bluuebunny/crossref_metadata_2025 huggingface dataset:
Tibiotalocalcaneal Arthrodesis: A Biomechanical Analysis of the Rotational Stability of the Biomet Ankle Arthrodesis Nail
Authors: Mann Michael R. , Parks Brent G. , Pak Shane S. , Miller Stuart D.
Published: January 2017

We hypothesized that the posterior-to-anterior (PA) calcaneal interlocking screw of the Biomet Ankle Arthrodesis Nail would increase rotational stability secondary to increased bone purchase compared with the standard lateral-to-medial (transverse) screw. Each of 10 fresh human cadaver lower limbs (five matched pairs) were stabilized with a nail inserted retrograde through the calcaneus, talus, and tibia according to standard technique. One limb of each pair was fixed with a transverse calcaneal screw; the contralateral limb, with a PA calcaneal screw. Each limb was then subjected to torsional testing on an MTS Mini Bionix load frame. The PA screw construct was significantly stiffer than the transverse screw construct: 1.96 and 1.41 Nm/E, respectively (P < 0.036).
Foot and Ankle Survey in Adults with Diabetes Mellitus
Authors: Reveal Gregory T. , Laughlin Richard T. , Capecci Piero , Reeve Fredrick M.
Published: January 2017

The purpose of this study was to examine the foot and ankle care patterns and shoe wear habits in patients with clinically proven diabetes mellitus who were attending diabetes education classes for the first time. One hundred subjects were recruited from outpatient adult diabetes education classes. No attempts were made to select patients on the basis of disease duration or severity. Each subject completed a questionnaire assessing life-style, shoe wear habits, health care status and interaction with healthcare providers.

Thirty-seven percent of the subjects reported prior foot problems. Twenty percent had their feet examined regularly and 59% had never had their feet examined. Foot problems reported were: corns 11%, calluses 11%, bunions 3%, ulcers 1%, gout 1%.

Sensation was tested using the 5.07 Semmes Weinstein monofilament across seven zones of the plantar surface of the foot. Subjects unable to feel this varied from 5% to 20% in each of the zones.

Shoe wear was assessed for fit and style. Thirty percent of the patients had shoes that were too narrow and 81% of the patients with poorly fitting shoes were women. Shoe wear history and factors influencing shoe selection were recorded.

Diabetes mellitus is a common disease, often affecting the feet. Preventive care can help patients deal with the manifestations of diabetic neuropathy. This study showed that a low percentage of subjects with diabetes regularly have their feet examined and that a relatively high percentage (31%) wear shoes that are too narrow. Identifying these patients early may allow modification of habits that put their feet at risk.
Development of a Nurse-Provided Health System Strategy for Diabetic Foot Care
Authors: Pinzur Michael S. , Keman-Schroeder Diane , Emanuele Nicholas V. , Emanuel MaryAnn
Published: January 2017

A nurse-provided university health system diabetic foot screening/education/treatment program evaluated 403 patients in the initial 12 months of development. All patients were provided individualized foot-specific patient education, varying in intensity with the magnitude of their risk status. One hundred and forty-five (36%) were categorized as being at risk for the development of a diabetic foot ulcer. Improper footwear capable of producing foot ulceration was recorded in 268 (66.5%) of the enrollees. Seven patients with previously undiagnosed Charcot foot disorder were identified. Eighty-three of the enrollees were seen at least once in follow-up. Sixty-one (73%) used improper footwear at the initial evaluation, which was decreased to 36 (43%) at the first follow-up visit.

Nurse-provided foot-specific diabetic screening and education, combined with protective footwear, has been shown to be a cost- and resource-effective method of decreasing the rate of diabetic foot ulcers, and the risk for eventual lower extremity amputation.
First Metatarsophalangeal Arthrodesis: A Clinical, Pedobarographic and Gait Analysis Study
Authors: DeFrino Paul Francis , Brodsky James White , Pollo Fabian E. , Crenshaw Stephanie J. , Beischer Andrew D.
Published: January 2017

This study investigated the results of first metatarsophalangeal (MTP) arthrodesis in terms of clinical outcome measures, plantar pressure distribution, and gait patterns. Ten feet in nine patients with severe hallux rigidus (HR) who underwent first MTP arthrodesis were studied. The preoperative evaluation included a subjective questionnaire, physical exam, AOFAS hallux score, radiographs and dynamic pedobarography (EMED). At follow-up (average 34 months) these were repeated, and gait analysis studies were obtained. Patients showed significant clinical improvement based on the subjective criteria. The mean AOFAS score improved from 38 preoperatively to 90 postoperatively. Postoperative EMED analysis showed restoration of the weightbearing function of the first ray, with greater maximum force carried by the distal hallux at toe-off. Kinematic and kinetic gait analysis from each patient's operative limb were compared to the unaffected contralateral limb and to age- and sex-matched healthy subjects. The kinematic data indicated a significantly shorter step length with some loss in ankle plantar flexion at toe-off on the fused side. The kinetic data indicated a reduction in both ankle torque and ankle power at push-off. Clinical results indicated effective pain relief and a high level of patient satisfaction, consistent with previous reports in patients with symptomatic Hallux Rigidus.
An Evaluation of Two Foot-Specific, Health-Related Quality-of-Life Measuring Instruments
Authors: Landorf Karl B. , Keenan Anne-Maree
Published: January 2017

In the past decade, health-related quality-of-life (HRQoL) assessment has become an important tool to measure change as a result of treatment in clinical trials. The aim of this project was to compare and contrast two foot-specific HRQoL questionnaires: the Foot Function Index (FFI) and the Foot Health Status Questionnaire (FHSQ). To assist in this process, a quasi-experimental trial was performed to evaluate the effectiveness of foot orthoses in improving HRQoL in people suffering from plantar fasciitis. The results from this study found that the FFI is generally less responsive to change, particularly in the domain of Activity Limitation. Nevertheless, significant improvements were found for two out of the three domains (Pain and Disability, but not Activity Limitation) for the FFI, as well as the overall score of FFI. In contrast, all four domains (Pain, Function, Footwear and General Foot Health) of the FHSQ showed significant improvement. Our experience with the questionnaires also revealed that certain questions in the Activity Limitation domain of the FFI can lead to inconsistent scoring, thus casting doubts over the suitability of this domain for use with patients with plantar fasciitis. Therefore, the FHSQ has several advantages when evaluating HRQoL in patients being treated with foot orthoses for plantar fasciitis, and should be viewed as the preferred questionnaire.
Visualization of Ankle Tendons and Ligaments with MR Imaging: Influence of Passive Positioning
Authors: Farooki Sheila , Sokoloff Ronald M. , Theodorou Daphne J. , Trudell Debra J. , Clopton Paul , Feng Sunah A. K. , Resnick Donald
Published: January 2017

Purpose:

To determine if passive positioning of the ankle influences the MR imaging appearance of ankle tendons and ligaments.

Methods:

A positioning device was used during imaging of 10 volunteers. Axial and coronal T1-weighted images were acquired in six positions of the ankle, and the appearance of the tendons and lateral ligaments was subjectively evaluated.

Results:

The peroneus longus (PL), peroneus brevis (PB), anterior tibialis (AT), extensor digitorum longus (EDL), and extensor hallucis longus (EHL) tendons were best visualized in 20° of plantarflexion and 20° of inversion (p<0.0001). The anterior talofibular (ATF) and calcaneofibular (CF) ligaments were best seen in 20° of plantarflexion (p<0.0001). Ten degrees of dorsiflexion was the least useful imaging plane for all of the aforementioned structures.

Conclusion:

When there is clinical concern regarding pathology of a specific structure about the ankle, passive positioning may allow optimal evaluation.
Ultrasonography of Non-Traumatic Rupture of the Achilles Tendon Secondary to Levofloxacin
Authors: Cebrian Paloma , Manjon Palmira , Caba Pedro
Published: January 2017

Rupture of Achilles tendon (AT) is an uncommon complication of treatment with fluoroquinolones. We describe a case of bilateral tendinosis and rupture of the right AT in a patient who began levofloxacin treatment for community acquired pneumonia. Sonography showed thickening and hypoecogenicity of both AT and complete rupture and separation of the right Achilles tendon.
Tarsal Tunnel Syndrome Associated with an Accessory Muscle
Authors: Kinoshita Mitsuo , Okuda Ryuzo , Morikawa Junichi , Abe Muneaki
Published: January 2017

Between 1986 and 1999, we surgically treated 41 patients (49 feet) with Tarsal Tunnel Syndrome (TTS) in whom seven (eight feet) were associated with an accessory muscle. An accessory flexor digitorum longus muscle was present in six patients, and an accessory soleus muscle was in one patient (both feet). Three of them were males and four females, with the mean age of 33.1 years (12 to 59 years).

The mean interval from the onset of symptoms to operation was 7.5 months (range, six to nine months). All patients with an accessory muscle had a history of trauma or strenuous sporting activity. The diagnosis of TTS was made based on physical findings in all the patients (eight feet) and confirmed in five patients (six feet) by electrophysiological examination. Imaging examinations (radiography, ultrasonography, MRI) revealed abnormal bone and soft tissue lesions in and around the tarsal tunnel. Preoperative signs and symptoms disappeared average 4.1 months after decompression of the tibial nerve in addition to excision of the muscle. No functional deficit was observed at final follow-up (24 to 88 months).
Suture-Endobutton Fixation of Ankle Tibio-Fibular Diastasis: A Cadaver Study
Authors: Thornes Brian , Walsh Alan , Hislop Matt , Murray Paraic , O'Brien Moira
Published: January 2017

Suture-Endobutton fixation is proposed as a minimally invasive, flexible fixation of ankle tibio-fibular diastasis, which would not require routine removal. This study tested the Suture-Endobutton construct in a cadaver syndesmosis injury model and compared this against A.O. syndesmosis screw fixation. Sixteen embalmed cadaver legs were used. Phase one consisted of placing the leg in a jig, generating an external rotation torque and measuring diastasis with increasing intraosseous membrane division. Phase two then compared the Suture-Endobutton construct vs. single four-cortex 4.5 mm A.O. screw fixation. Diastasis increased significantly with increasing intraosseous membrane division (p<0.001). No significant differences were seen in the mean rate of failure between the Suture-Endobutton and A.O. screw fixation. However, the Suture-Endobutton did give a significantly more consistent performance; the distribution of standard deviations for A.O. screw fixation was 0.64 mm higher than that for the Endobutton (95% C.I. 0.46 to 0.84). These results show that Suture-Endobutton fixation at least equals the performance of screw fixation and encourages clinical trials in ankle injuries with a syndesmosis diastasis.
Operative Repair of Fourth and Fifth Toe Corns
Authors: Coughlin Michael J. , Kennedy Michael P.
Published: January 2017

Methods:

We report a retrospective review of 57 consecutive patients (72 feet) over a period of 20 years who had been treated operatively for either a lateral fifth toe corn or an interdigital corn of the fourth interdigital space more than two years previously. Of these, 51 patients (62 feet) returned for a follow-up evaluation at a minimum of two years (average of over seven years) which included a review of the interval history since the surgery, a physical examination, a radiographic evaluation, and assessment of the patient's satisfaction with the alignment and results of surgery. Treatment of 31 lateral fifth toe corns involved either a lateral condylectomy and flexor tenotomy or a complete condylectomy. Treatment of 31 interdigital corns comprised either a single condylectomy, double condylectomy of adjacent corns, or a complete condylectomy (hammertoe repair) of a symptomatic corn. Treatment in each case was dependent upon the severity of the deformity.

Results:

There was found to be no significant difference in comparison of the two major groups (interdigital corns and lateral fifth toe corns) with the measurement of the relative length of the fourth and fifth metatarsals, toe malalignment, angulation of the fourth and fifth toes (MTP-4, MTP-5 angles), and the phalangeal-5 angle. Pain was relieved in 58 of 62 feet (93%) and subjective acceptable alignment was achieved in 54 of 62 feet (87%). At final follow-up 53 feet were rated by patients as excellent, seven as good, one as fair, and one as poor. Complications included numbness of the involved digit (six feet). There were two superficial infections. There were two cases of joint instability due to excessive bone resection. Joint stiffness was commonly observed (34/62 feet, 55%), but was not associated with diminished satisfaction at final follow-up. Mild asymptomatic recurrence of a callosity was noted in 10 feet and moderate or severe recurrence was noted in two feet. Dissatisfaction was associated with moderate or severe recurrence.

Conclusion:

In this retrospective study at an average of more than seven years, we achieved a high level of patient satisfaction treating both lateral fifth toe corns and interdigital corns with a partial and/or complete condylectomy, the choice depending upon the magnitude of the deformity and the callus, and the fixed nature of the lesser toe deformity.
Injury Characteristics and the Clinical Outcome of Subtalar Dislocations: A Clinical and Radiographic Analysis of 25 Cases
Authors: Bibbo Christopher , Anderson Robert B. , Davis W. Hodges
Published: January 2017

The objective of this study was to determine the mechanisms of injury and pattern of associated foot and ankle injuries and systemic injuries associated with subtalar dislocations, and, correlate these data with the radiographic and clinical/functional outcome of patients after subtalar dislocation.

Results:

Twenty-five patients with a subtalar dislocation were identified over a seven year period. The mean patient age was 38 years. Males (n=19) comprised 76% of patients, with a mean age of 36 years. High energy mechanisms (motor vehicle accidents, falls) accounted for 68% of subtalar dislocations. Although high energy mechanisms showed a strong trend toward open subtalar dislocations, the association was not statistically significant (p=0.0573, Fisher's exact test). Closed dislocations predominated (75%). Left and right-sided dislocations were nearly equally distributed, even among motor vehicle accidents. Medial dislocations predominated (65%): these were not influenced by mechanism of injury and did not result in statistically lower AOFAS ankle/hindfoot scores. Subtalar dislocation was irreducible (requiring open reduction) in 32%, with higher energy mechanisms of injury being statistically associated with an irreducible subtalar dislocation (p=0.0261, Fisher's exact test). Block to reduction was evenly distributed among soft tissue elements (posterior tibial tendon, flexor hallucis longus tendon, capsule, extensor retinaculum) and osseous elements. Eighty-eight percent of patients incurred concomitant injuries to the foot and ankle (95% of which were closed injuries), namely, the ankle and talus. Systemic injuries occurred in 88% of patients. At a mean follow-up of five years, the mean AOFAS score of the subtalar dislocation side was significantly lower (mean=71 vs. 93, p=0.0007, unpaired Student's t-test). No statistical relation was found between the number of associated extremity injuries and AOFAS score (Spearman correlation coefficient, r=(–)0.236, p=0.331). Radiographic follow-up demonstrated 89% of ankles with radiographic changes (31% symptomatic); however, the majority of these patients (61%) had an associated ankle injury. The subtalar joint demonstrated radiographic changes in 89% of patients, with 63% being symptomatic; 75% of patients with subtalar joint changes incurred a fracture about the subtalar joint at the time of dislocation. Four patients went on to subtalar fusion at an average of 8.8 months post-dislocation. The midfoot showed radiographic changes in 72% of patients, with only 15% of these patients being symptomatic. All patients with midfoot symptoms were well controlled by nonsurgical measures.
Review: Acute Compartment Syndrome of the Foot
Authors: Fulkerson Eric , Razi Afshin , Tejwani Nirmal
Published: January 2017

Foot compartment syndrome is a serious potential complication of foot crush injury, fractures, surgery, and vascular injury. The purpose of this article is to summarize and review the existing literature on this entity. Long-term sequelae of foot compartment syndrome (FCS) include contractures, deformity, weakness, paralysis, and sensory neuropathy. These complications are poorly tolerated, and often necessitate multiple procedures for rehabilitation. Therefore, the threshold for considering compartment syndrome and performing fasciotomy must be low to minimize such outcomes. The existence of nine foot compartments and frequent presence of complicating injuries necessitate multi-stick needle catheterization for direct measurement of compartment pressures. Fasciotomy is indicated when compartment pressure exceeds 30 mmHg, or if compartment pressure is greater than 10–30 mmHg below diastolic pressure. The approaches for compartment decompression generally include two dorsal incisions for access to forefoot compartments, and one medial incision for decompression of the calcaneal, medial, superficial, and lateral compartments.
Accuracy of Arthroscopic Assessment of Anterior Ankle Cartilage Lesions
Authors: Schäfer Dirk , Boss Andreas , Hintermann Beat
Published: January 2017

Purpose:

The accuracy of arthroscopic evaluation of the size of an osteochondral lesion in the ankle joint was assessed in 10 cadaver feet.

Materials and Methods:

A rectangular osteochondral defect was created in the anterior part of the talus. A 5 mm 30° arthroscope was utilized for evaluation of the size of the lesion from an anterior midline portal under carbon dioxide.

Results:

The size of the defect averaged 77.2±31 mm 2 (24–108 mm 2 ). The difference between area of the defect and measurement of three independent investigators averaged 52%, 49% and 49%, respectively.

Conclusion:

The assessment of the size of an osteochondral lesion in the ankle joint based on arthroscopy implicates over- and underestimation of the defect.
Revision of Ankle Arthrodesis
Authors: Cheng Yuh-Min , Chen Shen-Kai , Chen Jian-Chih , Wu Wen-Lan , Huang Peng-Ju , Chiang Hsiu-Chu , Lin Chen-Yu
Published: January 2017

From 1989 to 1996, we treated 18 cases (10 males, eight females; average age 48.2 years) of failed ankle arthrodesis by revision of ankle arthrodesis and followed their progress for at least two years. The average time interval between original surgery and revision was 17.3 months. Revisions were needed due to infection in one case, nonunion in 10 cases, and malalignment in seven cases. The salvage operations included debridement in the infected case, refreshed pseudoarthrosis in nonunion cases, and corrective osteotomy in malalignment cases. Sixteen cases were fixed by crossed screws with internal compression, one infected case was fixed by an external fixator, and one case with bone loss was fixed with buttress plate. The average follow-up period was 40.4 months. There was one nonunion and two delayed unions, with an ultimate fusion rate of 94%. The average AOFAS ankle-hindfoot score was 70.9 at final follow up. There was one excellent result (5.6%), five good results (27.8%), 11 fair results (61%), and one poor result (5.6%), and the overall results were poorer compared with our series of primary arthrodesis. The time to fusion also took longer in the revision cases (average 2.7 months in primary cases and 4.8 months in revision cases). Fusion techniques that ensure solid union in a functional position are essential. If an ankle arthrodesis fails, however, revision is a salvage procedure that can achieve an acceptable result.
Radiographic Changes in Forefoot Geometry with Weightbearing
Authors: Fuhrmann Renée A. , Layher Frank , Wetzel Wolf D.
Published: January 2017

Quality assessment of forefoot surgery depends mainly on weightbearing radiographs. A prospective study has been performed to compare the influence of weightbearing on forefoot geometry. Dorsoplantar radiographs for weightbearing and non-weightbearing conditions were performed in 99 patients. Hallux valgus angle, the intermetatarsal angles between the first and second and first and fifth metatarsals and intermetatarsal distance were measured using an interactive digitizer connected to a computer. The intermetatarsal angles showed a statistically significant increase during weightbearing. Unrelated to the severity of hallux valgus deformity, hallux valgus angles demonstrated an inverse behavior showing larger values under non-weightbearing conditions. For that reason, radiological evaluation of forefoot geometry strictly requires similar weightbearing conditions and comparable positioning of the foot.
Malunion following Trimalleolar Fracture with Posterolateral Subluxation of the Talus — Reconstruction Including the Posterior Malleolus
Authors: Weber Martin , Ganz Reinhold
Published: January 2017

Malunion after a malleolar fracture can include a displaced posterior malleolus with associated posterolateral subluxation of the talus. Corrective osteotomy including the posterior malleolus was performed in four patients. Joint congruity was obtained in every case. The patients were followed for 46 to 80 months postoperatively. They all experienced an improvement in pain and three of four patients were unlimited in their walking capacity. Mild to moderate residual symptoms were frequent. The symptoms were attributed to the damage of the cartilage and soft-tissues both from the initial injury and from weightbearing on the incongruous joint. Discrete, non-progressive osteophytes were seen in all patients. Delay in reconstruction did not preclude a good result, although early reoperation is felt to be preferable.
The Relationship of the Position of the Metatarsal Heads and Peak Plantar Pressure
Authors: Weijers René E. , Walenkamp Geert H.I.M. , van Mameren Henk , Kessels Alphons G.H.
Published: January 2017

We test the premise that peak plantar pressure is located directly under the bony prominences in the forefoot region. The right foot of standing volunteers was examined in three different postures by a CT-scanner. The plantar pressure distribution was simultaneously recorded. The position of the metatarsal heads and the sesamoids could be related to the corresponding local peak plantar pressures. The metatarsal heads 1, 4, and 5 had a significantly different position than the local peak plantar pressures. The average difference in distance between the position of the metatarsal heads and the peak plantar pressure showed a significant correlation: on the medial side the head was located more distally to the local peak plantar pressure, on the lateral side more proximally. The findings suggest that normal plantar soft tissue is able to deflect a load. The observations might improve insight into the function of the normal forefoot and might direct further research on the pathological forefoot and on the design of footwear.
MR Morphometry of Posterior Tibialis Muscle in Adult Acquired Flat Foot
Authors: Wacker Juergen , Calder James D.F. , Engstrom Craig M. , Saxby Terence S.
Published: January 2017

We conducted magnetic resonance imaging of the posterior tibial (PT) and flexor digitorum longus (FDL) muscle bellies in 12 patients undergoing surgical treatment for unilateral posterior tibial tendon (PTT) dysfunction. All patients had atrophy of the PT muscle compared to the normal leg (mean 10.7%, p=0.008). In those patients with a complete rupture of PTT there was replacement of the PT muscle by fatty infiltration. Conversely, the FDL muscle showed a compensatory hypertrophy (mean 17.2%, p<0.002). We support the use of FDL as an appropriate tendon for augmentation of PTT in stage II disease. This study also demonstrates that in the presence of a complete rupture, excision of the PTT is a reasonable surgical procedure and pure tenodesis will be more likely to fail because the PT muscle belly undergoes fatty infiltration. In patients with a diseased but intact PTT there was no fatty infiltration and the muscle volume was at least 83% of the normal side in all cases. We therefore suggest that in the presence of an intact PTT the PT muscle belly may provide some useful function if used to augment the FDL transfer when the diseased tendon is excised.
Bilobed Flaps for Nonhealing Ulcer Treatment
Authors: Yetkin Haluk , Kanatli Ulunay , Öztürk Akif Muhtar , Özalay Metin
Published: January 2017

Healing of round ulcers may be difficult particularly in the plantar area. Rigidity and thickness of the plantar skin do not allow fusiform excision and primary suturing. The bilobed flap is a simple reconstructive technique principally used to repair substantial defects in the facial region. The authors' experience with this local flap in the foot is presented with good short-term results. Between 1995 and 1998, five female and seven male neuropathic foot patients with round plantar ulcers were treated with bilobed flaps. The average age of the patients was 50 (range, 15–76). The average size of the ulcers was 1.6 cm (1–3.2 cm). Debridement and orthotic insoles were used at least for 3 months before considering bilobed flaps. Seven patients were diagnosed as type II diabetes mellitus, four patients had cerebral palsy, and another patient had meningomyelocele. The minimal follow-up period was 1 year (average, 19.5 months). The only complication was wound dehiscence at the lateral side of the heel in a type II diabetic. Subsequently, this complicated ulcer was managed with a sliding flap and skin graft without further problem. The study concluded that nonhealing foot ulcers can be effectively treated with a bilobed skin flap of healthy tissues rotated from nonweightbearing parts of the sole.
Results of Chronic Achilles Tendinopathy Surgery on Elite and Nonelite Track Athletes
Authors: Saxena Amol
Published: January 2017

Twenty-seven track athletes/runners with chronic Achilles tendinopathy underwent a retrospective review of 37 surgical Achilles procedures performed between 1990 and 1999. There were 22 males and 5 females. Average age of the group was 36.6 years (range, 16–75 years). The mean “return to activity” (RTA) was 10.6 ± 6.3 weeks. For elite athletes, RTA was 7.9 ± 4.8 weeks. For nonelite athletes, RTA was 15.0 ± 6.2 weeks, and was statistically higher ( p = .003). There was no significant difference between males' and females' RTA. Average follow-up for the group was 4.7 years (range, 1–10 years). Runners on average ran more than 60 miles a week. There were 14 elite and 13 nonelite athletes, including four Olympians, five sub-4-minute milers, and four National Champions. Return to competition and “100%” were 25.0 and 25.4 weeks, respectively, for the elite group. Return to competition for the nonelite group was 27.0 ± 11.0 weeks. Eighteen patients underwent peritenolysis with a mean RTA of 7.7 weeks. Of this group, four patients with concomitant bony procedures had significantly slower RTA as opposed to the 14 patients who had peritenolysis only (mean, 4.5 weeks). Four patients had Achilles debridement for mucoid degeneration, and a mean RTA of 12.8 weeks. Eleven patients had Haglund-type procedure (retrocalcaneal exostectomy) had a mean RTA of 15.1 weeks. Six Achilles tendocalcinosis repair patients had a mean RTA of 12.0 weeks. There were three reoperations, two of which were performed by the author. Using the Testa Achilles tendon surgery rating scale, this group of patients had 34 “excellent” and 3 “good” results. The patients who underwent a reoperation were able to achieve “good” or better results.
Osteochondral Autografts for Osteochondritis Dissecans of the Talus
Authors: Lee Chian-Her , Chao Kuo-Hua , Huang Guo-Shu , Wu Shing-Sheng
Published: January 2017

Eighteen symptomatic advanced-stage osteochondritis dissecans (OCD) of the talus (Berndt and Harty stages III 7 and IV 11) in 17 patients were treated with multiple autogenous osteochondral cylindrical grafts. The mean time of follow-up was 36 months (range, 25–49). The average age at surgery was 22.7 years (range, 19–34). The mean size of defect of OCD was 13.6 mm × 7.2 mm. Two or three osteochondral grafts (6 or 7 mm in diameter and 15–20 mm in length) were harvested from the superomedial margin of the ipsilateral knee. A partial osteotomy of the medial malleolus or osteotomy of the distal lateral tibia was performed for all cases. Being evaluated by the Freiburg ankle score, 16 of 18 ankles (88.8%) had excellent and two (11.8%) had good results. “Second-look” arthroscopy of 16 ankles revealed consistency of the osteochondral grafts and congruity between grafts and native cartilage in 14 (87.5%), and a softening or fissuring of the osteochondral graft in two. Our results showed that this procedure provided an effective treatment for a symptomatic advanced-stage OCD of the talus.
A Protocol for Treatment of Unstable Ankle Fractures Using Transarticular Fixation in Patients with Diabetes Mellitus and Loss of Protective Sensibility
Authors: Jani Mihir M. , Ricci William M. , Borrelli Joseph , Barrett Susan E. , Johnson Jeffrey E.
Published: January 2017

Background: Surgical treatment of ankle fractures in patients with diabetes mellitus is associated with a high complication rate. Diabetic patients with peripheral neuropathy are a particularly difficult group to treat because of their inability to sense deep infection, repeat trauma, and wound complications. The purpose of this study was to evaluate a protocol that included transarticular fixation and prolonged, protected weightbearing in the treatment of unstable ankle fractures in diabetic patients with peripheral neuropathy and loss of protective sensibility. Methods: The authors retrospectively reviewed the records of 15 patients with diabetes mellitus, unstable ankle fractures (AO classification 44B), and loss of protective sensibility confirmed via testing with a 5.07 Semmes-Weinstein monofilament. Retrograde trans-calcaneal-talar-tibial fixation using large Steinmann pins or screws in conjunction with standard techniques of open reduction and internal fixation was used. The postoperative treatment protocol included: 1) short leg, total contact casting and nonweightbearing status for 12 weeks; 2) removal of the intramedullary implants between 12 and 16 weeks; 3) application of a walker boot or short leg cast with partial weightbearing for an additional 12 weeks; and 4) transition to a custom-molded ankle-foot orthosis (AFO) or custom total-contact inserts in appropriate diabetic footwear. Results: The major complication rate for all fractures was 25% (4/16) and for closed fractures was 23% (3/13). These are lower than previously reported rates between 30% (3/10) and 43% (9/21) for diabetic patients with and without neuropathy. The amputation rate for all fractures was 13% (2/16) and for closed fractures alone was 8% (1/13). These are similar to previously reported rates of 10% (2/10) to 20% (2/21). There were no deaths or Charcot malunions in this series. The combination of transarticular fixation and prolonged, protected weightbearing provided 13 of 15 patients with a stable ankle for weightbearing. Conclusion: Although these fractures remain a treatment challenge, this study presents a successful, multidisciplinary protocol for treatment of unstable ankle fractures in the most challenging group of diabetic patients – those with loss of protective sensibility.
Strength Analysis and Comparison of the Teno Fix® Tendon Repair System with the Two-Strand Modified Kessler Repair in the Achilles Tendon
Authors: Lewis Nicky , Quitkin H. Matthew
Published: January 2017

Background: Various options exist for repair of Achilles tendon ruptures, yet a method that consistently provides sufficient gap resistance to allow early mobilization remains elusive. This study compares the mechanical performance of a modified Kessler repair with that of the Teno Fix® Tendon Repair System (Ortheon Medical, LLC) in matched pairs of cadaver Achilles tendons. Methods: The two-strand modified Kessler repair was selected as the control construct on the basis of literature review and physician interviews which identified it among the many options as a popular method for repair of acutely ruptured Achilles tendons. Test specimens were harvested from matched pairs of cadaver ankles. The tendons were transected 3.5 cm proximal to the calcaneal insertion and repaired with either the two-strand modified Kessler suture construct or the Teno Fix Tendon Repair System. Assignment to the modified Kessler or Teno Fix group was done randomly for the first member of each pair. All test and control repairs were performed by the same author to reduce variability. Evaluation of the repairs consisted of tensile strength testing and measurement of the gap formation and peak stresses. Results: Gap and peak stress for the two-strand modified Kessler repair were 0.30 ±0.15 N/mm 2 and 1.03 ±0.51 N/mm 2 , respectively. For the Teno Fix repairs the mean gap and peak stress values were 0.80 ± 0.46 N/mm 2 and 1.19 ± 0.12 N/mm 2 , respectively. The mean gap formation stress was significantly higher in the Teno Fix repairs than in the control repairs ( p <.0005). There was no significant difference in peak strength between the repairs ( p <.10). Conclusions: The Teno Fix repair was superior to the modified Kessler repair. In the Teno Fix repairs, the gap formation stress was 67% of the peak tensile stress. In comparison, in the modified Kessler repairs, the gap formation stress was 29% of the peak stress. This can be correlated to the elastic property of the modified Kessler suture and the initial tightening of the suture around the tendon fibers. The Teno Fix system is nonelastic and is fully tensioned during installation. This lends to a more gap resistant repair.
Symptom Duration of Plantar Fasciitis and the Effectiveness of Orthotripsy®
Authors: Alvarez Richard G. , Ogden John A. , Jaakkola Juha , Cross G. Lee
Published: January 2017

Background: The use of surgically noninvasive application of Orthotripsy® (extracorporeal shock waves) for various musculoskeletal disorders is being increasingly utilized. Because most patients have had prolonged symptoms refractory to nonoperative treatments, this study evaluated the effectiveness of electrohydraulic Orthotripsy for chronic proximal plantarfasciitis compared to the duration of symptoms prior to treatment. Methods: Following evaluation for study inclusion (unresponsive symptoms for more than 6 months), qualified patients received Orthotripsy or placebo. The study patients were randomized per described protocol. Additional groups of nonrandomized patients also were studied. Results: In both the randomized and nonrandomized patient groups, those who received Orthotripsy were slightly more likely to have a positive result (complete symptom relief or satisfactory improvement) if symptoms had been present and unresponsive to other nonoperative therapeutic attempts for less than 2 years. The same trend was evident in patients undergoing a second Orthotripsy application. In the placebo group, there was no correlation between symptom duration and outcome. However, when placebo patients crossed over to the treatment arm of the study, the same response was evident: patients with symptoms for less than 2 years were slighty more likely to have a positive therapeutic response. Interestingly, the two patients with the longest duration of symptoms (15 and 18 years) both had complete symptom relief. Conclusions: The longevity of symptoms of chronic proximal plantar fasciopathy had a minimal impact on the likelihood of a positive response to Orthotripsy.
Flexor Hallucis Longus Tendon Transfer: Evaluation of Postoperative Morbidity
Authors: Coull Roderick , Flavin Robert , Stephens Michael M.
Published: January 2017

Clinical and pedobarograph evaluation was performed on 16 patients following flexor hallucis longus (FHL) tendon transfers to determine the resulting morbidity due to the loss of FHL function. All patients underwent FHL tendon transfer for either chronic tendon Achilles rupture or chronic Achilles tendinosis. Clinical evaluation of hallux function was performed using the American Orthopaedic Foot and Ankle Society (AOFAS) hallux metatarsophalangeal-interphalangeal scale, the SF-36 score, and a clinical questionnaire to assess alteration in the clinical function of the hallux during activities of daily living. Pedobarography was carried out using the Musgrave pedobarograph system to detect changes in forefoot loading in comparison to the contralateral normal foot. Fourteen of the 16 patients scored maximally on the hallux metatarsophalangeal-interphalangeal scale and none of the patients noticed functional weakness of the hallux during activities of daily living at a mean follow-up of 43.6 months (range, 5–120 months). Pedobarograph readings showed a trend toward reduction in peak pressure loading on the distal phalanx, but this was not significant for the numbers of patients studied. There was no significant increase in loading of the first or second metatarsophalangeal joints to suggest that transfer metatarsalgia may complicate FHL tendon transfer. According to the results of the study morbidity from FHL transfer should be clinically insignificant.
Use of Computer-Assisted Learning Module to Achieve ACGME Competencies in Orthopaedic Foot and Ankle Surgery
Authors: Thomas Ruth L. , Allen Ruth M.
Published: January 2017

The Accreditation Council for Graduate Medical Education (ACGME) has charged academic institutions with finding methods to assess learning in specific areas of resident education. Computer-assisted education offers a reliable mode for teaching residents important information and skills. The CD-ROM “Fundamentals of Orthopaedic Foot Care,” produced by the American Academy of Orthopaedic Surgeons, was tested as a tool to provide nonoperative foot and ankle care education for a group of orthopaedic residents ( N = 14) and a group of family practice residents ( N = 11). The CD-ROM's educational format includes an interactive tutorial on anatomy, video demonstrations on selected topics in physical examination and basic treatment of nonoperative problems of the foot and ankle, and patient education information sheets on multiple common foot disorders. Both resident groups scored significantly higher on their post-test exams after spending 1 hour with the computer program ( p ≤ .05). This study suggests that this program can be used reliably in an orthopaedic residency program to achieve ACGME required competency of “medical knowledge” in evaluation and nonoperative management of common foot and ankle problems.
Open Reduction for Intra-articular Calcaneal Fractures: Evaluation Using Computed Tomography
Authors: Kurozumi Taketo , Jinno Yasushi , Sato Toru , Inoue Hajime , Aitani Tetsuro , Okuda Kazuhiro
Published: January 2017

Radiographic and computed tomography features of unilateral intra-articular calcaneal fractures after open reduction and internal fixation were compared with late functional outcomes to identify prognostic factors. Sixty-one of 67 patients treated between 1997 and 2002 could walk painlessly postoperatively (average, 19.7 months). Functional results (Laasonen's criteria) were excellent or good in 92.5%. Factors associated with better functional results were lower age ( p = .0227), greater Böhler angle at the time of injury ( p <.0001), lower Sanders' grade ( p = .0497), increased height of fractured regions ( p = .0249), better reduction of the posterior facet ( p = .0126), and better reduction of the calcaneocuboid joint ( p = .0023). Only the latter two were found to be surgical prognostic factors.
Bilateral Calcaneal Fractures: Operative Versus Nonoperative Treatment
Authors: Dooley Paul , Buckley Richard , Tough Suzanne , McCormack Bob , Pate Graham , Leighton Ross , Petrie Dave , Galpin Bob
Published: January 2017

Background: There is poor information in the literature regarding patients who suffer from bilateral calcaneal fractures. The objective of this study was to analyze demographic characteristics and objective clinical features of patients with bilateral calcaneal fractures as well as subjective outcomes following either operative or conservative management. It was a prospective randomized trial. It was performed at four level 1 trauma centers. Methods: Forty-seven patients sustaining bilateral calcaneal fractures were randomized to either operative (open reduction and internal fixation) or conservative treatment groups. Demographic features and fracture patterns were compared between those sustaining unilateral fractures (large calcaneal database) and those sustaining bilateral fractures. Following treatment, comparison of both objective outcome measures (Bohler's angle and subtalar range of motion) and subjective outcomes, as measured by the previously validated visual analogue scale (VAS) and SF-36 scores, was performed. Outcomes were also compared (with existing data from trauma database) for those treated for unilateral calcaneal fracture. Results: No difference in demographic features was found between individuals suffering unilateral and bilateral calcaneal fractures. Among bilaterally injured patients, initial Bohler's angle was slightly, but significantly, more depressed relative to that in the unilateral comparison data ( p < .05). Post-treatment range of motion was significantly better when injury was confined to one side regardless of treatment modality ( p < .01). Surgical intervention did not significantly affect subjective patient outcome as measured by either SF-36 or the VAS. This remained true following stratification by Worker's Compensation Board (WCB) status. However, those who were treated nonoperatively were significantly more likely to require late subtalar arthrodesis ( p < .05). In general, patients whose injury was not associated with a WCB claim demonstrated significantly better subjective outcomes ( p < .01 for SF-36 and VAS). Conclusions: Other than demonstrating a slightly more depressed Bohler's angle, patients sustaining bilateral calcaneal fractures are very similar to those in whom the injury is confined to one side. The evidence presented here does not definitively support primary operative intervention for bilateral calcaneal fractures. Neither objective nor subjective functional outcomes are significantly improved following such intervention. However, careful operative patient selection will minimize complications and lessen the need for late subtalar arthrodesis.
Foot Function After Ray Resection for Malignant Tumors of the Phalanges and Metatarsals
Authors: Ramseier L.E. , Jacob H.A.C. , Exner G.U.
Published: January 2017

Four patients with malignant tumors of the proximal toe phalanx who had closed contact or direct involvement of the metatarsophalangeal joints or direct infiltration of the metatarsal bone were treated. Treatment included ray resection and reconstruction either by free microvascular fibula transfer, intermetatarsal bony fusion, or soft-tissue stabilization. Foot function was analyzed by Novel pedobarography. The four patients with a follow-up between 21 months and 8 years show almost normal gait. All patients have remained relapse free. If adequate margins can be achieved, ray resection and appropriate reconstruction may be an alternative to amputation.
The Anterior Ankle Impingement Syndrome: Diagnostic Value of Oblique Radiographs
Authors: Tol Johannes L. , Verhagen Ronald A.W. , Krips Rover , Maas Mario , Wessel Ronald , Dijkgraaf Marcel G.W. , van Dijk C. Niek
Published: January 2017

Background: The diagnostic value of an oblique radiograph, in addition to a lateral radiograph, for detecting osteophytes in the anterior ankle impingement syndrome was evaluated in a prospective study. The hypothesis was that the application of a lateral radiograph is insufficient to detect osteophytes that are located in the anteromedial aspect of the ankle joint. Oblique anteromedial impingement (AMI) radiographs were hypothesized to be a relevant adjunct, because of their utility to detect these anteromedially located osteophytes. Methods: Presence or absence of tibial and talar osteophytes on both radiographs was compared with the combined findings of CT, MRI scan, and arthroscopic surgery. Estimates of test characteristics were obtained for 60 consecutive patients with an anterior ankle impingement syndrome. Results: It was shown that the sensitivity of lateral radiographs for detecting anterior tibial and talar osteophytes was 40% and 32%, respectively (specificity, 70% and 82%). When the lateral radiograph was combined with an oblique AMI radiograph, these figures increased to 85% and 73%, respectively (specificity decreased to 45% and 68%). This increase was due to the high sensitivity of the oblique AMI radiographs for detecting anteromedial osteophytes (93% for tibial and 67% for talar osteophytes). Conclusion: A lateral radiograph is insufficient to detect all anteriorly located osteophytes. An oblique AMI radiograph is a useful adjunct to routine radiographs and is recommended to detect anteromedial tibial and talar osteophytes.
The Effect of Ankle Position on Plantar Pressure in a Short Leg Walking Boot
Authors: Crenshaw Stephanie J. , Pollo Fabian E. , Brodsky James W.
Published: January 2017

Short leg walking boots have been shown to be an effective alternative to total contact casting for the reduction of plantar pressure. Conventional theory indicates that placing the ankle in different positions may affect the plantar pressure and ultimately the healing time for a plantar ulcer. This study attempted to determine the changes in plantar pressures due to alterations in the position of the ankle angle in a walking boot. Thirteen healthy subjects were recruited and tested with an insole pressure measurement system. The result demonstrated that small changes in ankle position in dorsiflexion or plantarflexion have a significant impact on resulting forefoot and hindfoot plantar pressures while walking in a prefabricated boot.
Interdigital Neuroma: Clinical Examination and Histopathologic Results in 63 Cases Treated with Excision
Authors: Giannini Sandro , Bacchini Patrizia , Ceccarelli Francesco , Vannini Francesca
Published: January 2017

Between November 1993 and September 1999, 60 patients (three bilateral) were consecutively treated with excision of interdigital neuroma. The clinical examination was preoperatively performed and a personal interview, physical examination, and routine radiographs were included. A specific clinical rating system was developed. The clinical results were excellent or good in 49 (78%) feet, fair in 12 (19%), and poor in two (3%). Prior to surgery, the clinical evaluation score was an average of 16 points. Postoperative average score was 67 points, with an average improvement of 50 points. Histopathologically, intraneural fibrosis and sclerohyalinosis were observed, as in the interstitium; furthermore, an increase of the elastic fibers in the stroma was also observed. The precise etiology of interdigital neuroma remains obscure.