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Moon SJ, Choi Y, Chung CY, Sung KH, Cho BC, Chung MK, Kim J, Yoo MS, Lee HM, Park MS. Normative Values of Physical Examinations Commonly Used for Cerebral Palsy. Yonsei Med J 2017; 58:1170-1176. [PMID: 29047241 PMCID: PMC5653482 DOI: 10.3349/ymj.2017.58.6.1170] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 07/02/2017] [Accepted: 08/03/2017] [Indexed: 11/27/2022] Open
Abstract
PURPOSE The aim of this study was to establish normative values and to identify age-related change in physical examinations that are commonly used while evaluating patients with cerebral palsy (CP). MATERIALS AND METHODS One hundred four healthy volunteers (mean age 36 years, standard deviation 15 years) were enrolled and divided into four age groups: 13-20, 21-35, 36-50, and 51 years and older. The eighteen physical examination tests for CP were selected by five orthopedic surgeons in consensus-building session. The measurements were taken by three orthopedic surgeons. RESULTS There was no significant difference in the measures of physical examination among all the age groups, except for the Staheli test (p=0.002). The post hoc test revealed that the mean hip extension was 2.7° higher in the 13-20-year-old group than in the other age groups. The bilateral popliteal angle had a tendency to increase in those over 36-years-old. There were 31 participants (30%) with a unilateral popliteal angle greater than 40°. CONCLUSION We documented normative values that can be widely used for evaluating CP in patients 13 years and older.
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Affiliation(s)
- Seung Jun Moon
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Young Choi
- Department of Orthopaedic Surgery, Kosin University Gospel Hospital, Busan, Korea
| | - Chin Youb Chung
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Ki Hyuk Sung
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Byung Chae Cho
- Department of Orthopaedic Surgery, Seoul Jaeil Hospital, Pyeongtaek, Korea
| | - Myung Ki Chung
- Department of Orthopaedic Surgery, Kangwon National University Hospital, Chuncheon, Korea
| | - Jaeyoung Kim
- Department of Orthopaedic Surgery, H Plus Yangji Hospital, Seoul, Korea
| | - Mi Sun Yoo
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hyung Min Lee
- Department of Orthopaedic Surgery, Kosin University Gospel Hospital, Busan, Korea
| | - Moon Seok Park
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea.
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Xu Y, Cao YX, Li XC, Zhu Y, Xu XY. Double calcaneal osteotomy for severe adolescent flexible flatfoot reconstruction. J Orthop Surg Res 2017; 12:153. [PMID: 29041945 PMCID: PMC5645836 DOI: 10.1186/s13018-017-0655-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 10/11/2017] [Indexed: 12/05/2022] Open
Abstract
Background The timing and strategy of treatment for flatfoot still remain controversial. It is a difficult problem when facing severe adolescent flexible flatfoot because a single procedure cannot realign flatfoot deformity effectively. Methods We reviewed 13 adolescent flexible flatfoot patients who underwent double calcaneal osteotomy during May 2012 to June 2015. The mean age of patients was 15.2 ± 1.8 (range, 10–18) years. The American Orthopaedic Foot and Ankle Society Ankle-Hindfoot (AOFAS-AH) scores and SF-36 score were adopted to evaluate the preoperative and postoperative functions of the foot. Changes of hindfoot valgus angles, talonavicular uncoverage angles on AP view and talo-first metatarsal angles, and talar pitch angles and calcaneal pitch angles on the lateral film before and after surgery were measured. Results All 13 patients (15 ft) were followed. The mean duration of follow-up was 34.5 ± 15.7 (range, 21–60) months. The hindfoot valgus angle improved from 16.5 ± 4.1 to 2.9 ± 1.6. On the foot AP view, the mean preoperative and postoperative talonavicular coverage angles were 24.9 ± 8.5 and 6.5 ± 3.6. On the lateral view of the foot, the average preoperative and postoperative talo-first metatarsal angles were 18.1 ± 5.5 and 4.9 ± 4.4. The mean preoperative and postoperative talar pitch angles were 36.4 ± 4.7 and 24.0 ± 5.6. The AOFAS-AH score improved from 68.9 ± 12.3 preoperatively to 94.6 ± 3.9 postoperatively. Conclusion With additional procedures, double calcaneal osteotomy was an effective method for severe adolescent flexible flatfoot.
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Affiliation(s)
- Yang Xu
- Department of Orthopedics, Shanghai Ruijin Hospital North, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yong-Xing Cao
- Department of Orthopedics, Shanghai Ruijin Hospital North, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Xing-Chen Li
- Department of Orthopedics, Shanghai Ruijin Hospital North, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yuan Zhu
- Department of orthopedics, Shanghai Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, China
| | - Xiang-Yang Xu
- Department of orthopedics, Shanghai Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, China.
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Hoefnagels EM, Belkoff SM, Swierstra BA. Gastrocnemius recession: A cadaveric study of surgical safety and effectiveness. Acta Orthop 2017; 88:411-415. [PMID: 28403726 PMCID: PMC5499333 DOI: 10.1080/17453674.2017.1314157] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - Many methods of gastrocnemius lengthening have been described, with different surgical challenges, outcomes, and risks to the sural nerve. Our aims were (1) to locate the gastrocnemius muscular-tendinous junction in relation to the mid-length of the fibula (from here on designated the mid-fibula), (2) to compare the dorsiflexion achieved with dorsal recession or ventral recession, and (3) to determine the risk of injury to the sural nerve during gastrocnemius recession. Methods - In 10 pairs of fresh-frozen adult cadaveric lower extremities transected above the knee, we measured dorsiflexion, performed dorsal or ventral gastrocnemius recession at the mid-fibula, and then measured the increase in dorsiflexion and fasciotomy gap. We noted the course of the sural nerve and whether the gastrocnemius muscle provided it with enough muscular coverage to protect it during recession. Results - Dorsal and ventral recession produced statistically (p < 0.05) and clinically significant mean increases in dorsiflexion with extended knee from 12° to 19°, but they were not statistically significantly different from each other in this measure or in fasciotomy gap size. At the mid-fibula, the sural nerve coursed superficially between both heads of the gastrocnemius muscle in 14 of 20 specimens. Sufficient gastrocnemius muscle coverage to protect the sural nerve was provided by the medial head in 18 of 20 specimens and by the lateral head in only 5 of 20 specimens. Interpretation - A ventral gastrocnemius recession proximal to the mid-fibula level poses less risk to the sural nerve than a recession at the mid-fibula. This procedure provides adequate lengthening (1-3 cm) and increased dorsiflexion (compared with baseline), with less risk to the sural nerve than is incurred with recession at the mid-fibular reference line.
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Affiliation(s)
- Eva M Hoefnagels
- Department of Orthopedics, Sint Maartenskliniek, Nijmegen, the Netherlands;,Correspondence:
| | - Stephen M Belkoff
- International Center for Orthopedic Advancement, Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, MD, USA
| | - Bart A Swierstra
- Department of Orthopedics, Sint Maartenskliniek, Nijmegen, the Netherlands
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Abstract
Joint disruptions to the tarsometatarsal (TMT) joint complex, also known as the Lisfranc joint, represent a broad spectrum of pathology from subtle athletic sprains to severe crush injuries. Although injuries to the TMT joint complex are uncommon, when missed, they may lead to pain and dysfunction secondary to posttraumatic arthritis and arch collapse. An understanding of the appropriate anatomy, mechanism, physical examination, and imaging techniques is necessary to diagnose and treat injuries of the TMT joints. Nonsurgical management is indicated in select patients who maintain reduction of the TMT joints under physiologic stress. Successful surgical management of these injuries is predicated on anatomic reduction and stable fixation. Open reduction and internal fixation remains the standard treatment, although primary arthrodesis has emerged as a viable option for certain types of TMT joint injuries.
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Calcaneus Exostectomy and Achilles Tendon Reattachment for the Treatment of Haglund Deformity. TECHNIQUES IN FOOT AND ANKLE SURGERY 2017. [DOI: 10.1097/btf.0000000000000150] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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106
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Rodríguez-Sanz D, Losa-Iglesias ME, López-López D, Calvo-Lobo C, Palomo-López P, Becerro-de-Bengoa-Vallejo R. Infrared thermography applied to lower limb muscles in elite soccer players with functional ankle equinus and non-equinus condition. PeerJ 2017; 5:e3388. [PMID: 28560116 PMCID: PMC5446768 DOI: 10.7717/peerj.3388] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 05/08/2017] [Indexed: 11/20/2022] Open
Abstract
Gastrocnemius-soleus equinus (GSE) is a foot-ankle complaint in which the extensibility of the gastrocnemius (G) and soleus muscles (triceps surae) and ankle are limited to a dorsiflexion beyond a neutral ankle position. The asymmetric forces of leg muscles and the associated asymmetric loading forces might promote major activation of the triceps surae, tibialis anterior, transverses abdominal and multifidus muscles. Here, we made infrared recordings of 21 sportsmen (elite professional soccer players) before activity and after 30 min of running. These recordings were used to assess temperature modifications on the gastrocnemius, tibialis anterior, and Achilles tendon in GSE and non-GSE participants. We identified significant temperature modifications among GSE and non-GSE participants for the tibialis anterior muscle (mean, minimum, and maximum temperature values). The cutaneous temperature increased as a direct consequence of muscle activity in GSE participants. IR imaging capture was reliable to muscle pattern activation for lower limb. Based on our findings, we propose that non-invasive IR evaluation is suitable for clinical evaluation of the status of these muscles.
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Affiliation(s)
- David Rodríguez-Sanz
- Physical Therapy & Health Sciences Research Group; Physiotherapy Department, Faculty of Health, Exercise and Sport, European University, Madrid, Spain
| | | | - Daniel López-López
- Research, Health and Podiatry Unit, Department of Health Sciences, Faculty of Nursing and Podiatry, Universidade da Coruña, Ferrol, Spain
| | - César Calvo-Lobo
- Nursing and Physical Therapy Department, Institute of Biomedicine (IBIOMED), Universidad de León, León, Spain
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Holtmann JA, Südkamp NP, Schmal H, Mehlhorn AT. Gastrocnemius Recession Leads to Increased Ankle Motion and Improved Patient Satisfaction After 2 Years of Follow-Up. J Foot Ankle Surg 2017; 56:589-593. [PMID: 28476392 DOI: 10.1053/j.jfas.2017.01.037] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2015] [Indexed: 02/03/2023]
Abstract
The isolated gastrocnemius contracture present in neurologic healthy patients results in a significant limitation of ankle dorsiflexion causing pathologic gait patterns and a greater risk of further foot disorders. Gastrocnemius recession is an established procedure to increase ankle dorsiflexion. However, little evidence is available of the use of gastrocnemius recession in these patients. Complication rates, recurrence of gastrocnemius contracture, and the prevalence of additional foot disorders needs further evaluation. A study group of 64 operated limbs undergoing gastrocnemius recession was evaluated to determine the prevalence of foot disorders, pre- and postoperative ankle dorsiflexion, and incidence of complications. A subgroup of 15 (23.4%) patients without additional operative procedures was examined regarding ankle dorsiflexion, strength (Janda method), sensitivity in the operated limb, and the pre- and postoperative Foot Function Index scores. The prevalence of foot disorders showed pes planus (41%), hallux valgus (38%), metatarsalgia (19%), hammertoe deformity (13%), and symptomatic Haglund exostosis (11%). At 31 months of follow-up, the patients had significantly benefited from increased ankle dorsiflexion of 13.3° ± 7.9° (p < .001). Postoperatively, 16% patients experienced complications. In the subgroup of 15 patients, the follow-up examination after 44 months showed ankle dorsiflexion of 14° ± 7.1°. The plantarflexion strength was 4 of 5 (Janda method). The Foot Function Index score had improved significantly from 65.4 ± 26.5 points to 33.4 ± 19.5 points (p < .001). Patients with isolated gastrocnemius contracture seem to have a high prevalence of symptomatic foot disorders. At a mid-term follow-up examination, gastrocnemius recession (Strayer) was shown to be an effective procedure to significantly improve ankle dorsiflexion, functionality, and pain symptoms. More attention should be given to the development of postoperative complications.
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Affiliation(s)
- Julia Alessandra Holtmann
- Orthopaedic Resident, Department of Orthopedic and Trauma Surgery, Inselgruppe Spital Tiefenau, Bern, Switzerland.
| | - Norbert P Südkamp
- Professor, Department of Orthopedic and Trauma Surgery, University Medical Center, Freiburg, Germany
| | - Hagen Schmal
- Professor, Department of Orthopedic and Trauma Surgery, University Medical Center, Freiburg, Germany; Orthopaedic Surgeon, Department of Orthopedics and Traumatology, Odense University Hospital, Odense, Denmark; Orthopaedic Surgeon, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Alexander T Mehlhorn
- Assistant Professor, Department of Orthopedic and Trauma Surgery, University Medical Center, Freiburg, Germany; Orthopaedic Surgeon, Center of Foot and Ankle Surgery, Schön Klinik München Harlaching, Munich, Germany
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108
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Abstract
Gastrocnemius contracture is a common condition associated with painful overload symptoms in the forefoot and midfoot. Multiple techniques have been described for the recession of gastrocnemius tendon in patients who failed nonsurgical treatment. We present an endoscopic recession technique for the release of the gastrocnemius tendon just distal to the level of the musculotendinous junction as a minimally invasive operative option. This technique aims to decrease wound complications, unsightly scar, overlengthening, and postoperative pain, while having versatility for performing with supine or prone positioning.
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Affiliation(s)
- Phinit Phisitkul
- 1 Department of Orthopaedics and Rehabilitation, University of Iowa, Iowa City, IA, USA
| | - Alexej Barg
- 2 Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA
| | - Annunziato Amendola
- 3 Department of Orthopedic Surgery, Chief, Division of Sports Medicine, Duke University, Durham, NC, USA
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109
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Abstract
Equinus is linked to most lower extremity biomechanically related disorders. Defining equinus as ankle joint dorsiflexion less than 5° of dorsiflexion with the knee extended is the basis for evaluation and management of the deformity. Consistent evaluation methodology using a goniometer with the subtalar joint in neutral position and midtarsal joint supinated while dorsiflexing the ankle with knee extended provides a consistent clinical examination. For equinus deformity with an associated disorder, comprehensive treatment mandates treatment of the equinus deformity. Surgical treatment of equinus offers multiple procedures but the Baumann gastrocnemius recession is preferred based on deformity correction without weakness.
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Affiliation(s)
- Patrick A DeHeer
- Surgery Department, Indiana University Health North Hospital, Carmel, IN, USA; Surgery Department, Johnson Memorial Hospital, Franklin, IN, USA; Department of Podiatric Medicine and Radiology, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA.
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Kaplan N, Fowler X, Maqsoodi N, DiGiovanni B, Oh I. Operative Anatomy of the Medial Gastrocnemius Recession vs the Proximal Medial Gastrocnemius Recession. Foot Ankle Int 2017; 38:424-429. [PMID: 28367689 DOI: 10.1177/1071100716682993] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Isolated gastrocnemius contracture (IGC) is associated with various foot and ankle pathologies. To address the problem of IGC, a number of gastrocnemius lengthening procedures have been described. Although proximal medial gastrocnemius recession (PMGR) has shown to be an effective operative treatment for IGC, it poses risks to various anatomic structures around the knee joint and requires the patient to be positioned prone. As an alternative, we proposed to release the medial gastrocnemius at the division between the proximal one-third and distal two-thirds of the gastrocnemius muscle to correct equinus contracture, while minimizing risk to other structures. The aim of this study was to describe an anatomic basis for a medial gastrocnemius recession (MGR) and to investigate the anatomic structures at risk in comparison to PMGR. METHODS Eight cadaveric lower leg specimens were used in the study. The standard PMGR and the novel MGR were performed on each specimen. After completion of the 2 procedures, complete dissection was performed to investigate the distances between surgically released fascia margins and surrounding anatomic structures, including the greater saphenous vein, small saphenous vein, saphenous nerve, medial sural cutaneous nerve, semimembranosus tendon, tibial nerve, and popliteal artery. The mean distances were calculated and the shortest distances for each structure were reported. RESULTS Proximities of anatomic structures to surgically released gastrocnemius fascia at the medial and lateral margins were notably different between the 2 techniques. For the PMGR, the semimembranosus tendon (95% confidence interval of 2.4-7.4 mm), small saphenous vein (3.4-10.0 mm), popliteal artery (3.9-9.3 mm), and tibial nerve (5.0-11.1 mm) were in greater proximity to the operative margin. For the MGR, the greater saphenous vein (5.3-17.6 mm) and saphenous nerve (5.1-18.6 mm) were at greater risk. CONCLUSIONS MGR at the proximal one-third of the gastrocnemius muscle may be a safe alternative for operative treatment of IGC. CLINICAL RELEVANCE We identified the major structures at risk when performing the proximal medial gastrocnemius release and propose a novel, possibly safer alternative for the medial gastrocnemius release.
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Affiliation(s)
- Nathan Kaplan
- 1 Department of Orthopaedics and Rehabilitation, University of Rochester Medical Center, Rochester, NY, USA
| | - Xavier Fowler
- 2 School of Medicine and Dentistry, University of Rochester Medical Center, Rochester, NY, USA
| | - Noorullah Maqsoodi
- 3 Rochester Institute of Technology, School of Medicine and Dentistry, University of Rochester Medical Center, Rochester, NY, USA
| | | | - Irvin Oh
- 2 School of Medicine and Dentistry, University of Rochester Medical Center, Rochester, NY, USA
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Searle A, Spink MJ, Ho A, Chuter VH. Association between ankle equinus and plantar pressures in people with diabetes. A systematic review and meta-analysis. Clin Biomech (Bristol, Avon) 2017; 43:8-14. [PMID: 28167343 DOI: 10.1016/j.clinbiomech.2017.01.021] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 12/20/2016] [Accepted: 01/30/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Diabetes is one of the most common chronic diseases in the world and is associated with a life-time risk of foot ulcer of 12-25%. Diabetes related restriction in ankle joint range of dorsiflexion is proposed to contribute to elevated plantar pressures implicated in the development of foot ulcers. METHODS A systematic search of EBSCO Megafile Premier (containing MEDLINE, CINAHL, SPORTSdiscus and Academic Search Complete) and The Cochrane Library was conducted to 23rd November 2016. Two authors independently reviewed and selected relevant studies. Meta-analysis of study data were conducted where possible. FINDINGS Fifteen studies met the inclusion criteria. Three studies were eligible to be included in the meta-analysis which found that equinus has a significant, but small, effect on increased plantar pressures (ES=0.26, CI 95% 0.11 to 0.41, p=0.001). Of the remaining studies, eight found evidence of an association between limited ankle dorsiflexion and increased plantar pressures while four studies found no relationship. INTERPRETATION Limited ankle joint dorsiflexion may be an important factor in elevating plantar pressures, independent of neuropathy. Limited ankle dorsiflexion and increased plantar pressures were found in all the studies where the sample population had a history of neuropathic foot ulceration. In contrast, the same association was not found in those studies where the population had neuropathy and no history of foot ulcer. Routine screening for limited ankle dorsiflexion range of motion in the diabetic population would allow for early provision of conservative treatment options to reduce plantar pressures and lessen ulcer risk.
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Affiliation(s)
- A Searle
- School of Health Sciences, Faculty of Health, University of Newcastle, Australia.
| | - M J Spink
- School of Health Sciences, Faculty of Health, University of Newcastle, Australia
| | - A Ho
- School of Psychology, Faculty of Science and Information Technology, University of Newcastle, Australia
| | - V H Chuter
- School of Health Sciences, Faculty of Health, University of Newcastle, Australia
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112
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Abstract
Gastrocnemius equinus is a frequent comorbidity with traumatic injuries of the foot and ankle. Gastrocnemius lengthening at the time of definitive treatment facilitates obtaining and maintaining an anatomic reduction of the injury. The lengthening procedure is accomplished in 5 steps and results in fewer long-term, problematic sequelae.
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113
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Naraghi R, Bremner A, Slack-Smith L, Bryant A. The relationship between foot posture index, ankle equinus, body mass index and intermetatarsal neuroma. J Foot Ankle Res 2016; 9:46. [PMID: 27980684 PMCID: PMC5131555 DOI: 10.1186/s13047-016-0179-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Accepted: 11/25/2016] [Indexed: 11/25/2022] Open
Abstract
Background The main purpose of this study was to investigate the presence of an association between intermetatarsal neuroma and foot type, as measured by the Foot Posture Index. The study also examined whether there was a relationship between foot type and the interspace affected with intermetatarsal neuroma, and whether ankle equinus or body mass index had an effect. Methods In total, 100 participants were recruited from The University of Western Australia’s Podiatry Clinic, 68 of whom were diagnosed with inter-metatarsal neuroma from 2009 to 2015. There were 32 control participants recruited from 2014 to 2015. The age of subjects was recorded, as were weight and height, which were used to calculate body mass index. The foot posture index and ankle dorsiflexion were measured using standard technique. Independent t-tests and Kruskal-Wallis tests were used to compare differences in foot posture index, body mass index and ankle dorsiflexion between the inter-metatarsal neuroma and control groups. Multivariable logistic regression was also used to model relationships for outcome. Results The 68 intermetatarsal neuroma subjects had a mean age of 52 years (range 20 to 74 years) and comprised of 56 females and 12 males. The 32 control subjects had a mean age of 49 years (range 24 to 67 years) with 26 females and six males. There were no significant differences between the control and the intermetatarsal neuroma groups with respect to the mean foot posture index scores of the left and right foot (p = 0.21 and 0.87, respectively). Additionally no significant differences were detected between the affected intermetatarsal neuroma interspace and foot posture index (p = 0.27 and 0.47, respectively). There was no significant difference in mean body mass index between the intermetatarsal neuroma (26.9 ± 5.7) and control groups (26.5 ± 4.1) (p = 0.72). There was, however, a significant difference in mean ankle dorsiflexion between the intermetatarsal neuroma and control groups (p < 0.001 for both feet). Logistic regression models, adjusted for age, sex, foot posture index and body mass index estimated that the odds of having an intermetatarsal neuroma in the right foot increased by 61% (OR 1.61; 95% CI 1.32–1.96) with each one degree reduction of ankle dorsiflexion, and in the left foot by 43% (OR 1.43; 95% CI 1.22–1.69). Conclusion No relationships were found between foot posture index and body mass index with intermetatarsal neuroma, or between foot posture index and the interspaces affected. However, a strong association was demonstrated between the presence of intermetatarsal neuroma and a restriction of ankle dorsiflexion.
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Affiliation(s)
- Reza Naraghi
- School of Surgery, Podiatric Medicine Unit M422, The University of Western Australia, 35 Stirling Highway, Crawley, WA 6009 Australia
| | - Alexandra Bremner
- School of Population Health M431, The University of Western Australia, 35 Stirling Highway, Crawley, WA 6009 Australia
| | - Linda Slack-Smith
- School of Dentistry M512, The University of Western Australia, 35 Stirling Highway, Crawley, WA 6009 Australia
| | - Alan Bryant
- School of Surgery, Podiatric Medicine Unit M422, The University of Western Australia, 35 Stirling Highway, Crawley, WA 6009 Australia
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114
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Patients With Insertional Achilles Tendinopathy Exhibit Differences in Ankle Biomechanics as Opposed to Strength and Range of Motion. J Orthop Sports Phys Ther 2016; 46:1051-1060. [PMID: 27796197 DOI: 10.2519/jospt.2016.6462] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Study Design Controlled laboratory study; cross-sectional. Background Little is known about ankle range of motion (ROM) and strength among patients with insertional Achilles tendinopathy (IAT) and whether limited ankle ROM and plantar flexor weakness impact IAT symptom severity. Objectives The purposes of the study were (1) to examine whether participants with IAT exhibit limited non-weight-bearing dorsiflexion ROM, reduced plantar flexor strength, and/or altered ankle biomechanics during stair ascent; and (2) to determine which impairments are associated with symptom severity. Methods Participants included 20 patients with unilateral IAT (mean ± SD age, 59 ± 8 years; 55% female) and 20 individuals without tendinopathy (age, 58.2 ± 8.5 years; 55% female). A dynamometer was used to measure non-weight-bearing ROM and isometric plantar flexor strength. Three-dimensional motion analysis was used to quantify ankle biomechanics during stair ascent. End-range dorsiflexion was quantified as the percentage of non-weight-bearing dorsiflexion used during stair ascent. Group differences were compared using 2-way and 1-way analyses of variance. Pearson correlations were used to test for associations among dependent variables and symptom severity. Results Groups differed in ankle biomechanics, but not non-weight-bearing ROM or strength. During stair ascent, the IAT group used greater end-range dorsiflexion (P = .03), less plantar flexion (P = .02), and lower peak ankle plantar flexor power (P = .01) than the control group. Higher end-range dorsiflexion and lower ankle power during stair ascent were associated with greater symptom severity (P<.05). Conclusion Patients with IAT do not experience restrictions in non-weight-bearing dorsiflexion ROM or isometric plantar flexor strength. However, altered ankle biomechanics during stair ascent were linked with greater symptom severity and likely contribute to decreased function. J Orthop Sports Phys Ther 2016;46(12):1051-1060. Epub 29 Oct 2016. doi:10.2519/jospt.2016.6462.
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115
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Abstract
BACKGROUND Several studies report performing a recession of the gastrocnemius tendon as surgical treatment of foot and ankle pain related to an isolated gastrocnemius contracture. Few report ankle range of motion using a validated measurement device or report a control group. All previous studies reporting measurements using a validated device have been small in number. METHODS Using a previously validated device, 66 patients presenting with foot or ankle pain and 66 controls were measured for ankle range of motion and isolated gastrocnemius contractures. Clinical and goniometer measurement of ankle range of motion was also performed. RESULTS The foot and ankle pain group had a mean dorsiflexion of 11.6 degrees compared with a mean of 17.2 degrees in the control group (P < .0001). No patients in either group had less than 15 degrees of motion with the knee flexed. The difference in dorsiflexion was less using a goniometer than using the validated device, which may be due to measurement technique and external landmarks. CONCLUSION Patients with foot and ankle pain had less ankle dorsiflexion than the control group. This is the largest study to date using a validated measurement device as well as a control group and supports the findings of previous authors. LEVEL OF EVIDENCE Level II, prospective cohort study.
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Affiliation(s)
- James R Jastifer
- Borgess Orthopedics, Kalamazoo, MI, USA .,Homer Stryker, MD, School of Medicine, Western Michigan University, Kalamazoo, MI, USA
| | - Jessica Marston
- Homer Stryker, MD, School of Medicine, Western Michigan University, Kalamazoo, MI, USA
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Xu Y, Li XC, Xu XY. Calcaneal Z Lengthening Osteotomy Combined With Subtalar Arthroereisis for Severe Adolescent Flexible Flatfoot Reconstruction. Foot Ankle Int 2016; 37:1225-1231. [PMID: 27402620 DOI: 10.1177/1071100716658975] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The timing and strategy for operative treatment of flatfoot are still controversial. The purpose of this study was to evaluate clinical outcomes and radiographic changes following calcaneal Z osteotomy combined with subtalar arthroereisis for severe adolescent flexible flatfoot. METHODS Data were analyzed for 16 patients (20 feet) who had flatfoot without tibialis posterior tendon dysfunction and were treated by calcaneal Z osteotomy combined with arthroereisis between October 2011 and February 2015. The mean age of patients at the time of surgery was 12.8 ± 1.4 years (range, 10-14 years). Preoperative and postoperative measurements included changes in hindfoot valgus angles; changes in talonavicular uncoverage angles on anteroposterior (AP) radiographic view; and changes in talo-first metatarsal angles, talar pitch angles, and calcaneal pitch angles on lateral radiographic view. The American Orthopaedic Foot & Ankle Society Ankle-Hindfoot Score (AOFAS-AH) was used to assess foot function. The mean follow-up was 18.9 ± 6.9 months (range, 13-33 months). RESULTS The hindfoot valgus angle improved from 14.9 ± 4.2 degrees to 2.3 ± 1.7 degrees. On the AP view, the preoperative and postoperative talonavicular uncoverage angles were 30.5 ± 9.4 degrees and 9.8 ± 4.8 degrees, respectively. On lateral radiographs, the preoperative talo-first metatarsal angle, talar pitch angle, and calcaneal pitch angle were -22.1 ± 7.9 degrees, 36.1 ± 4.4 degrees, and 14.4 ± 4.0 degrees, respectively. Postoperative lateral radiographs demonstrated talo-first metatarsal angle, talar pitch angle, and calcaneal pitch angle of -6.2 ± 4.7 degrees, 27.3 ± 4.9 degrees, and 19.0 ± 4.3 degrees, respectively. The AOFAS-AH score improved from 66.8 ± 24.1 preoperatively to 96.5 ± 3.4 postoperatively. CONCLUSIONS For adolescents with flatfoot, calcaneal Z osteotomy combined with subtalar arthroereisis provided satisfactory results. LEVEL OF EVIDENCE Level IV, retrospective case series.
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Affiliation(s)
- Yang Xu
- Department of Orthopedics, Shanghai Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.,Shanghai Institute of Traumatology and Orthopedics, Shanghai, China
| | - Xing-Chen Li
- Department of Orthopedics, Shanghai Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.,Shanghai Institute of Traumatology and Orthopedics, Shanghai, China
| | - Xiang-Yang Xu
- Department of Orthopedics, Shanghai Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China .,Shanghai Institute of Traumatology and Orthopedics, Shanghai, China
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Villanueva M, Iborra Á, Rodríguez G, Sanz-Ruiz P. Ultrasound-guided gastrocnemius recession: a new ultra-minimally invasive surgical technique. BMC Musculoskelet Disord 2016; 17:409. [PMID: 27716217 PMCID: PMC5048654 DOI: 10.1186/s12891-016-1265-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2016] [Accepted: 09/24/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Isolated gastrocnemius contracture is thought to lead to numerous conditions. Although many techniques have been described for gastrocnemius recession, potential anesthetic, cosmetic, and wound-related complications can lead to patient dissatisfaction. Open and endoscopic recession techniques require epidural anesthesia, lower limb ischemia, and stitches and may lead to damage of the sural nerve, which is not under the complete control of the surgeon at all stages of the procedure. The purpose of this study was to evaluate the safety and efficacy of a new technique based on ultrasound-guided ultra-minimally invasive gastrocnemius recession. METHODS We performed a pilot study with 22 cadavers to ensure that the technique was effective and safe. In the second phase, we prospectively performed gastrocnemius recession in 23 patients (25 cases) with chronic non-insertional Achilles tendinopathy, equinus foot, and other indications. In the clinical study, we evaluated the range of dorsiflexion before and after the procedure, clinical outcomes with VAS and AOFAS scores, and potential complications, including neurovascular injuries. RESULTS We achieved complete release of the gastrocnemius tendon in all cases in the cadaveric study, with no damage to the sural nerve or vessels and minimal damage to the underlying muscle fibers. Ankle dorsiflexion increased for every patient in the study (mean, 14°; standard deviation, 3°) and was maintained throughout follow-up. The mean preoperative VAS score was 7 (6-9), which improved to 0 (0-1). The AOFAS Ankle-Hindfoot Score improved from a mean of 30 (20-40) to 93 (85-100) at 6 months. No major complications were observed. All patients returned to their previous sports after 6 months. CONCLUSIONS After cadaveric and clinical study, we considered the technique to be safe and effective to perform ultrasound-guided ultra-minimally invasive gastrocnemius recession using a 1-mm incision in vivo. This novel technique represents an alternative to open techniques, with encouraging results and with the advantages of reducing pain, obviating lower limb ischemia, deeper anaesthesia, thus decreasing complications and contraindications and accelerating recovery.
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Affiliation(s)
- Manuel Villanueva
- Avanfi Institute and Unit for Ultrasound-guided Surgery, Hospital Beata María Ana, Calle Orense 32., 28020, Madrid, Spain.
| | - Álvaro Iborra
- Avanfi Institute and Unit for Ultrasound-guided Surgery, Hospital Beata María Ana, Calle Orense 32., 28020, Madrid, Spain
| | - Guillermo Rodríguez
- Avanfi Institute and Unit for Ultrasound-guided Surgery, Hospital Beata María Ana, Calle Orense 32., 28020, Madrid, Spain
| | - Pablo Sanz-Ruiz
- Orthopaedic and Trauma Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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Liu RW, Xie KK. Association between Achilles tightness and lower extremity injury in children. HSS J 2016; 12:245-249. [PMID: 27703418 PMCID: PMC5026660 DOI: 10.1007/s11420-016-9506-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 05/04/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND It is unclear whether isolated gastroc/soleus tightness can increase the risk of lower extremity injury in an otherwise healthy child. QUESTIONS/PURPOSES (1) Is there a difference in gastroc/soleus tightness, as represented by ankle dorsiflexion with the knee extended, in children presenting with upper versus lower extremity complaints? (2) Is there a difference in gastroc/soleus tightness in children presenting with atraumatic versus traumatic lower extremity complaints? METHODS We performed a cross-sectional study of 206 consecutive walking age children presenting to a county orthopedic clinic with new upper or lower extremity complaints. Passive ankle dorsiflexion was measured based on the lateral border of the foot versus the anterior lower leg with the knee fully extended and the foot in inversion. RESULTS Average age was 10.0 ± 4.5 years. In the 117 patients presenting with upper extremity complaints, ankle dorsiflexion was 15.0° ± 11.6°. Of the lower extremity patients, 40 presented without trauma, with dorsiflexion of 11.8° ± 14.5°, while 49 presented with trauma, with dorsiflexion of 6.5° ± 12.0°. Multiple regression analysis found significantly decreased ankle dorsiflexion with increasing age and in the lower extremity trauma group. Twelve percent of upper extremity patients had 0° or less of dorsiflexion, as compared to 25% of lower extremity nontrauma patients and 41% of lower extremity trauma patients. CONCLUSIONS Patients presenting with lower extremity trauma had significantly more gastroc/soleus tightness in their well leg than patients presenting with upper extremity complaints. Gastroc/soleus tightness may present a simple target for reducing lower extremity injury rates in children.
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Affiliation(s)
- Raymond W. Liu
- Division of Pediatric Orthopaedic Surgery, Case Western Reserve University, Rainbow Babies and Children’s Hospital, 11100 Euclid Avenue, RBC 6081, Cleveland, OH 44106 USA
| | - Katherine K. Xie
- Division of Pediatric Orthopaedic Surgery, Case Western Reserve University, Rainbow Babies and Children’s Hospital, 11100 Euclid Avenue, RBC 6081, Cleveland, OH 44106 USA
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Ankle dorsiflexion: what is normal? Development of a decision pathway for diagnosing impaired ankle dorsiflexion and M. gastrocnemius tightness. Arch Orthop Trauma Surg 2016; 136:1203-1211. [PMID: 27418341 DOI: 10.1007/s00402-016-2513-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Impaired ankle dorsiflexion (ADF) is known to increase forefoot pressure, which is associated to various pathologies affecting the foot and ankle. M. gastrocnemius tightness (MGT) is its most common cause. Up to date we are missing a standardized examination procedure, norm values, and a valid decision pathway to diagnose impaired ADF and MGT. The aim of this study was to define norm values for ADF using a standardized examination procedure. These were used to define a decision pathway to diagnose impaired ADF and MGT. MATERIALS AND METHODS 64 young, asymptomatic subjects were examined. Based on a standardized examination procedure, bilateral ADF, both with the knee extended and flexed, non-weight bearing and weight bearing, was assessed by three investigators. Inter-rater test reliability and norm values for ADF were calculated. Side differences were analyzed. ADF differences between the knee extended and flexed were calculated. RESULTS The standardized examination procedure revealed high ICC values (0.876-0.915). ADF values with the knee extended for the left/right limb were 22.7° ± 5.9° [95 % CI 21.2°-24.3°]/23.4° ± 6.5° [95 % CI 21.7°-25.1°] non-weight bearing and 33.3° ± 5.5° [95 % CI 31.9°-34.7°]/33.6° ± 5.6° [95 % CI 32.1°-35.0°] weight bearing. Physiological side differences with the knee extended were <6° (95 % CI). Knee flexion resulted in an approximate ADF increase of 10°. CONCLUSIONS Based on an extensive systematic approach, physiological values for ADF were assessed in a large asymptomatic population. This allowed the definition of a decision pathway to diagnose impaired ADF and MGT. Patients presenting with pathologies associated with impaired ADF should be examined according to the herein presented examination protocol. This systematic approach provides a consistent definition of impaired ADF and MGT, which is the prerequisite to study the effectiveness of treatment strategies for MGT.
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Amis J. The Split Second Effect: The Mechanism of How Equinus Can Damage the Human Foot and Ankle. Front Surg 2016; 3:38. [PMID: 27512692 PMCID: PMC4961717 DOI: 10.3389/fsurg.2016.00038] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Accepted: 06/14/2016] [Indexed: 01/03/2023] Open
Abstract
We are currently in the process of discovering that many, if not the majority, of the non-traumatic acquired adult foot and ankle problems are caused by a singular etiology: non-neuromuscular equinus or the isolated gastrocnemius contracture. There is no question that this biomechanical association exists and in time much more will be uncovered. There are three basic questions that must be answered: why would our calves tighten as we normally age, how does a tight calf, or equinus, actually cause problems remotely in the foot and ankle, and how do the forces produced by equinus cause so many seemingly unrelated pathologies in the foot and ankle? The purpose of this paper is to address the second question: how does a tight calf mechanically cause problems remotely in the foot and ankle? There has been little evidence in the literature addressing the biomechanical mechanisms by which equinus creates damaging forces upon the foot and ankle, and as a result, a precise, convincing mechanism is still lacking. Thus, the mere concept that equinus has anything to do with foot pathology is generally unknown or disregarded. The split second effect, described here, defines exactly how the silent equinus contracture creates incremental and significant damage and injury to the human foot and ankle resulting in a wide variety of pathological conditions. The split second effect is a dissenting theory based on 30 years of clinical and academic orthopedic foot and ankle experience, keen clinical observation along the way, and review of the developing literature, culminating in examination of many hours of slow motion video of normal and abnormal human gait. To my knowledge, no one has ever described the mechanism in detail this precise.
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Affiliation(s)
- James Amis
- Department of Orthopaedic Surgery, University of Cincinnati , Cincinnati, OH , USA
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Baumbach SF, Braunstein M, Regauer M, Böcker W, Polzer H. Diagnosis of Musculus Gastrocnemius Tightness - Key Factors for the Clinical Examination. J Vis Exp 2016. [PMID: 27500825 DOI: 10.3791/53446] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Common foot and ankle pathologies have been linked to isolated Musculus gastrocnemius tightness (MGT). Various examination techniques have been described to assess MGT. Still, a standardized examination procedure is missing. Literature argues for weightbearing examination but the degree of knee flexion needed to eliminate the restraining effect of the M. gastrocnemius on ankle dorsiflexion (ADF) is unknown. This manuscript investigates the effect of knee flexion on ankle dorsiflexion and provides a detailed description of a standardized examination protocol. Examination on 20 healthy individuals revealed, that 20° of knee flexion is sufficient to fully eliminate the influence of the M. gastrocnemius on ADF. This builds the prerequisite for a standardized examination for MGT. Non-weightbearing and weightbearing examination of ADF has to be conducted with the knee fully extended and at least 20° flexed. Two investigators should conduct non-weightbearing testing with the subject in supine position. In order to obtain reliable results, the axis of the fibula should be marked. One examiner can conduct weightbearing examination with the subject in lunge stance. Isolated MGT is present if ADF is impaired with the knee fully extended and knee flexion results in a significant ADF increase. The herein presented standardized examination is the prerequisite for future studies aiming at establishing norm values.
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Affiliation(s)
- Sebastian F Baumbach
- Foot and Ankle Surgery, Munich University Hospital; Department of Trauma Surgery, Munich University Hospital
| | - Mareen Braunstein
- Foot and Ankle Surgery, Munich University Hospital; Department of Trauma Surgery, Munich University Hospital
| | - Markus Regauer
- Foot and Ankle Surgery, Munich University Hospital; Department of Trauma Surgery, Munich University Hospital
| | | | - Hans Polzer
- Foot and Ankle Surgery, Munich University Hospital; Department of Trauma Surgery, Munich University Hospital;
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Chimenti RL, Forenza A, Previte E, Tome J, Nawoczenski DA. Forefoot and rearfoot contributions to the lunge position in individuals with and without insertional Achilles tendinopathy. Clin Biomech (Bristol, Avon) 2016; 36:40-5. [PMID: 27209257 DOI: 10.1016/j.clinbiomech.2016.05.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Revised: 03/14/2016] [Accepted: 05/09/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND Clinicians use the lunge position to assess and treat restricted ankle dorsiflexion. However, the individual forefoot and rearfoot contributions to dorsiflexion and the potential for abnormal compensations are unclear. The purposes of this case-control study were to 1) compare single- (representing a clinical lunge position measure) versus multi-segment contributions to dorsiflexion, and 2) determine if differences are present in patients with tendinopathy. METHODS 32 individuals (16 with insertional Achilles tendinopathy and 16 age- and gender-matched controls) participated. Using three-dimensional motion analysis, the single-segment model was defined as tibial inclination relative to the whole foot. The multi-segment model consisted of rearfoot (tibia relative to calcaneus) and forefoot (1st metatarsal relative to calcaneus) motion. Two-way (kinematic model and group) analyses of variance were used to assess differences in knee bent and straight positions. Associations between models were tested with Pearson correlations. FINDINGS Single-segment modeling resulted in ankle DF values 5° greater than multi-segment modeling that isolated rearfoot dorsiflexion for knee bent and straight positions (P<0.01). Compared to controls, the tendinopathy group had 10° less dorsiflexion with the knee bent (P<0.01). For the tendinopathy group, greater dorsiflexion was strongly associated with greater rearfoot (r=0.95, P<0.01) and forefoot (r=0.81, P<0.01) dorsiflexion. For controls, dorsiflexion was strongly associated with rearfoot (r=0.87, P<0.01) but not forefoot dorsiflexion (r=0.23, P=0.39). INTERPRETATION Clinically used single-segment models of ankle dorsiflexion overestimate rearfoot dorsiflexion. Participants with insertional Achilles tendinopathy may compensate for restricted and/or painful ankle dorsiflexion by increased lowering of the medial longitudinal arch (forefoot dorsiflexion) with the lunge position.
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Affiliation(s)
- R L Chimenti
- University of Rochester, School of Nursing, 255 Crittenden Blvd, Rochester, NY 14642, United States.
| | - A Forenza
- Ithaca College, Program in Physical Therapy, 953 Danby Rd, Ithaca, NY 14850, United States
| | - E Previte
- Ithaca College, Program in Physical Therapy, 953 Danby Rd, Ithaca, NY 14850, United States
| | - J Tome
- Ithaca College, Program in Physical Therapy, 953 Danby Rd, Ithaca, NY 14850, United States
| | - D A Nawoczenski
- University of Rochester, Department of Orthopaedics, 601 Elmwood Ave, Rochester, NY 14642, United States
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Nawoczenski DA, DiLiberto FE, Cantor MS, Tome JM, DiGiovanni BF. Ankle Power and Endurance Outcomes Following Isolated Gastrocnemius Recession for Achilles Tendinopathy. Foot Ankle Int 2016; 37:766-75. [PMID: 26989087 DOI: 10.1177/1071100716638128] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Studies have demonstrated improved ankle dorsiflexion and pain reduction following a gastrocnemius recession (GR) procedure. However, changes in muscle performance during functional activities are not known. The purpose of this study was to determine the effect of an isolated GR on ankle power and endurance in patients with Achilles tendinopathy. METHODS Fourteen patients with chronic unilateral Achilles tendinopathy and 10 healthy controls participated in this study. Patient group data were collected 18 months following GR. Pain was compared to preoperative values using a 10-cm visual analog scale (VAS). Patient-reported outcomes for activities of daily living (ADL) and sports were assessed using the Foot and Ankle Ability Measure (FAAM). Kinematic and kinetic data were collected during gait, stair ascent (standard and high step), and repetitive single-limb heel raises. Between-group and side-to-side differences in ankle plantarflexor muscle power and endurance were evaluated with appropriate t tests. RESULTS Compared with preoperative data, VAS pain scores were reduced (pre 6.8, post 1.6, P < .05). Significant differences were observed between GR and Control groups for FAAM scores for both ADL (GR 90.0, Control 98.3, P = .01) and Sports subscales (GR 70.6, Control 94.6, P = .01). When compared to controls, ankle power was reduced in the involved limb of the GR group for all activities (all P < .05). Between-group and side-to-side deficits (GR group only) were also found for ankle endurance. CONCLUSION The gastrocnemius recession procedure provided significant pain reduction that was maintained at the 18-month follow-up for patients with chronic Achilles tendinopathy who failed nonoperative interventions. There were good patient-reported outcomes for activities of daily living. However, compared to controls, ankle plantarflexion power and endurance deficits in the GR group were noted. The functional implications of the muscle performance deficits are unclear, but may be reflective of patients' self-reported difficulty during more challenging activities. LEVEL OF EVIDENCE Level III, comparative study.
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Affiliation(s)
- Deborah A Nawoczenski
- Department of Orthopaedics and Rehabilitation, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Frank E DiLiberto
- Department of Physical Therapy, Rosalind Franklin University of Medicine & Science, North Chicago, IL, USA
| | - Maxwell S Cantor
- Physical Therapist, Wellesley Therapeutic Services, Holliston, MA, USA
| | - Josh M Tome
- School of Health Science and Human Performance, Ithaca College, Ithaca, NY, USA
| | - Benedict F DiGiovanni
- Department of Orthopaedics and Rehabilitation, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
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Morales-Muñoz P, De Los Santos Real R, Barrio Sanz P, Pérez JL, Varas Navas J, Escalera Alonso J. Response to "Letter Regarding: Proximal Gastrocnemius Release in the Treatment of Mechanical Metatarsalgia". Foot Ankle Int 2016; 37:792-3. [PMID: 27440058 DOI: 10.1177/1071100716654967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Lin CH, Chiang SL, Lu LH, Wei SH, Sung WH. Validity of an ankle joint motion and position sense measurement system and its application in healthy subjects and patients with ankle sprain. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2016; 131:89-96. [PMID: 27265051 DOI: 10.1016/j.cmpb.2016.03.026] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2015] [Revised: 03/04/2016] [Accepted: 03/29/2016] [Indexed: 06/05/2023]
Abstract
BACKGROUND AND OBJECTIVE Ankle motion and proprioception in multiple axis movements are crucial for daily activities. However, few studies have developed and used a multiple axis system for measuring ankle motion and proprioception. This study was designed to validate a novel ankle haptic interface system that measures the ankle range of motion (ROM) and joint position sense in multiple plane movements, investigating the proprioception deficits during joint position sense tasks for patients with ankle instability. METHODS Eleven healthy adults (mean ± standard deviation; age, 24.7 ± 1.9 years) and thirteen patients with ankle instability were recruited in this study. All subjects were asked to perform tests to evaluate the validity of the ankle ROM measurements and underwent tests for validating the joint position sense measurements conducted during multiple axis movements of the ankle joint. Pearson correlation was used for validating the angular position measurements obtained using the developed system; the independent t test was used to investigate the differences in joint position sense task performance for people with or without ankle instability. RESULTS The ROM measurements of the device were linearly correlated with the criterion standards (r = 0.99). The ankle instability and healthy groups were significantly different in direction, absolute, and variable errors of plantar flexion, dorsiflexion, inversion, and eversion (p < 0.05). CONCLUSIONS The results demonstrate that the novel ankle joint motion and position sense measurement system is valid and can be used for measuring the ankle ROM and joint position sense in multiple planes and indicate proprioception deficits for people with ankle instability.
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Affiliation(s)
- Chueh-Ho Lin
- School of Gerontology Health Management and Master Program in Long-Term Care, Taipei Medical University, Taipei, Taiwan
| | | | - Liang-Hsuan Lu
- Department of Physical Therapy and Assistive Technology, National Yang-Ming University, Taipei, Taiwan
| | - Shun-Hwa Wei
- Department of Physical Therapy and Assistive Technology, National Yang-Ming University, Taipei, Taiwan
| | - Wen-Hsu Sung
- Department of Physical Therapy and Assistive Technology, National Yang-Ming University, Taipei, Taiwan.
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Morales-Muñoz P, De Los Santos Real R, Barrio Sanz P, Pérez JL, Varas Navas J, Escalera Alonso J. Proximal Gastrocnemius Release in the Treatment of Mechanical Metatarsalgia. Foot Ankle Int 2016; 37:782-9. [PMID: 27036137 DOI: 10.1177/1071100716640612] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Gastrocnemius shortening causes an equinus deformity that may clinically manifest in foot disorders, including metatarsalgia. We use this term to describe pain localized to the metatarsal heads. The purposes of this prospective study were to review the effect of medial gastrocnemius proximal release on ankle dorsiflexion and assess the outcome of this technique on pain and functional limitations in patients who have mechanical metatarsalgia and isolated gastrocnemius shortening. METHODS We prospectively followed a consecutive series of 78 feet in 52 patients with metatarsalgia who had an isolated gastrocnemius contracture assessed with the Silfverskiöld test. Surgical release was evaluated with visual analog scale (VAS) and American Orthopaedic Foot & Ankle Society (AOFAS) scales. Ankle dorsiflexion was measured at 1, 3, and 6 months postoperatively. RESULTS Preoperative values of VAS and AOFAS were 7.4 and 46.8, respectively. After 3 months postoperatively, the values were 3.0 and 81.7, and 6 months after surgery these values were 3.5 and 83.6. No patient worsened clinically. There were no major complications. Thirty-six patients (69.2%) were completely satisfied with the results of the surgery. Preoperatively, ankle dorsiflexion with the knee straight was -17.5 degrees, which improved to 2.5 degrees at 6 months postoperatively. CONCLUSION We believe proximal medial gastrocnemius recession is an alternate procedure to treat selected patients with mechanical metatarsalgia and gastrocnemius shortening. It had acceptable morbidity and cosmetic results. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
- Patricia Morales-Muñoz
- Foot and Ankle Unit, Orthopaedic Surgery, Infanta Sofia University Hospital, Madrid, Spain
| | | | - Patricia Barrio Sanz
- Foot and Ankle Unit, Orthopaedic Surgery, Infanta Sofia University Hospital, Madrid, Spain
| | - Jose Luis Pérez
- Foot and Ankle Unit, Orthopaedic Surgery, Infanta Sofia University Hospital, Madrid, Spain
| | - Jesús Varas Navas
- Foot and Ankle Unit, Orthopaedic Surgery, Infanta Sofia University Hospital, Madrid, Spain
| | - Javier Escalera Alonso
- Foot and Ankle Unit, Orthopaedic Surgery, Infanta Sofia University Hospital, Madrid, Spain
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Baumbach SF, Braunstein M, Polzer H. Letter Regarding: Proximal Gastrocnemius Release in the Treatment of Mechanical Metatarsalgia. Foot Ankle Int 2016; 37:790-1. [PMID: 27440057 DOI: 10.1177/1071100716654966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Effects of gastrocnemius recession on ankle motion, strength, and functional outcomes: a systematic review and national healthcare database analysis. Knee Surg Sports Traumatol Arthrosc 2016; 24:1355-64. [PMID: 26685692 DOI: 10.1007/s00167-015-3939-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 12/09/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE The purpose of this systematic review was to report the effects of gastrocnemius recession on ankle dorsiflexion range of motion, function, and push-off power. METHODS The MEDLINE and EMBASE databases were reviewed with terms "gastrocnemius recession". The inclusion criteria were: (1) clinical studies, (2) published in a peer-reviewed journal within the past 10 years, and (3) published in English. Excluded were: (1) review articles, (2) cadaveric studies, (3) studies including patients under the age of 18 years, (4) studies evaluating a neurologic condition, (5) level of evidence 5, and (6) Quality of Evidence Score <3. Data were then extracted and analysed for trends. The PearlDiver Database was also used to review de-identified patient information retrospectively between 2007 and 2011. RESULTS Full-text review yielded 23 articles that fit the inclusion criteria. Twenty-one of 23 (91%) and 2/23 (9%) studies were level of evidence 4 and 3, respectively. Twelve of 23 (52%) studies reported follow-up assessment between 12 and 36 months, and no studies reported longer-term follow-up. Twelve of 12 (100%) studies reported improved dorsiflexion range of motion 9/9 (100%) reported improved AOFAS, and 11/11 (100%) reported improved VAS. Five of 23 (22%) studies reported strength in a measured and controlled fashion with variable results, but of these, no study reported a return to normal power. The mean complication rate was 14%. CONCLUSION The available evidence supports that GR improves functional outcomes and increases dorsiflexion range of motion. Furthermore, GR affects gait kinematics, which may cause compensatory effects at the knee, ankle, and subtalar joints. Evidence has shown that power does not return to normal levels. Clinicians may utilize these data clinically to determine whether patients may benefit from GR or not. LEVEL OF EVIDENCE IV.
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Toepfer A, von Eisenhart-Rothe R, Harrasser N. [Metatarsalgia: Differential diagnosis and therapy]. Wien Med Wochenschr 2016; 167:285-292. [PMID: 26935709 DOI: 10.1007/s10354-016-0445-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Accepted: 02/08/2016] [Indexed: 11/27/2022]
Abstract
Metatarsalgia refers to localized or generalized forefoot pain in the region of the metatarsal heads. Symptoms can be isolated or in combination with accompanying deformities occurring in the forefoot and/or hindfoot. Anamnesis and clinical investigation usually yield to the diagnosis, the underlying cause on the other hand is not always easy to identify. In the foreground of the treatment is the exhaustion of conservative forms of therapy to minimize the symptoms of local pressure increase and callus under the metatarsal heads. In addition, various surgical methods are available, such as corrective osteotomy of the metatarsale bone, soft tissue interventions and the correction of associated deformities. The indications for surgical intervention should be made with caution in order to avoid failures and complaints persisting after surgery. The most common problems are an inadequate indication for surgery, technical problems and insufficient postoperative treatment.
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Affiliation(s)
- Andreas Toepfer
- Klinik für Orthopädie und Sportorthopädie, Klinikum Rechts der Isar, Technischen Universität München, Ismaninger Straße 22, 81675, München, Deutschland.
| | - Rüdiger von Eisenhart-Rothe
- Klinik für Orthopädie und Sportorthopädie, Klinikum Rechts der Isar, Technischen Universität München, Ismaninger Straße 22, 81675, München, Deutschland
| | - Norbert Harrasser
- Klinik für Orthopädie und Sportorthopädie, Klinikum Rechts der Isar, Technischen Universität München, Ismaninger Straße 22, 81675, München, Deutschland
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130
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Slullitel G, López V, Calvi JP, Seletti M, Bartolucci C, Pinton G. Effect of First Ray Insufficiency and Metatarsal Index on Metatarsalgia in Hallux Valgus. Foot Ankle Int 2016; 37:300-6. [PMID: 26542161 DOI: 10.1177/1071100715615323] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Two concepts have been proposed to explain the etiology of metatarsalgia in hallux valgus patients: First, as the magnitude of hallux valgus increases, there is a mechanical overload of the lesser metatarsals. Second, increased relative lesser metatarsal length is a factor in the development of metatarsalgia. However, there is no current evidence that these structural factors lead to primary metatarsalgia. The purpose of the study was to evaluate the factors associated with metatarsalgia in hallux valgus patients. METHODS A cross-sectional study of 121 consecutive adult patients with non-arthritic hallux valgus was carried out. Binary logistic regression was performed to identify the effect of the clinical and demographic factors on the occurrence of metatarsalgia. One hundred twenty-one patients (184 feet) with hallux valgus were analyzed. The median weight was 65 kg (interquartile range 58-72). RESULTS Metatarsalgia was present in 84 (45.6%) feet. The binary logistic regression showed that lesser toe deformity (OR 2.6, 95% CI 0.2-0.5), gastrocnemius shortening (OR 5.8, 95% CI 2.8-12.3), metatarsal index (OR 0.3, 95% CI 0.2-0.5), and weight (OR 2.5, 95% CI 1.2-5.3) were significantly associated. CONCLUSION Metatarsalgia occurs in almost half of hallux valgus patients. It has a multifactorial etiology. Our findings contradict the common theory that both the magnitude of hallux valgus deformity and an increased length of the lesser metatarsals, by themselves, lead to primary metatarsalgia. Metatarsalgia was associated with Achilles shortening, excessive weight, and associated lesser toe deformity. These factors should be addressed in order to treat this disorder adequately. LEVEL OF EVIDENCE Level III, comparative series.
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Affiliation(s)
- Gaston Slullitel
- Institute of Orthopaedics "Dr. Jaime Slullitel," Rosario, Santa Fe, Argentina
| | - Valeria López
- Institute of Orthopaedics "Dr. Jaime Slullitel," Rosario, Santa Fe, Argentina
| | - Juan Pablo Calvi
- Institute of Orthopaedics "Dr. Jaime Slullitel," Rosario, Santa Fe, Argentina
| | - Maximiliano Seletti
- Institute of Orthopaedics "Dr. Jaime Slullitel," Rosario, Santa Fe, Argentina
| | - Carla Bartolucci
- Institute of Orthopaedics "Assist Sport," Rosario, Santa Fe, Argentina
| | - Gustavo Pinton
- Institute of Orthopaedics "Assist Sport," Rosario, Santa Fe, Argentina
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131
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Gougoulias N, Lampridis V. Midfoot arthrodesis. Foot Ankle Surg 2016; 22:17-25. [PMID: 26869495 DOI: 10.1016/j.fas.2015.04.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Revised: 03/15/2015] [Accepted: 04/02/2015] [Indexed: 02/04/2023]
Abstract
BACKGROUND Surgery for midfoot arthritis is challenging and technically demanding, especially in the presence of deformity. METHODS Thirty patients (30 feet) with symptomatic midfoot arthritis and deformities, underwent arthrodesis, along with adjuvant procedures to realign the hindfoot and forefoot where needed. RESULTS Union was achieved in 28 out of 30 (93.3%) patients. Mean time to union was 12.9 weeks (range 10-18). Five patients (16.6%) developed postoperative complications and six patients (20%) required unplanned surgical procedures. Orthotics was needed postoperatively in 14 patients (34%). Fourteen out of 30 patients rated their outcome as excellent (47%), 13 out of 30 as good (43%) and 3 out of 30 (10%) as fair or poor. CONCLUSIONS Although the vast majority of patients rated their outcome as good or excellent, the foot is not completely normal, with residual pain from the adjacent joints, need for unplanned surgery and use of orthotics postoperatively.
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Affiliation(s)
- Nikolaos Gougoulias
- Frimley Health NHS Foundation Trust, Frimley Park Hospital, Portsmouth Road, Camberley, Surrey GU16 7UJ, United Kingdom.
| | - Vasileios Lampridis
- Frimley Health NHS Foundation Trust, Frimley Park Hospital, Portsmouth Road, Camberley, Surrey GU16 7UJ, United Kingdom
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132
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Oravakangas R, Leppilahti J, Laine V, Niinimäki T. Proximal Opening Wedge Osteotomy Provides Satisfactory Midterm Results With a Low Complication Rate. J Foot Ankle Surg 2016; 55:456-60. [PMID: 26905255 DOI: 10.1053/j.jfas.2016.01.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2014] [Indexed: 02/03/2023]
Abstract
Hallux valgus is one of the most common foot deformities. Proximal opening wedge osteotomy is used for the treatment of moderate and severe hallux valgus with metatarsus primus varus. However, hypermobility of the first tarsometatarsal joint can compromise the results of the operation, and a paucity of midterm results are available regarding proximal open wedge osteotomy surgery. The aim of the present study was to assess the midterm results of proximal open wedge osteotomy in a consecutive series of patients with severe hallux valgus. Thirty-one consecutive adult patients (35 feet) with severe hallux valgus underwent proximal open wedge osteotomy. Twenty patients (35.5%) and 23 feet (34.3%) were available for the final follow-up examination. The mean follow-up duration was 5.8 (range 4.6 to 7.0) years. The radiologic measurements and American Orthopaedic Foot and Ankle Society hallux-metatarsophalangeal-interphalangeal scores were recorded pre- and postoperatively, and subjective questionnaires were completed and foot scan analyses performed at the end of the follow-up period. The mean hallux valgus angle decreased from 38° to 23°, and the mean intermetatarsal angle correction decreased from 17° to 10°. The mean improvement in the American Orthopaedic Foot and Ankle Society hallux metatarsophalangeal-interphalangeal score increased from 52 to 84. Two feet (5.7%) required repeat surgery because of recurrent hallux valgus. No nonunions were identified. Proximal open wedge osteotomy provided satisfactory midterm results in the treatment of severe hallux valgus, with a low complication rate. The potential instability of the first tarsometatarsal joint does not seem to jeopardize the midterm results of the operation.
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Affiliation(s)
- Rami Oravakangas
- Researcher, Department of Surgery, Oulu University Hospital, Oulu, Finland
| | - Juhana Leppilahti
- Professor and Head, Division of Orthopaedic and Trauma Surgery, Department of Surgery, Oulu University Hospital, Oulu, Finland
| | - Vesa Laine
- Physiotherapist, Department of the Physical and Rehabilitation Medicine, Oulu University Hospital, Oulu, Finland
| | - Tuukka Niinimäki
- Orthopaedic Surgeon, Department of Surgery, Oulu University Hospital, Oulu, Finland.
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133
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Kleeblad LJ, van Bemmel AF, Sierevelt IN, Zuiderbaan HA, Vergroesen DA. Validity and Reliability of the Achillometer(®): An Ankle Dorsiflexion Measurement Device. J Foot Ankle Surg 2016; 55:688-92. [PMID: 26830445 DOI: 10.1053/j.jfas.2015.11.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Indexed: 02/03/2023]
Abstract
Limited ankle dorsiflexion is closely related to important foot and ankle pathologies. Various measurement devices and methods have been examined, but these have demonstrated limited validity and reliability. The purpose of the present study was to assess the validity and intra- and interobserver reliability of the Achillometer(®). A total of 22 consecutive subjects with ankle or foot pathologies and 39 healthy participants were included. All participants were measured using the goniometer and the Achillometer(®), a portable device used to assess ankle dorsiflexion in the weightbearing position with knee in extension. The intraclass correlation coefficient, standard error of the mean, and minimal detectable change were determined. The goniometer and Achillometer(®) revealed high intraobserver reliability coefficients with an intraclass correlation coefficient of 0.88 (standard error of the mean 1.49, minimal detectable change 4.12) and 0.85 (standard error of the mean 1.57, minimal detectable change 4.34), respectively. The interobserver reliability of both measurement techniques ranged from 0.63 to 0.67. The Achillometer(®) showed a strong correlation with the goniometer for both observers. In conclusion, the Achillometer(®) is a valid measurement device to assess ankle dorsiflexion range of motion in the weightbearing position with an extended knee in a heterogeneous population. The device has good intraobserver and moderate interobserver reliability and measurement properties comparable to those of the goniometer.
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Affiliation(s)
- Laura J Kleeblad
- Orthopaedic Resident, Center of Orthopaedic Research, Linnaesinstituut, Spaarne Gasthuis, Hoofddorp, The Netherlands.
| | | | - Inger N Sierevelt
- Orthopaedic Resident, Center of Orthopaedic Research, Linnaesinstituut, Spaarne Gasthuis, Hoofddorp, The Netherlands; Clinical Epidemiologist, Spaarne Gasthuis, Hoofddorp, The Netherlands
| | - Hendrik A Zuiderbaan
- Orthopaedic Resident, Center of Orthopaedic Research, Linnaesinstituut, Spaarne Gasthuis, Hoofddorp, The Netherlands
| | - Diederik A Vergroesen
- Orthopaedic Surgeon, Center of Orthopaedic Research, Linnaesinstituut, Spaarne Gasthuis, Hoofddorp, The Netherlands
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134
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Jeon IC, Kwon OY, Yi CH, Cynn HS, Hwang UJ. Ankle-Dorsiflexion Range of Motion After Ankle Self-Stretching Using a Strap. J Athl Train 2015; 50:1226-32. [PMID: 26633750 DOI: 10.4085/1062-6050-51.1.01] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
CONTEXT A variety of ankle self-stretching exercises have been recommended to improve ankle-dorsiflexion range of motion (DFROM) in individuals with limited ankle dorsiflexion. A strap can be applied to stabilize the talus and facilitate anterior glide of the distal tibia at the talocrural joint during ankle self-stretching exercises. Novel ankle self-stretching using a strap (SSS) may be a useful method of improving ankle DFROM. OBJECTIVE To compare the effects of 2 ankle-stretching techniques (static stretching versus SSS) on ankle DFROM. DESIGN Randomized controlled clinical trial. SETTING University research laboratory. PATIENTS OR OTHER PARTICIPANTS Thirty-two participants with limited active dorsiflexion (<20°) while sitting (14 women and 18 men) were recruited. MAIN OUTCOME MEASURE(S) The participants performed 2 ankle self-stretching techniques (static stretching and SSS) for 3 weeks. Active DFROM (ADFROM), passive DFROM (PDFROM), and the lunge angle were measured. An independent t test was used to compare the improvements in these values before and after the 2 stretching interventions. The level of statistical significance was set at α = .05. RESULTS Active DFROM and PDFROM were greater in both stretching groups after the 3-week interventions. However, ADFROM, PDFROM, and the lunge angle were greater in the SSS group than in the static-stretching group (P < .05). CONCLUSIONS Ankle SSS is recommended to improve ADFROM, PDFROM, and the lunge angle in individuals with limited DFROM.
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Affiliation(s)
- In-cheol Jeon
- Laboratory of Kinetic Ergocise Based on Movement Analysis, Department of Physical Therapy, College of Health Science, Yonsei University, Wonju, Kangwon, South Korea
| | - Oh-yun Kwon
- Laboratory of Kinetic Ergocise Based on Movement Analysis, Department of Physical Therapy, College of Health Science, Yonsei University, Wonju, Kangwon, South Korea
| | - Chung-Hwi Yi
- Laboratory of Kinetic Ergocise Based on Movement Analysis, Department of Physical Therapy, College of Health Science, Yonsei University, Wonju, Kangwon, South Korea
| | - Heon-Seock Cynn
- Laboratory of Kinetic Ergocise Based on Movement Analysis, Department of Physical Therapy, College of Health Science, Yonsei University, Wonju, Kangwon, South Korea
| | - Ui-jae Hwang
- Laboratory of Kinetic Ergocise Based on Movement Analysis, Department of Physical Therapy, College of Health Science, Yonsei University, Wonju, Kangwon, South Korea
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135
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Rompe JD, Furia J, Cacchio A, Schmitz C, Maffulli N. Radial shock wave treatment alone is less efficient than radial shock wave treatment combined with tissue-specific plantar fascia-stretching in patients with chronic plantar heel pain. Int J Surg 2015; 24:135-42. [DOI: 10.1016/j.ijsu.2015.04.082] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Accepted: 04/27/2015] [Indexed: 12/21/2022]
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136
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Rong K, Ge WT, Li XC, Xu XY. Mid-term Results of Intramuscular Lengthening of Gastrocnemius and/or Soleus to Correct Equinus Deformity in Flatfoot. Foot Ankle Int 2015; 36:1223-8. [PMID: 26041542 DOI: 10.1177/1071100715588994] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Intramuscular lengthening of the gastrocnemius and/or soleus (Baumann procedure) is widely used in patients who have cerebral palsy, with several advantages over other lengthening techniques. Tightness of the gastrocnemius or gastrocnemius-soleus complex has been confirmed to be related to flatfoot deformity. The purpose of this study was to evaluate the mid-term results of the Baumann procedure as a part of the treatment of flatfoot with equinus deformity. METHODS We reviewed 35 pediatric and adult patients (43 feet) with flatfoot who underwent the Baumann procedure for the concomitant equinus deformity. The mean duration of follow-up was 39.4 months. Preoperative and follow-up evaluations included the maximal angle of dorsiflexion of the ankle with the knee fully extended and with the knee flexed to 90 degrees, the American Orthopaedic Foot & Ankle Society ankle-hindfoot (AOFAS-AH) scores, and postoperative complications. RESULTS Preoperatively, the mean angle of passive ankle dorsiflexion with the knee extended was -4.7 ± 2.7 degrees and that with the knee flexed was 2.3 ± 2.5 degrees. At the final follow-up, both values improved significantly by a mean of 13.6 degrees (P < .001) and 9.7 degrees (P < .001), respectively. The average AOFAS-AH scores improved from 56.8 points preoperatively to 72.1 at the final follow-up. Recurrence of equinus was observed in 3 patients (4 feet). There were no cases of overcorrection, neurovascular injury, or healing problems. CONCLUSIONS Our results indicate that the Baumann procedure can effectively and sequentially correct the tightness of the gastrocnemius or the gastrocnemius-soleus complex in patients with flatfoot deformity, without obvious postoperative complications. LEVEL OF EVIDENCE Level IV, retrospective case series.
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Affiliation(s)
- Kai Rong
- Shanghai Institute of Traumatology and Orthopaedics, Shanghai, China Department of Orthopaedics, Rui Jin Hospital Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wen-tao Ge
- Shanghai Institute of Traumatology and Orthopaedics, Shanghai, China Department of Orthopaedics, Rui Jin Hospital Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xing-chen Li
- Shanghai Institute of Traumatology and Orthopaedics, Shanghai, China Department of Orthopaedics, Rui Jin Hospital Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiang-yang Xu
- Shanghai Institute of Traumatology and Orthopaedics, Shanghai, China Department of Orthopaedics, Rui Jin Hospital Shanghai Jiao Tong University School of Medicine, Shanghai, China
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137
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Baumbach SF, Polzer H. Letter to the editor on "Gastrocnemius recession for foot and ankle conditions in adults: Evidence-based recommendations". Foot Ankle Surg 2015; 21:224-5. [PMID: 26235870 DOI: 10.1016/j.fas.2015.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2015] [Accepted: 06/11/2015] [Indexed: 02/04/2023]
Affiliation(s)
- Sebastian F Baumbach
- Munich University Hospital, Department of Trauma Surgery - Campus Innenstadt, LMU Nussbaumstr. 20, 80336 Munich, Germany
| | - Hans Polzer
- Munich University Hospital, Department of Trauma Surgery - Campus Innenstadt, LMU Nussbaumstr. 20, 80336 Munich, Germany.
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138
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Abstract
Hallux rigidus is a painful condition of the great toe characterized by restriction of the metatarsophalangeal joint arc of motion and progressive osteophyte formation. Precise cause of hallux rigidus remains under debate. Anatomic variations and historical, clinical, and radiographic findings have been implicated in the development and progression of hallux rigidus. Radiologic findings associated with hallux rigidus include metatarsal head osteochondral defects, altered metatarsal head morphology, and an elevated hallux interphalangeus angle measure. Associated historical findings include a positive family history and history of trauma to the joint. An understanding of relevant anatomy and pathophysiology is essential during the approach to hallux rigidus treatment.
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139
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Cychosz CC, Phisitkul P, Belatti DA, Glazebrook MA, DiGiovanni CW. Response to letter to the editor on "Gastrocnemius recession for foot and ankle conditions in adults: Evidence-based recommendations". Foot Ankle Surg 2015; 21:226. [PMID: 26235871 DOI: 10.1016/j.fas.2015.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
| | - Phinit Phisitkul
- Department of Orthopaedics and Rehabilitation, The University of Iowa Hospitals and Clinics, Iowa City, IA, USA.
| | - Daniel A Belatti
- University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | | | - Christopher W DiGiovanni
- Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, 55 Fruit St, Boston MA 02114, USA
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140
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Tallerico VK, Greenhagen RM, Lowery C. Isolated Gastrocnemius Recession for Treatment of Insertional Achilles Tendinopathy: A Pilot Study. Foot Ankle Spec 2015; 8:260-5. [PMID: 25389232 DOI: 10.1177/1938640014557077] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Many surgeries exist for treatment of insertional Achilles tendinopathy. Another surgical option to consider is an isolated gastrocnemius recession. Recent studies have demonstrated the success of a gastrocnemius recession for noninsertional Achilles tendinitis. We hypothesize that an isolated gastrocnemius recession can be a successful, effective, and less invasive surgery for patients with chronic insertional Achilles tendinopathy. MATERIALS AND METHODS This article presents a retrospective review of one surgeon's results of 11 patients (2010-2012), with an average age of 59 years who presented with chronic insertional Achilles tendinopathy. Gastrocnemius recessions, either endoscopic or open, were performed after an average of 6.2 months of conservative treatment. All patients' radiographs were reviewed preoperatively for any calcaneal spurs and divided into groups accordingly. Average follow-up time postoperatively was 13.8 months. Plantarflexion strength, equinus deformity, as well as the American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot instrument was assessed. RESULTS In all, 10/11 (91%) patients had high patient satisfaction, pain relief, no residual equinus deformity, loss in muscle strength and returned to regular activities successfully at 1-year follow up. All patients and groups had significant improvement in AOFAS scores. The median postoperative AOFAS score was 94.8. All patients and patient groups had significant improvement pre- to postoperatively. Patients without spurs appear to do better than patients with spurs. One patient developed recurrence of insertional heel pain and equinus deformity. Other complications included 2 sural nerve parasthesias, which resolved. CONCLUSION An isolated gastrocnemius recession for chronic insertional Achilles tendinopathy can provide high satisfaction, pain relief, and a faster recovery period with few or no complications. LEVELS OF EVIDENCE Therapeutic, Level IV: Case series.
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Affiliation(s)
- Valerie K Tallerico
- UnityPoint Health-St Lukes Hospital, UnityPoint Clinic-Podiatry, Sioux City, Iowa (VKT)Foot and Ankle Center of Nebraska, P.C., Omaha, Nebraska (RMG)Podiatric Medicine and Surgery Residency, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (CL)
| | - Robert M Greenhagen
- UnityPoint Health-St Lukes Hospital, UnityPoint Clinic-Podiatry, Sioux City, Iowa (VKT)Foot and Ankle Center of Nebraska, P.C., Omaha, Nebraska (RMG)Podiatric Medicine and Surgery Residency, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (CL)
| | - Clinton Lowery
- UnityPoint Health-St Lukes Hospital, UnityPoint Clinic-Podiatry, Sioux City, Iowa (VKT)Foot and Ankle Center of Nebraska, P.C., Omaha, Nebraska (RMG)Podiatric Medicine and Surgery Residency, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (CL)
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141
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La Fontaine J, Lavery LA, Hunt NA, Murdoch DP. The role of surgical off-loading to prevent recurrent ulcerations. INT J LOW EXTR WOUND 2015; 13:320-34. [PMID: 25384915 DOI: 10.1177/1534734614555002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Foot ulcerations in patients with diabetes are common. Most ulcers heal with conservative treatment, but recurrence is common. The pathway of ulcer development includes neuropathy, deformity, and trauma. The first attempt to avoid recurrence is by the use of shoes and insoles. When shoes and insoles fail, surgical correction of deformity leading to the ulcer can be attempted. This article reviews the most common procedures performed to heal ulcers or avoid recurrence.
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Affiliation(s)
| | | | - Nathan A Hunt
- Orthopaedic Center of the Rockies, Fort Collins, CO, USA
| | - Douglas P Murdoch
- Texas A&M Health Science Center College of Medicine, Temple, TX, USA
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142
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Rong K, Li XC, Ge WT, Xu Y, Xu XY. Comparison of the efficacy of three isolated gastrocnemius recession procedures in a cadaveric model of gastrocnemius tightness. INTERNATIONAL ORTHOPAEDICS 2015; 40:417-23. [DOI: 10.1007/s00264-015-2860-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Accepted: 05/10/2015] [Indexed: 10/23/2022]
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143
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Wood PS, Krüger PE. Flexibility as risk factor for stress-fracture development in South African male soldiers. S Afr Fam Pract (2004) 2015. [DOI: 10.1080/20786190.2015.1024017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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144
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Russ BS, Olivencia O. Considerations for Improving Triceps Surae Flexibility. Strength Cond J 2015. [DOI: 10.1519/ssc.0000000000000144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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145
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Cychosz CC, Phisitkul P, Belatti DA, Glazebrook MA, DiGiovanni CW. Gastrocnemius recession for foot and ankle conditions in adults: Evidence-based recommendations. Foot Ankle Surg 2015; 21:77-85. [PMID: 25937405 DOI: 10.1016/j.fas.2015.02.001] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Revised: 11/13/2014] [Accepted: 02/13/2015] [Indexed: 02/04/2023]
Abstract
BACKGROUND Gastrocnemius recession is a surgical technique commonly performed on individuals who suffer from symptoms related to the restricted ankle dorsiflexion that results when tight superficial posterior compartment musculature causes an equinus contracture. Numerous variations for muscle-tendon unit release along the length of the calf have been described for this procedure over the past century, although all techniques share at least partial or complete release of the gastrocnemius muscle given its role as the primary plantarflexor of the ankle. There exists strong evidence to support the use of this procedure in pediatric patients suffering from cerebral palsy, and increasingly enthusiastic support-but less science-behind its application in treating adult foot and ankle pathologies perceived to be associated with gastrocnemius tightness. The purpose of this study, therefore, was to evaluate currently available evidence for using gastrocnemius recession in three adult populations for whom it is now commonly employed: Achilles tendinopathy, midfoot-forefoot overload syndrome, and diabetic foot ulcers. METHODS A systematic review of the literature was performed on December 21, 2013 using the PubMed, Scopus, and Cochrane databases along with the search term "(gastrocnemius OR gastrocsoleus) AND (recession OR release OR lengthening)." This search generated 1141 results; 12 articles found in the references of these papers were also screened for inclusion. In total, 18 articles met our inclusion criteria. These articles were reviewed and assigned a classification (I-V) of Level of Evidence, according to the criteria recommended by the Journal of Bone & Joint Surgery. Based on these classifications, a Grade of Recommendation was assigned for each of the indications of interest. RESULTS Grade B evidence-based literature ("fair") exists to support the use of gastrocnemius recession for the treatment of isolated foot pain due to midfoot/forefoot overload syndrome in adults. There are some data in support of utilizing gastrocnemius recession to treat midfoot or forefoot ulcers and non-insertional Achilles tendinopathy in adults, but to date this evidence remains Grade Cf. Insufficient evidence (Grade I) is currently available to make any recommendation either for or against this procedure for the treatment of insertional Achilles tendinopathy. CONCLUSION Scientific literature continues to grow in support of using isolated gastrocnemius recession as an effective treatment strategy for a variety of lower limb pathologies, although it remains clear that higher evidence levels and more carefully controlled investigations will be necessary to more convincingly define the true efficacy and ideal applications of gastrocnemius recession in the adult population. LEVEL OF EVIDENCE Level IV systematic review.
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Affiliation(s)
- Chris C Cychosz
- University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Phinit Phisitkul
- Department of Orthopaedics and Rehabilitation, The University of Iowa Hospitals and Clinics, Iowa City, IA, USA.
| | - Daniel A Belatti
- University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | | | - Christopher W DiGiovanni
- Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114, USA
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146
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Reliability of the Nonweightbearing Inclinometric Measurements of the Ankle Range of Motion in Older Adults With Orthopedic Problems. TOPICS IN GERIATRIC REHABILITATION 2015. [DOI: 10.1097/tgr.0000000000000028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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147
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Endoscopic gastrocnemius recession procedure using a single portal technique: a prospective study of fifty four consecutive patients. INTERNATIONAL ORTHOPAEDICS 2015; 39:1099-107. [DOI: 10.1007/s00264-015-2723-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Accepted: 02/22/2015] [Indexed: 10/23/2022]
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148
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Abstract
Endoscopic surgery provides a minimally invasive approach to visualize and treat several pathologic conditions of the Achilles tendon. Open surgery on the Achilles tendon is notorious for wound complications, whereas endoscopic procedures have been recognized for less scaring, less perioperative pain, fewer wound complications, and faster recovery. This article reviews various endoscopic techniques for the treatment of equinus contracture, Achilles rupture, Haglund's deformity, and noninsertional Achilles tendinopathy.
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Affiliation(s)
- Dominic Carreira
- Orthopedics and Sports Medicine, Broward Health, NOVA Southeastern University, 300 Southeast 17th Street, Fort Lauderdale, FL 33316, USA.
| | - Alicia Ballard
- Orthopedic Department, Broward Health, 1600 South Andrews Avenue, Fort Lauderdale, FL 33316, USA
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149
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Nawoczenski DA, Barske H, Tome J, Dawson LK, Zlotnicki JP, DiGiovanni BF. Isolated gastrocnemius recession for achilles tendinopathy: strength and functional outcomes. J Bone Joint Surg Am 2015; 97:99-105. [PMID: 25609435 DOI: 10.2106/jbjs.m.01424] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Gastrocnemius recession has emerged as a viable intervention for patients with recalcitrant foot and ankle disorders associated with isolated gastrocnemius contracture. The purpose of this case-control study was to investigate the effects of an isolated gastrocnemius recession on pain, patient-reported function, and strength in patients with chronic Achilles tendinopathy and an isolated gastrocnemius contracture. METHODS Thirteen patients with unilateral Achilles tendinopathy (mean age [and standard deviation], fifty-two ± 7.7 years) who received a gastrocnemius recession and ten matched-control subjects participated. A visual analog scale was used to assess pain, and the Foot and Ankle Ability Measure was used to evaluate patient-reported function in activities of daily living and sports. Patients were asked about their satisfaction with the results of the gastrocnemius recession. Ankle plantar flexion peak torque was assessed at 60°/sec and 120°/sec. Appropriate t tests were used to assess limb symmetry and strength differences between the groups. RESULTS The mean duration of follow-up was eighteen months (range, twelve to twenty-eight months). Gastrocnemius recession provided significant pain relief (mean preoperative visual analog scale score [and standard deviation], 6.8 ± 1.8; mean follow-up visual analog scale score, 1.4 ± 2.7; p < 0.05). Foot and Ankle Ability Measure outcomes showed between-group differences in activities of daily living (Achilles tendinopathy group, 89.7; control group, 98.5; p = 0.05) and sports subscales (Achilles tendinopathy group, 71.9; control group, 95.1; p = 0.05). The activities reported to be the most challenging included going up hills, climbing stairs, running, and jumping. Eleven of the thirteen patients in the Achilles tendon group were satisfied with treatment. Side-to-side strength comparisons showed no differences at 60°/sec. Significant differences were observed at 120°/sec (Achilles tendinopathy group, 21%; control group, 3%; p < 0.05); however, the involved limb reached a peak torque similar to that in the control limb. CONCLUSIONS Isolated gastrocnemius recession provides significant and sustained pain relief for chronic Achilles tendinopathy. Good function can be expected for activities of daily living, but power and endurance activities were more problematic for the Achilles tendinopathy group. Isokinetic strength assessment may not effectively capture patient-reported functional deficits. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Deborah A Nawoczenski
- Center for Foot and Ankle Research, Rochester Center, Ithaca College, 1100 South Goodman Street, Rochester, NY 14620. E-mail address for D.A. Nawoczenski:
| | - Heather Barske
- Winnipeg Regional Health Authority, Pan Am Clinic, 75 Poseidon Bay, Winnipeg, Manitoba R3M 3E4, Canada
| | - Joshua Tome
- Center for Foot and Ankle Research, Rochester Center, Ithaca College, 1100 South Goodman Street, Rochester, NY 14620. E-mail address for D.A. Nawoczenski:
| | - Laura K Dawson
- Department of Orthopaedic Surgery, Blanchfield Army Hospital, 650 Joel Drive, Fort Campbell, KY 42223
| | - Jason P Zlotnicki
- University of Rochester School of Medicine and Dentistry, 601 Elmwood Avenue, Rochester, NY 14642. E-mail address for B.F. DiGiovanni:
| | - Benedict F DiGiovanni
- University of Rochester School of Medicine and Dentistry, 601 Elmwood Avenue, Rochester, NY 14642. E-mail address for B.F. DiGiovanni:
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150
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Sullivan J, Burns J, Adams R, Pappas E, Crosbie J. Musculoskeletal and activity-related factors associated with plantar heel pain. Foot Ankle Int 2015; 36:37-45. [PMID: 25237175 DOI: 10.1177/1071100714551021] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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.
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Affiliation(s)
- Justin Sullivan
- Discipline of Physiotherapy, Faculty of Health Sciences, The University of Sydney, Sydney, New South Wales, Australia
| | - Joshua Burns
- The Children's Hospital at Westmead, The University of Sydney, Sydney, New South Wales, Australia
| | - Roger Adams
- Discipline of Physiotherapy, Faculty of Health Sciences, The University of Sydney, Sydney, New South Wales, Australia
| | - Evangelos Pappas
- Discipline of Physiotherapy, Faculty of Health Sciences, The University of Sydney, Sydney, New South Wales, Australia
| | - Jack Crosbie
- School of Science and Health, The University of Western Sydney, Sydney, New South Wales, Australia
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