bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comparison of Mid-term Outcomes Between an Arthroscopic and an Open Modified Broström Procedure for Ankle Instability
Authors: Lee Young Koo , Park SungBum , Lee SangWoo 
Published: September 2018

Category: Arthroscopy Introduction/Purpose: Although the short-term results of an all-inside arthroscopic Modified Broström operation (MBO) have been as satisfactory as open MBO, there is always a concern about the long-term stability of an arthroscopic MBO. The purpose of this study was to compare clinical and radiologic outcomes of all-inside arthroscopic and open MBOs at mid-term follow up. Methods: From August 2012 to July 2014, totally 87 patients underwent an arthroscopic MBO and an open MBO. Of these, we retrospectively reviewed 48 patients who had a more than 3 years follow-up period. They were divided into two groups: all-inside arthroscopic MBO goup (26 patients), open MBO group (22 patients). The American Orthopaedic Foot & Ankle Society (AOFAS) ankle–hindfoot score, visual analog scale (VAS) score, and Karlsson score were used to evaluate clinical outcomes. Anterior talar translation and talar tilt were used to evaluate radiologic outcomes. Clinical and radiologic outcome evaluations were performed preoperatively, at 12 months postoperatively, and at a final follow-up at a minimum of 36 months postoperatively. Results: Evaluations were performed for 26 ankles in the all-inside arthroscopic MBO group and 22 in the open MBO group. There was no difference in age, gender, symptom duration, preoperative AOFAS, VAS, Karlsson scores, anterior talar translation, or talar tilt between the 2 groups (all P > .05). At the final follow-up, the AOFAS, VAS, and the Karlsson scores had improved significantly in both groups (P < .001). There was no difference in the Karlsson, AOFAS, or VAS scores, anterior talar translation, or talar tilt between the 2 groups at final follow-up (all P > .05). Conclusion: There was no difference in the clinical and radiologic outcome between the all-inside arthroscopic MBO and open MBO for the treatment of lateral ankle instability at up to 3 years after surgery. An all-inside arthroscopic MBO should be a good treatment option in patients who have lateral ankle instability.
Identification of the Medial Column Line collapse variation is Crucial in Flat Foot Management
Authors: Mason Lyndon , Alsousou Joseph , Ellison Phil , Molloy Andrew 
Published: September 2018

Category: Midfoot/Forefoot Introduction/Purpose: The incompetence of both dynamic and static structures in the foot is responsible for acquired pes planus deformity. The aim of this study was to identify the anatomical location of the midfoot break in symptomatic pes planus deformity, and its relationship with other pes planus radiographic foot measurements. Methods: We completed the radiographic evaluation of 75 feet diagnosed with symptomatic pes planus. The break in the medial column line (Meary’s line) was measured on the lateral radiograph at the intersection of the anatomical axis of the talus and the first metatarsal. Pes planus measurements were performed on each the weight-bearing AP and lateral radiographs, including talonavicular coverage angle, talar – first/ second metatarsal angle, talar uncoverage, talocalcaneal angle, Meary’s angle line break, calcaneal and talar inclination, talocalcaneal angle, cuneiform - metatarsal, tarsal joints angles and distances. Due to Gaussian distribution, unpaired t-test and ANOVA tests were used. Results: The medial column line collapse was at the talonavicular joint in 77.3%, naviculocuneiform in 20%, and cuneiform metatarsal in 2.6%. The line angle severity was proportional to the talonavicular coverage angle and talar uncoverage (p 0.001, R2 0.4915 and P 0.003, R2 0.223). On comparison of the 3 line-break groups, the talocalcaneal angle was significantly higher when the line break was at talonavicular joint (P 0.001) although Meary’s angle was not significantly more severe. Conclusion: The apex of the medial column collapse occurs not only at the talonavicular joint but also distal to the spring ligament and tibialis posterior insertion. Foot abduction increases with the increase in the line collapse regardless of the breaking point. Talus flexion is worse if the arch collapse is at the talonavicular joint, suggesting incompetency of the spring ligament. Assessing the apex of deformity is essential to decide the correct operative strategy.
Risk Factors for Non-union in First MTPJ Arthrodesis
Authors: Molloy Andrew , Butcher Clifford , Mason Lyndon 
Published: September 2018

Category: Midfoot/Forefoot Introduction/Purpose: Hallux rigidus occurs in up to 1 in 40 adults with 1st MTPJ arthrodesis being the gold standard operation for advanced disease. Our aim was to retrospectively identify risk factors for delayed / non-union of first metatarsophalangeal joint arthrodesis using a dorsal plate with cross screw. Methods: Case note and radiograph analysis was performed for operations between April 2014 and April 2016 with at least 6 months post-operative follow up. Union was defined as bridging bone across the fusion site on AP and lateral radiographic views with no movement or pain at the MTPJ on examination. All patients operations were performed or directly supervised by one of three fellowship trained consultant foot surgeons. Surgery was performed through a dorsal approach using a dorsal locking plate with compression screw. Blinded preoperative AP radiographs were analysed for the presence of a severe hallux valgus angle equal to or above 40 degrees. Intra-observer reliability was acceptable (95% CI: 1.6-2.3 degrees). Smoking and co-morbidities underwent univariate analysis for significance. Following initial result results, surgery in patients with arthritic hallux valgus were fixed using a separate plantar to dorsal / medial to lateral lag screw and dorsal locking plate Results: 71 patients with a mean age of 61 years (range, 29 to 81) comprised the initial patient group. Mean follow up time was 13 months for both union and nonunion groups (range 6 to 30 months). 7 patients were identified as delayed or nonunion (9.9%). All had hallux valgus angles of >25%. Age, diabetes, COPD and rheumatoid arthritis did not show significant associations with non-union. All smokers progressed to union (n = 17). Moderate to severe hallux valgus (relative risk: 1.29, p < 0.005) and under correction of >25 valgus at the MTPJ (relative risk: 14.44, p < 0.001) were significantly associated with non/delayed union. In the second group, 18 patients of similar demographics, there were no failure of reductions and 100% union rate Conclusion: Preoperative moderate to severe hallux valgus and under-correction of deformity are the most significant risk factors for non-union. The construct used for fixation needs to be chosen on the basis of the deforming forces. If so, excellent union rates can be achieved
Outcomes of spring ligament reconstruction for idiopathic flexible flatfoot deformity
Authors: Molloy Andrew , Swanton Eric , Mason Lyndon 
Published: September 2018

Category: Hindfoot Introduction/Purpose: Idiopathic flatfeet are usually caused by attenuation of the medial soft tissues rather than a lateral osseous deficiency. Our prospective study aimed to quantify the functional and radiological outcome of a new technique for spring ligament reconstruction using a hamstring graft for idiopathic flat feet Methods: Our prospective study included 17 feet in 14 patients, from 05/14 to 05/17, on which a spring ligament reconstruction was performed. This pre-tensioned allograft reconstruction was performed using a blind talar tunnel, with the graft being passed deep to the navicular tuberosity, through a tunnel in the medial cuneiform and then sutured back onto its proximal limb to control abduction. Additional procedures included medial head of gastrocnemius recession (17), calcaneal osteotomy (16), FDL transfer (3), tibialis posterior synovectomy (2), peroneus longus to brevis transfer (2). There was a minimum of 6 months follow-up. Radiographic analysis was performed for standardised parameters. Paired t-test was used for analysis Results: The average age was 41 (range 23 -65). The mean BMI was 31.1 (range 24.6 – 37.3). Mearys line improved from a mean of 24.1 (9 – 36.4) to a mean of 13.8 (-3.1 – 26.7). This was statistically significant (p<0.001). Talar uncoverage angle improved from a mean of 39.5 (27.7 – 55.8) to 23.9 (3.5 – 39.7). First metatarsal talar angle improved from a mean of 18.9 (8.4 – 33.9) to 10.3 (-6.1 – 21.5). There were no wound infections. There was one revision (5.9%) to a triple arthrodesis; at revision it was found that the allograft had attenuated to incompetency. Of the patients that improved the least, 80% (4/5) were over the age of 49. Our numbers are insufficient to statistically analyse this Conclusion: This new method of spring ligament reconstruction provides a predictable solution for more anatomical reconstruction of idiopathic flatfoot deformity, with statistically significant improvements in all radiographic parameters. Further numbers will be needed but we would exercise caution in using this technique in older patients.
Should the Tibiotalar Angle Be Measured Using an AP or Mortise X-ray?
Authors: Najefi Ali-Asgar , Buraimoh Olatunbosun , Goldberg Andrew 
Published: September 2018

Category: Basic Sciences/Biologics Introduction/Purpose: The tibiotalar angle(TTA) is an important radiographic tool to determine alignment or malalignment of the ankle and hindfoot.Two methods of measuring the TTA have been described. The midline TTA(MTTA) is when the first line is along the anatomical axis of the tibia, and the second line is along the superior articular surface of the talus. Another method measures a line along the lateral border of the tibia, and a line along the superior articular surface of the talus (the lateral TTA, LTTA). The aims of the study were to compare the two angles as measured on mortise and AP radiographs in normal and pathological cases.We also compared the MTTA and LTTA, to see if they are comparable and if both methods are reliable and reproducible. Methods: A retrospective radiograph review was performed of sequential ankle radiographs taken between 2016 and 2017 across 4 specialist orthopaedic centres in the United Kingdom. Patients were categorised into two distinct groups. In the Normal Group (NG), patients had no evidence of injury and normal radiological appearances. In the Arthritis Group (AG), patients had radiographic changes as per the Kellgren-Lawrence scale 2 to 4. All radiographs were weightbearing and classified as either AP or mortise views based on the position of the talus and overlap of the tibia and fibula. The MTTA and the LTTA were measured on each radiograph. Results: There were 320 radiographs for review;158 normal radiographs and 162 radiographs had arthritis.There were 117 AP and 203 mortise radiographs. The overall mean MTTA was 88.7±5.1 degrees(range 77-104), and the mean LTTA was 87.5±5.2 degrees(range 73-104);p<0.01.There was no significant difference between the MTTA and LTTA in the normal group. There was a significant difference(p<0.01) when comparing the MTTA and LTTA in the arthritis group(Table 1). There was no significant difference when the MTTA was measured between the AP and Mortise radiographs. There was a significant difference in the LTTA between AP and mortise radiographs(p=0.04). There was no significant difference between the MTTA or LTTA when measuring the angles on AP radiographs(p=0.09).However, there was a significant difference when measuring these angles in the mortise radiographs(p=0.02). Conclusion: Understanding the tibiotalar angle is key to planning for deformity correction. It is important that consistency of methods for measurement are used for reporting. In this paper we have shown the MTTA to be a reliable and reproducible tool for measuring the TTA, in both normal ankle radiographs and in patients with ankle arthritis. There is no significant difference when the MTTA is measured using an AP or a mortise radiograph. In contrast, we have shown that the LTTA to be unreliable and statistically different when measured on both AP and mortise radiographs.
Midfoot Angle Changes During Running After an 8-week Foot Strengthening Program
Authors: Ridge Sarah , Henderson Adrienne , Bruening Dustin , Jurgensmeier Kevin , Olsen Mark , Griffin David , Johnson Aaron , Davis Irene 
Published: September 2018

Category: Other Introduction/Purpose: The arch has been referred to as the core of the foot. The arch’s structure, movement, and integrity during running gait largely depends on the function of intrinsic and extrinsic foot muscles. There are many injuries that can be associated with a dysfunctional medial longitudinal arch. Improving the strength of the foot muscles could help improve arch function during running. The purpose of this study was to compare changes in arch deformation after eight weeks in a foot strengthening exercise group (FS), a group walking in minimalist shoes (MSW), and a control group (C). Methods: 24 healthy runners (average of 15-30 miles/week, no experience with minimalist footwear) were randomly assigned to FS (n=9), MSW (n=7) or C (n=8). FS subjects followed a series of progressive exercises designed to strengthen the intrinsic and extrinsic foot muscles. MSW subjects walked in minimal footwear, increasing from 2,500 to 7,000 steps/day over an 8 wk period. All runners maintained their pre-study mileage in conventional running shoes throughout the 8-week study Three-dimensional motion analysis data was collected at the beginning of the study and after week 8. Passive-reflective markers were placed according to the Oxford Foot Model. Subjects ran at a self-selected pace on a treadmill while data were collected for at least 10 strides. Peak midfoot angles were extracted and averaged within each trial. Group means at week 0 and week 8 were compared using paired t-tests with alpha set at 0.05. Results: While all groups experienced a decrease in midfoot angle, only the FS group experienced a significant change (see table). These results suggest that the foot exercise intervention resulted in more arch control during running than the progressive walking in minimal shoes. Greater changes may have been found if the subjects progressively ran in the minimal shoes which would have placed greater demands on the arch musculature. Conclusion: Based on these data, it seems possible for patients to reduce the amount of arch deformation during running by using targeted foot exercises. This could help with patients who have overuse injuries associated with increased arch deformation. These results also suggest that foot strengthening may be an effective way to prepare for minimal footwear running.
Morton Neuroma Excision
Authors: Shah Ashish , Pinter Zachariah , Lehtonen Eva , Naranje Sameer , Odom Christopher , Paul Kyle , Huntley Samuel , Dahlgren Nicholas , DeBell Henry 
Published: September 2018

Category: Midfoot/Forefoot Introduction/Purpose: Morton’s Neuroma is a benign enlargement of the second or third common digital branch of the medial plantar nerve. This causes a compressive neuropathy of the distal medial plantar nerve. When conservative management fails, surgery becomes the treatment of choice via either a dorsal or plantar approach to the nerve. When using a dorsal approach for a Morton Neurectomy, neuroma commonly recurs due to insufficiently resection of the medial plantar nerve. It is unclear how far the nerve can be resected and which type of retractor provides superior visualization to allow greater resection. The present cadaveric study investigates how proximally the nerve can be resected and examines both the Laminar spreader and Galpie retractor to determine which instrument facilitates maximal proximal resection of the nerve. Methods: This study involved 12 fresh-frozen below-knee cadaver specimens that underwent a dorsal approach to the medial plantar nerve with proximal resection of the nerve in both the 2nd and 3rd intermetatarsal spaces as is performed during a Morton Neurectomy. The senior surgeon made a 3 cm incision just proximal to the 2nd and 3rd webspaces, and used blunt dissection to the level of the transverse intermetatarsal ligament. The transverse intermetatarsal ligament was then transected, and either a Laminar spreader or Galpie retractor was used to improve visualization of the intermetatarsal space. The medial plantar nerve was then identified and transected, and the lengths of the distal segment of the cut nerves were measured and recorded. These values were then compared based on the retractor employed. Results: In the 2nd intermetatarsal space, the Laminar spreader allowed the nerve to be dissected an average of 2.42 cm proximal to the distal end of the 3rd metatarsal (head)compared to 1.93 cm by the Galpie retractor. Thus, use of the Laminar spreader rather than the Galpie retractor resulted in greater resection of the nerve, although this was not significant. In the 3rd intermetatarsal space, the Laminar spreader allowed the nerve to be dissected an average of 2.14 cm proximal to the distal end of the 3rd metatarsal, while the Galpie retractor allowed 1.48 cm. Thus, use of the Laminar spreader in the 3rd intermetatarsal space resulted in greater excision of the nerve than the Galpie retractor, although this was not significant. Conclusion: These results demonstrate that use of the Laminar spreader during dorsal approach to a Morton Neuroma results in superior proximal resection of the medial plantar nerve when compared to use of the Galpie retractor, thereby decreasing the risk of recurrent Morton Neuroma. Further evaluation of the available retractors is needed to support the superiority of the laminar spreader compared to the Galpie retractor.
Suture Button versus Syndesmotic Screw for Syndesmotic Injuries
Authors: Shimozono Yoshiharu , Hurley Eoghan , Kennedy John 
Published: September 2018

Category: Trauma Introduction/Purpose: Syndesmotic injuries are a common athletic injury and involved in approximately 13% of ankle fractures. Screw fixation (SS) has been the most common fixation treatment for syndesmotic injury, however syndesmosis malreduction has been reported to occur up to more than 50% in syndesmotic screw fixation. Recently, suture-button fixation (SB) technique has been developed to restore anatomic function of the syndesmosis, with potential advantages of allowing physiological movement of syndesmosis, anatomic healing, avoidance of implant removal and earlier rehabilitation. However, optimal surgical treatment is still controversial to date. The purpose of this study was to compare the clinical outcomes of SB and SS fixation techniques for syndesmotic injuries with a meta-analysis of the clinical studies comparing SB and SS fixation for syndesmosis injuries. Methods: The literature search was performed according to the PRISMA guidelines to identify cohort studies comparing SB and SS fixation for syndesmosis injuries. The level of evidence (LOE) was assessed based on the criteria by the Oxford-Centre for Evidence Based Medicine. Statistical analysis was performed using RevMan, and a p-value of < 0.05 was considered to be statistically significant. Results: Ten clinical studies were identified comparing 222 patients with SB to 235 patients with SS fixation. Patients treated with SB had a higher postoperative AOFAS score at a mean of 17.2 months (90.9 vs 87.3, p = 0.002). SB resulted in a lower rate of implant failure (0.0% vs 27.1%, p < 0.0001), implant removal failure (4.0% vs 37.5%, p < 0.0001), and joint malreduction (0.8% vs 10.7%, p = 0.009). However, there was no significant difference in the rate of other complications with SB (4.2% vs 8.6%, p = 0.21). Conclusion: SB fixation results in improved functional outcomes, lower rates of implant failure, and joint malreduction. Based on the findings of this meta-analysis SB appears to be favorable to SS for treating syndesmotic injuries.
Postoperative analgesia with the use of peripheral nerve block of the foot and ankle
Authors: Stéfani Kelly , Ferraz Gabriel 
Published: September 2018

Category: Basic Sciences/Biologics Introduction/Purpose: Peripheral nerve block in the foot and ankle is usually used for anesthesia in forefoot and midfoot surgeries. However, since the postoperative analgesia obtained is prolonged, we can expand its use, as an adjuvant after the end of the spinal or general anesthesia. The aim of this study was to evaluate the use of peripheral nerve block of the foot and ankle as a method of postoperative analgesia. Methods: A prospective, randomized, blinding study was performed. The study group included 30 patients (32 feet) submitted to peripheral anesthetic block after surgery with spinal anesthesia and the control group (30 patients, 31 feet) were patients not submitted to nerve block. The inclusion criterion was: patients submitted to foot and ankle surgery at our institution. Patients answered the questionnaire postoperatively, with the measurement of pain intensity by the Visual Analog Scale (VAS) and the time of onset of pain. All local peripheral block was performed by the same orthopedic team with 20 mL of Ropivacaine at a concentration of 7.5 mg / mL (0.75%). Results: The mean patient age was 52,5 years, and the majority of patients were women (66%). The results showed a statistically significant difference between the control group and the study group, with a longer time of postoperative analgesia (p <0.001) and lower pain intensity in the immediate postoperative period (p <0.001) in patients submitted to blockade anesthetic. There was no statistical difference between the two groups regarding pain intensity on the first and second postoperative day. Conclusion: In the study group, the mean postoperative pain (six hours after surgery) was lower when compared to the control group, with statistical significance. This result showed that the ankle block helped to control pain, in a safe and effective mode. The use of ropivacaine presents a sensitive block similar to bupivacaine, but with shorter motor block, allowing early initiation of rehabilitation. The study demonstrated that peripheral nerve block in the foot and ankle region can be used effectively in postoperative analgesia, reducing pain intensity in the immediate postoperative period and also prolonging analgesia and thus maximizing physiotherapy postoperative period.