bluuebunny/crossref_metadata_2025 huggingface dataset:
Movement Coupling at the Ankle During the Stance Phase of Running
Authors: Stacoff Alex , Nigg Benno M. , Reinschmidt Christoph , van den Bogert Anton J. , Lundberg Arne , Stüssi Edgar , Denoth Jachen
Published: January 2017

The purpose of this study was to quantify movement coupling at the ankle during the stance phase of running using bone-mounted markers. Intracortical bone pins with reflective marker triads were inserted under standard local anaesthesia into the calcaneus and the tibia of five healthy male subjects. The three-dimensional rotations were determined using a joint coordinate system approach. Movement coupling was observed in all test subjects and occurred in phases with considerable individual differences. Between the shoe and the calcaneus coupling increased after midstance which suggested that the test shoes provided more coupling for inversion than for eversion. Movement coupling between calcaneus and tibia was higher in the first phase (from heel strike to midstance) compared with the second phase (from midstance to take-off). This finding is in contrast to previous in-vitro studies but may be explained by the higher vertical loads of the present in-vivo study. Thus, movement coupling measured at the bone level changed throughout the stance phase of running and was found to be far more complex than a simple mitered joint or universal joint model.
Augmented Repair of Acute Achilles Tendon Ruptures
Authors: Zell Richard A. , Santoro Vincent M.
Published: January 2017

Twenty-five patients who had an acute Achilles tendon rupture were managed with an augmented repair using the gastrocnemius-soleus fascia. All patients healed their repair and there were no re-ruptures. There was one infection. Augmented repair allowed early functional recovery as evidenced by full ankle motion by four to eight weeks, full unassisted weight bearing by three weeks, cessation of braces by four weeks, and return to work by one to six weeks post-operatively. Augmentation adds a sufficient amount of collagen to allow early range of motion and weight bearing without re-rupture. Disadvantages included a long incision, soft tissue prominence, one infection, and sural nerve injury.
The Viladot Implant in Flatfooted Children
Authors: Black Peter R. M. , Betts Roderick P. , Duckworth Thomas , Smith Thomas W. D.
Published: January 2017

In 1991, Viladot 1 described an implant for the treatment of painless flatfeet in children. This was inserted through a double approach to allow the talus to function while limiting its ability to slide off the calcaneus. The wineglass shaped prosthesis was inserted into the sinus tarsi with a tibialis posterior advancement and soft tissue correction to allow the foot to adopt a neutral position. This is in keeping with other procedures described for the correction of flatfoot. Viladot reported excellent results in 234 feet operated on in such a manner using clinical, radiological and photopodographic parameters. In Sheffield, over three years, 22 implants were inserted for similar painless flatfeet in children. The results were assessed using clinical, radiological and pedobarographic parameters.

Viladot was able to demonstrate an improvement in all cases, clinically, radiologically and photopodographically with little or no discomfort and a return to preoperative levels of activity including sport. We found that in all cases, postoperative pain was a major feature which limited activity in all but 2 feet and which reduced the ability to take part in sport and other preoperative pastimes. Unlike Viladot, we were unable to demonstrate consistent improvements radiologically. Pedobarographically, the loading of the first metatarsal head remained unchanged and the centre of pressure was corrected in only 14%.
Talo-Navicular Arthrodesis For Residual Midfoot Deformities Of A Previously Corrected Clubfoot
Authors: Wei Steven Y. , Sullivan Raymond J. , Davidson Richard S.
Published: January 2017

Triangular navicular, dorsal-lateral subluxation of the talo-navicular (TN) joint with a secondary forefoot cavo-varus deformity, and degenerative changes of the TN joint are frequent causes of residual clubfoot deformity and pain in the midfoot after surgical correction. This study investigates the usefulness of TN arthrodesis to correct these deformities and to resolve symptoms resulting from these deformities. During the period from 1991–1996, the senior author performed 19 TN fusions (16 patients) for the above residual clubfoot deformities involving a painful TN joint. Eight of the procedures (seven patients) also required a lateral column shortening with a calcaneal wedge osteotomy to allow for a complete correction of the TN joint. The procedure was only performed in cases involving a hindfoot that was adequately aligned during a previous clubfoot correction. The average age of the patients at the time of surgery was 11 years (range: 4–20). One patient (bilateral procedures) was lost to follow-up. Fifteen patients (17 procedures) were followed-up for an average of four years (range: 2–6). All patients reported symptomatic improvement after the TN arthrodesis. Fourteen of the patients (15 procedures) were completely satisfied. The remaining patient (bilateral procedures) was only partially satisfied due to the subsequent development of navicular-cuneiform osteoarthritis in both feet. Two cases (2 patients) developed complications requiring a second procedure for satisfactory results. In addition, the procedure resulted in an improvement of the talus-first metatarsal angle on both antero-posterior and lateral radiographs. TN arthrodesis produced a correction of the residual clubfoot deformities of the midfoot and resulted in satisfactory clinical improvement in all the patients.
The MR Imaging Appearance of Longitudinal Split Tears of the Peroneus Brevis Tendon
Authors: Major Nancy M. , Helms Clyde A. , Fritz Russell C. , Speer Kevin P.
Published: January 2017

Purpose

Longitudinal split tears of the peroneus brevis tendon have been increasingly reported as a source of lateral ankle pain and disability. MR imaging is useful in identifying the appearance of longitudinal split tears of the peroneus brevis tendon to differentiate this entity from other causes of chronic lateral ankle pain. We observed variations in anatomy associated with these tears.

MATERIALS AND METHODS

Twenty-two patients (eleven males, eleven females) were identified as having longitudinal split tears of the peroneus brevis tendon. These cases were reviewed retrospectively to evaluate for the following: shape of the peroneus brevis tendon, high signal in the peroneus brevis tendon, tendon subluxation, appearance of the superior peroneal retinaculum, presence of osseous changes in the ankle, lateral ankle ligaments, presence of a bony fibular spur, flattening of the peroneal groove of the fibula and presence of a peroneus quartus. A control group consisted of twenty ankles imaged for reasons other than lateral ankle pain. The same structures were assessed in this group. A Fisher's exact P-value was used to determine the significance of each finding in the two groups.

RESULTS

Statistically significant associated findings were chevron shaped tendon (p = .0001), high signal in the peroneus brevis (p = .0017), bony changes (p = .0001), flat peroneal groove (p = .0001), abnormal lateral ligaments (p = .0004), and lateral fibular spur (p = .0006).

Conclusions

MR imaging is useful in differentiating longitudinal split tears of the peroneus brevis tendon from other lateral ankle disorders. It can show the extent of the abnormality in the tendon and the associated findings of soft tissue and/or bone variations which must be addressed at the time of surgery.
Comparison of Results of Retrocalcaneal Decompression for Retrocalcaneal Bursitis and Insertional Achilles Tendinosis with Calcific Spur
Authors: Watson Anthony D. , Anderson Robert B. , Davis W. Hodges
Published: January 2017

Sixteen feet with retrocalcaneal bursitis (RB) and twenty-two feet with calcific Achilles insertional tendinosis (IAT-CS) underwent retrocalcaneal decompression after failure of nonoperative treatment. Follow-up evaluation at least two years after surgery included AOFAS Ankle-Hindfoot subscale scores, satisfaction, time until maximum symptomatic improvement, and radiographs. Statistically significant differences between the groups include the following: IAT-CS patients were older, required nearly twice the time to reach maximum symptomatic improvement, had lower satisfaction rates, had a lower pain score, and more frequently had shoewear restrictions. Radiographic recurrence did not correlate with outcome or symptomatic recurrence.
Calcaneocuboid Joint Pressure after Lateral Column Lengthening in a Cadaveric Planovalgus Deformity Model
Authors: Momberger Nathan , Morgan James M. , Bachus Kent N. , West John R.
Published: January 2017

The purpose of this study is twofold: first, to measure the joint contact pressure across the calcaneocuboid joint in a planovalgus deformity and compare the results to pressures measured in a normal foot; and second, to determine the change in pressure across the calcaneocuboid joint after an Evan's-type calcaneal lengthening osteotomy. The effect of this procedure on the calcaneocuboid joint was evaluated using seven cadaver feet to measure peak pressure across the calcaneocuboid joint under a constant load. Each foot was sectioned medially to reproduce a deformity consistent with an adult, acquired flat-foot. Each flatfoot deformity was then corrected using a ten-millimeter lateral column lengthening osteotomy. Joint pressures were measured in the normal foot, the created flatfoot and then in the corrected flatfoot. Peak pressures across the joint increased significantly from baseline in the flatfoot (p <0.05). However, the change in pressure from the flatfoot to the corrected foot was not significant, and in some cases peak pressures in the corrected foot were actually lower than in the flatfoot. These findings indicate that calcaneal lengthening through an Evan's osteotomy does not increase pressure across the calcaneocuboid joint beyond physiologic loads in the flatfoot.
Biomechanical Comparison of Syndesmosis Fixation with 3.5- and 4.5-millimeter Stainless Steel Screws
Authors: Thompson Michael C. , Gesink Dirk S.
Published: January 2017

Although most authors recommend either 3.5-mm or 4.5-mm cortical screws for syndesmosis fixation, the optimum screw size has yet to be defined. The present study was designed to biomechanically compare syndesmosis fixation with 3.5-mm and 4.5-mm stainless steel screws. Simulated pronation external rotation ankle injuries were created in twelve paired, fresh-frozen cadaveric leg specimens. One limb from each pair received a 3.5-mm tricor-tical stainless steel screw for syndesmosis fixation (group I), while the contralateral specimen was stabilized using a 4.5-mm screw (group II). Sub-maximal axial ramp (0 to 1200 N) and external rotation/torsional ramp (0 to 5 N-m) loading was performed on each specimen prior to ligament division, following ligament division and following syndesmosis fixation. Axial fatigue testing was then performed at 1.5 Hz for a total of 100,000 cycles (0 to 900 N), and each specimen was subsequently tested to failure in external rotation. Ligament division resulted in syndesmosis widening (p<0.001) and reduced stiffness (p<0.001) during torsional ramp loading. Subsequent syndesmosis screw placement reduced syndesmosis widening (p<0.05) and increased stiffness (p<0.05). Following screw fixation, however, widening remained greater (p<0.005) and stiffness less (p<0.001) than pre-injury levels. No differences between groups I and II were observed during submaximal testing. In external rotation to failure testing, group I failed at a greater angle (38.9° ± 4.1° vs. 32.0° ± 3.8° in group II; p<0.05). Failure torque was slightly higher in group I; however, the difference was not statistically significant (17.8 ± 2.0 N-m vs. 14.3 ± 2.6 N-m in group II; p=0.082). Five specimens in group I failed by screw pullout and five specimens in group II failed by fibula fracture (p=0.061). The present results suggest that there is no biomechanical advantage of a 4.5-mm screw over a 3.5-mm in fixation of the syndesmosis.
Dorsomedial Cutaneous Nerve Syndrome: Treatment with Nerve Transection and Burial Into Bone
Authors: Miller Stuart D.
Published: January 2017

Damage to the dorsomedial cutaneous nerve of the foot, which innervates the medial hallux, may occur with crush injury or iatrogenically with bunion surgery. Severe neuritic pain after bunion surgery may alert the surgeon that this small nerve has been damaged. The term “dorsomedial cutaneous nerve syndrome” is suggested for this condition, and nine patients with such forefoot presentations, all of which were unresponsive to nonoperative interventions, are described. The nerve had been either transected or bound in scar tissue; in these nine cases, the nerve was then resected and buried in the proximal aspect of the first metatarsal or the medial cuneiform. Most patients underwent an additional procedure (other than the nerve procedure), such as revision bunionectomy or arthrodesis, but all felt they could clearly delineate nerve pain from bone or joint pain. All patients experienced marked relief of their symptoms, usually within days after the surgery, and were satisfied with the results. The verbal analog pain score, on a scale of 0 (no pain) to 10 (pain requiring amputation), improved from a preoperative level of 8.6 to a postoperative level of 2.0. Resection and burial of this nerve appears to be a useful treatment for neuritis unresponsive to nonoperative measures.
Assessing the Subtalar Joint: The Brodén View Revisited
Authors: Sijbrandij Elisabeth S. , van Gils Ad P.G. , van Hellemondt Frank J. , Louwerens Jan Willem K. , de Lange Eduard E.
Published: January 2017

We prospectively evaluated subtalar inversion stress views (Brodén view) with inversion stress views on helical CT in a group of 10 patients with unilateral instability. The contralateral, asymptomatic ankle was used as control. All patients were examined with inversion stress views on plain stress radiography and helical CT. Subtalar tilt was demonstrated in all cases on conventional stress radiography. Helical CT didn't show tilting in any of the patients except in the subluxated posteromedial part of the subtalar joint. Our data do not support prior reports that the Brodén view is useful for screening patients with subtalar instability.
Bednar Tumor of the Foot: A Case Report
Authors: Vandeweyer E , Deraemaecker R. , de Saint Aubain Somerhausen N. , Geledan L. , Gebhart M.
Published: January 2017

Pigmented dermatofibrosarcoma protuberans (Bednar tumor) is a rare neoplasm accounting for approximately 1–5% of all cases of dermatofibrosarcoma protuberans. The majority occurs on the trunk, and the remainders are more or less equally distributed in the upper and lower extremities and the head and neck. Microscopically it is characterized by spindled cells arranged in a tight storiform pattern and admixed with a small population of melanin-containing dendritic cells. The dendritic cells are the primary feature that distinguish this lesion from conventional dermatofibrosarcoma protuberans.

We report here a case of Bednar tumor occurring on the dorsal aspect of the foot in a young female.
Results of Operative Fixation of Unstable Ankle Fractures in Geriatric Patients
Authors: Pagliaro Andre J. , Michelson James D. , Mizel Mark S.
Published: January 2017

It is widely accepted that operative fixation of unstable ankle fractures yields predictably good outcomes in the general population. The current literature, however reports less acceptable results in the geriatric population age 65 years and older. The current study analyzes the outcome of the surgical treatment of unstable ankle fractures in patients at least 65 years old. Twenty three patient over 65 years old were surgically treated after sustaining 21 (91%) closed and 2 (9%) open grade II unstable ankle fractures. Fractures were classified according to the Danis-Weber and Lauge-Hansen schemes. Fracture type was predominantly Weber B (21/23, 91%), or supination external rotation stage IV (21/23, 91%). Fracture union rate was 100%. There were three significant complications including a lateral wound dehiscence with delayed fibular union in an open fracture dislocation, and two below knee amputations, neither of which was directly related to the fracture treatment. There were three minor complications; one superficial wound infection and two cases of prolonged incision drainage, all of which resolved without further surgical intervention. Complications were associated with open fractures and preexisting systemic disease. These results indicate that open reduction and internal fixation of unstable ankle fractures in geriatric patients is an efficacious treatment regime that with results that are comparable to the general population.
Intra-Articular Neuropathic Fracture of the Calcaneal Body Treated by Open Reduction and Subtalar Arthrodesis
Authors: Campbell John T.
Published: January 2017

A novel pattern of neuropathic intra-articular calcaneal fracture in a diabetic patient is described. This fracture combined proximal retraction of the tuberosity and body along with hindfoot collapse and plantar ulceration. Following control of the acute Charcot process with total contact casting, surgical reduction and subtalar arthrodesis was performed to stabilize the hindfoot and decrease the risk of recurrent ulceration. After healing, the patient successfully resumed ambulation and presently uses extra-depth shoes for daily activities. Despite the risks of surgical treatment, this difficult fracture may be treated operatively to maintain plantigrade alignment and offer limb salvage for the neuropathic patient.
Percutaneous vs. Open Repair of the Ruptured Achilles Tendon—A Prospective Randomized Controlled Study
Authors: Lim Justin , Dalai Rakesh , Waseem Mohammed
Published: January 2017

A prospective randomized controlled trial comparing open and percutaneous repair of closed ruptured Achilles tendons was performed over a period of 30 months. Sixty-six patients from seven district general hospitals were entered into the study with 33 patients randomized into each group. A modification of the technique described by Ma and Griffith was used in the percutaneous group and a Kessler suture supplemented with interrupted sutures was used in the open group. Patients were followed up for a minimum of six months. The mean age was 38.5 years (26 to 53 years). Forty patients were male and 26 female. After the rupturing event but prior to surgery, it was noted that seven patients had paresthesia in the territory of the sural nerve. The mean duration of immobilization was 12.4 weeks (10 to 14). The complications in the open group included seven wound infections (21%), two adhesions (6%) and two cases of re-rupture (6%). In the percutaneous group there were three cases of wound puckering (9%), one re-rupture (3%) and one case with persistent paresthesia in the sural nerve territory (3%). The difference in infective wound complications between the two groups was statistically significant (Fisher's exact test P = 0.01). Percutaneous repair is advocated on the basis of the low rate of complications and improved cosmetic appearance.
An Analysis of Skin Perfusion Over the Achilles Tendon in Varying Degrees of Plantarflexion
Authors: Poynton Ashley R. , O'Rourke Kieran
Published: January 2017

Delayed wound healing and, less commonly, wound breakdown are significant complications following open Achilles tendon repair. Skin perfusion over the Achilles tendon may be reduced when the ankle is plantarflexed. The aim of this study was to analyse skin perfusion over the Achilles tendon with the ankle in varying degrees of plantarflexion in 20 volunteers.

Skin perfusion was determined by measuring the transcutaneous skin oxygen pressure (tcPO2) using the Novametrix TcO2M 860 monitor. Measurements were taken at the medial edge of the Achilles tendon in 20 volunteers. Skin perfusion was maximal with the ankle plantarflexed to 20°. With plantarflexion beyond this skin perfusion was reduced. At 40° plantarflexion skin perfusion was reduced by up to 49% (mean 35%, range 27% to 49%). We conclude plantarflexion beyond 20° reduces skin perfusion in the region of the Achilles tendon. Though this study was performed on non-operated cases, and is thus limited, the findings may have clinical implications with regard to cast position following Achilles tendon repair.
Ligamentous Restraints of the Second Tarsometatarsal Joint: A Biomechanical Evaluation
Authors: Solan Matthew C. , Moorman Claude T. , Miyamoto Ryan G. , Jasper Louis E. , Belkoff Stephen M.
Published: January 2017

Ligamentous injury of the tarsometatarsal joint complex is an uncommon, but disabling condition that frequently occurs in elite athletes. There are few options for managing these injuries, in part because the relative mechanical contribution of the ligaments of the tarsometatarsal joint is unknown, complicating decisions regarding which ligaments need reconstruction. In the current study, strength and stiffness of the dorsal, plantar, and Lisfranc ligaments of 20 paired cadaver feet were measured and compared. The plantar and Lisfranc ligaments were significantly stiffer and stronger than the dorsal ligament, and the Lisfranc ligament was significantly stronger and stiffer than the plantar ligament.
The Relationship of the Heel Pad Compressibility and Plantar Pressure Distribution
Authors: Kanatli Ulunay , Yetkin Haluk , Simsek Aykin , Besli Koksal , Ozturk Akif
Published: January 2017

Loss of heel pad elasticity has been suggested as one of the possible explanations of heel pain. This study aimed to determine the effect of heel pad thickness and its compressibility to heel pressure distribution, in 47 (94 feet) normal subjects and 59 (94 feet) patients with heel pain, using radiological measurements and EMED-SF (Novel, Munich) plantar pressure distribution measurement system.

Both heels of the patients and control group were radiographed with and without weight bearing. The ratio of the heel pad thickness in loading to unloading position was defined as “the heel pad compressibility index.” The plantar peak pressure of the heel was measured at heel strike phase of the gait cycle.

The compressibility index for control and patient groups were found to be 0.60 and 0.69, respectively. The peak pressure under the heel pad was recorded to be 28.4 N/cm2 for patients and 31.7 N/cm2 for control group. No significant difference was found for heel pad compressibility index and heel pad pressures between patient and control groups (p>0.05).

This study revealed that there is no relationship between heel pad compressibility and pressure distribution of the heel pad both in control and patient group. We feel the flexibility of the heel pad does not have any influence on heel pain syndromes.
Outcome of Ankle Arthrodesis Performed by Dowel Technique in Patients with Rheumatic Disease
Authors: Belt Eero A. , Mäenpää Heikki , Lehto Matti U.K.
Published: January 2017

Between the years 1988 and 1994, 19 ankle arthrodeses were performed on 18 patients (nine men) using the dowel technique. Patients were followed until a fusion had occurred, a non-union was successfully rearthrodesed, or a pseudoarthrosis was stabilized with orthosis treatment. Patients' radiographs and documents were analyzed both preoperatively and during the healing period. Subtalar fusion had been performed previously in eight ankles and rheumatoid destruction of subtalar complex was observed in seven other hindfeet. The original dowel method was used in 13 ankles and a modified procedure was performed in six. Local bone grafts were utilized. Solid fusion was achieved in 13 ankles (68%), but with delayed union in two cases. Non-union was present in six ankles, and two re-arthrodeses were performed with successful fusion in the other. Orthosis treatment was necessary in three of five ankles with permanent non-union. One chronic infection leading to non-union was detected. Only two of the six ankles (33%) with the modified technique using additional exposures healed without complications. In the dowel technique, the preoperative position of the ankle and location of the guiding Kirschner wire are of crucial importance and the original technique with a large cutter should be used. In patients with rheumatic disease, this fusion method did not yield acceptable results.
Crescentic Proximal Metatarsal Osteotomy for Moderate to Severe Hallux Valgus: A Mean 12.2 Year Follow-Up Study
Authors: Veri J.P. , Pirani S.P. , Claridge R.
Published: January 2017

The senior author's (R.C.) first 25 patients (37 feet) treated with a combination proximal crescentic osteotomy and distal soft-tissue reconstruction made up the patient cohort. All 25 patients were reviewed at a minimum of one year post-op (short-term follow-up) and 20/25 (31/37 feet) were reviewed again at a mean 12.2 years (range 11.4 to 13.0 yrs) post-op (long-term follow-up). This allowed for a comparison of short- and long-term results and led to a long-term follow-up rate of 84% (31/37 feet, mean 12.2 yrs). Clinical, radiographic and patient outcome measures were obtained and compared pre-op and at short- and long-term follow-up. The mean preoperative hallux valgus (HVA) and intermetatarsal angles (IMA) were 37° and 16° respectively. The mean HVA correction was 24° and IMA correction 10° at long-term follow-up with no tendency toward recurrence. Sesamoid position and first MTP subluxation was markedly improved postoperatively and the correction was maintained at long-term follow-up.

Patients were asked about their satisfaction in terms of pain, appearance and motion. At long-term follow-up, more than 90% of patients were completely satisfied with pain and motion and greater than 80% with their appearance. Ninety-four percent of patients said they would have the operation again. The AOFAS clinical rating scale for the hallux was calculated retrospectively for pre-op and short-term follow-up and prospectively for long-term follow-up. The mean pre-op score was 37/100 (16 to 60) which significantly improved to 92/100 (67 to 100) at both follow-up periods, suggesting no evidence of decrease in outcome over time.

Complications included two patients (5%) that were over-corrected into varus (one symptomatic, one asymptomatic), and four patients (11%) that were undercorrected, developing asymptomatic recurrences (>10° increase HVA) at long-term follow-up. In addition, two patients (5%) developed new transfer lesions postoperatively, likely related to technical error (one varus overcorrection, one dorsiflexion malunion).

In conclusion, the long-term results, with a mean follow-up of 12.2 years, of the resection realignment procedure for moderate to severe hallux valgus are generally excellent and the complication rate is low and acceptable. Attention to detail, avoiding both undercorrection, which can lead to recurrence, and overcorrection, which can cause symptomatic varus, is essential.
Neuromas of the Calcaneal Nerves
Authors: Kim Jaesuk , Dellon A. Lee
Published: January 2017

A neuroma of a calcaneal nerve has never been reported. A series of 15 patients with heel pain due to a neuroma of a calcaneal nerve are reviewed. These patients previously had either a plantar fasciotomy (n = 4), calcaneal spur removal (n = 2), ankle fusion (n = 2), or tarsal tunnel decompression (n = 7). Neuromas occurred on calcaneal branches that arose from either the posterior tibial nerve (n = 1), lateral plantar nerve (n = 1), the medial plantar nerve (n = 9), or more than one of these nerves (n = 4). Operative approach was through an extended tarsal tunnel incision to permit identification of all calcaneal nerves. The neuroma was resected and implanted into the flexor hallucis longus muscle. Excellent relief of pain occurred in 60%, and good relief in 33%. One patient (17%) had no improvement and required resection of the lateral plantar nerve. Awareness that the heel may be innervated by multiple calcaneal branches suggests that surgery for heel pain of neural origin employ a surgical approach that permits identification of all possible calcaneal branches.
The Role of Ankle Arthroscopy in the Treatment Strategies of Osteochondritis Dissecans Lesions of the Talus
Authors: Schimmer Ralph C. , Dick Walter , Hintermann Beat
Published: January 2017

Thirty-six cases of osteochondritis dissecans (OD) of the talus were diagnosed among 413 ankle arthroscopies performed within a period of six years. In 52.8% of the cases the OD was found on the medial and in 41.7% on the lateral talus. 53.3% of the lateral OD presented stage III and IV lesions while only 26.3% of the medial OD were to be graded stage III and IV. Patients with grade I and II lesions had mostly excellent outcome scores between 90 and 100. However, four patients with medial OD at less severe stages who were treated surgically, showed a particularly unfavorable outcome with scores between 11 and 36. All these patients needed either ankle arthrodesis or total ankle joint replacement. For stage II and III medial lesions, our experience has led to a more conservative approach due to the unfavorable outcome of surgical treatment observed in these patients. Despite the usefulness of MRI in the diagnosis of OD of the talus, arthroscopy has been proven to represent a very helpful diagnostic tool in assessing extent and in particular stability and integrity of the osteochondritic lesion. Apart from enabling the various minimally invasive surgical treatment options, ankle arthroscopy should be performed in all patients with OD of the talus in order to help define the treatment strategy and avoid unnecessary surgery on stable lesions.
Tumoral Calcinosis of the Foot
Authors: Prahinski John R. , Schaefer Richard A.
Published: January 2017

Tumoral calcinosis is characterized by periarticular deposition of calcium phosphate, usually in the setting of normocalcemia and hyperphosphatemia. The term tumoral calcinosis can be used to describe lesions with periarticular deposition of calcium phosphate resulting either from a primary disorder or a secondary disorder, such as renal failure with associated secondary hyperparathyroidism. Treatment entails phosphate deprivation, control of any primary disease processes such as secondary hyperparathyroidism, and resection for recalcitrant symptoms. We present a case of tumoral calcinosis involving the foot which required resection and ultimately hyperparathyroidectomy.
Early Ankle Motion after Triple Bundle Technique Repair vs. Casting for Acute Achilles Tendon Rupture
Authors: Jaakkola Juha I. , Beskin James L. , Griffith Letha H. , Cernansky George
Published: January 2017

The purpose of our study is to evaluate the triple bundle technique for acute Achilles tendon rupture repair followed by early (at 14 days) postoperative ankle range of motion compared to nonoperative treatment with delayed ankle range of motion.

We retrospectively reviewed 73 patients with an acute Achilles tendon rupture treated with either a plantar flexed cast or surgical repair. We found operative treatment reduces immobilization time, allows safe early return to weight-bearing, and diminishes risk of rerupture compared to nonoperative treatment. However, at an average follow-up of greater than 3.5 years, there was no statistical difference in AOFAS hindfoot scores, strength, or patient satisfaction between the two groups. Significant complications were higher in the nonoperative group manifested by three reruptures (7.7%) vs. one deep wound dehiscence in the operative group (3%).
Limited Open Repair of Ruptured Achilles Tendons with Bunnel-Type Sutures
Authors: Park Hong Gi , Moon Dou Hyun , Yoon Jong Min
Published: January 2017

A new method of repairing Achilles tendons, which uses a small medial skin incision with a Bunnel-type suture, was performed on 14 patients, and the clinical results were found satisfying. In order to restore the Achilles tendon to its original length, restore tensile strength in the suture site, and minimize injury to the sural nerve, an operative procedure has been devised which uses a limited open repair with a Bunnel-type suture. We followed 14 patients who had undergone the new procedure for a mean interval of 26 months after the injury. They returned to work in six weeks and to playing sports in 25 weeks. There were no cases of late rerupture nor injuries to the sural nerve. This technique approximated the preinjury length and resting tension of the musculotendinous apparatus and minimized sural nerve injury.
Nerve Entrapment in Painful Heel Syndrome
Authors: Öztuna Volkan , Özge Aynur , Eskandari Metin M. , Çolak Mehmet , Gölpinar Alper , Kuyurtar Fehmi
Published: January 2017

Subcalcaneal heel pain is one of the most common foot ailments, yet the exact etiology is still controversial. Nerve entrapment has been suggested as one of the possible causes of this painful condition in recalcitrant cases. The purpose of this study is to determine the role of nerve entrapment in painful heels. Twenty patients with heel pain (25 heels) were compared with an age and body mass index-matched control population using electrodiagnostic methods. The results of the study revealed 22 heels (88%) with heel pain had lateral plantar nerve entrapment signs with or without medial plantar nerve findings on EMG. There were no abnormal values in the control group. Nerve entrapment syndrome has previously been considered only in cases with intractable heel pain, but this study suggests that it may play a role the early phases of painful heel syndrome.
The Shape of the Metatarsal Head as a Cause of Hallux Abductovalgus
Authors: Ferrari Jill , Malone-Lee James
Published: January 2017

The curvature of the 1st metatarsal head was evaluated on 100 radiographs by calculating the functional angle of the joint surface. This measure of curvature varied positively with the degree of hallux abductovalgus (HAV). Using measures of correlation it was found that in males, the association was linear (r2=0.39, p<0.001). In females, a linear relationship was identified only after logarithmic transformation of the data (r2=0.25, p<0.001). Comparison of the functional angle between males and females showed a significant difference (t=−5.03, df=98, p<0.001).
Comparison of Two Methods Used to Assess First-Ray Mobility
Authors: Glasoe Ward M. , Allen Mary K. , Saltzman Charles L. , Ludewig Paula M. , Sublett Sandy H.
Published: January 2017

Mobility of the first-ray is associated with several common lower extremity disorders. However, the reliability and validity of clinical measurement remains unclear. In this study we examined first-ray mobility by using one hand to stabilize the lesser metatarsals while the clinician's other hand applied a displacement force to the head of the first metatarsal. The amount of mobility was graded as stiff, normal or hypermobile. We then used a well-validated mechanical device to perform similar tests and assessed validity, intrarater reliability and interrater reliability. Three clinicians having varied levels of experience graded first-ray mobility on 15 subjects. A separate investigator measured dorsal mobility with a mechanical device. Both methods of testing were repeated to assess measurement reliability. Reliability was estimated by kappa (K) statistics. Spearman correlation assessed the relationship between mobility graded manually and dorsal mobility measured by device. Manual examination intrarater K values ranged from 0.50 to 0.85, and interrater agreement from 0.09 to 0.16. Manual grading was not related (r = −0.21) to the absolute measure of total dorsal mobility made by device. This brings into question the validity and reliability of manual estimates of first-ray mobility.
Extracorporeal Shockwave Therapy (ESWT) in Patients with Chronic Proximal Plantar Fasciitis
Authors: Hammer Dietrich S. , Rupp Stefan , Kreutz Andreas , Pape Dietrich , Kohn Dieter , Seil Romain
Published: January 2017

The aim of this study was to compare the effect of extracorporeal shockwave therapy (ESWT) in patients with chronically painful proximal plantar fasciitis with a conventional conservative treatment consisting of nonsteroidal anti-inflammatory drugs, heel cup, orthoses and/or shoe modifications, local steroid injections and electrotherapy. Forty-seven patients (49 feet) with a previously unsuccessful conservative treatment of at least six months were randomized to two groups. Treatment of Group 1 (25 heels) started immediately with three sessions of ESWT (3000 shockwaves/session of 0.2 mJ/mm2) at weekly intervals. In the patients of Group 2 (24 heels) treatment was continued for 12 weeks. After this period they were treated using the protocol of Group 1. No significant difference of pain and walking time after further non-ESWT treatment (three months) was seen. Six months after ESWT pain decreased by 64% to 88% on the visual analog scale (VAS) and the comfortable walking time had increased significantly in both groups.
The Functional Outcome of Displaced Intra-articular Calcaneal Fractures: A Comparison between Isolated Cases and Polytrauma Patients
Authors: Aktuglu Kemal , Aydogan Umur
Published: January 2017

This study was conducted to analyze the functional outcome of displaced intra-articular calcaneal fractures in polytrauma patients and isolated cases, and to make a comparison between them. Twenty-eight patients (12 women and 16 men) with an average age of 37 (range, 13 to 60) who had 35 displaced intra-articular calcaneal fractures were included in this study. Among these, 17 fractures were due to polytrauma and 18 were due to isolated trauma. According to Sanders CT classification, 19 fractures (54.3%) were classified as type II, 10 fractures (28.5%) as type III and six fractures (17.2%) as type IV. The treatment consisted of operative and closed methods. The average follow-up time was 38 months (range, 18 to 83 months). The functional outcome was evaluated using Maryland Foot Score and there were three (17%) excellent, nine (52.9%) good and five (29.5%) fair results in polytrauma patients Seven (38.8%) excellent, 10 (55.6%) good and one (5.6%) fair results were seen in isolated cases.

When compared with isolated cases, the functional outcome of displaced intra-articular calcaneal fractures in polytrauma patients was worse. With the findings available, it appears that foot trauma is usually ignored and should be treated without delay as for other system injuries in polytrauma patients.
Patellar Tendon-Bearing, Patten-Bottom Caliper Suspension Orthosis in Active Charcot Arthropathy: Crutch-Free Ambulation with No Weight Bearing in the Foot
Authors: Trepman Elly , Donnelly Patrick
Published: January 2017

A custom, patellar-tendon bearing (PTB), patten-bottom, caliper suspension orthosis was constructed for six patients with severe, active (Eichenholtz stage I) Charcot arthropathy of the ankle and hindfoot. With the orthosis, the suspended foot and ankle remained completely non-weight-bearing, and the lower extremity supported full weight bearing along the posterior and anterior leg shells and PTB crest. Four of the six patients used the orthosis to ambulate without crutches, leaving the upper extremities free for functional use. Frequent adjustment of the orthosis and skin examination were required. Minor problems with the orthosis included superficial skin breakdown and downward pistoning of the leg associated with improper, loose donning. Patient compliance was poor in four of the six patients because of general debility, difficulty with balance, and discomfort. However, in the other two patients, the absence of mechanical forces on the foot and ankle in the orthosis allowed the swelling and erythema of the active phase of Charcot arthropathy to resolve within several weeks, with maintenance of functional ambulation during the months required for healing of the Charcot process.
Functional Outcome of Multiply Injured Patients with Associated Foot Injury
Authors: Tran Trieu , Thordarson David
Published: January 2017

Fourteen polytrauma patients with foot injuries were compared to 14 polytrauma patients without foot injury in this review. The patients were selected from our institution's trauma registry. Criteria for selection included a minimum Injury Severity Score of 12 and a minimum follow-up of 12 months. The AAOS lower limb and foot and ankle outcomes data collection questionnaires were used to evaluate a patient's perception of the results. Marked differences were noted in the patients' physical function (80.7 vs. 38.9), role physical (87.5 vs. 41.1), bodily pain (81.9 vs. 50.6), social function (96.6 vs. 67.9), physical health and pain (83.3 vs. 43.5), satisfaction with symptoms (4.0 vs. 1.5), global foot and ankle (100 vs. 57.6), and shoe comfort scores (100 vs. 18.9) in foot injured vs. control patients, respectively. Although it is intuitively obvious that a patient with a foot injury vs. one without a foot injury who has suffered polytrauma may have a worse outcome, the profound differences in the above scores draw attention to the importance of the proper management of patients with musculoskeletal injuries who survive polytrauma injuries.
Symptomatic Bipartite Medial Cuneiform in an Adult Athlete: A Case Report
Authors: Chiodo Christopher P. , Parentis Michael A. , Myerson Mark S.
Published: January 2017

We present the case of a 32-year-old female marathon runner with a symptomatic bipartite medial cuneiform. The bipartite articulation was best visualized on a 30° external oblique radiograph of the foot. Surgical exploration revealed a noncartilaginous articulation between the two osseous segments. The smaller medial segment was excised. Postoperatively the patient's symptoms resolved, and at one-year follow-up she remains asymptomatic and has returned to competitive running. This case demonstrates that surgical excision is indicated for a symptomatic bipartite medial cuneiform that fails to respond to nonoperative measures.
Checkrein Deformity–Flexor Hallucis Tethering: Two Case Reports
Authors: Sanhudo José Antônio Veiga , Lompa Paulo Arlei
Published: January 2017

The authors present two cases of checkrein deformity, a tethering of the flexor hallucis longus (FHL) tendon, following ankle surgery. The first case was treated by tenolysis and tendon lengthening posterior to the ankle. The second case was treated by lengthening of the FHL at the midfoot, a more simple procedure which produced a better outcome and faster recovery. The authors recommend this latter treatment should be considered to treat this problem.
Stenosing Tenosynovitis of the Flexor Hallucis Longus Tendon at the Sesamoid Area
Authors: Sanhudo José Antônio Veiga
Published: January 2017

The author presents a case of stenosing tenosynovitis of the flexor hallucis longus tendon at the sesamoid area of the great toe following injury of the hallux. Although stenosing tenosynovitis of the flexor hallucis longus tendon is not rare, occurring frequently in ballet dancers, its entrapment at the sesamoid area was rarely described in the literature. Early recognition of this condition is very important for successful treatment. This patient did not respond to nonoperative treatment and surgical tenolysis was very successful for relief of the symptoms.
Pedobarometric Evaluation of the Normal Adult Male Foot
Authors: Imamura Marta , Imamura Satiko Tomikawa , Salomão Osny , Pereira César Augusto Martins , De Carvalho Antonio Egydio , Neto Raul Bolliger
Published: January 2017

Static and dynamic pedobarometric evaluations were performed on the feet of 100 normal adult white men aged from 20 to 49 years old (mean = 29.9±6.9), using version 3.848 of the F-SCAN system. All evaluations were performed using new pressure sensor insoles with standardized conditions. Maximum vertical forces and plantar peak pressure measurements were taken during 7.88 seconds each of walking in a straight line at subject's own pace and standing. Feet were separated based on their side and lower limb dominance. The means of three consecutive and three alternate tests provided quantitative data. Maximum static and vertical dynamic forces were found to be greater on the dominant side and were significantly correlated with body weight. There were significant differences between dominant and non-dominant sides in static plantar peak pressure evaluations at the forefoot and midfoot, and in the dynamic evaluations at the midfoot. There was a significant correlation between dynamic plantar peak pressures at the midfoot and body weight.
Posterior Tibial Tendon Force Requirement in Early Heel Rise After Calcaneal Osteotomies
Authors: Sung II-Hoon , Lee Samuel , Otis James C. , Deland Jonathan T.
Published: January 2017

Posterior tibial tendon insufficiency leads to decreased inversion strength. The purpose of this study was to measure the posterior tibial tendon force required to achieve early heel rise, defined as 7° of calcaneal plantar flexion and 5° of calcaneal inversion, in the intact foot and compare it to the requirements following medial displacement calcaneal osteotomy and following posterior distraction osteotomy. Thirteen cadaver specimens were loaded in a custom testing apparatus. The force required of the posterior tibial tendon to achieve early heel rise decreased from 399±50 N in the intact foot to 328±78 N (p<0.001) after medial displacement osteotomy and 206±122 N (p<0.001) after posterior distraction. Therefore, both the medial displacement and the posterior distraction osteotomies reduced the inversion demand at the posterior tibial tendon, with the distraction osteotomy being more effective in this reduction. Interestingly, these osteotomies also reduced the Achilles force required to achieve the heel rise position.
Treatment of Post-traumatic Ankle Arthrosis with Bipolar Tibiotalar Osteochondral Shell Allografts
Authors: Kim Choll W. , Jamali Amir , Tontz William , Convery F. Richard , Brage Michael E. , Bugbee William
Published: January 2017

We report on tibiotalar osteochondral shell allografts for post-traumatic ankle arthropathy in seven patients. Average follow-up was 148 months (range, 85 to 198). Patients were evaluated by a questionnaire, SF-12 survey, ankle score, physical exam and radiographs. The ankle score increased from 25 preoperatively to 43 at latest follow-up (maximum score 100). SF-12 scores increased from 30 to 38 (Physical Component) and 46 to 53 (Mental Component). The failure rate was 42%. Four of seven patients reported good or excellent results. Five patients stated they would undergo a similar procedure again. Complications included graft fragmentation, poor graft fit, graft subluxation, and non-union. Follow-up radiographs demonstrated joint space narrowing, osteophytes, and sclerosis, even in cases with excellent clinical status. Fresh osteochondral shell allografting may provide a viable alternative for the treatment of post-traumatic ankle arthrosis in selected individuals.
Posterior Tibial Tendon Transfer and Tendo-Achilles Lengthening for Equinovarus Foot Deformity Due to Severe Crush Injury
Authors: Atesalp Ali Sabri , Yıldız Cemil , Kömürcü Mahmut , Basbozkurt Mustafa , Gür Ethem
Published: January 2017

Surgical correction was performed on nine patients who had equinovarus deformity caused by severe crush injury of the leg sustained in an earthquake. The operative procedure used involved the transfer of the posterior tibial tendon to the dorsum of the foot by passing it through the interosseous membrane using a modified procedure as published in 1978. 5 This procedure was combined with percutaneous Achilles tendon lengthening and tenotomy of toe flexors when needed. The average follow-up time after the operation was 21 months. The treatment improved the heel-toe steppage gait in all patients and all were able to walk in standard shoes. There were no complications in the postoperative period. Recurrence of varus deformity was not seen in any of the patients. They had active dorsiflexion of the foot, with a median active dorsiflexion of 5° (0 to 10°) and median active plantarflexion of 16.1° (10 to 25°) compared to the median active dorsiflexion and plantarflexion on the uninvolved side. The total range-of-motion was 21.1° (10 to 35°).