bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prevalence of neuropathic pain in the foot and ankle patients
Authors: Sidon Eliezer , McDonald Elizabeth , Daecher Annemarie , Shakked Rachel , Pedowitz David , Daniel Joseph , Winters Brian , Raikin Steven 
Published: September 2018

Category: Other Introduction/Purpose: The management of pain in patients with foot and ankle pain can be challenging. Cumulative data suggest that, in addition to nociceptive mechanisms, other neuropathic mechanisms can contribute to pain in a subset of people with osteoarthritis. Neuropathic mechanism include central sensitization or peripheral neuropathic hyper activated pain. Heterogeneous pain mechanisms may explain variable responses to recommended pain therapies. Accurate classification of pain phenotype using clinically feasible tools has potential to improve pain management. The PainDETECT score, a validated patient-report questionnaire was developed to identify neuropathic pain. A recent study found a prevalence of 23% of neuropathic pain following ORIF of Ankle fractures. The purpose of this study is to examine the prevalence of neuropathic pain (NP) in a variety of foot and ankle disorders. Methods: This is a cross-sectional study investigating the prevalence of NP in a population of patients undergoing foot and ankle surgery. The patient cohort will include 500 patients. Patients were prospectively reviewed, prior to their surgery, using a patient-self-report questionnaire (painDETECT). Patients’ demographics, diagnosis, comorbidities and functional scores were also prospectively collected. painDETECT score of less than 13 was considered as Nociceptive, score of more than 18 was considered as Neuropathic. Scores of 12 to 18 were considered as Unclear. ANOVA and Student’s t-tests were performed to compare the pain VAS scores, duration of pain prior to surgery, severity of the disease and the prevalence of NP, and among different foot and ankle procedures (bone versus tissue, elective versus trauma) and procedural regions (hindfoot/ankle, midfoot, forefoot). Results: A total of 116 patients were included in this preliminary study. 9 patients (7.7%) were diagnosed with neuropathic pain and 24 (20.6%) were Unclear according to their results in the painDETECT. There were 28 patients scheduled for surgery due to recent trauma, none of which had neuropathic pain. One patient with neuropathic pain was scheduled for excision of Morton’s neuroma and 2 patients for removal of foreign body or hardware. There was no significant correlation with age, BMI or smoking status nor with the patients’ functional scores. Patients with NP described their worst and current level of pain significantly higher than those with nociceptive pain. (9.4 Vs 7.4 for worst pain and 6.9 Vs 4.6 for current level in a scale from 0-10, p-value<0.05). Conclusion: A considerable number of the patients with foot and ankle problems requiring surgeries also has pain of a neuropathic mechanism. It is more common in chronic pain than in trauma. This should be evaluated pre-op and taken into attention when deciding on a surgical intervention or pain management.
The Influence Of Obesity in Stage IIB Posterior Tibial Tendon Dysfunction Corrective Surgery
Authors: Silva Amila , Rikhraj Inderjeet 
Published: September 2018

Category: Hindfoot Introduction/Purpose: In the western population prevalence of posterior tibial tendon dysfunction (PTTD) is said to be 3.3% and it is one of the most commonly undiagnosed foot and ankle pathologies. Stage IIB disease according to Johnson and Strom criteria is managed surgically and there are literature demonstrating good clinical outcomes. Obesity being a global epidemic it affects the patient both biomechanically and biochemically. Aim of the study was to investigate the influence of obesity on functional outcome scores, incidence of postoperative surgical site infection (SSI), and repeat surgery after corrective surgery for stage IIB posterior tibial tendon dysfunction (PTTD). Methods: Between January 2007 and December 2013, 102 patients who underwent corrective surgery for stage IIB PTTD at a tertiary hospital were evaluated. We categorized the group with a BMI less than 30 kg/m as control and the group with BMI more than 30 kg/m as obese. The patients were prospectively followed for 2 years. AOFAS mid foot and hind foot scores, mid foot and hind foot VAS scores, SF36 physical and mental function scores were measured pre-operative, post-operative 6 months and post-operative 24 months. SPSS was used for statistical analysis. P value <0.05 was considered as a significant value. Results: 19.6 percent of our study population was obese, there were 38 males and 64 females. The average age of the population was 44.3years and the average BMI for the population was 28.78kg/m2. Clinical outcomes are as follows SF36 physical function score demonstrated statistical significance (p=0.0001, CI -22.20 to -9.80), AOFAS midfoot scores (p=0.82, CI -9.55 to 7.56), AOFAS hindfoot scores (p=0.23, CI -10.60 to 2.60), Midfoot Visual Analogue Scores (p=0.54, CI 0.31 to 0.76), Hindfoot Visual Analogue Scores (p=0.45, CI 0.21 to 0.68) and SF36 mental health scores (p=0.99, CI -5.76 to 7.74) did not demonstrate any significance (6%) in the control group and 10% in the obese group required repeated surgery for complications. Conclusion: Both groups of patients who underwent corrective surgery for stage IIB pttd demonstrated good functional outcomes but there was a significantly higher risk of repeat surgery in the obese group. Obese patients should not be excluded from stage IIB PTTD corrective surgery but patients should be counselled of the higher risk percentage.
Propensity-matched analysis of general versus spinal anaesthesia for patients undergoing ankle fracture surgery
Authors: Sing David , Vora Molly , Tornetta Paul 
Published: September 2018

Category: Ankle Introduction/Purpose: The choice of anaesthesia is a modifiable risk factor in optimizing post-operative outcomes in hip and knee surgery, with decreased rates of transfusion, thromboembolic events, and infection with the use of spinal anaesthesia versus general anaesthesia. Regional anaesthesia has been evaluated with respect to its effect on early pain in patients undergoing ORIF of the ankle, but there is no data regarding complication rates. The purpose of this study was to compare operating time, length of stay, and rates of post-operative adverse events within 30-days in patients undergoing open reduction and internal fixation (ORIF) of the ankle using spinal vs. general anaesthesia. Methods: Adult patients who underwent ORIF of a closed ankle fracture from 2012 to 2016 were identified from the American College of Surgeons National Surgical Quality Improvement Program database. Patients who were operated on after admission from the ED are not included in the database. Operative time (skin to skin), length of stay, thirty-day adverse events, and unplanned readmissions were compared between patients who received general anaesthesia and those who received spinal anaesthesia. Propensity-adjustment with respect to known risk factors for complications and adjunctive regional block was used to match patients using a 1:4 ratio of spinal to general anaesthesia. Adverse events tracked included wound dehiscence, surgical site infection (superficial and deep), sepsis, venous thrombolic events, cardiac events, prolonged intubation, need for unplanned intubation, return to operating room, pneumonia, urinary tract infection, renal insufficiency, and re-admission within 30 days. Comparisons were performed using a propensity based multivariate analysis. Results: Of the 10,795 patients meeting inclusion criteria, 9,862 (91.4%) were treated with only general anaesthesia and 933 (8.6%) were treated with only spinal anaesthesia. Using propensity-scored matching, 822 patients in the spinal cohort were matched to 3,288 patients in the general cohort with similar baseline demographics (61.5% female, mean age 56.4). Procedure performed was similar in both cohorts (47% lateral malleolus ORIF, 34% bimalleolar ORIF, 10% trimalleolar ORIF, 8% medial malleolus ORIF, 1% posterior malleolus ORIF). Spinal anaesthesia was associated with increased length of stay (+0.5 days, 95% confidence interval (CI) 0.20-0.75, p<0.001) and increased mortality (0.6% vs 0.2%, OR: 4.02, 95% CI 1.15-14.1, p=0.03). Rates of overall complications (4.0% vs 4.2%) and readmissions (0.8% vs 0.7%) were similar and available in Table 1. Conclusion: General anaesthesia is predominantly used for fixation of ankle fractures. While spinal anaesthesia is associated with lower complication rates in hip and knee surgery, we found no advantage in patients undergoing ORIF of the ankle.
Consumer Prices for Surgical Management of Ankle Arthritis
Authors: Smyth Niall , Dawkins Brody , Goldstein Joshua , Kaplan Jonathan , Aiyer Amiethab 
Published: September 2018

Category: Ankle Arthritis Introduction/Purpose: In the United States alone there are over 50,000 new cases of ankle arthritis every year. The financial healthcare burden for surgical management of ankle arthritis likely continues to rise with the volume of total ankle replacements (TAR) increasing 100-fold over the last 20 years. Healthcare consumers however are generally unaware of the costs of the services they use. Understanding the costs associated with operative management of ankle arthritis is an important facet of patient care although access to this information may not be readily available. The purpose of this study was to determine the access to the surgical cost of TARs and ankle arthrodesis and the variability of the cost between the two procedures. Methods: 50 foot and ankle centers (25 academic, 25 private) that perform TARs and ankle arthrodeses were contacted using a standardized patient script. The described patient was a healthy 63-year-old male who had failed conservative treatment of ankle arthritis. Each institution was contacted up to three times to attempt to obtain a full bundled operative quote for a TAR and an ankle arthrodesis. Results: 21 centers (42%, 14 academic, 7 private) were able to provide a quote for a TAR and ankle arthrodesis. The mean bundled price for a TAR was $50,332 (SD +/- $25,744) with the mean academic and private center quote being $56,529 and $37,937 respectively. The mean bundled price for an ankle arthrodesis was $41,756 (SD +/- $26,033) with the mean academic and private center quote being $48,116 and $29,037 respectively. There was no statistically significant difference between the bundled price for TAR and ankle arthrodesis. Conclusion: There was limited availability of consumer prices for TAR and ankle arthrodesis thus hindering healthcare consumers’ decision making. When comparing different institutions for surgical management of ankle arthritis, there was a wide range of quotes for both TAR and ankle arthrodesis. When comparing the choice of surgical management for ankle arthritis, there was no difference in price between TAR and ankle arthrodesis.
The Use of a Synthetic Cartilage Implant for Hallux Rigidus
Authors: Smyth Niall , Kaplan Jonathan , Aiyer Amiethab 
Published: September 2018

Category: Other Introduction/Purpose: Hallux rigidus is one of the most common pathologies afflicting the foot. Various joint salvage techniques have been described with a multitude of different implants. Recently, a synthetic cartilage implant composed of polyvinyl alcohol (PVA) received FDA premarket approval for treatment of arthritis of the great toe and has been used in over 4,000 cases. The purpose of this study was to systematically review the clinical evidence supporting the use of a PVA implant in hallux rigidus. Methods: A systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). Using the terms “cartiva OR polyvinyl alcohol OR synthetic cartilage OR hemiarthroplasty AND hallux rigidus OR great toe arthritis OR first toe arthritis “ we searched the PubMed/Medline database in December 2017. In addition, the reference list of publications were scanned for further relevant studies. Results: 4 studies met the inclusion criteria, all of which were derived from a single randomized controlled trial. At short-term follow-up (2 years), patients undergoing placement of a PVA implant had significant improvement in Foot and Ankle Ability Measure (FAAM) sports and activity of daily living, as well as VAS pain scores. The outcomes of the surgery were found to be noninferior compared to arthrodesis. At intermediate follow-up (5 years), the improvement in clinical outcomes persisted and implant survivorship was 96%. Conclusion: There are limited studies available detailing the outcomes of a PVA implant for hallux rigidus, however the results that are available demonstrate a high level of evidence. There are no long-term publications assessing the outcomes of a PVA implant for hallux rigidus.
Results and analyses of preoperative isokinetic and balance tests in patients with chronic lateral ankle instability who underwent surgical treatments
Authors: Sung Ki-Sun , Kim Dae-Wook 
Published: September 2018

Category: Sports Introduction/Purpose: To (1) describe muscle strength and postural stability in patients with chronic lateral ankle instability, and (2) analyze the correlation between weakness of muscle strength and deficits of postural stability Methods: Results of preoperative isokinetic and balance tests in 203 patients whose contralateral ankle was normal were retrospectively reviewed. Isokinetic peak torque values of eversion and inversion at 2 angular velocities (30°/s, 120°/s) were measured in injured and normal ankles. In balance test, the percent differences of 3 actual scores (Overall, Anterior-Posterior, and Medial-Lateral) between injured and normal ankles were calculated. Additional statistical analyses were performed to describe weakness of muscle strength, deficits of postural stability, and their correlation. Results: There were significant differences in 4 peak torque values and 4 relative peak torque values (peak torque/body weight) between injured and normal ankles. Eight values were significantly lower in injured ankles. Weakness was severe during inversion and at 30°/s. In balance test, 49 subjects (24.1%) had significant deficits in postural stability; the results in 109 subjects (53.7%) were favorable. There was no strong association between weakness of muscle strength and deficits of postural stability. Conclusion: Considering correlation between weakness of muscle strength and deficits of postural stability, strength measurement alone is insufficient in evaluating preoperative functional ability, and other functional test such as postural stability test is required. In addition, the results of this study may provide further evidence for rehabilitation program consisting of proprioceptive training as well as muscle strengthening.
Identifying Risk Factors for Failure of a Modified Broström’s Procedure
Authors: Tadley Madeline , Tan Timothy , Shakked Rachel , Daniel Joseph , Raikin Steven , Pedowitz David 
Published: September 2018

Category: Ankle Introduction/Purpose: The modified Broström’s procedure has been widely accepted as the operative treatment of choice for treating lateral ankle instability in patients that have failed nonoperative management. However, the predisposing risk factors for failure of operative treatment, which has important implications for patient selection, is unknown. The purpose of this study is to thus identify independent risk factors for failure of an index Broström’s procedure. Methods: A retrospective single institutional study of 123 modified Broström’s procedures, average age 40 years, was performed with a minimum of 2 year follow-up. An electronic query based on Current Procedural Terminology codes was initially performed followed by a manual review of the operative report. Patients with any concurrent osteotomy, arthrodesis, or arthroplasty procedures were excluded. Foot and Ankle Ability Measure (FAAM) and Short Form Survey 12 (SF-12) were obtained both preoperatively and postoperatively. Cormorbidities and relevant demographic information were manually obtained. Treatment success was defined as a postoperative FAAM Sport score increase by greater than 9 points, an established minimal clinical difference established in the literature. A linear regression controlling demographic factors and baseline scores was utilized to predict scores at last follow-up. Results: At last follow-up, 31.4% did not demonstrate a self reported clinical improvement in the FAAM Sport scores with 2% (3/123) of the entire cohort requiring reoperation. A higher preoperative physical SF-12 score was associated with a reduction in the postoperative physical SF-12 score (p=0.035) while higher body mass index (p=0.010) was associated lower mental component SF-12 scores at follow-up. Interestingly, higher age is associated with higher 2-year PCS score. Furthermore, the occurrence of a complication was associated with lower ADL (p<0.001), Sport (p=0.002), and total FAAM (p=0.002) scores and higher pain (p=0.017) at 2-years. Conclusion: A significant amount of patients did not demonstrate a clinical improvement in functional outcomes although the overall reoperation rate was low. Surgeons should be aware that approximately one third of patients may not have achieved their desired clinical outcome and that BMI and preoperative function is associated with worse outcomes.
Clinical Outcomes Following Minimally Invasive Dorsal Cheilectomy
Authors: Teoh Kar , Tan Weiteen , Hariharan Kartik 
Published: September 2018

Category: Midfoot/Forefoot Introduction/Purpose: Hallux rigidus is a degenerative condition of the first metatarsophalangeal (MTP) joint, usually characterised by a dorsal osteophyte. This typically result in impingement pain and limitation of movement of the first MTP joint. Following failure of conservative treatment, a dorsal cheilectomy can be performed for patients in early stages of hallux rigidus. Minimally invasive forefoot surgery is becoming more popular with advances in technology and it is now possible to perform a minimally invasive dorsal cheilectomy (MIDC) of the first metatarsal with a wedge burr. We aim to report our clinical outcomes following MIDC. Methods: Eighty-nine patients (98 feet; 44 Right, 36 Left, 9 Bilateral) who had symptomatic hallux rigidis with failed conservative treatment, between 2011 and 2016, were included in this study. The average age was 54 (range: 29 – 71) years old. There were 25 Male and 64 Female in our cohort. They were graded preoperatively by Coughlin and Shurnas Classification (Grade 1, n=30; Grade 2, n=48; Grade 3, n=11). Clinical data were recorded. Pre and postoperative Manchester-Oxford Foot Questionnaire [MOxFQ] scores and visual analog scale (VAS) pain score were collected. The mean follow-up was 50 months (range: 12 - 84). Results: Average VAS score improved from 8.0 (range: 6 – 10) preoperatively to 3 (range: 0 – 10) postoperatively. The mean MOxFQ summary index score decreased from 58.6 (range: 30 – 94) preoperatively to 30.5 (range: 0 – 92) postoperatively. All three MOxFQ domains also improved. Swelling took an average of 5.3 (1 – 12) weeks to settle. There were 2 wound infections and 2 delayed wound healing. Two patients had transient nerve paraesthesia while two (2%) patients had permanent numbness in the dorsomedial cutaneous nerve distribution. Twelve patients (12%) had a reoperation, of which 7 had a first MTP joint fusion for ongoing pain (Coughlin Grade 2, n=6; Grade 3, n=1), 4 had repeat cheilectomy for residual impingement, and 1 had an open removal of loose bone. Conclusion: Our results suggest that minimally invasive dorsal cheilectomy (MIDC) shows significant improvement in patient reported outcome measure with MOxFQ scores. MIDC seems to be a safe technique with minimal complications. There is an associated learning curve as 5% of our reoperations were due to incomplete cheilectomy. Coughlin grade 1 do well with MIDC but 10% of our grade 2 & 3 went onto a fusion.
Structures at Risk from an Intermetatarsal Screw for Lapidus Bunionectomy
Authors: Van Dyke Bryan , So Eric , Brandao Roberto , Larson David , Hyer Christopher 
Published: September 2018

Category: Midfoot/Forefoot Introduction/Purpose: The Lapidus procedure is a common procedure for the treatment of hallux abducto valgus. Traditional fixation consists of two crossing screws in the sagittal plane. Despite arthrodesis of the first tarsometatarsal joint, recurrence of the hallux abducto valgus deformity remains a concern. A transverse screw spanning the base of the first metatarsal to the base of the second metatarsal has been advocated to provide transverse plane stability. However, the neurovascular bundle is located within the proximity of this screw. The literature is sparse with a standard technique to safely provide appropriate fixation. An anatomic cadaver study was undertaken to assess the risk of injury to the neurovascular bundle. Methods: Ten unmatched cadaveric limbs that had been disarticulated at the knee were used. Under fluoroscopic guidance, the guide wire to a 4.0-mm screw was driven across the base of the first metatarsal and into the second metatarsal. A 4.0-mm screw was inserted, taking care to obtain osseous purchase into the second metatarsal. A longitudinal incision was made and careful dissection was carried to identify the neurovascular bundle and screw. The neurovascular bundle was inspected for trauma and the proximity of the screws was measured using a digital caliper. Results: There were three left-sided and seven right-sided specimens. Five of the specimens were male and five were female. The mean age of the specimens at date of death was 71.4 years. The mean body mass index was 20.5. The mean distance from the 4.0-mm screw to the first metatarsal base 11.24 mm distal to the first tarsometatarsal joint. The deep plantar artery and deep peroneal nerve was free from injury in 10/10 (100%) specimens. However, the screw was measured to be less than 5 mm in three specimens. In these instances, the average distance of the screw distal to the first tarsometatarsal joint was 12.1 mm. Conclusion: The addition of the intermetatarsal screw for Lapidus bunionectomy is widely accepted clinical practice. Descriptions of the operative technique for the placement of hardware into the second metatarsal have not included specific recommendations to avoid potential risk to the neurovascular bundle as it courses between the bases of the first and second metatarsals. According to this cadaveric study, the neurovascular bundle was avoided with placement of the intermetatarsal screw, if placed approximately 11.24 mm distal to the first tarsometatarsal joint. Further study is warranted to evaluate the optimal distance distal to the first tarsometatarsal joint.