bluuebunny/crossref_metadata_2025 huggingface dataset:
Triple Arthrodesis: A Long-term Study with Force Plate Analysis
Authors: Southwell Richard B. , Sherman Frederick C.
Published: March 2013

This study evaluated triple arthrodesis at late follow-up using the liquid crystal force plate and standard clinical methods. Twenty-four patients with 36 triple arthrodeses were followed-up at an average of 8 ± 2 years. Fifty-eight per cent of patients achieved an ideal or good rating with 11% failures. Failures were due to inadequate surgical correction of varus deformity. Seven per cent of joints with roentgenographic degenerative changes had associated mild pain. Triple arthrodesis produced many deviations from normal load-bearing: 1) calcaneovalgus residuals produced symptomatic posterior heel force concentrations; 2) residual forefoot supination produced symptomatic force concentrations under the fifth metatarsal and toe; 3) residual forefoot pronation produced increased midfoot and medial metatarsal load-bearing, generally asymptomatic; and 3) a significant increase in midfoot weightbearing occurred in most triple arthrodesis patients.
The Role of the Lateral Malleolus as a Stabilizing Factor of the Ankle Joint: Preliminary Report
Authors: Segal David , Pick Robert Y. , Klein Harvey A. , Heskiaoff David
Published: March 2013

A preliminary report evaluating the role of the distal fibula as the lateral supporting structure of the ankle is presented. The study involved loading the knee of an above the knee amputation specimen and recording the resultant strains on the distal fibula. This was done with the ankle of the specimen in neutral, dorsiflexion, and eversion. Results show the susceptibility of the lateral fibula to compressive strains, with the greatest compression noted when the ankle is in eversion. Early findings also indicate that the fibula and lateral malleolus play an insignificant role in the weightbearing process in the lower limb.
Standardizing Methods of Measurement of Foot Shape by Including the Effects of Subtalar Rotation
Authors: Cobey James C. , Sella Enzo
Published: March 2013

At the present time, there is no easily performed method of measuring foot shape that can quantitatively differentiate types of feet. We studied 44 feet of individuals with normal appearing asymptomatic feet and flat symptomatic feet to find criteria for measurement of foot shape. We found that measurements of footprints are unreliable. Radiographic methods must include measurements in different positions, or at least specify the position of subtalar rotation to be meaningful, since the height of the arch can change just by rotating the tibia. Traditional measurements of talocalcaneal angles have no precision and are unreproducible.
Thoughts on In-toeing and Out-toeing: Twenty Years' Experience with Over 5000 Cases and a Review of the Literature
Authors: Weseley Martin S. , Barenfeld Philip A. , Eisenstein Arthur L.
Published: March 2013

We are reporting over 5000 cases of children presenting with toeing-in or toeing-out problems. Patients were seen over a period of 20 years. The toeing-in and toeing-out gait patterns are discussed in terms of the relationship to the hip joint and the tibiofibular unit.

It is concluded by the authors that most of these problems represent normal variants in the development of the child and require no treatment. The necessity and modalities of therapy for the remainder are discussed in detail. The current literature on the subject is also reviewed.
Surgical Correction of Resistant Talipes Equinovarus: Observations and Analysis—Preliminary Report
Authors: Adelaar Robert S. , Kyles Michael K.
Published: March 2013

The preliminary results of a comprehensive talipes equinovarus release on 16 patients with 20 idiopathic clubfoot deformities were analyzed with an 18-month follow-up. Our conclusions were that each component of the clubfoot can be managed in a single stage operative procedure without any significant risk to the patient; bilateral surgery could be done at the same sitting; and dorsiflexion was difficult to achieve because of the anatomical deformity of the talus and resistant anterior capsule. Fixation after comprehensive release with Kirschner wires is important in maintaining the reduction, and no patient had a return of the deformity after satisfactory correction at the time of surgery. The complications were excessive hindfoot valgus, loss of the longitudinal arch by excessive midfoot release and casts, and forefoot valgus from complete transfer of the anterior tibial.
Ankle Arthroscopy: Technique and Indications
Authors: Drez David , Guhl James F. , Gollehon Douglas L.
Published: March 2013

The value of arthroscopy in the diagnosis and treatment of knee disorders has been well established. Little has been written in the American literature regarding the value of arthroscopy of the ankle joint. Based on a review of the literature and a review of our 56 cases a systematic approach to ankle arthroscopy is given. Basic arthroscopic anatomy is given and the technique of ankle arthroscopy is outlined and demonstrated in detail. The indications, contraindications, and complications are reviewed.
The Role of Arthroscopy in the Diagnosis and Treatment of Disorders of the Ankle
Authors: Parisien J. Serge , Shereff Michael J.
Published: March 2013

Arthroscopy has been recognized as a useful method in the diagnosis and treatment of disorders of the knee. The application of this technique to other joints is presently being investigated. We have had the opportunity to use this procedure as a diagnostic and therapeutic tool for abnormalities of the ankle joint. The technique of ankle arthroscopy and the correlative anatomy is described. The indications, complications, and end results of 30 procedures are reviewed.
The Intermetatarsal Nerve: A Microscopic Evaluation
Authors: Graham Charles E. , Johnson Kenneth A. , Ilstrup Duane M.
Published: March 2013

Microscopic evaluation of the interdigital neuroma is difficult because the appearance of the normal nerve has not been described precisely. In an effort to characterize the normal interdigital nerve, 104 nerves were removed at autopsy from the intermetatarsal spaces of 14 women who were more than 48 years old. A positive relationship between perineurial width and internal diameter of the nerve fascicle in web spaces 2, 3, and 4 was defined. In addition, the number and the diameter of blood vessels had a positive correlation in all web spaces. These measurements should be of help in the objective differentiation of the common interdigital neuroma from the normal interdigital nerve.
Sural Nerve Entrapment by Avulsion Fracture of the Base of the Fifth Metatarsal Bone
Authors: Gould Nathaniel , Trevino Saul
Published: March 2013

Three cases of sural nerve entrapment by an avulsion fracture of the base of the fifth metatarsal bone are reported. The fracture was incurred while running, the foot twisting in a depression in the ground. The fracture included a fairly large piece of bone which avulsed and strutted the overlying sural nerve causing continued pain and dysesthesias for months following the injury. All patients promptly recovered completely following removal of the incriminating, ununited fragment and neurolysis of the sural nerve.
Lisfranc's Fracture-Dislocation with Intercuneiform Dislocation: Presentation of Two Cases and a Plan for Treatment
Authors: Cain Paul R. , Seligson David
Published: March 2013

Intercuneiform dislocation is an important consideration in the initial treatment of fracture dislocations of the tarsometatarsal joint. The cuneiforms form a mortise for the second metatarsal which is the keystone of the tarsometatarsal articulations. The position of the second cuneiform is crucial to the integrity of the transverse arch of the foot. Proper initial treatment of these fractures includes precise reduction and stable fixation via open or closed methods so that the second metatarsal is restored as the tenon within a solid mortise formed by the cuneiforms.
Calcaneal Fractures: A Good Prognosis
Authors: Hammesfahr Rick , Fleming Lamar L.
Published: March 2013

Calcaneal fractures at Grady Memorial Hospital were reviewed for the period of 1973 to 1980. Sixty-two of these fractures were available for follow-up. Treatment was with compression dressings, plaster, pin reduction or open reduction. Grading was by the previously published criteria of Allen and Lindsey. 1 , 21 This paper identifies a positive correlation between facet reduction and successful treatment results.

Recommendations are made for fracture classification, surgical treatment and postoperative management.
Problems Encountered in the Diagnosis and Treatment of Osteoid Osteoma of the Talus
Authors: Kenzora John E. , Abrams Robert C.
Published: March 2013

Although osteoid osteomata of the talus are documented fairly often in the pathology literature, clinical case reports are rare. Two cases are detailed in this paper. The first lesion was located in the cancellous bone of the talar neck. The second lesion was a subperiosteal para-articular variant of osteoid osteoma. The problems encountered in the diagnosis and treatment are reviewed.
General Considerations in the Examination of the Foot and Ankle in Your Patient in Office Practice
Authors: Miller Wallace E.
Published: March 2013

This article contains observations regarding history taking and physical examination of the foot and ankle which previously have not been compiled in this exact manner. The significance of the chief complaint in relation to problem solving is a major feature. The steps in the actual physical examination are related in a practical order. Terminology is reviewed. Documentation is stressed. The panorama of those involved in decisions relating to solving foot problems is placed in perspective. The general considerations reflect long-standing involvement in minuscule attention required to accurately arrive at a diagnosis. There may be more than one solution for a problem but only one accurate diagnosis.
Surgical Principles Based on Anatomy of the Foot: Preoperative Planning
Authors: Acton Rush
Published: March 2013

The time for planning an operative incision and approach begins in the office when the patient is first examined and his problem is reviewed. The area anatomy should be carefully studied in the interim prior to the surgical date. At surgery, a sterile marking pencil is employed and its outline carefully studied before the actual incision is made.

A thorough knowledge of biomechanics dictates the procedures which may be considered feasible.

Only by following such a carefully outlined course, can the surgeon feel reasonably secure that the surgery he proposes to his patient in his office, has a logical chance for a successful outcome.
Applications of Doppler Ultrasound to Foot and Ankle Care
Authors: Kwong Phillip K.
Published: March 2013

Systolic blood pressures are well correlated with limb ischemia. The simplicity of Doppler ultrasound technique makes it ideally suited for office use by the interested physician. Topics presented include the use of properly chosen equipment, the clinical indications, and establishment of specific pressure measurements consistent with limb ischemia, rest pain, and healing prognosis.
Conservative Management of the Hypersensitive Foot in Rheumatoid Arthritis
Authors: Gould John S.
Published: March 2013

Treatment of the painful foot in rheumatoid arthritis requires an understanding of the abnormal mechanics and progressive disease process. The clinical problems are manifested in the forefoot (MP joints and toes) and in the longitudinal arch and subtalar joint. The evaluation includes a thorough history and physical, and the use of various tools to indicate and quantitate abnormal weightbearing, problems in circulation and sensation. Nonsurgical treatment includes appropriate drugs, and devices and shoes which reduce shear, redistribute weightbearing, support unstable joints, and accommodate irregular shapes and surfaces. Certain infections and neurovascular problems require early surgical solutions.
The Management of Superficial Disorders of the Forefoot
Authors: Scranton Pierce E.
Published: March 2013

Superficial disorders of the forefoot are frequently seen in any office practice. Soft corns, ingrown toenails, plantar calluses, and plantar warts are the most common of these disorders. Their etiology, recognition, and operative and nonoperative management are discussed.
Office Practice: Footwear and Orthotic Therapy
Authors: Cracchiolo Andrea
Published: March 2013

The evaluation of a patient with a foot disorder should include a careful history and examination of the foot. A more extensive evaluation may be indicated as many systemic diseases may initially involve the foot. The patient's shoes are most important and frequently correlate well with the foot pathology. Appropriate radiographs which should include weightbearing views are essential, and selected laboratory studies may be indicated.

Although it may be practical to divide the foot into the components of forefoot, midfoot, and hindfoot; these three areas are functionally connected. A deformity in one area usually affects the other areas of the foot.

Office procedures should include practical care of the nails and hyperkeratotic lesions which are easy to trim. Shoes must be of appropriate size to fit the forefoot and heel. The shoe may require modification or orthotic devices to accommodate existing pathology.
Cartilaginous Sesamoid or Nodule of the Interphalangeal Joint of the Interphalangeal Joint of the Big Toe
Authors: Miller William A. , Love Benjamin P.
Published: March 2013

Since 1971, a cartilaginous sesamoid or nodule has been identified in the plantar ligament of the interphalangeal joint of the big toe in 29 of the 58 patients (50%) from whom spurs of the plantar medial aspect of the adjacent phalanges were removed because of painful callouses. It is felt that the firm mass of the cartiginous sesamoid may have contributed to the callous formation in many cases. These cartilaginous sesamoids have all been removed when found.
Pes Planus: Radiographic Changes with Foot Orthoses and Shoes
Authors: Penneau Karl , Lutter Lowell D. , Winter Robert D.
Published: March 2013

Radiographic evaluation of 10 children with bllateral pes planus was performed. Radiogrephe taken barefoot, with a Thomas heel, with an over-the-counter insert, with two specially molded plastic foot orthoses were used. No significant change was seen after the donning of these appliances in their comparison to barefoot evaluation. The conclusion is that there was not a significant change radiographically of these feet by the utilization of any of the appliances.
Collagen Diseases Affecting the Foot
Authors: Bluestone Rodney
Published: March 2013

This article classifies various forms of arthritis which may affect the foot. Osteoarthritis of the foot usually involves the first metatarsophalangeal joint or the ankle, the latter usually being secondary to prior trauma. Secondary osteoarthritis of the foot is frequently due to Charcot destruction which is usually secondary to diabetic neuropathy. Seronegative spondyloarthropathies include ankylosing spondylitis and Reiter's syndrome. The three variants of psoriatic arthritis of the foot are also discussed.
Juvenile Rheumatoid Arthritis of the Foot
Authors: Rana Nasim A.
Published: March 2013

Rheumatoid arthritis occurring in children under 16 years of age is defined as juvenile rheumatoid arthritis. It is more common in females and the peak incidence is between 1 and 3 years of age. It can present in different forms. Mono- and pauciarticular type is complicated by iridocyclitis in 20%. Growth disturbances are common. Any conceivable combination of foot deformities can occur. Some of the secondary deformities can be prevented with conservative care. Principals of soft tissue and bony surgery have been outlined.
Pedal Manifestations of DISH
Authors: Garber Elayne K. , Silver Steve
Published: March 2013

Diffuse idiopathic skeletal hyperostosis (DISH), also known as Forestier's disease, is an ossifying diathesis characterized by excessive bone formation at specific skeletal sites. The condition is best recognized for its spinal features. However, the tendency toward bone formation is often manifested in extraspinal locations, particularly the foot. The radiographical, pathological, and clinical features of the disorder are reviewed with special emphasis on the foot as a target organ. Abnormalities in the foot that suggest the diagnosis of DISH are emphasized.
Management of the Arthritic Forefoot
Authors: Cracchiolo Andrea
Published: March 2013

Rheumatoid diseases frequently involve the forefoot producing severe hallux valgus and dislocated metatarsophalangeal (MTP) joints. One must stress the importance of continual evaluation of the foot in these patients. The relationship of midfoot and hindfoot deformities, especially pronation deformities, to the forefoot is essential. Nonoperative treatment can be highly effective and consists of skin and nail care and proper shoes which enclose and support early deformities. Operative care now spans the gamut from excising all or part of the MTP joints, to silicone implant arthroplasty of the MTP joints.
Physical Modalities for Treating the Foot Affected by Connective Tissue Diseases
Authors: Bardwick Peter A. , Swezey Robert L.
Published: March 2013

Physical therapy is often necessary in the optimum treatment of foot and ankle disorders associated with connective tissue diseases, particularly rheumatoid arthritis. Thermal modalities and transcutaneous electrical nerve stimulation use for pain control are described, as well as a therapeutic exercise, ambulatory assistive devices, below the knee bearing braces, and the prescription of appropriately supportive and corrective footwear and shoe modification are discussed in the context of increasing comfort and minimizing deformity and disability.
Revision Rates in Forefoot Surgery
Authors: Cameron Hugh U. , Fedorkow Donna M.
Published: March 2013

In an attempt to determine failure or reoperation rates for common forefoot procedures, the records of 706 patients who had 1003 forefoot operations were studied.

The revision rate for the Keller procedure was 2.26% when no interposition implant was used. The revision rate for metatarsal osteotomies, mainly due to nonunion, was 2.7%. The revision rate for proximal phalangectomies was 3.3%, being 1.9% when the distal end of the phalanx was removed and 4.4% when the proximal end was removed. The failure rate for proximal interphalangeal joint fusion was 17.8%.

These results demonstrate that the antiquity of a procedure is not necessarily a recommendation.
Running Athlete in Office Practice
Authors: Lutter Lowell D.
Published: March 2013

The running athlete has different needs from other athletes in terms of determination of his/her specific injury. Causation determination can be done through history. Specific pointers in terms of physical examination are noted to lead one to the diagnosis. Basic general treatment modalities are noted.
The Modified Blair Fusion
Authors: Lionberger David R. , Bishop John O. , Tullos Hugh S.
Published: March 2013

The Blair fusion is the accepted method to achieve an ankle arthrodesis in the presence of avascular necrosis or absence of the body of the talus. This procedure has not however, been reliable. A pseudarthrosis rate of 28% and fibrous ankylosis of the foot secondary to prolonged immobilization compromise the end result.

A tibiotalar compression arthrodesis has been developed using an intermediate hip compression screw and a modified Stone staple. Five patients with avascular necrosis of the talus underwent a modified Blair fusion. Protected weightbearing was started at 6 weeks and healing occurred within 3 months.

Although the number of cases is small, this study indicates that the addition of compression fixation to the Blair arthrodesis will significantly decrease the pseudarthrosis rate and perhaps the healing time.
Talar Compression Syndrome in Dancers
Authors: Quirk Ronald
Published: March 2013

Talar compression syndrome is a painful condition at the back of the ankle in which a protruding bone (either the posterior tubercle or an os trigonum) crowds the tissues, and causes them to be compressed when the foot is forcibly and repeatedly pointed, as in classical ballet. The condition is easy to diagnose, but care must be taken to distinguish it from a number of other painful conditions at the back of the ankle which are commonly seen in dancers. Some cases respond to rest and conservative treatment, but in many cases operating is necessary to remove the protruding bone, and this provides a good relief of pain.
Stenosing Tenosynovitis of the Flexor Hallucis Longus Tendon and Posterior Impingement upon the Os Trigonum in Ballet Dancers
Authors: Hamilton William G.
Published: March 2013

The problems of flexor hallucis tendonitis and os trigonum syndrome in dancers are presented. The mechanism of injury, diagnosis, treatment, and rehabilitation are outlined. Pitfalls in diagnosis are discussed as well as prognosis for return to dance class and the stage. The best surgical access to the os trigonum is a lateral approach.
Forefoot Conditions in Dancers—Part II
Authors: Sammarco G. James , Miller Edward H.
Published: March 2013

Conditions in the dancer's forefoot can be divided into five categories. Part II of our study presents two categories: acute conditions of the forefoot and conditions which masquerade as forefoot problems. Five hundred dancers were studied. Of those, some had conditions including muscle spasm, soft tissue trauma, fractures, dislocations, and abscesses, and were treated accordingly. The general health of the dancer was an important factor in treatment as well as difficulty in diagnosing the injury. Prolonged periods of healing were expected but did not prevent the return to dance class and rehearsal. The highly motivated, goal-oriented dancer often did not complain of systemic disease or pain and this prevented diagnosis until triggering tendons or muscle paralysis made it obvious. Such a sequence gave rise to prolonged convalescence or termination of the dancer's career.
Sprained Ankles in Ballet Dancers
Authors: Hamilton William G.
Published: March 2013

Ankle sprains are common in dancers. They result from working in the positions which allow increased risk of sprain on the lateral side of the ankle for many hours a day. One hundred ankle injuries were evaluated. The mechanisms of injury are presented, as well as a classification of these injuries. The recommended treatment and rehabilitation are discussed. Leg muscle strength must be restored before rehabilitation is considered complete.
A Review of Lateral Ankle Ligamentous Reconstructions
Authors: Pierre Rick St. , Allman Fred , Bassett Frank H. , Goldner J. Leonard , Fleming Lamar L.
Published: March 2013

We have performed an ongoing retrospective and prospective multi-institutional review of 50 patients who underwent 53 lateral ligamentous reconstructive procedures of the ankle. The point grading system used for postoperative evaluation of our patients allowed for classification of functional activity. The grading system included evaluation of the patient's return to preinjury activities and athletics, degree of pain, degree of swelling, number of recurrent sprains, and any disability that the patient incurred secondary to the tendon transfer. Preoperative and postoperative stress radiographs were obtained to evaluate the talar tilt angle. Of our 53 lateral ankle ligamentous reconstructions, we consider 45 to be excellent, with the patients returning to full activity and athletics. Our results show no statistically significant difference in long-term function among the five ligamentous repairs employed in this series (Pearson Chi-square test; χ2 = 2.30, df = 4, P = 0.68). No correlation could be made between the long-term clinical response of the various procedures and the postoperative talar tilt angle. We conclude that lateral ligamentous reconstructive repairs of the ankle are indicated, and that good or excellent clinical results, greater than 91 %, can be obtained with any of the five reconstructive procedures, performed correctly.
The Measurement of Pressures under the Foot
Authors: Duckworth T. , Betts R. P. , Franks C. I. , Burke J.
Published: March 2013

An apparatus is described which gives a rapid and detailed picture of the distribution of pressure under the foot, this being displayed either as a continuous grey scale or a color contour map on a television monitor. Automatic analysis systems are outlined which enable the quantitation of the distribution of pressures and loads under the foot during standing and walking, utilizing computer techniques. The use of the static system is illustrated by the results of analytic procedures carried out on normal feet and in the assessment of surgical correction of a series of equino-varus feet in children suffering from spina bifida. The clinical application of the dynamic system is illustrated by the measurement of pressure/time curves encountered under the heel, the five metatarsal heads, and the great toe of a control group of feet and the feet of patients who had undergone metatarsophalangeal fusions, Keller arthroplasties, and Swanson arthroplasties.
Spontaneous Rupture of the Tibialis Posterior Tendon: Clinical Findings, Tenographic Studies, and a New Technique of Repair
Authors: Jahss Melvin H.
Published: March 2013

Ten patients with spontaneous rupture of the tibialis posterior tendon were evaluated in regards to clinical and roentgenographic diagnostic criteria, tenographic findings, conservative treatment, and surgical repair. It was concluded that while tenography was a significant diagnostic adjuvant, the diagnosis and decision for surgical intervention must be based primarily upon the clinical findings. Previously described surgical repairs either gave less than optimum results or were impossible to achieve due to the extent of tendon damage. A new surgical technique, consisting of a side to side anastamosis of both the normal proximal and distal portions of the tibialis posterior tendon to the adjacent flexor digitorum longus tendon, proved a simple procedure and gave consistently excellent results.
Surgery of the Forepart of the Foot in Rheumatoid Arthritis
Authors: Gould Nathaniel
Published: March 2013

The purpose of this paper is to introduce a surgical approach to treatment of severe forefoot deformities of rheumatoid arthritis. Briefly, the surgery consists of base of the first metatarsal osteotomy to correct metatarsus primus varus, and metatarsal head resection beginning with the fifth metatarsal and carried around in crescentic fashion through the necks of the other metatarsals, so that as an end result the great toe is the longest, the second next to the longest, etc. The short extensor tendons are dissected to their insertions and, since they have drifted laterally into the “valleys” pulling the toes into lateral drift with them, they are usually sacrificed. The long extensor tendons are appropriately lengthened to proper tension. All the toes are straightened by plantar capsulotomies, dermotomies, and long flexor tenotomies, and the toes held straight with C-.045 wire in shishkabob fashion. Then, under direct vision, each wire is drilled up into the metatarsal shaft, aligning the toes into parallel cosmetic fashion. In the early cases, a single stem silastic implant was utilized but for the past 5 years now the double stem silastic implant is employed for the first MTP joint and is inserted “upside down” in order to give its greater power towards the floor.

A cast is not used, but the patient ambulates on a well-padded bandaged foot by the second or third day.

Twenty patients (40 feet) were operated upon (17 females and 3 males, ages 28 to 72 years, average 47 years), with a follow-up of 3 to 5 years.

Pain relief has been remarkable. Good great toe function has been obtained in all cases with excellent power to the floor and a satisfactory range of dorsiflexion ability. About 67% have developed some mild recurrence of hallux valgus, but none so severe that it has been disabling.

All patients have been pleased with their final results.
Mitchell Osteotomy for Hallux Valgus: Long-term Follow-up and Gait Analysis
Authors: Merkel Kurt D. , Katoh Yoshihisa , Johnson Einer W. , Chao Edmund Y. S.
Published: March 2013

In this retrospective study of 96 Mitchell first-metatarsal osteotomies performed on 69 patients with an average follow-up of 7 years, we found that more than 86% were completely satisfied and that the procedure was equally effective in all age groups. Excessive first metatarsal shortening, dorsiflexion of the osteotomy, and failure to correct the intermetatarsal angle to 10° or less correlated with poorer results. This study demonstrates a relationship between metatarsal shortening and osteotomy plan-tarflexion. Gait analysis demonstrated that these patients do not have normal foot mechanics postoperatively.
Foot Growth Rate in Children Age One to Six Years
Authors: Wenger Dennis R. , Mauldin Donald , Morgan Dean , Sobol Marion G. , Pennebaker Mary , Thaler Roni
Published: March 2013

Previous guidelines suggested that children age 2 to 6 years require a shoe size change every 1 to 2 months. Our study of foot growth in 112 children enrolled in a prospective treatment protocol for flatfoot demonstrates that children age 12 to 30 months will require shoe size change every two to three months but that foot growth slows over the subsequent four years, necessitating shoe size change only every 4 months in children up to 4 years of age and every 6 months in children from age 4 to 6 years.
The Arthrogrypotic Foot Plan of Management and Results of Treatment
Authors: Zimbler Seymour , Craig Clifford L.
Published: March 2013

Fifty-one arthrogrypotic feet have been treated and followed by the Pediatric Orthopaedic Unit, Tufts New England Medical Center, (1970–1980). Forty of the 51 feet presented as equinovarus with the residual divided among metatarsus adductus, vertical tali, and calcaneo-valgus. Equinovarus deformities are the most resistant in all cases. Corrective casts are applied for at least the first 3 months of life. Surgical procedures were then initiated with any evidence of lack of progression of treatment. Varus and equinus were treated by an extensive posterior and medial release. Lateral soft tissue releases in addition to calcaneocuboid fusion or cuboid osteotomy were necessary in 24 of the 70 operations. Recurrence rate has been a problem in the simple type of posterior release including only an Achilles tendon lengthening, and posterior capsulotomy of the ankle and subtalar joint. Tal-ectomy has been carried out in four feet and appears to be one type of reasonable salvage procedure in smaller children with recurrent varus. Treatment is difficult in these patients but a plantigrade foot should be achieved in all cases.
McKeever Arthrodesis for the Painful Hallux
Authors: Riggs Stanley A. , Johnson Einer W.
Published: March 2013

Three hundred nine McKeever arthrodeses for treatment of the painful hallux were performed on 234 patients at the Mayo Clinic from 1955 to 1980. Two hundred six cases were contacted, and 71 were personally examined and X-rayed. The average follow-up was 15 years (1 to 28 years). Ninety-one percent wore shoes within 2 months, 92% are painless, and 98% without other foot pathology are wearing dress shoes of their choosing. Complications, which consisted of failed fixation, infection, and recurrence of deformity, occurred in 8%. The screw fixation was removed in 30%. Eighty-six percent of the patients are satisfied.
Painful Heel Syndrome: Rationale of Diagnosis and Treatment
Authors: Graham Charles E.
Published: March 2013

Recent developments in isotope imagery have allowed orthopaedic surgeons some insight into stress areas of the skeleton that are not readily seen on routine X-rays. This X-ray imagery has been used in evaluating patients with painful heel syndrome. In 97.7% of the cases, the bone scan was positive on the side of the heel that had the pain. An X-ray technique exposing the painful heel at a 45° angle on the medial side with the cassette underneath the foot showed a bony condensation in many of the cases which was thought to represent a fatigue fracture. Based on these bone scans and X-ray findings, a classification system has been devised. A flow chart is described using logical progression in the diagnosis and treatment phase of this problem.
An Anatomic Study of the Anterior Superior Process of the Os Calcis and Its Clinical Application
Authors: Jahss Melvin H. , Kay Bruce S.
Published: March 2013

The anatomy of the anterior superior process of the calcaneus was studied from 15 fresh amputation specimens and from two cases of surgical intervention of fractures of this process. Specific anatomic relationships exist between the associated ligamentous attachments and the production of fractures of this process. It was found that both the anterior interosseus talocalcaneal and calcaneocuboid ligaments were tight on inversion and on inversion plus plantarflexion, suggesting that both of these ligaments may play a part in the production of avulsion fractures of the anterior calcaneal process.

The relationship between the articular facets of the calcaneal process, including the inconstant anterior talocalcaneal facet, and the occasional unexpected poor results encountered with these fractures is described. Finally, the local anatomy is correlated with tarsal coalitions found in this area.
Radiological Aspects of the Tarsometatarsal Joints
Authors: Stein Robert E.
Published: March 2013

Considerable difficulty may be encountered in evaluation of the disrupted tarsometatarsal joint complex as seen in variations of fracture dislocations of the Lisfranc's joint. This report points out constant relationships between the tarsal and metatarsal bones as seen on the standard anteroposterior and medial oblique views. Awareness of these constant radiological relationships can help the operating surgeon reconstruct the normal anatomic alignment.
Proximal Diaphyseal Fractures of the Fifth Metatarsal (Jones' Fracture): Two Cases Treated by Cross-Pinning with Review of 106 Cases
Authors: Arangio George A.
Published: March 2013

Two cases of successful percutaneous cross-pinning of one acute and one delayed union of Jones' fracture are presented. One hundred six cases of Jones' fracture, taken from the literature, are reviewed and tabulated.
Early Epiphyseal Fusion in Freiberg's Infraction
Authors: Sedlin Elias D.
Published: March 2013

A case of Freiberg's Infraction of the third metatarsal which demonstrates early epiphyseal closure in this condition is presented. The etiology of this phenomenon is unclear.
Evolution of the Human Foot: Evidence from Plio-Pleistocene Hominids
Authors: Susman Randall L.
Published: March 2013

The human foot serves a dual role during locomotion. It functions at times as a mobile structure and at times as a rigid lever. The human foot shows the hallmarks of an arboreal heritage wherein the foot was primarily a grasping organ. Over the course of the human career the human foot has evolved an elaborate plantar aponeurosis, strong plantar ligaments, longitudinal arches, an enlarged musculus flexor accessorius, an adducted (non-opposable) hallux, a remodeled calcaneocuboid joint, a long tarsus, and shortened toes (II to V). Comparisons of the chimpanzee and human foot allow us to reconstruct the pathway of foot evolution. Fossil foot bones of Homo habilis, dated at 1.76 million years, are remarkably like those of modern humans. Foot bones from Hadar, dated at around 3.5 million years, are remarkably chimpanzee-like, with only incipient human traits. The surprising chimpanzee-like qualities of the Hadar fossils strongly support the use of living apes as models of ancestral pongid-hominid morphotypes.
Functional Aspects of Neandertal Pedal Remains
Authors: Trinkaus Erik
Published: March 2013

The fossil foot remains of the Neandertals (immediate predecessors of anatomically modern humans in Europe and western Asia between about 100,000 and 35,000 to 40,000 years ago) indicate an overall pedal configuration for these prehistoric humans that was largely indistinguishable from that of modern humans. They had fully adducted halluces, longitudinal and transverse pedal arches, compact posterior tarsal regions, slight valgus deviation of the hallux, and abbreviation of the lateral toes. Their pedal remains differed from those of modern humans only in their tendency to be more robust and their relatively short proximal hallucial phalanges and associated elongated distal hallucial phalanges. The former is related to their habitual levels of physical activity, which were greater than those of modern humans, and the latter is a pleiotropic effect of a biomechanical adaptation in the pollex for strength during manipulation.
Electromyographic Studies of the Human Foot: Experimental Approaches to Hominid Evolution
Authors: Reeser Lori A. , Susman Randall L. , Stern Jack T.
Published: March 2013

Theories about the functions of the foot muscles have centered on their role in arch support. Previous anatomical and electromyographic studies (reviewed herein) have demonstrated that the arches are normally maintained by bones and ligaments. This study reports an electromyographic investigation of five foot muscles (flexor digito-rum longus, flexor digitorum brevis, flexor accessorius, abductor hallucis, and abductor digiti quinti) conducted on four humans. The three toe flexors act together to resist extension of the toes during the stance phase of locomotion. Despite the large flexor accessorius in humans, neither this muscle nor the flexor digitorum brevis are preferentially recruited over the flexor digitorum lon-gus for any normal posture or locomotion. The abductors affect the mediolateral distribution of pressure by positioning the forefoot. We suggest that the foot muscles play an important role in positioning of the forces on the foot in both posture and locomotion. Future electromyographic experiments on human and ape foot muscles in conjunction with detailed studies of early hominid fossils promise to elucidate the pathways of human locomotor evolution.
Foot Reconstruction by Free Flap Transfer
Authors: Wood Michael B. , Irons George B. , Cooney William P.
Published: March 2013

Free skin flap transfer for foot salvage and reconstruction was done in 10 patients whose follow-up exceeded 1 year. Nine of the 10 had successful results, and generally all achieved the desired reconstructive goal in one stage, with a minimum of hospitalization and disability time. In using a free skin flap transfer in weightbearing locations, the need for cutaneous innervation of the flap should be considered, but such innervation is not necessary for success.
Tendon Lacerations in the Foot
Authors: Floyd Donald W. , Heckman James D. , Rockwood Charles A.
Published: March 2013

An extensive search of the English and foreign language literature yields clinical reports on only 87 patients with open injuries of various tendons about the foot and ankle. This retrospective review is presented to document case histories in 80 additional patients, to present the results of 46 patients, and to assess the treatment recommendations outlined in the literature.
Diabetic Neuroarthropathy in the Foot: Patient Characteristics and Patterns of Radiographic Change
Authors: Cofield Robert H. , Morrison Michael J. , Beabout John W.
Published: March 2013

The diagnosis of diabetic neuroarthropathy of the foot can be difficult. A series of 96 patients (116 extremities) who had diabetes and peripheral neuropathy with bone and joint changes was reviewed. Typically, the patients were middle-aged or older, were taking insulin, and had had diabetes for more than 10 years. Retinopathy, nephropathy, and peripheral vascular disease were often present. There were abnormalities of vibratory sensation (94%) and of the gastrosoleus reflex (88%). The finding of specific radiographic abnormalities assisted but did not reliably differentiate neuropathy from infection. Three patterns of radiographic changes were noted: (1) at the metatarsophalangeal and interphalangeal joints, usually with underlying ulceration; (2) at the tarsometatarsal joints; and (3) in the anterior pillar-medial column of the foot, with talus, talonavicular, navicular, or naviculocuneiform destruction. Ulceration and infection in patients with patterns (2) and (3) were rare. When correlated, the demographic features, mode of presentation, physical signs, specific radiographic abnormalities, and patterns of change were distinctive and allowed the diagnosis of this complication of diabetes to be readily made.
An Anatomic Study of the Short Oblique Fracture of the Distal Fibula and Ankle Stability
Authors: Harper Marion C.
Published: March 2013

The short oblique fracture of the distal fibula occurring as a stage 2 supination-external rotation injury was investigated in respect to its effect on ankle stability in a series of cadaver dissections. Approximately 25 and 20 degrees of external rotational displacement of the distal fibula and talus, respectively, as well as approximately 1 mm of direct lateral talar shift were noted to be possible with this injury. This degree of rotational or lateral talar displacement was seen to result in tibiotalar joint incongruity. The deltoid ligament effectively prevented talar eversion but not the initial 2 to 3 mm of lateral talar displacement. Ankle stability in respect to medial talar shift was not compromised by removal of the medial malleolus.
A Dorsal Wedge V Osteotomy for Painful Plantar Callosities
Authors: Sclamberg Edward L. , Lorenz Mark A.
Published: March 2013

A dorsal closing wedge proximal V metatarsal osteotomy is described for treatment of painful plantar callosities due to prominence of any of the five metatarsal heads. Forty-one osteotomies were performed over a 3-year period. In all patients so treated relief of symptoms was achieved, plantar callosities were resolved, and no significant complications occurred.
Lateral Talocalcaneal Angle in Assessment of Subtalar Valgus: Follow-up of Seventy Grice-Green Arthrodeses
Authors: Aronson James , Nunley James , Frankovitch Karl
Published: March 2013

To determine whether definitive radiographic criteria could be elucidated tor the Grice-Green extra-articular subtalar arthrodesis, all 70 cases performed at the Shri-ner's Hospital for Crippled Children, Erie, Pennsylvania, from 1972 to 1980 were reviewed. Patients were followed both clinically and radiographically an average of 4 years and 11 months. Major conclusions were as follows: 1) the standing lateral talocalcaneal angle is the most reliable measurement for operative selection and assessment of postoperative success; and 2) by using strict operative techniques and proper patient selection, a 90% success rate can be expected.
The Arterial Anatomy of the Talus
Authors: Gelberman Richard H. , Mortensen Wayne W.
Published: March 2013

The extraosseous and intraosseous vascularity of the talus was studied in 26 fresh cadaver limbs. The specimens were injected with latex or Batson's compound, debrided by a nondissection technique, and cleared by a modified Spalteholz method. The extraosseous vascularity was through the branches of the three major regional arteries which entered the five nonarticulating surfaces of the bone. The major blood supply to the body was provided by the artery of the tarsal canal. The deltoid and sinus tarsi vessels provided significant minor sources of vascularity. The superior neck and posterior tubercle vessels supplied small areas of the body, but did have anastomoses with the other arteries in some specimens. These vascular patterns correlated well with the reported incidence of avascular necrosis of the body of the talus following injury.
Functional Anatomy of the Medial Collateral Ligament of the Ankle Joint
Authors: Quiles Manuel , Requena Francisco , Gomez Luis , Garcia-Sancho Luis
Published: March 2013

The calcaneotibial and posterior talotibial ligaments slacken and the naviculotibial ligament tightens as the nakle plantarflexes; the reverse occurs in ankle extension. The naviculotibial ligament increases its length and the posterior talotibial ligament relaxes in abduction. The cutting of the posterior talotibial ligament repercutes on other parts of the medial collateral ligament. The cutting of other parts of the medial collateral ligament produces very little change on the posterior talotibial ligament. When the whole medial collateral ligament is severed, there is a lateral displacement of the talus. This may be important in the diagnosis and surgical treatment of a torn medial collateral ligament.
Ankle-Foot Peripheral Nerve Block for Mid and Forefoot Surgery
Authors: Sarrafian S. K. , Ibrahim I. N. , Breihan J. H.
Published: March 2013

A simplified, predictable method of peripheral nerve block at the ankle and foot with a long acting anesthetic agent bupivacaine (Marcaine) 0.5% is presented. Combined with the use of a pneumatic tourniquet it allows the performance of mid and forefoot surgery on an inpatient or outpatient basis. It alleviates the risks of general or spinal anesthesia and avoids the use of analgesics for a period of 10 to 25 hours. The posterior tibial nerve is blocked at the level of the neurovascular tunnel on the posterior aspect of the distal tibia. The deep peroneal nerve is blocked at the level of the midtarsus in the fourth fascial compartment. The intermediate and medial dorsal cutaneous branches of the superficial peroneal nerve and the saphenous nerve are blocked subcutaneously on the dorsum of the foot. The sural nerve is blocked subcutaneously at one fingerbreadth distal to the tip of the lateral malleolus. The results have been excellent to good. No adverse reactions occurred affecting the central nervous system or the myocardium.
Displaced Fractures of the Os Calcis Involving the Subtalar Joint: The Key Role of the Superomedial Fragment
Authors: Stephenson John R.
Published: March 2013

Fourteen displaced intra-articular fractures of the os calcis are reviewed following open reduction and internal fixation using a lateral approach with an average follow-up of 22 months (range, 12 to 44 months). Postoperative management consisted of early subtalar motion with delayed weightbearing. Twelve of 14 fractures were considered good results on the basis of no pain, 50% normal subtalar motion, and near-normal anatomy. Pain correlated with incomplete reduction of the superomedial fragment and, thus, incongruent reduction of the posterior facet in two cases. The importance of effecting a reduction of the superomedial border of the os calcis is emphasized.
Postoperative Wound Infection in Foot and Ankle Surgery
Authors: Miller William A.
Published: March 2013

In 20 years through 1981, the author performed 1841 clean foot and ankle operations without any prophylactic antibiotics. Excluded from this study group are patients with compound fractures or open wounds, prior infection, toenail procedures, and other superficial operations. All postoperative wound infections were recorded in a timely manner and healing was documented. Infections occurred in 41 cases (gross infection rate, 2.2%). Thirty-seven cases healed without further surgery and without sequellae from the infection. Three cases required further surgery. One patient developed narrowing of the ankle joint (permanent damage rate, 0.05%). These four patients represent 0.22% of the study group.