bluuebunny/crossref_metadata_2025_split huggingface dataset:
Validity of the Paper Pull Test for Strength in Patients with Hallux Valgus
Authors: Hutchison Marcey Keefer , Houck Jeff , Kau Jaymee , Omohundro Kristen E. , Hughes Alex , Oshiro Kara , Eckel Taylor 
Published: November 2020

Category: Bunion; Midfoot/Forefoot Introduction/Purpose: The purpose of this study was to explore validity of the paper pull test (PPT) to assess hallux flexion strength and function in persons with hallux valgus (HV). The following hypotheses were tested: 1) The PPT is valid for inferring 1st MTP flexion strength and heel rise (HR) performance (e.g. heel height). 2) A specified threshold of force during the PPT can be identified that discriminates patients with HV. 3) Muscle activity (abductor hallucis [AH], flexor hallucis brevis [FHB]), in patients with HV will be distinct from controls across three tasks: 1) PPT, 2) lowering phase of a HR, and 3) rising phase of a HR. Methods: Participants (24 controls, 22 with HV) performed: 1st MTP flexion, PPT, and heel rise. A force transducer in a jig assessed 1st MTP flexion. The same transducer recorded force during the PPT. Electromyography (EMG) was used to record FHB/AH muscle activity during 1st MTP flexion, PPT, and heel rising. 3D movement analysis was used to measure heel height and divide the HR into an up (HR-Up) and down (HR-Dwn) phase. One practice and 3 maximum 1st MTP flexion efforts were recorded. Manchester Scale of hallux deformity was used; 63.6% were classified as C or D. Validity was assessed with Pearson correlation’s between force during the PPT and 1st MTP flexion and PPT and HR height. Assessment of a threshold value for discriminating participants with HV from controls was determined using receiver operator curve (ROC) analysis. A two-way ANOVA for muscle groups and tasks were used to assess muscle activation. Results: The correlation between PPT force and maximum 1st MTP force was high (r=0.87, p<0.01) and the correlation with HR height was significant (r=-0.41, p<0.01). The ROC analysis yielded a high area under the curve (0.88(0.05)) for discriminating HV participants. Participants with HV that were below a threshold of 4.5% BW (44.1 N for a 100 kg person) on the PPT showed an 88% specificity/80% sensitivity in distinguishing HV participants from control participants (control average 64.1(37.3) N) versus HV (average 21.8 (16.4) N). Muscle activity was significantly higher across tasks for the AH (p=0.02) but was similar for the FHB (p=0.22). Conclusion: This data validates the PPT as simple, effective, clinical evaluation of 1st MTP flexion strength in patients with HV. This data also documents that patients with HV (surgery or not) may avoid using 1st MTP flexion explaining their significant weakness. The importance of this weakness on function is supported by the correlation with the heel rise test. The abnormal EMG findings suggests altered muscle control contributes to a lower PPT. The threshold of 1st MTP strength may assist with clinical decisions regarding whether rehabilitation or advice on increasing physical activity might benefit patients with various degrees of HV.
Household Items-Based Personalized Video Rehabilitation amidst the COVID-19 Pandemic: Handouts We All Wish We Had
Authors: Khan Irfan , Martin Kevin D. , Quatman Carmen E. , Groth Adam T. , Rodriguez Rudy 
Published: November 2020

Category: Ankle; Sports Introduction/Purpose: Rehabilitation is vital in the recovery of countless foot and ankle injuries and operations.1With our attention directed to providing care on the frontlines of the COVID-19 pandemic, rehabilitation has fallen by the wayside with poor consequences. Access to outpatient rehabilitation services and their specialized exercise equipment has significantly decreased,2 leaving patients feeling abandoned and surgeons looking for help on how to guide patients’ postoperative rehabilitation. This poster serves to introduce household items-based personalized video rehabilitation (PVR). Methods: Rehabilitation exercise videos were produced by a board-certified athletic trainer and board-certified orthopaedic foot and ankle surgeon. The videos showed how to perform rehabilitation exercises with common household items (Figure 3).The videos were produced in a structured order, explaining the purpose of the exercise, showing what household items are needed, and demonstrating the proper technique of the exercise. Following recording of the videos, they were assembled into injury/scenario-specific infographics (Figure 1). Results: 34 rehabilitation exercise videos were recorded, with an average length of two minutes, 11 seconds.11 injury/scenario- specific infographics were assembled, with each page of an infographic containing seven exercises (Figure 1), with specific information and access for each exercise (Figure 2).Patients can access the videos by clicking on the hyperlink, or by scanning the QR code. When giving infographics, healthcare professionals can guide patients on which exercises to perform. Conclusion: Household items-based PVR provides patients with an interactive infographic that gives access to concise videos of rehabilitation exercises, especially during a time of reduced rehabilitation accessibility. Healthcare professionals can assign patient- specific exercises on the infographic that are appropriate for a patients’ phase of rehabilitation. Not meant to replace the current rehabilitation model, household item-based PVR is a paradigm shift that will allow physicians to bridge gaps in care.
The Effect of a Leveling Procedure for Addressing Bony Step-off Following Medial Displacement Calcaneal Osteotomy
Authors: Kim Jaeyoung , Kim Chulho , Day Jonathan 
Published: November 2020

Category: Hindfoot; Other Introduction/Purpose: Due to the nature of the medial displacement calcaneal osteotomy (MDCO), bony step-off at the osteotomy site is inevitable and can lead to lateral prominence pain. Theoretically, this bony prominence can lead to irritation of the peroneal tendon, sural nerve, and overlying skin resulting in pain and discomfort. While these symptoms have been loosely described in the literature, the incidence and prevention are largely unexplored. The purpose of this study is to investigate the incidence of lateral prominence pain after MDCO as well as the efficacy of a leveling procedure (LP) as a preventive technique. Methods: We retrospectively identified 175 feet in 160 patients who underwent MDCO from 2016 to 2018. Of the 175 feet, 102 underwent MDCO with LP, and 73 without LP. LP was performed after calcaneal fixation by flattening the residual bony prominence using rongeur and bone impactor (Figure 1). Lateral prominence symptoms were defined as pain present at 12 month follow-up after MDCO, either 1) over the lateral prominence on direct contact with the floor or footwear, or 2) associated with callus formation over the osteotomy site due to continued irritation. The overall incidence of lateral prominence symptoms after MDCO and the incidence with or without LP were investigated. The relationship between the amount of calcaneal displacement and the occurrence of lateral prominence pain with or without LP was also analyzed. Results: The overall incidence of lateral prominence was 12.6% (22 of 175): 4.9% (5 of 102) in patients who underwent LP and 23.3% (17 of 73) in patients who did not undergo LP (p<0.001, Figure 2). In patients who did not undergo LP, a significant correlation was observed between incidence of lateral prominence symptoms and the amount of calcaneal displacement (p=0.013). This correlation was not observed in patients who underwent MDCO with LP (p=0.617). Six patients (one who had LP, five who did not have LP) underwent ostectomy as a secondary procedure to relieve symptoms at average 11.2 months (range, 8- 14) after the index surgery. Conclusion: It is important to address the bony step-off following MDCO procedure, as failure to do so may result in lateral prominence pain postoperatively. We demonstrate that a leveling procedure to remove the step-off yields promising results. Therefore, we suggest concomitant LP especially when a larger amount of correction is needed in performing MDCO.
Short-Term Complications Following Early Protected Weight Bearing after Flatfoot Reconstruction when Utilizing a Fibertape Device for Spring Ligament Reefing Augmentation
Authors: Kim Morgan S. , Vannatta Emily , Stauch Chris M. , Juliano Paul J. , Aynardi Michael C. , Koroneos Zachary , Luick Laura R. 
Published: November 2020

Category: Ankle Introduction/Purpose: In an estimated 70% of cases of Adult Acquired Flatfoot Deformity (AAFD) reconstruction, the spring ligament is elongated and/or damaged. Spring ligament reefing can be performed through several techniques including augmentation with Fibertape devices. In addition, biomechanical studies have demonstrated its safety and suggest early weight bearing may be performed. The purpose of this study is to evaluate the outcomes of early weight bearing following flatfoot reconstruction with use of InternalBrace augmentation for spring ligament reefing when performed in combination with medical displacing calcaneal osteotomy (MCO) and FDL tendon transfer. Methods: From 2016-2018, 45 patients underwent flatfoot reconstruction (MCO, FDL transfer, and gastrocnemius recession) with spring ligament reefing and augmentation with the InternalBrace device. All surgeries were performed by the senior orthopaedic surgeons (PJJ & MCA). Institutional early post-operative weight bearing protocol involves weight bearing as tolerated in a splint with crutches for two weeks, transitioning at 2 weeks to a Cam boot with 1 wedge WBAT. At 4 weeks, the patient is weaned off crutches and recommended to start therapy restricting excessive eversion and concentrating on calf strengthening, gait, and ROM. At weeks 6-8 they are weaned from the Cam boot into lace up ASO and shoe with arch support. Data were recorded at 2 weeks, 6 weeks, 12 weeks, 6 months and at yearly intervals. Outcomes and complications were documented. Results: Of the 45 cases there were no complications related to early weight bearing. Radiographic bony union rate of the MCO was 100% (45/45). Moreover, there was no loss of fixation of either the FDL transfer or spring ligament reefing with InternalBrace augmentation with early weight bearing. Lastly, radiographic evaluation noted no loss of Meary’s talo-first metatarsal angle when comparing initial postoperative radiographic to their final follow up. Additional complications in our cohort included the following: removal of painful hardware (1, 2.22%), sural neuritis (2, 4.44%), superficial cellulitis (1, 4.44%), and delayed lateral wound healing (1, 2.22%). Conclusion: Preliminary data shows that early protected weight bearing after flatfoot reconstruction and augmentation of the spring ligament with the InternalBrace device is safe and demonstrates few complications and no early loss of correction.
The Epidemiology and Trends of Primary Total Ankle Arthroplasty and Revision Procedure in South Korea Between 2007 and 2017
Authors: Kim Sung-Jae 
Published: November 2020

Category: Ankle Arthritis Introduction/Purpose: The aim of this study was to investigate the surgical trends of primary total ankle arthroplasty (TAA) and revision procedure in South Korea from 2007 to 2017 using the national population-based data. Methods: We reviewed the national health insurance data of South Korea from 2007 to 2017. The data includes diagnosis codes, procedure codes, prescriptions, medical costs, and other demographic data. Trends of primary diagnosis for primary TAA were evaluated. Annual trends and incidences per 100,000 person-years of primary TAA and revision procedures as well as compound annual growth rate (CAGR) during the study period were analysed. Surgical trends according to patients’ age, hospital grades, and insurance systems were also evaluated. Results: Primary diagnosis for primary TAA was mostly degenerative arthritis (6501 cases, 90.5%). From 2007 to 2017, the total number of cases of primary TAA and revision procedures was 7183 and 585, respectively. The number of cases in 2007 of primary TAA were 313; there were no cases of revision. The number of cases in 2017 of primary TAA were 986 and of revision were 108. The CAGR during this period was 28.6% for primary TAA and 44.6% for revision procedures. Incidences per 100,000 person- years in 2017 were 1.91 for primary TAA and 0.21 for revision procedures. The average cost paid by patients themselves was 813$ (19%) and by the national health insurance service was 3480$ (81%). Conclusion: Trends of primary TAA and revision procedures have been steadily rising in South Korea during the 11-year study period.
Measurement of Physical Activity Level in Patients with Ankle Osteoarthritis
Authors: Kimura Seiji , Yamaguchi Satoshi , Ono Yoshimasa 
Published: November 2020

Category: Ankle Arthritis Introduction/Purpose: Maintaining physical activity (PA) is important for reducing the risk of lifestyle-related diseases and fundamental to keep healthy. PA is reduced in patients with knee and hip osteoarthritis, but PA of patients with ankle osteoarthritis has not been clarified. The purpose of this research is to compare PA level and proportion of patients who meet recommendations for health between ankle osteoarthritis and control patients. Methods: The subjects were 50 patients with ankle osteoarthritis (OA group), and 50 patients with minor hand disease matched by age and gender (control Group), who visited our outpatient clinic from October 2016 to April 2019. Both groups had 16 men and 34 women, with an average age of 68 years for the OA group and 66 years for the control group. The visual analogue scale for foot pain was 5.5 on average in the OA group and 0.3 in the control group. The physical activity for one week was measured using a tri-axial accelerometer. Unpaired t-tests were used to compare the number of steps per day and moderate or higher activity time between the OA group and the control group. The proportions of the OA group and the control group that met the recommendations set by Japan and the World Health Organization were compared using Fisher’s exact test. Results: The number of steps per day was 4177 +- 2312 steps in the OA group and 6802 +- 2851 steps in the control group, which was significantly lower in the OA group (p <0.001). Moderate PA time was 448 +- 232 minutes in the OA group and 634 +- 336 minutes in the control group, OA group was significantly lower (p = 0.02). Vigorous PA time was no difference between the two groups. The WHO recommendations were met by 45 patients in the OA group and 48 in the control group, no difference. The Japanese criterion were met by 33 patients in the OA group and 46 in the control group, which was significantly lower in the OA group (p = 0.001). Conclusion: PA of patients with ankle osteoarthritis was less than control patients. The proportion of patients meeting recommendations for health was lower in the OA group than the control group.
Novel Pathology Classification System (FEMASK-Score) for Charcot Neuropathic Arthropathy Reveals Intraneural Vasculopathy and Predicts Outcome
Authors: King Jesse , Murie Ben , Fanburg-Smith Julie C. , Stauch Chris M. , Flemming Donald , Klein Michael J. , Frauenhoffer Elizabeth E. , Fritsche Madelaine W. , Smith Jessica , Elfar John , Aynardi Michael C. 
Published: November 2020

Category: Basic Sciences/Biologics; Ankle; Diabetes; Midfoot/Forefoot Introduction/Purpose: Charcot neuropathic arthropathy (CNA) is a debilitating, rapidly destructive degenerative joint disease that occurs in diabetic, neuropathic midfoot. Clinicoradiologic assessment for CNA previously relied on Eichenholtz Stage. There is limited data on CNA histopathology. The goal of this study was to independently develop a histopathologic scoring system for Charcot neuropathic arthropathy. Methods: Retrieval of surgical pathology specimens from neuroarthropathic CNA patients (2012-2019) were analyzed to evaluate joint soft tissue and bone. Considering progression from large to small periarticular bone fragments to resolution, we devised and applied a CNA FEMASK-score (named after coauthors): 0= intraneural arteriolosclerosis; 1= large bone fragments without host histiocytic response; 2= mixed bone fragments with host histiocytic response; 3= small minute bone spicules resorption to fibrosis. Clinical modified Eichenholtz staging and outcome were then compared the CNA FEMASK-score to assess for associations between these three elements. Results: Forty-eight cases of CNA included 34 males and 14 females, mean age 60.3 and age range 28-83 years, with clinical diabetes mellitus (predominantly Type II) and longstanding neuropathy. Elevated HbA1C, Eichenholtz stage, American Society of Anesthesia score, and Charlson comorbidity index were predictive of amputation. Pathologic specimens varied from fixation tissue to amputation. In addition to neurotraumatic, neurovascular and inflammatory findings, a distinctive intraneural hyalinized arteriolosclerosis was observed. FEMASK-scores:1 = 10%, 2= 58%, and 3=32%. FEMASK-score comparisons were 98% accurate compared with the modified Eichenholtz criteria scores of each patient and 98% reproducible among pathologists. FEMASK 2 and 3 correlates strongly with amputation. Conclusion: Our novel CNA FEMASK-score classification, derived from the largest cohort of diabetic neuropathic specimens, is reproducible, explains pathophysiology, correlates with Eichenholtz, and predicts amputation. The unique intraneural vasculopathy observed contributes to CNA etiology.
The Positive Association Between Metatarsal Length and Meary’s Angle and Hammertoe Deformity
Authors: King Jesse , Stauch Chris M. , Ridenour Ryan M. , Aydogan Umur 
Published: November 2020

Category: Lesser Toes; Midfoot/Forefoot Introduction/Purpose: Hammertoe deformities are the most common pathology of the forefoot, accounting for up to 48% of all forefoot operations. There is currently limited evidence documenting differences in foot radiographs and radiographic measurements that may represent a predisposition to developing hammertoe deformity. The purpose of this study was to investigate whether patients with hammertoe deformity demonstrate increased radiographic measurements of first, second, or third metatarsal (MT) lengths as well as Meary’s angle compared to a healthy control group. Methods: Following IRB approval, an institutional radiology database was queried from January 2009-2018 for patients with ICD- 9 and ICD-10 diagnosis codes for hammertoe deformity of the 2nd or 3rd phalange. Control cases were selected using diagnosis codes for acute plantar fascial pain in the same timeframe with medical record review to exclude patients with prior lower extremity injury, surgery or pathology. 234 hammertoe and 110 control patients met inclusion and exclusion criteria. Automated 1:1 case-control matching was performed to control for age, sex and laterality. Following matching, the sample size consisted of 80 patients in each cohort. Proximal to distal end-to-end articular surface radiographic lengths were documented for metatarsals and phalanges of the 1st, 2nd and 3rd rays on anteroposterior radiographs. Lateral talar-first metatarsal (Meary’s) angle was measured using weightbearing sagittal radiographs by calculating the angle formed by lines that bisect the talar neck and anatomic neck of the first metatarsal. Results: A total of 160 patients (80 cases and 80 controls) were included in the study. Mean age was 47.7 years among hammertoe cases and 47.5 years among controls (p=0.92). 54 of 80 cases in each group were female. There was a statistically significant increase in the average Meary’s angle among hammertoe patients (5.23 +- 8.60°) compared to controls (2.15 +- 5.96°) (p<0.01). The average length for the 1st, 2nd and 3rd metatarsals were 65.6, 80.0, and 76.7 mm, respectively for the hammertoe patients and 62.8 mm, 76.0 mm, and 73.5 mm among control cases, respectively. For all three metatarsals, this difference was statistically significant (p<0.01; Table 1). There was no statistically significant difference between lengths of the proximal or distal phalanges. Conclusion: Patients with hammertoe deformity were associated with an increased length on the 1st, 2nd and 3rd metatarsals. Also, these patients demonstrated an increased Meary’s angle creating pes planus deformity. These results illustrate the importance of both medial column instability and long metatarsal length in the development of hammertoe deformity. [Table: see text]
Long-Term Patient Reported Outcomes after Correction of Traumatic Foot Drop
Authors: Kohring Jessica M. , Karnyski Steven , Joo Peter , Liu Andrew Y. , Baumhauer Judith F. , Flemister Adolph S. , Ketz John P. 
Published: November 2020

Category: Trauma; Ankle Introduction/Purpose: There is limited literature on patient reported outcomes after tendon transfer for traumatic foot drop. The purpose of this study was to determine long-term patient reported functional outcomes after posterior tibialis tendon (PTT) transfer in patients with foot drop resulting from a traumatic common peroneal nerve injury. Methods: Between August 2006 to January 2019, 31 patients underwent PTT transfer for foot drop secondary to a traumatic injury to their common peroneal nerve at our institution. The average follow-up was 14 months. A retrospective chart review was performed to document physical exam measures and to review postoperative radiographs for changes in foot alignment. There were 17 out of the initial 31 patients available at a mean follow-up of 5.9 years who responded to a phone questionnaire, including the Foot and Ankle Ability Measure (FAAM) questionnaire, and questions on brace and assistive device use, activity level, and satisfaction with surgery. Results: Preoperatively, all patients had an equinus contracture with no dorsiflexion strength, abnormal gait, and used an ankle- foot orthosis (AFO) or pneumatic boot for ambulation. Postoperatively, the average ankle dorsiflexion strength was 4/5 with 28/31 patients reporting a normal gait and 26/31 not using a brace for ambulation. Postoperative radiographs did not show changes in alignment or progression to flatfoot deformity. For the subset of 17 patients who responded to the phone questionnaire, the mean FAAM ADL subscale score was 68.1 and the Sport subscale score was 52.1 at an average of 5.9 years after surgery. The majority of patients (76%) were very or quite satisfied with the outcome of surgery and 15/17 (88%) patients reported they would undergo the PTT transfer procedure again. Conclusion: Posterior tibialis tendon transfer for patients with foot drop secondary to a traumatic injury to their common peroneal nerve showed a high satisfaction rate and improvement in function after surgery without the need for brace or assistive device use at long-term follow-up at an average of 6 years. Additionally, there was no progression to flatfoot deformity after posterior tibialis tendon transfer at 1 year postoperatively. [Table: see text]