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Journal Cover Foot & Ankle International     [SJR: 1.021]   [H-I: 62]
   [11 followers]  Follow    
   Hybrid Journal Hybrid journal (It can contain Open Access articles)
   ISSN (Print) 1071-1007
   Published by Sage Publications Homepage  [756 journals]
  • Correlation Between Static Radiographic Measurements and Intersegmental
           Angular Measurements During Gait Using a Multisegment Foot Model
    • Authors: Lee, D. Y; Seo, S. G, Kim, E. J, Kim, S. J, Lee, K. M, Farber, D. C, Chung, C. Y, Choi, I. H.
      Pages: 1 - 10
      Abstract: Background: Radiographic examination is a widely used evaluation method in the orthopedic clinic. However, conventional radiography alone does not reflect the dynamic changes between foot and ankle segments during gait. Multiple 3-dimensional multisegment foot models (3D MFMs) have been introduced to evaluate intersegmental motion of the foot. In this study, we evaluated the correlation between static radiographic indices and intersegmental foot motion indices. Methods: One hundred twenty-five females were tested. Static radiographs of full-leg and anteroposterior (AP) and lateral foot views were performed. For hindfoot evaluation, we measured the AP tibiotalar angle (TiTA), talar tilt (TT), calcaneal pitch, lateral tibiocalcaneal angle, and lateral talcocalcaneal angle. For the midfoot segment, naviculocuboid overlap and talonavicular coverage angle were calculated. AP and lateral talo-first metatarsal angles and metatarsal stacking angle (MSA) were measured to assess the forefoot. Hallux valgus angle (HVA) and hallux interphalangeal angle were measured. In gait analysis by 3D MFM, intersegmental angle (ISA) measurements of each segment (hallux, forefoot, hindfoot, arch) were recorded. Results: ISAs at midstance phase were most highly correlated with radiography. Significant correlations were observed between ISA measurements using MFM and static radiographic measurements in the same segment. In the hindfoot, coronal plane ISA was correlated with AP TiTA (P < .001) and TT (P = .018). In the hallux, HVA was strongly correlated with transverse ISA of the hallux (P < .001). Conclusion: The segmental foot motion indices at midstance phase during gait measured by 3D MFM gait analysis were correlated with the conventional radiographic indices. Clinical Relevance: The observed correlation between MFM measurements at midstance phase during gait and static radiographic measurements supports the fundamental basis for the use of MFM in analysis of dynamic motion of foot segment during gait.
      PubDate: 2014-12-30T16:10:11-08:00
      DOI: 10.1177/1071100714559727|hwp:master-id:spfai;1071100714559727
      Issue No: Vol. 36, No. 1 (2014)
  • Performance of Total Ankle Arthroplasty and Ankle Arthrodesis on Uneven
           Surfaces, Stairs, and Inclines: A Prospective Study
    • Authors: Jastifer, J; Coughlin, M. J, Hirose, C.
      Pages: 11 - 17
      Abstract: Background: Both total ankle arthroplasty (TAA) and ankle arthrodesis are options for the treatment of ankle arthritis and have been shown to improve gait postoperatively. Little is known about the postoperative performance of these patients on uneven surfaces. Methods: Between 2010 and 2013, 77 consecutive patients were enrolled in a prospective study and completed 12 months of follow-up. Patients received either a TAA (61 patients) or an ankle arthrodesis (16 patients). Preoperatively, at 6 months and 12 months postoperatively, patients were evaluated clinically and functionally on stairs, an inclined ramp, and an uneven surface. Patients graded their function on these surfaces using a visual analog scale (VAS) in addition to standard clinical grading scales. Results: There was no statistically significant difference between the patient groups preoperatively (all P > .05). Both TAA and ankle arthrodesis groups had high patient satisfaction, 3.5 and 3.4 out of 4.0, respectively. Both groups had improvement in Buechel-Pappas scores, VAS pain scores, AOFAS Ankle Hindfoot scores, and functional scores (all P values < .05). TAA patients had a significantly better outcome than the arthrodesis patients in the Buechel-Pappas scale (P = .036), AOFAS Ankle Hindfoot score (P = .03), ankle dorsiflexion (P < .001), ankle plantarflexion (P < .001), walking upstairs (P = .013), walking downstairs (P = .012), and walking uphill (P = .016). Conclusions: Patients with TAA and ankle arthrodesis had improved performance walking on uneven surfaces at 12 months of follow-up compared to preoperatively. TAA patients had higher scores than the ankle arthrodesis patients walking upstairs, downstairs, and uphill. Level of Evidence: Level II, prospective cohort study.
      PubDate: 2014-12-30T16:10:11-08:00
      DOI: 10.1177/1071100714549190|hwp:master-id:spfai;1071100714549190
      Issue No: Vol. 36, No. 1 (2014)
  • The Effect of Ankle Joint Immobilization on Lower Limb Venous Flow
    • Authors: Craik, J. D; Clark, A, Hendry, J, Sott, A. H, Hamilton, P. D.
      Pages: 18 - 23
      Abstract: Background: Below-knee cast immobilization is associated with an increased risk of developing deep vein thrombosis secondary to venous stasis. We investigated the effect of weight-bearing in a below-knee cast or pneumatic walking boot on lower limb venous blood flow. Methods: Duplex ultrasonography was used to measure venous blood flow in the popliteal vein of 10 healthy volunteers. Venous blood flow was measured while at rest, ambulating non-weight-bearing, partial weight-bearing, and full weight-bearing. Measurements were performed without ankle joint immobilization, with the ankle immobilized in a neutral cast, and with the ankle immobilized in a pneumatic walking boot in both neutral and equinus. Results: There was no significant reduction in venous blood flow measurements between full weight-bearing without ankle joint immobilization and full weight-bearing in a neutral cast or neutral pneumatic walking boot. However, venous blood flow was reduced when partial weight-bearing (50%) and when full weight-bearing in a pneumatic walking boot in equinus. Conclusion: These results demonstrate that venous blood flow returned to normal levels when the subjects were permitted to fully bear weight in below-knee casts or walking boots, provided that the ankle joint was not in equinus. Clinical Relevance: Weight-bearing status and ankle joint position should be appreciated during decisions for the provision of chemical thromboprophylaxis.
      PubDate: 2014-12-30T16:10:11-08:00
      DOI: 10.1177/1071100714552823|hwp:master-id:spfai;1071100714552823
      Issue No: Vol. 36, No. 1 (2014)
  • Natural History of Nonoperatively Treated Osteochondral Lesions of the
    • Authors: Klammer, G; Maquieira, G. J, Spahn, S, Vigfusson, V, Zanetti, M, Espinosa, N.
      Pages: 24 - 31
      Abstract: Background: We hypothesized that patients undergoing nonoperative treatment for asymptomatic or minimally symptomatic osteochondral lesions of the talus (OLTs) would not deteriorate clinically or radiologically over time. Methods: Forty-eight patients (mean age = 48 years; range, 13-78 years) with an OLT confirmed by magnetic resonance imaging (MRI) who had not undergone ankle joint surgery were retrospectively reviewed. All patients were evaluated after a minimum follow-up of 2 years (mean = 52 months; range, 27-124 months). All patients filled out an individual questionnaire and underwent a physical and radiographic assessment (radiograph and hindfoot MRI). Results: At final follow-up, 43 ankles (86%) in 41 patients were pain-free (visual analogue scale [VAS] 0, n = 12) or less painful (VAS 1-3, n = 31). Radiographically, osteoarthritis was absent in 47%, and grade 1 and 2 osteoarthritis each were found in 27% (van Dijk classification). Magnetic resonance imaging revealed no substantial progression in staging or lesion size. Pain at time of follow-up correlated with the depth of the lesion at initial MRI (P < .05) and with subchondral cyst formation and presence or change of bone marrow edema at follow-up MRI (P < .05). Conclusion: Minimally symptomatic OLTs did not appear to progress or worsen over time when treated nonoperatively. Level of Evidence: Level IV, case series.
      PubDate: 2014-12-30T16:10:11-08:00
      DOI: 10.1177/1071100714552480|hwp:master-id:spfai;1071100714552480
      Issue No: Vol. 36, No. 1 (2014)
  • Comparison of Rates of Union and Hardware Removal Between Large and Small
           Cannulated Screws for Calcaneal Osteotomy
    • Authors: Sayres, S. C; Gu, Y, Kiernan, S, DeSandis, B. A, Elliott, A. J, O'Malley, M. J.
      Pages: 32 - 36
      Abstract: Background: The calcaneal osteotomy is a common procedure to correct hindfoot malalignment. Reported union rates are high, utilizing fixation methods including staples, plates, and most commonly cannulated screws. We began our practice using 6.5 mm and 7.3 mm cannulated screws, but complaints of postoperative posterior heel pain led to hardware removal in many patients. A switch to smaller 4.5 mm cannulated screws resulted in fewer symptoms, thus we hypothesized that using a smaller screw would decrease screw removal while maintaining an equally high union rate. Methods: The records of patients who underwent a calcaneal osteotomy by 2 surgeons between January 1996 and April 2012 were retrospectively reviewed. The rates of hardware removal and union were compared between osteotomies held with two 7.3 mm, 6.5 mm, and 4.5 mm cannulated screws. Results: There were 272 feet that met the inclusion criteria. The hardware removal rate for 130 osteotomies held with two 7.3 mm screws was 29.2% and the removal rate for 115 osteotomies held with 4.5 mm screws was 13.0%, which was significantly different (P < .05). The removal rate for 27 osteotomies with 6.5 mm screws was 33.3%. The union rate for all groups was 100%. Conclusion: Fixation of calcaneal osteotomies with two 4.5 mm screws is advantageous over larger screws with respect to future hardware removal. There was no loss of position from the smaller screws and we feel that the 4.5mm cannulated screw provides sufficient compression and achieves a high rate of union equal to that of the larger screws. Level of Evidence: Level IV, retrospective case series.
      PubDate: 2014-12-30T16:10:11-08:00
      DOI: 10.1177/1071100714549191|hwp:master-id:spfai;1071100714549191
      Issue No: Vol. 36, No. 1 (2014)
  • Musculoskeletal and Activity-Related Factors Associated With Plantar Heel
    • Authors: Sullivan, J; Burns, J, Adams, R, Pappas, E, Crosbie, J.
      Pages: 37 - 45
      Abstract: Background: Despite the prevalence and impact of plantar heel pain, its etiology remains poorly understood, and there is no consensus regarding optimum management. The identification of musculoskeletal factors related to the presence of plantar heel pain could lead to the development of better targeted intervention strategies and potentially improve clinical outcomes. The aim of this study was to investigate relationships between a number of musculoskeletal and activity-related measures and plantar heel pain. Methods: In total, 202 people with plantar heel pain and 70 asymptomatic control participants were compared on a variety of musculoskeletal and activity-related measures, including body mass index (BMI), foot and ankle muscle strength, calf endurance, ankle and first metatarsophalangeal (MTP) joint range of motion, foot alignment, occupational standing time, exercise level, and generalized hypermobility. Following a comparison of groups for parity of age, analyses of covariance were performed to detect differences between the 2 groups for any of the variables measured. Results: The plantar heel pain group displayed a higher BMI, reduced ankle dorsiflexion range of motion, reduced ankle evertor and toe flexor strength, and an altered inversion/eversion strength ratio. There were no differences between groups for foot alignment, dorsiflexor or invertor strength, ankle inversion or eversion range of motion, first MTP joint extension range of motion, generalized hypermobility, occupational standing time, or exercise level. Conclusion: Plantar heel pain is associated with higher BMI and reductions in some foot and ankle strength and flexibility measures. Although these factors could be either causal or consequential, they are all potentially modifiable and could be targeted in the management of plantar heel pain. Level of Evidence: Level III, comparative study.
      PubDate: 2014-12-30T16:10:11-08:00
      DOI: 10.1177/1071100714551021|hwp:master-id:spfai;1071100714551021
      Issue No: Vol. 36, No. 1 (2014)
  • Talectomy and Tibiocalcaneal Arthrodesis With Intramedullary Nail Fixation
           for Treatment of Equinus Deformity in Adults
    • Authors: Gursu, S; Bahar, H, Camurcu, Y, Yildirim, T, Buyuk, F, Ozcan, C, Sahin, V.
      Pages: 46 - 50
      Abstract: Background: Severe equinovarus foot deformity in adults is a challenging problem. Conservative treatment rarely is effective, and operative options are limited. The aim of this study was to evaluate the results of talectomy and tibiocalcaneal arthrodesis with intramedullary nail fixation for the treatment of severe equinovarus deformity in adults. Methods: Twelve patients (average age 39 years, range 15-70 years) with severe equinovarus deformities of the foot were treated with talectomy and tibiocalcaneal arthrodesis with intramedullary nail fixation between March 2010 and February 2013. Average follow-up was 20 months (range 10-37 months). Results: Tibiocalcaneal fusion was achieved in all patients at an average of 12 weeks (range 8-17 weeks). Preoperatively, all patients had severe, irreducible equinovarus deformities; at last follow-up, almost all feet had mild residual deformity, but were plantigrade and did not require a brace or orthosis. The average AOFAS ankle score improved from 41.1 (range 8-66) preoperatively to 78.4 (range 67-86) postoperatively (P = .02). There was a similar improvement in the average VAS score from 6.3 (range 2-10) preoperatively to 0.8 (range 0-4) postoperatively (P = .02). Conclusion: The combination of talectomy and tibiocalcaneal arthrodesis was effective in correcting severe rigid equinovarus deformity in adults. Removal of the talus resulted in laxity of the soft tissues, making correction of the deformity easier. Tibiocalcaneal arthrodesis achieved a stable foot without the problems associated with talectomy alone. Level of Evidence: Level IV, case series.
      PubDate: 2014-12-30T16:10:11-08:00
      DOI: 10.1177/1071100714550649|hwp:master-id:spfai;1071100714550649
      Issue No: Vol. 36, No. 1 (2014)
  • Effect of Pathology on Union of First Metatarsophalangeal Joint
    • Authors: Korim, M. T; Allen, P. E.
      Pages: 51 - 54
      Abstract: Background: Arthrodesis is an established treatment for symptomatic degeneration of the first metatarsophalangeal (MP) joint. The published case series have often been small with different surgeons using a variety of joint preparation and fixation methods. The nonunion frequency comparing the different pathologies has not been described. We describe the senior author’s results comparing the union of an MP arthrodesis in hallux valgus, hallux rigidus, inflammatory arthropathy, and salvage surgery with identical joint preparation and fixation methods. Methods: The logbook of the senior author was used to identify the first MP joint arthrodeses from 2003 to 2011. The radiographic data were reviewed on the Picture Archiving and Communication system to assess the severity of deformity, radiographic union, type of fixation, and need for revision surgery. If there was no definite radiographic union of the last radiograph, the medical notes were reviewed. In all, 134 MP joint arthrodeses were performed in 78 females and 38 males, with a mean age of 65 ± 12 years (range, 20-94). Fixation was achieved by crossed screws (124) and dorsal plate (10). The primary diagnoses were hallux valgus in 49 joints (36.6%), hallux rigidus in 46 joints (34%), inflammatory arthropathy in 34 joints (25.4%), and salvage surgery in 5 joints (3.7%). Results: The overall radiographic union rate was 91.8% (123/134). There were significantly more nonunions in the hallux valgus group (14.3% vs 0%, OR 16, P = .05). Conclusion: Biplanar cuts and crossed screw fixation gave similar union frequencies to published case series. Hallux valgus was associated with higher nonunion frequencies in this single surgeon series. It may be that the hallux valgus group needs a stronger construct to achieve comparable union frequencies to the hallux rigidus group. Level of Evidence: Level III, retrospective comparative study.
      PubDate: 2014-12-30T16:10:11-08:00
      DOI: 10.1177/1071100714549046|hwp:master-id:spfai;1071100714549046
      Issue No: Vol. 36, No. 1 (2014)
  • Ultrasound-Guided Alcohol Injection for Morton's Neuroma
    • Authors: Pasquali, C; Vulcano, E, Novario, R, Varotto, D, Montoli, C, Volpe, A.
      Pages: 55 - 59
      Abstract: Background: Ultrasonography-guided alcohol injection (USGAI) of Morton’s neuroma represents an alternative to operative treatment. Nonetheless, the literature only reports few small studies evaluating the effectiveness of the treatment. The aim of the present retrospective study was to assess the effectiveness of USGAI to treat Morton’s neuroma in 508 patients at 2 medical centers. Methods: Between January 2001 and January 2012, 508 patients with 540 Morton’s neuroma had USGAI for Morton’s neuroma. Only second and third web-space neuromas were included in this study. Results: A mean number of 3.0 (range, 1 to 4) injections were performed for each neuroma. Mean local inflammatory reaction was 0.7 (range, 0 to 2). There were no other local or systemic complications. The overall mean pre-USGAI VAS score was 8.7 (range, 6 to 10), while the post-USGAI VAS score at 1 year was 3.6 (range, 0 to 9). The delta VAS between the pre- and post-USGAI was statistically significant (P < .0001). At 1-year follow-up 74.5% of patients were satisfied with the procedure. Conclusion: USGAI produced encouraging results in over 500 patients affected by Morton’s neuroma. The procedure proved to be safe in all patients. Level of Evidence: Level IV, retrospective case series.
      PubDate: 2014-12-30T16:10:11-08:00
      DOI: 10.1177/1071100714551386|hwp:master-id:spfai;1071100714551386
      Issue No: Vol. 36, No. 1 (2014)
  • Fractures of the Hallux in Children
    • Authors: Petnehazy, T; Schalamon, J, Hartwig, C, Eberl, R, Kraus, T, Till, H, Singer, G.
      Pages: 60 - 63
      Abstract: Background: Foot fractures account for 5% to 13% of pediatric fractures. Fractures of the hallux require special attention due to its role in weight bearing, balance, and pedal motion. In this study, a large series of children with hallux fractures is presented. Methods: All children treated with fractures of the hallux between June 2004 and December 2011 were included. The medical records were analyzed and X-rays were reviewed. The fractures were classified according to their anatomic location and the type of fracture. Three hundred seventeen patients (mean age = 11.7 years; range, 1-18 years; 65% male) sustained a fracture of the hallux. Results: Most accidents (28%) occurred at sports facilities, and soccer was the most common cause of a fracture of the hallux (28%). Closed injuries were diagnosed in 92% of the patients; 8% of the children presented with open fractures. In 144 children, the growth plate was affected. Fifty-nine patients presented with diaphyseal fractures, 42 patients with osseous avulsions, and 40 patients with fractures of the distal part of the phalanx. Nineteen children had incomplete and 13 patients comminuted fractures. The vast majority of the children (86%) were treated conservatively. Operative interventions were required in 14% of the patients. Good outcome was achieved in both conservatively and operatively treated patients. Conclusion: In children, fractures of the hallux were most often caused by ball sports and had a good prognosis. The vast majority of these fractures could be treated conservatively yielding good outcome. Level of Evidence: Level IV, case series.
      PubDate: 2014-12-30T16:10:11-08:00
      DOI: 10.1177/1071100714552482|hwp:master-id:spfai;1071100714552482
      Issue No: Vol. 36, No. 1 (2014)
  • Anatomical Predisposition of the Ankle Joint for Lateral Sprain or Lateral
           Malleolar Fracture Evaluated by Radiographic Measurements
    • Authors: Lee, K. M; Chung, C. Y, Sung, K. H, Lee, S, Kim, T. G, Choi, Y, Jung, K. J, Kim, Y. H, Koo, S. B, Park, M. S.
      Pages: 64 - 69
      Abstract: Background: Injury mechanism and the amount of force are important factors determining whether a fracture or sprain occurs at the time of an ankle inversion injury. However, the anatomical differences between the ankle fracture and sprain have not been investigated sufficiently. This study was performed to investigate whether an anatomical predisposition of the ankle joint results in a lateral malleolar fracture or lateral ankle sprain. Methods: Two groups of consecutive patients, one with lateral malleolar fracture (274 patients, mean age 49.0 years) and the other with lateral ankle sprain (400 patients, mean age 38.4 years), were evaluated. Ankle radiographs were examined for 7 measures: distal tibial articular surface (DTAS) angle, bimalleolar tilt (BT), medial malleolar relative length (MMRL), lateral malleolar relative length (LMRL), medial malleolar slip angle (MMSA), anterior inclination of tibia (AI), and fibular position (FP). After an interobserver reliability test, the radiographic measurements were compared between the 2 groups. Linear regression analysis was performed to correct for age and sex effects between the groups. Results: The fracture group and the sprain group showed significant differences in BT (P = .001), MMSA (P < .001), AI (P = .023), and FP (P < .001). In multiple regression analysis, after adjusting for age and sex effects, fracture and sprain groups showed a significant difference in BT (P = .001), MMRL (P < .001), MMSA (P < .001), and FP (P < .001). Conclusions: The lateral malleolar fracture group tended to show more bony constraint than that of the lateral ankle sprain group. Further 3-dimensional assessment of the bony structure and subsequent biomechanical studies are needed to elucidate the mechanism of injury according to the various types of ankle fractures and ankle sprain. Level of Evidence: Level III, retrospective comparative study.
      PubDate: 2014-12-30T16:10:11-08:00
      DOI: 10.1177/1071100714551019|hwp:master-id:spfai;1071100714551019
      Issue No: Vol. 36, No. 1 (2014)
  • Endoscopic Repair of Posterior Ankle Impingement Syndrome Due to Os
           Trigonum in Soccer Players
    • Authors: Lopez Valerio, V; Seijas, R, Alvarez, P, Ares, O, Steinbacher, G, Sallent, A, Cugat, R.
      Pages: 70 - 74
      Abstract: Background: An os trigonum may cause posterior ankle impingement syndrome (PAIS), which may lead to poor sports performance, especially in soccer players. The aim of the present study was to analyze the outcomes of endoscopic repaired posterior ankle impingement (PAI) secondary to os trigonum syndrome within a group of soccer players as well as their return to play time. Methods: A retrospective review of 20 soccer players with Tegner activity level 9 was performed. All players were diagnosed of PAIS due to os trigonum. Chief complaint was pain produced with forced plantarflexion when kicking the ball. Conservative treatment was first performed during a 6-week rehabilitation program. When conservative treatment failed, arthroscopic surgical resection of the os trigonum was proposed. Visual analogue scale (VAS) was used to measure pain before and after surgery as well as time until their return to previous sports level. Results: VAS showed a mean preoperative pain score of 7.5 (SD = 0.9), whereas postoperative VAS at 1 month after surgery decreased to 0.8 (SD = 1.36). Mean symptomatic period was 8.5 months (SD = 4.3), from the beginning of symptoms up to the surgery day. Once patients had undergone surgery, mean time until their return to previous level of sports was 46.9 days (SD = 25.96), reaching the same pre-lesion Tegner level. Conclusions: Endoscopic treatment of posterior ankle impingement syndrome due to os trigonum showed excellent results. Hindfoot endoscopy with a posterior approach was an effective treatment and allowed for a prompt return to play in soccer players with a high activity level. Level of Evidence: Level IV, therapeutic study.
      PubDate: 2014-12-30T16:10:11-08:00
      DOI: 10.1177/1071100714552078|hwp:master-id:spfai;1071100714552078
      Issue No: Vol. 36, No. 1 (2014)
  • Influence of Contralateral Radiographs on Accuracy of Anatomic Reduction
           in Surgically Treated Calcaneus Fractures
    • Authors: Kwon, J. Y; Zurakowski, D, Ellington, J. K.
      Pages: 75 - 82
      Abstract: Background: The purpose of this study was to determine whether obtaining a radiograph of the uninjured contralateral calcaneus (template) before surgery allowed for more precise restoration of Bohler’s angle and calcaneal length when performing open reduction internal fixation (ORIF) of intra-articular calcaneus fractures. Methods: Patients who sustained an intra-articular calcaneus fracture requiring surgery who met inclusion criteria were prospectively randomized into those who had a preoperative template obtained for review at the time of ORIF (group 1) versus those who had the contralateral radiograph obtained after surgery (group 2). Results: There was no benefit of the preoperative template in allowing for more anatomic restoration of Bohler’s angle or calcaneal length. Operative time was decreased with the use of a preoperative template when using the extensile lateral or percutaneous approaches. Conclusion: Preoperative templating of the uninjured contralateral calcaneus did not allow for more anatomic reduction or restoration of pre-injury morphology of the calcaneus undergoing operative fixation as based on Bohler’s angle and calcaneal length. Templating may be of benefit by reducing operative time. Level of Evidence: Level II, prospective comparative series.
      PubDate: 2014-12-30T16:10:11-08:00
      DOI: 10.1177/1071100714552483|hwp:master-id:spfai;1071100714552483
      Issue No: Vol. 36, No. 1 (2014)
  • Effect of Posterior Tibial Tendon Dysfunction on Unipedal Standing Balance
    • Authors: Kulig, K; Lee, S.-P, Reischl, S. F, Noceti-DeWit, L.
      Pages: 83 - 89
      Abstract: Background: Foot pain and diminished functional capacity are characteristics of tibialis posterior tendon dysfunction (TPTD). This study tested the hypotheses that women with TPTD would have impaired performance of a unipedal standing balance test (USBT) and that balance performance would be related to the number of single limb heel raises (SLHR). Methods: Thirty-nine middle-aged women, 19 with early stage TPTD (stage I and II), were instructed to perform 2 tasks; a USBT and repeated SLHR. Balance success was defined as a 10-second stance. For those who were successful, center of pressure (COP) data in anterior-posterior (AP) and medial-lateral (ML) directions were recorded as a measure of postural sway. SLHR performance was divided into 3 bins (≤2; 3-9 and > 10 repetitions). The between-balance success on performing the SLHR test was analyzed using the Fisher’s exact test (2 x 3). Independent t tests were used to compare between-group differences in postural sway. Relationship of postural sway to the number of heel raises was assessed using Spearman’s rho. Results: The success rate of the USBT was significantly lower in women with TPTD than the controls (47% vs 85%, P = .041). In addition, women with TPTD who completed the USBT exhibited increased AP COP displacement (14.0 ± 7.4 vs 8.4 ± 1.3 mm, P = .008), and a strong trend of increased ML COP displacement (8.3 ± 4.5 vs 6.1 ± 1.2 mm, P = .050). The success rate of USBT was correlated with the number of SLHR (P = .01). The AP and ML COP displacement were correlated with SLHR (r = –.538 and .495), respectively. Conclusions: Women with TPTD have difficulty in performing the USBT. Performance of the USBT and SLHR are highly correlated and predictive of each other. Clinical Relevance: A unipedal balance test may be used as a proxy TPTD assessment tool to the heel raising test when pain prevents performance. Level of Evidence: Level III, case control study.
      PubDate: 2014-12-30T16:10:11-08:00
      DOI: 10.1177/1071100714551020|hwp:master-id:spfai;1071100714551020
      Issue No: Vol. 36, No. 1 (2014)
  • Finite Element Analysis of Plantar Fascia During Walking: A Quasi-static
    • Authors: Chen, Y.-N; Chang, C.-W, Li, C.-T, Chang, C.-H, Lin, C.-F.
      Pages: 90 - 97
      Abstract: Background: The plantar fascia is a primary arch supporting structure of the foot and is often stressed with high tension during ambulation. When the loading on the plantar fascia exceeds its capacity, the inflammatory reaction known as plantar fasciitis may occur. Mechanical overload has been identified as the primary causative factor of plantar fasciitis. However, a knowledge gap exists between how the internal mechanical responses of the plantar fascia react to simple daily activities. Therefore, this study investigated the biomechanical responses of the plantar fascia during loaded stance phase by use of the finite element (FE) modeling. Methods: A 3-dimensional (3-D) FE foot model comprising bones, cartilage, ligaments, and a complex-shaped plantar fascia was constructed. During the stance phase, the kinematics of the foot movement was reproduced and Achilles tendon force was applied to the insertion site on the calcaneus. All the calculations were made on a single healthy subject. Results: The results indicated that the plantar fascia underwent peak tension at preswing (83.3% of the stance phase) at approximately 493 N (0.7 body weight). Stress concentrated near the medial calcaneal tubercle. The peak von Mises stress of the fascia increased 2.3 times between the midstance and preswing. The fascia tension increased 66% because of the windlass mechanism. Conclusion: Because of the membrane element used in the ligament tissue, this FE model was able to simulate the mechanical structure of the foot. After prescribing kinematics of the distal tibia, the proposed model indicated the internal fascia was stressed in response to the loaded stance phase. Clinical Relevance: Based on the findings of this study, adjustment of gait pattern to reduce heel rise and Achilles tendon force may lower the fascia loading and may further reduce pain in patients with plantar fasciitis.
      PubDate: 2014-12-30T16:10:11-08:00
      DOI: 10.1177/1071100714549189|hwp:master-id:spfai;1071100714549189
      Issue No: Vol. 36, No. 1 (2014)
  • Comparison of Two Fixation Methods for Arthrodesis of the Calcaneocuboid
           Joint: A Biomechanical Study
    • Authors: Milshteyn, M. A; Dwyer, M, Andrecovich, C, Bir, C, Needleman, R. L.
      Pages: 98 - 102
      Abstract: Background: The traditional fixation for a calcaneocuboid (CC) arthrodesis in triple arthrodesis is with a 6.5-mm cancellous screw. This procedure can be technically challenging. Fixation with a locking compression plate (LCP) may be easier to perform while achieving compression perpendicular to the fusion site. The purpose of this study was to compare the load to failure and the stiffness for each fixation method. Methods: Five matched-pair cadaver feet had an arthrodesis of the CC joint. For each matched pair, one was fixed with a screw and the other with an LCP. Surface bead markers were applied. Each specimen was then secured to a material testing machine through the calcaneus. The plantar surface of the cuboid faced the hydraulic ram to simulate weightbearing. A force was applied while the specimen was recorded with a high-resolution camera. The endpoint was maximal force at 2-mm separation between the calcaneus and cuboid measured along a horizontal axis. Results: The average force to failure and the average stiffness in the screw group were significantly less than the LCP group (P < .05). The screw construct failed in pullout from the cuboid; the LCP construct failed by plastic deformation of the plate. Conclusion: Calcaneocuboid joint fixation with the LCP withstood a higher load until failure and demonstrated greater stiffness than with a 6.5-mm cancellous lag screw. Clinical Relevance: The use of LCP fixation can be considered as an alternative to oblique lag screw fixation for CC arthrodesis in a triple arthrodesis. It remains to be determined if LCP fixation leads to better clinical outcomes.
      PubDate: 2014-12-30T16:10:11-08:00
      DOI: 10.1177/1071100714552479|hwp:master-id:spfai;1071100714552479
      Issue No: Vol. 36, No. 1 (2014)
  • Fibulectomy, Tibial Shortening, and Ankle Arthrodesis as an Alternative
           Treatment of Nonhealing Wounds Following Open Ankle Fracture in
           Compromised Elderly Adults
    • Authors: Crespo, A. M; Rautenberg, A. F, Siev, N, Saadeh, P, Egol, K. A.
      Pages: 103 - 107
      PubDate: 2014-12-30T16:10:11-08:00
      DOI: 10.1177/1071100714550653|hwp:master-id:spfai;1071100714550653
      Issue No: Vol. 36, No. 1 (2014)
  • Arthroscopic Transfibular Approach for Removal of Bone Fragments in
           Posterior Malleolar Fracture: Technical Tip
    • Authors: Noh, K. C; Hong, D. Y, Kim, Y. T, Kadakia, A. R, Park, Y. W, Kim, H. N.
      Pages: 108 - 112
      PubDate: 2014-12-30T16:10:11-08:00
      DOI: 10.1177/1071100714551789|hwp:master-id:spfai;1071100714551789
      Issue No: Vol. 36, No. 1 (2014)
  • Hallux Metatarsophalangeal (MTP) Joint Arthroscopy for Hallux Rigidus
    • Authors: Hunt; K. J.
      Pages: 113 - 119
      Abstract: Arthroscopy of the hallux metatarsophalangeal (MTP) joint is an evolving technique for hallux rigidus and other disorders of the hallux MTP joint. Purported advantages of this minimally invasive procedure include rapid rehabilitation and the ability to identify and address other intra-articular and sesamoid pathologies without additional dissection. Larger, prospective, and comparative outcomes studies are needed to optimize the treatment algorithm. Level of Evidence: Level V, expert opinion.
      PubDate: 2014-12-30T16:10:11-08:00
      DOI: 10.1177/1071100714559728|hwp:resource-id:spfai;36/1/113
      Issue No: Vol. 36, No. 1 (2014)
  • Quality and Patient Safety
    • Authors: Pinzur; M. S.
      Pages: 120 - 120
      PubDate: 2014-12-30T16:10:11-08:00
      DOI: 10.1177/1071100714546851|hwp:resource-id:spfai;36/1/120
      Issue No: Vol. 36, No. 1 (2014)
  • Education Calendar
    • Pages: 121 - 121
      PubDate: 2014-12-30T16:10:11-08:00
      DOI: 10.1177/1071100714566402|hwp:resource-id:spfai;36/1/121
      Issue No: Vol. 36, No. 1 (2014)
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