bluuebunny/crossref_metadata_2025_split huggingface dataset:
Injury Characteristics and the Clinical Outcome of Subtalar Dislocations: A Clinical and Radiographic Analysis of 25 Cases
Authors: Bibbo Christopher , Anderson Robert B. , Davis W. Hodges 
Published: January 2017

The objective of this study was to determine the mechanisms of injury and pattern of associated foot and ankle injuries and systemic injuries associated with subtalar dislocations, and, correlate these data with the radiographic and clinical/functional outcome of patients after subtalar dislocation. Results: Twenty-five patients with a subtalar dislocation were identified over a seven year period. The mean patient age was 38 years. Males (n=19) comprised 76% of patients, with a mean age of 36 years. High energy mechanisms (motor vehicle accidents, falls) accounted for 68% of subtalar dislocations. Although high energy mechanisms showed a strong trend toward open subtalar dislocations, the association was not statistically significant (p=0.0573, Fisher's exact test). Closed dislocations predominated (75%). Left and right-sided dislocations were nearly equally distributed, even among motor vehicle accidents. Medial dislocations predominated (65%): these were not influenced by mechanism of injury and did not result in statistically lower AOFAS ankle/hindfoot scores. Subtalar dislocation was irreducible (requiring open reduction) in 32%, with higher energy mechanisms of injury being statistically associated with an irreducible subtalar dislocation (p=0.0261, Fisher's exact test). Block to reduction was evenly distributed among soft tissue elements (posterior tibial tendon, flexor hallucis longus tendon, capsule, extensor retinaculum) and osseous elements. Eighty-eight percent of patients incurred concomitant injuries to the foot and ankle (95% of which were closed injuries), namely, the ankle and talus. Systemic injuries occurred in 88% of patients. At a mean follow-up of five years, the mean AOFAS score of the subtalar dislocation side was significantly lower (mean=71 vs. 93, p=0.0007, unpaired Student's t-test). No statistical relation was found between the number of associated extremity injuries and AOFAS score (Spearman correlation coefficient, r=(–)0.236, p=0.331). Radiographic follow-up demonstrated 89% of ankles with radiographic changes (31% symptomatic); however, the majority of these patients (61%) had an associated ankle injury. The subtalar joint demonstrated radiographic changes in 89% of patients, with 63% being symptomatic; 75% of patients with subtalar joint changes incurred a fracture about the subtalar joint at the time of dislocation. Four patients went on to subtalar fusion at an average of 8.8 months post-dislocation. The midfoot showed radiographic changes in 72% of patients, with only 15% of these patients being symptomatic. All patients with midfoot symptoms were well controlled by nonsurgical measures.
Accuracy of Arthroscopic Assessment of Anterior Ankle Cartilage Lesions
Authors: Schäfer Dirk , Boss Andreas , Hintermann Beat 
Published: January 2017

Purpose: The accuracy of arthroscopic evaluation of the size of an osteochondral lesion in the ankle joint was assessed in 10 cadaver feet. Materials and Methods: A rectangular osteochondral defect was created in the anterior part of the talus. A 5 mm 30° arthroscope was utilized for evaluation of the size of the lesion from an anterior midline portal under carbon dioxide. Results: The size of the defect averaged 77.2±31 mm 2 (24–108 mm 2 ). The difference between area of the defect and measurement of three independent investigators averaged 52%, 49% and 49%, respectively. Conclusion: The assessment of the size of an osteochondral lesion in the ankle joint based on arthroscopy implicates over- and underestimation of the defect.
Associated Deformities and Hypermobility in Hallux Valgus: An Investigation with Weightbearing Radiographs
Authors: King David M. , Toolan Brian C. 
Published: January 2017

Background: Hallux valgus has been reported to recur after surgical correction in patients subsequently diagnosed with hypermobility of the first ray, pronation of the foot, and pes planovalgus. An objective means of assessing the foot for these deformities preoperatively may avert a poor outcome. This investigation evaluated the efficacy of full-length weightbearing radiographs to recognize associated deformities in patients with hallux valgus before surgery. Methods: This study compared five parameters from anteroposterior and four parameters from lateral weightbearing pedal radiographs of patients with moderate to severe hallux valgus to a control group to identify differences in the alignment of the midfoot and the first metatarsal-medial cuneiform joint. An examination for clinical evidence of hypermobility was also performed on both groups. Results: The hallux valgus group demonstrated increased abduction and dorsiflexion of the midfoot. The mean talonavicular coverage angle and lateral talo-first metatarsal angle of this group was greater than the mean values for the controls. Radiographic evaluation also revealed differences in the alignment of the first metatarsal-medial cuneiform joint in the sagittal plane. The hallux valgus group possessed a mean of 2 mm of dorsal translation and 2° of dorsiflexion at this joint compared to the controls. Conclusions: Weightbearing radiographs permit the recognition of associated malalignments of the foot in patients with hallux valgus. The comparisons performed in this study identified deformities consistent with pes planovalgus and hypermobility of the first ray in patients with moderate to severe hallux valgus. The results of our study support a recommendation for a thorough evaluation of full-length, biplanar weightbearing radiographs via the measurement of midfoot and first ray alignment for concomitant deformities of the foot in patients with hallux valgus.
Etiology of the Anterior Ankle Impingement Syndrome: A Descriptive Anatomical Study
Authors: Tol Johannes L. , van Dijk C. Niek 
Published: January 2017

Background: In the anterior ankle impingement syndrome, recurrent traction to the anterior joint capsule is stated to be the cause of formation of talotibial osteophytes. This hypothesis involves the assumption that the osteophytes originate at the site where a capsular attachment is located. A soft tissue component that can get squeezed between the distal tibia and talus is thought to be responsible for impingement complaints during dorsiflexion movements. Methods: In eight ankle specimens, the width of the nonweightbearing tibial cartilage rim and the distance of the tibial and talar cartilage to the capsular attachment were measured. The relationship of the soft tissue components to the anterior joint was studied. The average tibial cartilage rim width was 2.4 mm (1.5–3.0 mm). Tibial and talar cartilage-capsule distances were 4.3 mm (0.5–9.0 mm) and 2.4 mm (1.8–3.3 mm), respectively. In all specimens, the anterior joint space contained a triangular soft tissue component, overlying the joint capsule. The component consisted of a synovial membrane and subsynovial located fat and collagen tissue. It was observed that in 15° dorsiflexion the soft tissue component was squeezed between the tibia and talus. Conclusions: The anterior ankle joint capsule attaches proximal to the site where the anterior talotibial spurs originate. The hypothesis of formation of talotibial spurs due to repetitive capsule traction therefore does not seem plausible. The anatomic findings do support the hypothesis that an anteriorly located soft tissue component is present that can give impingement symptoms.
The Efficacy of Two Methods of Ankle Immobilization in Reducing Gastrocnemius, Soleus, and Peroneal Muscle Activity during Stance Phase of Gait
Authors: Kadel Nancy J. , Segal Ava , Orendurff Michael , Shofer Jane , Sangeorzan Bruce 
Published: January 2017

Background: Immobilization to limit muscle activity is a common therapeutic and posttreatment event. There are potential time and resource savings if a prefabricated boot can replace a custom applied cast. The purpose of this study was to determine if muscle activity reduction is similar using a fiberglass cast versus a prefabricated (Aircast FoamWalker) boot. Methods: Surface EMG data were recorded from the gastrocnemius, soleus, and peroneals of 12 normal adults while walking barefoot, in a fiberglass cast with a cast shoe (cast), and while wearing an Aircast FoamWalker (boot). Subjects walked at their self-selected speed for 10 trials in each condition, and the order of barefoot, cast, and boot was randomly assigned. The data were rectified, integrated across stance phase and normalized to a percent of each subject's barefoot mean integrated EMG (iEMG) value. For each muscle, a linear mixed-effects statistical model (subject by trial by condition) was utilized to determine if iEMG activity levels were reduced by immobilization compared to barefoot walking. Results: Activity for all muscles was significantly lower in the boot compared with barefoot ( p <.05). The cast iEMG levels were significantly different from barefoot for the soleus and peroneals ( p <.05). Gastrocnemius activity was significantly decreased in the boot when compared with the cast ( p <.0001). The greater reduction in iEMG levels for the boot indicates that it is superior to a fiberglass cast in reducing gastrocnemius muscle activity during the stance phase of gait. Conclusions: The data show that a prefabricated boot is as effective as a custom applied cast in reducing soleus and peroneal muscle iEMG during stance phase. The boot was more effective in reducing gastrocnemius activity when compared to the cast. Clinical Relevance: This study suggests that a prefabricated boot may be used in place of a custom cast when the goal of treatment is to limit muscle activity of the leg.
Mid-Term Results of Titanium Hemi-Great Toe Implants
Authors: Konkel Kurt Frederick , Menger Andrea Gayle 
Published: January 2017

Background: We reviewed the mid-term results of metatarsophalangeal hemiarthroplasty with titanium hemi-great toe implants. This study may help with future prosthetic design and evaluation leading to improved management and patient satisfaction. Methods: Ten of 12 patients were contacted more than 2.5 years after surgery. Their charts were reviewed, and they were evaluated clinically and radiographically. Results: All patients were improved and satisfied in the first 5 years after surgery, but subsidence and lucency in all patients and a painful fracture in one patient bring long-term implant survival into question. The ultimate longevity of the implant and its long-term functionality should be questioned. Conclusions: Metallic hemi-great toe implants have satisfactory mid-term results. Improved prosthetic design may lead to less implant subsidence and stem lucency.
Location Modalities for Focused Extracorporeal Shock Wave Application in the Treatment of Chronic Plantar Fasciitis
Authors: Dorotka Ronald , Sabeti Manuel , Jimenez-Boj Esther , Goll Alexandra , Schubert Simone , Trieb Klemens 
Published: January 2017

Background: Focused extracorporeal shock waves (ESWT) has been used in the treatment of plantar fasciitis with heel spurs. The optimal location for administering treatment, however, has not been determined. The purpose of this study was to determine whether fluoroscopy-guided location of a heel spur or patient location of the maximal point of tenderness is more effective in administering ESWT. Methods: In a prospective, examiner-blinded trial, 41 patients were randomized into two groups for treatment by ESWT: group 1, location of the heel spur for ESWT by fluoroscopy, and group 2, patient location for ESWT by maximal point of tenderness. Each group had three session of ESWT at 1-week intervals. The success rates between the two groups were assessed at 6 and 12 weeks. Results: No significant differences were noted between the groups. Conclusions: Despite the small number of patients in the study, patient location for positioning the focus in ESWT in treatment of plantar fasciitis with a heel spur is recommended.
Biphalangeal Fifth Toe
Authors: Dereymaeker Greta , van der Broek Chris 
Published: January 2017

Background: A biphalangeal fifth toe is a common variant in the European population. The frequency is higher in the Japanese population. It is considered an anatomical variant of the normal triphalangeal fifth toe. Methods: Patients divided into three study groups were retrospectively reviewed to determine the effect of a biphalangeal fifth toe on the occurrence of clinically symptomatic pathology of the fifth ray. Results: The prevalence of a biphalangeal fifth toe in patients with hammer or claw toes was 65%, bunionettes 47%, and overriding fifth toe 37%. Only for the group with hammer or claw toes was prevalence significantly higher than that in the control group (39%). Conclusion: The stiffness and rigidity of the biphalangeal fifth toe may predispose it for symptomatic hammer or claw toe.
Etiologic Factors Associated with Symptomatic Achilles Tendinopathy
Authors: Holmes George B. , Lin Johnny 
Published: January 2017

Background: The purpose of this study was to determine if a statistical association exists between Achilles tendinopathy (also referred to as tendinosis) and obesity, diabetes mellitus, hypertension, the supplemental use of estrogen, and exposure to local or systemic steroids. Methods: From July, 1997, to February, 2003, 82 patients with a diagnosis of Achilles tendinopathy were identified. The diagnosis of Achilles tendinopathy was confirmed by a review of medical records, radiographs, and MRI. There were 44 women and 38 men with an average age of 50 (range 27 to 77) years. For the parameters of obesity, hypertension, diabetes, steroid exposure, and the use of estrogen compounds, all patients were analyzed both cumulatively and stratified into subgroups by gender and age. Chi-square 2 times 2 tables were used to compare the observed prevalence of the parameters in patients with Achilles tendinopathy to the expected prevalence of these disorders and exposures in the population at large. Results: Cumulatively, 98% percent (43 of 44 women; 29 of 38 men) had hypertension, diabetes, obesity, and steroid or estrogen exposure. Seventy-six percent of men (29) had hypertension, diabetes, and obesity, or steroid exposure. Sixty-eight percent of women (15 of 22) had a history of hormone replacement therapy and 44% (8 of 15) had a positive history for use of oral contraceptives. When compared with published national data using Chi-square analysis, the association between tendinopathy and hormone replacement therapy and oral contraceptives was found to be statistically significant with p-values of 0.01 and 0.001, respectively. For both women and men, obesity was statistically associated with Achilles tendinopathy with p-values of 0.025 and. 001, respectively. Hypertension was statistically associated with Achilles tendinopathy only for women. Diabetes mellitus and Achilles tendinopathy were found to have a statistical association only for men younger than 44 years old Conclusions: Obesity, hypertension, and steroids have as their end-organ effect a diminution of local microvascularity. The significant correlation of these factors with Achilles tendinopathy suggests the importance of their effect on microvascularity in the development of Achilles tendinopathy.
Effectiveness of Custom-Made Orthopaedic Shoes in the Reduction of Foot Pain and Pressure in Patients with Degenerative Disorders of the Foot
Authors: Jannink Michiel , van Dijk Henk , Ijzerman Maarten , Groothuis-Oudshoorn Karen , Groothoff Johan , Lankhurst Gustaf 
Published: January 2017

Background: Degenerative disorders of the foot often are painful during standing and walking. It is assumed that, because of bone deformity, callus, and deformity of the plantar pads, the plantar pressure distribution changes. Prescription of orthopaedic shoes for patients with degenerative disorders of the foot is based on the hypothesis that excessive pressure under the foot causes pain. The goal of this study was to evaluate the effectiveness of custom-made orthopaedic shoes, in terms of pressure and pain, in patients with degenerative disorders of the foot. Additionally, the relationship between plantar pressure parameters and foot pain was studied, with special emphasis on second and third metatarsal heads. Methods: Seventy-seven consecutive patients with degenerative disorders of the foot were recruited from the outpatient clinics of seven rehabilitation centers and rehabilitation departments of university hospitals in the Netherlands. The study was prospective. The Questionnaire for Usability Evaluation for Orthopaedic Shoes was used to measure perceived foot pain. To measure plantar pressures, the Pedar in-shoe pressure measurement system (Novel GmbH, Munich) was used. The effectiveness of custom-made orthopaedic shoes, in terms of pressure and pain in patients with degenerative disorders of the foot, was analyzed by means of a paired sample t-test. To select the pressure parameter (Pmax, PTI, and Pav) most closely associated with walking pain, within-subject correlation coefficients were calculated. Results: Custom-made orthopaedic shoes significantly decreased perceived foot pain by at least 23%, and significantly reduced plantar pressure under all foot regions by at least 9%. A significant correlation ( r = 0.521) was found between walking pain and the average pressure beneath the second and third metatarsal heads. Conclusions: Based on these results, it can be concluded that custom-made orthopaedic shoes are effective in reducing foot pain and foot pressure. The moderate (significant) relationship between average pressure and walking pain can be used as a tool for evaluating custom-made orthopaedic shoes prescribed for patients with degenerative disorders of the foot.
First Ray Instability in Hallux Valgus Deformity
Authors: Dietze Albrecht , Bahlke Ulf , Martin Heiner , Mittlmeier Thomas 
Published: January 2017

Background: Hallux valgus remains a common forefoot condition where different causes may contribute to the pathology. The extent of first ray mobility and, in particular, instability of the first tarsometatarsal joint represents a key argument in the debate on the selection of an appropriate operative treatment. Until now, assessment of first ray instability has relied on clinical examination or static assessment only. For dynamic evaluation in our study, pedobarographic, clinical, and standard weightbearing radiographic findings were correlated with the radiokinematically determined first ray instability in the sagittal plane in hallux valgus patients. Methods: Eight patients with hallux valgus deformity and a clinically unstable first tarsometatarsal joint were enrolled. Seven patients were females; 1 was male. Mean age was 44 years (range, 15-65). Clinical symptoms, American Orthopaedic Foot and Ankle Society forefoot scores, and standard parameters of weightbearing radiographs in 2 planes of the forefoot were recorded. A mobile C-arm fluoroscope with a novel distortion-free flat-screen detector and a pedobarographic platform were synchronized during the rollover process. Fluoroscopic image analysis was performed employing a specific CAD model. Pedobarographic parameters were determined within 8 defined areas of the forefoot contact zone. Results: The mean dorsiflexion distance and angle of the first ray was 13.9 ± 9.4 mm (range, 6.3 to 34.5) and 5.9 ± 4.0 degrees (range, 2.4 to 14.5). At the first tarsometatarsal joint, the mean maximum dorsiflexion angle was 2.6 ± 1.3 degrees (range, 0.1 to 4.0). The intermetatarsal angle correlated significantly ( P = .013) with the radiokinematically determined maximum dorsiflexion. Furthermore, a significant correlation between maximum force transfer to the central ( P = .021) and lateral forefoot (fourth metatarsal; P = .032) and first tarsometatarsal joint instability was detected with an unloading of the first metatarsal. Conclusion: Although our analysis was limited to the sagittal plane only, we can support the notion that an enlarged intermetatarsal angle was associated with increased maximum dorsiflexion of the first ray during gait in hallux valgus patients. Gross instability of the first tarsometatarsal joint during weightbearing was not detectable in our patients, while first tarsometatarsal joint instability increased maximum force transfer to the central forefoot with the potential risk of metatarsalgia. Clinical Relevance: The results here may shed further light on the role of hypermobility of the first ray on hallux valgus deformity which could have implications for its surgical management.
Evidence-Based Analysis of the Efficacy for Operative Treatment of Hallux Rigidus
Authors: McNeil Daniel S. , Baumhauer Judith F. , Glazebrook Mark A. 
Published: January 2017

Background: The aim of this article is to provide an evidence-based literature review and assessment of the quality of literature regarding operative interventions for hallux rigidus. Methods: A comprehensive evidence-based literature review of the PubMed database was conducted on June 24, 2011, identifying 586 articles, of which 135 were relevant in assessing the efficacy of common operative interventions for hallux rigidus. The 135 studies were then assigned a level of evidence (I-V) to denote quality. They were then reviewed to provide a grade of recommendation (A-C, I) in support of or against the operative intervention in treatment of hallux rigidus. Results: Based on the results of this evidence-based review, there is fair evidence (grade B) in support of arthrodesis for treatment of hallux rigidus. There is poor evidence (grade C) in support of cheilectomy, osteotomy, implant arthroplasty, resection arthroplasty, and interpositional arthroplasty for treatment of hallux rigidus. There is insufficient evidence (grade I) for cheilectomy with osteotomy for treatment of hallux rigidus. Conclusion: There are no consistent findings in comparative studies that are properly powered with validated and appropriate outcome measures to allow any definitive conclusions on which procedure is best. However, the grade B recommendation assigned to arthrodesis may make it the logical leading candidate for future high-quality randomized controlled trials. Clearly, further studies—ideally, high-quality Level I randomized controlled trials with validated outcome measures—are needed to allow stronger recommendations to be made. Level of Evidence: Level III, systematic review.