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Foot & Ankle International    [8 followers]  Follow    
  Hybrid Journal Hybrid journal (It can contain Open Access articles)
     ISSN (Print) 1071-1007
     Published by Sage Publications Homepage  [718 journals]   [SJR: 1.021]   [H-I: 62]
  • Platelet-Rich Plasma Efficacy Versus Corticosteroid Injection Treatment
           for Chronic Severe Plantar Fasciitis
    • Authors: Monto; R. R.
      Pages: 313 - 318
      Abstract: Background: Chronic plantar fasciitis is a common orthopedic condition that can prove difficult to successfully treat. In this study, autologous platelet-rich plasma (PRP), a concentrated bioactive blood component rich in cytokines and growth factors, was compared to traditional cortisone injection in the treatment of chronic cases of plantar fasciitis resistant to traditional nonoperative management. Methods: Forty patients (23 females and 17 males) with unilateral chronic plantar fasciitis that did not respond to a minimum of 4 months of standardized traditional nonoperative treatment modalities were prospectively randomized and treated with either a single ultrasound guided injection of 3 cc PRP or 40 mg DepoMedrol cortisone. American Orthopedic Foot and Ankle Society (AOFAS) hindfoot scoring was completed for all patients immediately prior to PRP or cortisone injection (pretreatment = time 0) and at 3, 6, 12, and 24 months following injection treatment. Baseline pretreatment radiographs and MRI studies were obtained in all cases to confirm the diagnosis of plantar fasciitis. Results: The cortisone group had a pretreatment average AOFAS score of 52, which initially improved to 81 at 3 months posttreatment but decreased to 74 at 6 months, then dropped to near baseline levels of 58 at 12 months, and continued to decline to a final score of 56 at 24 months. In contrast, the PRP group started with an average pretreatment AOFAS score of 37, which increased to 95 at 3 months, remained elevated at 94 at 6 and 12 months, and had a final score of 92 at 24 months. Conclusions: PRP was more effective and durable than cortisone injection for the treatment of chronic recalcitrant cases of plantar fasciitis. Level of Evidence: Level I, prospective randomized comparative series.
      PubDate: 2014-03-31T17:52:32-07:00
      DOI: 10.1177/1071100713519778|hwp:master-id:spfai;1071100713519778
      Issue No: Vol. 35, No. 4 (2014)
  • Prospective Study of Hammertoe Correction With an Intramedullary Implant
    • Authors: Catena, F; Doty, J. F, Jastifer, J, Coughlin, M. J, Stevens, F.
      Pages: 319 - 325
      Abstract: Background: Operative correction of a hammertoe deformity is often accomplished by excision of the articular surface of the proximal interphalangeal joint (PIP) and fixation across the joint. This study aimed to prospectively evaluate clinical and radiographic outcomes of hammertoe operative correction utilizing an internal implant and assess its ability to maintain postoperative alignment. Methods: Twenty-nine patients (53 toes) with a painful rigid hammertoe deformity were prospectively enrolled and operatively treated with resection arthroplasty of the PIP joint and fixation with an implant. Five patients were lost to follow-up, and 24 patients (42 toes) returned at an average of 12 months for final clinical and radiographic evaluation. All patients were evaluated pre- and postoperatively by AOFAS and Visual Analog Pain Scale (VAS) scores. On physical exam, the location and magnitude of the deformity, callosities, and digit circumference were recorded. Radiological parameters evaluated were digital alignment, successful union, implant position, and bone reaction. Results: All patients reported satisfaction at final follow-up, with an average improvement of AOFAS score from 52 (range, 24-87 points) to 71 (range, 42-95 points) points. The mean VAS pain score improved from 5 points (range, 2 to 10) preoperatively to 1 point (range, 0 to 5) postoperatively. Of patients, 87% reported an ability to return to their preoperative activities without limitations. Regarding digital alignment, there were no recurrent deformities or transverse plane deformities; 1 toe presented with a minor digital rotational deformity at final follow-up. Postoperative radiographs indicated 100% of proximal interphalangeal (PIP) joints with good alignment, and 81% demonstrated bony union. Conclusion: Our results suggest that utilization of an internal implant for hammertoe correction was safe and provided acceptable alignment, pain reduction, and improved function at final follow-up. Level of Evidence: Level IV, case series.
      PubDate: 2014-03-31T17:52:32-07:00
      DOI: 10.1177/1071100713519780|hwp:master-id:spfai;1071100713519780
      Issue No: Vol. 35, No. 4 (2014)
  • Comparison of the Short-Term Results of the First and Last 50 Scandinavian
           Total Ankle Replacements: Assessment of the Learning Curve in a
           Consecutive Series
    • Authors: Schimmel, J. J. P; Walschot, L. H. B, Louwerens, J. W. K.
      Pages: 326 - 333
      Abstract: Background: Total ankle replacement (TAR) is presently considered to be an acceptable alternative to ankle fusion for patients with debilitating conditions of the ankle. The placing of a total ankle prosthesis is a technically demanding procedure. We hypothesized that the challenging conditions could cause a longer learning curve (>30 cases), and therefore the short-term results of the first and the last 50 cases in a consecutive series of 134 cases were compared. Methods: The first and last consecutive 50 cases by a single surgeon in a series of 134 Scandinavian Total Ankle Replacements (STAR; Waldemar Link, Hamburg, Germany), inserted between May 1999 and May 2008, were evaluated. Operation characteristics, clinical outcome (Foot Function Index [FFI], Kofoed score), complications, and the component alignment on X-rays were assessed. The outcome measures for both groups were compared using independent Student t tests, chi-square tests, and nonparametric alternatives (P < .05). Results: Surgery time decreased from a median of 125 (83-160) to 100 (65-170) minutes (P < .001), and fewer perioperative complications were observed (12 vs 4, P = .04). The sagittal alignment of the tibial component was closer to normal in the last series (P < .001). The clinical outcome did not differ between the 2 series (median FFI: 32 [0-74] vs 25 [0-75], Kofoed score: median 71 [21-96] vs 80.5 [23-100]). The major underlying pathology did change from rheumatoid arthritis (60%) to osteoarthritis (44%; P = .002). No differences in type and number of complications were reported. Conclusion: The surgery time did decrease, there were fewer perioperative fractures, and the tibial component orientation improved, suggesting the presence of a learning curve. Operative experience and a shift in major underlying pathology did not influence clinical outcome. In view of this learning curve we suggest more restrictive patient selection for at least the first 50 TARs. Level of Evidence: Level III, comparative series.
      PubDate: 2014-03-31T17:52:32-07:00
      DOI: 10.1177/1071100713518187|hwp:master-id:spfai;1071100713518187
      Issue No: Vol. 35, No. 4 (2014)
  • Economic Burden of Foot and Ankle Surgery in the US Medicare Population
    • Authors: Belatti, D. A; Phisitkul, P.
      Pages: 334 - 340
      Abstract: Background: Musculoskeletal diseases affecting the foot and ankle are common and can result in debilitating pain and chronic disability. The purpose of this study was to estimate the economic burden associated with operative interventions targeting these afflictions in the Medicare population. Methods: Procedure incidence was determined using data from Medicare Part B National Summary Data Files (for 2000-2011). Health care and productivity costs were estimated for each year using an incidence-based cost model, using demographic information from 10 633 patient encounters at the University of Iowa Hospitals and Clinics over the period January 1, 2000, to December 31, 2010. Results: The estimated economic burden of foot and ankle surgery in the Medicare population was $11 billion in 2011, up 38.2% since 2000. Direct health care costs were responsible for only 11% of this total, while indirect productivity costs contributed the remainder. Procedures targeting the foot accounted for over two-thirds of total economic burden, or $7.6 billion. Treatments for fracture and dislocation contributed the most to overall economic burden (31.0% of total), followed by reconstructive procedures (30.7%) and amputations (13.3%). Conclusion: Even in an older population, considerable productivity losses are associated with foot and ankle surgery. An increasing share of the population older than 65 expects to be fit to work, making disability in older Americans more monetarily important. At the same time, trends in chronic disease mean that the incidence of foot and ankle problems is likely to increase in the Medicare population. Level of Evidence: Level III, economic analysis.
      PubDate: 2014-03-31T17:52:32-07:00
      DOI: 10.1177/1071100713519777|hwp:master-id:spfai;1071100713519777
      Issue No: Vol. 35, No. 4 (2014)
  • Viability of Talus Osteochondral Defect Cartilage for Chondrocyte
           Harvesting: Results of 151 Patients
    • Authors: Kreulen, C; Giza, E, Kim, J, Campanelli, V, Sullivan, M.
      Pages: 341 - 345
      Abstract: Background: Large talar cartilage defects can be treated with either autologous chondrocyte implantation or matrix autologous chondrocyte implantation. Both techniques depend on successful harvesting of the chondrocytes. In the past, they have come from the ipsilateral knee, which has been associated with donor site morbidity. We hypothesized that damaged cartilage from the talus can be used as a reliable source for chondrocyte cell harvesting in preparation for possible matrix-induced autologous chondrocyte implantation (MACI). Methods: Chondrocytes were harvested from the injured talar cartilage during ankle arthroscopy and sent to a cell laboratory, measured for initial biopsy weight, cultured for 4 to 6 weeks, and then analyzed for viability. A total of 151 patients were analyzed. Results: The average biopsy initial weight was 187.1 mg. The average number of cells was 3.13 x 105. The viability of the chondrocytes provided by the manufacturer averaged 92.3% (range, 33%-100%). Conclusions: Chondrocytes harvested from the damaged talar articular cartilage were functional and proliferated with an average viability of 92%. Clinical Relevance: This technique may provide a useful source of chondrocytes if needed for a future cell-based regenerative procedure such as MACI while eliminating the need to harvest chondrocytes from the knee or other intact areas of cartilage on the talus. Level of Evidence: Level IV, case series.
      PubDate: 2014-03-31T17:52:32-07:00
      DOI: 10.1177/1071100714523272|hwp:master-id:spfai;1071100714523272
      Issue No: Vol. 35, No. 4 (2014)
  • Peroneus Longus Tears Associated With Pathology of the Os Peroneum
    • Authors: Stockton, K. G; Brodsky, J. W.
      Pages: 346 - 352
      Abstract: Background: There is a range of different types of tears and pathology of the peroneal tendons. One of the least common types is the tear of the peroneus longus associated with fracture, enlargement, or entrapment at the cuboid tunnel of the os peroneum. The purpose of this study was to evaluate the pathologic patterns of these uncommon peroneal tendon tears, to review the treatment, and to report the patient outcomes following treatment with excision of the os peroneum, debridement, and tenodesis of the peroneus longus to the peroneus brevis. Methods: A 5-year retrospective review of all patients with peroneal tendon tears identified 12 patients operatively treated for peroneus longus tendon tears with associated pathology of the os peroneum, and in whom there was a viable peroneus brevis. All patients were treated with an operative procedure consisting of excision of the os peroneum, debridement, and tenodesis of the peroneus longus to the peroneus brevis. Mean age was 51.5 (range, 33 to 73) years, including 7 males and 5 females. Operative and radiographic records were reviewed to characterize the nature of the peroneus longus tears and associated pathology. Preoperative and postoperative AOFAS hindfoot, SF-36 questionnaires, and Visual Analog Scale (VAS) pain scores were compiled and patient records were reviewed for complications. Mean follow-up after surgery was 63.3 (range, 12 to 114) months. Results: All of the patients had an os peroneum associated with a complex, irreparable tear of the peroneus longus tendon. The peroneus longus was typically enlarged, fibrotic, and adhered to the surrounding tissues. In 8 patients, the peroneus longus tendon tear was associated with a fracture of the os peroneum, and in 4 patients with an enlarged and entrapped os peroneum which prevented movement at the cuboid tunnel. Of the 12 patients, 9 had partial tears of the peroneus brevis, which were treated with debridement and suture repair. AOFAS hindfoot scores increased from a preoperative mean of 61 (range, 46 to 75) to a postoperative mean of 91.7 (range, 60 to 100). Mean preoperative SF-36 Physical Component Scores (PCS) increased from 36 to 52 postoperatively. Mean VAS pain scores decreased from a preoperative mean of 6.3 (range, 4 to 8) to a postoperative mean of 1.0 (range, 0 to 4). Complications included 2 patients with sural neuritis and 3 with superficial delayed wound healing successfully treated nonoperatively. Conclusion: Tears of the distal peroneus longus tendon, which are much less commonly reported than tears of the peroneus brevis, can be associated with pathology of the os peroneum. Excision of the os peroneum, tendon debridement, and tenodesis of the longus to brevis was an effective surgical technique. Level of Evidence: Level IV, case series.
      PubDate: 2014-03-31T17:52:32-07:00
      DOI: 10.1177/1071100714522026|hwp:master-id:spfai;1071100714522026
      Issue No: Vol. 35, No. 4 (2014)
  • Comparison of Clinical Outcome of Pronation External Rotation versus
           Supination External Rotation Ankle Fractures
    • Authors: Schottel, P. C; Berkes, M. B, Little, M. T. M, Garner, M. R, Fabricant, P. D, Lazaro, L. E, Helfet, D. L, Lorich, D. G.
      Pages: 353 - 359
      Abstract: Background: A pronation external rotation (PER) ankle fracture is a relatively uncommon injury. The purpose of this study was to examine the immediate and short-term clinical outcomes of operatively treated PER IV ankle fractures and compare them with a similarly treated cohort of supination external rotation IV (SER IV) fractures. Methods: 22 PER IV and 108 SER IV fractures were identified from a single surgeon’s prospectively collected database from 2004 to 2010. All patients were treated with fracture fragment and ligament specific fixation during the same time period by the same surgeon. Postoperative radiographs and bilateral ankle computed tomography (CT) scans were reviewed for articular incongruity, syndesmotic malreduction, and loss of reduction. Clinical outcome measures, including the Foot and Ankle Outcome Score (FAOS) and ankle range of motion (ROM), were collected at latest follow-up visit. Results: There was no difference in the rate of wound complications, fracture nonunion, or loss of reduction between the PER IV and SER IV groups. There was no significant difference in the incidence of postoperative articular incongruity (19% vs 8%, P = .23); however, the PER IV cohort was found to have a significantly higher rate of syndesmotic malreduction (40% vs 18%, P = .04). No clinically or statistically significant differences were detected between the 2 groups in regard to all FAOS domains. Conclusion: In a cohort of operatively treated PER IV fractures, fracture fragment and ligament specific fixation resulted in good short-term outcomes that were comparable to those seen in similarly treated patients with an SER IV fracture pattern. However, a notably greater number of syndesmotic malreductions were noted in the PER IV cohort, and therefore heightened scrutiny is recommended in treating this particular injury pattern. Level of Evidence: Level III, retrospective comparative study.
      PubDate: 2014-03-31T17:52:32-07:00
      DOI: 10.1177/1071100714520694|hwp:master-id:spfai;1071100714520694
      Issue No: Vol. 35, No. 4 (2014)
  • Surgical Correction of Severe Deformity of the Ankle and Hindfoot by
           Arthrodesis Using a Compressing Retrograde Intramedullary Nail
    • Authors: Brodsky, J. W; Verschae, G, Tenenbaum, S.
      Pages: 360 - 367
      Abstract: Background: Tibiotalocalcaneal arthrodesis with a retrograde intramedullary nail is a widely used surgical technique for the treatment of concomitant tibiotalar and subtalar arthritis and correction of accompanying deformity. This study was undertaken to evaluate the union rate, deformity correction, and clinical outcomes achieved using a compressing retrograde intramedullary nail. Methods: Thirty tibiotalocalcaneal arthrodeses with an osseous compressing arthrodesis nail system were studied with a mean follow-up of 26 months. Radiographic data were collected on deformity correction and union rate, and clinical outcomes were evaluated using the Visual Analogue Scale (VAS) for pain, the American Orthopaedic Foot & Ankle Society (AOFAS) Ankle/Hindfoot Score, and the Short Form-36 (SF-36) health survey. Records were reviewed for complications and concomitant procedures. Results: Thirteen of 30 operated limbs had a preoperative coronal plane deformity exceeding 15 degrees. Mean magnitude of correction was 13.2 degrees (range, 0-32 degrees, standard deviation ±9.6). In total, 76% of limbs (23/30) had postoperative coronal deformity of less than 5 degrees. Union was achieved in 96.6% of patients. There were 3 cases of tibial stress reaction, 3 cases of transient plantar nerve irritation, and 3 cases of wound infection. Clinical outcomes demonstrated a reduction in mean VAS score from 6.5 to 1.3 (P < .01), an increase in mean AOFAS Ankle/Hindfoot Scores from 29.7 to 74.3 (P < .01), and an increase in mean total SF-36 scores from 85.6 to 98.8 (P < .01). Conclusion: A compressing retrograde intramedullary nail was effective in achieving deformity correction, a high union rate, and improvement in clinical outcomes. Level of Evidence: Level IV, retrospective case series.
      PubDate: 2014-03-31T17:52:32-07:00
      DOI: 10.1177/1071100714523270|hwp:master-id:spfai;1071100714523270
      Issue No: Vol. 35, No. 4 (2014)
  • Proximal Reverse Chevron Metatarsal Osteotomy, Lateral Soft Tissue
           Release, and Akin Osteotomy Through a Single Medial Incision for Hallux
    • Authors: Jung, H.-G; Kim, T.-H, Park, J.-T, Shin, M.-H, Lee, S.-H.
      Pages: 368 - 373
      Abstract: Background: Scarring on the dorsal first web space after lateral soft tissue release can be a major contributor to patient dissatisfaction following hallux valgus surgery. We hypothesized that performing distal soft tissue procedure (DSTP), proximal reverse chevron metatarsal osteotomy (PCMO), and Akin osteotomy through a single medial incision would provide better clinical and radiographic results with improved patient satisfaction compared with bunion corrections performed through 2 incisions. Methods: The study included 117 feet (of 98 patients) with moderate to severe hallux valgus. Clinically, the preoperative and final follow-up visual analog scale (VAS) pain scores, the preoperative and final follow-up American Orthopaedic Foot & Ankle Society (AOFAS) hallux metatarsophalangeal (MTP)-interphalangeal (IP) scores, first MTP joint range of motion (ROM), and patient satisfaction after the surgery were evaluated. Radiographically, the hallux valgus angle (HVA), intermetatarsal angle (IMA), hallux valgus interphalangeal angle (HIA), medial sesamoid position (MSP), and first to fifth metatarsal width (1-5MTW) were analyzed before and after surgery. Results: The mean AOFAS hallux score improved from 56.3 preoperatively to 90.6 at the final follow-up, and the mean VAS pain score decreased from 6.8 preoperatively to 1.5 at the final follow-up (P
      PubDate: 2014-03-31T17:52:32-07:00
      DOI: 10.1177/1071100713517099|hwp:master-id:spfai;1071100713517099
      Issue No: Vol. 35, No. 4 (2014)
  • A Comparative Study of Clinicopathological Features Between Simple Bone
           Cysts of the Calcaneus and the Long Bone
    • Authors: Takada, J; Hoshi, M, Oebisu, N, Ieguchi, M, Kakehashi, A, Wanibuchi, H, Nakamura, H.
      Pages: 374 - 382
      Abstract: Background: The potential unrevealed clinicopathological differences between simple bone cysts situated in the calcaneus (calcaneal bone cysts) and those situated in long bones (long bone cysts) were investigated in the present study. Methods: A total of 41 cysts from 41 patients who underwent operative treatment were evaluated: 16 cysts in the calcaneus, 17 in the humerus, 7 in the femur, and 1 in the tibia. The clinical course, radiological findings, and histological features were retrospectively reviewed. Results: The mean patient age was 11.5 years (range, 3 to 25 years), and the mean follow-up was 33.0 months (range, 12 to 77 months). The mean patient age was significantly higher in patients with calcaneal bone cysts (13.5 years; long bone cysts, 10.2 years, P < .05). No treatment failure was seen for patients with calcaneal bone cysts, while 7 long bone cysts required reoperation. In H&E-stained specimens of the cyst wall, cholesterol clefts were identified in 10 of the 16 calcaneal bone cysts (62.5%), whereas none were identified in long bone cysts (0%; P < .0001). Conclusion: Our study elucidates the different clinicopathological features existing between calcaneal bone cysts and long bone cysts. Cholesterol clefting is most likely due to hemorrhaging and the subsequent breakdown of blood in the cyst. The significance of these differences between long bone and calcaneal cysts is still open to conjecture. Level of Evidence: Level III, retrospective comparative series.
      PubDate: 2014-03-31T17:52:32-07:00
      DOI: 10.1177/1071100713519600|hwp:master-id:spfai;1071100713519600
      Issue No: Vol. 35, No. 4 (2014)
  • The Effect of Medial and Lateral Calcaneal Osteotomies on the Tarsal
    • Authors: Bruce, B. G; Bariteau, J. T, Evangelista, P. E, Arcuri, D, Sandusky, M, DiGiovanni, C. W.
      Pages: 383 - 388
      Abstract: Background: As an entrapment phenomenon, tarsal tunnel syndrome has been described after calcaneal osteotomy, and since the tibial nerve has also been shown to be very sensitive to ankle position, position of the calcaneus after osteotomy and displacement was thought to likely influence the environment of the tibial nerve within the tarsal canal. The respective volume of the tarsal canal was therefore hypothesized to decrease with medial or lateral displacement osteotomies of the calcaneus. Methods: Anterior and posterior calcaneal osteotomies were made in cadaveric matched pairs and brought through sequential medial and lateral displacements. Magnetic resonance imaging was used to estimate the comparative resultant volume of the tarsal canal after each of these new positions were assumed, as compared with baseline. The proximity of the osteotomy cut to the nerve’s location was also measured. Results: The tarsal tunnel volume was calculated for all 5 displacement states and were as follows: far-lateral (9506 mm3), near-lateral (10 073 mm3), normal (11 839 mm3), near-medial (11 489 mm3), and far-medial (11 760 mm3). No significant difference in tarsal tunnel volume was identified between the normal, nondisplaced specimens in the anterior or posterior groups (11 954 mm3 vs 11 809 mm3). No difference in tarsal tunnel volume was identified between the anterior and posterior osteotomies at any of the 4 displacements. The distance from tibial nerve to the medial exit site of the osteotomy was found to be significantly less in the anterior group compared to the posterior group (4 mm vs 14.2 mm, P < .0001). Conclusion: Lateral, but not medial, osteotomy fragment displacement results in significant reduction of tarsal tunnel volume. The location of the cut does not seem to affect any substantive change in volume. Anteriorly placed osteotomies appear to jeopardize the neurovascular structures more than posteriorly placed osteotomies. Clinical Relevance: These findings provide surgeons with clinical evidence in support of performing a prophylactic tarsal tunnel release for patients undergoing lateralizing calcaneal osteotomies.
      PubDate: 2014-03-31T17:52:32-07:00
      DOI: 10.1177/1071100713519599|hwp:master-id:spfai;1071100713519599
      Issue No: Vol. 35, No. 4 (2014)
  • Comparison of Radiographic and Anatomic Distal Metatarsal Articular Angle
           in Cadaver Feet
    • Authors: Jastifer, J. R; Coughlin, M. J, Schutt, S, Hirose, C, Kennedy, M, Grebing, B, Smith, B, Cooper, T, Golano, P, Viladot, R, Doty, J. F.
      Pages: 389 - 393
      Abstract: Background: A few studies report correlations between radiographic and anatomic measurements of the distal metatarsal articular angle (DMAA). However, little is known about how the DMAA correlates with the hallux valgus angle (HVA) and with anatomic and clinical radiographic measurements. Methods: We dissected, measured, and radiographed 39 cadaveric feet for evidence of hallux valgus and the DMAA. We then correlated these values with paired clinical radiographic measurements made by physician evaluators. Results: Physician measurement of DMAA and anatomic measurement of DMAA were significantly correlated with a mean r = 0.64 (evaluator range, 0.44-0.66). Pairwise correlation between physician evaluators ranged from r = 0.63 to 0.84. Sixty-six percent of physician-measured DMAAs were within 5 degrees of anatomic DMAA. Conclusion: The percentage of radiographic DMAAs that were within 5 degrees of anatomic DMAAs was only 66%. Additionally, the DMAA was increased in the specimens with moderate and severe hallux valgus compared with those with normal or mild hallux valgus angles. Clinical Relevance: The DMAA is an important consideration in patients with hallux valgus. While it is less reliable than other radiographic measures, it was correlated to deformity severity in specimen with hallux valgus.
      PubDate: 2014-03-31T17:52:32-07:00
      DOI: 10.1177/1071100714522027|hwp:master-id:spfai;1071100714522027
      Issue No: Vol. 35, No. 4 (2014)
  • Intraosseous and Extraosseous Blood Supply to the Medial Cuneiform:
           Implications for Dorsal Opening Wedge Plantarflexion Osteotomy
    • Authors: Kraus, J. C; McKeon, K. E, Johnson, J. E, McCormick, J. J, Klein, S. E.
      Pages: 394 - 400
      Abstract: Background: Osteotomies of the medial cuneiform are commonly used to correct forefoot deformity. Bone healing occurs despite periosteal stripping of the dorsal and medial surfaces of this widely articulated bone followed by osteotomy in the midsection of the bone. The objective of this study was to characterize the blood supply of the medial cuneiform. Methods: Thirty matched pairs of adult cadaver legs, 60 legs total, were amputated below the knee, and arterial casts were created with India ink and latex. Soft tissues were debrided, allowing visualization of the extraosseous blood vessels. In 53 specimens the vascular supply to the medial cuneiform was photographed and recorded. Forty-nine specimens were then cleared using a modified Spälteholz technique. The intraosseous vascularity of the medial cuneiform was successfully characterized and reviewed in 48 of these specimens. Results: The extraosseous blood supply was similar to previous reports with a middle pedicle branch originating from the dorsalis pedis artery. The medial plantar and superficial medial plantar artery supplied the plantar aspect of the bone. Intraosseous analysis showed a dense capillary network throughout the cuneiform, with typically one central medial major and several minor nutrient arteries noted. Areas of hypovascularity were infrequent and when noted occurred at inconsistent locations. Conclusion: These findings support the clinical suspicion that the medial cuneiform is well vascularized from multiple sources. The plantar blood supply is likely sufficient to allow bone healing after dorsal periosteal exposure and possible injury to the middle pedicle branch of the distal medial tarsal artery. Clinical Relevance: A medial cuneiform opening wedge osteotomy can be used to correct forefoot deformity. This study investigates the blood supply to that bone to better characterize the healing potential of the medial cuneiform.
      PubDate: 2014-03-31T17:52:32-07:00
      DOI: 10.1177/1071100713518505|hwp:master-id:spfai;1071100713518505
      Issue No: Vol. 35, No. 4 (2014)
  • Stabilization of Proximal Interphalangeal Joint in Lesser Toe Deformities
           With an Angulated Intramedullary Implant
    • Authors: Coillard, J.-Y; Petri, G. J, van Damme, G, Deprez, P, Laffenetre, O.
      Pages: 401 - 407
      Abstract: Background: Hammertoe and claw toe are among the most common foot deformities. Proximal interphalangeal (PIP) joint realignment can be performed using specifically designed intramedullary implants. The aim of this study was to assess the clinical outcome of patients with lesser toes deformities undergoing PIP joint realignment using an intramedullary implant. Methods: Patients requiring PIP joint realignment were included in this prospective multicenter observational study and followed for 12 months. A total of 156 toes, in 117 patients were implanted with the implants. Complications and radiological and functional outcome were assessed. Results: The proportion of joints fused on X-rays was 83.8% (95% CI: 77.8, 89.7) after 1 year. American Orthopaedic Foot and Ankle Society lesser metatarsophalangeal-interphalangeal scale (AOFAS-LMIS) improved from 40.4 (SD = 18.3) preoperatively to 85.5 (SD = 9.2) after 1 year. The proportion of patients with pain was 15.5% after 6 weeks and decreased to 4.7% after 1 year. Of the patients, 98% were satisfied about the operation. In patients with incomplete fusion of the PIP joint after 1 year, AOFAS-LMIS improved from 36.7 (SD = 18.9) preoperatively to 84.2 (SD = 10.1) 1 year postoperatively, while pain was reported by 2 patients (8.3%) after 1 year. Toe malalignment and lack of toe pulp-contact were reported slightly more frequently than for the whole group of patients, but not for the majority of the cases. Overall, complications were reported intraoperatively in 1.3% of the patients (2 cases) and postoperatively in 3.2% (5 cases). Revision was required in 1 case. Mallet toe deformity was found in 2.0% of the patients after 1 year. Conclusion: This study showed that the use of an intramedullary implant for PIP realignment led to a high rate of fusion and a good outcome. No need of reoperation was reported for patients with incomplete joint fusion who had a stable joint with no pain. Level of Evidence: Level IV, prospective case series.
      PubDate: 2014-03-31T17:52:32-07:00
      DOI: 10.1177/1071100713519601|hwp:master-id:spfai;1071100713519601
      Issue No: Vol. 35, No. 4 (2014)
  • Percutaneous Osteotomy for Irreducible or Malunited Tongue-type Calcaneus
    • Authors: Heng, M; Kwon, J. Y.
      Pages: 408 - 414
      PubDate: 2014-03-31T17:52:32-07:00
      DOI: 10.1177/1071100713517874|hwp:master-id:spfai;1071100713517874
      Issue No: Vol. 35, No. 4 (2014)
  • Modified Oblique Keller Capsular Interposition Arthroplasty (MOKCIA) for
           Treatment of Late-Stage Hallux Rigidus
    • Authors: Johnson, J. E; McCormick, J. J.
      Pages: 415 - 422
      Abstract: Hallux rigidus is a term used to describe painful, limited motion and localized arthritis at the hallux metatarsophalangeal (MTP) joint. With early hallux rigidus, a dorsal cheilectomy can decrease pain and improve motion. With later stage disease, a hallux MTP arthrodesis is commonly chosen to decrease pain, sacrificing motion by fusing the hallux MTP joint. We present an alternative technique to arthrodesis for late stage hallux rigidus—the modified oblique Keller capsular interposition arthroplasty (MOKCIA). With this operation, the dorsal capsule of the hallux MTP joint is interposed into the joint, offering pain relief without sacrificing range of motion. Level of Evidence: Level V, expert opinion.
      PubDate: 2014-03-31T17:52:32-07:00
      DOI: 10.1177/1071100714523590|hwp:resource-id:spfai;35/4/415
      Issue No: Vol. 35, No. 4 (2014)
  • Letter to the Editor
    • Authors: Clayton; R. A. E.
      Pages: 423 - 423
      PubDate: 2014-03-31T17:52:32-07:00
      DOI: 10.1177/1071100714522232|hwp:resource-id:spfai;35/4/423
      Issue No: Vol. 35, No. 4 (2014)
  • Author Response
    • Authors: Rodriguez; E. K.
      Pages: 424 - 424
      PubDate: 2014-03-31T17:52:32-07:00
      DOI: 10.1177/1071100714522399|hwp:resource-id:spfai;35/4/424
      Issue No: Vol. 35, No. 4 (2014)
  • Education Calendar
    • Pages: 425 - 425
      PubDate: 2014-03-31T17:52:32-07:00
      DOI: 10.1177/1071100714530539|hwp:resource-id:spfai;35/4/425
      Issue No: Vol. 35, No. 4 (2014)
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