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Foot & Ankle International

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ISSN (Print) 1071-1007
Published by Sage Publications

[676 journals]

Injectable Treatments for Noninsertional Achilles Tendinosis: A Systematic Review
- Authors: Gross, C. E; Hsu, A. R, Chahal, J, Holmes, G. B.
  Pages: 619 - 628
  Abstract: Background: Although there has been a recent increase in interest regarding injectable therapy for noninsertional Achilles tendinosis, there are currently no clear treatment guidelines for managing patients with this condition. The objective of this study was (1) to conduct a systematic review of clinical outcomes following injectable therapy of noninsertional Achilles tendinosis, (2) to identify patient-specific factors that are prognostic of treatment outcomes, (3) to provide treatment recommendations based on the best available literature, and (4) to identify knowledge deficits that require further investigation. Methods: We searched MEDLINE (1948 to March week 1 2012) and EMBASE (1980 to 2012 week 9) for clinical studies evaluating the efficacy of injectable therapies for noninsertional Achilles tendinosis. Specifically, we included randomized controlled trials and cohort studies with a comparative control group. Data abstraction was performed by 2 independent reviewers. The Oxford Level of Evidence Guidelines and GRADE recommendations were used to rate the quality of evidence and to make treatment recommendations. Results: Nine studies fit the inclusion criteria for our review, constituting 312 Achilles tendons at final follow-up. The interventions of interest included platelet-rich plasma (n = 54), autologous blood injection (n = 40), sclerosing agents (n = 72), protease inhibitors (n = 26), hemodialysate (n = 60), corticosteroids (n = 52), and prolotherapy (n = 20). Only 1 study met the criteria for a high-quality randomized controlled trial. All of the studies were designated as having a low quality of evidence. While some studies showed statistically significant effects of the treatment modalities, often studies revealed that certain injectables were no better than a placebo. Conclusions: The literature surrounding injectable treatments for noninsertional Achilles tendinosis has variable results with conflicting methodologies and inconclusive evidence concerning indications for treatment and the mechanism of their effects on chronically degenerated tendons. Prospective, randomized studies are necessary in the future to guide Achilles tendinosis treatment recommendations using injectable therapies. Level of Evidence: Level II, systematic review.
  PubDate: 2013-04-30T19:06:52-07:00
  DOI: 10.1177/1071100713475353|hwp:master-id:spfai;1071100713475353
  Issue No: Vol. 34, No. 5 (2013)
Hallux Valgus in Males--Part 1: Demographics, Etiology, and Comparative Radiology
- Authors: Nery, C; Coughlin, M. J, Baumfeld, D, Ballerini, F. J, Kobata, S.
  Pages: 629 - 635
  Abstract: Background: The high frequency of hallux valgus deformities in females is well known and has been widely reported in the literature. This finding tends to obscure the importance and the characteristic details of hallux valgus deformities in males. The severity of the deformity, its onset at an earlier age, and its inheritability seem to be more frequent in males, but there are no reports in the literature to substantiate these concepts. The purpose of this study was to analyze these questions in regard to males with hallux valgus. Methods: The records and plain radiographs of 31 males (53 feet) with a diagnosis of hallux valgus that were treated over a 20-year period (1985-2005) were analyzed. During that same period, the senior author (CN) performed 812 procedures for the correction of hallux valgus deformities in women. In order to compare gender-related differences associated with this deformity, 31 women’s charts—paired by age and affected side—were randomly selected and both clinical and radiological data were statistically compared. Results: The onset of the complaints of first ray pain in males was equally distributed by decades, indicating that the deformity begins earlier in this group. Among males, we found 68% of the subjects had a familial history of bunion deformities—58% were maternal and 10% were fraternal. In the control group of females, only 35% of the women reported inheritance of the deformity. No correlation with footwear was found among males. The radiographic measurements were significantly higher in the male group, which included the hallux valgus angle (HVA), the distal metatarsal articular angle (DMAA), and the tarsal metatarsal angle (TMA). The main gender difference was found to be the DMAA with first metatarsophalangeal (MTP) joint congruence being much more common in males (males = 57%, females = 30%). No correlations were found for metatarsus primus varus or pes planus. Conclusion: Based on our observations, we conclude that hallux valgus in males is commonly hereditary in nature and is mainly transmitted by the mother, with early onset and higher severity when compared to women. We report a female/male ratio of 15:1. The main intrinsic factor associated with a hallux valgus deformity in males is a high DMAA. Level of Evidence: Level III, retrospective comparative series.
  PubDate: 2013-04-30T19:06:52-07:00
  DOI: 10.1177/1071100713475350|hwp:master-id:spfai;1071100713475350
  Issue No: Vol. 34, No. 5 (2013)
Hallux Valgus in Males--Part 2: Radiographic Assessment of Surgical Treatment
- Authors: Nery, C; Coughlin, M. J, Baumfeld, D, Ballerini, F. J, Kobata, S.
  Pages: 636 - 644
  Abstract: Background: In an early report on this patient cohort, we concluded that a hallux valgus deformity in males is frequently hereditary in nature. An increase in the distal metatarsal articular angle (DMAA) was observed to be the major defining characteristic of hallux valgus in males. In this follow-up study, our goal was to evaluate the effectiveness of surgical treatment for this cohort of male patients. Methods: Data from 50 feet of male patients with hallux valgus who were surgically treated by the same surgeon between 1985 and 2005 were retrospectively analyzed. The technique was algorithmically chosen according to the severity and complexity of the deformity. Thus, 10 chevron osteotomies, 9 biplanar chevron osteotomies, 12 Mitchell osteotomies, 9 scarf osteotomies, and 10 basilar first metatarsal osteotomies were performed. The average follow-up was 10 years (range, 2-20). Results: After analyzing the angular radiological parameters, sesamoid subluxation, and the articular congruency, most procedures proved to have achieved adequate correction of the angular deformities. When examining each of the procedures separately, 4 of the 5 procedures had similar corrective capacities; the scarf osteotomy however had decidedly inferior results. The improvement in the postoperative American Orthopaedic Foot and Ankle Society (AOFAS) score demonstrated the clinical and functional improvement. Conclusions: The algorithm was based mainly upon the presence of increased DMAA and increased severity of angular deformities. We conclude that hallux valgus deformities in males were adequately corrected with the selected techniques. Greater difficulty or resistance to surgical treatment could not be detected when we contrasted our results to females. The scarf osteotomy proved to have an inferior corrective capacity compared to the other techniques used in this series. Level of Evidence: Level III, retrospective comparative series.
  PubDate: 2013-04-30T19:06:52-07:00
  DOI: 10.1177/1071100713475351|hwp:master-id:spfai;1071100713475351
  Issue No: Vol. 34, No. 5 (2013)
Postoperative Range of Motion Trends Following Total Ankle Arthroplasty
- Authors: Ajis, A; Henriquez, H, Myerson, M.
  Pages: 645 - 656
  Abstract: Background: It is still unknown how ankle range of motion changes following total ankle arthroplasty. This study was undertaken to more accurately address patient expectations, guide postoperative rehabilitation, and improve our understanding of how ankle range of motion changes with time. Methods: 119 total ankle replacements of 3 different prosthetic designs from 1 surgeon were retrospectively examined and compared. Ankle dorsiflexion and plantar flexion ranges of motion were calculated and analyzed preoperatively and postoperatively at 6 weeks, 3 months, 6 months, and 1 year. The different ankle replacement systems were analyzed individually and together to determine whether trends were replicated. Results: No significant increase in ankle range of motion was found 6 months postoperatively (P = .75). Mean combined postoperative range of motion did not change significantly from 24.3 degrees at 1 year versus a preoperative mean of 22.7 degrees (P = .75). Mean dorsiflexion improved significantly at the 6-week postoperative stage by 5.5 degrees (P < .001), whereas plantar flexion only improved by 2.9 degrees (P = .06). Mean dorsiflexion improved from preoperative levels by 5.4 degrees (P = .001), whereas mean plantar flexion decreased by 3.7 degrees (P = .004). Conclusions: We found no notable improvement in ankle range of motion after 6 months following total ankle arthroplasty. We also found a disproportionately higher increase in dorsiflexion compared with plantar flexion following surgery and an overall reduction in mean plantar flexion range compared with preoperative values. Notwithstanding this discrepancy, total mean ankle range of motion 1 year postoperatively was similar to preoperative values. Reasons for the discrepancy between dorsiflexion and plantar flexion are unclear. Level of Evidence: Level III, retrospective comparative study.
  PubDate: 2013-04-30T19:06:52-07:00
  DOI: 10.1177/1071100713481433|hwp:master-id:spfai;1071100713481433
  Issue No: Vol. 34, No. 5 (2013)
Ankle Arthrodesis vs TTC Arthrodesis: Patient Outcomes, Satisfaction, and Return to Activity
- Authors: Ajis, A; Tan, K.-J, Myerson, M. S.
  Pages: 657 - 665
  Abstract: Background: It is believed that patients with an ankle arthrodesis (AA) have better outcomes than after a tibiotalocalcaneal (TTC) arthrodesis due to preservation of subtalar motion. However, there are no studies comparing actual functional outcomes and patient satisfaction between AA and TTC arthrodesis. Methods: We retrospectively analyzed patient satisfaction and functional outcomes of patients after an AA and TTC arthrodesis using a postal survey. A total of 173 patients who underwent TTC and 100 AA patients from 2002 to 2010 were identified with a minimum of 24 months follow-up. In all, 53 AA and 64 TTC arthrodesis patients were included in the study, with the remainder lost to follow-up. A return to activity questionnaire and SF-12 scores were used to compare functional outcomes. The mean follow-up time was 63 months. Results: Both groups showed good outcomes with a low visual analogue pain score (2.7 for AA and 2.8 for TTC), high satisfaction score (90.6% for AA and 87.5% for TTC), and return to work (77.4% for AA and 73.0% for TTC). In all, 84.6% of AA and 81.0% of TTC patients would have the surgery again. There were no significant differences between the 2 groups for these parameters. However, when asked if their desired activity level was met, fewer AA patients met their desired level (58.5% for AA and 66.5% for TTC, P = .02). AA patients were also more likely to feel their level was unmet due to the foot and ankle (85.6% for AA vs 25.7% for TTC, P < .001). Conclusions: Both AA and TTC arthrodesis were associated with good functional outcomes and satisfaction. AA patients had higher postoperative activity expectations and were less likely to meet them. When they failed to meet these expectations, they were much more likely to attribute it to their operated ankle. We believe it is because of the different ways the 2 groups of patients are counseled preoperatively, which highlights the importance of managing patient expectations. Level of Evidence: Level III, retrospective comparative study.
  PubDate: 2013-04-30T19:06:52-07:00
  DOI: 10.1177/1071100713478929|hwp:master-id:spfai;1071100713478929
  Issue No: Vol. 34, No. 5 (2013)
Single-Stage Flexor Tendon Transfer for the Treatment of Severe Concomitant Peroneus Longus and Brevis Tendon Tears
- Authors: Jockel, J. R; Brodsky, J. W.
  Pages: 666 - 672
  Abstract: Background: Although peroneal tendon injuries are a common cause of lateral ankle pain, there is a paucity of literature specifically addressing the treatment of severe concomitant peroneus longus and brevis tears. The purpose of this study was to evaluate patient outcomes following a single-stage flexor tendon transfer for the treatment of severe concomitant tears of both peroneal tendons. Methods: Eight patients were treated with a single-stage flexor tendon transfer for severe concomitant peroneus longus and brevis tears over a 15-year period. Mean age at the time of surgery was 54 years (range, 41-67 years), including 4 male and 4 female patients. Tendon transfer of either the flexor hallucis longus (FHL) or flexor digitorum longus (FDL) was performed when both peroneal tendons were found intraoperatively to have severe nonreconstructable tears. Mean follow-up time from surgery was 58 months (range, 12-91 months). Preoperative and postoperative AOFAS hindfoot and visual analog pain scores were prospectively collected, and patient charts were reviewed for complications. A postoperative outcome questionnaire was administered during latest follow-up to assess return to activities, satisfaction, and self-rated patient outcome. Results: Mean pre- and postoperative AOFAS hindfoot scores increased from 64 (range, 54-77) to 86 (range, 69-100), whereas mean score for pain on a visual analog scale decreased from 4.2 (range, 0.5-6) to 0.7 (range, 0-3). One surgical complication occurred following FDL transfer in a patient who developed a transient peroneal nerve palsy, and 1 patient underwent a subsequent calcaneal osteotomy. Seven of 8 patients reported a return to preoperative activity levels, and no patient required bracing for activities of daily living. All patients reported satisfaction with surgical results, and 7 rated their outcomes as good or excellent. Conclusion: Single-stage flexor tendon transfer is an effective surgical option for the treatment of severe concomitant peroneus longus and brevis tendon tears. Level of Evidence: Level IV, case series.
  PubDate: 2013-04-30T19:06:52-07:00
  DOI: 10.1177/1071100712470939|hwp:master-id:spfai;1071100712470939
  Issue No: Vol. 34, No. 5 (2013)
Clinical Outcomes and Static and Dynamic Assessment of Foot Posture After Lateral Column Lengthening Procedure
- Authors: Barske, H; Chimenti, R, Tome, J, Martin, E, Flemister, A. S, Houck, J.
  Pages: 673 - 683
  Abstract: Background: Lateral column lengthening (LCL) has been shown to radiographically restore the medial longitudinal arch. However, the impact of LCL on foot function during gait has not been reported using validated clinical outcomes and gait analysis. Methods: Thirteen patients with a stage II flatfoot who had undergone unilateral LCL surgery and 13 matched control subjects completed self-reported pain and functional scales as well as a clinical examination. A custom force transducer was used to establish the maximum passive range of motion of first metatarsal dorsiflexion at 40 N of force. Foot kinematic data were collected during gait using 3-dimensional motion analysis techniques. Results: Radiographic correction of the flatfoot was achieved in all cases. Despite this, most patients continued to report pain and dysfunction postoperatively. Participants post LCL demonstrated similar passive and active movement of the medial column when we compared the operated and the nonoperated sides. However, participants post LCL demonstrated significantly greater first metatarsal passive range of motion and first metatarsal dorsiflexion during gait than did controls (P < .01 for all pairwise comparisons). Conclusion: Patients undergoing LCL for correction of stage II adult-acquired flatfoot deformity experience mixed outcomes and similar foot kinematics as the uninvolved limb despite radiographic correction of deformity. These patients maintain a low arch posture similar to their uninvolved limb. The consequence is that first metatarsal movement operates at the end range of dorsiflexion and patients do not obtain full hindfoot inversion at push-off. Longitudinal data are necessary to make a more valid comparison of the effects of surgical correction measured using radiographs and dynamic foot posture during gait. Level of Evidence: Level III, comparative series.
  PubDate: 2013-04-30T19:06:52-07:00
  DOI: 10.1177/1071100712471662|hwp:master-id:spfai;1071100712471662
  Issue No: Vol. 34, No. 5 (2013)
Prospective Study of the Treatment of Adult Primary Hallux Valgus With Scarf Osteotomy and Soft Tissue Realignment
- Authors: Choi, J. H; Zide, J. R, Coleman, S. C, Brodsky, J. W.
  Pages: 684 - 690
  Abstract: Background: The scarf osteotomy has been a widely practiced bunion operation, but relatively limited prospective data on its outcomes have been reported. The purpose of this investigation was to prospectively evaluate the clinical and radiographic results of treatment of adult primary hallux valgus using the scarf osteotomy of the first metatarsal with soft tissue realignment. Methods: Hallux valgus corrections were performed on 51 patients (53 feet), who were followed for at least 1 year with an average follow-up of 24 months. Mean age at the time of surgery was 59 years, and subjects included 3 male and 48 female patients. Prospective clinical data collected included the American Orthopaedic Foot & Ankle Society (AOFAS) hallux-interphalangeal scale score, the SF-36 scores, and the visual analogue scale (VAS) for pain. Data were collected preoperatively and postoperatively. Prospective radiologic data were also collected including hallux valgus angle (HVA), first-second intermetatarsal angle (IMA), and medial sesamoid position (MSP). Clinical data were collected on complications and reoperations. Results: Mean AOFAS hallux-interphalangeal score increased from 52 preoperatively to 88 postoperatively. Mean preoperative and last follow-up SF-36 physical component summary increased from 46 preoperatively to 52 postoperatively, whereas mean VAS pain scores decreased from 5.8 preoperatively to 1.1 postoperatively. All the changes in clinical outcomes were statistically significant, except the Mental Component Summary of the SF-36. Mean preoperative HVA decreased from 29 degrees preoperatively to 10.7 degrees in the initial postoperative period and was maintained at last follow-up at 10.6 degrees. The mean preoperative IMA decreased from 13.6 degrees preoperatively to 5.6 degrees in the initial postoperative period and regressed mildly at last follow-up to 7.8 degrees. The mean preoperative MSP grade of 2.3 decreased to 0.5 in the initial postoperative period and regressed mildly to 0.9 at last follow-up. All radiographic changes were statistically significant. The overall complication rate was 15% (8/53), attributable to 4 feet with symptomatic hardware, 2 feet with hallux varus, and 2 feet with progression of first MTP arthritis. Reoperations were performed in 4 feet (8%) for removal of symptomatic hardware. Conclusion: Scarf osteotomy was a reliable technique for correction of moderate to severe hallux valgus and had low rates of complication or recurrence. Level of Evidence: Level IV, case series.
  PubDate: 2013-04-30T19:06:52-07:00
  DOI: 10.1177/1071100712472489|hwp:master-id:spfai;1071100712472489
  Issue No: Vol. 34, No. 5 (2013)
Prognostic Classification of Fifth Metatarsal Stress Fracture Using Plantar Gap
- Authors: Lee, K. T; Park, Y. U, Jegal, H, Park, J. W, Choi, J. P, Kim, J. S.
  Pages: 691 - 696
  Abstract: Background: There have been diverse results even in same Torg type of fifth metatarsal stress fractures. Methods: Eighty-six cases with a fifth metatarsal stress fracture that were treated with modified tension band wiring from January 2003 to May 2009 were evaluated retrospectively. Each case was classified according to Torg’s classification and a new classification. Using the new proposed classification, cases were subdivided into complete fracture and incomplete fracture. The cases of incomplete fracture were subdivided based on presence or absence of plantar gap more than 1 mm. After surgery, bone union was determined by CT. Statistical analysis of the Torg classification and time for bone union as well as the proposed new classification and time for bone union was performed. Results: There was a significant difference in the time for bone union among the three Torg types (P = 0.004). The mean time for bone union in group A (complete fracture, n = 32) was 67.5 ± 28.8, and it was 103.2 ± 47.7 for group B (incomplete fracture, n = 54). There was a significant difference in time for bone union between them (P < 0.001). The mean time for bone union in group B1 (incomplete fracture, plantar gap less than 1 mm, n = 16) was 73.9 ± 26.7, and it was 115.5 ± 45.4 for group B2 (incomplete fracture, plantar gap 1 mm or more, n = 38). There was a significant difference in time for bone union between them (P < 0.001). Conclusion: The results of this study suggest that the classification incorporating the plantar gap might be used for classification of fifth metatarsal stress fractures. Level of Evidence: Level III, retrospective comparative series.
  PubDate: 2013-04-30T19:06:53-07:00
  DOI: 10.1177/1071100713475349|hwp:master-id:spfai;1071100713475349
  Issue No: Vol. 34, No. 5 (2013)
Role of Preoperative Computed Tomography Scans in Operative Planning for Malleolar Ankle Fractures
- Authors: Black, E. M; Antoci, V, Lee, J. T, Weaver, M. J, Johnson, A. H, Susarla, S. M, Kwon, J. Y.
  Pages: 697 - 704
  Abstract: Background: There remains no consensus regarding the role of computed tomography (CT) scans in preoperative planning for malleolar ankle fractures. The aim of this study was to determine the role of preoperative CT scans on operative planning in these fractures. Methods: A retrospective analysis was performed on 100 consecutive patients treated at our institution for malleolar ankle fractures (AO type 44) with both preoperative radiographs and CT scans. Six study participants reviewed available radiographs and formulated an operative (or nonoperative) plan including positioning, operative approach, and fixation. Participants then analyzed CT scans of the same fractures, deciding whether (and how) they would alter operative strategy. Characteristics of fractures and radiographs were correlated with changes in operative strategy. Results: Operative strategy was notably changed in 24% of cases after CT review, with strong intraclass correlation (0.733). Common changes included alterations in medial malleolar (21%) or posterior malleolar (15%) fixation and fixation of an occult anterolateral plafond fracture (9%). Notable predictors of changes in operative strategy included trimalleolar over unimalleolar fractures (29% vs 10% rate of change), preoperative dislocation over no dislocation (31% vs 20%), the presence of only radiographs with overlying plaster versus fractures with at least 1 set of radiographs without plaster (25% vs 14%), and suprasyndesmotic versus trans- and infra-syndesmotic fractures (40% vs 20% and 4%, respectively). Conclusions: CT scans may be useful adjuncts in preoperative planning for malleolar ankle fractures, most notably in fracture dislocations, cases in which all available radiographs are obscured by plaster, trimalleolar fractures, and suprasyndesmotic fractures. Level of Evidence: Level III, retrospective comparative study.
  PubDate: 2013-04-30T19:06:53-07:00
  DOI: 10.1177/1071100713475355|hwp:master-id:spfai;1071100713475355
  Issue No: Vol. 34, No. 5 (2013)
Influence of Approach and Implant on Reduction Accuracy and Stability in Lisfranc Fracture-Dislocation at the Tarsometatarsal Joint
- Authors: Schepers, T; Oprel, P. P, Van Lieshout, E. M. M.
  Pages: 705 - 710
  Abstract: Background: Besides early diagnosis, an anatomical and stable reduction is paramount for obtaining a favorable outcome. The current study looked at the influence that the type of approach for tarsometatarsal injuries has on the accuracy of the reduction and the effect that the type of fixation has on stability. Methods: Consecutive patients treated surgically for an acute Lisfranc injury were included. All radiographs were reassessed for accuracy and secondary displacement following either a closed or an open approach and in terms of the type of fixation (Kirschner wires alone or a combination of screws and plates and Kirschner wires). A total of 28 patients were included. Six patients were treated with closed reduction and percutaneous fixation and 22 with open reduction internal fixation. Sixteen patients were treated with Kirschner wires only (6 closed, 10 open), 7 with screws with or without Kirschner wires, and 5 with medial plating with or without Kirschner wires. Results: In the closed reduction group, 2 of 6 (33%) reductions were considered acceptable versus 19 of 22 (86%) in the open group (P = .021). All 6 secondary displacements occurred in the Kirschner wire fixation group (37.5%) versus none in the rigid fixation group (P = .024). Conclusion: The results demonstrate that open reduction and internal fixation with screws or plate resulted in better reduction and better maintenance of reduction in both low- and high-energy Lisfranc injuries. These results should be further evaluated in light of functional outcome. Level of Evidence: Level III, retrospective comparative case series.
  PubDate: 2013-04-30T19:06:53-07:00
  DOI: 10.1177/1071100712468581|hwp:master-id:spfai;1071100712468581
  Issue No: Vol. 34, No. 5 (2013)
Minimally Invasive Reconstruction of Lateral Ligaments of the Ankle Using Semitendinosus Autograft
- Authors: Wang, B; Xu, X.-Y.
  Pages: 711 - 715
  Abstract: Background: Multiple techniques have been described for reconstruction of the lateral ligaments of the ankle. Most require extensive exposure and dissection, which may lead to potential problems with wound healing, higher risk of nerve injury, fibrosis, and stiffness. This study reports on the results of a minimally invasive method to reconstruct the ligaments using a semitendinosus tendon autograft and achieve a stable ankle while avoiding these problems. Materials and Methods: From September 2006 to May 2010, 25 patients (14 males, 11 females) with chronic ankle instability underwent lateral ligament reconstruction. The average age was 32.4 (range, 17 to 62) years old. A semitendinosus autograft was harvested through 2 small knee incisions. For the ankle reconstruction, 4 small incisions of 5 mm each were made at the medial and lateral side of the fibular tip, the talar neck, and the middle of the calcaneus. Anatomical reconstruction of the anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL) was then performed through these small incisions. The mean final follow-up was 32.3 (range, 12 to 56) months. AOFAS questionnaires were used to measure clinical outcomes and donor site morbidity and patient satisfaction are also reported. Preoperative and postoperative stress tests were performed and radiographic parameters were measured. Results: The mean AOFAS score increased on average from 71.1 to 95.1 (P < .001). Two patients reported residual instability on uneven ground. No patient reported weakness or disability from the donor site. The satisfaction level was excellent in 20 patients and good in 5 patients. Significant improvement in stress radiographic parameters was noted for the talar tilt angle, with reduction from a mean of 14.0 to 3.8 degrees (P < .001); anterior talar displacement reduced from a mean of 12.3 to 4.6 mm (P < .001). Conclusion: Reconstruction of the lateral ankle ligaments using a semitendinosus tendon autograft and a minimally invasive approach can achieve a stable ankle while avoiding extensive exposure and risk of nerve injury. Level of Evidence: Level IV, retrospective case series.
  PubDate: 2013-04-30T19:06:53-07:00
  DOI: 10.1177/1071100713478916|hwp:master-id:spfai;1071100713478916
  Issue No: Vol. 34, No. 5 (2013)
Metatarsal Head Resurfacing for Advanced Hallux Rigidus
- Authors: Kline, A. J; Hasselman, C. T.
  Pages: 716 - 725
  Abstract: Background: Advanced stages of first metatarsophalangeal (MTP) arthritis have traditionally been treated with various arthroplasties or arthrodesis. Studies suggest the outcomes of arthrodesis are superior to those of metallic joint replacement; however, complications and suboptimal outcomes in active patients still remain with arthrodesis of the first MTP joint. This study reports results of patients with advanced MTP arthritis who underwent metallic resurfacing of the metatarsal side of the MTP joint. Methods: From 2005 to 2006, 26 patients (30 implants) with stage II or III hallux rigidus underwent resurfacing with the HemiCAP® implant and consented to participate in a study comparing pre- and postoperative radiographs, range of motion (ROM), American Orthopedic Foot and Ankle Society, and Short Form 36 Health Survey (SF-36) scores. Average age of these patients was 51 years. Patients were assessed at a mean of 27 months with outcome measures and contacted at 60 months to assess current symptoms and satisfaction. Results: Assessment at 27 months demonstrated statistically significant improvements in ROM, AOFAS, and SF-36 scores (P < .05) when compared to baseline. Mean preoperative AOFAS scores improved from 51.5 to 94.1. Mean active ROM improved from 19.7 to 47.9 degrees. Mean passive ROM improved from 28.0 to 66.3 degrees. Mean RAND SF-36 physical component score improved significantly from 66.7 to 90.6. Average time for return to work was 7 days. At 60 months, all patients reported excellent satisfaction with their current state and would repeat the procedure. Implant survivorship was 87% at 5 years. Of the 30 implants, 4 were revised at 3 years. Conclusion: The results at 5 years were very promising. Preservation of joint motion, alleviation of pain, and functional improvement data were very encouraging. Because minimal joint resection was performed, conversion to arthrodesis or other salvage procedures would be relatively simple if further intervention became necessary. Level of Evidence: Level IV, prospective case series.
  PubDate: 2013-04-30T19:06:53-07:00
  DOI: 10.1177/1071100713478930|hwp:master-id:spfai;1071100713478930
  Issue No: Vol. 34, No. 5 (2013)
Reconstruction of Calcaneal Fracture Malunion With Osteotomy and Subtalar Joint Salvage: Technique and Outcomes
- Authors: Yu, G.-R; Hu, S.-J, Yang, Y.-F, Zhao, H.-M, Zhang, S.-M.
  Pages: 726 - 733
  Abstract: Background: The goal of this study was to discuss the outcomes of treating calcaneal fracture malunion by restoring the subtalar joint with a reconstructive osteotomy. Methods: From May 2005 to November 2008, 24 patients (26 feet) with calcaneal malunions after a displaced intra-articular calcaneal fracture were treated by osteotomy and autogenous bone graft. The subtalar joint was preserved. The mean time from initial injury to reconstructive operation was 5.7 months (95% confidence interval, 4.5-8.8 months). The displaced posterior facet was restored through a reconstructive osteotomy, whereas the bone defect in the calcaneus after reduction was filled with the exostosis that had been removed; iliac bone graft was used if necessary. All patients were evaluated clinically and radiographically at a minimum of 24 months. Twenty patients (21 feet) were followed for a mean of 34.2 months (29.0-39.4 months). Results: According to American Orthopaedic Foot & Ankle Society (AOFAS) ankle and hindfoot score, the average score was 85.9 points (95% confidence interval, 81.5-90.4 points), which was significantly higher than the preoperative assessment. Radiographs showed that Böhler’s angle, Gissane’s angle, talus declination angle, and width and height of calcaneus were improved to a great extent. Six patients had wound edge necrosis, and 2 had superficial infection. One patient required a subtalar fusion for subtalar arthritis at 2 years after surgery. Conclusions: Restoring the subtalar joint with a reconstructive osteotomy and autogenous bone graft was an effective treatment method for selected calcaneal fracture malunions. It reconstructed calcaneal morphology and preserved the subtalar joint. Level of Evidence: Level IV, retrospective case series.
  PubDate: 2013-04-30T19:06:53-07:00
  DOI: 10.1177/1071100713479766|hwp:master-id:spfai;1071100713479766
  Issue No: Vol. 34, No. 5 (2013)
Syndesmosis Fixation Using Dual 3.5 mm and 4.5 mm Screws With Tricortical and Quadricortical Purchase: A Biomechanical Study
- Authors: Markolf, K. L; Jackson, S. R, McAllister, D. R.
  Pages: 734 - 739
  Abstract: Background: Grade 3 syndesmosis (high ankle) sprains of the ankle are frequently treated using screws that fix the distal fibula to the tibia. We hypothesized that forces acting on the distal fibula and displacements of the distal fibula relative to the tibia recorded during simulated ankle loading tests would be significantly affected by syndesmosis screw size and the number of engaged tibial cortices. Methods: Distal fibular forces and displacements were measured after cutting the distal inferior tibiofibular ligaments and fixing the distal fibula to the distal fibula with 2 syndesmosis screws. Screws of 3.5 mm and 4.5 mm were applied with tricortical and quadricortical purchase. Results: There were no significant differences in distal fibular forces or displacements between any combination of screw size and cortical purchase tested. The highest mean fibular force recorded in the study (110.2 N) occurred when 10 N-m of external foot torque was applied to a dorsiflexed ankle loaded with 1000 N axial weight-bearing force. For ankle dorsiflexion and external foot torque tests, the distal fibula always displaced posteriorly with respect to the tibia. Mean displacements of the fibula from 1000 N applied axial weight-bearing force (maximum 0.15 mm) and from 10 N-m of forced foot dorsiflexion (maximum 0.43 mm) were considerably less than those from 10 N-m external foot torque (1.7 mm to 2.7 mm). Conclusions: Screw size and the number of engaged tibial cortices had no significant effect on mechanical stability of the distal fibula during these tests. Application of external foot torque (internal tibial torque) to a weight-bearing ankle produced the greatest bending displacements of the screws, and should be avoided during rehabilitation to reduce the possibility of screw breakage. Clinical Relevance: In terms of mechanical stability, surgeons may have considerable flexibility with regard to screw fixation of high ankle sprains.
  PubDate: 2013-04-30T19:06:53-07:00
  DOI: 10.1177/1071100713478923|hwp:master-id:spfai;1071100713478923
  Issue No: Vol. 34, No. 5 (2013)
Cannulated Screw Delivery of Bone Marrow Aspirate Concentrate to a Stress Fracture Nonunion: Technique Tip
- Authors: Adams, S. B; Lewis, J. S, Gupta, A. K, Parekh, S. G, Miller, S. D, Schon, L. C.
  Pages: 740 - 744
  PubDate: 2013-04-30T19:06:53-07:00
  DOI: 10.1177/1071100713478918|hwp:master-id:spfai;1071100713478918
  Issue No: Vol. 34, No. 5 (2013)
Pyoderma Gangrenosum Following Foot and Ankle Surgery: A Case Report
- Authors: Melo Grollmus, R; Fernandez de Retana, P.
  Pages: 745 - 748
  PubDate: 2013-04-30T19:06:53-07:00
  DOI: 10.1177/1071100712471661|hwp:master-id:spfai;1071100712471661
  Issue No: Vol. 34, No. 5 (2013)
Significance of Flake Fracture With Medial Malleolar Fracture
- Authors: Malik, A. K; Mehta, S, Solan, M.
  Pages: 749 - 752
  PubDate: 2013-04-30T19:06:53-07:00
  DOI: 10.1177/1071100713478920|hwp:master-id:spfai;1071100713478920
  Issue No: Vol. 34, No. 5 (2013)
Intraoperative O-arm Computed Tomography Evaluation of Syndesmotic Reduction: Case Report
- Authors: Hsu, A. R; Gross, C. E, Lee, S.
  Pages: 753 - 759
  PubDate: 2013-04-30T19:06:53-07:00
  DOI: 10.1177/1071100712468872|hwp:master-id:spfai;1071100712468872
  Issue No: Vol. 34, No. 5 (2013)
Myxoma of a Lesser Toe Distal Phalynx: Case Report and Technique Tip
- Authors: Konkel, K. F; Sizensky, J. A, Iossi, M. F.
  Pages: 760 - 763
  PubDate: 2013-04-30T19:06:53-07:00
  DOI: 10.1177/1071100712471337|hwp:master-id:spfai;1071100712471337
  Issue No: Vol. 34, No. 5 (2013)
Appropriateness of Surgery
- Authors: Pinzur; M. S.
  Pages: 764 - 765
  PubDate: 2013-04-30T19:06:53-07:00
  DOI: 10.1177/1071100712469339|hwp:resource-id:spfai;34/5/764
  Issue No: Vol. 34, No. 5 (2013)
Posterior Pilon Fractures
- Authors: Chen, D.-w; Li, B, Yang, Y.-f, Yu, G.-r.
  Pages: 766 - 767
  PubDate: 2013-04-30T19:06:53-07:00
  DOI: 10.1177/1071100713484008|hwp:resource-id:spfai;34/5/766
  Issue No: Vol. 34, No. 5 (2013)
Response
- Authors: Kadakia, A. R; Klammer, G, Joos, D. A, Seybold, J. D, Espinosa, N.
  Pages: 768 - 769
  PubDate: 2013-04-30T19:06:53-07:00
  DOI: 10.1177/1071100713487177|hwp:resource-id:spfai;34/5/768
  Issue No: Vol. 34, No. 5 (2013)
Education Calendar
- Pages: 770 - 770
  PubDate: 2013-04-30T19:06:53-07:00
  DOI: 10.1177/1071100713488875|hwp:resource-id:spfai;34/5/770
  Issue No: Vol. 34, No. 5 (2013)