bluuebunny/crossref_metadata_2025_split huggingface dataset:
Intrinsic Toe Flexion Deformity Following Correction of Spastic Equinovarus Deformity in Adults
Authors: Keenan Mary Ann E. , Gorai A. Patricia , Smith Carl W. , Garland Douglas E. 
Published: March 2013

In the treatment of spastic equinovarus foot deformities in adults with neurologic impairment, various surgical procedures are used including the split anterior tibialis tendon transfer and tendo achillis lengthening. Release of the flexor hallucis longus and flexor digitorum longus tendons in the midfoot is routinely included with these procedures to correct or prevent toe curling. In follow-up, residual toe curling has been observed in some patients despite release of the long toe flexor tendons. This study was undertaken to investigate this problem and its consequences, treatment, and treatment success. Forty-one feet in 34 consecutive patients were examined for residual toe curling an average of 2.5 years postoperatively. Thirty-two feet (78%) were noted to have significant flexion deformities of the lesser toes. The residual toe curling caused pain in 72% of the feet and was associated with callosities on the dorsum of the toes in 59%. The incidence of residual toe curling secondary to spasticity of the flexor digitorum brevis and intrinsic muscles of the foot was similar in the patients who had sustained traumatic brain injury and in those who had suffered a cerebrovascular accident. Twelve of these feet (37%) underwent surgical release of the flexor digitorum brevis and intrinsic tendons to correct the toe curling. There were no complications of surgery and no recurrences of deformity following the surgery. A second surgical procedure to release the flexor digitorum brevis and intrinsic tendons to correct the toe curling was more commonly performed in the younger more active brain-injured patients than in the older stroke patients (44% versus 20%, respectively). The second surgical procedure was also more common in the ambulatory patients compared with the nonambulators (44% versus 14%). Based on the results of this study, we recommend that release of the flexor hallucis longus, flexor digitorum longus, flexor digitorum brevis, and intrinsic tendons be performed at the base of each toe as part of the procedure to correct spastic equinovarus deformities in the adult neurologically impaired patient.
Gait Analysis before and after Osteotomy for Hallux Valgus
Authors: Vittas Dimitrios , Jansen Erik C. , Larsen Tommy K. 
Published: March 2013

Twenty-one female patients with bunions were treated by Mitchell osteotomy. Nineteen had clinically excellent or good results. This included no pain on walking, normal ambulation, and improved appearance. Two patients were dissatisfied. By using an instrumented treadmill the gait function was tested before and a median of 6 ½ months after operation. No significant improvements or losses were found in a large series of gait parameters. The benefits of operation were not due to an improved gait function and other factors must have influenced the final result.
Pathomechanics of Congenital and Acquired Hallux Varus: A Clinical and Anatomical Study
Authors: Joseph Benjamin , Chacko Verghese , Abraham Thomas , Jacob Mary 
Published: March 2013

Hallux varus was observed in 69 feet among patients from a rural Indian population. This included three types of congenital hallux varus. The congenital “primary” type was the commonest and was not associated with any other foot deformity. Among the acquired forms was idiopathic hallux varus of middle age, which developed spontaneously in unshod persons and progressed gradually. Hallux varus following chronic arthritis was part of a consistent pattern of foot deformities in which the first ray collapsed in a zig-zag manner in two planes. Although the development of hallux varus is often due to intrinsic muscle imbalance, hallux varus secondary to chronic arthritis seems to occur as a result of both intrinsic and extrinsic muscle imbalance associated with midtarsal and subtalar arthritis. Muscular factors contribute to progression of the deformity also. No anatomical basis for a racial prediliction for the deformity was noted. Failure to use footwear could account for the higher incidence of hallux varus in India.
New Jersey Low Contact Stress Total Ankle Replacement: Biomechanical Rationale and Review of 23 Cementless Cases
Authors: Buechel Frederick F. , Pappas Michael J. , Iorio Louis J. 
Published: March 2013

A congruent contact, unconstrained, multiaxial ankle replacement has been developed for use without cement. A talar onlay component with a trochlear surface and central fixation fin uses a cylindrical articulating axis that reproduces the lateral talar curvature. A tibial inlay component with a 7° anteriorly inclined short fixation stem uses a flat loading plate, recessed anatomically into the distal tibia to distribute tibial loads to the ankle joint. For both components, made of cast cobalt-chromium-molybdenum, a 275-μm pore-size, sintered-bead, porous coating is used to allow tissue ingrowth stabilization. A congruent ultrahigh molecular weight polyethylene bearing is inserted between the metallic implants. Its upper surface is flat, whereas its lower surface conforms to the trochlear surface, thereby providing unconstrained, sliding cylindrical motion with low contact stress on the bearing surfaces. Contact pressure and collateral ligaments maintain ankle stability during both static and dynamic loading conditions. Clinically, 23 total ankle arthroplasties were performed in 21 patients. The follow-up period ranged from 24 months to 64 months with a mean of 35.3 months. Diagnoses included rheumatoid arthritis, 6 patients (26.1%); osteoarthritis, 4 patients (17.4%); post-traumatic arthritis, 10 patients (43.5%); avascular necrosis of the talus, 2 patients (8.7%), and painful ankle fusion, 1 patient (4.3%). Pain was the primary reason for surgery in all cases. Postoperatively, 87% of ankles had no pain or, at most, mild pain. Postoperative complications included poor wound healing in four ankles, reflex sympathetic dystrophy in two ankles, deep infection in one ankle, and one bearing subluxation. No ankle replacements were removed and no fusions were performed for failed implants, although one bearing was exchanged without disrupting the metallic elements. In this report, the suggestion is made that total ankle arthroplasty may have an improved application in various arthritis disorders when used with biologic fixation and unconstrained mobile bearings.
Tarsal Coalition: A Review of the Literature and Presentation of 13 Cases
Authors: Percy E.C. , Mann David L. 
Published: March 2013

Tarsal coalition refers to the condition that exists when there is absent or restricted movement between two or more of the bones of the hindfoot. The usual cause of the restricted movement is a congenital abnormality with a fibrous (syndesmosis), cartilagenous (synchondrosis), or bony (synostosis) union between the adjoining involved bones. The commonest site of these congenital anomalous attachments are reported in the literature as being located at the calcaneonavicular, the talocalcaneal, and, less commonly, the talonavicular areas. Limited movement in the hindfoot can also result from trauma, arthritis, tumor, or injury involving those joints in the foot. The congenital form may often go unrecognized until such time as a twist or sprain of the ankle or foot leads to its diagnosis. On the other hand, the condition may go unrecognized as a cause for chronic pain or discomfort in the hindfoot or ankle. In this article, a series of 13 feet in 11 patients with this condition that have been noted in the sports medicine clinic at the University of Arizona Health Sciences Center during the past 8 years is described. A detailed historical, clinical, and biomechanical account is also included.
Ankle Fusion: A New Technique of Internal Fixation Using a Compression Blade Plate
Authors: Sowa David T. , Krackow Kenneth A. 
Published: March 2013

A new technique of tibiotalar arthrodesis has been developed offering wide exposure, excellent correction of deformity, good bony apposition, and blade plate fixation. This technique has even been effective in cases of ischemic necrosis of the talus. A modified pediatric blade plate is used to effect compression of the talus to the tibia and to provide stability against flexion/extension and varus/valgus movement. Fixation is augmented by a lateral fibular strut screwed to the tibia and talus. In this series, 17 compression blade plate tibiotalar arthrodeses were performed. Follow-up averaged 48 months (range 13 to 85 months). Preoperative diagnoses included postraumatic degenerative arthritis, rheumatoid arthritis, and ischemic necrosis of the talus. Solid fusion was achieved in 16 of 17 patients (94%) with a painless, stable pseudarthrosis in the remaining one. Time to fusion averaged 4 months (range 2 ½ to 6 months). Functional clinical results were excellent in 12 and good in 4 patients. Of 14 patients evaluated by the Mazur scale, 10 scored within the range of excellent; 2, good; and 2, fair.
Distal Oblique Osteotomy for Tailor's Bunion
Authors: Zvijac John E. , Janecki Chet J. , Freeling Ronald M. 
Published: March 2013

Thirty-six patients with a total of 50 symptomatic tailor's bunions were evaluated clinically, radiographically, and subjectively, both before and after a distal oblique osteotomy procedure was performed. Thirty-four of 36 patients were satisfied with pain relief. Radiographic measurements derived from this study were consistent with those of other studies. Avascular necrosis, nonunions, or neuroma formation were not encountered in this study. The significant advantages of this procedure are its simplicity, safety, and predictability. The procedure does not require internal fixation or postoperative immobilization.
Surgical Treatment of Clubfoot: A Comparison of Two Techniques
Authors: Nimityongskul Prasit , Anderson Lewis D. , Herbert Donald E. 
Published: March 2013

Between 1977 and 1989, 28 clubfeet were operated on, with follow-up ranging from 2 to 13 ½ years and averaging 79 months. Group I (16 feet; average follow-up 104 months) underwent a modified Turco's posteromedial release. The functional result in this group was satisfactory in general, but approximately one third of this group required a secondary procedure for persistent intoeing or residual metatarsus adductus. Group II (12 feet; average follow-up 45 months) underwent a modified, complete subtalar release of McKay and Simons utilizing the Cincinnati incision. No patient in this second group required a secondary procedure. In our experience, the more complete subtalar release procedure of McKay and Simons resulted in better correction than the Turco posteromedial release. Although follow-up in group II was much shorter than that in group I, we felt that 2 years of minimum follow-up in group II was meaningful, since most of the recurrence or residual deformities were noticed within 18 months after surgery. The Cincinnati incision allowed better exposure and a more complete release. Skin flap necrosis was not a problem in this series.
Traumatic Subluxation/Dislocation of the Peroneal Tendons
Authors: Brage Michael E. , Hansen Sigvard T. 
Published: March 2013

Traumatic subluxation/dislocation of the peroneal tendons has been reported following a variety of sports-related activities. The peroneal musculature contracts reflexively during the injury and overcomes the restraining soft tissue. The tendons can then dislocate anteriorly from behind the distal fibula. Some patients have anatomical variations of the posterolateral ankle that predispose them to injury. If the physician is unaware of the injury, the diagnosis may be missed in the acute setting and can develop into a chronic, disabling condition. Treatment of the acute injury is controversial because advocates exist for both conservative and surgical therapies. The chronic, painful lesion should be treated operatively. A tremendous number of surgical procedures have been described for the treatment of chronic tendon dislocations. Choice of a surgical procedure depends upon the anatomy of the peroneal groove and the retinaculum, and the nature of the damage to the area.
Anatomical Considerations of Posterior Tibialis Tendon Entrapment in Irreducible Lateral Subtalar Dislocation
Authors: Waldrop Jeffrey , Ebraheim Nabil A. , Shapiro Paul , Jackson W. Thomas 
Published: March 2013

Irreducible lateral subtalar dislocation is associated with posterior tibialis tendon entrapment. Mulroy 7 and Leitner 6 have proposed conflicting theories regarding the exact mechanism of tendon entrapment. Cadaveric analysis of lateral subtalar dislocation supported Leitner's 5 contention that tearing of the flexor retinaculum promotes posterior tibialis tendon entrapment. Retinacular disruption allowed tendon subluxation over the medial malleolus and talar head to the entrapped position. Entrapment of the flexor digitorum longus only occurred in the Leitner model. When the flexor retinaculum and deep posterior compartment fascia were preserved, the muscle failed at the musculotendinous junction. Flexor hallucis longus entrapment could not be produced in either experimental model. Plantarflexion of the great and lesser toes, noted on clinical presentation, is caused by functional lengthening of the route coursed by the flexor digitorum longus and flexor hallucis longus.
Microvascular Anatomy of the Peroneal Tendons
Authors: Sobel Mark , Geppert Mark J. , Hannafin Jo A. , Bohne Walther H. O. , Arnoczky Steven P. 
Published: March 2013

The etiology of longitudinal splitting of the peroneus brevis tendon is unclear. It has been hypothesized that compressive load applied to the tendon as it passes through the fibular groove may compromise the vascularity of the tendon with resultant inhibition of the repair response and degeneration of tendon structure. To investigate this possibility, a study of the microvascularity of the peroneal tendons was undertaken. Twelve fresh, frozen cadaveric limbs were injected with India ink. The vascularity of the peroneal tendons was examined in situ and the tendons were harvested and cleared using a modified Spalteholz technique. The vascularity of the cleared tendons was evaluated utilizing a dissecting microscope. The vascular supply of the peroneal tendons arises from two posterolateral vincula, one for the peroneus longus tendon and one for the peroneus brevis tendon. These vincula are supplied by branches of the posterior peroneal artery. A zone of hypovascularity within the peroneus brevis or peroneus longus tendon correlating with the site of peroneus brevis splits was not found. There was no relationship between increasing age of specimens and alteration in vascular supply.
Strength of Fixation Constructs for Basilar Osteotomies of the First Metatarsal
Authors: Lian George J. , Markolf Keith , Cracchiolo Andrea 
Published: March 2013

Twenty-four pairs of fresh-frozen human feet had a proximal osteotomy of the first metatarsal that was fixed using either screws, staples, or K wires. Each metatarsal was excised and the specimen was loaded to failure in a cantilever beam configuration by applying a superiorly directed force to the metatarsal head using an MTS ser-vohydraulic test machine. Specimens with a crescentic osteotomy that were fixed using a single screw demonstrated higher mean failure moments than pairs that were fixed with four staples or two K wires; staples were the weakest construct. All specimens fixed with staples failed by bending of the staples without bony fracture; all K wire constructs but one failed by wire bending. Chevron and crescentic osteotomies fixed with a single screw demonstrated equal bending strengths; the bending strength of an oblique osteotomy fixed with two screws was 82% greater than for a crescentic osteotomy fixed with a single screw. Basilar osteotomies of the first metatarsal are useful in correcting metatarsus primus varus often associated with hallux valgus pathology. Fixation strength is an important consideration since weightbearing forces on the head of the first metatarsal acting at a distance from the osteotomy site subject the construct to a dorsiflexion bending moment, as simulated in our tests. Our results show that screw fixation is the strongest method for stabilizing a basilar osteotomy. Based upon the relatively low bending strengths of the staple and K wire constructs, we would not recommend these forms of fixation. If, for some reason, these are the only methods of fixation available, then use of a short leg cast and limited weightbearing for several weeks postoperatively should be considered.
Syme Amputation in Patients with Severe Diabetes Mellitus
Authors: Laughlin Richard T. , Chambers Richard B. 
Published: March 2013

Surgical results and functional outcome of 52 patients treated with Syme amputations for forefoot gangrene between 1986 and 1988 were retrospectively reviewed with reference to the predictive value of posterior tibial artery Doppler examination. Wound healing was correlated with the preoperative status of the posterior tibial artery. Functional outcome was assessed by the ability to wear a prosthesis, ambulatory capabilities, episodes of ulceration, and revision surgery. Follow-up averaged 27 months. Twenty-nine patients had a posterior tibial artery with either a triphasic waveform (N = 23) or a normal pulse (6). Twenty-six (90%) of these achieved a healed wound suit able for prosthetic wear. Twenty-three patients had mon-ophasic flow in the posterior tibial artery. Thirteen (57%) of these achieved a healed wound. Ninety percent of the patients who achieved healed wounds were fit with a prosthesis. Functional level of ambulation was assessed in 20 patients. Eighteen were community level ambulators, 11 could walk three or more blocks, and 16 could climb stairs. Eighteen wore their prosthesis all day. These findings indicate that posterior tibial artery Dop pler examination is predictive of healing in the Syme amputation performed on diabetics. Furthermore, dia betics can attain a functional level of ambulation with a Syme amputation.
Tibiotalar Joint Dynamics: Indications for the Syndesmotic Screw—A Cadaver Study
Authors: Burns William C. , Prakash Karanvir , Adelaar Robert , Beaudoin Armaria , Krause William 
Published: March 2013

Pronation-external rotation ankle injuries involve varying degrees of disruption of the syndesmotic ligaments. The loss of ligament support and alteration in the stability of the mortise have been postulated to lead to an increase in joint reactive forces and traumatic arthritis. The purpose of this study was to determine the changes in tibiotalar joint dynamics associated with syndesmotic diastasis as a result of the sequential sectioning of the syndesmotic ligaments to simulate a pronation-external rotation injury. Dissections were conducted on 10 fresh-frozen, knee-disarticulated cadaveric specimens which were then axi-ally loaded in an unconstrained manner. Tibiotalar joint forces were measured at each level of sequential sectioning of the syndesmotic ligaments, the interosseous membrane, and finally the deltoid ligament. Complete disruption of the syndesmosis with the medial structures of the ankle intact resulted in an average syndesmotic widening of 0.24 mm and no significant change in the tibiotalar contact area or the peak pressure. However, deltoid ligament strain increases with sectioning of the syndesmosis. With the addition of deltoid ligament sectioning, there was an average syndesmotic diastasis of 0.73 mm, a 39% reduction in the tibiotalar contact area, and a 42% increase in the peak pressure. In a simulated unconstrained cadaveric model of a pronation-external rotation ankle injury that results in complete disruption of the syndesmosis, if rigid anatomic medial and lateral joint fixation is obtained and the deltoid ligament complex is intact, syndesmotic screw fixation is not required to maintain the integrity of the tibiotalar joint.
A Treatment Algorithm for Neuropathic (Charcot) Midfoot Deformity
Authors: Pinzur Michael S. , Sage Ronald , Stuck Rodney , Kaminsky Shari , Zmuda Ann 
Published: March 2013

Forty-nine feet in 47 patients with midfoot neuropathic foot deformity were referred for care to a comprehensive foot salvage clinic and followed for an average of 3.6 years. Twenty-three initially presented without open ulcers. Two underwent elective Syme's ankle disarticulation amputation, and the others were kept ambulatory with a combination of periods of nonweightbearing cast immobilization, accommodative extra-depth shoes with custom orthotics, and ankle-foot orthoses. Twenty-six of the feet initially presented for care with open ulcers and/or chronic osteomyelitis. Twenty-two of these patients underwent 32 surgical procedures. Sixteen underwent debridement of the infected bone and surrounding soft tissues. Excision of large, nonaccommodative boney prominence, termed ex-ostectomy, was performed in eight. Partial excision of the deformed midfoot combined with boney stabilization and attempted arthrodesis, termed partial tarsectomy, were performed in seven. All surgical patients were managed postoperatively with long-term custom accommodative bracing. Follow-up at an average of 3.6 years revealed that all but one of the patients remained ambulatory. Six walk with accommodative shoe gear and persistent stable chronic open ulcers. None required below-knee amputation. Five amputations were performed, three at the Syme's ankle disarticulation level, one at the Chopart's hind-foot level, and one at the mid-foot level. Neuropathic midfoot deformity is a disabling disorder that requires thorough patient education and compliance, prolonged palliative monitoring and care, accommodative orthotic shoe management, and selective surgery. It can markedly limit the patient's walking ability and independence. With careful monitoring and selective surgery to maintain a plantigrade foot, foot salvage and walking ability can be maintained. A treatment algorithm is presented to guide patient care.
Comminuted Fracture of the Calcaneus Associated with Subluxation of the Talus
Authors: Ebraheim Nabil A. , Savolaine Edward R. , Paley Kevin , Jackson W. Thomas 
Published: March 2013

Two cases of complex fracture dislocation of the calcaneus having an unusual pattern of injury are described. The cases exhibit the following special characteristics: (1) fracture dislocation of the calcaneus where the primary fracture line separates the calcaneus into an anteromedial fragment that maintains its normal relationship to the talus and a posterolateral fragment that is dislocated from the subtalar joint. This posterolateral fragment moves laterally and lies adjacent to the fibula; (2) a secondary fracture line separating the lateral portion of the posterior facet from the tuberosity of the calcaneus. Both fragments are dislocated from their normal anatomical position; (3) talar tilt as shown on AP view of the ankle caused by inversion of the talus due to rupture of the lateral collateral ligament. Also, the posterolateral fragments impinging on the fibula pushes the heel downward and contributes to the talar tilt; (4) involvement of the calcaneocuboid joint; (5) dislocation of the peroneal tendons. This fracture pattern is unusual and has not been described before. Recognition of this unusual injury with subsequent and proper management may prevent major disability to the patient. Conservative treatment by casting or early range of motion is contraindicated. Closed reduction should be attempted immediately, and if not successful, a lateral approach with open reduction and internal fixation is the treatment of choice for this complex injury.