bluuebunny/crossref_metadata_2025 huggingface dataset:
Intermediate Term Follow-up of Calcaneal Osteotomy and Flexor Digitorum Longus Transfer for Treatment of Posterior Tibial Tendon Dysfunction
Authors: Fayazi Amir H. , Nguyen Hoan-Vu , Juliano Paul J.
Published: January 2017

Twenty-three patients with stage II posterior tibial tendon dysfunction who had failed non-surgical therapy were treated with flexor digitorum longus transfer and calcaneal osteotomy. At latest follow-up averaging 35±7 months (range, 24 to 51 months), 22 patients (96%) were subjectively “better” or “much better.” No patient had difficulty with shoe wear; however, four patients (17%) required routine orthotic use consisting of a molded shoe insert. AOFAS scores were available on 21 patients and improved from a preoperative mean of 50±14 (range, 27 to 85) to a postoperative mean of 89±10 (range, 70 to 100). Our experience, at an intermediate date follow-up is that calcaneal osteotomy and flexor digitorum longus transfer is a safe and effective form of treatment for stage II posterior tibial tendon dysfunction.
Redistribution of Foot Pressure in Healthy Adults During Sideslope Walking
Authors: Urry Stephen R.
Published: January 2017

Normal adult plantar pressures were measured during both level and sideslope walking. Sideslope pressures increased, depending on the relative position of the foot on the slope. With upslope placement, pressures increased significantly at the midfoot (≈20%) and fifth metatarsal (≈16%). With downslope placement, pressure increased predominantly beneath the first metatarsal (≈11%). Pressure changes were relatively small at the heel (≈3%) and central metatarsals (≈4%). Significant increases occurred on sideslopes as small as 2°. Since gradients of this size are likely to be encountered commonly in outdoor daily activities, this finding may have substantial implications for individuals with peripheral neuropathy.
A New Method of Functional Tendon Transfer for the Dysfunction of Extensor Hallucis Longus
Authors: Leung Y.F. , Shirley P.S. , Chung O.M.
Published: January 2017

A surgical technique of functional tendon transfer for the treatment of extensor hallucis longus (EHL) rupture is described. By using the extensor digitorum longus tendon of the second toe, the patient regains active dorsiflexion of the big toe and the deformity of the toe is corrected.
Tuberculous Tenosynovitis of the Tibialis Anterior Tendon: A Case Report
Authors: Hooker Michael S. , Schaefer Richard A. , Fishbain Joel T. , Belnap Christina M.
Published: January 2017

Tuberculous tenosynovitis is an uncommon form of extrapulmonary tuberculosis occurring primarily in the hands and wrists with limited reports involving the lower extremities. We report a rare case of tuberculous tenosynovitis of the tibialis anterior tendon occurring in a 37-year-old Filipino male. The tendon was surgically debrided and the patient was given a six month course of antituberculin chemotherapy. At one year postoperatively, the patient has good function with no evidence of recurrence.
Open Reduction and Internal Fixation of Calcaneal Fractures with a Low Profile Titanium Calcaneal Perimeter Plate
Authors: Thordarson David B. , Latteier Michael
Published: January 2017

Forty-two intra-articular calcaneus fractures underwent open reduction and internal fixation with a low profile, titanium plate with a shape similar to the lateral aspect of the calcaneus. All 42 fractures healed without complication. There were no cases of hardware breakage. None of the patients were noted to have a loss of reduction. The plates were applied without bending and molded to the side of the calcaneus with tightening of the screws. No patient complained of symptomatic hardware during the follow-up period. With postoperative plain radiographs, the reduction was judged as anatomic in 35 patients, less than a 2 mm step off in six patients, and one patient with greater than 2 mm step off. Use of this new plate allows for easy application as it does not require contouring, is well tolerated without complaints of hardware prominence, and none of the hardware broke prior to fracture union.
Salvage Technique for Treatment of Periplafond Tibial Fractures: The Modified Fibula-Pro-Tibia Procedure
Authors: DeOrio James K. , Ware Anthony W.
Published: January 2017

We describe a technique of fixation for treatment of distal tibia periplafond fractures and nonunions that uses a modification of the principle of the fibula-pro-tibia procedure (fusing the tibia and fibula together to create a one-bone lower leg). The fibula is plated, and the screws are brought across to the medial tibial cortex. The procedure is accomplished with or without a tibial buttress plate and always includes iliac crest bone grafting of the nonunion site and synostosis. We have used this technique in five patients with satisfaction.
Tendon Transfer Fixation: Comparing a Tendon to Tendon Technique vs. Bioabsorbable Interference-Fit Screw Fixation
Authors: Sabonghy Eric Peter , Wood Robert Michael , Ambrose Catherine Glauber , McGarvey William Christopher , Clanton Thomas Oscar
Published: January 2017

Tendon transfer techniques in the foot and ankle are used for tendon ruptures, deformities, and instabilities. This fresh cadaver study compares the tendon fixation strength in 10 paired specimens by performing a tendon to tendon fixation technique or using 7times20–25 mm bioabsorbable interference-fit screw tendon fixation technique. Load at failure of the tendon to tendon fixation method averaged 279N (Standard Deviation 81N) and the bioabsorbable screw 148N (Standard Deviation 72N) [p=0.0008]. Bioabsorbable interference-fit screws in these specimens show decreased fixation strength relative to the traditional fixation technique. However, the mean bioabsorbable screw fixation strength of 148N provides physiologic strength at the tendon-bone interface.
Evaluation of the Sports Ankle Rating System in Young, Athletic Individuals with Acute Lateral Ankle Sprains
Authors: Williams Glenn N. , Molloy Joseph M. , DeBerardino Thomas M. , Arciero Robert A. , Taylor Dean C.
Published: January 2017

The purpose of this paper is to introduce the Sports Ankle Rating System and provide the initial validation for its use. As its name implies, this outcomes measurement system is intended for use in assessing the functional outcomes of athletes with ankle injuries. This unique system consists of three distinct instruments: the Quality of Life Measure, the Clinical Rating Score, and the Single Assessment Numeric Evaluation. We began the validation process of the Sports Ankle Rating System with subjects who had sustained lateral ankle sprains because this is the most common injury in sports. The results of this study indicate that the Sports Ankle Rating System is:

effective at assessing the impact that an ankle sprain has on an athlete's functional and psychosocial status responsive to changes in an athlete's ankle-related health status, and valid and reliable as tested.
Dual-Function Foot Orthosis: Effect on Shock and Control of Rearfoot Motion
Authors: Butler Robert J. , Davis Irene McClay , Laughton Carrie M. , Hughes Malcolm
Published: January 2017

Orthoses have been designed that claim to both reduce shock and control rearfoot motion. It was hypothesized that the dual-purpose soft orthosis would reduce shock and control rearfoot motion greater than a no-orthotic condition. Three-dimensional kinematic and kinetic data were collected along with tibial acceleration while subjects ran in no-orthotic, the dual-purpose orthotic, and a rigid orthotic condition. Variables of interest were eversion excursion, peak eversion, eversion velocity, peak positive acceleration, loading rate, and leg stiffness. None of the evaluated variables were significantly different ( p = .05) between the three conditions. These data suggest that shock attenuation and rearfoot motion cannot be controlled by the orthoses used in this study for a group of healthy runners.
Treatment of Mucous Cysts of the Toes
Authors: Calder James D.F. , Buch Barbara , Hennessy Michael S. , Saxby Terence S.
Published: January 2017

The outcome of surgically treated mucous cysts of the foot is poorly documented in the orthopaedic literature. This study reports on the treatment of mucous cysts of the toes by simple excision and joint debridement. This is in contrast to treatment of similar lesions in the fingers which is often treated by excision of the cyst, joint debridement, and rotational flap. Following this procedure on 15 patients (15 cysts), at a minimum of 2 years postoperatively, only one cyst had recurred at 9 months. All patients were satisfied by the cosmetic appearance of their toe. The authors reviewed the available literature on this condition and suggest that this method of treatment provides good functional and cosmetic results with a minimal rate of recurrence.
Osteochondritis of the Navicular: A Case Report
Authors: Sharp Robert J. , Calder James D.F. , Saxby Terry S.
Published: January 2017

Brailsford's disease and Kohler's disease are two conditions of uncertain etiology affecting the navicular in adults and children, respectively. Kohler's disease has been universally agreed to have an excellent outcome in all cases. There have been no recorded cases of a child with Kohler's disease having persistent clinical and radiological abnormalities into adulthood and no cases of patients with Brailsford's disease having had abnormalities in childhood. This case report presents a teenage patient with osteochondritis of the navicular bone with symptoms that persisted into skeletal maturity.
Subtalar Arthroereisis for Posterior Tibial Tendon Dysfunction: A Preliminary Report
Authors: Viladot Ramón , Pons Miquel , Alvarez Fernando , Omaña Jorge
Published: January 2017

Background:

The purpose of this study was to evaluate preliminary results with Kalix® subtalar arthroereisis in sinus tarsi for stage II posterior tibial tendon dysfunction.

Methods:

Twenty-one patients with stage II posterior tibial dysfunction, according to Johnson and Storm, underwent surgical treatment between July 1999 and December 2000. All patients were evaluated clinically using the America Orthopaedic Foot and Ankle Society (AOFAS) hindfoot-ankle score. We performed a tendon repair depending on the type and location of the injury and implanted a Kalix® endorthesis in the sinus tarsi.

Results:

Nineteen patients attended for clinical review with an average follow-up of 27.31 months (range, 19–36). AOFAS scale improved from a preoperative average of 47.2 to an average of 81.6 at revision. The most important improvement was observed in pain (16.3 preoperative to 31.6 postoperative). Two cases required removal of the endorthesis for pain, probably because the endorthesis was too big, without any loss of correction. Patient satisfaction was “satisfied” or “very satisfied” in 17/19. All except three patients would have elected to undergo the same procedure.

Conclusions:

Subtalar arthroereisis by means of implantation of a Kalix® endorthesis in the sinus tarsi, with prior correction of the deformity and tendon repair, offers an alternative to bone operations such as calcaneal osteotomies, lengthening the external column, or arthodesis in patients with stage II posterior tibial dysfunction.
Volume of Ambulatory Care Visits and Patterns of Care for Patients Diagnosed with Plantar Fasciitis: A National Study of Medical Doctors
Authors: Riddle Daniel L. , Schappert Susan M.
Published: January 2017

Background:

Plantar fasciitis is a relatively common disorder of the foot, yet little is known about its prevalence, what types of physicians see patients with the disorder, or how, on a national scale, patients are typically managed. The purpose of this study was to generate national estimates of the volume of patient visits and characteristics of care given to patients diagnosed with plantar fasciitis by medical doctors.

Methods:

Data from the National Ambulatory Medical Care Survey (NAMCS) and the National Hospital Ambulatory Medical Care Survey (NHAMCS) for the years 1995–2000 were studied. These are multistage probability sample surveys of visits to office-based physicians (NAMCS) and visits to nonfederal, short-stay, and general hospitals (NHAMCS) to consult doctors of medicine and doctors of osteopathy. Sample data have been weighted to produce national estimates. Data describing the number of patient visits for plantar fasciitis and the characteristics of the care given during those visits were summarized using univariate analyses. Data were combined for the 6-year period to increase the reliability of the estimates, and figures are presented as annual averages.

Results:

Approximately 1 million patient visits per year were made to office-based physicians and hospital outpatient departments for the diagnosis and treatment of plantar fasciitis during 1995–2000. Approximately 62% of all visits were made to primary care practitioners, and 31% were made to orthopaedic surgeons. Patient visits for plantar fasciitis accounted for approximately 1% of all patient visits to orthopedic surgeons. Pain medication, including nonsteroidal anti-inflammatory drugs (NSAIDs), was the most frequently used intervention (47% of visits). Exercise counseling was cited at 26% of visits, and physical therapy was ordered or provided at 19% of visits.

Conclusions:

This research suggests that plantar fasciitis is a relatively common disorder that is seen by several physician specialties. The disorder is not managed in a consistent way. Rather, there appears to be a large amount of variation in the way that these patients are managed. These findings support the argument that additional research is needed to identify effective interventions for plantar fasciitis and to determine if physician specialty influences treatment outcome.
Chopart Joint Fracture-Dislocation: Initial Open Reduction Provides Better Outcome than Closed Reduction
Authors: Richter Martinus , Thermann Hajo , Huefner Tobias , Schmidt Ulf , Goesling Thomas , Krettek Christian
Published: January 2017

Injury cause, treatment, and long-term results [American Orthopaedic Foot and Ankle Society (AOFAS) Midfoot Score, Hannover Scoring System, Hannover Outcome Questionnaire] of patients with Chopart joint dislocations or fracture-dislocations were evaluated. Between 1972 and 1997, 100 patients with 110 Chopart joint dislocations were treated in the authors' institution. Pure Chopart joint dislocations were observed in 28 (25%) feet, fracture-dislocations in 60 (55%) feet, and combined Chopart-Lisfranc joint fracture-dislocations in 22 (20%) feet. The primary treatment was operative in 91 (83%) feet and nonoperative in 19 (17%) feet. Sixty-five (65%) patients had follow-up after an average of 9 years (range, 2–25 years). The mean scores of the entire follow-up group were: AOFAS score, 75 points; Hannover Scoring System, 69 points (maximium possible score = 100 points); Hannover Outcome Questionnaire, 68 points (maximium possible score = 100 points). There were no differences between the scores for pure dislocations or fracture-dislocations of the Chopart joint, but significantly lower scores were noted with combined Chopart-Lisfranc joint fracture-dislocations. In all three injury pattern groups, an initial anatomic reduction was essential for good results. The high functional restrictions in Chopart dislocations can most likely be minimized with initial open reduction, especially in fracture-dislocations. A closed reduction yielded good results only with pure dislocations, when anatomic conditions could be restored, or if there were contraindications to surgery.
Operative Outcome of Partial Plantar Fasciectomy and Neurolysis to the Nerve of the Abductor Digiti Minimi Muscle for Recalcitrant Plantar Fasciitis
Authors: Conflitti Joseph M. , Tarquinio Thom A.
Published: January 2017

A retrospective review was conducted of 23 patients (26 feet) to assess operative outcome of partial plantar fasciectomy and neurolysis to the nerve of the abductor digiti minimi muscle for recalcitrant plantar fasciitis. Nonsurgical treatment was implemented in all patients with no relief of symptoms (average 20.8 months) prior to surgery. Using a visual analog pain scale (0-10), the average preoperative pain was 9.2 (range, 8-10). Prior to surgery, 65.2% of patients had severe limitations of activity, and 34.8% of patients had moderate limitations of activity. An average 25.3-month follow-up (range, 8-51) was performed by telephone interview. Average postoperative pain decreased to 1.7 using the same visual analog scale. Thirteen patients (57%) had no functional limitations postoperatively and nine patients (39%) had minimal functional limitations postoperatively. One patient (4%) had moderate functional limitations postoperatively. Twenty patients (87%) were completely satisfied with the surgery, two patients (9%) were satisfied with reservations, and one patient (4%) was unsatisfied with the surgery. The average period before return to work or daily activities was 1.5 months. Two patients had minor complications of partial wound dehiscence that healed uneventfully and mild dorsal midfoot pain which required temporary use of a boot walker. While the majority of patients with plantar fasciitis can be managed with nonoperative treatment, those patients with recalcitrant plantar fasciitis can be effectively treated with partial plantar fasciectomy and neurolysis to the nerve of the abductor digiti minimi muscle.
Fibular Nonunion After Closed Rotational Ankle Fracture
Authors: Walsh Eric F. , DiGiovanni Christopher
Published: January 2017

Background: Historically, the standard of care for minimally or nondisplaced, closed, distal fibula fractures has been short-term immobilization and progressive weight-bearing. The vast majority of such patients are expected to heal with excellent functional outcome after such treatment. There exists a subpopulation of patients sustaining these fibular fractures who develop symptomatic incomplete union or nonunion despite appropriate management, and later require operative intervention to eliminate pain. Methods: A retrospective review of 17 referred patients with rotational fibular fractures between August 1999 and July 2003 identified six persistently symptomatic distal fibular fractures after an adequate trial of conservative treatment. Due to their persistent localized pain and difficulty with ambulation, five patients underwent operative treatment of the nonunion with autologous bone grafting with plate and screw osteosynthesis. The sixth patient has refused operative intervention despite persistent symptoms. Results: All six of these patients were identified as low risk for nonunion. Two fibular nonunions were found to be complete and four were partial nonunions. One hundred percent of these patients presented with a chief complaint of pain, had reproducible tenderness with palpation directly at the fracture site, and exhibited a persistent antalgic gait pattern. Four of six patients who underwent surgery noticed complete resolution of their pain and return of their normal gait within an average of 2.3 months postoperatively, with an average follow-up of 19.5 months (range, 2-53 months). Conclusions: Distal fibula nonunion appears to be a relatively common cause of persistent lateral ankle symptoms in patients who do not enjoy a satisfactory recovery after appropriate conservative treatment. The authors believe that the persistent lateral pain in such patients results from micromotion strain at the incomplete fracture union site. Surgical stabilization of fibular nonunion seems to be a reliable means of resolving these symptoms when conservative measures fail.
Usefulness of Bioabsorbable Thread Pins After Resection Arthroplasty for Rheumatoid Forefoot Reconstruction
Authors: Tanaka Nobuyuki , Hirose Kazuya , Sakahashi Hisashi , Ishima Takumi , Ishii Seiichi
Published: January 2017

Background: Bioabsorbable thread pin has been used for internal fixation of bone. The results of resection arthroplasty of the lesser metatarsophalangeal (MTP) joints using internal intramedullary fixation with bioabsorbable pins have not been reported. Methods: Resection arthroplasty of the MTP joints of the lesser toes with poly-l-lactic acid (PLLA) thread pins or Kirschner wires was performed at random in reconstruction of the 87 rheumatoid forefeet (62 patients) with a grommet-protected silicone-rubber implant insertion of the first MTP joint. Clinical symptoms, the state of radiographic changes, and complications were assessed 5-10 years (average, 7.7 years) postoperatively. Results: The mean American Orthopaedic Foot and Ankle Society clinical scores at the preoperative and latest points were 31 and 91, respectively, in the operated patients with PLLA pins, while the mean scores were 32 and 82, respectively, in the operated patients with Kirschner wires. The lesser toes treated by bioabsorbable pins did not become rigid, although they were stable. Recurrent dorsal subluxation of the lesser MTP joints was visible on radiographs in three of the 46 feet with PLLA pins, while two feet had three dislocated MTP joints and one subluxated MTP joint postoperatively and recurrent dorsal subluxation of the lesser MTP joints was visible in four of the 41 feet with Kirschner wires. The postoperative hallux valgus did not progress to the preoperative level during the follow-up period in both groups. Two of the 46 feet with PLLA pins and two of the 41 feet with Kirschner wires had radiographic evidence of silicone synovitis without pathological fracture. Three patients with Kirschner wires had wire-track infection, and one patient had severe circulation disturbance of the corrected lesser toes necessitating wire removal. Conclusions: A new trial of internal fixation with bioabsorbable pins may lead to the establishment of a safe method for enhancing stability of the lesser toes after resection arthroplasty of the lesser MTP joints.
Change in Plantarflexion Strength after Complete Detachment and Reconstruction of the Achilles Tendon
Authors: Wagner Emilio , Gould John , Bilen Erkel , Fleisig Glenn S. , Wilk Kevin , Fowler Rachel
Published: January 2017

Background:

Chronic insertional tendinitis of the Achilles tendon is an overuse injury seen with increasing frequency because of an aging population and an increased interest in sports. We evaluated the change in plantarflexion strength in patients after our surgical technique for chronic insertional Achilles tendinitis.

Methods:

From our previous clinical series of detachment and reconstruction of the Achilles tendon for the treatment of insertional tendinitis, ten patients were evaluated with an average followup of 32.1 (range 18 to 52) months. The average age was 65.7 years. We developed a mathematical model to predict the difference in plantarflexion strength between a reconstructed ankle and a healthy contralateral one. Isokinetic testing at 60 degrees/second was performed, measuring plantarflexion peak torque, dorsiflexion peak torque, and total work.

Results:

Our mathematical model predicted a decrease of 4% in plantarflexion torque after the surgery. Isokinetic testing found no significant differences in plantarflexion torque, dorsiflexion torque, or total work between the operated and nonoperated ankles.

Conclusions:

Complete detachment and reconstruction of the Achilles tendon do not decrease the working capacity of the gastrocsoleus muscle.
Frequency and Effects of Intratendinous and Peritendinous Calcifications after Open Achilles Tendon Repair
Authors: Kraus Ralf , Stahl Jens-Peter , Meyer Christof , Pavlidis Theodorus , Alt Volker , Horas Uwe , Schnettler Reinhard
Published: January 2017

Background:

Although calcification of the Achilles tendon has been described by several authors, a detailed evaluation of its frequency and effects on clinical outcome has not been reported. The purposes of this work were to determine the frequency of calcifications in the Achilles tendon after open repair and their effects on clinical outcomes and to identify possible risk factors for postoperative calcification.

Methods:

Thirty-six patients with open Achilles tendon repair were evaluated at an average followup of 19 months. Evaluation included a self-assessment questionnaire concerning treatment outcomes, clinical examination, and radiographic and ultrasonographic examinations.

Results:

No patient had calcifications in the Achilles tendon area before surgery. Postoperatively, intratendinous or peritendinous calcifications, ranging in size from 3 mm to 37 mm, were found in 10 (28%) of the 36 patients. The development of calcifications was associated with chronic swelling, decreased range of motion of the ankle joint, and increase pain, especially with calcifications larger than 10 mm. No association was found between the development of calcifications and the surgical technique, suture materials, time from injury to surgery, or postoperative management, and no risk factors could be identified.

Conclusions:

Calcifications of the Achilles tendon appear to be frequent after open tendon repair and to have a negative effect on clinical outcome.
Bilateral Deficits in Postural Control following Lateral Ankle Sprain
Authors: Evans Todd , Hertel Jay , Sebastianelli Wayne
Published: January 2017

Background:

Although postural control deficits have been identified after lateral ankle sprains, objective and subjective comparisons of data before and after injury are limited. The purpose of this project was to prospectively assess and compare the changes in postural control and self-reported functional status in athletes who suffer acute lateral ankle sprains. We evaluated postural control and self-reported functional status before injury and at 1, 7, 14, 21, and 28 days after acute lateral ankle sprain.

Methods:

Postural control in single-limb stance and self-reported functional status were evaluated in 460 collegiate athletes during preseason examinations. Twenty-eight athletes suffered a lateral ankle sprain during the competitive season and participated in testing at 1, 7, 14, 21, and 28 days after injury.

Results:

Significant deficits in postural control were noted in both the injured and the uninjured ankles at 1 day after injury compared to the baseline measurements taken during the preseason examinations. Significant differences ( p < .05) also were noted between the uninjured and injured ankles at 1, 7, and 21 days after injury.

Conclusions:

After lateral ankle sprain, postural control deficits occur in the injured and uninjured ankles, suggesting a central impairment in neuromuscular control. Changes in self-reported functional status followed a trend of deficit and improvement that was similar to that shown by the postural control data taken after injury, but the two measures did not strongly correlate.
Displaced Intraarticular Calcaneal Fractures: Long-term Outcome in Women
Authors: Barla Jorge , Buckley Richard , McCormack Robert , Pate Graham , Leighton Ross , Petrie Dave , Galpin Robert
Published: January 2017

Background: This study compared the outcomes of displaced intraarticular calcaneal fractures in women treated operatively or nonoperatively. This was part of a prospective, randomized, controlled, multi-center, clinical trial performed at four level I trauma hospitals. In addition, we compared the long-term outcomes in women with those reported in men in an earlier study. 4 Methods: Forty-one women (43 fractures) required treatment for displaced intraarticular calcaneal fractures. Patients' ages ranged from 17 to 65 years at the time of injury. All fractures were closed injuries and had posterior facet displacement of more than 2 mm. Patients were randomly assigned to either the nonoperatively or operatively treated groups. Nonoperative treatment included ice and elevation, while operative treatment consisted of open reduction and internal fixation using a standard lateral approach. Outcomes were measured using the validated Short Form-36 Health Survey (SF-36) and the Visual Analogue Scale (VAS). Results: Women were 3.18 times (RR 3.18, 95% CI 1.03-9.79) more likely to report high SF-36 scores after operative treatment than those who received nonoperative treatment. Operative outcomes in women were better than those reported in an earlier study in men (SF-36: 77.47 in women compared to 67.56 in men, p = .07; VAS: 81.47 in women compared to 67.04 in men, p = .01). In women the fractures generally were caused by low-energy trauma that produced less severe injuries (higher Böhler angles). Most patients were not receiving Workman's Compensation benefits and did light to moderate work. Conclusion: Operative treatment of the fractures showed statistically significant better results when compared to nonoperative treatment (SF-36: p = .04; VAS: p = .10) in women. Displaced intraarticular calcaneal fractures in women should be treated by open reduction and internal fixation through a lateral approach.
Assessment of the Lateral Ligaments of the Ankle After Healed Fractures
Authors: Bombaci Hasan , Katioz Hasan Feyzi , Gorgec Mucahit
Published: January 2017

Background: Lateral ligament complex injuries are difficult to diagnose immediately after ankle fracture, and treatment is focused on the fracture. This study examines the prevalence of ligamentous injuries after severe ankle fractures. Methods: Liateral ligament instability can be revealed by inversion and anterior stress views after fracture healing. The results of 54 inversion and anterior stress examinations of the ankle after fracture healing, using a Telos stress device at 15 kPa force, were compared with uninjured ankles. Results: No patient had 5 degrees or more of talar tilt or 6 mm or more of anterior displacement of the talus in uninjured ankles; however, in ankles with fractures, we found abnormal talar tilt angle in 12 and excessive anterior displacement in five. An abnormal inversion stress test was found to be considerably more common in the fractured ankles. Conclusion: Our study revealed that lateral ligament injuries may occur simultaneously with ankle fractures, with the most frequently injured being the calcaneofibular ligament.
Pigmented Villonodular Synovitis of the Foot and Ankle
Authors: Brien Earl W. , Sacoman Damen M. , Mirra Joseph M.
Published: January 2017

Background: Pigmented villonodular synovitis (PVNS) is a rare disease of uncertain etiology usually affecting the synovium of weightbearing joints. Methods: We retrospectively evaluated 11 patients who were diagnosed and treated for PVNS of the ankle and foot over a 13-year period with a minimum of 2-year followup. Four patients with ankle joint PVNS and one patient with PVNS of the fifth metatarsophalangeal joint were seen initially at our institution and were treated with surgery alone. Six patients with ankle joint PVNS were referred to our institution for recurrent PVNS lesions; two of these patients were treated with excision alone, and the other four patients had surgical excision followed by radiation therapy with dosages ranging from 3600-4000 cGy. Results: No recurrence was noted at a mean followup of 9 years for primary lesions and 3.5 years for recurrent lesions. Conclusion: Based on these results, surgical excision of primary lesions and excision with postoperative radiation for recurrent lesions are recommended.
Torque Resistance After Fixation of Jones Fractures With Intramedullary Screws
Authors: Horst Frank , Gilbert Brett J. , Glisson Richard R. , Nunley James A.
Published: January 2017

Background: Intramedullary screws frequently are used for fixation of Jones fractures of the fifth metarsal. While the ability of intramedullary screw fixation in fifth metatarsals to resist bending and tensile forces is well known, the ability to withstand torsion has not been studied. This paper compares the torsional stiffness of Jones fractures treated with 6.5-mm short-threaded intramedullary screws to those treated with 5.0-mm cannulated short-threaded intramedullary screws. Methods: Nine fresh-frozen, matched pairs of cadaver fifth metatarsals had an acute Jones fracture simulated with an osteotomy. They were stabilized with intramedullary screws and then loaded to failure. Results: The torsional stiffness of the metatarsals fixed with the 6.5-mm did not differ significantly from that using 5.0-mm screws. However, to achieve stability, the 5.0-mm screw had to be long enough to reach the metatarsal head and neck. This tended to straighten the normally curved fifth metatarsal bone and caused lateral gapping at the fracture site. Conclusion: Both 5.0-mm or 6.5-mm screws provide equal torsional rigidity, but 5.0-mm screws may need to be longer, which could potentially straighten the fifth metatarsal shaft in patients who have a curved fifth metatarsal.
Survey of Tourniquet Use in Orthopaedic Foot and Ankle Surgery
Authors: Younger Alastair S.E. , Kalla Timothy P. , McEwen James A. , Inkpen Kevin
Published: January 2017

Background: Tourniquet technique varies among foot and ankle surgeons, and to establish a standard practice guideline the current standard of care should be examined. Methods: One hundred and forty responses were received after 253 surveys were mailed to American Orthopaedic Foot and Ankle Society (AOFAS) members, concerning type of tourniquets, location, and pressures used. Results: Cuff pressures most commonly used were 301 to 350 mmHg for thigh cuffs (49% of thigh cuff users) and 201 to 250 mmHG for calf and ankle cuffs (52% of calf cuff users, 66% of ankle cuff users). A substantial number of foot and ankle surgeons who use calf and ankle cuffs frequently use pressures above 250 mmHg (41% of calf cuff users, 19% of ankle cuff users). Only 9% use limb occlusion pressure when determining cuff pressure. Conclusion: Based on the existing evidence-based literature these pressures may be higher than necessary for many patients, and increased adoption of optimal pressure setting techniques as reported in the literature may help reduce tourniquet pressures used and risk of tourniquet injury. Respondents reported experiencing or hearing reports of breakthrough bleeding, nerve injury, and skin injuries under the cuff.
The Subtle Cavus Foot, “the Underpronator,” a Review
Authors: Manoli Arthur , Graham Brian
Published: January 2017

Subtle cavus foot deformity is ubiquitous, yet it continues to be commonly missed. Simple physical examination maneuvers can provide information that allows well-planned nonoperative care and selection of operative procedures to correct the underlying cause as well as presenting pathology.
The Intermetatarsal and Metatarsal Declination Angles: Geometry as a Source of Error
Authors: Weijers René , Kemerink Gerrit , Mameren Henkvan , Walenkamp Geert , Kessels Alphons G.H.
Published: January 2017

Background: The measurements on radiographs of the foot are believed to give an objective impression of foot deformities. In patient management, the outcome of these measurements is one of the factors that the physician takes into consideration. In fact, the radiograph is a projection of three-dimensional structures and is as such liable to a certain amount of distortion. To our knowledge this distortion has not been quantified, although it seems important for the interpretation of the measurements. Methods: First, mathematical models based on the geometry of standard anteroposterior and lateral radiographs were constructed and analyzed. Then, we simulated radiography with these models on three-dimensional data of metatarsals originating from CT scans of 10 normal volunteers. Results: The distortion of the declination angles of the metatarsals was practically negligible. The intermetatarsal angles were distorted up to 5.4 degrees. The measured angles underestimated the three-dimensional angles. Conclusions: In interpreting the measurements of the metatarsal declination angles, distortion was not a factor. For intermetatarsal angles variability of distortion was only about one third of the reported interobserver variability, but it may have cumulative effects on the error of measured intermetatarsal angles. Moreover, the theoretical models predicted larger distortions in patients with deformities. In interpretation of angular measurements the physician should be aware of these pitfalls.
Enhancement of Syndesmotic Fusion Rates in Total Ankle Arthroplasty with the Use of Autologous Platelet Concentrate
Authors: Barrow Craig R. , Pomeroy Gregory C.
Published: January 2017

Background: One of the challenges of total ankle arthroplasty continues to be achieving a solid distal fusion of the tibiofibular joint. Delayed union rates of 29% to 38% and the nonunion rates of 9% to 18% for syndesmotic fusion have been documented. The risk of tibial component migration has been reported to increase 8.5 times if a solid syndesmotic fusion is absent. Growth factors have been shown to accelerate bone healing and may enhance the fusion of the syndesmosis and, thereby, decrease the frequency of nonunion and subsequent tibial component migration. Methods: An autologous platelet concentrate was used to increase the amount of growth factors at the site of the distal tibiofibular joint fusion in 20 total ankle arthroplasties. Results: Our 6-month fusion rate was 100%. When compared to historical controls (6-month fusion rate of 62%) the difference was statistically significant ( p < 0.0001). Conclusion: The improved rate of distal tibiofibular fusion may be attributable to the increased presence of growth factors provided by an autologous platelet concentrate.
Ligamentous Lisfranc Joint Injuries: A Biomechanical Comparison of Dorsal Plate and Transarticular Screw Fixation
Authors: Alberta Frank G. , Aronow Michael S. , Barrero Mauricio , Diaz-Doran Vilmaris , Sullivan Raymond J. , Adams Douglas J.
Published: January 2017

Background: The current treatment of displaced ligamentous injuries of the tarsometatarsal (TMT) joints is open reduction and rigid fixation using transarticular screws. This technique causes further articular surface damage that theoretically may increase the risk of arthritis. Should the screws break, hardware removal is difficult. An alternative method that avoids these potential complications is rigid fixation using dorsal plates. Methods: The displacement between the first metatarsal and medial cuneiform, the second metatarsal and intermediate cuneiform, the first and second metatarsal bases, and the medial cuneiform and second metatarsal base were measured in 10 matched pairs of fresh-frozen cadaver lower extremities in the unloaded and loaded condition. After sectioning the Lisfranc and TMT joint ligaments, measurements were repeated in the loaded condition. The first and second TMT joints of the right feet were fixed with transarticular 3.5-mm cortical screws while those of the left feet with were fixed with dorsal 2.7-mm 1/4 tubular plates. Measurements were then repeated in the unloaded and loaded condition. Results: After ligament sectioning, significantly increased first and second TMT joint subluxation with loading was seen. No significant difference was noted with direct comparison between plates and screws with respect to ability to realign the first and second TMT joints and to maintain TMT joint alignment during loading. The amount of articular surface destruction caused by one 3.5-mm screw was 2.0 ± 0.7% for the medial cuneiform, 2.6 ± 0.5% for the first metatarsal, 3.6 ± 1.2% for the intermediate cuneiform, and 3.6 ± 1.0% for the second metatarsal. Conclusions: The model reliably produced displacement of the first and second TMT joints consistent with a ligamentous Lisfranc injury. Transarticular screws and dorsal plates showed similar ability to reduce the first and second TMT joints after TMT and Lisfranc ligament transection and to resist TMT joint displacement with weightbearing load. Clinical relevance: Dorsal plating may be an alternative to transarticular screws in the treatment of displaced Lisfranc injuries.
Results of an Internet Survey Determining the Most Frequently Used Ankle Scores by AOFAS Members
Authors: Lau Johnny T.C. , Mahomed Nizar M. , Schon Lew C.
Published: January 2017

Background: With technological advances in ankle arthroplasty, there has been parallel development in the outcome instruments used to assess the results of surgery. The literature recommends the use of valid, reliable, and responsive ankle scores, but the ankle scores commonly used in clinical practice remain undefined. Methods: An internet survey of members of the American Orthopaedic Foot and Ankle Society (AOFAS) was conducted to determine which three ankle scores they perceived as most commonly used in the literature, which ones they believe are validated, which ones they prefer, and which they use in practice. Results: According to respondents, the three most commonly used scores were the AOFAS Ankle score, the Foot Function Index (FFI), and the Musculoskeletal Outcomes Data Evaluation and Management System (MODEMS). The respondents believed that the AOFAS Ankle score, FFI, and MODEMS were validated. The FFI and MODEMS are validated, but the AOFAS ankle score is not validated. Conclusions: Most respondents preferred using the AOFAS Ankle score. The use of the empirical AOFAS Ankle score continues among AOFAS members.
Arthrodesis or Total Replacement Arthroplasty for Hallux Rigidus: A Randomized Controlled Trial
Authors: Gibson J. N. Alastair , Thomson Colin E.
Published: January 2017

Background: Arthrodesis is the current treatment for end-stage hallux rigidus, although there are many reports advocating total joint replacement arthroplasty. The aim of this randomized controlled trial was to evaluate clinical outcomes after first metatarsophalangeal joint (MTPJ) arthrodesis and replacement arthroplasty. Methods: Between November, 1998, and January 2001, 63 patients between the ages of 34 and 77 years, with unilateral or bilateral MTPJ arthritis were recruited and randomly selected to have either MTPJ arthrodesis or arthroplasty. Twenty-two patients (38 toes) had arthrodesis and 27 patients (39 toes) had arthroplasty. A single surgeon performed all surgery. The primary outcome measure determining successful surgery was a decrease in pain as measured on a Visual Analogue Scale (VAS). Functional outcome was assessed at 6 months and 1 and 2 years. Cost data were simultaneously collected. Results: At 24 months, pain improved in both groups ( p < 0.001), but there were significantly greater improvements after arthrodesis ( p = 0.01). All 38 arthrodeses united at a mean dorsiflexion angle of 26 degrees, with few complications. In contrast, in the arthroplasty group, six of the 39 inserted implants had to be removed because of phalangeal component loosening. In the remainder the range of motion gained was poor, and the patients tended to bear weight on the outer border of their foot. The cost ratio was 2:1 in favor of arthrodesis. Conclusions: Outcomes after arthrodesis were better than those after arthroplasty. The results were partially attributable to an unacceptably high incidence of loosening of the phalangeal components, which resulted in removal of the implants. However, even when data from the failures were excluded, arthrodesis was clearly preferred by most patients.
Fusion Rate of First Tarsometatarsal Arthrodesis in the Modified Lapidus Procedure and Flatfoot Reconstruction
Authors: Thompson Ian M. , Bohay Donald R. , Anderson John G.
Published: January 2017

Background: The purpose of this study was to determine the overall first tarsometatarsal joint (TMTJ) union rate in patients after they had a modified Lapidus procedure or a TMTJ arthrodesis as part of a flatfoot reconstruction. Methods: We retrospectively reviewed the charts of 182 patients (201 feet) who had a modified Lapidus procedure or a TMTJ arthrodesis as part of a flatfoot reconstruction between May, 1997, and May, 2001; all had at least a 6-month followup. The data collected included age, gender, tobacco use, diabetic status, complications, and radiographic evidence of union. There were 167 women and 15 men. The right foot was operated on in 106 patients and the left foot in 95. The average age was 53 (range 11 to 87) years. Results: First TMTJ arthrodesis healed uneventfully in 193 (96%), and eight (4%) had nonunions. Of those eight patients with nonunions, five had previous bunion surgeries, two were smokers, and one had diabetes. There were 25 (12%) patients with previous bunion surgeries and five of these (20%) had nonunions. Four patients (2%) had symptomatic nonunions resulting in revision. Of the 21 patients undergoing flatfoot reconstruction, none had a nonunion. Conclusion: One criticism of the modified Lapidus procedure is the unacceptable nonunion rate (10 to 12%). Out of the 201 feet, we had a 4% nonunion rate and a 2% revision rate, which is well below the reported nonunion rates. We also have found that patients with previous bunion surgery and recurrent deformity were at a higher risk for a nonunion. Clinical Relevance: We believe that the modified Lapidus procedure and first TMTJ arthrodesis can achieve acceptable union rates and be successful for correcting hallux valgus with a hypermobile first ray and can also be applied to certain patients undergoing flatfoot reconstruction.
Computerized Matching of Autologous Femoral Grafts for the Treatment of Medial Talar Osteochondral Defects
Authors: Marymont John V. , Shute Gerald , Zhu Hongseng , Varner Kevin E. , Paravic Vibor , Haddad John L. , Noble Philip C.
Published: January 2017

Background: Cored autologous graft from the distal ipsilateral femur has been used to fill osteochondral defects in the talus. There are no studies that compare the articular morphology of potential donor sites on the distal femur with recipient sites on the talus. Methods: Using coronal MRI of the talus and distal femur of five matched cadaver, computer reconstructions of the articular surfaces were prepared. From these, six 10-mm in diameter donor sites from the nonweightbearing surfaces of the medial and lateral aspects of the femoral condyles were matched to three recipient sites on the anterior, middle, and posterior aspects of the corresponding medial talus using customized computer software that minimized differences between the articular surfaces of the graft and the talus. After matching the femoral to the talar graft, the average and maximal distances between the surfaces (surface contour) and the average and maximal distances of the offset at the outer 1 mm of the graft periphery (step-off) were determined. Results: For all graft combinations, the average step-off was 0.24 +/−0.03 mm and the maximum 0.60 mm. The average surface contour was 0.32 +/−0.04 mm and the maximum was 1.16 mm. In all cases, the best donor site was from the superolateral femur for any medial talar lesion. Conclusion: In this study of grafts from the femoral condyles, the superolateral femur was the optimal location for an osteochondral graft for any medial talar lesion.
The Surgical Tibiotalar Angle: A Radiologic Study
Authors: Knupp Markus , Ledermann Hanspeter , Magerkurth Olaf , Hinterman Beat
Published: January 2017

Background: Many studies on cadaver specimens describe the hindfoot anatomy, but few measures have been defined and quantified on radiographs. Our aim was to determine the tibiotalar angle using the tibial tuberosity as a reference point. Methods: The tibiotalar angle, using the tibial tuberosity as reference point, was measured on anteroposterior views of 168 ankles. Bilateral radiographs were obtained in 75 patients. Results: The tibiotalar angle was 92.4 degrees (SD = 3.1) without significant intraindividual difference on the radiographs examined bilaterally. More varus was found in women and with increased age. Conclusions: The tibial tuberosity is a reliable reference point for the measurement of the tibiotalar angle and is used in numerous operative procedures of the hindfoot. If the angle cannot be measured because of progressed destruction, the measurement can be obtained from the contralateral leg, as no significant intraindividual difference was found in the tibiotalar angle ( p < 0.001).