bluuebunny/crossref_metadata_2025_split huggingface dataset:
Functional Capacity Evaluation for Work-Related Injuries to the Foot and Ankle is Associated with Low Return to Work Rate
Authors: Idarraga Alexander J. , Wright-Chisem Adam , Bohl Daniel D. , Lee Simon , Lin Johnny , Holmes George B. , Hamid Kamran S. 
Published: October 2019

Category: Hindfoot, Ankle, Midfoot/Forefoot, Injury and Rehabilitation Introduction/Purpose: The functional capacity evaluation (FCE) is used to determine a worker’s physical ability after treatment of a work-related injury. This evaluation is a critical determinant in the administration of benefits and the decision to return to work (RTW). The purpose of this study is to characterize FCE results and ability to RTW among patients treated for work- related orthopaedic injuries to the foot or ankle. Methods: A retrospective medical record review from the practices of four orthopaedic foot and ankle surgeons was conducted. Inclusion criteria were (1) treatment of a work-related injury to the foot or ankle, (2) at least 2 years of follow-up from the injury, and (3) documentation of an associated FCE. The FCE report and clinic notes were used to determine the patient’s pre-injury job requirement (Department of Labor Office category: light, medium, or heavy), post-injury FCE-determined work ability (light, medium, or heavy), specific FCE- or physician-imposed work restrictions, and clearance for RTW. Patients were considered cleared to RTW if their FCE-determined work ability met or exceeded their pre-injury job requirement and if there were no additional restrictions imposed by the FCE or physician that would prevent them from functioning in their pre-injury role. Results: A total of 188 patients met inclusion criteria. Missteps/rotational injuries (44.1%), falls from height (22.3%), and crush injuries (20.7%) were the most common mechanisms. 74.4% of patients had FCE-determined work abilities at or above their pre- injury job requirements, and 63.3% of patients were eventually cleared for RTW. The median time from injury to clearance for RTW was 2.0 ± 1.3 years. Reasons for not being cleared to RTW included failure to meet the pre-injury job requirement (67.2%), specific FCE-imposed limitations (28.3%), or specific physician-imposed limitations (4.5%). Less strenuous pre-injury job requirement was positively associated with both FCE-determined work ability meeting pre-injury job requirement and clearance for RTW (p<0.001 and p=0.034, respectively; Table 1). Conclusion: Approximately two-thirds of patients undergoing FCE after a work-related foot or ankle injury are cleared to RTW. However, it takes a median of two years to achieve this clearance. Patients with jobs that are more physically strenuous are less likely to be able to return to those jobs after injury to the foot or ankle.
The Achilles Heel of Rehabilitation: Communication: A First Look at a National Research Survey
Authors: Jenkins David , Urness Daniel , Thompson Austin , Meeker James 
Published: October 2019

Category: Hindfoot, Rehabilitation Introduction/Purpose: For decades, there has been much debate over the proper treatment and rehabilitation protocols regarding the management of Achilles tendon ruptures (ATRs). With so much controversy, communication between physical therapists (PTs) and orthopaedic surgeons could prove to be paramount in ensuring successful recovery and return to post- morbid activities. Little research has been done in identifying effective communication modalities between surgeons and PTs and it remains unclear how this dynamic impacts the rehabilitation course. We examined the frequency of how common it is for PTs to receive rehabilitation protocols from referring orthopedic surgeons in patients who suffered Achilles tendon ruptures. Methods: A blinded national research survey was conducted of PTs who had treated ATR from 2012-2017. Researchers sought to create a generalizable sample of US PTs by selecting physical therapy clinics located in rural and urban areas of randomly selected states. Those who were actively practicing as a PTs and held a corresponding degree (DPT, MPT, and MSPT) were included. Non-practicing PTs, and those without a degree in physical therapy were excluded. A total of 56 respondents took part in the survey. Results: PTs practicing for 10 or more years were more likely to promote slower rehabilitation for non-surgical patients, while PTs with less than 10 years of experience preferred slower progress for operative patients (p=0.04). PTs with 10 or more years of experience were significantly more likely to have patients full weight bearing (FWB) after 6 weeks (p=0.01). PTs were also asked what factor was most important for good ATR outcomes. Three themes emerged, one was good communication between PTs and doctors. One respondent wrote “better communication between MD and PT for best outcomes.” The second theme was timing and implementation of proper clinical techniques such as ”early ROM and weight bearing.” A final theme centered on patient education, especially physicians educating patients on mobility restrictions. Conclusion: Despite belief that protocol driven approach improves outcomes, it remains unclear how well applied this is in practice. One of the most common responses given by PTs when asked what the most important factor is to ensure good outcomes in ATRs was good communication between PTs and doctors. This insight juxtaposed with 49% of PTs stating most of their recent patients arrived with no protocol, suggests one way to help improve patient outcomes might be to focus on improving communication between doctors and PTs.
Rotational Distal Chevron Osteotomy for Correction of Hallux Valgus Associated with Metatarsus Adductus and Large Distal Metatarsal Articular Angle
Authors: Jeong Jae-Jung 
Published: October 2019

Category: Bunion Introduction/Purpose: Hallux valgus treatment in the setting of associated metatarsus adductus is less common and not well described. The presence of metatarsus adductus reduces the gap between the first and second metatarsals. Consequently, it complicates the measurement of the first-second intermetatarsal angle and can limit the area available for transposition of the first metatarsal head. If distal metatarsal articular angle (DMAA) is also increased here, it is difficult to correct. We investigated the effects of rotational distal chevron metatarsal osteotomy (DCMO) on hallux valgus associated with metatarsus adductus and increased DMAA. Methods: Twelve patients, (12 female, 15 feet), of average age 59 (SD 23) with symptomatic hallux valgus associated with metatarsus adductus and increased DMAA underwent a rotation DCMO and were reviewed at an average of 12 months postoperatively. Clinically preoperative and postoperative AOFAS hallux MP-IP scale and satisfaction after the surgery were analyzed. Radiologically hallux valgus angle, the 1st intermetatarsal angle, DMAA before and after the operation was analyzed. Results: Distal Chevron osteotomy was done in 15 cases. After DCMO, The distal fragment was translated to laterally as far as possible and rotated to reduce DMAA. Clinically AOFAS scale was increased from 65.3 points preoperatively to 92.2 points postoperatively. Two patients were not satisfied with the results. Radiologically hallux valgus angle was decreased from 21.8° preoperatively to 8.5° postoperatively. The first intermetatarsal angle was decreased from 11.8° preoperatively to 6.7° postoperatively. DMAA was decreased from 15.8° preoperatively to 5.5° postoperatively. Conclusion: The rotational DCMO was an effective procedure for correcting hallux valgus associated with metatarsus adductus and increased DMAA. It allowed good realignment of the first MTP joint without the need for lesser metatarsal surgery to reduce the metatarsus adductus.
Safety of Achilles Repair Using the Mini-Open Approach in Supine Position vs Prone Position: A Retrospective Study
Authors: Jones James Rush , McKissack Haley , Jha Aaradhana J. , Moraes Leonardo V. M. , He Jun Kit , Viner Gean C. , Williamson Brooklyn D. , Dahlgren Nicholas , Naranje Sameer M. , Shah Ashish 
Published: October 2019

Category: Sports Introduction/Purpose: Surgical repair of the Achilles tendon is a commonly-performed procedure in cases of acute tendon rupture. Open Achilles tendon surgery with traditional extensile approach is most often performed with the patient in prone position, but this can interfere with airway access, put increased pressure on the abdomen, and subject to increase perioperative period and comorbidities. Mini-open approach in supine repair may potentially avoid the risks of the prone position, but the safety and utility of this approach have not been established. The purpose of this study is to compare perioperative outcomes between patients undergoing acute Achilles rupture repair with mini-open approach in the supine position versus traditional approach in the prone position. Methods: Patients who underwent surgical repair of acute Achilles rupture between the years 2011 and 2018 at a single institution were retrospectively identified using CPT code 27650. Patients who underwent concurrent procedures for additional injuries were excluded. Charts of included patients were retrospectively reviewed for demographic information, intraoperative characteristics, and postoperative outcomes. Statistical analysis was conducted and p-values =0.05 were considered significant. Results: A total of 81 patients were included for analysis, 26 supine and 55 prone. Baseline characteristics were statistically similar between the two groups. Average total time in the operating room was significantly greater among patients in the prone position (118.7 minutes) than those in the supine position (100 minutes) (p = 0.0011). Average surgery time, blood loss, and time in PACU were greater among the prone group than the supine group, although these differences were not statistically significant. Average postoperative pain score, infection rate, dehiscence rate, sepsis rate, and DVT rate were also similar between the two groups. Conclusion: The mini open approach in supine position may be advantageous in repair of acute Achilles rupture in that it significantly reduces total time in the operating room while maintaining positive patient outcomes. Prospective clinical studies are warranted to validate these assessments.
Intermediate to Long Term Clinical and Radiographic Outcomes of Triple Arthrodesis: A 422 Case Retrospective Review
Authors: King Jesse , Henrikson Karl , Harper Thomas , Anderson Mike , Stauch Chris , Juliano Paul , Aynardi Michael 
Published: October 2019

Category: Ankle Arthritis, Hindfoot Introduction/Purpose: Triple arthrodesis is a commonly performed surgical treatment for hindfoot arthritis and deformity. No study has clearly delineated correlates of both clinical and radiographic outcomes in a sample size this large. The purpose of this study is to explore predictive and demographic outcome measures with long-term followup after triple arthrodesis. Methods: With IRB approval, an institutional radiology database was queried for patients undergoing triple arthrodesis between 2004 and 2016, by a single surgeon at a single institution. A total of 465 cases were identified. Pre- and post-operative clinical and radiographic data was collected retrospectively. Demographic and predictive data included: age, Body Mass Index (BMI), American Society of Anesthesiologists Score (ASA), Charleston Comorbidity Index (CCI), diabetic status, osteoporosis, hypothyroidism, and neuromuscular disease status. Clinical outcomes including infection rate, reoperation rate and clinical nonunion were recorded. Unintended return to the operating room defined clinical failure. Radiographic data including non-union rate, pre- and post- operative ankle degenerative joint disease was also recorded. Statistical analysis was then performed to evaluate the relationship between predictive measures and various outcomes including reoperation, infection, and non-union rates. 23 cases were lost to follow-up. Results: A total of 442 feet (397 patients) were analyzed. The average age was 54 years (14 to 85) with the majority of cases being female (60%). Average follow up was 593 days (40 to 4079). Overall failure rate was 13.7% with clinical nonunion rate of 4.5%. Infection rate was 5.9%. Mortality rate was 0% at 2 years post-operatively. Predictors of failure included: increased BMI, elevated ASA, history of diabetes, underlying neuromuscular disorder (Figure 1). We found no significant difference between pre and post-operative degenerative joint disease rates in the midfoot (9.4%, 12.5%) and ankle (11.7%,13.7%), respectively. Conclusion: Triple arthrodesis is a highly effective procedure for treating hindfoot arthritis. Certain predictive measures including BMI, ASA score, diabetic status and underlying neuromuscular disorders significantly correlate with radiographic union. Additionally, diabetic status significantly correlates with infection status postoperatively. An understanding of these predictive measures may help surgeons in their preoperative planning to improve their clinical and radiographic success rates.
Three Dimensional Analysis of Symmetry and Morphometry of the Bilateral Tarsal Bones Using Weightbearing Computed Tomography
Authors: Konow Tobias , Cain Jarrett D. , Siegler Sorin 
Published: October 2019

Category: Hindfoot Introduction/Purpose: Surgical restoration of the morphology of deformed tarsal bones caused by severe arthritis and complex fracture may require surgical procedure such as custom 3D printed total talar replacement, extensive bone reconstruction of complex fractured bones, etc. There are variations in the tarsal bones between individuals and with advances in medical imaging/personalized manufacturing techniques such as additive manufacturing; reliance on the contralateral side of the patient becomes important. The purpose of this study is to evaluate the left to right symmetry characteristics of tarsal bones utilizing weightbearing computed tomography in order to effectively and reliably use the 3D morphology of the contra-lateral foot. Methods: 15 bilateral data sets from weightbearing CT scans were used from a foot and ankle unit. The images were processed to produce 3-dimensional computer models of the distal tibia, talus, talar dome and calcaneus. The left and right tarsal bones in each pair were first mirror-imaged and then registered using a 3D optimal registration technique. After the registration, a distance-mapping algorithm was used to determine the surface-to-surface distance distribution between the paired and registered bones (Figure 1). Maximum surface-to-surface distance indicated the level of asymmetry between the bones. In addition, the volume and surface area of each bone was established and the percentage difference in volume and surface area were established providing an additional measure of left-to-right asymmetry. Figure 1 – Surface-to-surface distance map shiwing the left-to-right deviations (in millimeters) for a talus and distal tibia for one subject. Results: The results indicated a left-to-right volume mean difference of less than 2.6% for the talus, 3.1% for the distal tibia and 2.3% for the calcaneus. The mean difference of the surface area was 2.4% for the talus, 1.9% for the distal tibia and 1.6% for the calcaneus. The distance mapping showed a maximum average surface-to-surface left-to-right deviation of 0.8 mm for the talus, 0.4 mm for the talar dome, 0.65 mm for the distal tibia and 0.95 mm for the calcaneus. Conclusion: Based on the results of this study, morphometric analysis showed high level of bilateral symmetry indicating that restoration of the tarsal bone based on the contra-lateral foot is a feasible and reliable approach. The study established the level of confidence with which such an approach can be implemented.
Comparative Analysis of Dorsal Nerve Transfer vs Dorsal Neurectomy in Morton’s Neuroma
Authors: Koti Manjunath , Marhoon Zaid , Parikh Mirant , Edwards Max , McAllister Jack 
Published: October 2019

Category: Lesser Toes, Midfoot/Forefoot Introduction/Purpose: Comparative analysis of Dorsal Nerve Transfer and Dorsal Neurectomy in Surgical management of Morton’s Neuroma Methods: This clinical audit was conducted on patients who had undergone surgery for Morton’s neuroma (MN) between 2002 and 2014. Data was collected using an in-depth review of patients’ case-notes. During the period studied, there were a total of 77 patients, 4 the DNT and 40 in the DN groups. The key indication for surgery in all cases reviewed was failure of the condition to improve using conservative methods. A telephonic survey with Primary outcome measure being Coughlin’s Overall patient’s satisfaction criteria and secondary outcome measures were resolution of sensory symptoms and any footwear restrictions. Results: The results of this clinical study shows excellent to good results with the Dorsal nerve transfer group (84%) and Dorsal neurectomy (80%). There were poor results in 11% in the DNT group and 15% in the DN group. Key advantages of Dorsal nerve transfer are better resolution of sensory symptoms in the toes (82%) when compared to Dorsal Neurectomy (65%). 7% reported Nov change and 11% were worse after surgery. 20% had no change and 15% were worse following surgery in DN group. Around 83% had no restriction wearing any footwear in the DNT group when compared to 80%. 17% in the DNT group and 20% were in the DN group wore modified or shoes with no heels. Conclusion: In general there is no significant difference in the outcome of the two surgery all procedures. Key advantages of Dorsal nerve transfer is better resolution of sensory symptoms in the toes (82%) when compared to Dorsal Neurectomy (65%). Around 83% in DNT group and 80% in DN group had no restriction wearing any footwear gain is almost similar in both groups in the DNT group. Whilst Dorsal nerve transfer is a slightly longer procedure than Dorsal neurectomy as some problems were encountered relating to mobilising the nerve due to overlying prominent blood vessels or nerve anomalies.
The Effect of Subtalar Motion on Calcaneal Osteotomies
Authors: Krause Fabian , Zderic Ivan , Gueorguiev Boyko , Schmid Timo 
Published: October 2019

Category: Ankle Arthritis, Hindfoot Introduction/Purpose: Background There is evidence that the subtalar joint may compensate for supramalleolar deformities and thereby slower or halt progression of ankle arthritis. The mobile subtalar joint may also compensate for the effect of realigning osteotomies of the calcaneus and the tibia. The compensation is limited by the joint orientation and limited ROM (arthritic joint, tarsal coalitions, previous fusion). Objectives: The hypotheses are: - the curvature of posterior facet influences subtalar ROM - subtalar ROM influences subtalar compensatory capacity - there is compensation of realigning osteotomies through a mobile subtalar joint, resulting in a less effective correction of weightbearing axis - the osteotomy of the calcaneus (COT) is more affected by the compensation than the supramalleolar tibia osteotomy (SMOT) Methods: 11 fresh-frozen human lower leg cadaver were mounted into a carbon frame. High resolution ankle TekScan sensors were fixed in the ankle joint via anterior arthrotomy. 300 N load were applied according to half body weight and Achilles tendon pull was simulated. The center of force (COF) migration, max. pressure (Pmax), and the area loaded were measured in the ankle with 10 mm varus / valgus sliding calcaneus osteotomy and 10° varus / valgus SMOT. A CT evaluation of subtalar anatomy (curvature of posterior facet) was conducted and the correlation of posterior facet curvature and subtalar motion and the correlation of subtalar motion and SMOT/COT effect calculated. Results: The COF migration was significant for valgus COT and for both SMOT versus the initial position, while the varus SMOT versus the varus COT. Pmax and area loaded changed but not significantly. There was a significant correlation of posterior facet curvature and subtalar motion (r = 0.87), a moderate inverse correlation of subtalar motion and COT effect (r = -0.52), and a poor inverse correlation of subtalar motion and SMOT effect (r = -0.27). In contrast, in a previous study with a stiff cavovarus model significant COF migration and peak pressure changes were found in the ankle joint for all lateral closing SMOT and valgus COT. Conclusion: The compensatory capacity of mobile subtalar joint limits effect of COT more than SMOT, likely because the subtalar joint is closer to COT than to SMOT. Biomechanically, the COT is therefore less effective in influencing ankle joint pressure than SMOT. The effect of the COT is more reliable in stiff subtalar joints. The curvature of posterior facet correlates with subtalar ROM.
Arthroscopic Lift, Drill, Fill and Fix (LDFF) for Talar OCDs Stands the Test of Time: Mean 5 year Follow-Up Results in 25 Patients
Authors: Lambers Kaj , Altink Nienke , Dahmen Jari , Stufkens Sjoerd , Kerkhoffs Gino 
Published: October 2019

Category: Ankle, Arthroscopy Introduction/Purpose: The purpose of this study was to describe the long-term clinical and radiological outcome of a new arthroscopic fixation technique for primary osteochondral talar defects: Lift, Drill, Fill and Fix (LDFF). Methods: Twenty-five patients underwent an arthroscopic LDFF surgery for osteochondral talar defects. Two of these patients underwent surgery on both ankles. During the LDFF technique, the OCD was identified after which an osteochondral flap was created and lifted (lift-phase). The bone flake of the OCD as well as the osteosclerotic area of the bed was drilled (drill phase). Cancellous bone was harvested from the distal tibia and transported into the defect until there was sufficient substantial filling (fill phase). Finally, the osteochondral flap was fixed with an absorbable biocompression screw (fix phase). The mean follow-up was 63 months (SD 9.2). Pre- and postoperative clinical assessment included the Foot and Ankle Outcome Score (FAOS) and the numeric rating scales (NRS) of pain at rest and during walking. Remodeling and bone ingrowth after LDFF were analyzed on computed tomography scans during follow-up at one year after the surgery. Results: All patients were available for final follow-up. At final follow-up, LDFF led to a significant improvement of the NRS of pain during rest and the NRS of pain during walking in all patients. The FAOS significantly improved on all 5 subscales: pain, symptoms, activities of daily living, sport and recreation and quality of life. The NRS of pain at rest significantly improved from 2.3 to 1.0 (p = 0.01), and pain with walking significantly improved from 5.7 to 1.6 (p < 0.001). In total 24 out of 25 patients, and 26 out of 27 ankles, showed remodeling and bone ingrowth on CT scans 1 year after the arthroscopic fixation procedure. No complications occurred. Conclusion: Arthroscopic LDFF of an osteochondral talar defect shows good long-term results at 5 year follow-up after surgery. Although the radiological results at 1-year follow-up and the long-term clinical results are encouraging, more patients and long- term radiological follow-up is necessary in order to identify prognostic factors on outcomes.