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Journal Cover Foot & Ankle International
  [SJR: 1.544]   [H-I: 80]   [9 followers]  Follow
   Hybrid Journal Hybrid journal (It can contain Open Access articles)
   ISSN (Print) 1071-1007
   Published by Sage Publications Homepage  [852 journals]
  • Preoperative PROMIS Scores Predict Postoperative Success in Foot and Ankle
    • Authors: Ho, B; Houck, J. R, Flemister, A. S, Ketz, J, Oh, I, DiGiovanni, B. F, Baumhauer, J. F.
      Pages: 911 - 918
      Abstract: Background:The use of patient-reported outcomes continues to expand beyond the scope of clinical research to involve standard of care assessments across orthopedic practices. It is currently unclear how to interpret and apply this information in the daily care of patients in a foot and ankle clinic. We prospectively examined the relationship between preoperative patient-reported outcomes (PROMIS Physical Function, Pain Interference and Depression scores), determined minimal clinical important differences for these values, and assessed if these preoperative values were predictors of improvement after operative intervention.Methods:Prospective collection of all consecutive patient visits to a multisurgeon tertiary foot and ankle clinic was obtained between February 2015 and April 2016. This consisted of 16 023 unique visits across 7996 patients, with 3611 new patients. Patients undergoing elective operative intervention were identified by ICD-9 and CPT code. PROMIS physical function, pain interference, and depression scores were assessed at initial and follow-up visits. Minimum clinically important differences (MCIDs) were calculated using a distribution-based method. Receiver operating characteristic (ROC) curves were calculated to determine whether preoperative PROMIS scores were predictive of achieving MCID. Cutoff values for PROMIS scores that would predict achieving MCID and not achieving MCID with 95% specificity were determined. Prognostic pre- and posttest probabilities based off these cutoffs were calculated. Patients with a minimum of 7-month follow-up (mean 9.9) who completed all PROMIS domains were included, resulting in 61 patients.Results:ROC curves demonstrated that preoperative physical function scores were predictive of postoperative improvement in physical function (area under the curve [AUC] 0.83). Similarly, preoperative pain interference scores were predictive of postoperative pain improvement (AUC 0.73) and preoperative depression scores were also predictive of postoperative depression improvement (AUC 0.74). Patients with preoperative physical function T score below 29.7 had an 83% probability of achieving a clinically meaningful improvement in function as defined by MCID. Patients with preoperative physical function T score above 42 had a 94% probability of failing to achieve MCID. Patients with preoperative pain above 67.2 had a 66% probability of achieving MCID, whereas patients with preoperative pain below 55 had a 95% probability of failing to achieve MCID. Patients with preoperative depression below 41.5 had a 90% probability of failing to achieve MCID.Conclusion:Patient-reported outcomes (PROMIS) scores obtained preoperatively predicted improvement in foot and ankle surgery. Threshold levels in physical function, pain interference, and depression can be shared with patients as they decide whether surgery is a good option and helps place a numerical value on patient expectations. Physical function scores below 29.7 were likely to improve with surgery, whereas those patients with scores above 42 were unlikely to make gains in function. Patients with pain scores less than 55 were similarly unlikely to improve, whereas those with scores above 67 had clinically significant pain reduction postoperatively. Reported prognostic cutoff values help to provide guidance to both the surgeon and the patient and can aid in shared decision making for treatment.Level of Evidence:Level II, prognostic study.
      PubDate: 2016-09-06T09:55:14-07:00
      DOI: 10.1177/1071100716665113
      Issue No: Vol. 37, No. 9 (2016)
  • Effect on Clinical Outcome and Growth Factor Synthesis With Adjunctive Use
           of Pulsed Electromagnetic Fields for Fifth Metatarsal Nonunion Fracture: A
           Double-Blind Randomized Study
    • Authors: Streit, A; Watson, B. C, Granata, J. D, Philbin, T. M, Lin, H.-N, OConnor, J. P, Lin, S.
      Pages: 919 - 923
      Abstract: Background:Electromagnetic bone growth stimulators have been found to biologically enhance the bone healing environment, with upregulation of numerous growth factors. The purpose of the study was to quantify the effect, in vivo, of pulsed electromagnetic fields (PEMFs) on growth factor expression and healing time in fifth metatarsal nonunions.Methods:This was a prospective, randomized, double-blind trial of patients, cared for by 2 fellowship-trained orthopedic foot and ankle surgeons. Inclusion criteria consisted of patients between 18 and 75 years old who had been diagnosed with a fifth metatarsal delayed or nonunion, with no progressive signs of healing for a minimum of 3 months. Eight patients met inclusion criteria and were randomized to receive either an active stimulation or placebo PEMF device. Each patient then underwent an open biopsy of the fracture site and was fitted with the appropriate PEMF device. The biopsy was analyzed for messenger-ribonucleic acid (mRNA) levels using quantitative competitive reverse transcription polymerase chain reaction (QT-RT-PCR). Three weeks later, the patient underwent repeat biopsy and open reduction and internal fixation of the nonunion site. The patients were followed at 2- to 4-week intervals with serial radiographs and were graded by the number of cortices of healing.Results:All fractures healed, with an average time to complete radiographic union of 14.7 weeks and 8.9 weeks for the inactive and active PEMF groups, respectively. A significant increase in placental growth factor (PIGF) level was found after active PEMF treatment (P = .043). Other factors trended higher following active PEMF including brain-derived neurotrophic factor (BDNF), bone morphogenetic protein (BMP) -7, and BMP-5.Conclusion:The adjunctive use of PEMF for fifth metatarsal fracture nonunions produced a significant increase in local placental growth factor. PEMF also produced trends toward higher levels of multiple other factors and faster average time to radiographic union compared to unstimulated controls.Level of Evidence:Level I, prospective randomized trial.
      PubDate: 2016-09-06T09:55:14-07:00
      DOI: 10.1177/1071100716652621
      Issue No: Vol. 37, No. 9 (2016)
  • Correlation of Systemic Inflammatory Markers With Radiographic Stages of
           Charcot Osteoarthropathy
    • Authors: Hingsammer, A. M; Bauer, D, Renner, N, Borbas, P, Boeni, T, Berli, M.
      Pages: 924 - 928
      Abstract: Background:Charcot osteoarthropathy (COA) is characterized by a progressive destruction of bone and joint associated with neuropathy and is most common in the foot and ankle. Clinical manifestation of COA is frequently indistinguishable from other causes of pain, swelling, and erythema of the affected extremity, in particular, infection. Diagnosis of COA can be challenging in particular in early stages where radiographic changes are sparse. The presence of elevated systemic inflammatory parameters in the context of suspected infection may delay early diagnosis and treatment of COA. The aim of this retrospective analysis was to assess whether elevated systemic inflammatory parameters may be present, in particular in early stages of COA and thus not be used as an exclusion criterion for the diagnosis of COA.Methods:Forty-two patients (mean age 48.2 ± 9.4 years, 36 male, 6 female) with a diagnosis of unilateral COA were the subject of this retrospective study. The diagnosis of COA was confirmed by plain radiographs, magnetic resonance imaging and clinical course. Systemic inflammatory parameters were recorded at the time of referral. Acute stages (stages 0 and 1) were treated with a total contact cast (TCC) and protected weight bearing for a minimum of 6 weeks. For chronic stages (stages 2 and 3) custom-made shoes were prescribed. The feet were stratified into "acute" (Eichenholz stages 0 and 1) and "subacute/chronic" (Eichenholz stages 2 and 3) groups.Results:Statistically significant differences were observed for all recorded systemic inflammatory parameters (C-reactive protein level, WBC count, erythrocyte sedimentation rate) between the acute and subacute/chronic groups. No statistical difference was observed considering the anatomic pattern of involvement.Conclusion:The present study demonstrated that elevated systemic inflammatory parameters may be present in COA and can further be used to distinguish between acute and subacute stages of COA, based on the Eichenholtz classification. Thus, we suggest that elevated inflammatory markers should not be considered an exclusion criterion for the diagnosis of COA.Level of Evidence:Level III, retrospective comparative series.
      PubDate: 2016-09-06T09:55:14-07:00
      DOI: 10.1177/1071100716649173
      Issue No: Vol. 37, No. 9 (2016)
  • Sagittal Distal Tibial Articular Angle and the Relationship to Talar
           Subluxation in Total Ankle Arthroplasty
    • Authors: Veljkovic, A; Norton, A, Salat, P, Abbas, K. Z, Saltzman, C, Femino, J. E, Phisitkul, P, Amendola, A.
      Pages: 929 - 937
      Abstract: Background:Longevity of total ankle replacement (TAR) depends heavily on anatomic alignment. The lateral talar station (LTS) classifies the sagittal position of the talus relative to the tibia. We hypothesized that correcting the sagittal distal tibial articular angle (sDTAA) during TAR would anatomically realign the tibiotalar joint and potentially reduce the risk of prosthesis subluxation.Methods:The LTS (millimeters) and sDTAA (degrees) were measured twice by 2 blinded observers using weight-bearing lateral ankle radiographs obtained before (n = 96) and after (n = 94) TAR, with excellent interobserver and intraobserver reliability (correlation coefficient >0.9).Results:Preoperative LTS was as follows: anterior (60.4%), posterior (27.1%), and neutral (12.5%). A strong preoperative correlation was found between LTS and sDTAA (r = 0.81; P < .0001). In ankles that were initially anterior and became less anterior postoperatively (n = 41), LTS decreased from an average 8.1 mm to 6.5 mm and the LTS changed 1.1 mm per degree of sDTAA change. In ankles that were initially posterior (n = 25), LTS increased from an average of –5.1 mm to –2.8 mm and the LTS changed 0.6 mm per degree of sDTAA change. The correlation between LTS and sDTAA was reduced postoperatively (r = 0.62; P < .0001).Conclusions:Our results suggest that rather than following generic recommendations, the surgeon should customize the sagittal distal tibial cut to the individual patient based on the preoperative LTS in order to achieve neutral TAR alignment.Level of Evidence:Level III, retrospective comparative series.
      PubDate: 2016-09-06T09:55:14-07:00
      DOI: 10.1177/1071100716660523
      Issue No: Vol. 37, No. 9 (2016)
  • Early Patient Satisfaction Results on a Modern Generation Fixed-Bearing
           Total Ankle Arthroplasty
    • Authors: Oliver, S. M; Coetzee, J. C, Nilsson, L. J, Samuelson, K. M, Stone, R. M, Fritz, J. E, Giveans, M. R.
      Pages: 938 - 943
      Abstract: Background:This study presents patient-reported outcomes and patient satisfaction data for the largest series of US patients undergoing modern fixed-bearing total ankle arthroplasty (TAA).Methods:We retrospectively reviewed the records of 300 consecutive patients who underwent 321 modern, fixed-bearing TAAs at a single institution. Veterans Rand 12-Item Health Survey (VR-12), Ankle Osteoarthritis Scale (AOS), and the American Orthopaedic Foot & Ankle Society (AOFAS) Hindfoot score were collected preoperatively and at subsequent follow-up appointments. A patient satisfaction survey was also distributed to each patient postoperatively. Of the 321 TAAs, 245 (232 patients) had a minimum of 2-year follow-up and a complete data set. Furthermore, 192 patients underwent concomitant procedures. The average follow-up was 38.9 months (24-84.5). Eight patients have been lost to follow-up (7 deceased and 1 refused further follow-up).Results:The mean AOFAS score preoperatively was 41.1 and at latest follow-up was 84.6 (P < .01). The mean VR-12 score was 29.7 (Physical) and 54.1 (Mental) preoperatively and 42.7 (Physical) and 55.7 (Mental) at latest follow-up (P < .01 and P > .05, respectively). AOS pain and disability scores improved significantly after TAA (P < .01). The patient satisfaction survey indicated that 84% experienced very good to excellent pain relief, 78% reported improved ability to perform daily tasks, and 54% indicated improvement in their ability to perform heavy work or recreational activities. In addition, 94% would probably or definitely have the procedure on the contralateral ankle. Two patients underwent revision TAA at a minimum of 36 months; 8 patients failed the primary TAA and were converted to ankle fusions at a mean of 20.1 months (6.1-46.1).Conclusion:Early results of a large series of a modern TAA system demonstrate improvement in patient satisfaction, quality of life, activity, and pain for patients with end-stage ankle arthritis. Early revision was due to infection or loosening of the tibial component.Level of Evidence:Level IV, case series.
      PubDate: 2016-09-06T09:55:14-07:00
      DOI: 10.1177/1071100716648736
      Issue No: Vol. 37, No. 9 (2016)
  • Radiographic Evaluation of Ankle Joint Stability After Calcaneofibular
           Ligament Elevation During Open Reduction and Internal Fixation of
           Calcaneus Fracture
    • Authors: Wang, C.-S; Tzeng, Y.-H, Lin, C.-C, Huang, C.-K, Chang, M.-C, Chiang, C.-C.
      Pages: 944 - 949
      Abstract: Background:The aim of this prospective study was to evaluate the influence of sectioning the calcaneofibular ligament (CFL) during an extensile lateral approach during open reduction and internal fixation (ORIF) of calcaneal fractures on ankle joint stability.Methods:Forty-two patients with calcaneal fractures that received ORIF were included. Talar tilt stress and anterior drawer radiographs were performed on the operative and contralateral ankles 6 months postoperatively.Results:The average degree of talar tilt on stress radiographs was 3.4 degrees (range, 0-12 degrees) on the operative side and 3.2 degrees (range, 0-14 degrees) on the contralateral side. The mean anterior drawer on stress radiographs of the CFL incised ankle was 6.1 mm (range, 2.4-11.8 mm) and on the contralateral ankle was 5.7 mm (range, 2.6-8.6 mm). There was no statistically significant difference of talar tilt and anterior drawer between the CFL incised side and the contralateral side (P = .658 and .302, respectively).Conclusion:The results suggest that sectioning of the CFL without any repair during ORIF of a calcaneal fracture does not have a negative effect on stability of the ankle. Repair of the CFL is, thus, probably not necessary following extended lateral approach for ORIF of calcaneal fractures.Level of Evidence:Level II, comparative study.
      PubDate: 2016-09-06T09:55:14-07:00
      DOI: 10.1177/1071100716649928
      Issue No: Vol. 37, No. 9 (2016)
  • Radiographic and CT Assessment of Reduction of Calcaneus Fractures Using a
           Limited Sinus Tarsi Incision
    • Authors: Scott, A. T; Pacholke, D. A, Hamid, K. S.
      Pages: 950 - 957
      Abstract: Background:The lateral extensile incision for fixation of displaced intra-articular calcaneus fractures allows for fracture reduction but has been associated with high rates of soft tissue complications. This has prompted a search for less invasive methods of fracture fixation. The purpose of the present study was to determine the adequacy of reduction and rate of complications associated with operative fixation of calcaneal fractures using a limited sinus tarsi approach.Methods:A limited sinus tarsi incision with plate fixation was utilized for treatment of 39 displaced intra-articular calcaneal fractures in 35 consecutive patients as part of a single surgeon series. Imaging assessment of previously described fracture displacement measures was undertaken in preoperative and postoperative radiographs and CT. A retrospective chart review was conducted to identify postoperative complications.Results:Mean preoperative Bohler angle measurement was 7.7 (range, –26.0 to 30.0) degrees and the mean final postoperative standing Bohler angle was 25.5 (range, 12.3 to 37.7) degrees. Postoperative CT demonstrated that subtalar articular reduction was within 2 mm of anatomic in 91% of patients. There were 2 instances of superficial wound dehiscence (5.1%) and 1 deep infection (2.6%) that required debridement and complete hardware removal. Visual analog score (VAS) for pain averaged 3 of 10 in the 32 available patients at 1-year follow-up. Eight of these patients (25%) reported no pain (0/10) at final follow-up.Conclusion:Operative fixation of displaced intra-articular calcaneal fractures utilizing the limited sinus tarsi approach resulted in acceptable fracture reduction and a low rate of complications.Level of Evidence:Level IV, retrospective case series.
      PubDate: 2016-09-06T09:55:14-07:00
      DOI: 10.1177/1071100716650538
      Issue No: Vol. 37, No. 9 (2016)
  • Case Series With Histopathologic and Radiographic Analyses Following
           Failure of Fresh Osteochondral Allografts of the Talus
    • Authors: Pomajzl, R. J; Baker, E. A, Baker, K. C, Fleischer, M. M, Salisbury, M. R, Phillips, D. M, Fortin, P. T.
      Pages: 958 - 967
      Abstract: Background:Fresh osteochondral allografting of the talus is one treatment option for large chondral defects. Following positive early term results, failure rates of up to 35% have been reported. A retrieval study was performed to characterize failed talar allografts.Methods:Failed fresh osteochondral allografts of the talus were retrieved on revision. Cases of deep infection were excluded. After tissue fixation, samples were decalcified, embedded, and stained with Safranin-O/Fast Green, osteocalcin, tumor necrosis factor alpha (TNF-α), CD4, CD8, and CD68. Slides were graded according to the modified Mankin scoring system or severity scale. Medical record review was performed.Results:Eight allografts (7 patients) were retrieved from patients, following an average term of implantation of 31 months (range, 12-58). There were 3 types of allografts in this series (hemidome, n=5; segmental, n=2; bipolar, n=1). Reasons for transplantation were post-traumatic arthritis or osteonecrosis; reasons for revision were graft failure/collapse, nonunion, progressive arthritis, and/or pain. Prior to revision, all grafts exhibited collapse and subchondral lucencies. At the graft host interface, Safranin-O staining demonstrated substantial loss of sulfated glycosaminoglycans, Osteocalcin immunostaning was nearly absent, CD68 (indicating osteoclast activity) was predominantly exhibited, and CD4+ helper T cells as well as CD8+ cytotoxic T cells and NK cells—cell types commonly implicated in allogeneic organ transplant rejection—were found in high concentrations. TNF-α was present throughout the graft.Conclusion:A histopathologic analysis of 8 retrieved, failed talar allografts was performed. Graft failure appeared to be primarily biologic, with an extensive loss of viable cartilaginous and osseous tissue at the graft-host interface. This study provides the first evidence of a potential CD4+ and CD8+ lymphocyte-mediated failure mechanism in fresh osteochondral allografts that were revised following collapse.Level of Evidence:Level IV, case series.
      PubDate: 2016-09-06T09:55:14-07:00
      DOI: 10.1177/1071100716651963
      Issue No: Vol. 37, No. 9 (2016)
  • Clinical and MRI Donor Site Outcomes Following Autologous Osteochondral
           Transplantation for Talar Osteochondral Lesions
    • Authors: Fraser, E. J; Savage-Elliott, I, Yasui, Y, Ackermann, J, Watson, G, Ross, K. A, Deyer, T, Kennedy, J. G.
      Pages: 968 - 976
      Abstract: Background:Autologous osteochondral transplantation (AOT) has an inherent risk of donor site morbidity (DSM). The reported rates of DSM vary from 0% to 50%, with few studies reporting clinical or imaging outcomes at the donor site as a primary outcome and even fewer report these outcomes when a biosynthetic plug backfill is employed. Although TruFit (Smith & Nephew, Andover, MA) plugs have been removed from the market for regulatory purposes, biphasic plugs (including TruFit plugs) have been used for several years and the evaluation of these is therefore pertinent.Methods:Thirty-nine patients who underwent forty AOT procedures of the talus, with the donor graft being taken from the ipsilateral knee, were included. Postoperative magnetic resonance imaging (MRI) was used to assess the donor site graded with magnetic resonance observation of cartilage repair tissue (MOCART) scoring. Lysholm scores were collected preoperatively, at the time of magnetic resonance imaging (MRI), and again at 24 months and at final follow-up to assess clinical outcomes. Statistical analysis was performed to establish if there was any correlation between MRI assessment of the donor site and clinical outcomes. The mean patient age was 36.2 ± 15.7 years with a mean follow-up of 41.8 ± 16.7 months.Results:All patient donor site defects were filled with OBI TruFit biphasic plugs. DSM was encountered in 12.5% of the patient cohort at 24 months, and in these patients, the Lysholm score was a mean 87.2 ± 5.0. At final follow-up, DSM was reduced to 5%. Lysholm scores for the entire cohort were 98.4 ± 4.6 and 99.4 ± 3.1 at 24 months and final follow-up, respectively. MRI of the donor sites were taken at an average of 18.1 ± 13.5 (range, 3-48) months postoperatively and the mean MOCART score was 60.0 ± 13.5. No correlation was found between the MOCART score and Lysholm outcomes at the donor knee (P = .43, r = 0.13).Conclusion:Low incidence of DSM and good functional outcomes were achieved with AOT. Additionally, MRI findings did not predict clinical outcomes in our study.Level of Evidence:Level IV, retrospective case series.
      PubDate: 2016-09-06T09:55:14-07:00
      DOI: 10.1177/1071100716649461
      Issue No: Vol. 37, No. 9 (2016)
  • Impact of Intraoperative Cone Beam Computed Tomography on Reduction
           Quality and Implant Position in Treatment of Tibial Plafond Fractures
    • Pages: 977 - 982
      Abstract: Background:The intraoperative assessment of the articular surface in displaced intra-articular distal tibia fractures can be challenging using conventional fluoroscopy. The aim of the study was to determine the frequency and the method of intraoperative corrections of fracture reductions or implant placements during open reduction, internal fixation by using cone beam computed tomography (CT) after conventional fluoroscopy.Methods:Displaced intra-articular distal tibia fractures were retrospectively analyzed from August 2001 until December 2011. The fractures were classified according to the standards of the AO/OTA as type B or C and treated with open reduction and internal plate fixation. After primary reduction using conventional fluoroscopy, an additional cone beam CT scan was used to determine the alignment of the joint line and the implant position. The number of intraoperative revisions of the primary reduction due to the use of cone beam CT was analyzed.Results:A total of 143 patients with an intra-articular tibial plafond fracture were included in the analysis. In 43 patients (30%), an intraoperative correction was performed after the cone beam CT scan. In 34 (24%) of these cases, intraoperative correction was required because of inadequate joint line reduction. Nine (6%) corrections were required as a result of a malposition of the implant. The revision rate did not differ by fracture classification.Conclusion:Despite its acceptance as the standard method of imaging, intraoperative conventional fluoroscopy for the assessment of implant positioning and fracture reduction of tibial plafond fractures is limited. The intraoperative utilization of cone beam CT provided additional information for the surgeon to detect insufficient reduction or implant malposition.Level of Evidence:Level III, retrospective comparative series.
      PubDate: 2016-09-06T09:55:14-07:00
      DOI: 10.1177/1071100716650532
      Issue No: Vol. 37, No. 9 (2016)
  • Relationship of Self-Reported Ability to Weight-Bear Immediately After
           Injury as Predictor of Stability for Ankle Fractures
    • Authors: Chien, B; Hofmann, K, Ghorbanhoseini, M, Zurakowski, D, Rodriguez, E. K, Appleton, P, Ellington, J. K, Kwon, J. Y.
      Pages: 983 - 988
      Abstract: Background:Determining the stability of ankle fractures, particularly Weber B fibula fractures, can be challenging. Ability to weight-bear after injury may be predictive of stability. We sought to determine whether patients’ ability to weight-bear immediately after injury was an effective indicator for ankle stability following fracture.Methods:A prospective review was conducted of patients sustaining ankle fractures. Patients’ ability to weight-bear after injury was elicited and correlated with ankle radiographs, which were deemed stable or unstable based on commonly used indices to assess stability.Results:For the entire cohort (n = 121), patients who were able to weight-bear immediately after injury were over 8 times more likely to have a stable fracture than those who could not (odds ratio [OR] = 8.6, P < .001). Positive predictive value (PPV) for being able to fully weight-bear as it related to stability was 73%. Inability to weight-bear was 85% specific among patients with an unstable fracture. When analyzing patients with radiographic isolated fibula fractures (n = 67), PPV = 82%, negative predictive value [NPV] = 53%, specificity = 79%, whereas the OR was 5.0 (P = .003) for those who could weight-bear having a stable fracture. When subanalyzing patients who presented with isolated fibula fractures and anatomic mortises (n = 43), PPV = 74%, NPV = 52%, specificity = 62%, whereas the OR was 3.6 (P = .07) for those who could weight-bear having a stable fracture.Conclusion:Patients’ ability to weight-bear immediately after injury was a specific and prognostic indicator for stability across a range of ankle fracture subtypes. Patients with an isolated fibula fracture and anatomic mortise were 3.6 times more likely to have a stable fracture if they were able to fully weight-bear at the time of injury. Although a patient’s history does not preclude the need for appropriate imaging studies and clinical judgment, it may aid in the assessment of ankle stability following fracture.Level of Evidence:Level II, clinical diagnostic.
      PubDate: 2016-09-06T09:55:14-07:00
      DOI: 10.1177/1071100716648009
      Issue No: Vol. 37, No. 9 (2016)
  • Topical Ketoprofen Versus Placebo in Treatment of Acute Ankle Sprain in
           the Emergency Department
    • Authors: Serinken, M; Eken, C, Elicabuk, H.
      Pages: 989 - 993
      Abstract: Background:Topical agents have been shown to be effective in soft tissue injuries and commonly used in outpatient clinics. However, the data regarding topical agents in the emergency department is insufficient, and they are not used often in the emergency department setting. The present study aimed to compare the effect of 2.5% topical ketoprofen (gel form) to placebo in patients presenting with ankle sprain to the emergency department.Methods:Patients presenting with ankle sprain composed the study population. Study patients were randomized into 2 study arms: 2.5% ketoprofen gel and placebo administered over a 5-cm area locally. Pain alleviation was measured by visual analog scale at 15 and 30 minutes. A total of 100 patients were included in the final analysis.Results:The median pain reduction in ketoprofen and placebo groups at 15 minutes was 27 (19.8-33.4) and 9 (7.6-17), respectively. The median pain reduction at 30 minutes for both groups was 42 (36-50.8) and 20 (17.6-24.4), respectively. Pain improvement either at 15 minutes (median difference: 16 [9-22]) or 30 minutes (median difference: 21 [15-27]) was better in the ketoprofen group than placebo. There were no adverse effects in either group.Conclusion:Ketoprofen gel was superior to placebo at 30 minutes in alleviating pain secondary to ankle sprain in the ED with a high safety profile. Further studies are needed concerning the effect of ketoprofen gel for long-term effects.Level of Evidence:Level I, high quality prospective randomized study.
      PubDate: 2016-09-06T09:55:14-07:00
      DOI: 10.1177/1071100716650530
      Issue No: Vol. 37, No. 9 (2016)
  • Relationship and Classification of Plantar Heel Spurs in Patients With
           Plantar Fasciitis
    • Authors: Ahmad, J; Karim, A, Daniel, J. N.
      Pages: 994 - 1000
      Abstract: Background:This study classified plantar heel spurs and their relationship to plantar fasciitis.Methods:Patients included those with plantar fasciitis who were treated from 2012 through 2013. Plantar heel spur shape and size were assessed radiographically and correlated to function and pain before and after treatment. Function and pain were scored with the Foot and Ankle Ability Measures and a visual analog scale, respectively. This study included 109 patients with plantar fasciitis.Results:The plantar heel spur shape was classified as 0/absent in 26 patients, 1/horizontal in 66 patients, 2/vertical in 4 patients, and 3/hooked in 13 patients. The plantar heel spur size was less than 5 mm in 75 patients, 5-10 mm in 28 patients, and greater than 10 mm in 6 patients. Initially, patients with any shape or size to their spur had no difference in function and pain. With treatment, patients with horizontal and hooked spurs had the greatest improvement in function and pain (P < .05). With treatment, patients with larger spurs had the greatest improvement in function and pain (P < .05).Conclusion:Plantar heel spurs can be classified by shape and size in patients with plantar fasciitis. Before treatment, neither the spur shape nor size significantly correlated with symptoms. After treatment, patients with larger horizontal or hooked spurs had the greatest improvement in function and pain. These findings may be important when educating patients about the role of heel spurs with plantar fasciitis and the effect of nonsurgical treatment with certain spurs.Level of Evidence:Level III, comparative series.
      PubDate: 2016-09-06T09:55:14-07:00
      DOI: 10.1177/1071100716649925
      Issue No: Vol. 37, No. 9 (2016)
  • Supramalleolar Osteotomy With or Without Fibular Osteotomy for Varus Ankle
    • Authors: Hongmou, Z; Xiaojun, L, Yi, L, Hongliang, L, Junhu, W, Cheng, L.
      Pages: 1001 - 1007
      Abstract: Background:Supramalleolar osteotomy (SMOT) is an alternative operative procedure for the management of early and midstage varus ankle arthritis. However, whether fibular osteotomy is needed is controversial. The purpose of the current study was to evaluate the functional and radiologic outcomes of pre- and postoperative SMOT, and to compare the outcomes between patients with and without fibular osteotomy.Methods:Forty-one Takakura stage 2 and 3 varus ankle osteoarthritis patients treated with SMOT were included. Fourteen males and 27 females with a mean age of 50.7 (range, 32-71) years were followed with a mean of 36.6 (range, 17-61) months. There were 22 cases with fibular osteotomy and 19 without. The American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score, Maryland foot score, and Ankle Osteoarthritis Score (AOS) were used for pre- and postoperative functional evaluation. The tibial articular surface angle (TAS), talar tilt (TT), tibiocrural angle (TC), and tibial lateral surface angle (TLS) were evaluated pre- and postoperatively.Results:At the last follow-up, the mean AOFAS score (from 50.8 to 83.1 points) and Maryland score (from 58.3 to 81.6 points) in overall were improved (P < .01); the mean AOS pain (from 42.6 to 26.1 points) and function (from 53.4 to 36.8 points) scores were decreased (P < .01). For radiologic evaluation, all the included parameters were improved (P < .05) except TLS. The mean Takakura stage was decreased (P < .01). No significant difference could be detected in comparing the functional outcomes between those with and without fibular osteotomy. However, in the fibular osteotomy group, TT was decreased (P < .05) and TC was improved (P < .01) significantly.Conclusion:SMOT was promising, with substantial functional improvement and malalignment correction for varus ankle arthritis. Fibular osteotomy may be necessary in cases with large TT and small TC angles.Level of Evidence:Level III, retrospective comparative study.
      PubDate: 2016-09-06T09:55:14-07:00
      DOI: 10.1177/1071100716649926
      Issue No: Vol. 37, No. 9 (2016)
  • Habitual Use of High-Heeled Shoes Affects Isokinetic Soleus Strength More
           Than Gastrocnemius in Healthy Young Females
    • Authors: Farrag, A; Elsayed, W.
      Pages: 1008 - 1016
      Abstract: Background:Habitual use of high-heeled shoes (HHS) has been reported to negatively impact different body structures. However, few studies have investigated its effect on plantarflexor performance. The aim of this study was to investigate the effect of habitual wear of HHS and knee joint position (to isolate the function of the gastrocnemius) on the isokinetic performance of the plantarflexors and ankle joint range of motion (ROM).Methods:A high-heel (HH) group included 12 women (25.4 ± 4.8 y) who have been wearing HHS for ≥40 hours/wk and for at least a year. A control group (CTRL) had 12 women (21.3 ± 0.5 y) who have occasionally been wearing HHS for
      PubDate: 2016-09-06T09:55:14-07:00
      DOI: 10.1177/1071100716649172
      Issue No: Vol. 37, No. 9 (2016)
  • Effects on the Tarsal Tunnel Following Malerba Z-type Osteotomy Compared
           to Standard Lateralizing Calcaneal Osteotomy
    • Authors: Cody, E. A; Greditzer, H. G, MacMahon, A, Burket, J. C, Sofka, C. M, Ellis, S. J.
      Pages: 1017 - 1022
      Abstract: Background:Tarsal tunnel syndrome is a known complication of lateralizing calcaneal osteotomy. A Malerba Z-type osteotomy may preserve more tarsal tunnel volume (TTV) and decrease risk of neurovascular injury. We investigated 2 effects on the tarsal tunnel of the Malerba osteotomy compared to a standard lateralizing osteotomy using a cadaveric model: (1) the effect on TTV as measured by magnetic resonance imaging (MRI) and (2) the proximity of the osteotomy saw cuts to the tibial nerve.Methods:Ten above-knee paired cadaveric specimens underwent MRI of the ankle to obtain a baseline measurement of TTV. One foot in each pair received a standard lateralizing calcaneal osteotomy, with the other foot receiving a Malerba osteotomy. MRIs were performed after each of 3 increasing amounts of lateral displacement, which were accompanied by increasing amounts of wedge resection in the Malerba osteotomy group. TTV was measured on MRI using previously described and validated parameters. Differences in TTV with osteotomy type, displacement, and their interaction were assessed with generalized estimating equations. After all MRIs were completed, each specimen was dissected and the nearest distance of tibial nerve branches to the osteotomy site was measured.Results:Baseline TTV averaged 13 229 ± 2354 mm3 and did not differ between groups (P = .386). TTV decreased on average by 7% after the first translation, 14% after the second, and 27% after the third (P < .005 for each). The magnitude of the decrease in TTV did not differ between those specimens with standard osteotomies versus those with Malerba osteotomies (P = .578). At least one of the major branches of the tibial nerve crossed the osteotomy site in 5 of 5 specimens that received the Malerba osteotomy versus 2 of 5 that received a standard osteotomy.Conclusion:Regardless of osteotomy type, lateralizing calcaneal osteotomy decreased TTV. In all specimens, the osteotomy was at the level of branches of the tibial nerve.Clinical Relevance:Our results demonstrate that lateralizing calcaneal osteotomies must be performed with care to avoid excessive lateral translation as well as direct nerve injury on the nonvisualized medial side of the calcaneus.
      PubDate: 2016-09-06T09:55:14-07:00
      DOI: 10.1177/1071100716651966
      Issue No: Vol. 37, No. 9 (2016)
  • Osteochondral Lesions of the Ankle
    • Authors: Wodicka, R; Ferkel, E, Ferkel, R.
      Pages: 1023 - 1034
      PubDate: 2016-09-06T09:55:14-07:00
      DOI: 10.1177/1071100716654691
      Issue No: Vol. 37, No. 9 (2016)
  • Becoming a Team Player
    • Authors: Pinzur M. S.
      Pages: 1035 - 1035
      PubDate: 2016-09-06T09:55:14-07:00
      DOI: 10.1177/1071100716630955
      Issue No: Vol. 37, No. 9 (2016)
  • Education Calendar
    • Pages: 1036 - 1036
      PubDate: 2016-09-06T09:55:14-07:00
      DOI: 10.1177/1071100716669333
      Issue No: Vol. 37, No. 9 (2016)
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