bluuebunny/crossref_metadata_2025_split huggingface dataset:
Superficial Peroneal Nerve Entrapment: Diagnosis and Surgical Management. A Retrospective Study of 46 Patients
Authors: Brown Cortez L. , Worts Phillip , Borom Andrew 
Published: October 2019

Category: Ankle Introduction/Purpose: Superficial peroneal nerve entrapment (SPNE) is an uncommon and often misdiagnosed condition which can lead to pain or paresthesia of a patient’s distal anterolateral leg and dorsal foot. A past medical history of an ankle sprain, specifically an inversion sprain, places SPNE on the differential diagnosis. Mismanagement of SPNE may result in continued lower leg dysfunction, unnecessary medical procedures, increased medical costs, and patient frustration. The purpose of our study was to describe an alternative diagnostic technique for SPNE and clinical outcomes following surgical decompression. Methods: Using ICD-9/10 and CPT codes, we identified 46 patients in the private practice of a single foot and ankle orthopaedic surgeon who underwent a SPN surgical decompression between 2012 and 2017. A thorough chart review confirmed all patients underwent an SPN decompression. Additionally, the primary author compiled our variables of interest (mechanism of injury, prior medical management of ankle pain, physical exam findings, diagnostic testing, intraoperative findings, and resolution of pain or paresthesia) from this chart review. Results: 46 patients (40.1 ± 14.6 years of age; 11 males and 35 females) underwent a decompression of the SPN. Average time to evaluation was 2.8 ± 5.9 years (range: 0 - 25). Ten of 46 patients (22%) reported a history of inversion ankle sprain. Positive exam findings were: tender to palpation at the fascial exit point 40/46 (87%) and positive Tinel’s sign 38/46 (84%). Pre-operative SPN diagnostic nerve block at point of maximum tenderness was performed in 44/46 patients (96%). 31/44 (70%) patients reported complete pain relief after diagnostic block. Of the 31 patients, 26 (84%) reported post-operative pain improvement. When cases were isolated to SPN entrapment with complete pre-operative pain relief following diagnostic nerve block, 18/19 (95%) experienced complete post-operative pain relief. Conclusion: A thorough examination of the foot and lower leg can appropriately diagnose SPNE using palpation of fascial exit point and a positive Tinel’s sign. Additionally, a nerve block proved clinically useful as an effective technique for SPNE diagnosis. Patients undergoing an isolated SPN decompression experienced pain improvement at higher rates compared to patients with concomitant surgical procedures. Future work is needed to determine if a positive diagnostic nerve block is a predictor of post- operative pain improvement. Further, while preliminary evidence is encouraging, larger cohorts across various patient populations are needed.
Endoscopic Treatment for Chronic Achilles Tendon Rupture on High Demand Patients
Authors: Caetano Joao , Dias Rafael , Silva Miguel Duarte , Figueiredo João , de Sousa João Vieira , Wircker Patrícia , Corte-Real Nuno 
Published: October 2019

Category: Ankle, Arthroscopy, Sports, Trauma Introduction/Purpose: Chronic Achilles Tendon Rupture (CATR) is still a prevalent condition that includes neglected ruptures and re-ruptures after surgical treatment. CATR is responsible for marked functional impairment that usually requires surgical repair and an open procedure is traditionally performed. Endoscopic treatment has been described but there is no consensus in its role due to lack of quality papers. There is some experience with endoscopic transfer of Flexor Hallucis Longus (ETFHL) but most authors recommend this technique only on low demanding patients. The purpose of this paper is to present our results with ETFHL on athletic patients (recreational sports or high demanding job), contributing to the establishment of this technique. Methods: In this retrospective study, the authors report a series of 14 patients submitted to ETFHL, 12 patients due to Chronic Achilles rupture and 2 due to acute re-rupture, between May 2014 and January 2018. The mean follow-up period was 28 months (range 12 to 48 months). We measured pre and post-operative AOFAS score and Achilles Tendon Total Rupture Score (ATRS), along with post-operative heel rise height test. Results: In our 14 patients (11 male, 3 female) the mean age was 42 years old (range 23 to 59). There were 10 non-professional athletes and 4 high demand workers. The mean pre-operative AOFAS score was 61,1 (range 49 to 79) and ATRS was 11,6 (range 10 to 14). Post-operative results: the mean AOFAS score was 96 (ranging 90 to 100). All patients were able to do single foot heel rise with a mean height of 6,2 cm (range 5 to 9,6 cm). The mean ATRS was 95 (range 81 to 100). All patients showed complete functional recuperation of the gastrocnemius complex and returned to sports or labor activities at their previous level. One patient had transient hypoesthesia of tibial nerve. No other complications were registered. Conclusion: We present a small group of recreational athletes and high demand workers in which ETFHL for CATR showed good results with remarkable functional rehabilitation. Our results are comparable to open classic techniques, with less invasiveness and soft tissue complications. Our experience made us believe that ETFHL may play a role in the treatment of CATR, not only in low demand patients but also in the athletic population. Further studies are necessary to compare this technique with the open procedure to ensure its safety and efficacy.
Total Ankle Arthroplasty and Ankle Arthrodesis Utilization: An American Board of Orthopaedic Surgery (ABOS) Part II Database Study
Authors: Carender Christopher N. , Glass Natalie A. , Amendola Annunziato , Duchman Kyle R. 
Published: October 2019

Category: Ankle, Ankle Arthritis Introduction/Purpose: Total ankle arthroplasty (TAA) utilization has increased over the last 20 years, while ankle arthrodesis (AAD) utilization has remained constant. However, annual hospital procedure volume for TAA and AAD remains low, with 50% of hospitals performing a median of =5 cases per year. Practicing in a low-volume setting may have implications for technical performance and patient outcomes, especially amongst early-career surgeons. The purpose of this study was to examine trends in utilization of TAA and AAD in ABOS part-II candidates while considering the influence of fellowship training status on treatment of end-stage ankle arthritis. Methods: The American Board of Orthopedic Surgery (ABOS) Part II database was queried to identify all candidates who performed =1 TAA or AAD from exam years 2009-2018. Candidates were categorized by exam year and by self-reported fellowship training status. Descriptive statistical methods were used to report procedure volumes. Trends in utilization of TAA and AAD were examined using log-modified regression analyses. Results: From 2009-2018, there was no significant change in the utilization of TAA or AAD amongst all candidates (p=0.92, p=0.20) (Table 1). Candidates reporting a foot and ankle (FA) fellowship trended towards increased utilization of TAA relative to AAD versus non-FA fellowship candidates, but this failed to reach statistical significance (p=0.06). The utilization of arthroscopic AAD increased over time (p<0.01) amongst all candidates. There was no difference in the rates of utilization of open versus arthroscopic AAD amongst FA trained candidates. High-volume (=5 TAA) candidates represented 10.5% of all candidates performing TAA, and accounted for 34.2% of all TAAs performed over the study period. Conclusion: Utilization of TAA and AAD did not change over the study period, and the number of these procedures performed by early-career surgeons remains low. The majority of both procedures are performed by FA trained surgeons with relatively low practice volumes. There was a trend toward increased TAA utilization relative to AAD utilization in FA trained surgeons, but this did not reach statistical significance. The findings in this study may have implications for technical performance impacting patient outcomes and may guide potential changes in training curricula.
Percutaneous Chevron Osteotomy Combined with Adductor Tendon Release for Hallux Valgus Correction
Authors: Carlucci Sofia , Carrasco Nelly , Santini-Araujo Maria , Parise Ana , Conti Leonardo , Villena Daniel , Dozo Daniel , Sotelano Pablo 
Published: October 2019

Category: Bunion, Midfoot/Forefoot Introduction/Purpose: The use of minimally invasive techniques for hallux valgus may provide complete deformity correction with minor soft tissue damage, which reduces morbidity and shortens recovery. In this way, some open osteotomies were adapted to percutaneous approaches, with good outcomes reported. The minimally invasive chevron-Akin (MICA) described by Vernois and Redfern in 2011, combines benefits of percutaneous approaches with a stable internal fixation. Since 2015 we have adapted this technique, by adding a percutaneous adductor tenotomy to dispense with the Akin osteotomy. The aim of this study was to report a single surgeon series of consecutive patients with moderate hallux valgus managed with a minimally invasive chevron osteotomy and a percutaneous adductor tendon release. Methods: This was a prospective cohort study. A total of 38 feet with moderate hallux valgus underwent the procedure and were followed up for a minimum 12 months (SD 1.10). The median age was 58 years (IQR 52 - 65), 36 women and 2 men. Radiological parameters were compared at preoperatory and at the last follow-up and included: Hallux Valgus Angle (HVA), Inter- Metatarsal Angle (IMA), Distal Metatarsal Articular Angle (DMAA) and first metatarsal shortening. Time to consolidation was also assessed. For clinical evaluation the American Orthopaedic Foot & Ankle Society score (AOFAS) was evaluated. Complications during the follow up were reported. Patients in which another procedure in the hallux was performed, with previous surgeries or not completed 1 year follow-up were excluded. Results: Radiologic postoperative parameters demonstrated to achieved correction. At the last follow up there was a statistically significant decrease in the hallux valgus angle, the intermetatarsal angle and distal metatarsal articular angle. Shortening of the first metatarsus was a mean 7.02 mm (IQR 1.24 - 10,27). The mean AOFAS score increased from 58.23 (SD 9.02) pre-operatively to 97.15 (SD 4.72) post-operatively (p< 0.001). Complications reported were 2 superficial infections, 1 broken screw, 1 screw extraction. Five patients referred metatarsalgia after surgery and 1 presented a fourth metatarsal stress fracture. Only one patient presented lost of correction in the first postoperative week and needed a second surgery. Conclusion: Our series of hallux valgus correction with a minimally invasive chevron osteotomy combined with the adductor tendon release shows good clinical and radiological outcomes, and results are comparable to series with the additional Akin osteotomy. Comparative studies are needed for major evidence.
Economic Impact of Comorbidity burden in Total Ankle Arthroplasty and Ankle Arthrodesis
Authors: Chan Jimmy J. , Guzman Javier Z. , Chan Jesse C. , Zubizarreta Nicole , Poeran Jashvant , Vulcano Ettore 
Published: October 2019

Category: Ankle, Ankle Arthritis, Diabetes Introduction/Purpose: Demand for total ankle arthroplasty (TAA) and ankle arthrodesis surgery is increasing. Findings from other orthopaedic populations suggest an increasing comorbidity burden among those planned for surgery, however, data on TAA and ankle arthrodesis is lacking. Methods: This retrospective cohort study utilized data from the nationwide Premier Healthcare Database (2006-2016) which contains inpatient claims on N=10,085 ankle arthrodesis and N=4,977 TAA procedures. Patients were categorized into Deyo Charlson comorbidity index groups with higher scores representing higher comorbidity burden: 0, 1, 2, =3. Outcomes were cost of hospitalization, length of stay (LOS), total opioid utilization (in oral morphine equivalents), discharge to a skilled nursing facility (SNF) and 30-day readmission. Mixed-effects models estimated associations between Deyo-Charlson comorbidity index and outcomes. We report odds ratios (OR, or % change for continuous outcomes) and 95% confidence intervals (CI). Results: In the TAA group, 64.4% of patients were in Deyo-Charlson category 0 while 24.1%, 7.6%, and 3.9% were in the 1, 2, and =3 Deyo-Charlson categories, respectively; this was 50.3%, 23.2%, 12.4% and 14.1% in the ankle arthrodesis group. The most common comorbidities were obesity, diabetes mellitus and chronic pulmonary disease. After adjustment for relevant covariates, patients in the Deyo-Charlson group =3 (compared to ‘0’) were associated with stepwise effects of 77.1% (CI 70.9%;83.6%) longer LOS and 48.5% (CI 44.0%;53.2%) higher cost of hospitalization with higher odds for admission to a SNF (OR=3.12 CI 2.64;3.70), all P<0.0001. Smaller or non-significant effects of comorbidity burden were seen for opioid utilization and 30 day readmission. These effects were also present but less pronounced in TAA patients. Conclusion: Comorbidity burden is particularly increasing among patients undergoing ankle arthrodesis where it is associated with significantly increased resource utilization. Our data demonstrate the potential impact of patient selection, which may be crucial in optimizing preoperative status.
Epidemiology of Operative Foot injuries in College Level Athletes
Authors: Chan Jimmy J. , Chen Kevin K. , Guzman Javier Z. , Vulcano Ettore 
Published: October 2019

Category: Hindfoot, Lesser Toes, Midfoot/Forefoot, Sports, Trauma Introduction/Purpose: Foot injuries represent a broad category of injuries that may have profound implications in National Collegiate Athletic Association (NCAA) athletes. Accordingly, a more thorough characterization of these injuries and what predisposes NCAA athletes to them is crucial to their prevention. This study examines the incidence and effect of foot injuries on NCAA athletes and their athletic season. Methods: Foot injuries across 16 sports among men and women during the 2004-05 to 2013-14 academic years were analyzed from the NCAA Injury Surveillance Program (NCAA-ISP). Three common orthopaedic foot injuries were sub-analyzed, including fifth metatarsal injuries (5MT), Lisfranc injuries, and turf toes. Multiple variables were reported including injury rates per 100,000 athlete-exposures (IR), operative rate, annual injury rate trends, re-injury rates, in-season status (pre/in/post-season) at time of injury, and time loss distributions were compiled and calculated. Results: A total of 3718 foot injuries were identified over 10-year period. 4.4% of all injuries were operative. Overall foot injury rate was comparable between male (IR=31.1) and female athletes (IR=32.4); however, the operative injury rate was greater in male compared to female (IR=2.0 vs. 0.6) athletes. The top three operative injuries were 5MT (45.1%), stress fractures (12.2%), and Lisfranc injuries (7.9%). 10.8% of turf toes are re-injury, and average time loss was 7.0 days. 43% of 5MT injuries were operative, and 19.2% were re-injuries. 40.6% of 5MT injuries were season-ending with an average time loss of 36.5 days. 33% of Lisfranc injuries were operative, and 7.5% were re-injuries. 45.9% of Lisfranc injuries were season-ending with an average time loss of 25.9 days. Conclusion: Foot injuries are among the most common form of injuries that occur in NCAA athletics. In addition, these injuries can sometimes lead to significant loss of playing time and may even result in the end of the athlete’s season or career. Certain NCAA sports such as men’s football and basketball may more likely predispose patients to season ending injuries and require operative fixation. Close examination of the kinds of foot injuries and their respective mechanisms may help elucidate trends useful in the development of various prevention strategies.
Analysis of Congenital Postaxial Polydactyly of the Foot Using Magnetic Resonance Imagings
Authors: Choi Jun Young 
Published: October 2019

Category: Midfoot/Forefoot Introduction/Purpose: We aimed to evaluate the magnetic resonance imaging (MRI) findings of congenital postaxial polydactyly of the foot. Methods: Three-hundred and forty-seven feet of 288 patients who underwent congenital postaxial polydactyly or polysyndactyly correction were divided into five subtypes according to the radiographic shapes of deformity origins (widened metatarsal head, bifid, fused duplicated, incompletely duplicated, or completely duplicated). MRIs were assessed to determine whether they unrevealed areas were fused or separated. MRI was also used to assess cases with radiographic phalangeal aplasia. Results: Huge variations were noted in MRIs. Fusion or separation at the base or head between original and extra digits were observed, and MRI effectively depicted phalangeal aplastic. Conclusion: MRI evaluations of congenital postaxial polydactyly of the foot are useful for determining the anatomical statuses which were not visualized by plain radiography.
Structural Effect of Long-Term Use of Medial Arch Support Insole on Children with Pediatric Flexible Flatfoot
Authors: Choi Jun Young , Kim Min Jin , Suh Jin Soo 
Published: October 2019

Category: Midfoot/Forefoot Introduction/Purpose: This prospective study aimed to rule out the effect of the normal physiologic maturation in applying medial arch support insole for patients with pediatric flexible flatfoot (PFFF). Methods: From January 2005 to June 2015, 18 patients (34 feet) in group 1 (insole was continuously applied) and 16 patients (32 feet) in group 2 (untreated group) were enrolled. A medial arch support insole was applied from age 10-11 years until radiographic physeal closure. Results: In group 1, the talonavicular coverage angle, lateral talo-first metatarsal angle, calcaneal pitch angle, and medial cuneiform height were significantly changed at final follow-up, although all values were still within the abnormal range. Moreover, no significant differences were found in any of the increments of the radiographic parameters between groups 1 and 2. Conclusion: Radiographic improvements were found in both medial arch support insole-treated and untreated groups even if all radiographic values were still within the abnormal range. This means that PFFF could be somehow improved with heel stretching exercise until the physes were closed. Further, hindfoot alignment remained unchanged regardless of the medial arch support insole application.
The Long-Term Structural Effect of Orthoses for Pediatric Flexible Flat Foot: A Systematic Review
Authors: Choi Jun Young , Kim Min Jin , Suh Jin Soo 
Published: October 2019

Category: Midfoot/Forefoot Introduction/Purpose: Several conservative treatment methods, from intrinsic muscle exercises to orthoses, including insoles or specially designed shoes, have been introduced for pediatric flexible flat foot (PFFF). However, the structural effects of orthoses use remain unclear because the normal physiological maturation of the medial longitudinal arch cannot be ruled out. Methods: A comprehensive literature search using five databases, namely MEDLINE, the Cochrane Library, Scopus, the Web of Science, and EMBASE, was performed for pertinent articles published before March 30, 2018. Studies with quantitative data on the effects of the long-term use of orthoses for PFFF were included. The search strategy was adapted as appropriate for all other databases searched considering the differences in indexing terms and search syntax for each database. Results: All studies, including randomized controlled trials or prospective cohort studies, could not prove the estimated effects of orthoses on the medial longitudinal arch. However, they revealed that flexible flat feet in young children slowly improved with growth, regardless of the type of footwear used. However, three of four studies, which were case series, revealed that positive long-term effects could be achieved using orthoses. Conclusion: There is no strong evidence that the long-term use of orthoses improved the structural problem of PFFF.
Pain and Complications following Bone Marrow Aspirate Concentrate (BMAC) Harvested from the Iliac Crest in Foot and Ankle Surgery
Authors: Christophersen Christy M. , Elattar Osama , Farber Daniel 
Published: October 2019

Category: bone graft in foot and ankle surgery Introduction/Purpose: Autologous bone is recognized as the gold standard for bone grafting in orthopedics with the iliac crest being the common harvest site. In an attempt to minimize morbidity associated with structural bone graft harvest from the iliac crest and still maintain the proposed benefit of collecting and transplanting live cells and growth factors, Bone Marrow Aspirate Concentrate (BMAC) obtained from the iliac crest has become increasingly popular. However, any harvest procedure can potentially induce pain and introduce complications. The purpose of this study was to evaluate the safety and complications of BMAC from the anterior iliac crest for use in various foot and ankle fusion procedures. Methods: A retrospective chart review was performed on all patients that underwent BMAC harvest from the iliac crest at the time of their foot or ankle surgical procedure by one of four fellowship trained surgeons between 2014 and 2017 with a minimum of six-month follow-up. Patients were evaluated for complications, pain, and functional limitation secondary to the BMAC harvest. The final outcome follow-up for the cohort was conducted using a specifically designed telephone questionnaire to assess patient satisfaction. A total of 55 patients were included, with a median age of 58 years (range 31 to 81 years) and 69% were female. Results: Out of the 55 patients, 52 patients (94.5%) reported reported good to excellent results and were satisfied with the procedure at the time the questionnaire was conducted. Only 3 patients reported persistent complications and some element of dissatisfaction with the procedure after 6 months (the minimum follow up), 1 patient reported persistent numbness at the harvest site, and 2 reported some persistent pain at the harvest site lasting up to 6 months. Some patients reported transient complications that eventually resolved with no implication on their satisfaction of the procedure at the time of the telephone questionnaire. Four patients reported hematoma that was treated conservatively and eventually resolved spontaneously. Four patients reported transient numbness at the harvest site with eventual resolution. Immediately post-operatively, 50% of patients reported some element of post-operative pain. However, at the time of the final follow-up (at least 6 months), only 2 patients reported persistent pain at the harvest site lasting up to 6 months, but it was not considered activity-limiting pain. Conclusion: BMAC harvest is a safe procedure with a high rate of patient satisfaction and minimal morbidity with mostly self- limiting complications. This is the first study to evaluate the safety of BMAC as a part of foot and ankle surgical procedures.