bluuebunny/crossref_metadata_2025_split huggingface dataset:
Chronic Lateral Ankle Instability
Authors: Peters J. Wesley , Trevino Saul G. , Renstrom Per A. 
Published: March 2013

Chronic lateral ankle instability may be present in as many as 10% to 30% of people suffering from acute lateral ankle ligament injuries. Ankle instability has been referred to as either functional instability or mechanical instability. Management options consist of either nonoperative or operative treatment, with the majority of the literature emphasizing operative management for chronic instability. Long-term studies assessing the different types of available operative repairs have now been published. This review article discusses chronic lateral ankle ligament instability from a functional, anatomical point of view. The indications for treatment, nonoperative and operative treatment, as well as the biomechanical information available regarding these methods of treatment are considered. The major emphasis of this review is discussion and analysis of the many different surgical treatment options. Following this review, we presently recommend anatomical repair to the bone of both the anterior talofibular ligament and the calcaneofibular ligament, together with imbrication of the ligaments. In patients with hypermobility, long-standing instability, or arthritis, reconstruction using the Chrisman-Snook technique is recommended.
Stabilization of the Interphalangeal Joint of the Big Toe: Comparison of Three Methods
Authors: Asirvatham Rajan , Rooney Ronald J. , Watts H. G. 
Published: March 2013

Three methods of stabilizing the IP of the big toe were compared. In group A, 10 patients underwent tenodesis of the extensor hallucis longus to the extensor digitorum brevis tendon. All of them developed a toe-drop; two patients had significant symptoms that required IP fusion. In group B, 19 patients underwent IP fusion using smooth or threaded intramedullary Kirschner wire fixation. There were nine nonunions, three requiring refusion. In group C, 32 patients underwent IP fusion using intramedullary screw fixation. There was one nonunion with screw failure that required revision. Although none of our patients considered the toe-drop after extensor hallucis longus tenodesis cosmetically unacceptable, this may not be so in other cultures. All complications following IP fusion with screw fixation were technical and are avoidable. When stabilization of IP is required, we recommend fusion of IP with screw fixation.
The Retrocalcaneal Bursa: Anatomy and Bursography
Authors: Frey Carol , Rosenberg Zehava , Shereff Michael J. , Kim Hose 
Published: March 2013

The retrocalcaneal bursae, located between the posterior angle of the os calcis and the Achilles tendon, may become inflamed and hypertrophied. There are few objective tests available for the diagnosis of pain syndromes involving the hindfoot and it is often difficult to differentiate Achilles tendinitis and retrocalcaneal bursitis. Retrocalcaneal bursograms can provide further insight into chronic changes in the bursae associated with traumatic and inflammatory conditions. This report describes the anatomy of the retrocalcaneal bursa, the technique of its opacification, and the application of this technique to the diagnosis and treatment of painful hindfoot syndromes. In addition, the anatomy of the retrocalcaneal bursa was investigated further using latex casting techniques. Twelve cadaver limbs were injected with radiopaque latex casting material or renografin into the retrocalcaneal bursae. AP, lateral, and oblique radiographs were then obtained on the specimens. The size, capacity, and configuration of the postmortem bursae were measured and recorded. Subsequently, the cadaver limbs injected with the latex material were cooled and dissection was made of the retrocalcaneal bursae. The latex bursal molds were measured, graphically recorded, and photographed. Fifteen patients with signs and symptoms of retrocalcaneal bursitis and eight asymptomatic patients were selected for this study and injected with radiopaque material into the bursae. Anteroposterior, lateral, and oblique radiographs were then obtained. The size, capacity, and configuration of the retrocalcaneal bursae were measured and recorded. The anatomic characteristics noted from the latex bursal molds correlated well with the findings on bursography. Bursographic findings in patients with retrocalcaneal bursitis can provide insight into the diagnosis and clinical management of this disorder.
The Art and Science of Fitting Shoes
Authors: Janisse Dennis J. 
Published: March 2013

The two primary components of achieving proper shoe fit are shoe shape and shoe size. Shoe shape refers to the shape of both the sole and the upper. Proper fit is achieved when shoe shape is matched to foot shape. Shoe size is determined by arch length rather than overall foot length. The proper shoe size is the one that accommodates the first metatarsal joint in the widest part of the shoe. A set of seven guidelines for achieving proper shoe fit is offered. Properly fitting shoes are important in avoiding foot discomfort and deformity, and are absolutely essential in patients with arthritis, diabetes, and other foot disorders.
Transcutaneous Oxygen as a Predictor of Wound Healing in Amputations of the Foot and Ankle
Authors: Pinzur Michael S. , Sage Ronald , Stuck Rodney , Ketner Larry , Osterman Helen 
Published: March 2013

Thirty-eight amputations of the foot and ankle were performed in patients with peripheral vascular insufficiency over a 20-month period. Amputation level selection was based on clinical examination, a minimum ankle-brachial index of 0.5 as a measure of vascular supply, serum albumin of 3.0 gm/dl as a measure of tissue nutrition, and a total lymphocyte count of 1500 as a measure of immunocompetence. Transcutaneous oxygen tension was measured at the midfoot and ankle levels prior to surgery. Thirty-two of 38 patients (84.2%) healed their amputation wounds. When the transcutaneous oxygen tension was greater than 30 mm Hg, 24 of 26 patients (92.3%) healed. When the value was below 30 mm Hg, only eight of 12 patients healed. When the propensity to support wound healing is factored out, with patients having the metabolic capacity to heal an amputation wound in the foot and ankle, it appears that transcutaneous oxygen tension is an accurate measure of vascular inflow to support amputation wound healing.
Adult Acquired Flatfoot Deformity at the Talonavicular Joint: Reconstruction of the Spring Ligament in an in Vitro Model
Authors: Deland Jonathan T. , Arnoczky Stephen P. , Thompson Francesca M. 
Published: March 2013

The mobile unilateral flatfoot deformity of chronic posterior tibial tendon insufficiency has been difficult to correct by soft tissue procedures. The procedures can decrease pain, but they do not always correct the longitudinal arch or relieve all the symptoms. Using 10 fresh frozen cadaveric specimens and a rig for stimulation of weightbearing, the deformity associated with chronic posterior tibial tendon insufficiency was produced by multiple ligamentous release and documented by AP and lateral radiographs. Reconstruction of the spring ligament using a ligament bone autograft from the superficial deltoid ligament was then performed and tested under load. The mean correction was within 2.5° of normal (over or undercorrection) on both the AP and lateral radiographs with the specimens under load. Clinical Relevance. In posterior tibial tendon insufficiency, it may be possible to address the ligament as well as tendon insufficiency to gain a corrected arch. The success of such a procedure will depend upon adequate tendon and ligament reconstruction in a fully mobile deformity. Questions remain as to the adequacy of this ligament graft, and a stronger free ligament graft, as well as correction of any bony malalignment, may be required.
Range of Motion of the Foot as a Function of Age
Authors: Nigg B.M. , Fisher V. , Allinger T.L. , Ronsky J.R. , Engsberg J.R. 
Published: March 2013

Movement of the foot is essential for human locomotion. The purpose of this paper was to quantify the range of motion of the foot as a function of age and to compare the rage of motion measurements for the foot in a laboratory coordinate system and a coordinate system fixed to the tibia. The measurements were taken in vivo using a range of motion instrument developed by Allinger (University of Calgary, Canada, 1990) from 121 subjects. The results suggest that: (1) the range of motion in general is greater for women than for men in the young adult group; (2) the range of motion in general is in the same order of magnitude for women and men in the oldest age group; and (3) the range of motion is about 8° smaller in dorsiflexion and about 8° higher in plantarflexion for women than for men in the oldest age group. It is speculated that physical activity and common shoe wear are factors influencing the age- and gender-dependent differences in range of motion. Furthermore, it has been shown that the range of motion values measured in a laboratory coordinate system and in a coordinate system fixed in the tibia are different in all directions except inversion. The differences in plantarflexion and dorsiflexion and inversion and eversion are relatively small. However, they are substantial for adduction and abduction. In all cases, the results were bigger for measurements in the laboratory coordinate system compared with the tibia coordinate system, because the movement of the lower leg was included in the measurements in the laboratory coordinate system. The data indicate that foot range of motion is different for women and men. Consequently, it is speculated that these differences may be related to possible overloading of the locomotor system, especially in sporting activities in which the loading of the foot is significant. The differences in the plantarflexion and dorsiflexion direction were assumed to influence the loading of the Achilles tendon, and it is suggested that some of the Achilles tendon problems may be predictable based on range of motion measurements.
The Microvasculature of the Sesamoid Complex: Its Clinical Significance
Authors: Sobel Mark , Hashimoto Jun , Arnoczky Steven P. , Bohne Walther H.O. 
Published: March 2013

The microvascular anatomy of the sesamoid complex was investigated in 15 cadaver specimens using histology and tissue clearing (Spalteholz) techniques. It was found that both sesamoids appeared equally well vascularized and the vascular supply to each sesamoid originated from two major sources (proximal and plantar) and one minor source (distal). Proximally, vessels originating from the first plantar metatarsal artery enter the sesamoid at its attachment to the flexor hallucis brevis. In addition, vessels enter the plantar surface of the sesamoid near the midline and arborize throughout the bone, anastamosing with the proximal vessels. The distal vascular supply to the sesamoids originates from its distal capsular attachment and appears to contribute minimally to the overall vascular scheme. The lateral attachments of the sesamoids to the plantar plate and joint capsule were relatively avascular. In two bipartite specimens examined, the major blood supply originated from the proximal and distal poles of the sesamoid. No vessels were observed entering the plantar surface of these specimens. The results of this study suggest that injury to the proximal or plantar aspects of the sesamoids could disrupt the vascular supply to these bones. These areas should, therefore, be avoided during the surgical approach to the sesamoids.
Great Toe Metatarsophalangeal Joint Arthrodesis: A User-Friendly Technique
Authors: Smith Ronald W. , Joanis Terry L. , Maxwell Phyllis D. 
Published: March 2013

Thirty-four feet (23 patients) were treated with a metatarsophalangeal (MP) joint fusion of the hallux using five threaded 0.062-in K wires for fixation. Operations were done for the following diagnoses: rheumatoid arthritis (26 procedures), hallux rigidus (1), salvage of previous bunionectomies (3), hallux valgus with absent toe, bilateral fusion (2), severe hallux valgus with chronic MP joint synovitis (1), and congenital hallux varus (1). The ages ranged from 17 to 73 years, with an average of 55 years. Follow-up was available on 31 of the fusions by questionnaire and telephone contact, with an average follow-up of 24 months and a minimum of 1 year. The successful arthrodesis rate was 97%. In 9% of the procedures (three cases), the patients were dissatisfied: This was due to pain under the first metatarsal head in two cases and to impingement between the first and second toes in a third case. In 91% of the fusions (29 of 32 patient responses), the patients stated that they would have the surgery if they had to choose again. Patients indicated “complete satisfaction” in 15 fusions and “satisfaction with reservations” in 14. Patients felt that their ability to wear desired shoes was improved in 48% of the procedures, was unchanged by the fusions in 26%, and was worse than before the operation in 26%. Based on this study and review of the literature, a recommendation is made for fusing the rheumatoid hallux with 25° to 30° of valgus and 10° of extension. In general, selection of toe position for fusion is based on reducing stress on the hallux interphalangeal joint and accommodating the position of the second toe. The multiple pin fixation technique gives a high incidence of fusion, it is easy to perform, and it is adaptable to the varying requirements for toe position.
Radiological Assessment of a Modified Anterior Drawer Test of the Ankle
Authors: Nyska M. , Amir H. , Porath A. , Dekel S. 
Published: March 2013

Chronic ankle instability is a common complication of ankle sprain. The clinical assessment of ankle instability is usually incomplete and difficult to interpret. Recently, more attention has been paid to the value of the anterior drawer test of the ankle. We assessed the accuracy of a modification of the anterior drawer test, comparing it with radiological stress view of the ankle in 25 patients with recurrent ankle sprain. The radiological examinations were performed by a TELOS instrument and included lateral and anteroposterior stress views. We found that the modified anterior drawer test correlated with the posterior opening of the tibiotalar joint and with the lateral tilt of the talus. We conclude that a slightly positive modified anterior drawer test may indicate injury to the anterior talofibular ligament. A significant movement of the ankle elicited by the modified anterior drawer test may indicate combined injury to anterior talofibular and calcaneofibular ligaments.
Treatment of Hallux Valgus by Oblique Osteotomy of the First Metatarsal
Authors: Mizuno Kosaku , Hashimura Masataka , Kimura Mayako , Hirohata Kazushi 
Published: March 2013

This paper describes a simple technique of oblique osteotomy of the first metatarsal for treatment of symptomatic hallux valgus deformity. The osteotomy is performed at a 30° angle from the long axis of the metatarsal shaft. The head of the metatarsal is then displaced laterally to provide correction of the hallux valgus. This is an uncomplicated procedure for the treatment of hallux valgus. From 1984 through 1989, 53 feet in 31 patients were treated with an oblique osteotomy of the first metatarsal. A total of 49 feet in 27 patients were followed up more than 2 years. The follow-up x-rays and clinical examinations revealed a good result in 43 feet. In six feet of three patients, all of whom had simultaneous oblique osteotomies of both the first and second metatarsals, a fair or poor result was obtained. It was learned that oblique osteotomy for hallux valgus greater than 40° provided insufficient correction of the valgus angle or limitation of motion at the metatarsophalangeal joint of the great toe.
Excision of Ununited Fractures of the Posterior Process of the Talus: A Treatment for Chronic Posterior Ankle Pain
Authors: Veazey Barry L. , Heckman James D. , Galindo Mayo J. , McGanity Peter L. J. 
Published: March 2013

The cases of nine patients with ununited fracture of the posterior process of the talus were reviewed. The most common mechanism of injury was forced plantarflexion. All patients had pain in the posterior ankle region. Common physical findings included tenderness between the lateral malleolus and the Achilles tendon and pain on forced plantarflexion. Of the radiographic imaging modalities used, 99Tc bone scan was found to be the most helpful in diagnosis. All nine patients eventually underwent surgical excision at a mean period of 9.4 months post injury. At average follow-up of 27 months after surgery (range 7–69 months), six of nine patients had good or excellent results with respect to pain relief and return to function. There were two complications of sural neuroma formation, one of which resulted in severe persistent pain after surgery. Based on these findings, we believe the differential diagnosis of chronic posttraumatic ankle pain should include fracture of the posterior process of the talus. Furthermore, excision of an ununited fragment through a lateral approach, taking care to preserve and protect the sural nerve, should lead to the return of painless function in the majority of cases.
The Validity of Measurements Made on Standard Foot Orthoroentgenograms
Authors: Perry Mark D. , Mont Michael A. , Einhorn Thomas A. , Waller John D. 
Published: March 2013

In certain clinical settings, standard x-rays may be misleading since they only provide two-dimensional representations of three-dimensional structures. After metatarsal osteotomy, the actual first metatarsal shortening may appear magnified on standard x-rays. We investigated variations in metatarsal and intermetatarsal angle (IMA) in a cadaver model and variations of first metatarsal length following in vivo Chevron osteotomies. For skeletal models, changing the foot arch from pes planus to pes cavus changed the first metatarsal length by as much as 19%, whereas the measured IMA remained relatively unchanged. Pronation of the first metatarsal was found to alter the IMA (decreased for planus, increased for cavus). In vivo studies revealed a 3.2-fold difference when actual metatarsal length change following chevron osteotomy was correlated to corrected x-ray change in length (9.5% versus 2.9% P ≤ .005). Previous investigators have evaluated hallux valgus deformities with emphasis on metatarsal lengths and IMAs to determine choices of procedure. 3 , 5 , 10 Based on the results of this study, treatment plans and further evaluation for forefoot surgery may be inaccurate if based solely on x-ray measurements.
Medial Deviation of the First Metatarsal Head as a Result of Flexion Forces in Hallux Valgus
Authors: Sanders Antal Petrus , Snijders Christiaan Johannes , van Linge Bert 
Published: March 2013

Several questions with regard to the hallux valgus complex, which includes metatarsus primus varus, give rise to discussion. How do bunions develop? Is disturbed muscle balance at the first metatarsophalangeal joint important in the pathogenesis of the hallux valgus complex? What is the relation between dynamic plantar load distribution and pain in the ball of the foot? What is the cause of recurrences of deformity after surgery? To answer these questions, we started with the bio-mechanical model of Snijders et al., 31 which states that contraction of flexor muscles of the hallux worsens its valgus angle and causes medial deviation of the first metatarsal head. The present study was designed to validate the model on patients. When pressing the hallux downward, simultaneously the force under the toe and the medial deviation of the first metatarsal head were measured on preoperative patients and on controls (35 subjects in all). We could demonstrate with statistical significance that (1) when the subjects with hallux valgus push the great toe on the ground, the first metatarsal head moved in medial direction; in other words the foot widened. In the controls, as an average, the foot became narrower. (2) The greater the valgus deviation of the hallux, the greater the effect of the toe flexors, and (3) the greater the valgus deviation of the hallux, the less maximal flexion force it can apply. Implications of these findings on conservative and surgical therapy are discussed. The recurrences of deformity after first metatarsal osteotomies are explained by the action of the hallux flexors. The stable result of arthrodesis of the first metatarsophalangeal joint is expected to be accompanied by narrowing of the foot as a result of contraction of the flexor muscles.
Transfer versus Lengthening of the Posterior Tibial Tendon in Duchenne's Muscular Dystrophy
Authors: Greene Walter B. 
Published: March 2013

Transfer of the posterior tibialis tendon to the dorsum of the foot was compared with lengthening of this tendon in 15 patients with Duchenne's muscular dystrophy. Patients undergoing tendon transfer ( N = 9) had a longer operating time and two perioperative complications, but retained plantigrade posture of their feet even after walking ceased. By contrast, lengthening of the posterior tibialis tendon (A/ = 6) was associated with a recurrent equinovarus foot deformity that frequently interfered with shoe wear. Although transfer of the posterior tibialis is out of phase and technically more demanding, the unique prolongation of posterior tibialis strength in Duchenne's muscular dystrophy makes this operation a better option for these patients.
Anatomic Study of Arthroscopic Portal Sites of the Ankle
Authors: Feiwell Lawrence A. , Frey Carol 
Published: March 2013

Numerous anatomic structures are at risk when performing ankle arthroscopy through the more commonly utilized portals. The purpose of this paper was to demonstrate the relative safety of each of the arthroscopic portal and Acufex external ankle distractor pin sites by measuring their proximity to the neurovascular structures surrounding the ankle joint. Six fresh cadaver specimens and 12 fresh-frozen, be-low-knee amputations were utilized for this study. An Acufex ankle distractor was applied using the standard technique. Anteromedial, anterolateral, anterocentral, posterolateral, and posteromedial portals were placed using an 11-blade scalpel to make 5-mm longitudinal incisions. The joint capsule was penetrated and a 3-mm arthroscope was placed into the ankle joint. The skin surrounding each of the portals was carefully removed and the proximity of any nerves or vessels was measured with respect to the arthroscope. At least one incidence of contact or penetration of a nerve or vessel was noted for each site. The anterocentral portal was at greatest risk for nerve or vessel damage. The anterolateral, anteromedial, and posterolateral portals were the safest areas for portal placement, with no penetration of neurovascular structures in any case.
Clinical Applications of a Pneumatic Intermittent Impulse Compression Device after Trauma and Major Surgery to the Foot and Ankle
Authors: Myerson Mark S. , Henderson Michael R. 
Published: March 2013

A prospective study was designed to evaluate the effect of a pneumatic intermittent impulse device in the treatment of postsurgical and posttraumatic swelling of the adult foot and ankle. Two groups of patients and their respective controls were studied. Group A consisted of 19 patients and 19 controls with acute swelling of the foot and ankle after major elective or posttraumatic surgery. Group B comprised 18 patients and 16 controls with chronic postsurgical or posttraumatic swelling. The pneumatic intermittent impulse device was used according to a predetermined daily regimen in both the control and experimental groups. The control patients were treated identically, except that their impulse device was modified to prevent effective compression. Reduction in swelling was measured by volumetric analysis with water displacement at selected intervals for each group. When compared with their respective controls, those patients who used an active impulse device had a statistically significant reduction in swelling. We conclude that this device is effective in the control of both acute and chronic swelling after trauma and surgery of the foot and ankle.