bluuebunny/crossref_metadata_2025 huggingface dataset:
Ingrown Toenail: Results of Surgical Treatment
Authors: Pettine Kenneth A. , Cofield Robert H. , Johnson Kenneth A. , Bussey Randy M.
Published: March 2013

When an ingrown toenail is unresponsive to simple treatment methods, surgical treatment options are available. At our institution, 100 patients with 142 affected toes were surgically treated by one of five techniques and observed for a mean of 9.7 years (range, 7.8 to 10.0 years). Plastic nail wall reduction was effective (four of four nail edges) for mild disease. After marginal nail excision with chemical matrix ablation, the recurrence rate was 20% (12 of 61 nail edges); eight required further surgical treatment. Marginal nail excision combined with surgical excision of the associated nail matrix (Heifetz procedure) was more successful: recurrence occurred in only 6% (6 of 95 nail edges), and only one toe required further surgical treatment. For severe nail deformity, nail ablation with matrix excision (Zadik procedure) was followed by recurrence in 33% (three of nine toes); all three required additional surgical treatment. After terminal amputation (Lapidus/Thompson-Terwilliger procedure), the recurrence rate was 12% (2 of 17 toes); only one nail required additional surgical treatment.
High Resolution Analysis of Ground Foot Reaction Forces
Authors: Rhodes Anthony , Sherk Henry H. , Black Jonathan , Margulies Craig
Published: March 2013

A new system of hardware and software has been designed for quantitative high resolution analysis of ground foot pressures during stance and gait. In the system, a large photoelastic sheet is used as the transducer and a computerized video system for analysis and display. This system offers a larger active surface at higher resolution and at lower cost than any other system heretofore described. It will be used to predict diabetic plantar ulceration as well as to detect anatomic and motor defects affecting the feet.
Pigmented Villonodular Synovitis of the Talus in a Child
Authors: Aghasi Maurice K. , Robinson Dror , Reif Renata M. , Halperin Nachum
Published: March 2013

An unusual case of localized pigmented villonodular synovitis of the ankle joint in a 3-year-old boy is described. The child was brought to the hospital because of abrupt onset of pain and joint effusion. A soft tissue mass eroding the talar dome was seen in roentgenograms. Exact diagnosis was established by excisional biopsy. Curettage of the lesion resulted in healing without recurrence at 10-year follow-up examination.
Long-Term Follow-up of Achilles Tendon Repair with an Absorbable Polymer Carbon Fiber Composite
Authors: Parsons John R. , Weiss Andrew B. , Schenk Richard S. , Alexander Harold , Pavlisko Frank
Published: March 2013

In this cooperative multicenter study for surgical repair of Achilles tendon rupture using a composite implant, 48 patients underwent 52 procedures. This implant is composed of filamentous uniaxially aligned carbon fibers coated with an absorbable polymer. This highly biocompatible implant acts as a scaffold for regrowth of collagenous tissue. The early strength of this repair is provided by the composite implant and by the rapid ingrowth and attachment of new tissue, which allows for an earlier and more vigorous rehabilitation program. Patients with a minimum follow-up of 1 year form the basis of this article. The overall average follow-up is 2.1 years. Three cohort groups were observed on a temporal basis and quantitatively evaluated at 1 year (N = 29), 18 months (N = 22), and 2 years (N = 20), respectively. These three groups demonstrated continuous improvement during the first postoperative year. A high level of function was maintained throughout the second year. Repair of chronic injuries (N = 15) was compared with repair of acute injuries (N = 12) at 1 year following surgery. Both groups greatly improved. However, the acute group had more serious preoperative deficits but improved to a slightly better overall level. Of the patients having at least 1 year follow-up, 86% had a good or excellent result. There was no increased morbidity associated with the use of the carbon implant.
Treatment of Hallux Valgus in Adolescents by the Chevron Osteotomy
Authors: Zimmer Timothy J. , Johnson Kenneth A. , Klassen Rudolph A.
Published: March 2013

Between 1978 and 1984, 20 adolescent patients underwent 35 chevron osteotomies of the first metatarsal for correction of painful hallux valgus. After an average follow-up of 64 months, 85% of the patients expressed overall satisfaction. The cosmetic effect was the most satisfactory result (90%), followed by relief of pain (85%) and lack of limitations in footwear (65%). Radiographic evaluation did not seem to correlate with the final clinical result. The chevron osteotomy is a reasonable operative procedure for correction of hallux valgus in adolescents.
Posterior Tibial Tendon Dysfunction: Its Association with Seronegative Inflammatory Disease
Authors: Myerson Mark , Solomon Gary , Shereff Michael
Published: March 2013

Idiopathic inflammation and rupture of the posterior tibial tendon (PTT) has received much attention in the recent literature. In this report of the presentation of PTT dysfunction as a manifestation of seronegative inflammatory disease, we describe the clinical and laboratory features of 76 patients with inflammation and/or rupture of the PTT. Analysis of all patients identified two discrete groups. Group A patients were younger (mean age 39 years) and had multiple manifestations of inflammation at other sites of ligament and tendon attachments (enthesopathy). Other features of a systemic inflammatory disorder such as oral ulcers, conjunctivitis, colitis, and especially psoriasis were common in the latter patients and their families. Group B consisted predominantly of elderly patients (mean age 64 years) with isolated dysfunction of the PTT. These two groups differed widely in the manner of clinical presentation, demographic data, family history, HLA data, and surgical pathology. These distinctions suggest different pathogeneses for posterior tibial tendinitis. Group A demonstrated local manifestations of a systemic inflammatory disease, whereas group B exhibited the effects of mechanical trauma and degeneration.
Proximal Closing Wedge Osteotomy and Adductor Tenotomy for Treatment of Hallux Valgus
Authors: Resch Sylvia , Stenström Anders , Egund Niels
Published: March 2013

After 2 to 4 years, 25 patients (27 feet) who had a proximal closing wedge osteotomy of the first metatarsal and an adductor tenotomy were reviewed. A total of 20 patients (22 of 27 feet) were completely satisfied; 5 patients not completely satisfied had metatarsalgia because of dorsal displacement of the first metatarsal head. Radiographic measurements showed a narrowing of the forefoot rather than a large change in the intermetatarsal angle. The recovery period was long, an average of 11 weeks. Pin inflammation occurred in 5 patients and incisional neuromas in 2 patients. The risk of these complications must be taken into consideration when using this operation.
Combined Effect of Foot Arch Structure and an Orthotic Device on Stress Fractures
Authors: Simkin Ariel , Leichter Isaac , Giladi Michael , Stein Michael , Milgrom Charles
Published: March 2013

In a prospective study, quantitative measures of the structure of the longitudinal arch of the foot were established and related to the incidence of stress fractures in the bones of the lower limbs of military recruits. In addition, the role of a semirigid orthotic device (Langer military stress orthotic) in preventing stress fractures was evaluated as a function of the structure of the longitudinal arch. Femoral and tibial stress fractures were found to be more prevalent in the presence of feet with high arches, whereas the incidence of metatarsal fractures was higher in feet with low arches. The use of an orthotic device reduced the incidence of femoral stress fractures only in the presence of feet with high arches and the incidence of metatarsal fractures only among feet with low arches. The findings suggest that the normal foot with a low arch acts as a better shock absorber than the normal foot with a high arch, and that an orthotic device may improve the shock absorbing capacity of the arch.
Treatment of High-Pressure Water Gun Injection Injury of the Foot with Adjunctive Hyperbaric Oxygen: A Case Report
Authors: Calhoun Jason H. , Gogan William J. , Viegas Steven F. , Mader John T.
Published: March 2013

High-pressure injection injuries are reported often in the hand and occasionally in the foot. Injection with water and air causes minimal tissue damage but nevertheless requires irrigation, minimal debridement, administration of antibiotics, and concern for development of compartment syndrome. The outcome for patients injected with water and air should be excellent. Adjunctive hyperbaric oxygen causes immediate resolution of subcutaneous emphysema, edema, and pain for more rapid rehabilitation.
Experimental Intra-Articular Calcaneal Fractures: Anatomic Basis for a New Classification
Authors: Carr James B. , Hamilton James J. , Bear Lance S.
Published: March 2013

Experimental calcaneus fractures were produced by axially loading 18 specimens. Anatomic dissections were performed and documented. Two constant primary fracture lines were identified, dividing the calcaneus in the coronal and sagittal planes. A constant anterolateral fragment was identified, as were three patterns of calcaneocuboid joint fracture involvement. Based on the pathoanatomy and surgical anatomy of the calcaneus, a medial and lateral column classification is proposed. The medial column includes the superomedial fragment. The lateral column includes the calcaneocuboid joint, lateral wall and posterior facet. This concept can help identify fracture displacements and correlate them with a treatment plan.
The HPC-Device: A Method to Quantify the Heel Pad Shock Absorbency
Authors: Jørgensen Uffe , Larsen Eilif , Varmarken Jens Erik
Published: March 2013

Previous studies have indicated that the shock absorbency of the heel pad is significant in the pathophysiology of pain conditions connected with heel strike. The purpose of this study was to develop a simple clinically usable method for quantification of the heel pad shock absorbency. The results of our efforts was the HPC-device which consists of a fixing device and a transducer. The HPC-device was found suitable in the evaluation of the heel pad force/deformation characteristics. The reproducibility of heel pad deformation was 0.96. Tests of six cadaver heel pads revealed a high correlation between the HPC result and the shock absorbency found by drop tests. In a normal material (200 heel pads), it was found that the shock absorption decreased with age and that men had significantly higher shock absorbency than women. Men also had significantly thicker heel pads than women. However, there was no linear correlation between the thickness of the heel pad and the shock absorbency, although the thinnest heel pads had the lowest shock absorbency. The HPC-device was found clinically usable and will be used in further testing of the significance of heel pad shock absorption for the development of heel strike dependent over-use injuries.
Assessing Fibular Length Using Bimalleolar Angular Measurements
Authors: Rolfe Bruce , Nordt William , Sallis Julian G. , Distefano Michael
Published: March 2013

Shortening of the fibula after fracture is common and often difficult to appreciate. Loss of lateral malleolar anatomy causes significant biomechanical changes in the ankle and correlates with poor clinical results. We studied angular measurements of distal fibular length to serve as a guide for assessing fibular reduction after ankle fracture. Mortise view X-rays of 50 normal ankles from 25 healthy volunteers were obtained. The average talocrural angle measured 78.5°. However, individual variation was high with values ranging from 75 to 86°. Comparing contralateral ankles demonstrated an average difference of 1.3° (range 0 to 4°). A new, simpler bimalleolar angle was devised which compares the long axis of the fibula with a line drawn between the tips of the malleoli. The average bimalleolar angle measured 77.8° (range 72 to 86°). The contralateral difference averaged 1.2° (range 0 to 3°). This angle was simpler to use and more reproducible. Angular measurements were tolerant of usual radiographic techniques. Internal or external rotation of the ankle up to 5° caused an insignificant change in the angular measurements. One degree change in the talocrural or bimalleolar angle was found to correspond with a 1 mm change in fibular length for the average ankle, calculated radiographically and confirmed in a cadaver study. Abnormal fibular shortening is detected with an angular difference between injured and contralateral sides of 3.0° using the talocrural angle or 2.5° using the bimalleolar angle (95% confidence limits). Thus, a 2.5 to 3.0° contralateral difference should serve as a minimum value required to direct a change in therapy. We conclude that comparing angular measurements of the injured with the contralateral ankle provides the most accurate guide for assessing fibular length.
In Vitro Determination of Midfoot Motion
Authors: Ouzounian Tye J. , Shereff Michael J.
Published: March 2013

Midfoot motion was determined using an in vitro model. Ten fresh-frozen below-the-knee amputation specimens were instrumented by inserting reference pins into each of the bones of the hindfoot, midfoot and metatarsals. Dorsiflexion-plantar flexion and supination-pronation were simulated and the reference pin location in three dimensional space was determined. Comparing the location of the reference pins at each simulated position, motion was determined. Motion occurring through each articulation (dorsiflexion-plantar flexion/supination-pronation) in degrees was: talonavicular (7.0/17.7), calcaneocuboid (2.3/ 7.3), naviculo-medial cuneiform (5.0/7.3), naviculo-middle cuneiform (5.2/3.5), naviculo-lateral cuneiform (2.6/2.1), medial cuneiform-first metatarsal (3.5/1.5), middle cuneiform-second metatarsal (0.6/1.2), lateral cuneiform-third metatarsal (1.6/2.6), cuboid-fourth metatarsal (9.6/11.1), and cuboid-fifth metatarsal (10.2/9.0).
Salvage of Lisfranc's Tarsometatarsal Joint by Arthrodesis
Authors: Sangeorzan Bruce J. , Verth Robert G. , Hansen Sigvard T.
Published: March 2013

Sixteen patients with fractures or fracture-dislocations of the tarsometatarsal (Lisfranc) joint who failed initial treatment were salvaged by arthrodesis using a technique of rigid internal fixation. Preoperative symptoms included local pain in all patients, progressive flatfoot deformity with forefoot abduction in 12 patients, and ankle or lateral impingement pain in five. The technique involved exposing the joint, denuding it of cartilage and scar, and reduction and fixation with lag screws. A total of 49 joints were fused. When significant deformity was present, reduction was performed before arthrodesis. Clinically symptomatic and radiographically proven nonunion occurred in four sites in three patients. One healed after revision. Good to excellent results were obtained in 11 patients (69%). Five patients had a fair or poor results. All but one of the patients were subjectively improved. Four patients were symptom free and returned to their preinjury lifestyles. Accurate reduction and early treatment had a significant positive relationship with outcome. Injuries that occurred in the workplace and those that incurred a long delay until treatment showed a significant negative correlation to outcome. Neither the age of the patient nor the number of joints fused had a significant impact on result
Replacement of the First Metatarsophalangeal Joint with a Silicone Elastomer Ball-Shaped Spacer
Authors: McAuliffe T.B. , Helal B.
Published: March 2013

We report the use of a silicone elastomer ball-shaped spacer for the treatment of hallux valgus and hallux rigidus. One hundred and eleven operations were performed in 77 patients over a 5-year period. The best results were obtained in patients with hallux rigidus. Good results were obtained in hallux valgus, but it was found that in patients with severe preoperative deformity the correction obtained was inadequate, and an additional procedure would be required for full correction. There were no cases of silicone synovitis.
The Effect of Loading on Tibiotalar Alignment in Cadaver Ankles
Authors: Michelson James D. , Clarke Hugh J. , Jinnah Riyaz H.
Published: March 2013

The tibiotalar movements which occur with axial loading, without applied moment forces were studied in cadaver ankles using a minimally constrained testing apparatus. Lateral translation of the talus measured up to 2 mm, which was associated with increased tibiotalar valgus angulation. Neither displacing the distal fibula laterally, nor sectioning the deltoid ligament, significantly influenced the talar shift. The tibiotalar motion which was observed after simple axial loading in a stable configuration (e.g., fibula and deltoid ligament intact) is of the same magnitude that is usually regarded as signifying an unstable ankle fracture. Consequently, this study suggests that the criteria for an unstable ankle fracture may need closer scrutiny.
Rupture of the Flexor Hallucis Longus Tendon: Case Report
Authors: Rasmussen Roar B. , Thyssen Erik P.
Published: March 2013

A case of acute rupture of the flexor hallucis longus tendon is described. This occurrence is rare and has only been reported in connection with other lesions. A gliding tendon is apparently not essential to obtain good functional results in such a case of rupture or laceration.
The Treatment of Spastic Planovalgus Foot Deformity in the Neurologically Impaired Adult
Authors: Young Serena , Ann E. Keenan Mary , R. Stone Lance
Published: March 2013

The surgical correction of 14 feet with spastic planovalgus in the neurologically impaired adult is reviewed. Evaluation of the patterns of lower extremity muscle activity preoperatively by dynamic EMG showed overactivity of the peroneus longus. A new gait pattern which has not been previously reported was observed. This “combination foot” deformity, noted in six patients, consists of equinovarus in swing, and planovalgus in stance during the gait cycle. The remaining eight patients exhibited planovalgus in swing and stance. Transfer of the peroneus longus tendon to either the cuboid or navicular was performed in seven (50%) patients. Release of the peroneus longus was performed in four (29%) patients. Two patients had Z-lengthening of the peroneus longus, and tenodesis of the peroneus longus to posterior tibialis was performed in one patient. The mean postoperative follow-up time was 34.6 months. All feet were plantigrade. Ten (71%) feet were balanced. Four (29%) feet were improved. There were no failures or complications. Thirteen patients were able to ambulate independently after surgery and one patient continued to require only stand-by-assistance secondary to balance problems. No patient decreased in ambulation level. Seven (64%) of the 11 patients who required bracing, preoperatively became brace free. Peroneus longus was found to be the major deforming force in spastic planovalgus. Release, transfer, or tenodesis of the peroneus longus is effective in correcting planovalgus.
Irreducible Dorsal Dislocation of the Interphalangeal Joint of the Great Toe: Report of Two Cases
Authors: Yasuda Tadashi , Fujio Keiji , Tamura Kiyoshi
Published: March 2013

In this paper, we report two cases of dislocation of the hallux interphalangeal joint with interposition of the plantar plate including the sesamoid bone. These dislocations were treated with open reduction: one through lateral approach and the other through plantar approach. Plantar approach afforded repair of the plantar plate with preservation of the sesamoid bone and satisfactory result.
Compartment Syndromes of the Foot: Current Concepts
Authors: Manoli Arthur
Published: March 2013

The foot has been mentioned as a site for the development of a compartment syndrome for approximately 9 years. Despite this, very little information exists in the literature containing specifics on the nature of the disorder.

Very recent work has shown that crush injuries, forefoot and midfoot fractures and dislocations, and calcaneal fractures are prone to the development of foot compartment syndromes (FCS). The classical clinical signs of pain with passive stretch of the involved muscles, and dysfunction of the nerves that pass through the involved compartments are less helpful in the diagnosis of the syndrome in the foot than elsewhere. Tense swelling of the foot may be of some help in arousing suspicion that a FCS has developed, but the diagnosis is best made by invasive catherization of the foot compartments. Since recent work has discovered that at least nine foot compartments exist, multi-stick catherization is recommended. Fasciotomy should be performed when the pressures are significantly elevated, to prevent the development of late contractures.

A communication exists between a newly-found compartment of the foot, the calcaneal compartment, and the deep posterior compartment of the leg. A combined pattern of FCS and deep posterior compartment syndromes of the leg exists, and should be remembered by the clinician treating injuries of the foot or leg. Also, a foot injury alone may cause a deep posterior compartment syndrome in the leg. Claw-toe deformity seems to be the primary late sequela of FCS. Local procedures may be of only temporary benefit.
Fibular Mobility in Chronic Lateral Instability of the Ankle
Authors: Löfvenberg Richard , Kärrholm Johan , Selvik Göran
Published: March 2013

Using roentgen stereophotogrammetric analysis we recorded the mobility of the lateral malleolus under maximum passive plantarflexion and dorsiflexion and during the anterior drawer and the adduction tests in 29 patients with chronic lateral instability of the ankle. Medial and anterior displacements were observed during plantarflexion, at the adduction test and at the posterior loading of the tibia. At dorsiflexion we recorded posterior fibular shifts. The simultaneously occuring fibular rotations were small. Chronic lateral instability of the ankle was associated with slightly increased fibular movements during plantarflexion and dorsiflexion, and at the adduction test in some patients with bilateral symptoms, perhaps reflecting a generalized joint laxity.
A Biomechanical In Vitro Comparison of Open Versus Percutaneous Repair of Tendon Achilles
Authors: Hockenbury R. Todd , Johns James C.
Published: March 2013

A study was undertaken to compare the in vitro strengths of percutaneous Achilles tendon repair to open Achilles tendon repair. Ten fresh frozen cadaver below-the-knee specimens underwent Achilles tenotomy. The specimens were divided into two groups of five specimens each. Group I specimens underwent open Achilles repair using a Bunnell suture technique. Group II specimens underwent percutaneous repair. Each specimen was placed on an apparatus which produced progressive ankle dorsiflexion. Measurements of anastomotic gap were correlated with angle of dorsiflexion. Group I anastomoses were able to resist almost twice the amount of ankle dorsiflexion compared to Group II anastomoses ( P <. 05). Entrapment of the sural nerve occurred in three out of five specimens in Group II. Percutaneous anastomoses were malaligned in four out of five specimens. Based on this study, percutaneous repair of Achilles tendon ruptures provides approximately 50% of the initial strength afforded by open repair. Percutaneous repair places the sural nerve at risk for injury.
Deep Peroneal Nerve Entrapment on the Dorsum of the Foot
Authors: Dellon A. Lee
Published: March 2013

The anatomic site of entrapment of the deep peroneal nerve's sensory branch over the dorsum of the foot is described. The clinical syndrome in 20 patients is reported. An operative approach to release the entrapment is illustrated. The results in twenty nerves in eighteen patients followed a mean of 25.9 months after surgery is excellent in 60%, good in 20%, and not improved in 20%.
Free Tissue Transfer and Calcanectomy as Treatment of Chronic Osteomyelitis of the Os Calcis: A Case Report
Authors: Anderson Robert B. , Foster Mark D. , Gould John S. , Hanel Douglas P.
Published: March 2013

Chronic osteomyelitis of the os calcis presents a formidable management dilemma. Successful treatment requires aggressive surgical debridement of devitalized bone and soft tissue and appropriate antibiotic therapy. Difficulties arise, however, when radical debridement results in significant loss of weight-bearing bone. Recalcitrant osteomyelitis of the os calcis or major loss of bone secondary to debridement has been treated by amputation. Advances in microsurgical reconstruction now provide the opportunity for limb salvage in this situation.
The Keller Resection Arthroplasty: A 13-year Experience
Authors: Vallier Garry T. , Petersen Steve A. , LaGrone Michael O.
Published: March 2013

The clinical results following Keller resection arthroplasty were reviewed in 54 feet with a 2- to 10-year follow-up. Patients were evaluated by radiographs, physical examination, and questionnaire. The primary indication for surgery was painful hallux valgus with associated degenerative changes of the first metatarsophalangeal joint. Additionally, rheumatoid arthritis was the underlying diagnosis in four feet. Seventy-five percent of all patients had complete relief of their symptoms. There was significant ( P < .01) improvement in both the metatarsophalangeal and intermetatarsal angles, but a decreased range of motion in the first metatarsophalangeal joint, with a complete lack of plantarflexion in 67%. Application of the Bonney and MacNab 2 grading system yielded a 72% rate of good and excellent results. The subjective patient satisfaction rate was 87.5%. Patient satisfaction was most strongly associated with the use of a K-wire for postoperative fixation ( P = .03), and a limited resection of the proximal phalanx ( P = .03). We conclude that the Keller resection arthroplasty is a reasonable alternative for the treatment of hallux valgus in the presence of degenerative changes in the first metatarsophalangeal joint.
Treatment of Bunionette Deformity with Longitudinal Diaphyseal Osteotomy with Distal Soft Tissue Repair
Authors: Coughlin Michael J.
Published: March 2013

Twenty patients (30 feet) with symptomatic bunionettes refractory to conservative care underwent longitudinal diaphyseal osteotomy, lateral condylectomy, and distal metatarsophalangeal realignment. At an average of 31 months followup, 93% (28 feet) noted good or excellent results. This technique was found to be useful and predictable in correcting the bunionette deformity.
The Stability of Fixation of First Metatarsal Osteotomies
Authors: Shereff Michael J. , Sobel Mark A. , Kummer Frederick J.
Published: March 2013

Five different types of osteotomies for the correction of the hallux valgus deformity were performed on dried human first metatarsal bones. These included the step-cut Mitchell osteotomy, a distal transverse osteotomy, a distal biplanar osteotomy, the Chevron osteotomy, and a basilar osteotomy. Each type of procedure was then fixed using a variety of clinically appropriate techniques including single K-wires, crossed K-wires, a single A-0 cancellous screw, a single A-0 cortical screw, and three different types of sutures. Specimens were placed in a test jig and physiological loads applied with a Materials Testing Systems servohydraulic testing machine (Minneapolis, Minnesota). No difference in stability was observed between the various types of osteotomies, except for the Chevron osteotomy, which did possess greater inherent stability. Fixation by screws or multiple K-wires provided the most stable configuration when compared to other methods. The postoperative regimen following first metatarsal osteotomy should take into account the relative stability of fixation. Cast immobilization and a nonweight-bearing status may be preferable after procedures characterized by less mechanical stability.
The Use of Open Phenol Blocks to the Motor Branches of the Tibial Nerve in Adult Acquired Spasticity
Authors: Moore Thomas J. , Anderson Robert B.
Published: March 2013

Spasticity of the posterior calf muscles often occurs following head injury or spinal cord injury. If left untreated, equinovarus contractures of the foot and ankle may occur in a relatively short time period. This paper retrospectively reviews nine patients with either closed head injury (six patients) or spinal cord injury (three patients) who underwent open phenol injections into the motor branches of the tibial nerve in 16 limbs. Spasticity was decreased in all patients. No significant equinus contractures had occurred at final follow-up. Five of the patients were subsequently able to ambulate. One patient had recurrence of spasticity requiring a second surgical procedure (split anterior tibial tendon transfer), and two patients had significant toe clawing at final follow-up. Open phenol injections to the motor branches of the tibial nerve safely and effectively prevent foot and ankle contractures following spinal cord injury or head injury.
First Metatarsophalangeal Joint Reaction Forces during High-Heel Gait
Authors: McBride Ian D. , Wyss Urs P. , Cooke T.D.V. , Murphy Laura , Phillips Julie , Olney Sandra J.
Published: March 2013

First metatarsophalangeal (MTP) joint reaction forces were calculated for 11 normal females during the toe-off phase of gait while walking in bare feet and in high heeled shoes. A biomechanical model was used to calculate the forces utilizing kinematic, kinetic, footprint, and radiographic data. The results showed that the MTP joint reaction forces (FJ), the metatarsal-sesamoid forces (FS), and the resultant of these forces (FRES), were twice as large in high heels compared to barefoot walking. The average peak forces for barefoot and high-heeled gait were FJ: 0.8 and 1.58 times body weight, FS: 0.44 and 1.03 times body weight, and FRES: 0.93 and 1.88 times body weight. Also, the kinematics changed when wearing high heels, making angles of application of forces and sesamoidal articulations less favorable.
Magnetic Resonance Imaging of the Foot and Ankle: Correlation of Normal Anatomy with Pathologic Conditions
Authors: Ferkel Richard D. , Flannigan Bonnie D. , Elkins Brad S.
Published: March 2013

Abnormalities of the foot and ankle can be difficult to diagnose by conventional examination and x-rays. Recently, magnetic resonance imaging (MRI) has emerged as a diagnostic tool for soft tissue and bony imaging. One hundred and ten normal feet and ankles were studied to define normal MRI anatomy. An additional 150 MRI scans were performed to diagnose and characterize various abnormal conditions. MRI demonstrated excellent definition of normal structures and pathologic entities. Surgical correlation with the MRI was done in 42 patients. MRI appears to be a useful examination for patients with certain soft tissue and bony abnormalities. A special oblique view also has been developed to assist in the diagnosis of injuries to the tibialis posterior, flexor hallucis longus, and flexor digitorum longus tendons.
Primary Lymphoma of the Bones of the Foot: Management of Two Cases
Authors: Singh Deepinder Pal , Dhillon Mandeep Singh , Sur Ranjan Kumar , Sharma Suresh Chander , Radotra Bishan D.
Published: March 2013

Non-Hodgkin's lymphoma rarely presents with an osseous lesion in the foot. Two cases of primary lymphoma of the foot are reported. The patients presented with a history of pain and swelling of the foot. Radiographs revealed a lytic lesion in the calcaneus of one patient, and in the second metatarsal of the other. Open biopsy revealed high grade lymphoblastic non-Hodgkin's lymphoma of the diffuse variety. The patients were treated with localized radiation therapy and have been disease free for more than a year.
Biomechanical Evaluation of the Anterior Drawer Test: The Contribution of the Lateral Ankle Ligaments
Authors: Bulucu Can , Thomas Kevin A. , Halvorson Thomas L. , Cook Stephen D.
Published: March 2013

The contributions of the lateral ankle ligaments to resisting anterior-posterior displacement of the talus were evaluated in eight unembalmed cadaveric ankles. While holding the distal tibia fixed, loads of 150 N were applied to the talus in the anterior and posterior directions in the neutral, dorsiflexed, and plantarflexed positions using an hydraulic test system. Tests were performed on the intact specimens then after sequential sectioning of the lateral ligaments of the ankle. Under strictly anteroposterior loading and without an axial (weight-bearing) load applied, no single ligament could be isolated as having a dominant stabilizing function.
Localized Nodular Synovitis of the Ankle: A Case Report
Authors: Green Andrew , Sutherland William , Trafton Peter G.
Published: March 2013

Localized nodular synovitis of the ankle in a 52-year-old male was treated with excision. Extensive articular destruction of the talar dome was noted. The diagnosis was confirmed by histology. A report of a similar lesion was not found.
Recurrent Dislocation of the Peroneal Longus Tendon as a Complication of Multiple Osteochondromatosis
Authors: Mizuno Kosaku , Ozaki Takuma , Yamada Masahiro , Hirohata Kazushi
Published: March 2013

This is a report of recurrent dislocation of the peroneal tendon in a patient with multiple osteochondromatosis. The distorted anatomy at the ankle from the osteochondromas was the source of the tendon's recurrent dislocations. There were two areas in the ankle in which the retinacula supporting the tendons failed because of the osteochondromas. At the lateral site of fibula, the origin of the supporting retinacula was attenuated by the presence of an osteochondromas. At the medial site of fibula, a large osteochondroma distorted and widened the tibiofibular joint. The widening of the distal tibiofibular joint by this osteochondromas also attenuated the retinacula of the peroneal tendons, permitting their dislocation.
Dysplasia Epiphysealis Hemimelica (Trevor Disease) Presenting as Peroneal Spastic Flatfoot Deformity: A Case Report
Authors: Graves Stanley C. , Kuester David J. , Richardson E. Greer
Published: March 2013

Trevor disease (dysplasia epiphysealis hemimelica) involving the foot and ankle is not uncommon, but its presentation as a progressive spastic flatfoot deformity is unusual. The patient reported had an isolated lesion in the medial facet of the subtalar joint. In addition to the unusual presentation and location, the lesion recurred 1 year after surgical excision.
Human Achilles Tendon: Morphological and Morphometric Variations as a Function of Age
Authors: Strocchi Rita , De Pasquale Viviana , Guizzardi Stefano , Govoni Paolo , Facchini Alberto , Raspanti Mario , Girolami Mauro , Giannini Sandro
Published: March 2013

Aging of human Achilles tendon results in changes in both cellular and fibrous components. Cells flatten and become less numerous. Their thin and long cytoplasmatic projections tend to shorten and diminish in number. Tendon fibers lose their typical undulating appearance and become quite straight. Collagen fibril diameter, small and uniform in the neonatal period, becomes large and extremely variable from adolescence onwards. Age related morphometric changes include a decrease in the average, maximum diameter and density of collagen fibrils and an increase of fibril concentration. In our opinion these morphological and morphometric variations are strictly related to functional requirements.
Congenital Dysplasia of the Heel Fat Pad: A Case Report of a Previously Undescribed Entity
Authors: Porat S. , Wexler M.R.
Published: March 2013

We describe a 13-year-old girl who was born with a congenital anomaly of her left heel fat pad. We call this anomaly congenital dysplasia of the heel pad, due to under development of all elements of the heel fat pad. In the case presented the vertical fibrous septa were missing and the amount of fat and its distribution were abnormal. As a result, the abnormal biomechanical shock absorber mechanism caused a painful callosity formation. A surgical procedure aiming to produce adhesions between the fat pad and the calcaneous in order to decrease the shear of the heel pad was only partially successful. Different types of orthotic devices did not resolve the clinical problem of the painful heel. Such a congenital anomaly has never been described in the English literature, and we coined the term congenital dysplasia for the previously undescribed entity.
Triple Arthrodesis in Adults
Authors: Bennett Gordon L. , Graham Charles E. , Mauldin Donald M.
Published: March 2013

Twenty-two adult patients who underwent a triple arthrodesis because of hindfoot pain and/or deformity were reviewed retrospectively with a minimum 3-year follow-up. All procedures were performed by the same surgeon using a two-incision technique and internal fixation. Objective results were good in eight (36%) patients, fair in 13 (59%), and poor in one (5%). There were two asymptomatic nonunions of the talonavicular joint, no infections, and no neuromas. Eleven patients had radiographic evidence of tibiotalar arthritis, and eleven patients had midfoot arthritic changes that had progressed after the operation. Patient satisfaction with the procedure was high, and 21 of 22 (95%) patients felt that they were improved overall and would have the surgery again if indicated. Although the procedure is technically demanding, patient satisfaction is high and complications can be kept to a minimum if proper surgical technique is utilized.
Results of Arthrodesis of the Tarsus: Talocalcaneal, Midtarsal, and Subtalar Joints
Authors: Scranton Pierce E.
Published: March 2013

A 10-year prospective study was carried out on arthrodesis surgery of the major tarsal joints of the foot. The guiding principle of the study was that foot symmetry would be preserved, except where both feet were deformed. Correction in the frontal, coronal, and sagittal planes would be used to restore normal talocalcaneal relationships. In patients with normal relationships, triple, subtalar (talocalcaneal), and isolated tarsal arthrodesis would be carried out by iliac-crest-inlay grafting to preserve tarsal relationships.

In 41 patients, 47 arthrodeses were carried out. There were 31 triple arthrodeses, 10 talocalcaneal fusions, four talonavicular fusions, and two naviculocuneiform fusions. In patients with deformity, significant improvement in the angles of anteroposterior talocalcaneal divergence and lateral talocalcaneal convergence was recorded. There were 27 good results, 15 fair results, and five poor results. Supplementary bone grafting and the use of internal fixation improved the rate of arthrodesis.
Longitudinal Splitting of the Peroneus Brevis Tendon: An Anatomic and Histologic Study of Cadaveric Material
Authors: Sobel Mark , DiCarlo Edward F. , Bohne Walther H.O. , Collins Leslie
Published: March 2013

Gross and microscopic examinations of 21 split and 10 intact cadaveric peroneus brevis tendons were performed in an effort to determine the pathogenesis of longitudinal splitting of this tendon. The split regions were centered over the posterior margin of the distal fibula and were characterized by splaying of the collagen bundles with accompanying proliferation of blood vessels and fibrovascular connective tissue. Inflammatory infiltrates were not present. Regions of the tendons that were not altered had normal cellularity and orientation of the collagen. The findings of this study suggest that the splitting of the tendon develops through a mechanical mechanism.
The Arterial Supply of the Sesamoid Bones of the Hallux: The Course and Source of the Nutrient Arteries as an Anatomical Basis for Surgical Approaches to the Great Toe
Authors: Pretterklieber Michael L. , Wanivenhaus Axel
Published: March 2013

The arterial supply of the hallux sesamoids was studied in 29 human feet by anatomical dissection. Eight of them underwent radiographic analysis prior to dissection. The sesamoid arteries branch off from the digital plantar arteries of the hallux, which, in turn, are derived from the medial plantar artery and the plantar arch (type A), the plantar arch (type B), or the medial plantar artery (type C). The respective frequencies of types A, B, and C were 52%, 24%, and 24%. The number of sesamoid arteries varied from one (55%) to three (10%) and the number increased with the size of the sesamoid bones. Anatomical knowledge of the course and distribution of these vessels may be of great help to the orthopedist in the understanding of the pathogenesis of avascular necrosis and may provide insight into several technical aspects regarding surgery of the hallux.
Fracture of the Calcaneus: An Unusual Fracture Pattern with Subtalar Joint Interposition of the Flexor Hallucis Longus. A Report of Two Cases
Authors: Romash Michael M.
Published: March 2013

Two closed calcaneal fractures with interposition of the flexor hallucis longus tendon in the subtalar joint are reported. The radiographic findings of dissociation of the superior medial fragment of the posterior facet from the sustentaculum talus are presented. The rationale for surgical treatment is discussed.
The Significance of Pes Planus in Juvenile Hallux Valgus
Authors: Kilmartin Timothy E. , Wallace W. Angus
Published: March 2013

Pes planus of the foot is believed to be an important etiological factor in hallux valgus. This study compares the degree of pes planus in normal and hallux valgus feet. The arch index, or ratio of the area of the middle third of the foot to the total footprint area, was calculated on 128 footprints. An unpaired t-test determined no significant difference between the arch index of 32 11-year-old children with hallux valgus and 11-year-olds with no first metatarsophalangeal joint deformity ( P >.05). The height of the arch is not relevant to the hallux valgus deformity. Arch supports designed to raise the height of the arch can play only a palliative role in the management of the condition.
Magnetic Resonance Imaging Evaluation of Calcaneal Fat Pads in Patients with Os Calcis Fractures
Authors: Levy Andrew S. , Berkowitz Richard , Franklin Peter , Corbett Michael , Whitelaw George P.
Published: March 2013

Destruction of the calcaneal fat pad has been implicated as a source of chronic pain following fractures of the os calcis. Several investigators postulate that the initial trauma that produces a calcaneal fracture also results in destruction of the U-shaped fibrous septa that maintain the piston-like organization of the fat columns. Fibrosis and loss of the protective cushioning provided by the fat pad may eventually occur. The authors report on the largest series of magnetic resonance images of the calcaneal fat pad in the heels of patients with calcaneal fractures. A prospective consecutive study utilizing magnetic resonance imaging was performed on 22 heels with calcaneal fractures. Ten contralateral heels without calcaneal fracture and the heels of five normal subjects were scanned as controls. No signal changes suggestive of increased fat pad edema, fibrosis, or fatty release were detected. In addition, the vertical septa were well visualized and found to be intact in all cases. The height of the fat pad was measured, with no changes noted as compared with the contralateral heel. In those patients with acute fractures, signal changes suggestive of hematoma were well visualized in the soft tissue surrounding the calcaneus. In two of these cases, there was extension beneath the plantar fascia, but no penetration into the fat columns. Magnetic resonance imaging allows excellent detailed visualization of the calcaneal fat pad and surrounding structures. No evidence is found to support the hypothesis that marked damage to the gross structure of the fat pad occurs at the time of injury. Furthermore, no data were found to support the suggestion that changes in the fat pad structure contribute to the chronic pain often associated with calcaneal fractures.
Management of Acquired Adult Dropfoot
Authors: Jaivin Jonathan S. , Bishop John O. , Braly W. Grant , Tullos Hugh S.
Published: March 2013

Dropfoot is a catchall term for ankle equinus, equinovarus, and equinovalgus. The deformity can be flexible or rigid and may be associated with other pathology. In the adult, dropfoot may be congenital or acquired. Acquired dropfoot results from weakness of the ankle dorsiflexors, overpull of the plantarflexors, contracture of the soft tissues, bony deformity, or any combination of these factors. Appropriate treatment includes observation, orthotic devices, bracing, tendon transfers, arthrodesis, and neurolysis. The purpose of this paper is to review the pathophysiology and treatment of acquired dropfoot.
The Intraosseous Blood Supply of the Fifth Metatarsal: Implications for Proximal Fracture Healing
Authors: Smith Judith W. , Arnoczky Steven P. , Hersh Alexander
Published: March 2013

Fractures of the proximal fifth metatarsal can be divided into two distinct groups based on anatomical location and clinical course. Fractures of the tuberosity often heal well with nonoperative treatment, whereas fractures occurring in the proximal diaphysis (up to 1.5 cm distal to the tuberosity) have significantly increased risk for delayed union or nonunion. It is the purpose of this paper to describe the intraosseous vascular anatomy of the fifth metatarsal, and the clinical implications for basilar fracture healing.

Ten fresh-frozen amputation or cadaver specimens were studied following arterial injection with India ink or barium sulfate suspension. The intraosseous blood supply to the fifth metatarsal tuberosity arose from numerous metaphyseal vessels penetrating the nonarticular surfaces of the tuberosity in a random, radiate pattern. The blood supply to the proximal diaphysis was derived primarily from the nutrient artery, which gave rise to longitudinal intramedullary branches. The arterial supply to the tuberosity joined the supply of the proximal diaphysis in the area just distal to the tuberosity, corresponding to the region of poor prognosis for fracture healing. This suggests that a relative lack of blood supply following a proximal diaphyseal fracture may contribute to delayed union and nonunion.
An Anatomic Basis for Recurrence after Morton's Neuroma Excision
Authors: Amis James A. , Siverhus Scott W. , Liwnicz Boleslaw H.
Published: March 2013

Dissections of the common digital nerve and its branches were performed in the second and third web spaces in five fresh-frozen cadaveric feet. Plantarly directed nerve tetherings, which were histologically demonstrated to be nerve branches, were consistently present along the course of each common digital nerve. These plantarly directed nerve branches were found in highest concentration in the distal aspect of the common digital nerve proximal to the bifurcation into the proper digital branches. The presence of these nerve branches may contribute to the high incidence of Morton's neuroma recurrence either due to traumatic neuroma formation in the branches or to failure of proximal retraction of the more distally resected nerve stump.