bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Effects of Cheilectomy on Dorsiflexion of the First Metatarsophalangeal Joint
Authors: Heller William A. , Brage Michael E. 
Published: March 2013

Our purpose in this study was to determine the effects of cheilectomy on the mechanics of dorsiflexion of the first metatarsophalangeal (MTP) joint. Ten fresh-frozen cadaver feet were utilized, of which two demonstrated radiographic evidence of hallux rigidus. Each specimen was rigidly mounted on a custom-made slide tray that was articulated with a hinge mechanism designed to dorsiflex the first MTP joint. Range-of-motion measurements were made on the first MTP joint. Cheilectomy of 30% of the metatarsal head diameter was performed. Lateral radiographs with the beam centered on the MTP joint were taken with the joint at neutral, 20°, 40°, and at the limits of dorsiflexion. This process was repeated after a 50% cheilectomy was performed. The radiographs were examined for changes in joint congruence and in patterns of surface motion as the hallux moved from neutral to full dorsiflexion. Instant centers of rotation were determined by a method first described by Rouleaux. We constructed surface velocity vectors to describe patterns of motion of the first MTP joint. The mean dorsiflexion of the first MTP joint was 67.9° and increased to 78.3° after 30% cheilectomy. The increase in dorsiflexion was significantly greater in the two specimens with hallux rigidus (33%) than in the other specimens (12.1%). After both levels of cheilectomy, the proximal phalanx demonstrated pivoting at the resection site on the metatarsal head. This pivoting resulted in abnormal motion patterns across the MTP joint. Normal sliding motion predominated in early dorsiflexion, with compression peaking at the end stage of dorsiflexion, producing jamming of the articular surfaces. Cheilectomy significantly increased dorsiflexion of the MTP joint, but resulted in abnormal motion patterns. The increase in dorsiflexion resulted from pivoting of the proximal phalanx on the metatarsal head, resulting in anomalous velocity vectors and compression across the MTP joint.
Effective Treatment of Chronic Plantar Fasciitis with Dorsiflexion Night Splints: A Crossover Prospective Randomized Outcome Study
Authors: Powell Mark , Post William R. , Keener Jay , Wearden Stanley 
Published: March 2013

Chronic plantar fasciitis frustrates patients and treating physicians. Our hypothesis was that use of a dorsiflexion night splint for 1 month would effectively treat patients with recalcitrant plantar fasciitis. A 6-month randomized crossover study included 37 patients with chronic plantar fasciitis. Patients were treated with dorsiflexion night splints for 1 month. Group A wore splints for the 1st month and group B for the 2nd month. No splints were used in either group for the final 4 months of the study. No other medications, stretching, or strengthening exercises were prescribed. Eighty-eight percent of patients who completed the study improved. Eighty percent of the involved feet improved subjectively. Results of the AOFAS Ankle-Hindfoot Rating System 17 and the Mayo Clinical Scoring System 7 demonstrated significant improvement for both groups during the period of splint wear. Improvements were maintained at study completion. Response to splinting did not correlate with foot type, degree of obesity, or the presence of heel spur on radiographs. We believe dorsiflexion splints provide relief from the symptoms of recalcitrant plantar fasciitis in the majority of patients.
Tarsal Tunnel Syndrome: Diagnosis, Surgical Technique, and Functional Outcome
Authors: Bailie David S. , Kelikian Armen S. 
Published: March 2013

During a 10-year period, 47 patients underwent surgical management for tarsal tunnel syndrome (TTS). Of these, 34 (36 feet) were available for complete retrospective analysis by record review, questionnaire, and physical examination. An additional 10 patients were evaluated by record review alone. The mean age was 38 years (range, 12–65 years). Overall, average follow-up was 35 months (range, 15–102 months). All patients had nonsurgical care for an average of 16 months before surgery (range, 1–72 months). The symptom triad of pain, paresthesias, and numbness was the most common clinical presentation. All had a positive Tinel's sign and nerve compression test (NCT) at the tarsal tunnel. Electrodiagnostic studies were abnormal in 38 feet (81%). Two-point discrimination was diminished significantly by an average of 6.7 mm. At a follow-up examination two-point discrimination improved by an average of 3.8 mm ( P < 0.001). Eighteen feet continued to have a positive Tinel's sign and had a residual NCT. Subjectively, patients were satisfied with the surgical outcome in 72% of the cases. Postoperative improvement in the median Symptom Severity Score and the Functional Foot Score reflected this satisfaction. The perioperative complication rate was 30%. We conclude that the diagnosis of TTS is made primarily on history and clinical evaluation with electrodiagnostic studies supporting the diagnosis in 81%. Surgical treatment is warranted after nonsurgical management has failed. Division of the deep portion of the abductor hallucis fascia is important to ensure a complete release.
The Effects of Foot Position and Load on Tibial Nerve Tension
Authors: Daniels Tim R. , Lau John Tak-Choy , Hearn Trevor C. 
Published: March 2013

Patients with tarsal tunnel syndrome of unknown etiology do poorly after surgical decompression. Although surgical decompression addresses the soft tissue constraints, it ignores the role of osseous support. Some authors have suggested that a pes planus deformity (i.e., valgus hindfoot and abducted forefoot) is an unrecognized cause of tarsal tunnel syndrome due to increased tibial nerve tension. An in vitro study was performed on nine cadaveric feet to determine the effects of foot position and load on tibial nerve tension. Tensile forces placed through the tibial nerve were measured when the foot was placed in dorsiflexion, eversion, combined dorsiflexion-eversion, and then under cyclical load and increasing internal rotation at 5° increments from 0° to 20°. The nerve tension was reassessed after the creation of a pes planus deformity under the previous conditions. Tibial nerve tension in the stable and unstable foot was significantly increased by eversion, dorsiflexion, and combined dorsiflexion-eversion. Tibial nerve tension was significantly greater in an unstable foot when compared with a stable foot during eversion, dorsiflexion, and combined dorsiflexion-eversion. In the stable foot, tibial nerve tension was significantly increased during axial loading with increasing internal rotation when compared with 0° rotation. The increased tibial nerve tension in the stable foot was significant with increasing internal rotation when 0° was compared with 10°, 15°, and 20°. In the unstable foot, the tibial nerve tension was significantly increased with increasing internal rotation compared with the nerve tension at 0° of rotation. The increased tibial nerve tension in the unstable foot was significant with increasing internal rotation when 0° was compared with 5°, 10°, 15°, and 20°. When stability of the foot and internal rotation were compared independently, each factor increased tibial nerve tension. However, these factors acting together did not significantly compound the increase in nerve tension. This study demonstrates that tibial nerve tension is increased in an unstable foot compared with a stable foot during eversion, dorsiflexion, combined dorsiflexion-eversion, and cyclical load with increasing internal rotation.
Anatomic Investigation of the Deep Posterior Compartment of the Leg
Authors: Cheney Robert A. , Melaragno Paul G. , Prayson Michael J. , Bennett Gordon L. , Njus Glen O. 
Published: March 2013

The purpose of this study is to critically investigate the anatomy of the deep posterior compartment of the leg. Specifically, the relationship of the deep posterior compartment to the superficial posterior compartment and their insertion onto the posteromedial border of the tibia are assessed. Cross-sectioning of 10 fresh-frozen cadaver legs was performed at 2-cm increments. The inferior surface of each section was photographed. The photographs were visually analyzed, and the fascial separation between the posterior compartments along with their relationship to the posteromedial border of the tibia were recorded for each specimen. Magnetic resonance images in the axial plane of 10 healthy, normal volunteers’ lower extremities at 2-cm increments were obtained and analyzed. All specimens and images demonstrated that the medial fascial attachment of the deep posterior compartment was along the posteromedial aspect of the tibia in the proximal third of the leg and was not superficially accessible. In the proximal third of the leg, the superficial posterior compartment fascial attachment overlapped the deep posterior compartment by inserting medial and anterior to the deep posterior compartment fascial attachment. In the middle and distal thirds of the leg, the medial fascial attachment of the deep posterior compartment shifted medially and anteriorly, making the deep posterior compartment superficially accessible. The surgeon must appreciate the change in the anatomic relationships along the medial side of the leg while performing double-incision four-compartment fasciotomy release to obtain a complete release of the muscular portion of the deep posterior compartment.
Surgical Treatment of Neuroarthropathic Foot Deformity
Authors: Sammarco G. James , Conti Stephen F. 
Published: March 2013

Twenty-seven feet with neuroarthropathic fracture resulting in significant deformity were treated with surgical reconstruction. The average age of the patients was 57 years with 21 patients having diabetes mellitus an average of 24 years. Five patterns of midfoot collapse were identified. The most common patterns involved abduction and dorsal displacement of the forefoot with equinus of the hindfoot. Preoperative evaluation included a medical assessment, adequate control of blood sugar, and a comprehensive vascular evaluation. Five patients presented for surgical consultation with open plantar ulcers. Four were healed with total contact casting alone whereas one patient required an exostectomy to heal the ulcer before surgery. After reconstruction, all feet had improvement in their weightbearing posture. For feet with midfoot involvement, the average anteroposterior talo-first metatarsal angle increased 5°, and the average lateral talo-first metatarsal angle decreased 6.5°. There was no significant loss of correction at long term follow-up. The average time in a cast postoperatively was 5.7 months, and the time to unrestricted weightbearing was 7 months. All patients were able to wear over-the-counter footwear postoperatively. Significant complications included six nonunions and two feet with extension of the neuroarthropathic process. One nonunion required revision surgery, and the feet with extension of their neuroarthropathic fractures required conversion of a triple arthrodesis to a pantalar fusion and the addition of a triple arthrodesis after a successful midfoot fusion. No infections or amputations occurred as a result of the surgery. Function increased and pain decreased as a result of successful arthrodesis. Surgical reconstruction of midfoot, hindfoot, and ankle neuroarthropathic deformity is a viable alternative to amputation for patients who fail nonoperative care. Proper preoperative evaluation and assessment will result in a rate of complications comparable to foot surgery in nondiabetic patients.
Surgical Treatment of Patients with Painful Instability of the Second Metatarsophalangeal Joint
Authors: Gazdag Andre , Cracchiolo Andrea 
Published: March 2013

An unstable second metatarsophalangeal joint may produce pain in the forefoot. Eighteen patients (20 feet) had a transfer of the flexor digitorum longus to the extensor side of the base of the proximal phalanx performed as the primary procedure to stabilize this painful joint. Most patients had a hallux valgus deformity that also required correction, because it either was also symptomatic or was preventing adequate reduction of the second toe. A ruptured plantar plate of the second metatarsophalangeal joint was demonstrated in 13 feet and in these joints appeared to be the cause of the vertical instability. However, all feet showed an unstable joint upon clinical examination. A vertical-stress test almost always reproduced the patient's pain while demonstrating instability in the joint; this was the most prominent physical finding in these patients. Eleven patients (13 feet) had an excellent result. Seven patients (seven feet) had a fair result, but they complained only of mild and occasional pain at the joint on exertion. Although difficult to quantify, it appears that postoperative stiffness in the joint provided some of the joint stability seen in our patients. The flexor tendon transfer appears to be a satisfactory method to treating the unstable metatarsophalangeal joint and of relieving patients' pain, but may not, however, restore a normal alignment of the second toe. Correction of other forefoot deformities as hallux valgus and hammertoes may also be important in restoring metatarsophalangeal stability.
Treatment of Diabetic (Neuropathic) Foot Ulcers with Two-Stage Debridement and Closure
Authors: Kumagai Steven G. , Mahoney Craig R. , Fitzgibbons Timothy C. , McMullen Scott T. , Connolly Thomas L. , Henkel Loree 
Published: March 2013

We reviewed 33 patients with 37 wounds treated between November of 1991 and December of 1995 in the Wound Care Center. A two-stage debridement and closure technique for neuropathic foot ulcers was performed. Patients selected included those with obvious osteomyelitis and those who had failed nonsurgical treatment. The approach included initial surgical excision of the ulcer with biopsy, bone resection with biopsy, and deep culture. The second-stage procedure 4 to 8 days later included debridement of the wound and delayed closure. Intravenous antibiotic treatment using a central line was given postoperatively in patients with documented osteomyelitis for at least 6 weeks and in patients with infected soft tissues only for about 4 weeks. All patients remained nonweightbearing for 4 weeks; this was felt necessary to prevent separation of the wound edges. Four wounds in four patients failed to heal, and two of these went on to amputation. Satisfactory healing occurred in 29 of 33 patients and in 33 of 37 wounds. The authors conclude that two-stage surgical debridement and closure is an acceptable treatment in selected nonhealing diabetic (neuropathic) foot ulcers.
Use of Ready-Made Insoles in the Treatment of Lesser Metatarsalgia: A Prospective Randomized Controlled Trial
Authors: Kelly Andrew , Winson Ian 
Published: March 2013

Two insoles designed to treat primary lesser metatarsalgia were compared in terms of their effect on plantar pressures and the subjective symptom relief. A prospective single blind randomized trial of 8 weeks' treatment in 46 feet in 33 patients was performed. Subjective outcome measures were visual analogue pain scores and estimated compliance. Objective outcome measures were dynamic plantar pressures using the Musgrave Footprint® System. In group 1 (Viscoped), 6 of 18 patients rated themselves much improved or somewhat improved, and in group 2 (Langer) the proportion was 12 of 15 ( P = 0.02). Reported mean compliance was 16% higher in the Langer group. Plantar forefoot pressure was lowered by the insoles in all cases. The reduction was significantly greater ( P < 0.001) in group 2, both in absolute pressure and as a percentage of initial pressure. Group 2 (Langer) was significantly better in terms of reduction of peak metatarsal pressure. All the subjective outcome measures were better for the group 2 (Langer).
Insufficiency Stress Fractures of the Foot and Ankle in Postmenopausal Women
Authors: Kaye Robert A. 
Published: March 2013

Eleven consecutive patients with 12 stress fractures of the foot or ankle were seen between October 1992 and July 1995. Charts were reviewed retrospectively for clinical information. The patients were all postmenopausal females. Average age was 62 years. Onset of symptoms was not associated with a specific episode of trauma. There were eight metatarsal fractures, three distal fibular fractures, and one fracture of the medial malleolus. Fractures were confirmed by radiographs, bone scan, or MRI in 9 of the 11 cases. Nonsurgical treatment utilizing rest, decreased activity, mechanical support, and analgesics resulted in successful union of the fracture except in one patient. Only four of the patients had been taking hormone or calcium supplements before injury. Just one patient had a prior bone density measurement, although four had a definite fracture previously and two had history suggestive of previous stress fracture. A careful history considering risk factors for osteoporosis should be obtained when an insufficiency type stress fracture is diagnosed. Bone density measurements should be considered for patients with this type of injury. Appropriate medical therapy directed at the treatment of the underlying osteoporosis in addition to orthopaedic management of the fracture constitute the treatment objectives. This dual approach may prevent subsequent injury.
Arthrodesis of the Ankle Secondary to Replacement
Authors: Carlsson Åke S. , Montgomery Fredrik , Besjakov Jack 
Published: March 2013

One hundred total ankle arthroplasties were performed in our department between 1974 and 1994, and of these, 21 have been reoperated on with arthrodesis due to septic or nonseptic failures after 6 months to 15 years (median 40 months). Immobilization using a Hoffman external fixator was the dominating method. The total ankles were of six different designs. Sixteen of the 21 patients suffered from rheumatoid arthritis. Four of the 21 ankles did not fuse whereas 17 did: 13 at the first attempt and 4 after repeat arthrodesis. At the time of the review, two patients had died. Of the remaining 15 patients whose ankles had fused, all but one were satisfied or somewhat satisfied with the result. Twelve of these 15 ankles rated excellent or good according to the Mazur and Kofoed scoring systems. We conclude that arthrodesis can be performed successfully after a failed ankle arthroplasty.
Natural Selection and High Heels
Authors: Smith Euclid O. , Helms Whitney S. 
Published: March 2013

EDITORIAL COMMENT This new section of the journal has been added to provide readers with a broader contact with specific information. In many cases, information which is of interest to the reader but does not conform to the strict peer review guidelines is available. We welcome submissions from our readers with opinions, ideas, or essays that are of interest to the readers of Foot & Ankle International. Lowell D. Lutter, M.D. Editor-in-Chief Foot & Ankle International
Comparison of the Results of the Weil and Helal Osteotomies for the Treatment of Metatarsalgia Secondary to Dislocation of the Lesser Metatarsophalangeal Joints
Authors: Trnka Hans-Jörg , Mühlbauer Michaela , Zettl Reinhard , Myerson Mark S. , Ritschl Peter 
Published: March 2013

We retrospectively reviewed the outcome of 30 patients who were treated surgically for metatarsalgia resulting from dislocation of one or more lesser metatarsophalangeal (MTP) joints. We used two treatments, including an osteotomy of the metatarsal head (Weil osteotomy, N = 15) or an osteotomy of the metatarsal shaft (Helal osteotomy, N = 15). Before surgery, all patients had been treated with various nonoperative modalities for a minimum of 6 months. Between 1991 and 1993,15 consecutive patients underwent a Helal osteotomy (22 metatarsals), and 15 consecutive patients were subsequently treated between 1994 and 1995 with a Weil osteotomy (25 metatarsals). All patients were evaluated clinically and radiographically at a mean follow-up period of 22 months (range, 12–39 months), noting especially persistent subluxation or dislocation, recurrent metatarsalgia, and transfer lesions. Patients managed with a Weil osteotomy had significantly higher satisfaction ( P = 0.049), lower incidence of recurrent metatarsalgia (0 vs 27%, P = 0.107), and fewer transfer lesions (0 vs 41%, P = <0.001) than those managed with a Helal osteotomy. Furthermore, those managed with the Weil procedure had a higher percentage of radiographic reduction and maintenance of the MTP joint dislocation (21 of 25, 84% vs 8 of 22,36% P = 0.002) than those managed with the Helal procedure. In the Weil group, there was also no malunion or pseudoarthrosis; in the Helal group there were five malunions and three pseudoarthroses. Although the follow-up period for the Weil osteotomy (15 months) was shorter than that for the Helal osteotomy (26 months), the former group had higher American Orthopaedic Foot and Ankle Society forefoot scores, which were significantly different from the results attained with the Helal osteotomy. A telephone update was performed on the Weil osteotomy group at an average of 27 months postsurgery, and no patient had experienced changes since the clinical follow-up. We concluded that the Weil procedure is a satisfactory method for correcting metatarsalgia caused by dislocation of the MTP joint and that, because of the high complication rate, the Helal osteotomy is not an acceptable procedure for correcting this condition.
Effect of Ankle and Knee Position on Tension in the Achilles Tendon
Authors: Davis William L. , Singerman Robert , Labropoulos Panagiotis A. , Victoroff Brian 
Published: March 2013

The purpose of this study was to evaluate the relative contributions of ankle and knee position to tension in the Achilles tendon and to determine whether there exists a position of plantarf lexion at which the passive tensioning effect of knee extension is eliminated. Seven matched pairs of fresh-frozen cadaver lower extremities were tested. A buckle transducer was used to measure forces in the tendon throughout the full range of knee motion, with the hindfoot fixed. Positioning the hindfoot in 20° to 25° of plantarflexion effectively eliminates tension in the Achilles tendon, regardless of knee position. This information is directly applicable both to the nonoperative treatment of ruptures of the Achilles tendon employing a short leg cast and to surgical repairs, in which tension must be controlled precisely.
Arthroscopic Evaluation of the Subtalar Joint: Does Sinus Tarsi Syndrome Exist?
Authors: Frey Carol , Feder Keith S. , DiGiovanni Christopher 
Published: March 2013

This is a retrospective review of 49 subtalar arthrosco-pies performed between 1989 and 1996. Patients were evaluated in the following areas: (1) preoperative diagnosis, (2) preoperative tests and clinical evaluation, (3) intraoperative findings, (4) postoperative diagnosis,(5) complications, and (6) clinical outcome. Particular attention was paid to the accuracy of the preoperative diagnosis, subtalar instability, intraoperative findings in sinus tarsi syndrome, and clinical outcome. Overall, this study demonstrated a success rate of 94% good and excellent results in the treatment of various types of subtalar pathologic conditions with arthroscopic techniques. The Workers’ Compensation cases reported 90% good and excellent results. The complication rate was low, with five minor complications reported. The most common complication was a transient neuropraxia involving branches of the superficial peroneal nerve. Of the 14 feet that had a preoperative diagnosis of sinus tarsi syndrome, all the diagnoses were changed at the time of arthroscopy. The postoperative diagnoses included 10 interosseous ligament tears, two cases of arthrofibrosis, and two degenerative joints. Based on these findings, “sinus tarsi syndrome” seems to be an inaccurate term that should be replaced with a specific diagnosis. Arthroscopy is the tool that will allow the orthopaedic surgeon to make a more accurate diagnosis.