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Elkaim M, Ankri M, Giunta JC. Endoscopic assisted flexor digitorum longus transfer in flexible flatfoot. Foot Ankle Surg 2024; 30:99-102. [PMID: 37891099 DOI: 10.1016/j.fas.2023.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 10/10/2023] [Indexed: 10/29/2023]
Abstract
BACKGROUND Posterior tibial tendon insufficiency is the commonest cause of adult flexible flatfoot. Transfer of the flexor digitorum longus (FDL) has been described a therapeutic arsenal in flexible flat feet and posterior tibial tendon disorders. It is often combined with bony procedure (open or percutaneous calcaneal osteotomy). METHODS We describe a technique and the steps endoscopic approach of FDL transfer. RESULTS The procedure is able to be performed safely and reproducible under perfect viewing CONCLUSION: In the future with a clinical study investigating, we purpose the results of such surgery in a cohort of patients with flexible flatfoot. Level IV Therapeutic study: case serie. No funding was received for this research project.
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Affiliation(s)
- Marc Elkaim
- Clinique Drouot Sport et Arthrose, 75009 Paris, France.
| | - Marine Ankri
- Hôpital Lariboisière AP-HP, 75010 Paris, France.
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2
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Guirguis J, El Sayad M, Kakwani M, Townshend D, Kakwani R. Safety of the neurovascular bundles when performing minimally invasive calcaneal osteotomy: A cadaveric study. Foot Ankle Surg 2024; 30:161-164. [PMID: 37993357 DOI: 10.1016/j.fas.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 10/16/2023] [Accepted: 11/01/2023] [Indexed: 11/24/2023]
Abstract
BACKGROUND Calcaneal osteotomies correct hindfoot deformities and are often performed using a minimally invasive technique. The aim was to compare the safety of three calcaneal osteotomy techniques (oblique, chevron with apex anterior and chevron with apex posterior). METHODS Each osteotomy technique was performed on five cadavers (n = 15). These were then dissected to identify any injury to the neurovascular bundles. The distance between the burr and these structures was measured. RESULTS Using the apex posterior technique, the burr was closer to the medial and lateral neurovascular structures, and in one case the sural nerve was injured. There were no neurovascular injuries using the other techniques. CONCLUSIONS Minimally invasive surgery using a burr is generally a safe, reliable method for performing calcaneal osteotomies. The chevron with apex posterior osteotomy should be performed with caution given the closer relationship between the burr and neurovascular bundles. The other two techniques provide safer alternatives. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- J Guirguis
- Northumbria NHS Foundation Trust, Wansbeck General Hospital Department of Trauma & Orthopaedics, Woodhorn Lane, Northumberland NE63 9JJ, UK.
| | - M El Sayad
- Gateshead Health NHS Foundation Trust, Queen Elizabeth Hospital, Gateshead, Tyne and Wear NE9 6SX, UK.
| | - M Kakwani
- University of Leeds, Woodhouse, Leeds, West Yorkshire LS2 9JT, UK.
| | - D Townshend
- Northumbria NHS Foundation Trust, North Tyneside General Hospital, Rake Lane, Tyne and Wear NE29 8NH, UK.
| | - R Kakwani
- Northumbria NHS Foundation Trust, North Tyneside General Hospital, Rake Lane, Tyne and Wear NE29 8NH, UK.
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3
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Lee W, Wang C, Prat D, Wapner KL, Chao W, Farber DC. Patient Satisfaction Following Hallux Rigidus Treatment With a Synthetic Cartilage Implant. Foot Ankle Spec 2023; 16:527-536. [PMID: 33769110 DOI: 10.1177/19386400211001993] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND There remains no clear consensus on patient satisfaction and functional outcomes following synthetic cartilage implant (SCI) implantation for hallux rigidus. The purpose of this study was to review our experience at a single academic institution using an SCI for treatment of hallux rigidus. METHODS A retrospective review was performed of patients who underwent the SCI procedure for treatment of hallux rigidus between January 2017 and May 2019. Functional outcomes were evaluated using Patient-Reported Outcome Measures Informational System (PROMIS)-10 scores as well as a survey investigating patient satisfaction, self-reported clinical improvement, and changes in sporting ability. Patients were divided into satisfied versus unsatisfied subgroups, and between-group differences in preoperative variables and complications were reviewed. A total of 90 patients (96 implants) were included in this study. The mean follow-up time was 26.4 months. RESULTS In all, 81.2% of patients reported that their foot was "much improved" (55.2%) or "improved" (26.0%) since undergoing the SCI procedure, whereas a slightly lower percentage, 74.0%, stated that they were "extremely satisfied" (41.7%) or "satisfied" (32.3%) at final follow-up. Patients were able to tolerate higher impact sporting activities after the procedure, and 75.0% of patients stated they would have the same surgery again. PROMIS-10 T-scores averaged 54.2 points for physical health and 57.4 points for mental health. Only 2.1% of patients required conversion to arthrodesis. Significant differences between the satisfied versus unsatisfied subgroups were found in preoperative corticosteroid injection use (21.1% vs 41.1%, respectively; P = .029) and preoperative VAS pain score (8.2 vs 7.1, respectively; P = .036). CONCLUSION The SCI procedure can be a viable option for treating hallux rigidus with high satisfaction overall, increased sport activity levels, and a very low revision rate. However, maximizing patient satisfaction may require more careful consideration of preoperative prognosticators and extensive patient counseling to ensure realistic expectations for recovery time and individual outcome. LEVEL OF EVIDENCE Level IV: Retrospective case series.
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Affiliation(s)
- Wonyong Lee
- Division of Foot and Ankle Surgery, Department of Orthopaedic Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - Carol Wang
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Dan Prat
- Division of Foot and Ankle Surgery, Department of Orthopaedic Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - Keith L Wapner
- Division of Foot and Ankle Surgery, Department of Orthopaedic Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - Wen Chao
- Division of Foot and Ankle Surgery, Department of Orthopaedic Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - Daniel C Farber
- Division of Foot and Ankle Surgery, Department of Orthopaedic Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania
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Kim JY, Kim SA, Kim Y, Hwang I, Heo NH. Radiologic changes of long term foot insole use in symptomatic pediatric flatfoot. Medicine (Baltimore) 2023; 102:e33152. [PMID: 36897708 PMCID: PMC9997835 DOI: 10.1097/md.0000000000033152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 02/10/2023] [Indexed: 03/11/2023] Open
Abstract
Clinically, flatfoot, known as pes planus, is quite prevalent. It is classified into 2 types: flexible and rigid, both of which may or may not have symptoms. If a flexible flatfoot is symptomatic, it must be treated to prevent subsequent complications. In principle, most physicians initially use conservative methods, such as foot insoles. This study aimed to demonstrate the effect of long term use of a foot insole using plain radiography as an objective measurement in children with symptomatic flexible flatfoot (SFFF) in large samples. This study analyzed the medical records of 292 children aged < 18 years who were diagnosed with SFFF. Of these, 200 children (62 boys and 138 girls, mean age: 6.49 ± 2.96 years) were selected and conservatively treated with foot insoles. They were periodically followed up within 3 to 4 months to modify the foot insole and perform radiologic evaluations, such as foot radiography. The calcaneal pitch angle (CPA) and talo first metatarsal angle were measured and compared individually using foot lateral radiographs, which were pictured in a bilateral barefoot state. The treatment was terminated by repeating the same procedure until the symptoms disappeared. A significant improvement (P < .001) was observed in the radiological indicators, both CPA and talo first metatarsal angle, regardless of age, after the application of soft foot insoles. However, the right foot CPA in the group with valgus deformity was an exception (P = .078). This study showed that in children diagnosed with SFFF under 18 years of age, wearing a periodically revised foot insole as conservative treatment could not only decrease the symptoms, but also improve the radiologic indices.
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Affiliation(s)
- Joon Yeop Kim
- Department of Physical Medicine and Rehabilitation, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Republic of Korea
| | - Soo A Kim
- Department of Physical Medicine and Rehabilitation, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Republic of Korea
| | - Yuntae Kim
- Department of Physical Medicine and Rehabilitation, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Republic of Korea
| | - Insu Hwang
- Department of Physical Medicine and Rehabilitation, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Republic of Korea
| | - Nam Hun Heo
- Clinical Trial Center, Soonchunhyang University Cheonan Hospital, Cheonan, Republic of Korea
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5
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Bilateral and concomitant pathology' surgeries do not affect the outcomes of mini-open distal linear metatarsal osteotomy (Bosch osteotomy) with manipulation for hallux valgus deformity. Foot Ankle Surg 2022; 28:1021-1028. [PMID: 35190276 DOI: 10.1016/j.fas.2022.02.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 01/11/2022] [Accepted: 02/14/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Bosch osteotomy for hallux valgus (HV) deformity has advantages of reduction both the operating time and surgical dissection, and may be performed bilaterally and with fewer complications than other surgical procedures as well as early weight-bearing. However, there are few reports on the effects of bilateral simultaneous surgery, simultaneous surgery on concomitant pathologies, and the preoperative HV angle on the postoperative results. The present assessed the factors that might affect the improvement in clinical outcomes following mini-open Bosch osteotomy with manipulation to treat HV deformity. METHODS Seventy patients with 110 feet were included. They were divided into groups as follows: unilateral and bilateral simultaneous surgery groups, Bosch osteotomy alone and simultaneous surgeries for concomitant pathologies groups, and preoperative HV angle< 40° and ≥ 40° groups. Subjective clinical outcome scores using the Self-Administered Foot Evaluation Questionnaire (SAFE-Q) and the HV and intermetatarsal first and second metatarsal (M1M2) angles according to the anteroposterior (A-P) view of the weighted foot X-ray were assessed preoperatively and at 12 months after surgery. RESULTS The mean HV angle, M1M2 angle and all subscales of the SAFE-Q score showed significant improvement at 12 months after surgery, regardless of simultaneous bilateral surgery, simultaneous surgery for concomitant pathologies, or the preoperative HV angle. On comparing the groups, there were no significant differences in the HV angle at 12 months after surgery. Significant inferiority at 12 months after surgery was found in the intermetatarsal angle in the simultaneous surgery for concomitant pathologies group and in all subscales of the SAFE-Q score in the HV angle ≥ 40° group. CONCLUSION Mini-open Bosch osteotomy with manipulation for HV deformity demonstrated good results in both radiological assessments and subjective clinical scores at 12 months after surgery, even for simultaneous bilateral surgery, simultaneous concomitant pathologies' surgery, and severe HV deformity. LEVEL OF EVIDENCE Prognostic Level III, retrospective cohort study.
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Fuller RM, Eble SK, Day J, Cororaton AD, Rajan L, Deland JT, Kumar P, Ellis SJ. Return to Physical Activity Following Flatfoot Reconstruction. Foot Ankle Int 2022; 43:772-782. [PMID: 35259974 DOI: 10.1177/10711007221077098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Progressive collapsing foot deformity (PCFD) is a debilitating condition encompassing several interrelated, progressive deformities requiring a combination of reconstructive procedures. Few studies investigate returns to activity following flatfoot reconstruction, and existing studies only examine 1 or 2 of the numerous procedures employed. This study aims to provide the first generalizable assessment of returns to sports and physical activity following reconstruction surgery in patients with flexible flatfoot deformity. METHODS Patients aged 18-60 years who underwent reconstructive surgery between February 16 and May 19 for symptomatic flexible-stage flatfoot deformity were identified by registry review. Eighty-two of 113 eligible patients (73%) were reached at a mean 2.9 years (range, 2.0-5.4) of follow-up with mean age at surgery of 48.9 years (range, 18-59). Returns to physical activity were evaluated with a sports-specific survey. Clinical outcomes were evaluated with Patient-Reported Outcomes Measurement Information System (PROMIS) scores. RESULTS Patients reported participation in 21 specific sports and activities. One-fourth (25.6%) of patients (21/82) reported increased difficulty with physical activities postoperatively, 15.9% reported equal difficulty, and 58.5% (48/82) reported decreased difficulty. Median return times were 9-12 months for participation and 12-18 months to reach maximum preoperative participation levels. Improvements in Physical Function (P= .001), Pain Interference (P < .001), Pain Intensity (P <.001), and Global Physical Health (P = .004) were associated with increased satisfaction with respect to sports and physical activities. DISCUSSION This study investigated participation in specific sports and physical activities following flatfoot reconstruction. Our findings suggest mixed outcomes, where many patients reported life-changing improvements but many also experienced prolonged pain and difficulty after surgery. Some patients reported increased difficulty or inability to return to their preoperative maximum level of participation, indicating that flatfoot reconstructions can lead to athletic limitations. CONCLUSION Although flatfoot reconstruction can be a powerful tool to increase patients' capacity to engage in physical activity, in our cohort many patients had reduced physical activity outcomes. LEVEL OF EVIDENCE Level IV, retrospective case series.
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Affiliation(s)
| | | | - Jonathan Day
- Department of Orthopaedics, Georgetown University Medical Center, Washington, DC, USA
| | | | - Lavan Rajan
- Hospital for Special Surgery, New York, NY, USA
| | | | - Prashanth Kumar
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
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Systematic review of tendon transfers in the foot and ankle using interference screw fixation: Outcomes and safety of early versus standard postoperative rehabilitation. Foot Ankle Surg 2022; 28:166-175. [PMID: 33766498 DOI: 10.1016/j.fas.2021.03.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 12/31/2020] [Accepted: 03/15/2021] [Indexed: 02/04/2023]
Abstract
AIMS To compare the outcomes of early and standard rehabilitation protocols following tendon transfers in the foot and ankle using interference screw fixation (ISF). METHODS A systematic review was performed for relevant articles (1998 to 2020) reporting foot tendon transfer using ISF in adults. The primary outcome was early tendon failure. Secondary outcomes included function and complications. RESULTS In total, 21 studies met the inclusion criteria, totalling 494 patients. Seven studies reported early rehabilitation protocols. The rate of early tendon failure was zero for each protocol and studies consistently reported a significant improvement in function. No differences were found comparing different rehabilitation protocols for tendon transfer for Achilles tendon pathology and foot drop. CONCLUSION Both early and standard rehabilitation protocols are associated with high patient satisfaction and low complication rates, but currently there is a lack of evidence to support early loaded activities or motion. LEVEL OF EVIDENCE IV Systematic review including case series.
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8
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Sun Z, Chen S, Liu W, Sun G, Liu J, Wang J, Wang W, Zheng Y, Fan C. Efficacy of ultrasound therapy for the treatment of lateral elbow tendinopathy (the UCICLET Trial): study protocol for a three-arm, prospective, multicentre, randomised controlled trial. BMJ Open 2022; 12:e057266. [PMID: 35039305 PMCID: PMC8765018 DOI: 10.1136/bmjopen-2021-057266] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Lateral elbow tendinopathy (LET) is a highly prevalent disease among the middle-aged population, with no consensus on optimal management. Non-operative treatment is generally accepted as the first-line intervention. Ultrasound (US) therapy has been reported to be beneficial for various orthopaedic diseases, including tendinopathy. The purpose of this study is to investigate the efficacy of US for LET treatment. METHODS AND ANALYSIS This protocol entails a three-arm, prospective, multicentre, randomised controlled trial. Seventy-two eligible participants with clinically confirmed LET will be assigned to either (1) US, (2) corticosteroid injections or (3) control group. All participants will receive exercise-based therapy as a fundamental intervention. The primary outcome is Patient-rated Tennis Elbow Evaluation. The secondary outcomes include Visual Analogue Scale for pain, shortened version of the Disabilities of the Arm, Shoulder and Hand for upper limb disability, pain free/maximum grip strength, Work Limitations Questionnaire-25 for functional limitations at work, EuroQol-5D for general health, Hospital Anxiety and Depression Scale for mental status, Global Rating of Change for treatment success and recurrence rate, and Mahomed Scale for the participant's satisfaction. Adverse events will be recorded. Intention-to-treat analyses will be used. ETHICS AND DISSEMINATION Ethics committees of all clinical centres have approved this study. The leading centre is Shanghai Sixth People's Hospital, whose approval number is 2021-153. New versions with appropriate amendments will be submitted to the committee for further approval. Final results will be published in peer-reviewed journals and presented at local, national and international conferences. TRIAL REGISTRATION NUMBER ChiCTR2100050547.
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Affiliation(s)
- Ziyang Sun
- Department of Orthopedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
- Shanghai Engineering Research Center for Orthopaedic Material Innovation and Tissue Regeneration, Shanghai, China
| | - Shuai Chen
- Department of Orthopedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
- Shanghai Engineering Research Center for Orthopaedic Material Innovation and Tissue Regeneration, Shanghai, China
| | - Weixuan Liu
- Department of Orthopedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
- Shanghai Engineering Research Center for Orthopaedic Material Innovation and Tissue Regeneration, Shanghai, China
| | - Guixin Sun
- Department of Orthopaedics, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Junjian Liu
- Department of Orthopedics, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Jian Wang
- Department of Orthopaedics, Pudong New Area People's Hospital, Shanghai, China
| | - Wei Wang
- Department of Orthopedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
- Shanghai Engineering Research Center for Orthopaedic Material Innovation and Tissue Regeneration, Shanghai, China
| | - Yuanyi Zheng
- Department of Ultrasound in Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Cunyi Fan
- Department of Orthopedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
- Shanghai Engineering Research Center for Orthopaedic Material Innovation and Tissue Regeneration, Shanghai, China
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Wang SP, Lai WY, Lin YY, Lin TW, Tsai MT, Yang YP, Hsu CE, Chen CP, Lee CH, Su KC. Biomechanical comparisons of different diagonal screw designs in a novel embedded calcaneal slide plate. J Chin Med Assoc 2021; 84:1038-1047. [PMID: 34596083 DOI: 10.1097/jcma.0000000000000625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Medial displacement calcaneal osteotomy (MDCO) is frequently used for the surgical correction of flatfoot. This study aims to investigate the biomechanical effect of the different diagonal screw design on a novel-designed embedded calcaneal plate for MDCO using finite element analysis (FEA), mechanical test and digital image correlation (DIC) measurement. METHODS Four groups according to the varied implanted plate were set as control group (Group 1), non-diagonal screw (Group 2), one-diagonal screw (Group 3), and two-diagonal screws groups (Group 4). For FEA, A 450 N load was applied to on the anterior process of the calcaneus from top to bottom. Observational indices included the stress on the cortical and cancellous bone of the calcaneus surrounding the implant, the plate itself as well as screws, and the displacement of the overall structure. In addition, this study also used in vitro biomechanics test to investigate the stiffness of the structure after implantation, and used DIC to observe the displacement of the calcaneus structure after external force. RESULTS Under a simulated load in FEA, there are significant overall instability and high stress concentration on the calcaneal surrounding host bone and the plate/screws system, respectively, in group 2 compared with other groups. Regard to the mechanical testing with DIC system, significant increased rotation stability, maximum force and stiffness with the addition of diagonal screws. In comparison to Group 2, the increase of 112% and 157% in maximum force as well as 104% and 176% in stiffness were found in Group 3 and 4, respectively. CONCLUSION For reducing stress concentration and enhancing overall stability, more than one-diagonal screw design is recommended and two-diagonal screws design will be superior. This study provided biomechanical references for further calcaneal implants design to prevent clinical failure after MDCO.
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Affiliation(s)
- Shun-Ping Wang
- Department of Orthopedics, Taichung Veterans General Hospital, Taichung, Taiwan, ROC
- Sports Recreation and Health Management Continuing Studies-Bachelor's Degree Completion Program, Tunghai University, Taichung, Taiwan, ROC
- College of Medicine, National Chung Hsing University, Taichung, Taiwan, ROC
| | - Wei-Yi Lai
- Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Yi-Yin Lin
- Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Tzu-Wei Lin
- Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Ming-Tzu Tsai
- Department of Biomedical Engineering, Hungkuang University, Taichung, Taiwan, ROC
| | - Yi-Ping Yang
- Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Cheng-En Hsu
- Department of Orthopedics, Taichung Veterans General Hospital, Taichung, Taiwan, ROC
- Sports Recreation and Health Management Continuing Studies-Bachelor's Degree Completion Program, Tunghai University, Taichung, Taiwan, ROC
| | - Chao-Ping Chen
- Department of Orthopedics, Taichung Veterans General Hospital, Taichung, Taiwan, ROC
- Department of Health Services Administration, China Medical University, Taichung, Taiwan, ROC
- Department of Acupressure Technology, Jen-Teh Junior College of Medicine, Nursing and Management, Miaoli, Taiwan, ROC
| | - Cheng-Hung Lee
- Department of Orthopedics, Taichung Veterans General Hospital, Taichung, Taiwan, ROC
- College of Medicine, National Chung Hsing University, Taichung, Taiwan, ROC
- Department of Food Science and Technology, Hungkuang University, Taichung, Taiwan, ROC
| | - Kuo-Chih Su
- Department of Biomedical Engineering, Hungkuang University, Taichung, Taiwan, ROC
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan, ROC
- Department of Chemical and Materials Engineering, Tunghai University, Taichung, Taiwan, ROC
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Calcaneal Osteotomies in the Treatment of Progressive Collapsing Foot Deformity. What are the Restrictions for the Holy Grail? Foot Ankle Clin 2021; 26:473-505. [PMID: 34332731 DOI: 10.1016/j.fcl.2021.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The progressive collapsing foot deformity is a complex three-dimensional deformity, including valgus malalignment of the heel. The medial displacement calcaneal osteotomy is an established surgical procedure reliably resulting in an efficient correction of the inframalleolar alignment. However, complications are common, including undercorrection of underlying deformity, progression of hindfoot osteoarthritis and/or deformity, and/or symptomatic hardware.
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Hanna M, Whicker EA, Traub B, Allam E, Labib SA. Sport activity levels following ankle fusion. INTERNATIONAL ORTHOPAEDICS 2021; 45:2347-2354. [PMID: 34228148 DOI: 10.1007/s00264-021-05100-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 05/25/2021] [Indexed: 01/12/2023]
Abstract
PURPOSE Ankle arthrodesis (AA) is frequently employed in the treatment of end-stage ankle arthritis, which is common following trauma and athletic injuries. While AA remains a popular therapeutic option, little data exists about activity and sporting capacity following AA. The objective of this research was to determine functional outcomes and sporting activity levels in patients following Ankle Arthrodesis. METHODS Validated questionnaires were emailed to 35 patients with a history of AA at an average follow-up of 52 months. Functional outcomes were assessed using the Foot and Ankle Disability Index (FADI), as well as the associated FADI-Sport. Responses were compared to those from a control population of RESULTS: 24 patients scheduled for AA, at an average pre-operative visit of three months. Activity levels were assessed prior to injury as well as pre- and post-operatively using the Tegner activity level scale. Average Tegner scores of the 35 surgical patients decreased from 3.82 ± 0.38 before their injury, to 1.15 ± 0.19 immediately pre-op, with recovery to 2.67 ± 0.26 following fusion. Average post arthrodesis FADI and FADI-sport scores in our patients were 76.5 ± 3.19% and 33.8 ± 23.06%. For the pre-operative control population, corresponding scores were 47.41 ± 2.61% and 22.24 ± 1.03%. Following AA, we found that patients improved upon their pre-op Tegner score, although they did not return to their pre-injury level of sporting participation. Additionally, patients reported that they had no current dysfunction with their lower leg. CONCLUSION Patients undergoing Ankle Arthrodesis should expect improved lower leg function, though will not likely return to their pre-injury level of activity.
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Affiliation(s)
- Maged Hanna
- Department of Orthopedics, University of Toledo Medical Center, 3000 Arlington Ave, Toledo, OH, 43614, USA.
| | - Emily A Whicker
- Department of Orthopaedics, Drexel University College of Medicine, 245 N Broad St, Philadelphia, PA, USA
| | - Brian Traub
- Depatment of Surgery, Montefiore Medical Center, 3400 Bainbridge Avenue, Bronx, NY, 10467, USA
| | - Emad Allam
- Department of Radiology, Emory University, 1364 Clifton Rd, Atlanta, GA, 30322, USA
| | - Sameh A Labib
- Department of Orthopaedics, Emory University, 59 Executive Park South Suite 3000, Atlanta, GA, 30329, USA
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Stress Fractures of the Fifth Metatarsal in Athletes. J Am Acad Orthop Surg 2021; 29:507-517. [PMID: 33826553 DOI: 10.5435/jaaos-d-20-01060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 03/04/2021] [Indexed: 02/01/2023] Open
Abstract
Stress fractures of the fifth metatarsal (zones 2 and 3) remain a challenging clinical problem. It has been well established that nonsurgical treatment has unacceptably high nonunion and refracture rates. Surgical fixation remains the treatment of choice in the athletic cohort, and intramedullary screw fixation with a solid screw has been established as the most predictable means of achieving a successful outcome. Recently, the use of a plantar plate has also been advocated as has been shown in some studies to be more biomechanically advantageous. The use of bone grafting at the primary surgery and morphology and screw type are also important decisions to be made when treating these patients. This review will discuss our management of both primary fractures and refractures of the fifth metatarsal in athletes.
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Goss M, Stauch C, Lewcun J, Ridenour R, King J, Juliano P, Aynardi M. Natural History of 321 Flatfoot Reconstructions in Adult Acquired Flatfoot Deformity Over a 14-Year Period. Foot Ankle Spec 2021; 14:226-231. [PMID: 32189513 DOI: 10.1177/1938640020912859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The purpose of this study was to report the natural history, demographics, and mechanisms of requirement for additional surgery in patients undergoing flatfoot reconstruction for adult acquired flatfoot. A total of 321 consecutive patients undergoing flatfoot reconstruction over a 14-year period were included (2002-2016). All procedures were performed by a senior orthopaedic foot and ankle surgeon at our institution. Demographic data, operative reports, clinic notes, and radiographs were available for review. Statistical analysis included calculation of relative risk (RR) ratios. The majority of patients were female (83.2%,) and most patients were overweight with a body mass index greater than 25 kg/m2 (56.4%). Patient comorbidities included diabetes (13.7%) and rheumatoid arthritis (3.7%). Additional surgery was required for 54 patients (16.8%). The most common reasons for additional surgery were the following: painful calcaneal hardware (57.4%), conversion to triple arthrodesis (16.7%), and wound healing complications (9.1%). An increased risk of need for additional surgery was associated with female gender (RR = 3.4; P = .0005), smoking status (RR = 1.9; P = .0081), and age (<60 years of age; RR = 1.8; P = .042). Although retrospective, the results provide insight into the natural history of this procedure. Clinicians may use these data to appropriately counsel patients who are at increased risk of requirement for additional surgery, such as smokers, women, and patients <60 years old, regarding treatment options.Levels of Evidence: Level IV.
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Affiliation(s)
- Madison Goss
- Penn State College of Medicine, Hershey, Pennsylvania (MG, JL, JK).,Department of Orthopaedics and Rehabilitation, Penn State College of Medicine, Milton S. Hershey Medical Center, Hershey, Pennsylvania (CS).,Orthopaedic Surgery, Penn State Health, Milton S. Hershey Medical Center, Hershey, Pennsylvania (RR).,Foot and Ankle Orthopaedics, Penn State College of Medicine, Milton S. Hershey Medical Center, Hershey, Pennsylvania (PJ, MA)
| | - Christopher Stauch
- Penn State College of Medicine, Hershey, Pennsylvania (MG, JL, JK).,Department of Orthopaedics and Rehabilitation, Penn State College of Medicine, Milton S. Hershey Medical Center, Hershey, Pennsylvania (CS).,Orthopaedic Surgery, Penn State Health, Milton S. Hershey Medical Center, Hershey, Pennsylvania (RR).,Foot and Ankle Orthopaedics, Penn State College of Medicine, Milton S. Hershey Medical Center, Hershey, Pennsylvania (PJ, MA)
| | - Joseph Lewcun
- Penn State College of Medicine, Hershey, Pennsylvania (MG, JL, JK).,Department of Orthopaedics and Rehabilitation, Penn State College of Medicine, Milton S. Hershey Medical Center, Hershey, Pennsylvania (CS).,Orthopaedic Surgery, Penn State Health, Milton S. Hershey Medical Center, Hershey, Pennsylvania (RR).,Foot and Ankle Orthopaedics, Penn State College of Medicine, Milton S. Hershey Medical Center, Hershey, Pennsylvania (PJ, MA)
| | - Ryan Ridenour
- Penn State College of Medicine, Hershey, Pennsylvania (MG, JL, JK).,Department of Orthopaedics and Rehabilitation, Penn State College of Medicine, Milton S. Hershey Medical Center, Hershey, Pennsylvania (CS).,Orthopaedic Surgery, Penn State Health, Milton S. Hershey Medical Center, Hershey, Pennsylvania (RR).,Foot and Ankle Orthopaedics, Penn State College of Medicine, Milton S. Hershey Medical Center, Hershey, Pennsylvania (PJ, MA)
| | - Jesse King
- Penn State College of Medicine, Hershey, Pennsylvania (MG, JL, JK).,Department of Orthopaedics and Rehabilitation, Penn State College of Medicine, Milton S. Hershey Medical Center, Hershey, Pennsylvania (CS).,Orthopaedic Surgery, Penn State Health, Milton S. Hershey Medical Center, Hershey, Pennsylvania (RR).,Foot and Ankle Orthopaedics, Penn State College of Medicine, Milton S. Hershey Medical Center, Hershey, Pennsylvania (PJ, MA)
| | - Paul Juliano
- Penn State College of Medicine, Hershey, Pennsylvania (MG, JL, JK).,Department of Orthopaedics and Rehabilitation, Penn State College of Medicine, Milton S. Hershey Medical Center, Hershey, Pennsylvania (CS).,Orthopaedic Surgery, Penn State Health, Milton S. Hershey Medical Center, Hershey, Pennsylvania (RR).,Foot and Ankle Orthopaedics, Penn State College of Medicine, Milton S. Hershey Medical Center, Hershey, Pennsylvania (PJ, MA)
| | - Michael Aynardi
- Penn State College of Medicine, Hershey, Pennsylvania (MG, JL, JK).,Department of Orthopaedics and Rehabilitation, Penn State College of Medicine, Milton S. Hershey Medical Center, Hershey, Pennsylvania (CS).,Orthopaedic Surgery, Penn State Health, Milton S. Hershey Medical Center, Hershey, Pennsylvania (RR).,Foot and Ankle Orthopaedics, Penn State College of Medicine, Milton S. Hershey Medical Center, Hershey, Pennsylvania (PJ, MA)
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14
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Kim DH, Choi JH, Park CH, Park HJ, Yoon KJ, Lee YT. The Diagnostic Significance of Ultrasonographic Measurement of the Achilles Tendon Thickness for the Insertional Achilles Tendinopathy in Patients with Heel Pain. J Clin Med 2021; 10:jcm10102165. [PMID: 34067786 PMCID: PMC8157148 DOI: 10.3390/jcm10102165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 05/03/2021] [Accepted: 05/13/2021] [Indexed: 12/16/2022] Open
Abstract
No consensus exists concerning the diagnostic role or cutoff value of the Achilles tendon thickness on ultrasonography (US) for the diagnosis of insertional Achilles tendinopathy. This study sought to assess the diagnostic utility of US measurement of the thickness and echogenicity of the Achilles tendon for the insertional Achilles tendinopathy in patients with heel pain, and to compare the results with those of the plantar fascia for the plantar fasciitis. We conducted US examinations in consecutive patients who presented with unilateral or bilateral heel pain at the foot clinic of a single tertiary hospital from February 2016 to December 2020. Each US evaluation assessed the thickness and echogenicity of the insertion area of the Achilles tendon and plantar fascia. We retrospectively compared these parameters between patients with insertional Achilles tendinopathy or plantar fasciitis and normal controls and analyzed the diagnostic utility of these parameters. Based on clinical diagnosis, 44 feet were diagnosed with insertional Achilles tendinopathy, 109 feet were diagnosed with plantar fasciitis, and 32 feet were classified as normal. There was a significant difference in the thickness of the plantar fascia between the plantar fasciitis and normal control groups (p = 0.032). There was also a significant difference in the echogenicity of the plantar fascia between the plantar fasciitis and normal groups (p < 0.001). However, there was no significant difference in the thickness of the insertional area of the Achilles tendon between the insertional Achilles tendinopathy and normal groups (p = 0.132). There was a significant difference in the echogenicity of the insertional area of the Achilles tendon between the insertional Achilles tendinopathy and normal groups (p < 0.001). US measurement of the thickness of the insertional area of the Achilles tendon might not reflect the clinical status of insertional Achilles tendinopathy, unlike that of plantar fasciitis.
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Affiliation(s)
- Du-Hwan Kim
- Department of Physical Medicine and Rehabilitation, College of Medicine, Chung-Ang University, Seoul 06973, Korea;
| | - Jae-Hyeong Choi
- Department of Physical and Rehabilitation Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 03181, Korea; (J.-H.C.); (C.-H.P.); (K.-J.Y.)
| | - Chul-Hyun Park
- Department of Physical and Rehabilitation Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 03181, Korea; (J.-H.C.); (C.-H.P.); (K.-J.Y.)
| | - Hee-Jin Park
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 03181, Korea;
| | - Kyung-Jae Yoon
- Department of Physical and Rehabilitation Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 03181, Korea; (J.-H.C.); (C.-H.P.); (K.-J.Y.)
| | - Yong-Taek Lee
- Department of Physical and Rehabilitation Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 03181, Korea; (J.-H.C.); (C.-H.P.); (K.-J.Y.)
- Correspondence:
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15
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Tang CYK, Ng KH. A valuable option: Clinical and radiological outcomes of braided suture tape system augmentation for spring ligament repair in flexible flatfoot. Foot (Edinb) 2020; 45:101685. [PMID: 33032155 DOI: 10.1016/j.foot.2020.101685] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 03/26/2020] [Accepted: 04/04/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND The purpose of this study was to evaluate the clinical and radiological outcomes of the briaded suture tape system augmentation in the treatment of flexible flatfoot. METHODS Patients who underwent suture tape system augmentation in addition to spring ligament repair and flexor digitorum longus (FDL) transfer were reviewed. Clinical and radiological outcomes were studied. The results were compared to a matched control group who underwent the conventional surgical treatment, which involved FDL transfer only or FDL transfer plus medial sliding calcaneal osteotomy. RESULTS A total of 40 patients (11 males and 29 females) who underwent hindfoot reconstruction for flexible flatfoot (Johnson stage 2) were reviewed. There were 18 patients in the suture tape system group and 22 patients in the control group. In the suture tape system group, there was excellent improvement in patients' symptoms, AOFAS score (97.9 improved from 76.7) and significantly more number of patients with stable single leg stance. Radiographic parameters improved postoperatively too. CONCLUSIONS This is the first clinical study which studied the outcome of suture tape system augmentation for spring ligament repair. Patients with suture tape system reconstruction showed more number of patients with single leg stance and better correction of forefoot abduction. It is a reasonable component of hindfoot reconstruction.
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Affiliation(s)
- Chris Yuk Kwan Tang
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Pokfulam, Hong Kong, China.
| | - Ka Ho Ng
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Pokfulam, Hong Kong, China
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16
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Cronin S, Conti M, Williams N, Ellis SJ. Relationship Between Demographic and Radiographic Characteristics and Second Ray Pathology in Hallux Valgus Patients. FOOT & ANKLE ORTHOPAEDICS 2020; 5:2473011420909088. [PMID: 35097369 PMCID: PMC8697280 DOI: 10.1177/2473011420909088] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Hallux valgus can alter load bearing in the foot leading to abnormal forces on the second toe. The purpose of this study was to determine demographic and radiographic factors associated with second ray hammertoes in hallux valgus using 3-dimensional weightbearing CT scans. METHODS Seventy-one patients who underwent a modified Lapidus procedure for hallux valgus with preoperative weightbearing CT scans were separated into 2 groups: (1) hallux valgus only (47 feet) and (2) hallux valgus with second ray hammertoe (29 feet). Preoperative age, body mass index (BMI), sex, hallux valgus angle (HVA), intermetatarsal angle (IMA), absolute and effective metatarsal (MT) lengths, ratios between metatarsal lengths, Meary angle, metatarsus adductus angle (MAA), and pronation were measured. Mean values of continuous variables were compared and both simple and multivariable logistic regression models were used to evaluate associations between variables and hammertoe occurrence. RESULTS Patients in the hammertoe group were found to be significantly older and have higher BMIs, HVAs, effective second MT lengths, IMAs, and more apex plantar Meary angles (all P < .05). The multivariable analysis demonstrated that a higher IMA and a more apex plantar Meary angle were the only significant predictors of second ray hammertoe risk (P = .03 and P = .01, respectively) once corrected for age and BMI. CONCLUSION Significant associations were found between older age, higher BMI, and more severe deformity and the occurrence of hammertoe in hallux valgus patients. These results may help clinicians counsel hallux valgus patients about the risk of developing an advanced hammertoe deformity. LEVEL OF EVIDENCE Level III, retrospective comparative series.
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Affiliation(s)
| | | | - Nicholas Williams
- Division of Biostatistics and Epidemiology, Weill Cornell Medicine, New York, NY, USA
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17
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Lee W, Tran S, Cooper MT, Park JS, Perumal V. Clinical Outcomes of Osteochondral Lesions of the Tibial Plafond Following Arthroscopic Microfracture. Foot Ankle Int 2019; 40:1018-1024. [PMID: 31130008 DOI: 10.1177/1071100719850145] [Citation(s) in RCA: 10] [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 The purpose of this study was to evaluate the clinical outcomes and the level of sports activity following arthroscopic microfracture for osteochondral lesions of the tibial plafond. METHODS A retrospective review was conducted for patients who underwent arthroscopic microfracture surgery for osteochondral lesions of the tibial plafond from January 2014 to June 2017. For functional evaluation, the visual analog scale (VAS) pain score, Foot and Ankle Ability Measure (FAAM) score, and Short Form-12 (SF-12) general health questionnaire were used. We also investigated the level of sports activity before and after the surgery. Sixteen patients were included in this study, and the mean follow-up period was 29.8 months. RESULTS The mean VAS score improved from 8.3 (range, 6-10) preoperatively to 1.8 (range, 0-4) postoperatively. The mean FAAM score was improved from 57.6 (range, 6.0-88.9) for the activities of daily living subscale and 34.5 (range, 3.1-92.6) for the sports subscale to 84.3 (range, 46.4-100.0) and 65.2 (range, 23.3-55.1) for each subscale, respectively, at the final follow-up. There were also improvements in the SF-12 score, from 36.3 (range, 23.3-55.1) preoperatively to 46.0 (range, 18.9-56.6) postoperatively for the SF-12 PCS, and from 41.3 (range, 14.2-65.0) preoperatively to 52.6 (range, 32.8-60.8) postoperatively for the SF-12 MCS. All functional scores showed significant differences clinically and statistically at the final follow-up. The level of sports activity after the surgery was significantly lower than their level before the surgery (P = .012). CONCLUSION Arthroscopic microfracture provided satisfactory clinical outcomes for osteochondral lesions of the tibial plafond. Though all the patients in this study were able to return to sports activity after the surgery, the postoperative level of sports activity was significantly lower than their preoperative level. LEVEL OF EVIDENCE Level IV, retrospective case series.
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Affiliation(s)
- Wonyong Lee
- 1 Division of Foot and Ankle Surgery, Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, VA, USA
| | - Sterling Tran
- 2 University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Minton T Cooper
- 1 Division of Foot and Ankle Surgery, Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, VA, USA
| | - Joseph S Park
- 1 Division of Foot and Ankle Surgery, Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, VA, USA
| | - Venkat Perumal
- 1 Division of Foot and Ankle Surgery, Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, VA, USA
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18
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Pavone V, Vescio A, Di Silvestri CA, Andreacchio A, Sessa G, Testa G. Outcomes of the calcaneo-stop procedure for the treatment of juvenile flatfoot in young athletes. J Child Orthop 2018; 12:582-589. [PMID: 30607205 PMCID: PMC6293325 DOI: 10.1302/1863-2548.12.180032] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 09/05/2018] [Indexed: 02/03/2023] Open
Abstract
PURPOSE Flexible flatfoot (FFF) is a widespread condition in juvenile patients. If symptomatic, FFF can require surgical treatment. The calcaneo-stop procedure has shown excellent clinical and radiographic outcomes and low rates of complications. The aim of the present study was to assess the sport practice of young athletes affected by FFF having undergone the calcaneo-stop procedure. METHODS Between 2008 and 2016, 68 sport practitioners were bilaterally treated by the calcaneo-stop procedure, for a total of 136 FFF cases. Clinical evaluation, including the American Orthopedic Foot and Ankle Score (AOFAS), the Yoo et al score and The Foot & Ankle Disability Index (FADI) and FADI Sport scores were assessed. Radiographic evaluation was based on measurement of talar declination, Costa-Bertani's angle and calcaneal pitch. RESULTS Mean follow-up was 57.6 months (sd 16.8). The AOFAS score mean increased from 79.3 (sd 5.7) to 97.3 (sd 4.5) three years after surgery. The Yoo score improved from 3.1 (sd 1.0) preoperatively to 11.7 (sd 0.6) three years after surgery. The FADI Sport subscale mean improved from 74.1 (sd 10.4) preoperatively to 95.9 (sd 4.9) three years after surgery.Costa-Bertani's angle decreased from 156.1° (sd 4.2°) to 135.8° (sd 7.3°) at three years postoperatively; mean talar declination angle decreased from 44.2° (sd 6.3°) to 30.6° (sd 3.2°) at three years postoperatively and mean calcaneal pitch increased from 12.6° (sd 2.3°) to 16.3° (sd 1.3°) at three years postoperatively. CONCLUSION Adolescent patients who underwent the calcaneo-stop procedure reported satisfactory outcomes in terms of clinical and radiological evaluations. Moreover, our results showed an improvement of sport activity levels, with patients recovering sports activity within three months of surgery and without limitation in the execution of preferred activities. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- V. Pavone
- Department of General Surgery and Medical Surgical Specialties – Section of Orthopaedics and Traumatology, University Hospital ‘Policlinico-Vittorio Emanuele’, University of Catania, Italy
| | - A. Vescio
- Department of General Surgery and Medical Surgical Specialties – Section of Orthopaedics and Traumatology, University Hospital ‘Policlinico-Vittorio Emanuele’, University of Catania, Italy
| | - C. A. Di Silvestri
- Department of General Surgery and Medical Surgical Specialties – Section of Orthopaedics and Traumatology, University Hospital ‘Policlinico-Vittorio Emanuele’, University of Catania, Italy
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - A. Andreacchio
- Department of Paediatric Orthopaedic Surgery, Regina Margherita Children’s Hospital, Torino, Italy
| | - G. Sessa
- Department of General Surgery and Medical Surgical Specialties – Section of Orthopaedics and Traumatology, University Hospital ‘Policlinico-Vittorio Emanuele’, University of Catania, Italy
| | - G. Testa
- Department of General Surgery and Medical Surgical Specialties – Section of Orthopaedics and Traumatology, University Hospital ‘Policlinico-Vittorio Emanuele’, University of Catania, Italy
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Abstract
Adult acquired flatfoot deformity is a debilitating condition typically affecting middle-aged patients. The multiple components include hindfoot valgus, first ray elevation, medial soft tissue compromise, and forefoot abduction. As the foot becomes unbalanced, the deformity progresses with repetitive loading and time. Untreated patients often need significant reconstructions or extensive arthrodesis after arthritis and joint contractures present. Medializing calcaneal osteotomy is the workhorse operation for correction of hindfoot valgus, reliably correcting deformity with a relatively low complication risk. This article reviews indications, techniques, complications, and outcomes for the medializing calcaneal osteotomy.
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Affiliation(s)
- Stephen Greenfield
- OrthoCarolina Foot & Ankle Institute, 2001 Vail Avenue, Suite 200B, Charlotte, NC 28207, USA.
| | - Bruce Cohen
- OrthoCarolina Foot & Ankle Institute, 2001 Vail Avenue, Suite 200B, Charlotte, NC 28207, USA
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20
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Gaulke R, Krettek C. [Tendinopathies of the foot and ankle : Evidence for the origin, diagnostics and therapy]. Unfallchirurg 2017; 120:205-213. [PMID: 28120032 DOI: 10.1007/s00113-016-0301-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Tendinopathies of the foot and ankle result in substantial impairment of the mobility of patients and have a high clinical significance. Knowledge of the origin of these diseases has been accumulated over decades from the multitude of intrinsic and extrinsic triggering factors based on biomechanical considerations with an evidence-based medicine (EBM) level 5. A high correlation between tendinopathy and hypervascularization of the Achilles tendon was found in a double-blind randomized prospective study using Doppler ultrasound (EBM level 1) but these results were not reproducible; therefore, the importance of these findings is unclear. Inspection and clinical examination supplemented by ultrasound and magnetic resonance imaging (MRI) are essential to achieve the correct diagnosis. The varying extent of load-dependent irritation of tendons and the surrounding tissues and the individual variation in experience of investigators mean that the results of clinical examinations are difficult to collate or not reproducible and cannot be investigated in studies. The expression of the varying results is difficult to assess even by the use of sonography and magnetic resonance imaging (MRI). Conservative treatment of tendinopathy is based on medical experience (EBM level 5). The effectiveness of physiotherapeutic eccentric loading and extracorporal shock wave treatment (ESWT) for Achilles tendinopathy was demonstrated in several case control studies and series (EBM level 3). Due to the high rate of healing with physiotherapy, surgery should only be performed following a minimum of 6-12 weeks of unsuccessful conservative treatment, because formation of scar tissue on the foot can result in permanent complaints (EBM level 4).
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Affiliation(s)
- Ralph Gaulke
- Sektion Obere Extremität, Fuß- und Rheumachirurgie, Unfallchirurgische Klinik, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland.
| | - Christian Krettek
- Sektion Obere Extremität, Fuß- und Rheumachirurgie, Unfallchirurgische Klinik, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
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