bluuebunny/crossref_metadata_2025 huggingface dataset:
Stabilization of Ankle Syndesmosis Injuries With a Syndesmosis Screw
Authors: Kaye Robert A.
Published: March 2013

A retrospective review was made of 30 patients who had disruption of the ankle syndesmosis that was treated at Santa Clara Valley Medical Center with a transfixation screw. Follow-up ranged from 3 months to 3 years. There were 21 pronation external rotation injuries and 9 Maisonneuve fractures. Screw size ranged from 3.5 cortical to 6.5 cancellous Synthes screws. Most were placed transversely from 1.5 to 3.5 cm above the joint line. Intraoperative difficulties with screw placement occurred in 2 patients, resulting in one bent screw and one screw placed directly into the ankle joint. Most patients were mobilized prior to screw removal; lucent lines developed around the syndesmosis screw before it was removed in two-thirds of the patients. No screw broke prior to removal. In 6 patients, calcification of the interosseous membrane was seen and, in 4, this progressed to a distal tibiofibular synostosis. It was found that transfixation screws provided satisfactory stability of the syndesmosis to permit stable healing of the interosseous membrane and distal ligaments after ankle fracture. Motion between the tibia and fibula developed despite screw fixation, as shown by the lytic bony changes that occurred with time.
Shock Absorbency of Factors in the Shoe/Heel Interaction—With Special Focus on Role of the Heel Pad
Authors: Jørgensen Uffe , Bojsen-Møller Finn
Published: March 2013

The heel pad acts as a shock absorber in walking and in heel-strike running. In some patients, a reduction of its shock-absorbing capacity has been connected to the development of overuse injuries. In this article, the shock absorption of the heel pad as well as external shock absorbers are studied. Individual variation and the effect of trauma and confinement on the heel pad were specifically investigated. Drop tests, imitating heel impacts, were performed on a force plate. The test specimens were cadaver heel pads (n = 10); the shoe sole component consisted of ethyl vinyl acetate (EVA) foam and Sorbothane inserts. The shock absorption was significantly greater in the heel pad than in the external shock absorbers. The mean heel pad shock absorption was 1.1 times for EVA foam and 2.1 times for Sorbothane. The shock absorption varied by as much as 100% between heel pads. Trauma caused a decrease in the heel pad shock absorbency (24%), whereas heel pad confinement increased the shock absorbency (49% in traumatized heel pads and 29.5% in nontraumatized heel pads). These findings provide a biomechanical rationale for the clinical observations of a correlation between heel pad shock absorbency loss and heel strike-dependent overuse injuries. To increase shock absorbency, confinement of the heel pad should be attempted in vivo.
Pes Planus After Tibial Osteotomy
Authors: McLaren C.A.N. , Wootton J.R. , Heath P.D. , Jones C.H. Wynn
Published: March 2013

When 100 patients who had had a high tibial osteotomy for monocompartmental arthritis were reviewed, 15 were found to have evidence of neurological impairment. A severe symptomatic pes planus deformity of the ipsilateral limb had developed in 4 patients within months of surgery. Electromyographic results showed evidence of dysfunction in the territory of the posterior tibial nerve in all 4 patients, and, in 3, there was evidence of deep peroneal nerve damage. All had surgery for varus malalignment.
Marcher's Digitalgia Paresthetica Among Recruits
Authors: Stein M. , Shlamkovitch N. , Finestone A. , Milgrom C.
Published: March 2013

In a prospective study of 30 male Israeli military recruits a 47% incidence of digitalgia paresthetica was found. The mean time of onset of symptoms was in the fourth week of training. The numbness was bilateral in 11 of 14 of the cases and the mean number of toes involved was 4.5. The first toe was the most commonly involved (11 of 14 patients). No correlation between shoe type (either 3/4 running shoes or standard military boots) was found. At 9-month follow-up, 7 of 9 affected recruits reviewed were asymptomatic. This finding suggests that marcher's digitalgia paresthetica is a neuropraxia. In this study, it developed during the early phases of march training when recruits are adapting to marching with heavy pack and rifle.
Relationship of Metatarsophalangeal Joint Fusion on the Intermetatarsal Angle
Authors: Mann Roger A. , Katcherian David A.
Published: March 2013

To evaluate the effect of fusion of the first metatarsophalangeal joint on the first intermetatarsal angle, a series of 62 consecutive first metatarsophalangeal fusions was reviewed. Of these, 47 had sufficient data to be included in this study. The results of this study showed that the change in the first intermetatarsal angle following a first metatarsophalangeal joint arthrodesis is directly proportional to the preoperative first intermetatarsal angle. Therefore, when a first metatarsophalangeal joint arthrodesis is performed on a patient with a wide intermetatarsal angle, a concomitant proximal first metatarsal osteotomy is usually not indicated.
Equinovarus Deformity in Arthrogryposis and Myelomeningocele: Evaluation of Primary Talectomy
Authors: Segal Lee S. , Mann David C. , Feiwell Earl , Hoffer M. Mark
Published: March 2013

As initial surgical management for rigid equinovarus deformities, 16 children with arthrogryposis (30 involved feet) and 16 myelodysplastic children (26 involved feet) underwent primary talectomies or extensive posterior-medial releases (PMR). When compared with primary PMRs in arthrogrypotic children, primary talectomies revealed a greater number of good and fair results, decreased recurrence rates, less procedures per foot, and maintenance of ambulatory status. Recurrent forefoot and cavus deformities were present after primary talectomies. Primary talectomy in arthrogrypotic children was more effective than posterior-medial releases or secondary (salvage) talectomy. Because of the small number of feet involved, the role of primary talectomy in myelomeningocele was not clarified by this study. Radical PMRs in myelodysplastic children resulted in a significant number of hindfoot valgus deformities that required secondary procedures.
Effect of the Syndesmotic Screw on Ankle Motion
Authors: Needleman Richard L. , Skrade David A. , Stiehl James B.
Published: March 2013

The purpose of this study was to determine the effect of syndesmotic screw fixation on ankle motion. Eight unpaired osteoligamentous cadaver ankles were tested. The study quantified ankle flexion, talar tilt, ankle drawer, and tibiotalar rotation for each specimen using an MTS biomechanical testing system. Each specimen was tested under a 15-kg and a 70-kg axial load. The testing was repeated after the placement of a syndesmotic screw, a 4.5-mm cortical screw, in accordance with AO technique. There was a statistically significant decrease ( P < .05) in tibiotalar external rotation. There was no statistical difference in ankle flexion. There was a significant decrease in the anterior and the posterior drawer tests with the foot in plantar flexion. These were the most significant results. Syndesmotic screw fixation is used for the internal fixation of certain unstable ankle fractures. Opinions differ as to whether the screw should be removed at 6 weeks (prior to weightbearing) or left in place indefinitely. It was concluded that the syndesmotic screw should be removed prior to the return to full activity. Leaving it in place will contribute to abnormal ankle motion; this may result in local discomfort and a possible fatigue fracture of the screw.
Chronic Peroneal Tendon Subluxation Produced by an Anomalous Peroneus Brevis: Case Report and Literature Review
Authors: Hammerschlag Warren A. , Goldner J. Leonard
Published: March 2013

Although congenital anomalies of the peroneal muscles have been well documented from anatomical studies, only a single clinically symptomatic case has been previously reported. In the present report, a previously unreported variation of the peroneus brevis, a bifid peroneus brevis, is described. This variation contributed to chronic subluxation of the peroneal tendons. Diagnosis was made at the time of operation, and resection of the duplicated tendon and reinforcement of the peroneal retinaculum relieved the symptoms of the patient.
Split Posterior Tibial Tendon Transfer for Spastic Equinovarus Foot Deformity
Authors: Medina Phillip A. , Karpman Robert R. , Yeung Anthony T.
Published: March 2013

This paper describes a simplified technique for split posterior tibial tendon transfer in the treatment of spastic equinovarus deformity of the foot. Thirteen children with spastic equinovarus foot deformities were treated at Children's Rehabilitative Services in Phoenix, Arizona, from 1983 to 1986. The technique was modified in 10 of the 13 patients by attaching the split posterior tibial tendon more proximally to the peroneus brevis, compared to a more distal attachment as described by other authors. The mean length of followup was 21 months. Eleven patients obtained a good or excellent result. Two patients were considered to have a fair result. No poor results or complications were noted in any of the patients. It was felt that the split posterior tibial tendon transfer was an effective procedure for correction of spastic equinovarus as reported by other authors. Modification of the technique significantly simplifies the operation by requiring less dissection while still producing favorable results.
Assessment of Collicular Fractures of the Medial Malleous
Authors: Skie Marty , Woldenberg L. , Ebraheim Nabil , Jackson W. Thomas
Published: March 2013

Collicular fractures of the medial malleolus have been described in literature as early as 1950 by Bonnin 1 and then by Pankovich 9 in 1979, yet have been given relatively little attention in orthopaedic and radiologic literature. A precise knowledge of the anatomy of the deltoid ligament, and anterior and posterior colliculi in relation to obtained radiographs is important in the determination of whether a fracture is considered to be stable or unstable, and thus bears an impact on its treatment. The intent of this discussion is to review the structures which comprise the medial malleolus and the assessment of their involvement in acute injury.
Ewing's Sarcoma of the Foot
Authors: Leeson Mark C. , Smith Michael J.
Published: March 2013

Ewing's sarcoma is a rare, malignant neoplasm that is most common in children and adolescents. It is common in both the axial and appendicular skeleton but has been rarely reported in the foot. Historically, treatment has consisted of chemotherapy and radiation therapy. The roll of surgery in the management of these lesions have recently been “rediscovered” and depends on the anatomic location. The purpose of this paper is to discuss five consecutive cases of Ewing's Sarcoma of the forefoot treated with below-the-knee amputation for local tumor control. Four of the five patients also underwent some systemic chemotherapy. After comparing the various forms of therapy for this tumor, the benefits of below-the-knee amputation make it an excellent primary treatment for Ewing's sarcoma of the foot.
The Etiology and Repair of Rotary Ankle Instability
Authors: Conlin F. Dixon , Johnson Paul G. , Sinning John E.
Published: March 2013

The ankle and subtalar joints form a coupling which acts like a universal joint. When the anterior talofibular ligament is disrupted, rotation of the talus about the long axis of the leg is permitted. This abnormal rotation in the transverse plane is the distinguishing feature of rotary ankle instability. The pathomechanics of rotary ankle instability are described. A simple and direct approach to repairing and reinforcing the anterior talofibular ligament and the results of 37 consecutive delayed reconstructions by this method are reported. Advantages of this procedure are felt to be a restoration of the original anatomy, preservation of the peroneal tendons, maintenance of the integrity of the subtalar joint and excellent postoperative results. Disadvantages include a lack of objective diagnostic criteria.
Osteochondritis Dissecans of the Talus: Long-Term Results of Surgical Treatment
Authors: Angermann Peter , Jensen Peter
Published: March 2013

Twenty patients with osteochondritis dissecans of the ankle were reviewed for a clinical and radiographical follow-up 9 to 15 years after surgery including multiple drilling of the lesion combined with excision of loose fragments. The short-term results of surgery were satisfactory: 85° of the patients were improved or cured. At follow-up, more than half of the patients had some degree of pain during activity, and swelling of the ankle, but only a few had locking or pain at rest. Only one of the 18 patients without osteoarthritis at the time of surgery had developed generalized osteoarthritis at the followup. Although the initial good results of surgery were demonstrated to deteriorate with time, the procedure can still be recommended in patients with longstanding symptoms.
The Painful Accessory Navicular: A Clinical and Histopathological Study
Authors: Grogan Dennis P. , Gasser Seth I. , Ogden John A.
Published: March 2013

Twenty-two skeletally immature patients with 39 accessory tarsal navicular bones were seen over a 4-yr period. Twenty-five of the feet with accessory naviculars were symptomatic and, after failure of conservative treatment, were treated by excision of the accessory bone, the synchondrosis, and the prominent portion of the main navicular ossification process. No attempt was made to reroute the posterior tibial tendon. All 25 operative feet were completely relieved of the preoperative pain. The external oblique view was found to be the best radiographic view to demonstrate the accessory navicular. Histological findings in the surgical specimens included areas of microfracture through the cartilaginous synchondrosis, acute and chronic inflammation, and cellular proliferation indicative of attempted repair. These changes are consistent with the theory that chronic chondro-osseous tensile failure can occur in this condition and is responsible for the clinical findings.
Technique Tips: A Jig to Use in the Chevron Osteotomy
Authors: Karno Martin L.
Published: March 2013

The use of a simple jig to facilitate the chevron hallux valgus procedure is described.
Foot Growth in Children Age One to Five Years
Authors: Gould Nathaniel , Moreland Morey , Trevino Saul , Alvarez Richard , Fenwick James , Bach Nguyen
Published: March 2013

As part of the protocol on the Development of the Child's Arch, 1 foot growth studies were monitored prospectively in 107 children from 1 year of age till 5 years of age. Under 15 months of age, growth necessitated a 1/2 size footwear change in less than 2 months; from 15 months to 2 years of age, 1/2 size increase occurred every 2 to 3 months; from 2 to 3 years of age, 1/2 size change every 3 to 4 months; and from 3 to 5 years of age, 1/2 size change every 4 months. Although foot growth in boys and girls is parallel, boys' feet tend to average one size longer and one size wider. Width growth remained proportional to length growth throughout the study.
Fracture of the Entire Posterior Process of the Talus: A Case Report
Authors: Nasser Sam , Manoli Arthur
Published: March 2013

A 31-year-old man sustained a displaced fracture of the entire posterior process of the talus. Despite anatomic reduction and internal fixation, limitation of ankle and subtalar joint motion persisted at follow-up, 32 months after the injury. Great toe dorsiflexon was also limited, presumably from flexor hallucis longus tethering behind the ankle joint. The fracture healed without evidence of avascular necrosis of either the talar body or the posterior fragment
Fasciotomy of the Foot: An Anatomical Study with Special Reference to Release of the Calcaneal Compartment
Authors: Manoli Arthur , Weber Timothy G.
Published: March 2013

Three patients with calcaneal fractures developed clawing of the lesser toes as a late sequela. Believing that this complication may be the result of contractures from an occult compartment syndrome of the foot, an investigation of the anatomical compartments of the foot was performed. The various compartments of 17 unembalmed adult lower limb specimens were injected with dyed gelatin in a controlled fashion. After freezing, the feet were sectioned either transversely or sagittally. The distribution of the dyed gelatin was then studied. Nine compartments were identified. These were the (1) medial, (2) superficial, (3) lateral, (4) adductor, (5–8) four interossei, and (9) calcaneal. The contents of each compartment was then studied as was the compartment's location in the foot and its position relative to other compartments. We identified a new, separate compartment which lies deep to the superficial compartment in the hindfoot area only. This compartment contains the quadratus plantae muscle. We have named it the “calcaneal” compartment to emphasize its hindfoot location. In addition, a communication was demonstrated between the calcaneal compartment and the deep posterior compartment of the leg through the retinaculum behind the medial malleolus, following the neurovascular and tendinous structures. Claw toe deformity following calcaneus fracture appears to be due to late contracture of the quadratus plantae muscle in the calcaneal compartment. A surgical technique for release of all of the foot compartments is described.
Chronic Retrocalcaneal Bursitis Treated by Resection of the Calcaneus
Authors: Angermann Peter
Published: March 2013

Resection of the posterosuperior aspect of the calcaneus was performed on 43 heels, in 35 patients with chronic retrocalcaneal bursitis. Forty heels in 32 patients were reviewed either by a clinical and radiographical examination (35 heels), or by a questionnaire (5 heels) after an average of 6 years (range 1–12 years). Fifty percent of the heels were cured and additionally 20% improved, but when surgery was performed within 1 year, 92% of the heels were either cured or improved. No correlation was found between the result of surgery and the estimated size of the resection made at surgery.
Regnauld Procedure for Hallux Valgus
Authors: Meyer H. R. , Muller G.
Published: March 2013

Between 1975 and 1986, 75 female patients with painful hallux valgus deformity underwent 100 Regnauld procedures. Of these 75 patients, 50 patients underwent unilateral surgery and 25 patients had simultaneous bilateral surgery. The average age of our patient was 45 years. These operations were performed by two different orthopedic surgeons. Over 90% of our patients were satisfied with the operation. Eighty-five percent had no pain, had a satisfactory cosmetic result, and had no complaints about their footwear. Only one patient had severe problems with high heels. Mobility and radiographic evaluation did not correspond with the clinical results. This type of procedure can be performed as an alternative to the Keller-procedure in the middle-aged or elderly patient with no severe arthritis and no osteoporosis.
Syndesmosis Sprains of the Ankle
Authors: Hopkinson William J. , Pierre Patrick St. , Ryan John B. , Wheeler James H.
Published: March 2013

A retrospective review of the clinical records and radiographs of 1344 ankle sprains occurring over a 41-month period at the United States Military Academy was performed. The incidence and severity of these sprains did not differ significantly from other studies with the exception of those injuries involving the tibiofibular ligaments. Those patients sustaining incomplete injuries to the ankle syndesmosis had a recovery time of almost twice that of those patients with severe (3rd degree) ankle sprains (55 vs. 28 days). Eight of 13 patients with 10 of 15 incomplete syndesmosis injuries were available for follow-up examination and radiographs at an average time of 20 months postinjury (range of 7–39 months). All patients with this injury had a positive “squeeze test” (compression of the fibula to the tibia at mid-calf) at the time of initial examination. Nine of 10 patients developed ossification of the syndesmosis in follow-up radiographs. None of these patients had developed chronic ankle instability, loss of motion, or arthritic changes of the joint at the time of final followup.
Ilizarov Technique in Correction of Foot Deformities: A Preliminary Report
Authors: Grant Alfred D. , Atar Dan , Lehman Wallace B.
Published: March 2013

Four deformed feet in three patients were corrected completely using the new limited intervention technique of Ilizarov. One foot in the younger patient was corrected by soft tissue distraction only. In three feet in the older patients V osteotomies were needed to initiate the distraction. Two complications occurred: herpes simplex infected two of the osteotomy sites, which were treated successfully with local treatment. The detailed method and indications are outlined.
Radiologic Anatomy of the Painful Bunionette
Authors: Nestor Bryan J. , Kitaoka Harold B. , Ilstrup Duane M. , Berquist Thomas H. , Bergmann Anthony D.
Published: March 2013

Radiographs were studied of 91 feet in 62 patients with the diagnosis of bunionette and no prior bunionette or hallux valgus operations. Various radiologic measurements were compared to a matched control group with no bunionette symptoms or previous forefoot operations. The bunionette group had a significantly increased metatarsophalangeal 5 angle, intermetatarsal 4–5 angle, and intermetatarsal 1–2 angle compared to the control group. Bunionettes were not commonly associated with lateral bowing of the fifth metatarsal or with an increased fifth metatarsal head width. Symmetry was noted between symptomatic and opposite asymptomatic feet, with the exception of an increased intermetatarsal 4–5 angle in the symptomatic feet.
Tarsal Tunnel Syndrome: Review of the Literature
Authors: Cimino William R.
Published: March 2013

Tarsal tunnel syndrome is defined as entrapment of the posterior tibial nerve at the level of the ankle. The syndrome has been associated with traumatic inflammatory etiologies. The diagnosis is made clinically by the presence of dysesthesia in the distribution of the medial and lateral plantar nerves, a positive Tinel's sign, paresthesias with compression of the nerve at the tarsal tunnel, tenderness of the nerve along its course (Valleix Phenomenon), and sensory or motor changes. Most authors suggest surgical decompression for the treatment of tarsal tunnel syndrome. The purpose of this review is to summarize the etiologies of tarsal tunnel found in the literature, to evaluate the current role of electrodiagnosis in the diagnosis of tarsal tunnel syndrome and to examine the results of treatment modalities presented.
Congenital Variations of the Peroneus Quartus Muscle: An Anatomic Study
Authors: Sobel Mark , Levy Matthew E. , Bohne Walther H. O.
Published: March 2013

There has been little research concerning this muscle since the 1920s, when Hecker 13 , 14 described this muscle to be present in (13%) of his dissections of cadaver legs. The purpose of our dissections was to establish the incidence of the peroneus quartus muscle, its origins, and insertions. One hundred and twenty-four legs from 65 fresh human cadavers were dissected under loupe magnification. When the peroneus quartus tendon was found, its origin, insertion, and anatomic relationship to the peroneus longus and peroneus brevis were observed. All specimens were sketched and photographed. The peroneus quartus muscle was present in 27 legs (21.7% of specimens). Its origins, insertions, and size varied. In 17 legs (63%) the muscle originated from the muscular portion of the peroneus brevis, and inserted on the peroneal tubercle of the calcaneus. The peroneal tubercle was hypertrophied at the insertion in most cases. The results of this study in general show that there was much higher incidence of the peroneus quartus muscle than Hecker claimed. Its course, origin, and insertion varied. Its tendon can be used for reconstructive procedures about the lateral aspect of the ankle, especially in anterior dislocation of the peroneal tendons and reconstruction of lateral ligaments.
A Function of the Talocalcaneal Joint during Running Support
Authors: Engsberg Jack R. , Allinger Todd L.
Published: March 2013

This study explored the possible function of the talocalcaneal joint during running support to minimize frontal plane rotation of the leg and thereby protect the knee from excessive frontal plane motions. The lower limb was modeled as two rigid segments representing the foot and the leg. The results indicated that for extreme ground-foot angles the talocalaneal joint was able to maintain the knee in a stable position in the frontal plane. It was concluded that the joint may function to minimize frontal plane rotation of the leg and thereby protect the knee from excessive frontal plane motions. The relevance of this function for a below-the-knee-amputee patient lies in the potential for improved prosthetic design.
The Ballet Technique Shoe: A Preliminary Study of Eleven Differently Modified Ballet Technique Shoes Using Force and Pressure Plates
Authors: Miller Clay D. , Paulos Lonnie E. , Parker Richard D. , Fishell Michael
Published: March 2013

Ballet dancers are vulnerable to various stress-related injuries; foot and ankle injuries are the most common. This study determined if the pressure across the foot could be more evenly distributed by wearing various modified technique shoes padded with PPT, Spenco, or Sorbathane, alone or in combinations. A professional ballet dancer performed a jump by taking a single step on his left foot, jumping and landing with his right foot on the force and pressure plates with each modified shoe plus one unmodified shoe. The results of this study revealed: (1) total force cannot be reduced, (2) center of gravity and the majority of the pressure is maintained over the first and second metatarsal heads, and (3) the modified technique shoe can more evenly distribute pressure to the medial arch and away from the toes, metatarsal heads, and heel.
Footprint Analysis Between Three and Seventeen Years of Age
Authors: Forriol Francisco , Pascual Jose
Published: March 2013

Footprints of both feet were analyzed from 1676 schoolchildren of both sexes (1013 girls and 663 boys), aged between 3 and 17 years. The sample was divided into five age groups. In each footprint the Footprint Angle and the Chippaux-Smirak 3 , 8 Index were obtained. Classification of individual shapes of foot arches and different types of foot morphology followed that used by Jaworski and Puch 5 in 1987. A high percentage of lowered longitudinal medial arch in the youngest age group of the study was found. The percentage is lower in the older age groups. The longitudinal medial arch has a physiological development in the earlier years of growth.
The Treatment of Tarsometatarsal Injuries
Authors: Resch Sylvia , Stenström Anders
Published: March 2013

In order to analyze the value of operative treatment for tarsometatarsal injuries, 31 consecutive fracture-dislocation injuries from 1975 to 1988, and 11 cases of undislocated injuries were reviewed. Forty patients (41 injuries) could be contacted. The average follow up was 5 years. Twenty-two of the dislocated injuries were treated with open reduction and fixation, usually K-wires. All injuries were classified radiologically. By means of a questionnaire, it was found that 7 had excellent results, 13 good, and 21 poor. No case where anatomical reduction was not achieved could be classified as excellent, and half (5 of 10) received full disability pension. When anatomical reduction was achieved, half had good or excellent results and only 5 of 20 received a disability pension. Initially undislocated injuries had a better prognosis, with 8 of 11 having excellent or good results, and none receiving pension. These injuries should be treated aggressively with open reduction and fixation when there is any displacement. Despite this treatment, one-half of patients with dislocated injuries as well as one-fourth of those with initially undislocated injuries will still suffer from pain and permanent disability probably due to soft tissue damage and instability.
Longitudinal Attrition of the Peroneus Brevis Tendon in the Fibular Groove: An Anatomic Study
Authors: Sobel Mark , Bohne Walther H.O. , Levy Matthew E.
Published: March 2013

There has been little research concerning the attrition of the peroneus brevis tendon since Meyer's observation in 1924. The purpose of our dissections was to establish the incidence of the attrition of the peroneus brevis tendon at the fibular groove, and observe the anatomical relationship of the tendon attrition to the bony anatomy of the distal fibula. One hundred and twenty-four fresh human cadavers ankles from 65 cadavers were dissected under loupe magnification. When attrition of the peroneus brevis was found, the extent of attrition was measured, and anatomic proximity of the tendon to distal fibular groove was observed. Evidence of other tendon attrition as well as the depth of the fibular groove was observed. Specimens which revealed attrition of the peroneus brevis were sketched and photographed. Attrition of the peroneus brevis tendon was found in 14 ankles (11.3% of specimens). The attrition was limited only to the peroneus brevis tendon, and in no specimens was the peroneus longus involved. The degree of tendon attrition varied from simple splaying out of the peroneus brevis in the fibular groove to longitudinal splits in the peroneus brevis tendon with significant fraying of the remaining halves of the tendon. The longitudinal ruptures in the peroneus brevis tendon averaged 1.9 cm (range 1–4 cm). In all cases, the central portion of the longitudinal split was centered over the distal tip of the fibula in the fibular groove. In no case was a complete rupture of the peroneus brevis tendon noted. There was gross evidence of chronic inflammation and synovitis in those ankles with attrition of the peroneus brevis tendon. The results of this study in general present a description of the incidence of peroneus brevis attrition, and when present, the variable degree of attrition, the anatomic relationship of the tendon attrition to the fibular groove, and the evidence of synovitis and chronic inflammation associated with tendon attrition. This incidence of occurrence has not been documented before. The significance of this finding is that chronic ankle pain disability may be related to attrition of the peroneus brevis tendon in the fibular groove.
Osseous Healing After CO2 Laser Osteotomy
Authors: Callahan Dennis J.
Published: March 2013

While some limited discussion of the role of CO2 laser application in orthopaedic surgery has appeared in professional literature, a search of orthopaedic and podiatric journals has failed to uncover reports of the laser's effects on bone healing. This study examined osteotomies created with an oscillating saw and a CO2 laser in a rabbit model. The results showed that bone healing was comparable in both groups, but that healing was delayed in the laser group because inert-appearing bone fragments seemed to inhibit the healing process. Further study is indicated to determine the mechanism by which the CO2 laser delayed healing and whether lasers can enhance healing under certain conditions.
Magnetic Resonance Imaging of the Calcaneus: Normal Anatomy and Application in Calcaneal Fractures
Authors: Zeiss Jacob , Ebraheim Nabil , Rusin Joe , Coombs Robert J.
Published: March 2013

Images obtained from normal volunteers demonstrate highly detailed anatomy of the soft tissue and bony structures near the calcaneus and subtalar joint. Cortical bone, marrow, articular cartilage, ligaments, tendons, muscles, fibrous tissue, vascular bundles, and nerves can be identified. However, images obtained of acute calcaneal fractures were found to offer unsatisfactory depiction of bony anatomy. The presence of small fragments was obscured by a change in normal marrow signal by contusion, hemorrhage, and edema, and by the inability of magnetic resonance (MR) to image small pieces of cortical bone. Only in rare instances might MR be helpful in the acute setting when the location or displacement of tendons cannot be clearly ascertained with computed tomography (CT). MR may prove more useful in the long-term follow-up of healed fractures with persistent pain. In this setting it might be used in the diagnosis of complications such as residual or recurrent tendon displacementdon displacement, tenosynovitis, heel fat integrity, and tarsal tunnel evaluation. However, this paper did not directly compare the efficacy of MR with that of CT in the long term. Therefore, the degree to which MR may eventually supplement or supplant CT is unclear and further study is required before the use of MR can be recommended in the routine clinical follow-up of calcaneal fractures.
Ingrown Toenail Treated with Cotton Collodion Insert
Authors: Ilfeld Frederic W.
Published: March 2013

Separating the distal anterior tip and lateral edges of an ingrown toenail from the adjacent soft tissue with a wisp of absorbent cotton coated with collodion gives immediate relief of pain and provides a firm runway for further growth of the nail. The collodion coating fixes the cotton in place, waterproofs, and permits bathing. This simple office method was successfully used on 86 private patients. It is not applicable in patients with infected acute paronychia.
Reconstruction for Subtalar Instability: A Review
Authors: Schon Lew C. , Clanton Thomas O. , Baxter Donald E.
Published: March 2013

Instability of the subtalar joint has become a more well-defined clinical entity in recent years. While there have been several articles which have discussed diagnosis of this condition, there has been little written on the surgical treatment. Reconstructive techniques with which we have had experience are presented. Technical aspects of these methods are described in detail.
Vascular Anatomy of the Fifth Metatarsal
Authors: Shereff Michael J. , Yang Quing Ming , Kummer Frederick J. , Frey Carol C. , Greenidge N.
Published: March 2013

The extraosseous and intraosseous vascular anatomy to the fifth metatarsal as visualized in a group of below-the- knee amputation specimens has been described. The extrinsic circulation to the area is provided by the dorsal metatarsal artery, the plantar metatarsal arteries, and the fibular plantar marginal artery. These three source arteries supply branches to the metatarsal and adjacent joints. The intraosseous vascularity consists of a periosteal plexus, a nutrient artery, and a system of metaphyseal and capital vessels.
Syme's Two-Stage Amputation in Insulin-Requiring Diabetics with Gangrene of the Forefoot
Authors: Pinzur Michael S. , Morrison Carol , Sage Ronald , Stuck Rodney , Osterman Helen , Vrbos Lori
Published: March 2013

Thirty-five insulin-requiring adult diabetic patients underwent 38 Syme's Two-Stage amputations for gangrene of the forefoot with nonreconstructible peripheral vascular insufficiency. All had a minimum Doppler ischemic index of 0.5, serum albumin of 3.0 gm/dl, and total lymphocyte count of 1500. Thirty-one (81.6%) eventually healed and were uneventfully fit with a prosthesis. Regional anesthesia was used in all of the patients, with 22 spinal and 16 ankle block anesthetics. Twenty-seven (71%) returned to their preamputation level of ambulatory function. Six (16%) had major, and fifteen (39%) minor complications following the first stage surgery. The results of this study support the use of the Syme's Two-Stage amputation in adult diabetic patients with gangrene of the forefoot requiring amputation.
Effect of Isolated Talocalcaneal Fusion on Contact in the Ankle and Talonavicular Joints
Authors: Beaudoin A.J. , Fiore S.M. , Krause W.R. , Adelaar R.S.
Published: March 2013

A cadaveric model was developed to establish the articular contact area and load distribution in the ankle joint, posterior facet of the talocalcaneal joint, and talonavicular joint using pressure sensitive film. Positions of dorsiflexion, neutral, and plantarflexion were evaluated. This model was further used to determine the effect of talocalcaneal fusion on the articular contact area in the talonavicular and ankle joints. Alteration of articular contact was most pronounced in the talonavicular joint. There, a statistically significant reduction in contact area postfusion was noted when the foot was in the plantarflexed position. Reductions in ankle joint articular contact area were observed in the dorsiflexed and plantarflexed positions in the majority of specimens. Lateral displacement of the region of articular contact was noted in some specimens. A pressure-weighted centroid calculation was performed to provide a quantitative measure of the shift of the contact region.
Psoriatic Arthritis of the Foot and Ankle: Analysis of Joint Involvement and Diagnostic Errors
Authors: Hammerschlag Warren A. , Rice John R. , Caldwell David S. , Goldner J. Leonard
Published: March 2013

Forty-two patients with psoriatic arthritic arthritis who were referred to a tertiary medical center from 1983 to 1987 were reviewed. The foot and/or ankle was the most common site of joint or bone involvement, (N = 36, 86%). Twenty-six of these patients demonstrated bilateral involvement. The foot and ankle was the most common site of initial arthritis (N = 23, 55%). Errors in patient diagnosis were noted and analyzed. Eight patients with foot and ankle involvement were diagnosed and treated for either gout or compression of a digital nerve. Major causes for misdiagnosis included failure to identify psoriatic skin lesions and failure to associate foot and ankle symptoms with psoriatic arthritis.
Comparison of Chevron Osteotomy and Modified McBride Bunionectomy for Correction of Mild to Moderate Hallux Valgus Deformity
Authors: Johnson Jeffrey E. , Clanton Thomas O. , Baxter Donald E. , Gottlieb Mark S.
Published: March 2013

The purpose of this study was to compare the results of the Chevron osteotomy to the DuVries' modification of the McBride procedure using identical criteria in two groups of patients. Thirty-two patients (48 feet) that had a Chevron osteotomy and 10 patients (17 feet) who had a modified McBride bunionectomy without metatarsal osteotomy for treatment of mild to moderate hallux valgus were retrospectively reviewed using subjective and objective criteria. Both groups were matched according to age, severity of deformity, and length of follow-up. Ninety-two percent of patients in the Chevron group and 88% of patients in the McBride group responded that they were either totally satisfied or improved regarding pain relief and appearance of the foot following surgery. Chevron osteotomy resulted in a statistically significant greater correction of the intermetatarsal 1–2 angle than did the McBride bunionectomy. Postoperative metatarsophalangeal joint range of motion was not significantly different for the two groups. Following Chevron osteotomy, five (10%) metatarsal heads exhibited radiographic changes of cyst formation and/or increased osteodensity and three (6%) of the osteotomies healed in a malunited postion. One of the three metatarsal head malunions occurred in a patient that also had a lateral capsular release, however, none of the five cases that developed radiographic changes in the first metatarsal head was associated with a lateral capsular release. Lateral capsular release with the Chevron osteotomy did not improve the amount of correction of the hallux valgus deformity and it may be a contributing factor to instability at the osteotomy site leading to a valgus malunion.
Early Mobilizing Treatment for Grade III Ankle Ligament Injuries
Authors: Konradsen Lars , Hølmer Per , Søndergaard Lars
Published: March 2013

Eighty patients with grade III lateral ligament ruptures were treated either with total immobilization in a walking plaster cast or early mobilization in a stabilizing orthosis. The criterion for entrance was a talar tilt of more than 9° and an anterior translation of more than 10 mm at stress radiography, a previously stable ankle, and a contralateral ankle showing normal stress radiographic values. Ninety-one percent of the patients were evaluated at 7 weeks, 3 months, and 1 year postinjury. While functionally treated patients reached normal mobility and resumed work and sports earlier than immobilized patients there were no differences between the treatment groups in ankle stability or symptoms during activity after 1 year. Ninety-five percent of the ankles in either group were mechanically stable after treatment. Residual symptoms were present 1 year postinjury in 13% of the functionally treated ankles and in 9% of the cast-mobilized ankles. In lateral ankle ligament ruptures causing gross mechanical instability early mobilization results in a better early functional result; however, at 1 year postinjury there was no statistically significant difference in outcome as compared to cast-immobilized ankles.
Basal Osteotomy of the Fifth Metatarsal for the Bunionette
Authors: Diebold P.F.
Published: March 2013

A proximal basal chevron osteotomy was carried out on 20 patients (22 feet) with a Tailor's bunion deformity. The follow-up was of a minimum of 3 years for all patients. Direct surgery on the fifth metatarsophalangeal joint for bunionette treatment has often been unsuccessful and there have been recurrences due to metatarsophalangeal instability. Basal osteotomy is therefore preferred. The patients were satisfied. The intermetatarsal 4–5 angle was noticeably reduced. There were no postoperative complications and no recurrences. The fifth metatarsophalangeal joint was corrected despite the absence of direct surgery and remains stable. This operation is recommended for acute bunionettes with intractable plantar keratosis.
Distal Chevron Metatarsal Osteotomy for Bunionette
Authors: Kitaoka Harold B. , Holiday Allan D. , Campbell Donald C.
Published: March 2013

Nineteen distal chevron metatarsal osteotomy operations were performed in 13 patients with painful bunionette. The average duration of follow-up was 7.1 years. Mean forefoot score improved from 35.8 points to 73.9 points out of a possible 75 points. Intermetatarsal 4–5 angle, metatarsophalangeal 5 angle, and forefoot width improved significantly. Overall results were considered good in 17 feet and fair in 2; there were no failures. Complications were transfer metatarsalgia (1 foot) and wound infection (1 foot). Distal chevron fifth metatarsal osteotomy is effective treatment for symptomatic bunionette.
Distal Oblique Osteotomy for Tailor's Bunion
Authors: Zvijac John E. , Janecki Chet J. , Freeling Ronald M.
Published: March 2013

Thirty-six patients with a total of 50 symptomatic tailor's bunions were evaluated clinically, radiographically, and subjectively, both before and after a distal oblique osteotomy procedure was performed.

Thirty-four of 36 patients were satisfied with pain relief. Radiographic measurements derived from this study were consistent with those of other studies.

Avascular necrosis, nonunions, or neuroma formation were not encountered in this study. The significant advantages of this procedure are its simplicity, safety, and predictability. The procedure does not require internal fixation or postoperative immobilization.
Squamous Cell Carcinoma Complicating Chronic Osteomyelitis in a Toe: A Case Report and Review of the Literature
Authors: Ziets Robert J. , Evanski Phillip M. , Lusskin Ralph , Lee Michael
Published: March 2013

Squamous cell carcinoma arising from chronic osteomyelitis is uncommon. Although the majority of cases occur in the lower extremity, incidence in the foot is relatively rare, and in the toe, exceptional. This report illustrates a particularly unusual incidence of squamous cell carcinoma complicating chronic osteomyelitis of the hallux. Guidelines for early diagnosis, recommendations for treatment, and prognostic data are included.
The Effects of Wearing High Heeled Shoes on Pedal Pressure in Women
Authors: Snow Rebecca E. , Williams Keith R. , Holmes George B.
Published: March 2013

The purpose of this study was to investigate the effects of increased heel height in women's shoes on foot pressure during walking. An increase in heel height increased the maximum peak pressure under the metatarsal heads in the forefoot, decreased the time to maximum peak pressure under the metatarsal heads, and increased the rate of loading to the metatarsals during early support. The higher pressures noted with increased heel height were accompanied by a more uniform distribution of pressure beneath the forefoot. These findings may denote increased stress to the various tissues in the foot when walking in high heeled shoes, which may contribute to deleterious orthopaedic changes. Quantitative studies need to be conducted to determine whether orthopaedic changes occur with prolonged wearing of high heeled shoes.
Surgical Treatment of Clubfoot: A Comparison of Two Techniques
Authors: Nimityongskul Prasit , Anderson Lewis D. , Herbert Donald E.
Published: March 2013

Between 1977 and 1989, 28 clubfeet were operated on, with follow-up ranging from 2 to 13 ½ years and averaging 79 months. Group I (16 feet; average follow-up 104 months) underwent a modified Turco's posteromedial release. The functional result in this group was satisfactory in general, but approximately one third of this group required a secondary procedure for persistent intoeing or residual metatarsus adductus.

Group II (12 feet; average follow-up 45 months) underwent a modified, complete subtalar release of McKay and Simons utilizing the Cincinnati incision. No patient in this second group required a secondary procedure. In our experience, the more complete subtalar release procedure of McKay and Simons resulted in better correction than the Turco posteromedial release.

Although follow-up in group II was much shorter than that in group I, we felt that 2 years of minimum follow-up in group II was meaningful, since most of the recurrence or residual deformities were noticed within 18 months after surgery. The Cincinnati incision allowed better exposure and a more complete release. Skin flap necrosis was not a problem in this series.
Plantar Fasciotomy for Intractable Plantar Fasciitis: Clinical Results and Biomechanical Evaluation
Authors: Daly Peter J. , Kitaoka Harold B. , Chao Edmund Y. S.
Published: March 2013

Thirteen consecutive patients underwent plantar fasciotomy in 16 feet for intractable plantar fasciitis and had follow-up from 4.5 to 15 years. Plantar fasciotomy was successful (good or excellent results) for 71% of the 14 feet operated on and for which follow-up data were available. However, time to full recovery was prolonged, additional treatment was frequently required, and abnormalities of foot function persisted. Flattening of the longitudinal arch occurred. Dynamic force-plate studies showed differences in peak vertical, fore-aft, and lateralmedial forces between patients and matched controls. More rapid progression of weightbearing along the longitudinal axis of the foot during stance phase in patients indicated avoidance of heel loading.
Investigations into the Fat Pads of the Sole of the Foot: Anatomy and Histology
Authors: Jahss Melvin H. , Michelson James D. , Desai Panna , Kaye Robert , Kummer Frederick , Buschman William , Watkins Frank , Reich Steven
Published: March 2013

Anatomical, histological, and histochemical studies were performed on normal and abnormal fat pads of the sole of cadaver feet. The fat pads were found to contain a significant nerve and blood supply separate from that to the surrounding musculature and skin. Pacinian corpuscles and free nerve endings within the fat were identified. Histological analysis indicated a meshwork of fibroelastic septae arranged in a closed-cell configuration. The mechanical consequences of this organization are discussed in the context of the weightbearing role of the fat pads of the feet. Alterations seen in dysvascular or senescent feet are consistent with the hypothesis that the septal anatomy of the fat pads is central to their cushioning function.