bluuebunny/crossref_metadata_2025_split huggingface dataset:
Shoes versus Sneakers in Toddler Ambulation
Authors: Gould Nathaniel 
Published: March 2013

The purpose of this study was to determine the relative values and differences between shoes and sneakers for young children just learning to walk. In phase 1 of the study, 79 toddlers (47 females and 32 males), ranging in age from 11 months to 3 years, were carefully measured for footwear. Only 15 toddlers (19%) could be properly fitted in the medium-width sneakers that are currently available on the market. The majority of the measured toddlers required widths greater than D, and to accommodate these wider feet, it was necessary to fit them with longer sneakers than they actually needed otherwise, thus making ambulation a bit more difficult and clumsy. In phase 2, eight toddlers, randomly selected except for sex (four male and four female), ranging in age from 11 to 16 months who had been ambulating 2 weeks to 5 months, were tagged with an identifying letter and videotaped in four walking situations: sneakers on tile, shoes on tile, sneakers on rugging, and shoes on rugging. Four hours of video taping was edited down to one-half hour. Twenty-three observers (orthopaedic surgeons, pediatricians, and shoe fitters) carefully reviewed the tape on multiple occasions and came to the following conclusions: better fit, stance, gait, cadence, and stability were noted with shoes in all the toddlers and in all situations. Falls were three times more frequent in sneakers as compared to shoes on tile surfaces and five times more frequent on rugging. It was concluded that the slight economic advantage of sneakers over shoes was not that great to warrant jeopardizing the capabilities of the toddler in the earliest stages of ambulation.
Fracture Dislocations of the Tarsometatarsal Joints: End Results Correlated with Pathology and Treatment
Authors: Myerson Mark S. , Fisher Robert T. , Burgess Andrew R. , Kenzora John E. 
Published: March 2013

Seventy-two patients with 76 fracture-dislocations of the Lisfranc tarsometatarsal joint complex were evaluated. Fifty-eight (81%) were polytrauma patients and the remainder suffered isolated injuries. Sixty of the original 72 patients were available for long-term study. Eight of these had an amputation at or shortly after the original admission, leaving 52 patients with 55 Lisfranc injuries for analysis. The average length of follow-up was 4.2 years (range, 20 months to 11 years). According to the Painful Foot Center scoring system, 27 feet (49%) achieved an excellent or good result and 28 (51%), a fair or poor result. Direct crush injuries did poorly with only one of eight scoring good or excellent. Of the various treatment modalities, open reduction and internal fixation with Kirschner wires yielded the best results. The major determinant of unacceptable results was identified as the quality of the initial reduction. Tarsal instability and late degenerative joint disease caused most of the symptoms. Twenty-three of the 52 patients (44%) have had or should have further mid-foot surgery to improve function and comfort. Because our results were often poor, our present protocol includes closed or open reduction and Kirschner wire internal fixation. Displacement greater than 2 mm or a talometatarsal angle greater than 15° on radiographs following a closed reduction mandates open reduction.
Common Forefoot Problems in Runners
Authors: Lillich James S. , Baxter Donald E. 
Published: March 2013

Forefoot injuries constitute a significant portion of the problems that affect runners. With the increasing popularity of recreational running, more emphasis on the treatment of specific running injuries has surfaced. For the orthopaedic surgeon interested in treating runners, a thorough understanding of foot anatomy, biomechanics, shoes, orthotics, running surfaces, and conservative and surgical treatment options is mandatory. Runners place high demands on their feet and therefore require careful evaluation prior to embarking on a specific treatment course. This article represents a current overview of common problems affecting the forefoot of recreational and world-class runners. Treatment plans are based on the senior author's experience in the care of runners over the past 14 years.
The Use of Footprint Contact Index II for Classification of Flat Feet in a Nigerian Population
Authors: Didia B C. , Omu E T. , Obuoforibo A A. 
Published: March 2013

The objective index as developed by Qaura, Deodhar, and Jit, in 1980 was used to estimate the incidence of flat foot (pes planus) in 990 school pupils (532 females and 458 males) between the ages of 5 and 14 years. The ratio of contact area to the total area of the middle of the footprint (contact index 1) (4/10), usually measured with a planimeter, is accepted as the true representative of the condition of arches. In this field study, contact index II (ratio of contact width to the total width of the foot) which is simple, reliable, and correlates with contact index I has been used to assess flat foot. The mean for the contact index and standard deviation have been calculated. Feet have been considered as normal up to 1 SD around the mean value of the index and values greater or lesser than this have been considered abnormal. Furthermore, mean ± 1 SD to 2 SD has been considered as possible flat foot, whereas mean ± 3 SD and above has been taken as definite flat foot. On the whole, bilateral flat foot is not common among children of school age in Port Harcourt (0.60%). It is, however, more common in females (0.75%) than males (0.44%). Unilateral flat foot (2.22%) is found to be more common than bilateral flat foot. Early introduction to the use of shoes may predispose to flat foot. We were not in a position to say if any of the subjects found with flat foot would have a painful foot. Clinically speaking it could become important when flat foot co-exists with painful feet or even with pain extending up to the vertebral column.
Triple Arthrodesis in Young Children: A Salvage Procedure After Failed Releases in Severely Affected Feet
Authors: Galindo Mayo J. , Siff Sherwin J. , Butler James E. , Cain Thomas E. 
Published: March 2013

A total of 19 triple arthrodeses were performed in 13 children aged 10 years or less for severe hindfoot deformities after failure of soft tissue releases. This was considered a salvage procedure and an alternative to talectomy. The average age at surgery was 8.4 years and average follow-up was 4 years. There were 68% excellent and good results, 16% fair, and 16% poor results. The nonunion rate was 7% of joints. Average shortening of the foot was 0.81 in but was not significant when compared with a group of clubfoot control patients. Except for one infection, fair and poor results were due to residual rather than recurrent deformity. Triple arthrodesis may be indicated in the young child for residual hindfoot deformity as an alternative to talectomy. The potential problems of increased nonunion, severe compromise of foot length, and recurrence of deformity were not observed in this series.
Selective Tarsal Arthrodesis: An in Vitro Analysis of the Effect on Foot Motion
Authors: Gellman Harris , Lenihan Michael , Halikis Nick , Botte Michael J. , Giordani Mauro , Perry Jacquelin 
Published: March 2013

Five different intertarsal arthrodeses were simulated in 15 fresh cadaver feet/ankles utilizing external fixation. Pin placement was verified radiographically. Range of motion measurements were performed before pin placement, after pin placement, and after simulated arthrodesis. The deficit in foot motion created by selected limited intertarsal fusions was then measured. The prearthrodesis range of motion measurements were found to be dorsiflexion (DF), 27°; plantarflexion (PF), 57°; total inversion (INVT), 29°; eversion total (EVT), 22°; hindfoot varus (VRH), 16°; hindfoot valgus (VLH), 12°. The deficits in motion after arthrodesis were as follows. Ankle (tibiotalar): DF, 50.7%; PF, 70.3%; INVT, 8.7%; EVT, 9.4%; VRH, 34.6%; VLH, 27.8%. Hindfoot arthrodesis (Tibiotalar calcaneal): DF, 53%; PF, 71.3%; INVT, 49.5%; EVT, 47.6%, VRH, 100%; VLH, 100%. Pantalar (Tibotalar calcanea cuboid navicular): DF, 62.8%; PF, 82.2%; INVT, 71.7%; EVT, 67.4%; VRH, 100%; VLH, 100%. Triple (Talocalcaneal cuboid navicular): DF, 12.5%; PF, 15.5%; INVT, 50%; EVT, 51.4%; VRH, 60.5%; VLH, 60.5%. Total tarsal arthrodesis: DF, 78.5%; PF, 90.2%, INVT, 87.5%; EVT, 83.6%; VRH, 100%; VLH, 100%.
Biomechanics of the Accessory Navicular Synchondrosis
Authors: Sella Enzo J. , Lawson Jack P. 
Published: March 2013

The accessory navicular is commonly considered an asymptomatic variant, but when traumatized, it can become the source of clinical symptoms. The accessory naviculars were divided into Types I, IIa and b, and III based on their appearance and location with relationship to their parent navicular. Only Type IIa and b accessory naviculars have a synchondrosis. The synchondrosis of Type IIa and b can undergo tension, shear, and compression forces causing avulsion or a painful pseudarthrosis to develop.
Calcaneal Fractures: Three-dimensional Treatment
Authors: Romash Michael M. 
Published: March 2013

A series of 22 calcaneal fractures operated over 4 yr is presented. Radiographic evaluation of these fractures using axial, lateral, anteroposterior, and oblique medial projection (Broden's view) with varying tube angulation toward the head and computerized axial tomography in two planes, coronal and transverse, were done. This repeatedly demonstrated intra-articular splitting fractures along the axis of the os calcis through the posterior facet, extending to the calcaneocuboid joint. These fractures were surgically reduced as described by McReynolds with sequential medial and lateral approaches. Intraoperative X-rays demonstrate the three-dimensional nature of this injury. Bohler's angle may be reconstituted with apparent reduction of the posterior facet when projected laterally; however, Broden's and axial views show persistent widening and split of the posterior facet. The 22 patients have been followed from 12 to 46 mo. All have heels of normal width and wear standard shoes. The first two cases, done only medially, have less than anatomic reconstruction of the subtalar joint. Functional results have been encouraging. Of six active duty members so treated, three returned to full duty, a second who was medically retired as a result of other injuries had minimal heel problems, and fifth had a contralateral open pilon fracture which hampers him, and the sixth patient is now 4 mo postbilateral calcaneal fractures with return to duty anticipated. Most of the 22 have some decrease in subtalar motion without apparent gait abnormality. No cases of medial or lateral impingement or tendinitis are present. Fractures of the calcaneus are amendable to open reduction and internal fixation. Sequential medial and anterolateral exposure allow anatomic reconstruction in three dimensions, avoiding pitfalls of two-dimensional analysis and treatment.
Atraumatic Avascular Necrosis of the Head of the Talus: A Case Report
Authors: Schmidt David M. , Romash Michael M. 
Published: March 2013

Avasular necrosis of the talus has frequently been reported following trauma. The incidence of avascular necrosis has been reported to be as high as 50% for Hawkins 8 Type II talar fractures and to range from 75–100% for Type III fracture-dislocations. 3 , 16 The resultant avascular necrosis has been reported to occur primarily in the body and dome of the talus with apparent sparing of the head of the talus. The close association of trauma to avascular necrosis of the talus has been alluded to by Cobey 3 and others. 10 , 12 , 14 , 17 Reports of avascular necrosis of the talus, without an antecedant history of trauma, have been rare. 13 This paper presents a case of atraumatic avascular necrosis of the talar head.
Review of the Girdlestone-Taylor Procedure for Clawtoes in Myelodysplasia
Authors: Cyphers Stephen M. , Feiwell Earl 
Published: March 2013

To clarify the role the flexor tendon to extensor hood transfer (Girdlestone-Taylor procedure) may have in correction of clawtoes in myelodysplasia, 20 patients with residual paralysis from myelomeningocele who underwent the procedure between 1976 and 1985 were reviewed. They were evaluated for the effectiveness of the procedure and occurrence of late deformities. A total of 25 feet with 65 toes were evaluated in patients ranging in age from 0.6 to 38.8 years. Results were classified as good if toes were straight, fair if mild deformity was present, and poor if definite clawing was noted. The overall results showed 60% good, 34% fair, and 6% poor results. Toes followed less than 24 months had more good results than those with longer follow-up. There was little difference in the results between great toes and lesser toes. No serious complications occurred. Our results indicate a sufficient level of success to utilize this method for correction of flexible claw toe deformities without resorting to bony procedures. We suggest this should be particularly useful in children.
The Mechanical Characteristics of the Collateral Ligaments of the Human Ankle Joint
Authors: Siegler Sorin , Block John , Schneck Carson D. 
Published: March 2013

In the present study, the tensile mechanical properties of all of the collateral ligaments of the human ankle joint were determined, in vitro, from tensile tests conducted on 120 ligaments obtained from 20 fresh lower limbs. The ultimate load of the lateral collateral ligaments increased in an anteroposterior sequence, with the anterior fibulotalar ligament less than the fibulocalcaneal ligament and less than the posterior fibulotalar ligament. For the medial collateral ligaments, the increasing order of ultimate load was found to be tibiocalcaneal ligament, tibionavicular ligament, tibiospring ligament, posterior tibiotalar ligament. The posterior tibiotalar ligament and tibiospring ligament, so frequently neglected in the anatomical and orthopaedic literature, demonstrated the highest yield force and ultimate load of all of the collateral ligaments of the ankle. Additionally, the tibiospring ligament showed high yield and ultimate elongation properties probably related to its distal attachment to the spring ligament. The fibulocalcaneal ligament was found to have high linear elastic modulus suggesting some type of unique material properties or internal fiber organization. Knowledge of the mechanical characteristics of the ligaments of the ankle joint contributes to an understanding of their normal function, pathomechanics of injury, and their optimal surgical reparative procedure and reconstructive material. A knowledge of the normal mechanical properties of the ankle ligaments provides a data base to evaluate which of the multiplicity of present tendon graft materials has mechanical properties similar to those of the ligaments to be replaced. Those tendon grafts will be the most suitable for replacement of specific ligaments. Finally, data on the mechanical properties of these ligaments offer the possibility for evaluating any future biological or prosthetic grafts.
Musculoskeletal Demands on Flamenco Dancers: A Clinical and Biomechanical Study
Authors: Bejjani F. J. , Halpern N. , Pio A. , Dominguez R. , Voloshin A. , Frankel V. H. 
Published: March 2013

The flamenco dancer acts on the floor like a drummer. The percussive footwork and vibration patterns created during dancing impose unusual demands on the musculoskeletal system. This study investigated the clinical and biomechanical aspects of this task. Using the electrodynogram and skin-mounted accelerometers, foot pressures as well as hip and knee vibrations were recorded in 10 female dancers after a thorough clinical evaluation. A health questionnaire was also distributed to 29 dancers. Foot pressures and acceleration data reveal the percussive nature of the dance. Some clinical findings, like calluses, are related to pressure distribution. Urogenital disorders, as well as back and neck pain, may be related to the vibrations generated by the flamenco dance form. The hip joint seems to absorb most of the impacts. “Vibration-pressure” diagrams are suggested as a useful tool for evaluating a dancer's biomechanical behavior, as well as the effect of floors and footwear on this behavior.
The Heel of Achilles: Calcaneal Avulsion Fracture from a Gunshot Wound
Authors: Cooper Daniel E. , Heckman James D. 
Published: March 2013

Greek mythology relates that the legendary warrior Achilles was made invincible by his mother Thetis, who dipped him in the River Styx while holding him by his heel. Because his heel was never immersed, it remained his one area of vulnerability. After the fall of Troy, Achilles met his demise when he was shot in the heel by Paris, whose arrow was guided by the Greek god Apollo. This is the derivation of the term “Achilles tendon.” Avulsion fractures of the tuberosity of the calcaneus are rare injuries. 1 , 2 , 3 , 6 , 7 , 12 Schonbauer 14 reviewed a series of 870,000 accident cases treated at the Vienna Trauma Hospital and found only four such cases in addition to 151 cases of subcutaneous Achilles tendon rupture. In Bohler's 4 series of 182 calcaneal fractures, avulsion of the calcaneal tuberosity accounted for less than 1% of these injuries. Rowe 13 reported four Achilles avulsion fractures in his series of 154 calcaneal fractures. Three basic mechanisms of injury have been described: (1) dorsiflexion violence against the maximally plantarflexed foot, typically occurring in a fall from a height; (2) powerful contraction of the triceps surae muscle with simultaneous extension of the knee such as when a person is about to sprint in a race; (3) a direct blunt blow to the hindfoot. 1 , 2 , 8 We are describing a case of avulsion of the calcaneal tuberosity due to direct penetrating trauma from a gunshot wound, a mechanism not previously reported.
Lateral Supporting Ligament of the Distal Phalanx
Authors: Winter William G. , Iwersen Lawrence J. , Johnson Eric D. 
Published: March 2013

A 49-year-old woman complained of 3 months of constant aching pain deep to the ingrown medial nail margin of her right hallux that was unaffected by shoe wear. Physical examination disclosed no purulence, discoloration, or obvious acute inflammation; an incurved medial nail plate was seen. There was mild chronic thickening of the medial nail fold. Tenderness was maximal 2 to 3 mm plantar to the medial edge of the nail. By roentgenogram ( Fig. 1 ), bony projections were seen arcing from the distal phalangeal tuft and the proximal metaphyseal flare toward each other. This was considered to be a “normal” radiological variant. A partial medial onychectomy and matricectomy (Winograd procedure) was performed. Further dissection 1 to 2 mm deeper along the medial phalangeal border revealed a 1-mm wide longitudinal ligament extending from the phalangeal distal tuft to the proximal metaphyseal flare. Bony projections and ligament were excised. The wound healed satisfactorily, and symptoms ceased.
Laser Use in Foot Surgery
Authors: Bennett Gordon L. 
Published: March 2013

Laser is an acronym for Light Amplification by the Stimulated Emission of Radiation. Laser surgery is rapidly gaining the interest of both the medical practitioner and the general public. Since the first reported use of laser surgery in podiatry in 1980, 23 a large number of laser surgery centers for treatment of foot and ankle disorders have appeared throughout the country. A relative paucity of literature exists about applications of lasers in foot and ankle surgery, and orthopaedic surgery as a whole. This is further compounded by the fact that very few of the existing studies are scientifically significant, either due to inadequate numbers, questionable study design, or a combination of these factors. At the present time, it appears that the only worthwhile application of lasers in foot and ankle surgery is for the treatment of plantar warts that are resistant to more conventional methods of treatment. As more well-controlled studies on the applications of lasers become available, the future of lasers in foot and ankle surgery will become more apparent. The purpose of this study is to present a summary of the use of lasers in orthopaedic foot and ankle surgery. The current clinical applications will be presented, followed by an overview of basic laser physics, laser characteristics and effects on tissue, and laser safety. Because of the growing interest in laser surgery by the medical profession, and the increasing public awareness of this relatively new and exciting technology, it is important that orthopaedic surgeons have a good understanding of laser surgery.
Elongation and Forces of Ankle Ligaments in a Physiological Range of Motion
Authors: Nigg B. M. , Skarvan G. , Frank C. B. , Yeadon M. R. 
Published: March 2013

The purposes of this study were: (1) to measure the distances between the insertion sites of selected ankle ligament fibers, (2) to measure the force-elongation characteristics of isolated bone-ligament-bone preparations, and (3) to relate the force measurements to angular positions of the ankle. The findings can be used to discuss clinically the correlation between possible ligament injuries and associated foot movement. Three fresh cadaveric ankles were dissected to expose the anterior talofibular ligament, the calcaneofibular ligament, and the superficial deltoid ligament. The ankles were first mounted on a fixture, and insertion to insertion distances of the ligament fibers were measured for selected positions of the ankle/subtalar joint. Bone-ligament-bone preparations were then removed, returned to their anatomical length and uniaxial force-extension testing was performed. The forces in each ligament were recorded for distances corresponding to those measured in situ for various ankle positions. These results allowed: (1) estimation of the forces in these three ligaments in various ankle positions, (2) identification of positions where ligaments were carrying no force, and (3) identification of positions where they carry large forces. The clinical analysis reveals that the anterior talofibular ligament is sensitive to excessive plantarflexion or dorsiflexion, the calcaneofibular ligament is sensitive to excessive inversion or eversion as well as dorsiflexion or plantarflexion, and that the deltoid ligament appears to be sensitive to plantarflexion, external rotation, and eversion. The fact that all three ligaments tested demonstrated different ranges of tension supports the view that there are optimal positions for testing ankle ligament integrity.
Pseudoaneurysm of the Dorsalis Pedis Artery After Lisfranc Amputation
Authors: Lieberman Jay R. , Goldstock Leonard E. , Jacobs Richard L. 
Published: March 2013

Pseudoaneurysm formation is usually associated with laceration, fracture, or iatrogenic arterial injury. 2 However, it may also develop as a result of blunt trauma. 5 We report the case of a pseudoaneurysm of the dorsalis pedis artery after a Lisfranc amputation in an individual with diabetes mellitus, Charcot joint changes in the left forefoot, and atherosclerosis of the distal vessels.