bluuebunny/crossref_metadata_2025 huggingface dataset:
Minocycline-Induced Lupus
Authors: Farver Debra K
Published: January 2017

OBJECTIVE:

To report a case of drug-induced lupus occurring 5 months after the initiation of minocycline therapy for acne.

DATA SOURCE:

Case report information was obtained from the physician, patient's family, and the medical record. MEDLINE and Index Medicus were searched to obtain relevant published literature from 1966 to 1996.

CASE SUMMARY:

A 14-year-old white girl developed symptoms of myalgias, arthralgias, polyarthritis, and flushed face. The antinuclear antibody test was positive. Minocycline was discontinued and the patient's condition dramatically improved within 7 days.

CONCLUSIONS:

Healthcare providers should recognize early common and unusual symptoms of minocycline-induced lupus in adolescents being treated for acne.
Topiramate: A New Antiepileptic Drug
Authors: Privitera Michael D
Published: January 2017

OBJECTIVE:

To review proposed mechanisms of action, clinical pharmacology, efficacy, safety, and tolerability of the antiepileptic drug (AED) topiramate.

METHODS:

All available data from the clinical development program — Published and unpublished data (provided by investigators or the RW Johnson Pharmaceutical Research Institute) — Were analyzed, with emphasis on the results of double-blind, placebo-controlled trials. Data from open-label studies provided information about long-term efficacy and tolerability.

FINDINGS:

Topiramate is highly effective in the control of previously therapy-resistant partial seizures, with or without secondary generalization. In the refractory adult patient population enrolled in controlled clinical trials, seizures were reduced by 50% or more in 27–47% of patients compared with 0–18% in placebo-treated patients and by 75% or more in 9–36% of the patients compared with 0–9% of those receiving placebo. The most common adverse effects involve the central nervous system and are mild to moderate in nature. Adverse effects include somnolence, fatigue, psychomotor slowing, and concentration problems. The currently recommended dosing is lower and titration slower than schedules used in the clinical trials; this may improve the tolerability of topiramate. Topiramate has few interactions with currently available AEDs, but phenytoin concentrations increased in some patients. Topiramate can be used initially as adjunctive therapy. Plasma topiramate concentrations are reduced substantially when used with enzyme-inducing AEDs. Open-label data and a single double-blind trial suggest that topiramate monotherapy may be effective. Open-label data also indicate that topiramate may be effective in generalized seizures of nonfocal origin, including those associated with Lennox-Gastaut syndrome.

CONCLUSIONS:

The robust clinical effects of topiramate expand the therapeutic options for patients with epilepsy. Controlled clinical trials are needed to verify initial observations that topiramate may be effective against a broad spectrum of seizure types and to directly compare efficacy and tolerability with other new and standard AEDs.
Advanced HIV Infection Treated with Zidovudine Monotherapy: Lifetime Values of Absolute Cost—Effectiveness as a Pharmacoeconomic Reference for Future Studies Evaluating Antiretroviral Combination Treatments
Authors: Messori Andrea , Becagli Paola , Berto Valeria , Trippoli Sabrina , Font Maria , Tosolini Francesca , Venturini Francesca , Martini Nello ,   The Osservatorio SIFO sui Farmaci
Published: January 2017

OBJECTIVE:

This study was undertaken to evaluate the cost and the effectiveness of zidovudine monotherapy in patients with advanced HIV infection and to derive preliminary data on the cost—effectiveness of the triple treatment with saquinavir plus zalcitabine plus zidovudine compared with zidovudine alone.

DESIGN:

We used a combined method of survival analysis utilizing both the quality-adjusted time without symptoms or toxicity (Q-TWIST) method and the Gompertz approach. This combined method was applied to assess the absolute cost-effectiveness and cost—utility ratios of zidovudine monotherapy and to perform a preliminary incremental cost—effectiveness comparison of saquinavir plus zalcitabine plus zidovudine versus zidovudine alone. The clinical material used in our study was derived from two reports on the treatment of advanced HIV infection. Data of lifetime costs of HIV infection were obtained from published information.

RESULTS:

In patients with advanced HIV infection treated with zidovudine monotherapy, lifetime survival was 252.1 discounted person-years per 100 patients. Using an average lifetime cost of $93 000 (discounted) per individual, the absolute ratio of cost—effectiveness for zidovudine monotherapy was $36 980 per life-year, while the absolute cost—utility ratio was $47 112 per quality-adjusted life-year. In the comparative analysis of saquinavir plus zalcitabine plus zidovudine versus zidovudine alone, our calculations showed that the administration of the triple treatment can have an “average” cost—effectiveness, provided that mean lifetime survival per patient (discounted) is improved to at least 3.68 years (with an average survival gain of at least 14 mo per patient).

CONCLUSIONS:

The values of absolute cost—effectiveness and cost—utility ratios for zidovudine monotherapy are a useful reference point for further pharmacoeconomic studies in the area of antiretroviral drugs.
Interdigital Neuroma: Intermuscular Neuroma Transposition Compared with Resection
Authors: Colgrove Robert C. , Huang Emily Y. , Barth Alan H. , Greene Marie A.
Published: January 2017

This prospective, randomized study compares the treatment of an interdigital neuroma (IDN) by the standard resection operation with a technique in which the IDN is transposed into the inter-muscular space between the adductor hallucis and the interossei muscles after division of the digital nerves distal to the IDN. The resection group contained 22 patients and 22 neuromas and the transposition group contained 22 patients and 23 neuromas. An interviewer, blinded as to the operative technique used, telephoned each patient preoperatively, and at 1 month, 3 months, 6 months, 12 months, and 36–48 months postoperatively. The interviewer recorded the patient's reported pain level on a numerical rating scale of 0 to 100. In the resection group the average pain level was slightly lower through the first 6 month period, but at the 12 month review the resection group had a slightly higher average pain level. At the 36–48 month survey the resection group again reported a greater average pain level and fewer asymptomatic patients.

It was concluded that it is unnecessary to excise the IDN to obtain excellent relief of pain. It was also concluded that transposition of the IDN into an intermuscular position between the adductor hallucis and the interossei muscles produced significantly better long term results than did the standard resection operation.
Endoscopic Plantar Fasciotomy for Chronic Heel Pain
Authors: O'Malley Martin J. , Page Alexandra , Cook Ruth
Published: January 2017

The purpose of our study was to determine whether endoscopic plantar fasciotomy is a safe and effective operation in this patient population. We reviewed our surgical results following endoscopic plantar fasciotomy in sixteen patients (twenty feet) with an average preoperative duration of symptoms of four years. Of the 20 feet, 9 had complete relief of pain while symptoms were improved in nine feet. One patient with bilateral symptoms had no relief in either foot. The average AOFAS hindfoot score improved from 62 to 80, a statistically significant difference. Unilateral patients did better than bilateral with no bilateral patients reporting complete resolution of symptoms. There were no iatrogenic nerve injuries. On the basis of our review, we recommend endoscopic plantar fasciotomy as an alternative to open plantar fascial release for those patients with recalcitrant heel pain.
Extending the Indications for Distal Chevron Osteotomy
Authors: Sanhudo José Antônio Veiga
Published: January 2017

Distal chevron osteotomy is a widely employed procedure for correction of mild to moderate hallux valgus. The author has modified the angle of the osteotomy to provide even greater stability and allow larger displacements of the distal fragment. This modification allows the correction of a greater degree of hallux valgus than originally described for the technique. This modification is relatively simple and increases the stability compared to the original publication.
Tibiocalcaneal Arthrodesis for the Management of Severe Ankle and Hindfoot Deformities
Authors: Myerson Mark S. , Alvarez Richard G. , Lam Peter W. C.
Published: January 2017

Purpose: The purpose of this investigation was to evaluate the outcome of tibiocalcaneal arthrodesis using an adolescent condylar blade plate for severe ankle and hindfoot deformities. Materials and Methods: We retrospectively reviewed the records of patients managed at our institutions between 1989 and 1996 whose tibiocalcaneal arthrodeses were performed with adolescent condylar blade plates and allograft bone. In these 30 patients (14 men, 16 women; average age, 53 years), the etiologies of the nonbraceable deformity included: diabetic neuroarthropathy with talar fragmentation and resorption (26), inflammatory arthritis (3), and posttraumatic avascular necrosis of the talus with collapse (1). Due to the severity of the deformity in 28 of these patients, the alternative treatment would have been amputation. Thirteen patients had undergone previous surgeries, eight had documented osteomyelitis, and 13 had ulcers ranging from 2 to 27 mm. At surgery, the remnants of the talus were removed. Morcellized bone graft mixed with tobramycin/vancomycin powder was inserted into the arthrodesis site and then fixed with a rigid plate. Intravenous antibiotics, followed by oral antibiotics, were given until wound healing and suture removal. Follow-up averaged 48 months (19 to 112 months). Results: Tibiocalcaneal fusion was achieved in 28/30 patients at an average of 16 weeks (12 to 18 weeks). Complications occurred in seven patients: two developed stress fractures of the tibia at the proximal end of the blade plate, three had superficial cellulitis that resolved with antibiotic therapy, and two had nonunions. Conclusion: Tibiocalcaneal arthrodesis using an adolescent condylar blade plate and allograft bone can be a successful procedure in the patient with severe neuropathic ankle deformity and can achieve a stable plantigrade foot for limited community ambulation with relatively few complications.
Precise Anatomic Configuration Changes in the First Ray of the Hallux Valgus Foot
Authors: Tanaka Yasuhito , Takakura Yoshinori , Sugimoto Kazuya , Kumai Tsukasa , Sakamoto Tatsuya , Kadono Kunihiko
Published: January 2017

To detect precise anatomical configuration of the first ray in feet with hallux valgus, a two-dimensional coordinate system was devised for evaluation of a weight-bearing dorsoplantar radiograph.

The radiographs, taken from 229 feet of 114 patients with symptomatic hallux valgus and 94 normal feet, were investigated. A comparative study showed the first metatarsal head of a foot with hallux valgus was located on the medial side of that of the normal foot and the base of the proximal phalanx of the hallux valgus foot was located on the same point of that of the normal foot. Lateral translation of the base of the proximal phalanx occurred only in cases with overlap toes. Our study shows that subluxation of the metatarsophalangeal joint in hallux valgus is primarily caused by metatarsus primus varus. This study indicated that first metatarsal osteotomies should be given the first priority in consideration for bunion surgery, because these procedures could move the first metatarsal heads laterally in a more normal position.
Retrograde Intramedullary Nail for Metastatic Lesion of the Lower Tibia
Authors: Tadross T.S.F. , Checketts R.G.
Published: January 2017

Two cases of distal tibial metastases are presented, and a suggestion is made for a method of treatment.
Subtalar Arthrodesis with Flexor Digitorum Longus Transfer and Spring Ligament Repair for Treatment of Posterior Tibial Tendon Insufficiency
Authors: Johnson Jeffrey E. , Cohen Bruce E. , DiGiovanni Benedict F. , Lamdan Ron
Published: January 2017

The surgical treatment of flexible pes planovalgus deformities resulting from Stage 2 posterior tibial tendon insufficiency is controversial and many techniques have been proposed. We retrospectively reviewed the results of subtalar arthrodesis combined with spring ligament repair/reefing and flexor digitorum longus (FDL) transfer to the navicular. There were sixteen patients (seventeen feet) with an average follow-up of 27 months (9–52). All deformities were passively correctable.

The average age was 56 yrs (39–78). All patients had failed conservative management, 88% had previously been treated with orthotics, and 53% had lateral pain from subfibular impingement. Two patients were noted to have degenerative changes of the subtalar joint.

Successful subtalar joint fusion occurred in all patients with an average time to radiographic union of 10.1 weeks (5–24). The average AOFAS hindfoot score and Maryland foot score postoperatively was 82 and 86 respectively. Standing radiographic analysis demonstrated an average improvement in the AP talo-1st metatarsal angle of 6° (24° preoperative, 18° postoperative). The talonavicular coverage angle improved an average of 17° (34° preoperative, 17° postoperative). The lateral talo-1st metatarsal angle improved an average of 10° (18° preoperative, 8° postoperative). The lateral talocalcaneal angle decreased an average of 21 o (55° preoperative, 34° postoperative). The distance of the medial cuneiform to the floor on the lateral radiograph averaged 12mm preoperatively and 18mm postoperatively (avg. improvement 6mm).

The combination of the flexor digitorum longus tendon transfer and spring ligament repair with subtalar arthrodesis is an effective and reliable procedure which provides excellent correction of hindfoot valgus as well as forefoot abduction and restoration of the height of the longitudinal arch. These results compare favorably with flexor transfer combined with either calcaneal osteotomy or lateral column lengthening.
Limited Intertarsal Arthrodesis Using Bone Grafting and Pin Fixation
Authors: Lin Sheldon S. , Bono Christopher M. , Treuting Robert , Shereff Michael J.
Published: January 2017

Iliac crest bone grafting and K wire fixation was used to fuse the arthritic intertarsal articulations of sixteen patients with post-traumatic or primary degenerative disease. Using pre-and post-operative AOFAS scores, foot function indices (FFI), and a subjective scoring system, functional and subjective outcome was critically evaluated. The AOFAS score improved an average of 41 points, the FFI decreased from 64 to 24, and 81 percent of patients rated their results as good or excellent. Fusion of the 4th and 5th TMT joints was associated with significantly poorer functional scores, and people with worker's compensation claims had poorer subjective scores. The authors demonstrated comparable results to previously published series using other methods of fixation.
Cavovarus Foot Treated with Combined Calcaneus and Metatarsal Osteotomies
Authors: Sammarco G. James , Taylor Ross
Published: January 2017

Twenty-one feet in fifteen patients underwent osteotomies of the calcaneus and one or more metatarsals for symptomatic cavovarus foot deformity. Seven (nine feet) were male, and eight (twelve feet) were female. The etiology included hereditary motor sensory neuropathy (HMSN) (fifteen feet), post-polio syndrome (two feet), sacral cord lipomeningocele (two feet), parietal lobe porencephalic cyst (one foot), and idiopathic peripheral neuropathy (one foot). Presenting complaints were metatarsalgia (fifteen feet), ankle instablility (five), and ulceration beneath the second metatarsal head (one foot). Eleven feet were assessed using the Maryland Foot Rating Score. Maryland Foot Rating Score (University of Maryland, Baltimore, MD) improved from 72.1 (avg.) pre-operatively to 89.9 (avg.) post-operatively (follow-up 70.9 months avg.). Eight feet were assessed using the AOFAS (American Orthopaedic Foot and Ankle Society) Ankle-Hindfoot and Midfoot Scores. The AOFAS Ankle-Hindfoot Score improved from 46.3 (avg.) pre-operatively to 89.1 (avg.) post-operatively, and the AOFAS Midfoot Score improved from 40.9 (avg.) pre-operatively to 88.8 (avg.) post-operatively (follow-up 20.8 months avg.). The postoperative AOFAS Ankle-Hindfoot Score for all nineteen feet was 90.8 (avg.) and the post-operative AOFAS Midfoot Score for all nineteen feet was 90.2 (avg.). Two patients were lost to follow-up and were not included in the study. Ankle, hindfoot, and midfoot motion was maintained or improved in sixteen feet. Complications included delayed union in two and nonunion in three of 66 metatarsal osteotomies. While three patients required an AFO (ankle-foot orthosis) for ambulation preoperatively, all patients were brace free postoperatively. All patients expressed willingness to undergo the same procedure again if it were necessary. Weight-bearing radiographs were available for 17 feet. Radiographic analysis revealed a decrease in forefoot adduction (9.6° avg.) and a reduction in both hindfoot (9.1° avg.) and forefoot cavus (10.6°) leading to an overall 13 percent reduction in the height of the longitudinal arch. Lateral sliding elevating calcaneal osteotomy combined with dorsolateral closing wedge osteotomies of one or more metatarsal bases in the severe symptomatic cavovarus foot can provide a pain-free, plantigrade foot with a lowered longitudinal arch and a stable ankle without sacrificing motion.
Sonographic Measurement of Instability of the Subtalar Joint
Authors: Waldecker Ute , Blatter Georges
Published: January 2017

A sonographic method of measuring instability of the subtalar joint was developed. After defining reference points, we determined a sonographic fibulo-trochlear angle. This angle was measured in a neutral position and under an inversion stress position. A ratio q representing the relationship between the fibulo-trochlear angle measured in the neutral position and under stress, was determined. The method was tested on volunteers with clinically and radiologically stable subtalar joints and a control group with unstable subtalar joints. The stress radiograph using the Zwipp method was utilized for radiologic correlation. A sonographic ratio q >1.6 correlated with a radiological unstable subtalar joint. The borderline zone in which there was an overlap of stable and unstable subtalar joints was characterized by a q value of 1.2-1.6. A ratio q>1.2 correlated with a stable subtalar joint.
Stress Fracture of the Talus Following Resection of a Talocalcaneal Coalition: A Case Report
Authors: Stocker Beate , Bennett James T.
Published: January 2017

We report the case of a 15-year-old male with bilateral talocalcaneal coalition. Following resection of the symptomatic coalition, the patient developed a painful ankle. MR imaging revealed a stress fracture of the talar body. In this report we discuss presentation and treatment of a symptomatic talocalcaneal coalition complicated by a later stress fracture as well as a review of the literature.
Experimental Flatfoot Model: The Contribution of Dynamic Loading
Authors: Chu In-Tak , Myerson Mark S. , Nyska Meir , Parks Brent G.
Published: January 2017

The goal of this study was to determine if the application of muscle forces (simulating the dynamic phase of the midstance part of gait) had an effect on flatfoot deformity. We created a flatfoot model in each of seven cadaver foot specimens by grasping the Achilles, peroneus longus, peroneus brevis, flexor digitorum longus, and flexor hallucis longus tendons with soft-tissue vice clamps connected via wire cables to pneumatic cylinders. The experiment included four stages: 1) initial static axial loading; 2) axial loading after 3,000 load cycles (average, 735 N; range, 70 to 1400 N); 3) axial loading after releasing the spring ligament and plantar fascia; and 4) axial loading after an additional 3,000 load cycles. At each stage, both static (with axial loading only) and dynamic (axial loading with tensioning of the tendons to simulate the muscle forces at midstance) conditions were evaluated radiographically. No change was observed between the static and dynamic conditions in the first two phases of the experiment. After the third phase, changes in the talar-first metatarsal angle and the height of the medial cuneiform were noted, particularly in the dynamic condition. These and additional radiographic changes were magnified in the fourth phase, but only in the dynamic condition. We concluded that, to create an effective flatfoot model, the medial structures, including the spring ligament and possibly the plantar fascia, must be severed. Cyclic loading of the foot further increased the arch flattening, and this effect was magnified by dynamic loading.
Intraosseous Bioabsorbable Poly-L-Lactic Acid Screw Presenting as a Late Foreign-Body Reaction: A Case Report
Authors: Mosier-LaClair Susan , Pike Howard , Pomeroy Gregory
Published: January 2017

A 17-year-old woman complained of a localized painful swelling in her foot 30 months after internal fixation of a closed tarsometatarsal joint fracture with interfragmentary poly-L-lactic acid screws. Aspiration revealed a sterile abcess. Radiographs displayed an osteolytic lesion corresponding to a screw track in the first tarsometarsal joint. Formation of a draining sinus tract required surgical excision of a small granulomatous lesion. Histologic analysis found deposits of birefringent polymeric particles surrounded by a nonspecific foreign-body type reaction. This represents the first reported case of a draining sinus tract secondary to the use of polylactic acid screw fixation.
Intermediate Follow-Up on the Double Osteotomy and Tendon Transfer Procedure for Stage II Posterior Tibial Tendon Insufficiency
Authors: Moseir-LaClair Susan , Pomeroy Gregory , Manoli Arthur
Published: January 2017

62 patients with 28 pes planovalgus feet secondary to Johnson stage 2 posterior tibial tendon insufficiency were treated with flexor digitorum longus tendon transfer, lateral column lengthening, medial displacement calcaneal osteotomy, and heel cord lengthening. The mean patient age at surgery was 48.5 years. The AOFAS ankle-hindfoot scale was applied postoperatively to assess clinical outcome. Preoperative and postoperative standing radiographs of the foot and ankle were analyzed to determine radiographic correction of the pes planovalgus deformities.

The mean follow-up to date is 5 years. The mean ankle-hindfoot score was 90 postoperatively. The medial cuneiform to fifth metatarsal distance improved from −0.2 mm preoperatively to 7.6 mm postoperatively. Similarly, the talonavicular distance improved from 19.4 mm preoperatively to 10.9 postoperatively. There were no nonunions. Four feet (14%) displayed radiographic signs of calcaneocuboid arthritis at follow-up. Only one was symptomatic requiring calcaneocuboid joint fusion.

The double osteotomy technique provides symptomatic relief and lasting correction of the pes planovalgus deformity associated with stage 2 posterior tibial tendon insufficiency at intermediate follow-up. It has a high patient satisfaction based on the AOFAS ankle-hindfoot scale and radiographic measurements demonstrate maintenance of correction of the adult acquired flatfoot.
Rubber Foreign Bodies in Puncture Wounds of the Foot in Patients Wearing Rubber-Soled Shoes
Authors: Chong Chang Haw , Verhoeven William , Mun Chay Wai
Published: January 2017

We report 8 cases of puncture wound of the foot associated with rubber foreign bodies in patients who were wearing rubber-soled shoes. The difficulty in making the correct diagnosis and the complications arising from these injuries are reviewed. The morbidity associated with these seemingly innocuous puncture wounds can be serious. Infective complications resolved only with removal of all imbedded rubber foreign bodies. A history of wearing rubber-soled shoes during the injury and a high index of suspicion may prevent complications.
Measurement of Isolated Subtalar Range of Motion: A Cadaver Study
Authors: Taylor Major Kenneth F. , Bojescul Captain John A. , Howard Robin S. , Mizel Mark S. , McHale Colonel Kathleen A.
Published: January 2017

Fifteen fresh-frozen cadaveric lower extremities were studied to evaluate the reliability of measuring subtalar motion using a bubble inclinometer. There was high intra-observer reliability for manual inversion and eversion of the subtalar joint with the tibiotalar joint locked and unlocked. Poor correlation of radiographic and clinical measurements questioned the validity of bubble inclinometer measurements. The contribution of the tibiotalar joint to apparent subtalar motion, as measured clinically and radiographically, was found to be one-third of the arc of motion, as compared to motion measured clinically and radiographically with the tibiotalar joint locked.
The Effect of Heel Elevation on Strain Within the Plantar Aponeurosis: In Vitro Study
Authors: Kogler Géza F. , Veer Franklin B. , Verhulst Steven J. , Solomonidis Stephan E. , Paul John P.
Published: January 2017

Mild, temporary reduction of symptoms from plantar fasciitis have been reported with the use of high heeled shoes (i.e. cowboy boots, ladies pumps). However, little is known on how heel elevation may contribute to a decrease in the pain and inflammation. The aim of this study was to quantify strain in the plantar aponeurosis in cadaveric feet with the use of various heel elevation configurations. An in vitro method that simulated “static” stance was used to determine the loading characteristics of the plantar aponeurosis (n = 12). Heel elevation was evaluated with blocks placed beneath the heel and with a contoured platform that simulated the arch profile of a shoe at three different heel heights (2.0, 4.0, 6.0 cm) with a level plane serving as the control.

Strain in the plantar aponeurosis decreased with elevations of the heel that simulated the arch profile of a shoe at load levels (337, 450 N) (P < 0.05). Elevations of the heel with blocks did not significantly affect strain in the plantar aponeurosis (P < 0.05). Contrasting results of some specimen limbs compared with the overall means suggests that the influence of heel elevation on loading of the plantar aponeurosis may be dependent on individual variation and foot structure differences. Therefore, clinicians should be cautious in recommending heel elevation as a treatment for plantar fasciitis since some subjects may not achieve the desired decrease in plantar aponeurosis strain.
Foot Pressures During Gait: A Comparison of Techniques for Reducing Pressure Points
Authors: Lawless Matthew W. , Reveal Gregory T. , Laughlin Richard T.
Published: January 2017

Purpose: Various methods have been used to redistribute plantar surface foot pressure in patients with foot ulcers. This study was conducted to determine the effectiveness of four modalities (fracture walker, fracture walker with insert, and open and closed toe total contact casts) in reducing plantar foot pressure.

Methods: Ten healthy, normal volunteer subjects had an F-scan sensor (ultra thin shoe insert pressure monitor) placed under the right foot. They then ambulated on a flat surface, maintaining their normal gait. Dynamic plantar pressures were averaged over 10 steps at four different sites (plantar surface of great toe, first metatarsal head, base of fifth metatarsal, and plantar heel). All subjects repeated this sequence under five different testing conditions (barefoot, with a fracture walker, fracture walker with arch support insert, open and closed toe total contact cast). Each subject's barefoot pressures were then compared with the pressures during the different modalities.

Results: All four treatment modalities significantly reduced (p < 0.05) plantar pressure at the first metatarsal head (no method was superior). The fracture walker, fracture walker with insert, and open toe total contact cast significantly reduced pressure at the heel. Pressures at the base of the fifth metatarsal and great toe were not significantly reduced with any treatment form.

Conclusion: The fracture walker, with and without arch support, and total contact cast can effectively reduce plantar pressure at the heel and first metatarsal head.
The Effect of Shoe Sole Composition on In Vivo Tibial Strains During Walking
Authors: Milgrom Charles , Finestone Aharon , Ekenman Ingrid , Simkin Ariel , Nyska Meir
Published: January 2017

To test the hypothesis that shoe sole composition can affect the level of bone strain and strain rates that contribute to the development of stress fractures, in vivo tibial strain measurements were made during treadmill walking while wearing four shoes which differed only in their sole composition. Soles of 65 Shore A polyurethane with an embedded heel air cell had significantly lower compression and shear strains and shear strain rates than soles of 65, 75 and a composite of 40/65 Shore A polyurethane with no embedded air cells. A sole composed of 65 Shore A polyurethane with an embedded air cell can potentially be protective against stress fracture in a walking shoe.
Theoretical Limitations of the AOFAS Scoring Systems: An Analysis Using Monte Carlo Modeling
Authors: Guyton Gregory Paul
Published: January 2017

The AOFAS foot scores are four related outcome instruments based on the use of quantitative interval data and have seen increasing use in the literature. The mathematical construction of the scales is particularly notable for a very small number of intervals available to answer each component item and for quantitatively unequal intervals for some items. Monte Carlo computer modeling techniques were used to simulate the responses to each item for a variety of idealized patient populations with several different means, standard deviations, and levels of interaction between items. The continuous data describing each patient's responses were categorized into the finite number of available intervals in the AOFAS Hindfoot score. The resultant distributions of net scores often demonstrated bizarre, skewed behavior that bore little resemblance to the original distributions of continuous data. The effects were magnified as the ends of the scale were approached and when strong correlations between the items measuring pain and function were present. The distributions did not become distorted when the original continuous data were not rounded off into intervals but were simply weighted by their relative contribution to the AOFAS score and summed. The AOFAS scores, therefore, have inherently limited precision which is entirely due to the small number of response intervals available to answer each component item of the scale. Minor changes in a patient's response to a series of correlated questions can potentially make a drastic difference in their total score. Because the population distributions may be badly skewed, the use of parametric statistics with the AOFAS scores should be regarded with genuine suspicion, and appropriate refinements of the scales should be sought.
A Comparison of Standard vs. Breakaway Bases: An Analysis of a Preventative Intervention for Softball and Baseball Foot and Ankle Injuries
Authors: Janda David H. , Bir Cynthia , Kedroske Beth
Published: January 2017

More than 40 million individuals participate in organized baseball and softball leagues in the United States every year. Unfortunately, it has also been estimated by the Consumer Product Safety Commission that softball and baseball are the two main sports leading to emergency-room visits in the United States. A previous field study has determined that the utilization of breakaway bases has the potential of preventing 96% of sliding injuries, thereby preventing 1.7 million injuries a year in the United States with a savings of $2 billion a year in health care costs. It is the purpose of this study to analyze and compare the potential attenuating capabilities of various types of bases. We found the force at the ankle upon impact when compared to the standard base revealed all breakaway bases reduced the force of impact to a statistically significant level. The force at the foot upon impact when compared to the standard base revealed all breakaway bases reduced the force at variable levels, with the Rogers bases having the only statistically significant reduction. However, the force delivered to the tibia/fibula was increased with the Stay Down and Mag-Net large bases as compared to the standard stationary base. The moments of inversion/eversion and dorsiflexion/plantar flexion upon impact, when compared to the standard base, revealed all safety bases were reduced to a statistically significant level.

We conclude breakaway bases reduce the force of impact and moments to a statistically significant level and confirm previous field studies. Though there is a difference among the breakaway bases themselves, they should be used on all fields.
Computed Tomographic Evaluation of the Position of the Leg for Mortise Radiographs
Authors: Takao Masato , Ochi Mitsuo , Naito Kohei , Iwata Atsushi , Uchio Yuji , Oae Kazunori , Kono Taisuke , Kawasaki Kenzo
Published: January 2017

We investigated the most advantageous internal rotation angle of the leg for mortise radiographs. One hundred and twenty-eight feet of 64 healthy volunteers with no histories of ankle or foot pathology (72 feet of 36 males, 56 feet of 28 females) were examined. The subjects had an average age of 29 years (range, 19 to 51 years), average height of 167 cm (range, 157 to 181 cm), and average foot length of 25 cm (range, 23 to 27 cm). We obtained a plain axial view at the level of the central patella and 5 mm proximal to the tibial plafond using computed tomography, and investigated the inclination angle of the distal tibiofibular joint to a horizontal plane, regarding it as a mortise angle. The mean mortise angle was 19.1 + 5.0°. However, two peaks were observed at around 15° and 20°. This indicated that the mean mortise angle of the males was 21.2 + 4.6°, and the mean mortise angle of the females was 16.4 + 4.1°, with a significant difference between the males and the females' mortise angle (P < 0.0001). There was no correlation between the mortise angle and the height (P = 0.899 in the males, and P = 0.871 in the females), nor between the mortise angle and the foot length (P = 0.359 in the males, and P = 0.512 in the females). Therefore, we concluded that the internal rotation angle of the leg for mortise radiography should be generally set up at about 20° on males and 15° on females.
Method for Manual Reduction of Displaced Intra-Articular Fracture of the Calcaneus: Technique, Indications and Limitations
Authors: Omoto Hideyuki , Nakamura Katsumi
Published: January 2017

One hundred and two cases of displaced intra-articular fractures of the calcaneus were treated using this method for manual reduction. All but three were treated within three days of injury. The average follow-up was seven years and three months (range three to 14 years). Patients' ages ranged from 21 to 76 years. Results were assessed by clinical outcome as well as roentgenographic appearance. Successful reductions were obtained in 92 cases. In the remaining 10 cases, the reduction was felt to be unsatisfactory and either percutaneous pinning or open reduction internal fixation was performed. In most cases fractures were reduced and treated successfully using this method of manual reduction. The use of this method does not preclude any further treatment options, and we therefore feel this method is the treatment of choice.
Calcaneocuboid Stability: A Clinical and Anatomic Study
Authors: Leland Robert H. , Marymont John V. , Trevino Saul G. , Varner Kevin E. , Noble Phillip C.
Published: January 2017

Injuries to the midtarsal joints are relatively uncommon and often unrecognized entities. Acute and chronic instability patterns to the calcaneocuboid joint can occur from such injuries. No previous determinations of normal calcaneocuboid laxity have been reported. Utilizing a previously described technique, stress radiographs were performed in human cadaveric specimens following serial sectioning of the ligamentous supports of the calcaneocuboid joint. Significant differences in calcaneocuboid gap and angle occurred between unstressed and stressed conditions. Cadaveric specimen testing determined that the dorsal and plantar calcaneocuboid ligaments both provide significant contributions to joint stability. Prior to defining pathologic states of joint laxity, normal ranges of stability must be determined. By more clearly defining normal stability of the calcaneocuboid joint and its ligamentous contributions, greater insight into the diagnosis and treatment of calcaneocuboid instability can be obtained.
Hardware in the Medial Malleolus: Is it Intra-Articular?
Authors: Romiti Steven L. , Leitschuh Paul C.
Published: January 2017

This paper is a radiographic approach to ascertain if the hardware at the medial malleolus is intra-articular. A human tibia was removed from a skeleton and pins were placed in the medial malleolus representing pins that would be intra- and extra-articular (in the mortise). Radiographs were obtained at precise rotation intervals. Those pins that were placed intra-articularly could not be made to appear otherwise. The pin that was placed extra-articularly was visualized on a single view to be extra-articular. Therefore, if hardware can be demonstrated to be extra-articular on any one view then it is not intra-articular.
Tarsal Navicular Fractures in Major League Baseball Players at Bat
Authors: Bartz Reed L. , Marymont John V.
Published: January 2017

Tarsal navicular fractures in athletes, although rare, can present both a diagnostic and therapeutic dilemma. Failure to recognize this injury and initiate treatment early can have devastating consequences. The physician must have a high index of suspicion for the injury in any patient with midfoot pain after a direct blow. Two case reports of tarsal navicular fractures sustained by baseball players at bat in which the diagnosis was not made early are presented.
Highlights of the Third Annual Congress of the European Foot and Ankle Society
Authors: Smith Tom
Published: January 2017

The European Foot and Ankle Society meeting in Stockholm was attended by over 250 delegates from 33 countries including Bosnia and Herzegovina. The meeting was organized as a series of symposia with instructional lectures followed by oral presentations on related topics.
Tibialis Posterior Insufficiency Occurring in a Patient without Peronei: A Mechanical Etiology
Authors: Kohls-Gatzoulis J. A. , Singh D. , Angel J.C.
Published: January 2017

A patient presented with a painful flatfoot deformity, which developed after the onset of a drop-foot secondary to a herniated lumbar disk. On examination, the only functioning muscles were her gastrocnemiussoleus complex and her intrinsic toe flexors. Her affected foot had taken the classic deformity seen with tibialis posterior dysfunction—a valgus heel, midfoot collapse and an abducted forefoot. Peroneus brevis was not functioning and therefore could not be implicated as part of the etiology of this patient's acquired flatfoot deformity. The mechanism in which the ground reaction force produces the foot deformity in a tibialis posterior insufficient foot will be presented.
Measurement of First-Ray Mobility in Normal vs. Hallux Valgus Patients
Authors: Lee Kyung Tai , Young Kiwon
Published: January 2017

Hypermobility of the first ray is one causative factor in development of hallux valgus and an important factor in the treatment of hallux valgus, but measuring first-ray motion is difficult. There are two known ways of measuring first-ray motion. One is measuring the bony angle on the lateral foot X-ray using a modified Coleman block. The other is using devices. However, neither is suitable for clinical application. We introduce a simple, fast and easy way of measuring first-ray range of motion. Using this method, we compared the first-ray motion between a normal group and a hallux valgus group.

Forty normal and 60 hallux valgus patients were included in the measurement. We measured the first-ray range of motion in the following way: with one hand we held the 2nd, 3rd, 4th, and 5th rays at the metatarsal head level with a simple right-angled indicator. With the other hand, we held the first ray at the metatarsal head level using a simple right-angled device, such as a scale. Keeping the other rays fixed, we moved the first ray up and down and recorded the average distance (d) 10 times to reduce intra-measurement differences. We also measured and recorded the first metatarsal length (L) on the anteroposterior foot X-ray film. Finally, we calculated the first-ray range of motion (a) using the above data. We also measured the hallux valgus angle and intermetatarsal angle in the hallux valgus patient group.

With this method, the average first-ray motion was 10.3° in the normal group and 12.9° in the hallux valgus patient group. If we define 14°, (that is, above the 95th percentile in the normal group) as having hypermobility, 38% of hallux valgus patients had first ray hypermobility. There was no correlation between first-ray hypermobility and either hallux valgus angle or intermetatarsal angle.
Revision Ankle Arthrodesis
Authors: Midis Nicholas , Conti Stephen F.
Published: January 2017

Between 1996 and 1999, we performed successful revision ankle arthrodesis for aseptic nonunion in 10 patients using external fixation with bone graft and an implantable bone stimulator. The etiology of the ankle arthrosis in the patients was post-traumatic in eight and rheumatologic in two. The average age of the patients was 54. On average, each patient had received 2.5 previous surgeries (range, 1 to 5) prior to the original fusion attempt.

Fusion occurred in all 10 of these patients at an average of 12.8 weeks following revision (range, nine to 20 weeks). Complications occurred in two patients: one had a pin tract infection which resolved with local pin care and oral antibiotics; the second patient had a varus malalignment which was accommodated with orthotics. This patient also had a deep peroneal nerve neuropraxia which resolved with observation.

We evaluated all 10 patients with clinical and radiographic examination, and determined their functional results for a duration of follow-up of 15 months (range, six to 36 months). Using a modification of the AOFAS ankle/hindfoot scoring system, the results were: three excellent, four good, two fair, and one poor. All but one of these patients were satisfied with the outcome of this procedure. Radiographic analysis supported good clinical alignment and solid fusion.
Compression Screw Fixation for First Metatarsal Basal Osteotomy
Authors: Fadel George E. , Rowley David I. , Jain Amar S.
Published: January 2017

Proximal osteotomy and distal soft tissue correction is recommended for correction of severe hallux valgus deformity. Basal closing wedge osteotomy is inherently unstable, and there is a tendency for dorsal displacement of the distal fragment. This has led many surgeons to attempt a variety of fixation techniques to counteract this instability, including AO-cortical and cancellous screws, K-wires, and shape-memory staples. 1 – 3

The Acutrak® screw (Acumed. Inc., Beaverton, Oregon) has been used to fix tibial spine avulsions and scaphoid fractures 5 but was not previously reported in hallux valgus surgery. We used a modified closing wedge basal osteotomy technique with Acutrak cannulated compression screw in order to add stability to the osteotomy.
Total Contact Casting: Its Effect on Contralateral Plantar Foot Pressure
Authors: Hartsell Heather D. , Brand Richard A. , Saltzman Charles L.
Published: January 2017

Total contact casts (TCC) are commonly used in the treatment of neuropathic ulcers of the foot related to diabetes. However, casts may alter the gait pattern and increase loading parameters of the contralateral foot. We determined the effects of total contact casting on plantar pressure parameters for the contralateral extremity. Ten healthy subjects consented to walk, for four consecutive trials, along a 25-meter corridor while wearing a running shoe (RS), fiberglass TCC and a traditional TCC. Parameters of peak pressure, contact time and pressure-time integrals for the contralateral forefoot, metatarsal V area and heel were recorded using the novel Pedar™ system of plantar pressure measurement. Repeated measures analyses of variance (footwear × region) were used to analyze the recorded parameters with post-hoc Tukeys selected for follow-up analysis. Each of the measured parameters for the forefoot, lateral foot over metatarsal V and heel regions on the contralateral foot were similar regardless of footwear worn. Use of a TCC does not appear to affect contralateral foot contact pressure parameters and likely does not increase the risk of contralateral ulceration.
Cavus Foot Correction in Adults by Dorsal Closing Wedge Osteotomy
Authors: Wülker Nikolaus , Hurschler Christof
Published: January 2017

Twelve patients (13 feet) who underwent dorsal closing wedge osteotomy for cavus foot deformity were re-examined clinically and radiographically 46 months after surgery (range, 24 to 80 months). A dorsally based bone wedge, sized according to the deformity on the preoperative radiographs, was excised between the Lisfranc and Chopart joint lines. Eight patients (nine feet) were satisfied with the procedure. Although significant improvement of both symptoms and foot alignment was achieved, most patients continued to experience mild to moderate pain postoperatively. The outcome seems not to be directly related to the achieved surgical correction.
Simultaneous Strain Measurement With Determination of a Zero Strain Reference for the Medial and Lateral Ligaments of the Ankle
Authors: Ozeki Satoru , Yasuda Kazunori , Kaneda Kiyoshi , Yamakoshi Kenichi , Yamanoi Takahiro
Published: January 2017

The strain changes of the central part of the anterior talofibular ligament (ATFL), the posterior talofibular ligament (PTFL), the calcaneofibular ligament (CFL), and the tibiocalcaneal ligament (TCL) were measured simultaneously for a full range of ankle motion. Twelve fresh frozen amputated ankles were used. To measure the strain changes of the ligaments, a Galium-lndium-filled silastic strain transducer was implanted in the center of each ligament. The zero strain reference was determined immediately after the measurement of strain changes in five of the 12 ankles by tensile testing of each bone-ligament-bone preparation. The maximum strain change of the ATFL, the PTFL, the CFL and the TFL were 7.9%, 5.9%, 5.3% and 5.2%, respectively. The ATFL was elongated in plantar flexion and shortened in dorsiflexion. The PTFL and the CFL were shortened in plantar flexion and elongated in dorsiflexion. The TCL was the longest around the neutral position and became shorter in planter flexion and dorsiflexion. The results showed that the ATFL was taut in plantar flexion over 16.2°, the PTFL and the CFL were taut in dorsiflexion over 18° and 17.8° respectively, and the TCL was taut between 9.5° of dorsiflexion and 9.5° of plantar flexion. The length change pattern was different among the ankle ligaments, although there was only a slight difference between that of the PTFL and the CFL. This study provides fundamental data useful in studying ankle ligament reconstruction.
Floating Lesser Metatarsals Associated with Lisfranc Type C–Total Displacement Injury
Authors: Rajan Rohan Ananda , Londhe Sanjay , Hyde Ian
Published: January 2017

We present a 30-year-old woman with a complex foot injury including floating lesser metatarsals, an intact base of second metatarsal and an irreducible fifth metatarsophalangeal joint. The recognition of potential associated injuries together with a Lisfranc fracture-dislocation must not be overlooked.