprain: Case Report and Review of the Literature
Authors: Marks Richard M. , Stroud C. Christopher , Walsh Daniel
Published: March 2013

A pseudoaneurysm of the peroneal artery or one of its branches is rare after trauma. The diagnosis is frequently delayed, resulting in substantial morbidity to the patient. The infrequent occurrence of this condition has resulted in a lack of diagnostic and treatment guidelines. However, when recognized, prompt attention involving either surgical ligation or embolization of the injured arterial branch is the most reliable method of treatment. Presented is a report of a patient who developed a lateral malleolar arterial pseudoaneurysm after an ankle sprain, which was treated successfully with aneurysmal excision and surgical ligation of the injured arterial branch. A review of the literature and treatment recommendations follow.
Osteochondral Lesions of the Talus: A Revised Classification
Authors: Hepple Stephen , Winson Ian G. , Glew David
Published: March 2013

Osteochondral lesions of the talus present a numerically small but therapeutically significant problem to the foot surgeon. The diagnosis and investigation of such lesions have been greatly enhanced by modern high resolution magnetic resonance imaging capabilities, which have provided far greater detail of the pathological anatomy. We have reviewed our experience in this area and suggest a revised classification for osteochondral lesions appropriate to the detail available on magnetic resonance imaging scans. The cause of osteochondral lesions is also discussed.
Medial Arch Strain After Lateral Column Lengthening: An In Vitro Study
Authors: Otis James C. , Deland Jonathan T. , Kenneally Sharon
Published: March 2013

Posterior tibial tendon dysfunction with concomitant progressive flatfoot deformity is associated with ligamentous failure along the medial arch. Lateral column lengthening is being used alone and in combination with other procedures with the expectation that it contributes to restoring and maintaining the arch. The primary objective of this study was to examine the effect of lateral column lengthening on medial arch strain. A secondary objective was to examine the effect of subtalar, talonavicular, double and triple fusions on medial arch strain. Whole cadaver feet were subjected to vertical loads while in a plantigrade position. Spring ligament length was monitored using liquid metal displacement gauges. Two outcomes were examined: the length of the ligament and the change in length of the ligament per unit of applied load. Ligament length was unchanged after lateral column lengthening. Ligament length was decreased after talonavicular, double and triple arthrodeses, consistent with the ligament being protected by these fusions. The change in length per unit of applied load after simulated lateral column lengthening was comparable to that for the intact foot, which is consistent with the ligament remaining functional during weightbearing and not being overloaded.
Cost Inflation and Price Inflation
Authors: Correa Romar
Published: March 2013

The distinction between costs and prices aggregates into the conflict between wages and profits in a macro-accounting framework. We exploit the Godley and Lavoie (2007) framework to derive a dynamical system in the variables. Deflation in at least one price is both necessary and sufficient for stability of the system.
National and Global Aspects of India’s Textiles and Apparel Industry and Trade: An Overview
Authors: Kar Mausumi
Published: March 2013

The elimination of Multi-Fibre Arrangement (MFA) quotas is expected to create a new environment for world trade in textiles and apparel by vastly increasing the scope for developing countries to expand their exports and thereby creating employment in this sector. As a natural consequence, a study of the true competitiveness of the exportables of the textile and apparel items of India in the international market becomes essential in order to make an informed projection for Indian exports vis-à-vis others beyond 2005. We discuss the national or domestic aspects of the textile and clothing industry of India with special emphasis on the domestic policies affecting the structural and performance indicators of the firms in this industry. Further, we offer measures of competition among firms in an industry, such as the indicators of industrial structure and performance. It seems that the level of industrial concentration in the textile sector has gone up in the post-MFA regime.
Green Branding and Eco-innovations for Evolving a Sustainable Green Marketing Strategy
Authors: Sarkar A.N.
Published: March 2013

Green marketing is a new and evolving concept of marketing green and eco-products with well-defined eco-standards—consisting of wide-ranging eco-friendly products, satisfying eco-labelling and eco-footprinting standard norms. The article focuses on the significance of green branding and eco-labelling with stress on eco-innovations with a view to developing a sound and sustainable green marketing strategy. The article examines how green consumerism can be linked to eco-market and to what extent this can be influenced by cross-cultural differences in consumer behaviour. The scope of involving green marketing with corporate ethics and corporate social responsibility (CSR) for inclusive growth of green markets has been explored. The article also examines how the green branding can leverage the eco-market through the mechanism of eco-labelling and eco-footprinting, complimented by green supply chain management practices. Finally, the article studies, at some length, the desirability of considering the aspects of sustainability factor and eco-innovations which can help promote green consumerism.
A Study on Gender Differences in Stress Faced by Life Insurance Marketing Employees
Authors: Radhakrishnan R. , P. Jins Joy.
Published: March 2013

Stress is a universal element in work and all human beings have to face stress in all walks of life. Currently, business establishments are critically analysing the stress management disputes that contribute to lower job performance of employees originating from dissatisfaction and high turnover, ultimately affecting organisational goals and objectives. In life insurance business, the employees involved in the selling of life insurance policies may face several stresses due to varied reasons. This can be grouped under five heads: superior’s behaviour, personal grumbles, job-specific factors, work policy of the company and external forces. Put together, 46 sub-variables are considered as responsible stress factors in the case of life insurance marketing employees. This study consists of 100 employees working in private life insurance companies in mid-western part of Tamil Nadu. A detailed structured questionnaire has been used for collecting data from the respondents. The questionnaire was pre-tested and consists of two parts: the first part focuses on the collection of socio-economic background, and the second part collects data for various sources of stress. Simple random sampling method has been adopted and data collected from the respondents are properly analysed with the help of simple percentage analysis, mean and standard deviation. Gender difference with regard to various sources of stress factors could be tested by using t-test analysis. This study concluded that there is a similarity in the stress level between male and female employees.
Factors Influencing FDI Inflow to India, China and Malaysia: An Empirical Analysis
Authors: Panigrahi T.R. , Panda B.D.
Published: March 2013

This article attempts to find out the factors which are significantly related and influence the FDI inflow into China, India and Malaysia during the study period ranging between 1991 and 2010. The objective of FDI is almost the same, but the factors that influence foreign investors when deciding the location of investment are receiving importance and attention. Correlation has been used to study the factors influencing FDI inflow. The study revealed that India and China are very similar, whereas in Malaysia the same factors do not influence inflow of foreign investment to the country. GDP of the country, gross capital formation, capital infrastructure, external debt, export and import volume are the major factors that significantly influence foreign capital inflow into the two highly populated, fast growing Asian countries, that is, China and India. In the case of Malaysia, only domestic investment or gross domestic capital formation is significantly related to its FDI inflow.
Global Financial Crisis and Stock Market Integration: A Study on the Impact of Global Financial Crisis on the Level of Financial Integration between the US and Indian Stock Markets
Authors: Gangadharan Srinivasa Rao , Yoonus C.A.
Published: March 2013

This article, using the daily returns of the indices of US (S&P 500) and the Indian stock markets (CNX S&P Nifty), examines the impact of the global financial crisis on the level of financial integration between the US and Indian stock markets from March 2005 to November 2010. The article also analyses the existence of cointegration and dynamic relationship between the two indices during the pre-crisis, crisis and post-crisis periods, and in the last five years, using the Johansen Cointegration analysis and the Vector Auto Regression (VAR) Model. The article finds no cointegration between the two indices in all the four periods. The returns from the Indian stock market with reference to the previous day’s return of the US stock market show a lot of feedback effect from the US to India, whereas the returns from the US stock market show no significant reaction. However, in terms of its own past, there is a strong negative reaction due to the overreaction or mean reversion of the stock market during the post-crisis period.
Financial Inclusion: A Saga of Indian Financial System
Authors: Dangi Vandana
Published: March 2013

Financial inclusion means improving access to financial services for poor people through the safe and sound spread of new approaches based on principles. The present article attempts to explore the diffusion of financial inclusion in the Indian financial system. Financial access with market size and depth in India is compared with select Asian peer group and Organisation for Economic Co-operation and Development (OECD) countries. The article also explores competition scenarios among scheduled commercial banks operating in India. The results of entropy, exponential index, Herfindahl index, Gini coefficient and concentration coefficient of 76 scheduled commercial banks operating in India indicate a fair degree of competition and concentration among themselves. Improved regulations, innovation, growth and value creation in the sector make it a highly competitive sector. But this sector is dominated by public sector banks, followed by private sector banks. This study identifies lessons learnt from nine principles of innovative financial inclusion (namely, leadership, diversity, knowledge, empowerment, protection, proportionality, innovation, cooperation and framework) that were applied in providing financial services to vulnerable groups in India. The results show that commercial banks, cooperative banks, regional rural banks and microfinance programmes have been playing a vital role in removing financial exclusion in India. Financial inclusion in the Indian financial system is through the larger number of banks, competition and good governance, with diversified ownership.