bluuebunny/crossref_metadata_2025_split huggingface dataset:
Increased Strength following Achilles Tendon Rupture Repair is Associated with Return to Same Level of Play in Patients with Higher Pre-Injury Level of Activity
Authors: Holzgrefe Russell E. , McCarthy Timothy , Wilson Jacob M. , Bariteau Jason T. , Labib Sameh A. 
Published: November 2020

Category: Hindfoot; Sports; Trauma Introduction/Purpose: Rupture of the Achilles tendon is a common injury that requires a lengthy duration of recovery and rehabilitation. Patients of various levels of physical activity, ranging from professional high-impact sports to low-impact recreational activities, can be affected by this injury. Often, one of the most important outcomes from the patient’s perspective is the ability to return to the same pre-injury level of sporting activity after recovery. The objective of the current study is to examine the relationship between global ankle strength and the ability to return to previous level of play following surgical repair of an Achilles tendon tear. Methods: Patients aged 18-50 years old at a minimum 1-year post-op from surgical repair of an isolated Achilles tendon rupture were recruited to return for a study visit. Patients reported both pre-injury and current activity level using the 10-point Tegner Activity Level Scale. Isokinetic strength testing was performed and the Isokinetic Strength Score (ISS) was calculated using maximal effort dorsiflexion and plantarflexion strength at 30o/s, 90o/s, and 240o/s comparing the operative and uninvolved extremity. The primary outcome was the patients’ ability to return to same level of play or within 1 Tegner activity level. Logitistic regression analysis was used to determine the relationship between ISS and return to play. Subgroup analysis was performed on patients participating in high level athletic activity (pre-injury Tegner >= 7) an those participating in only recreational or low level activity (pre-injury Tegner <7). Results: A total of 36 patients (mean 35 years, 72% male) completed the study protocol at a mean 1.8 years post-op (range 1 year to 3.6 years). Logistic regression revealed no association between ISS and return to play in the complete cohort. Subgroup analysis revealed that for 20 patients who had participated in high level competitive athletics prior to injury (Pre-injury Tegner >= 7), for every 16 point increase in ISS, the odds ratio for return to same level of play was 8.3 (p=0.055) and the OR for return to within 1 Tegner level of play was 6.3 (p=0.043). There was no association between ISS and return to previous activity in the 16 patients with lower pre-injury levels of activity. Conclusion: Improved ankle strength was associated with return to previous level of activity only in patients who participate in high level athletic activity. These results suggest that patients with more strenuous athletic activity prior to injury are more dependent on recovery of ankle strength in the post-operative time period in order to return to their previous high level of play. In contrast, regaining strength may be less important for returning to normal activities for less active patients. [Table: see text]
Cartiva Hemiarthroplasty for the Treatment of Hallux Rigidus
Authors: Hoskins Tyler , Patel Jay , Goyette David , Mazzei Christopher , Gianakos Arianna L. , Koss Justin , Wittig James , Epstein David M. 
Published: November 2020

Category: Lesser Toes; Arthroscopy; Other Introduction/Purpose: Hallux rigidus, degenerative arthritis of the first metatarsophalangeal (MTP) joint, is the most common type of arthritis of the foot, affecting nearly 2.5% of the population over the age of 50. The standard of treatment is non-operative in nature followed by surgical intervention if pain is not alleviated. Currently, first metatarsal dorsal cheilectomy and proximal phalanx osteotomy remain the two most common surgical interventions. Recently, first metartasophalangeal hemiartshroplasty with synthetic cartilage implant has become more popular. This procedure involves the implantation of synthetic cartilage in order to preserve motion and maintain joint space of the first metatarsophalangeal joint. Due to the scarce amount of literature reported on this technique, the goal of this study was to examine its efficacy in patients treated for hallux rigidus. Methods: From 2017 to 2019 twenty patients underwent a synthetic cartilage implant hemiarthroplasty for the treatment of hallux rigidus. Functional outcome scores were assessed using the American Orthopaedic Foot & Ankle scoring system (AOFAS) and the Foot and Ankle Outcome Score Survey (FAOS). Outcomes, complications, and any reoperations were recorded through retrospective chart review, direct patient examination, and phone calls to patients and their families. A statistical analysis was performed using Fischer’s Exact Test. Results were deemed statistically significant if the calculated p-value was less than 0.05. Results: The mean follow up for our patient cohort was 17.16 months (range, 12 to 26). The average age was 55.61 years (range, 47 to 73). Mean pre-op AOFAS and FAOS were 56.37 and 55 respectively, compared to 91.89 and 88.84 after surgery (p-value <0.05). There were no significant complications or reoperations reported in any of the patients at the time of publication. Conclusion: The pre-op and post-op AOFAS and FAOS scores were deemed statistically significant. Synthetic cartilage implant hemiarthroplasty, although new, offers promising results and remains a viable treatment option to decrease pain, improve function, and maintain motion for advanced hallux rigidus. However, a prospective randomized controlled trial comparing the efficacy of this procedure to other surgical methods would be necessary to further evaluate and validate our findings.
Comparison of Patient Reported Outcomes (PROs) for Major Pathologies of the Forefoot, Midfoot, Hindfoot, and Achilles Using PROMIS
Authors: Hu Daniel A. , Nayak Rusheel , Ogunkoya Elijah O. , Patel Milap , Kadakia Anish R. 
Published: November 2020

Category: Other; Hindfoot; Midfoot/Forefoot Introduction/Purpose: Many legacy patient reported outcomes (PROs) lack sufficient validity and reliability for the evaluation of clinical outcomes following foot and ankle procedures. Patient-Reported Outcomes Measurement Information System (PROMIS) is a newly developed PRO that has been validated for the general foot and ankle surgical population. It has since been used to assess the clinical outcomes of a variety of specific foot and ankle procedures. However, there is little data regarding clinical outcomes of patients at a more intermediate subgroup level. There has been some preconceptions that the different anatomic aspects of foot and ankle surgery have disparate functional and pain improvement. Thus, our study utilizes PROMIS to assess postoperative outcomes based on anatomical location in patients undergoing forefoot, midfoot, hindfoot, and Achilles procedures. Methods: Preoperative and one year postoperative PROMIS Physical Function (PF) and Pain Interference (PI) were prospectively collected from a cohort of patients undergoing a foot and ankle procedure at a tertiary medical center. The cohort was split into forefoot, midfoot, hindfoot, and Achilles procedure groups with 355, 95, 356, and 135 patients, respectively. Paired-t tests were used to compare preoperative versus postoperative outcomes within operative groups, while a one-way ANOVA was used to detect differences in PROMIS scores between operative groups. Results: Paired t-tests indicated that all four operative groups had significantly improved PROMIS PF and PI scores preoperatively versus one year postoperatively (all P <.001)(see attached figure). One-way ANOVA demonstrated that there were no differences in postoperative PROMIS PF and PI scores between the groups. A majority of patients achieved the minimal clinically important difference (MCID) level of improvement in PROMIS PF and PI scores following surgery. Conclusion: All four operative groups (forefoot, midfoot, hindfoot, Achilles) had significantly improved PROMIS PF and PI scores postoperatively compared to preperatively, indicating an improvement in physical function and pain outcomes in each of the operative groups. However, there were no differences in physical function and pain outcomes between the groups. [Table: see text]
Is it Safe to Offer Total Ankle Replacement (TAR) Surgery in Patients with Type II Diabetes?
Authors: Hutt Nicholas , Allport Jack , Shahid Zuhaib , Ramaskandhan Jayasree Ramas , Siddique Malik S. 
Published: November 2020

Category: Ankle; Ankle Arthritis; Diabetes; Midfoot/Forefoot Introduction/Purpose: The indications for Total Ankle Replacement (TAR) in patients with Type II Diabetes mellitus is poorly defined and there is paucity of literature reporting clinical, radiological and patient reported outcomes for TAR in this patient group. We aimed to explore the ideal pre-operative criteria for TAR in patients with Type II DM based on results from our center. Methods: We studied the x-rays, clinical findings and patient reported outcomes of surgery at pre-op and 5 years for patients who underwent a total ankle replacement at our center between 2006 and 2014 who had Type II DM. This was a retrospective study. The above findings were also compared between patients who had Type II DM vs. who were not diabetic. Pre-operative screening for diabetic patients included Hb1Ac levels, clinical reporting of swelling, warmth, erythema findings, neurovascular status including proprioception, vibration and neuro filament tests. Statistical analysis of WOMAC and SF-36 scores and differences between diabetic and non-diabetic patients were calculated using General Linear Model - repeated measures ANOVA. Patient satisfaction was analyzed using chi-square test. Rates of superficial and deep infection as well as revision were recorded. Results: Of 230 patients, 9 (3.9%) were diabetic. Pre-op radiographic analysis showed features confining to OA; x-ray, CT scan showed no signs of bone debris, fragmentation per articular fractures. Talus was not translated, no evidence of OA in Subtalar or Talonavicular joint. At 5 years, there was no implant subsidence, loosening, migration or peri-prosthetic cysts; hind and midfoot joints had no features of diabetic arthropathy/collapse. Comparing outcomes to Non-diabetic TAR patients, WOMAC & SF-36 scores showed significant (p<0.05) improvement and no significant difference between groups from pre-op to 5 years. In the diabetic group there was 1 superficial infection (11%) 1 deep infection that required revision (11%) compared to 30 superficial infections (13.6%), 1 deep infection (0.5%) and 12 revisions (5.4%) in the non-diabetic group. Conclusion: Painful end stage OA in Type II DM can be treated by TAR, taking into consideration the inclusion and exclusion criteria that we have used in our series.
Efficacy of Bilateral Simultaneous Hallux Valgus Correction in the Elderly Aged 70 to 79 Compared to Middle Age
Authors: Jang Chul-Young , Lee Ho-Jin , Park Eui Hyun , Chu In Tak 
Published: November 2020

Category: Bunion; Midfoot/Forefoot Introduction/Purpose: Due to the increase in life expectancy, the frequency of elderly patients with moderate to severe hallux valgus deformity is expected to increase. The aim of this study was to evaluate the clinical and radiological efficacy of bilateral simultaneous correction of hallux valgus in elderly patients aged 70s and to compare the results with those of middle age. Methods: From August 2014 to July 2017, 92 women (184 feet) patients, who underwent bilateral simultaneous correction surgery (proximal chevron metatarsal osteotomy, Akin osteotomy, and distal soft tissue procedure) due to moderate to severe hallux valgus deformity, were retrospectively analyzed. Based on the age at the time of surgery, elderly patients in their 70’s (70˜79 years) were defined as the ‘elderly’ group and middle aged patients in the 45˜50 years as the ‘middle age’ group. The VAS score, AOFAS-Hallux Metatarsophalangeal-Interphalangeal score, hallux valgus angle, 1-2 intermetatarsal angle, and post-operative complications were compared and analyzed between the two groups. The mean follow-up period was 30.6(24˜57) months. There was no significant difference in improvement of VAS scores after surgery between the middle age and elderly group (p=0.710). Results: Although the final AOFAS scores were significantly different between two groups, there was no significant difference in AOFAS score improvement after surgery between two groups (p=0.129) (Table 1). At the last follow up after surgery, the HV angles and 1-2 IM angles were all significantly improved compared to the preoperation (Table2). Complications occurred in 16 cases, 5 in middle age (11.1%) and 9 in the elderly (19.1%). In the middle age group, 1 case (2.2%) of HV recurrence (> 15 degrees), 1 case of medial incision site paresthesia, 2 plantar pain, and 1 MTP joint stiffness occurred. In the elderly group, 3 case (6.4%) HV recurrence, 2 cased of displacement after metatarsal bone fixation, 2 cases of medial incision site paresthesia, and 2 plantar pain. Conclusion: In patients aged 70s, bilateral simultaneous correction of moderate to severe hallux valgus showed good improvement of clinical and radiologic outcome without any significant difference compared to the middle age group. However, the attention should be paid to the fixation failure after correction in the simultaneous treatment of hallux valgus in elderly patients aged 70s. [Table: see text][Table: see text]
Socioeconomic Distressed Communities Index Associated with Higher Burden of Amputation in Diabetic Peripheral Arterial Disease
Authors: Jensen Katherine J. 
Published: November 2020

Category: Diabetes; Other Introduction/Purpose: The prevalence of diabetes and one of its complications, peripheral arterial disease (PAD), is increasing. Diabetic PAD is known to lead to high rates of lower extremity amputations. Diabetes disproportionately affects people of low socioeconomic status. The Distressed Community Index (DCI) is a proxy social risk factor, calculated at the zip code level as a function of seven metrics of community economic well-being: no high school diploma, housing vacancy rate, unemployment rate, poverty rate, median income ratio, change in employment, and change in establishments. Higher DCI has been linked to longer operative times, longer hospital length of stay, and increased incidence of postoperative complications. This analysis sought to analyze the impact of a socioeconomic risk factor, DCI, on amputation rate in patients with diabetic PAD. Methods: Data from a regional hospital abstract reporting system was obtained from the State Department of Health. It was sorted to include patient records with a diagnosis of peripheral arterial disease (ICD-10-CM diagnostic codes). Data was further stratified by diagnosis of diabetic PAD and DCI score. DCI scores were obtained from the Economic Innovation Group. Procedure codes were used to identify amputations starting with ‘detachment at [R/L] foot, complete, open approach’ and including all progressively distal amputations (ICD-10-PCS codes). Statistical analysis was performed using XLSTAT, significance was assigned at alpha of 0.05. Results: From 2016 to 2018, there were 33664 patients requiring inpatient treatment with a diagnosis of PAD. 13261 patients (39.4%) had diabetic PAD, 3078 patients (9.1%) originated from a zip code with a DCI score greater than or equal to 75 (top quartile) and 1394 patients (4.1%) had diabetic PAD and DCI greater than 75. While patients with diabetic PAD and a DCI less than 75 had approximately the same rate of amputations as all patients with diabetic PAD (15.3% and 15.7%, respectively), patients with diabetic PAD and a DCI greater than 75 were 1.30 times more likely (p=0.0003) to require amputation than all patients with diabetic PAD (19.1% and 15.7% overall amputation rates, respectively). The relationship with DCI was not significant in non- diabetic PAD patients. Conclusion: Approximately one in five patients presenting for inpatient treatment with a diagnosis of diabetic PAD originating from a zip code with a DCI score greater than or equal to 75 required a lower extremity amputation. Though diabetes by itself was a stronger risk factor for amputation (OR 8.24, p<0.0001) than DCI in the comprehensive PAD patient population, a patient with a high DCI score in the diabetic PAD population was significantly more likely to require amputation. DCI is a proxy social risk factor providers can use to preemptively identify patients at increased risk of lower extremity amputation secondary to PAD. [Table: see text]
The 3D Printed Total Talus Replacement: A Novel Treatment Option for Avascular Necrosis of the Talus
Authors: Kadakia Rishin J. , Akoh Craig C. , Chen Jie , Sharma Akhil , Parekh Selene G. 
Published: November 2020

Category: Ankle; Trauma Introduction/Purpose: Talus avascular necrosis (AVN) is a challenging entity to treat. Management options depend upon disease stage and severity. Total talus replacement (TTR) is a treatment option that maintains joint range of motion. The literature on TTR is limited with variability in implant design and material. The purpose of this study is to evaluate outcomes following total talus replacement with a custom 3D printed metal implant. Methods: Patients that underwent TTR were retrospectively reviewed over a three year period. Basic demographic data and comorbidities were collected. Medical records were reviewed to obtain postoperative and preoperative visual analog (VAS) scores, Foot and Ankle Outcomes Scores, (FAOS), ankle range of motion, and postoperative complications. Statistical analysis was conducted to compare clinical and patient-reported outcomes pre and postoperatively. Results: Twenty-eight patients underwent TTR for talar AVN with a mean follow-up of 16.4 months. Ankle range of motion remained unchanged statistically pre and postoperatively. VAS pain scores improved significantly pre and postoperative from 6.6 to 3.9 (p < 0.001). FAOS scores significantly improved postoperatively with regards to pain (p = 0.002), symptoms (p=0.03), quality of life (p < 0.001), and activities of daily living (P < 0.001). There were three complications requiring reoperation in this cohort. Conclusion:: 3D printed total talus replacements represent a unique surgical option for patients with talar collapse secondary to AVN. Patients in this cohort demonstrated significant improvements in pain scores and patient-reported outcomes while maintaining preoperative joint range of motion. TTR allows for symptomatic improvement with the preservation of motion in individuals with talar collapse and end-stage AVN.
The Difference of In-Shoe Plantar Pressure between Level Walking and Stair Walking
Authors: Kang Ho Won , Kim Dae-Yoo , Cho Yun Jae , Kyung Min Gyu , Hwang Il-ung , Cao Linying , Lee Dong Yeon 
Published: November 2020

Category: Basic Sciences/Biologics; Other Introduction/Purpose: Stair walking is one of common activities of daily living. It is more demanding than level walking and can aggravate discomfort of the foot, such as Morton’s neuroma, plantar fasciitis, Achilles tendinitis, pressure related-ulcer, and etc. Therefore, analysis of increased pressure in specific plantar area at stair walking can be used as a risk assessment of foot discomfort and basic data in the clinical field. The purpose of this study is to analyze plantar pressure distribution and pressure patterns during gait cycle at stair walking compared to level walking. Methods: Fourty healthy male adults were recruited. Radiologic measurements and gait analysis were performed to check participants’ normality, and 35 healthy males with 20-28 years old were included. They performed level walking (18 meters walkway), stair (26 steps stair, height:16.7cm, depth:29.8cm) ascending, and descending in same type of running shoes. Measurements of in-shoe plantar pressure including peak pressure, pressure-time integral (PTI) were done by Pedar-X system. The sole was masked in 7 segments (hallux, 2nd-5th toes, medial forefoot, central forefoot, lateral forefoot, midfoot, heel region) to analyze properly. Percentages were assigned in relation to the size for each mask segment. Statistical analysis was performed using repeated measure ANOVA, and Bonferroni post hoc test was done. Results: PP in all regions except for the midfoot were higher during level walking than stair walking. During stair descent, PP in all the regions except for the midfoot were generally lower than other types of walking, but it was the highest in the midfoot region. PTI in the medial and central forefoot was higher during stair descent than level walking. PTI in the central and lateral forefoot, and the midfoot was higher when stair ascending than level walking. PTI in the heel region was the highest during level walking, followed by stair ascent, stair descent. Conclusion: The risk of aggravation of discomfort in the midfoot area increases when stair descending. The medial region of forefoot bear high pressure load during stair descent, and the lateral region of forefoot and the midfoot region bear high pressure load during stair ascent. This is the first study to show plantar pressure patterns during level and stair walking in the large healthy gender-controlled population. We recommend that patients with pressure related foot lesions in the forefoot or midfoot avoid stair walking.
Predicting Syndesmotic Injury in Weber B Ankle Fractures
Authors: Kellam Patrick , DeKeyser Graham J. , Higgins Thomas F. , Rothberg David , Haller Justin , Marchand Lucas S. 
Published: November 2020

Category: Trauma; Ankle Introduction/Purpose: Accurate pre-operative diagnosis of syndesmotic injuries can be difficult in the setting of AO 44-B1 fractures. Ankle fractures with syndesmotic injuries have worse reported outcomes. No study has investigated the relative fracture height in determining potential syndesmotic injury. The goal of this study was to establish if pre-operative radiographs could accurately predict syndesmotic injury. Methods: Patients treated for an isolated AO 44-B1 fracture over a ten-year period (2007-2017) were reviewed. Anteroposterior and mortise views of the ankle were used to determine the zone of distal extent of the proximal fracture fragment (Figure 1). Syndesmotic injury was defined as positive intraoperative stress exam that required syndesmotic fixation. Relative risks were determined between zones with a statistical significance set at 0.05. Ten randomly selected radiographs were reviewed by two authors and assessed by intra-class correlation (ICC) for inter- and intra-observer reliability. Results: There were 548 AO 44-B1 fractures that were reviewed; and 287 patients were included in the study. There were 191 zone 1 injuries, 57 zone 2 injuries, and 39 zone 3 injuries. Of these, 17% (33 patients) of zone 1, 42% (24) of zone 2, and 74% (29) of zone 3 fractures had syndesmotic injuries. The relative risk of syndesmotic injury of Zone 1 compared to Zone 2 was 2.4 (p<0.001), Zone 1 to Zone 3 was 4.3 (p<0.001), Zone 2 to Zone 3 was 1.8 (p=0.002). The ICC for inter- and intra-observer reliability was perfect (ICC=1). Conclusion: AO 44-B1 fractures have a varying rate of syndesmotic injury. Weber B fractures that end between the level of the plafond and the physeal scar (Zone 2) are 2.6 times more likely to have a syndesmotic injury compared to those that end below the plafond (Zone 1). This is magnified in those injuries ending above the scar (Zone 3). This simple classification of AO 44-B1 fractures is predictive of syndesmotic injury and may aid in preoperative counseling and planning.