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Xie Q, Sui L, Sun Y, Li X, Liu S, Wang P. Comparisons of ankle arthrodesis with different internal fixation methods in the treatment of post-traumatic osteoarthritis. J Orthop Sci 2024; 29:621-626. [PMID: 36858837 DOI: 10.1016/j.jos.2023.02.009] [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: 06/22/2022] [Revised: 01/06/2023] [Accepted: 02/14/2023] [Indexed: 03/03/2023]
Abstract
BACKGROUND The aim of this study was to explore the clinical efficacy of ankle arthrodesis with different internal fixation methods in the treatment of post-traumatic osteoarthritis. METHODS We collected 85 patients with post-traumatic osteoarthritis who underwent different ankle arthrodesis between December 2015 and December 2020. The operation performance, complication rate, hindfoot alignment, talus tilt angle, visual analogue scale (VAS), and American Orthopedic Foot and Ankle Society (AOFAS) score were preoperatively and postoperatively evaluated. RESULTS In an anterior approach, the locking plate-fixation exhibited a similarity in operation time, incision length, postoperative drainage, bone fusion, hindfoot alignment, and talus tilt angle with fibula support compression screw-fixation, but it was better in increasing postoperative AOFAS. The locking plate-fixation in the anterior approach had lower operation time, incision length, and postoperative drainage than that in the lateral approach. In addition, the lateral locking plate combined with posterolateral compression screw fixation (LLPPCSF) presented shorter bone fusion time, higher AOFAS score, and lower complication rate than either plate- or screw-fixation alone. CONCLUSION Lateral locking plate fixation was better than fibula support compression screw fixation in relieving postoperative pain. Anterior locking plate fixation was more time-saving and less invasiveness than lateral locking plate fixation, but its application was limited in low degree of ankle deformation. LLPPCSF was the most effective in improving bone fusion and postoperative pain, considering an optimal option for the treatment of post-traumatic osteoarthritis.
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Affiliation(s)
- Qiang Xie
- Department of Hand and Foot Surgery, Affiliated Hospital of Chengde Medical University, Chengde City, Hebei Province, 067000, China
| | - Lei Sui
- Department of Hand and Foot Surgery, Affiliated Hospital of Chengde Medical University, Chengde City, Hebei Province, 067000, China
| | - Yupeng Sun
- Department of Hand and Foot Surgery, Affiliated Hospital of Chengde Medical University, Chengde City, Hebei Province, 067000, China
| | - Xiaodong Li
- Department of Hand and Foot Surgery, Affiliated Hospital of Chengde Medical University, Chengde City, Hebei Province, 067000, China
| | - Shibo Liu
- Department of Hand and Foot Surgery, Affiliated Hospital of Chengde Medical University, Chengde City, Hebei Province, 067000, China
| | - Pei Wang
- Department of Hand and Foot Surgery, Affiliated Hospital of Chengde Medical University, Chengde City, Hebei Province, 067000, China.
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Chapman LS, Jones J, Redmond AC, Flurey CA, Richards P, Hofstetter C, Smith TO, Arnold JB, Hannan MT, Maxwell LJ, Menz HB, Shea B, Golightly YM, Tugwell P, Beaton D, Conaghan PG, Helliwell PS, Siddle HJ. Developing a core outcome set for foot and ankle disorders in rheumatic and musculoskeletal diseases: A scoping review and report from the OMERACT 2022 foot and ankle special interest group session. Semin Arthritis Rheum 2023; 61:152210. [PMID: 37156170 DOI: 10.1016/j.semarthrit.2023.152210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 04/28/2023] [Accepted: 05/02/2023] [Indexed: 05/10/2023]
Abstract
OBJECTIVES Foot and ankle involvement is common in rheumatic and musculoskeletal diseases, yet high-quality evidence assessing the effectiveness of treatments for these disorders is lacking. The Outcome Measures in Rheumatology (OMERACT) Foot and Ankle Working Group is developing a core outcome set for use in clinical trials and longitudinal observational studies in this area. METHODS A scoping review was performed to identify outcome domains in the existing literature. Clinical trials and observational studies comparing pharmacological, conservative or surgical interventions involving adult participants with any foot or ankle disorder in the following rheumatic and musculoskeletal diseases (RMDs) were eligible for inclusion: rheumatoid arthritis (RA), osteoarthritis (OA), spondyloarthropathies, crystal arthropathies and connective tissue diseases. Outcome domains were categorised according to the OMERACT Filter 2.1. RESULTS Outcome domains were extracted from 150 eligible studies. Most studies included participants with foot/ankle OA (63% of studies) or foot/ankle involvement in RA (29% of studies). Foot/ankle pain was the outcome domain most commonly measured (78% of studies), being the most frequently specified outcome domain across all RMDs. There was considerable heterogeneity in the other outcome domains measured, across core areas of manifestations (signs, symptoms, biomarkers), life impact, and societal/resource use. The group's progress to date, including findings from the scoping review, was presented and discussed during a virtual OMERACT Special Interest Group (SIG) in October 2022. During this meeting, feedback was sought amongst delegates regarding the scope of the core outcome set, and feedback was received on the next steps of the project, including focus group and Delphi methods. CONCLUSION Findings from the scoping review and feedback from the SIG will contribute to the development of a core outcome set for foot and ankle disorders in RMDs. The next steps are to determine which outcome domains are important to patients, followed by a Delphi exercise with key stakeholders to prioritise outcome domains.
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Affiliation(s)
- Lara S Chapman
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, 2nd Floor, Chapel Allerton Hospital, Chapeltown Road, Leeds LS7 4SA, UK; Centre for Sport, Exercise and Osteoarthritis Research Versus Arthritis, UK
| | - Jennifer Jones
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, 2nd Floor, Chapel Allerton Hospital, Chapeltown Road, Leeds LS7 4SA, UK
| | - Anthony C Redmond
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, 2nd Floor, Chapel Allerton Hospital, Chapeltown Road, Leeds LS7 4SA, UK; Centre for Sport, Exercise and Osteoarthritis Research Versus Arthritis, UK; National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds, UK
| | - Caroline A Flurey
- Department of Health and Social Sciences, Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK
| | | | | | | | - John B Arnold
- Alliance for Research in Exercise, Nutrition & Activity (ARENA), Allied Health & Human Performance Unit, University of South Australia, Adelaide, Australia
| | - Marian T Hannan
- Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA
| | - Lara J Maxwell
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Hylton B Menz
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
| | - Beverley Shea
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Yvonne M Golightly
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, NC, USA; College of Allied Health Professions, University of Nebraska Medical Center, Omaha, NE, USA
| | - Peter Tugwell
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Dorcas Beaton
- Department of Occupational Science and Occupational Therapy, Institute for Work and Health, Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
| | - Philip G Conaghan
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, 2nd Floor, Chapel Allerton Hospital, Chapeltown Road, Leeds LS7 4SA, UK; Centre for Sport, Exercise and Osteoarthritis Research Versus Arthritis, UK; National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds, UK
| | - Philip S Helliwell
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, 2nd Floor, Chapel Allerton Hospital, Chapeltown Road, Leeds LS7 4SA, UK
| | - Heidi J Siddle
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, 2nd Floor, Chapel Allerton Hospital, Chapeltown Road, Leeds LS7 4SA, UK.
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Elattar O, Smith T, Ferguson A, Farber D, Wapner K. Republication of "Uses of Braces and Orthotics for Conservative Management of Foot and Ankle Disorders". FOOT & ANKLE ORTHOPAEDICS 2023; 8:24730114231193419. [PMID: 37566687 PMCID: PMC10408344 DOI: 10.1177/24730114231193419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/13/2023] Open
Abstract
Nonsurgical management is almost always considered the first-line treatment for the vast majority of foot and ankle pathologies. Foot orthoses, shoe modifications, and therapeutic footwear are considered essential tools for successful conservative management of different foot and ankle disorders. Orthopedic foot and ankle surgeons should have a meticulous understanding of the lower extremity biomechanics as well as the pathoanatomy and the sequelae of diseases affecting the foot and/or ankle. This is essential to the understanding of the desired effects of the different inserts, orthotics, shoe modifications, or braces that may be prescribed for these conditions. In this article, we will summarize the orthoses used for treatment of the most commonly encountered foot and ankle pathologies, with the exclusion of treatment for the diabetic foot because of the unique requirements of that disease process.
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Affiliation(s)
- Osama Elattar
- Department of Orthopedics, University of Pennsylvania Medicine, Philadelphia, PA, USA
| | - Tyler Smith
- Department of Orthopedics, Philadelphia College of Osteopathic Medicine, Philadelphia, PA, USA
| | - Adam Ferguson
- Department of Orthopedics, University of Pennsylvania Medicine, Philadelphia, PA, USA
| | - Daniel Farber
- Department of Orthopedics, University of Pennsylvania Medicine, Philadelphia, PA, USA
| | - Keith Wapner
- Department of Orthopedics, University of Pennsylvania Medicine, Philadelphia, PA, USA
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4
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Godoy-Santos AL, Fonseca LF, de Cesar Netto C, Giordano V, Valderrabano V, Rammelt S. Ankle Osteoarthritis. Rev Bras Ortop 2021; 56:689-696. [PMID: 34900095 PMCID: PMC8651441 DOI: 10.1055/s-0040-1709733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Accepted: 01/10/2020] [Indexed: 10/25/2022] Open
Abstract
Osteoarthritis (OA) is characterized by a chronic, progressive and irreversible degradation of the joint surface associated with joint inflammation. The main etiology of ankle OA is post-traumatic and its prevalence is higher among young and obese people. Despite advances in the treatment of fractures around the ankle, the overall risk of developing post-traumatic ankle OA after 20 years is almost 40%, especially in Weber type B and C bimalleolar fractures and in fractures involving the posterior tibial border. In talus fractures, this prevalence approaches 100%, depending on the severity of the lesion and the time of follow-up. In this context, the current understanding of the molecular signaling pathways involved in senescence and chondrocyte apoptosis is fundamental. The treatment of ankle OA is staged and guided by the classification systems and local and patient conditions. The main problems are the limited ability to regenerate articular cartilage, low blood supply, and a shortage of progenitor stem cells. The present update summarizes recent scientific evidence of post-traumatic ankle OA with a major focus on changes of the synovia, cartilage and synovial fluid; as well as the epidemiology, pathophysiology, clinical implications, treatment options and potential targets for therapeutic agents.
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Affiliation(s)
- Alexandre Leme Godoy-Santos
- Laboratório Prof Manlio Mario Marco Napoli, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
- Programa Aparelho Locomotor, Hospital Israelita Albert Einstein, São Paulo, SP, Brasil
| | | | - Cesar de Cesar Netto
- Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City, IA, United States
| | - Vincenzo Giordano
- Serviço de Ortopedia e Traumatologia Prof Nova Monteiro, Hospital Municipal Miguel Couto, Rio de Janeiro, SP, Brasil
| | | | - Stefan Rammelt
- Universitäts Centrum für Orthopädie und Unfallchirurgie, Universitätsklinikum Carl Gustav Carus, Dresden, Alemanha
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5
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Shibuya N, McAlister JE, Prissel MA, Piraino JA, Joseph RM, Theodoulou MH, Jupiter DC. Consensus Statement of the American College of Foot and Ankle Surgeons: Diagnosis and Treatment of Ankle Arthritis. J Foot Ankle Surg 2021; 59:1019-1031. [PMID: 32778440 DOI: 10.1053/j.jfas.2019.10.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 10/20/2019] [Indexed: 02/03/2023]
Affiliation(s)
- Naohiro Shibuya
- Professor, College of Medicine, Texas A&M University, Temple, TX.
| | | | - Mark A Prissel
- Faculty, Advanced Foot and Ankle Reconstruction Fellowship Program, Orthopedic Foot and Ankle Center, Worthington, OH
| | - Jason A Piraino
- Associate Professor, Department of Orthopaedic Surgery and Rehabilitation, University of Florida Health, Gainesville, FL
| | - Robert M Joseph
- Chairman, Department of Podiatric Medicine & Radiology, Dr. William M. Scholl College of Podiatric Medicine at Rosalind Franklin University, North Chicago, IL
| | - Michael H Theodoulou
- Chief, Division of Podiatric Surgery, Cambridge Health Alliance, Instructor of Surgery, Harvard Medical School, Cambridge, MA
| | - Daniel C Jupiter
- Associate Professor, Department of Preventive Medicine and Community, Department of Orthopaedic Surgery and Rehabilitation, University of Texas Medical Branch, Galveston, TX
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7
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Adukia V, Mangwani J, Issac R, Hussain S, Parker L. Current concepts in the management of ankle arthritis. J Clin Orthop Trauma 2020; 11:388-398. [PMID: 32405197 PMCID: PMC7211821 DOI: 10.1016/j.jcot.2020.03.020] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Accepted: 03/30/2020] [Indexed: 01/15/2023] Open
Abstract
Ankle arthritis is a common condition. It causes a significant socioeconomic burden, and is associated with significant morbidity. Patients with ankle arthritis are either elderly with significant co-morbidities, or young adults who have previously suffered with ankle injuries, resulting in post-traumatic arthritis. There is a wide variation in the management of these patients with ankle arthritis. We therefore present an overview of the current evidence based management of patients with symptomatic ankle arthritis.
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Affiliation(s)
- V. Adukia
- Academic Team of Musculoskeletal Surgery, Leicester General Hospital, Gwendolen Road, Leicester, LE5 4PW, United Kingdom,Corresponding author.
| | - J. Mangwani
- Academic Team of Musculoskeletal Surgery, Leicester General Hospital, Gwendolen Road, Leicester, LE5 4PW, United Kingdom
| | - R. Issac
- Academic Team of Musculoskeletal Surgery, Leicester General Hospital, Gwendolen Road, Leicester, LE5 4PW, United Kingdom
| | - S. Hussain
- Barts Health NHS Trust, The Royal London Hospital, Whitechapel, London, E1 1BB, United Kingdom
| | - L. Parker
- Barts Health NHS Trust, The Royal London Hospital, Whitechapel, London, E1 1BB, United Kingdom
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8
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Potter BK, Sheu RG, Stinner D, Fergason J, Hsu JR, Kuhn K, Owens JG, Rivera J, Shawen SB, Wilken JM, DeSanto J, Huang Y, Scharfstein DO, MacKenzie EJ. Multisite Evaluation of a Custom Energy-Storing Carbon Fiber Orthosis for Patients with Residual Disability After Lower-Limb Trauma. J Bone Joint Surg Am 2018; 100:1781-1789. [PMID: 30334889 DOI: 10.2106/jbjs.18.00213] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The Intrepid Dynamic Exoskeletal Orthosis (IDEO) is a custom energy-storing carbon fiber ankle-foot orthosis developed for lower-extremity trauma patients. Studies conducted at the military treatment facility where the IDEO was developed demonstrated benefits of the IDEO when used with the Return to Run Physical Therapy (RTR PT) program. The current study was designed to determine if results could be replicated at other military treatment facilities and to examine whether early performance gains in patient-reported functional outcomes remained at 12 months. METHODS Study participants included service members who had functional deficits that interfered with daily activities at least 1 year after a traumatic unilateral lower-extremity injury at or below the knee. Participants were evaluated before receiving the IDEO, immediately following completion of RTR PT, and at 6 and 12 months. Agility, strength/power, and speed were assessed using well-established performance tests. Self-reported function was measured using the Short Musculoskeletal Function Assessment (SMFA). The Orthotics and Prosthetics Users' Survey was administered to assess satisfaction with the IDEO. Of 87 participants with complete baseline data, 6 did not complete any physical therapy and were excluded from the analysis. Follow-up rates immediately following completion of the RTR PT and at 6 and 12 months were 88%, 75%, and 79%, respectively. RESULTS Compared with baseline, improvement at completion of RTR PT was observed in all but 1 performance test. SMFA scores for all domains except hand and arm function were lower (improved function) at 6 and 12 months. Satisfaction with the IDEO was high following completion of RTR PT, with some attenuation at the time of follow-up. CONCLUSIONS This study adds to the evidence supporting the efficacy of the IDEO coupled with RTR PT. However, despite improvement in both performance and self-reported functioning, deficits persist compared with population norms. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
| | - Robert G Sheu
- Naval Medical Center San Diego, San Diego, California
| | - Daniel Stinner
- San Antonio Military Medical Center, Fort Sam Houston, Texas
| | - John Fergason
- San Antonio Military Medical Center, Fort Sam Houston, Texas
| | - Joseph R Hsu
- Carolinas Medical Center, Charlotte, North Carolina
| | - Kevin Kuhn
- Naval Medical Center San Diego, San Diego, California
| | - Johnny G Owens
- San Antonio Military Medical Center, Fort Sam Houston, Texas
| | - Jessica Rivera
- San Antonio Military Medical Center, Fort Sam Houston, Texas
| | - Scott B Shawen
- Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Jason M Wilken
- San Antonio Military Medical Center, Fort Sam Houston, Texas
| | - Jennifer DeSanto
- METRC Coordinating Center at Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Yanjie Huang
- METRC Coordinating Center at Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Daniel O Scharfstein
- METRC Coordinating Center at Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Ellen J MacKenzie
- METRC Coordinating Center at Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Elattar O, Smith T, Ferguson A, Farber D, Wapner K. Uses of Braces and Orthotics for Conservative Management of Foot and Ankle Disorders. FOOT & ANKLE ORTHOPAEDICS 2018. [DOI: 10.1177/2473011418780700] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Nonsurgical management is almost always considered the first-line treatment for the vast majority of foot and ankle pathologies. Foot orthoses, shoe modifications, and therapeutic footwear are considered essential tools for successful conservative management of different foot and ankle disorders. Orthopedic foot and ankle surgeons should have a meticulous understanding of the lower extremity biomechanics as well as the pathoanatomy and the sequelae of diseases affecting the foot and/or ankle. This is essential to the understanding of the desired effects of the different inserts, orthotics, shoe modifications, or braces that may be prescribed for these conditions. In this article, we will summarize the orthoses used for treatment of the most commonly encountered foot and ankle pathologies, with the exclusion of treatment for the diabetic foot because of the unique requirements of that disease process.
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Affiliation(s)
- Osama Elattar
- Department of Orthopedics, University of Pennsylvania Medicine, Philadelphia, PA, USA
| | - Tyler Smith
- Department of Orthopedics, Philadelphia College of Osteopathic Medicine, Philadelphia, PA, USA
| | - Adam Ferguson
- Department of Orthopedics, University of Pennsylvania Medicine, Philadelphia, PA, USA
| | - Daniel Farber
- Department of Orthopedics, University of Pennsylvania Medicine, Philadelphia, PA, USA
| | - Keith Wapner
- Department of Orthopedics, University of Pennsylvania Medicine, Philadelphia, PA, USA
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10
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Williamson P, Lechtig A, Hanna P, Okajima S, Biggane P, Nasr M, Zurakowski D, Duggal N, Nazarian A. Pressure Distribution in the Ankle and Subtalar Joint With Routine and Oversized Foot Orthoses. Foot Ankle Int 2018; 39:994-1000. [PMID: 29696991 DOI: 10.1177/1071100718770659] [Citation(s) in RCA: 4] [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 Foot orthoses are used to treat many disorders that affect the lower limb. These assistive devices have the potential to alter the forces, load distribution, and orientation within various joints in the foot and ankle. This study attempts to quantify the effects of orthoses on the intra-articular force distribution of the ankle and subtalar joint using a cadaveric testing jig to simulate weight bearing. METHODS Five lower-limb cadaveric specimens were placed on a custom jig, where a 334-N (75-lb) load was applied at the femoral head, and the foot was supported against a plate to simulate double-leg stance. Pressure-mapping sensors were inserted into the ankle and subtalar joint. Mean pressure, peak pressure, contact area, and center of force were measured in both the ankle and subtalar joints for barefoot and 2 medial foot orthosis conditions. The 2 orthosis conditions were performed using (1) a 1.5-cm-height wedge to simulate normal orthoses and (2) a 3-cm-height wedge to simulate oversized orthoses. RESULTS The contact area experienced in the subtalar joint significantly decreased during 3-cm orthotic posting of the medial arch, but neither orthosis had a significant effect on the spatial mean pressure or peak pressure experienced in either joint. CONCLUSION The use of an oversized orthosis could lead to a decrease in the contact area and alterations in the distribution of pressure within the subtalar joint. CLINICAL RELEVANCE The use of inappropriate orthoses could negatively impact the force distribution in the lower limb.
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Affiliation(s)
- Patrick Williamson
- 1 Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.,2 Department of Mechanical Engineering, Boston University, Boston, MA, USA
| | - Aron Lechtig
- 1 Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Philip Hanna
- 1 Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Stephen Okajima
- 1 Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Peter Biggane
- 1 Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Michael Nasr
- 1 Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - David Zurakowski
- 3 Syracuse Orthopaedic Specialists, Department of General Orthopedics and Trauma, Foot and Ankle Division, Syracuse, NY, USA.,4 Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Naven Duggal
- 3 Syracuse Orthopaedic Specialists, Department of General Orthopedics and Trauma, Foot and Ankle Division, Syracuse, NY, USA
| | - Ara Nazarian
- 1 Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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Patient Response to an Integrated Orthotic and Rehabilitation Initiative for Traumatic Injuries: The PRIORITI-MTF Study. J Orthop Trauma 2017; 31 Suppl 1:S56-S62. [PMID: 28323803 DOI: 10.1097/bot.0000000000000795] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Although limb salvage is now possible for many high-energy open fractures and crush injuries to the distal tibia, ankle, hindfoot, and midfoot, orthotic options are limited. The Intrepid Dynamic Exoskeletal Orthosis (IDEO) is a custom, energy-storing carbon fiber orthosis developed for trauma patients undergoing limb salvage. The IDEO differs from other orthoses in that it allows patients with ankle weakness to have more normal ankle biomechanics and increased ankle power. This article describes the design of a study to evaluate the effectiveness of the IDEO when delivered together with a high-intensity, sports medicine-based approach to rehabilitation. It builds on earlier studies by testing the program at military treatment facilities beyond the Brooke Army Medical Center and the Center for the Intrepid where the device was developed. The PRIORITI-MTF study is a multicenter before-after program evaluation where participants at least 1 year out from a traumatic lower extremity injury serve as their own controls. Participants are evaluated before receiving the IDEO, immediately after 4 weeks of physical therapy with the IDEO and at 6 and 12 months after the completion of physical therapy. Primary outcomes include functional performance, measured using well-validated assessments of speed, agility, power, and postural stability and self-reported functioning using the Short Musculoskeletal Function Assessment (SMFA) and the Veterans Health Survey (VR-12). Secondary outcomes include pain, depression, posttraumatic stress, and satisfaction with the IDEO.
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12
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Witteveen AGH, Hofstad CJ, Kerkhoffs GMMJ. Hyaluronic acid and other conservative treatment options for osteoarthritis of the ankle. Cochrane Database Syst Rev 2015; 2015:CD010643. [PMID: 26475434 PMCID: PMC9254328 DOI: 10.1002/14651858.cd010643.pub2] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND The cause of ankle osteoarthritis (OA) is usually trauma. Patients are relatively young, since ankle trauma occurs at a relatively young age. Several conservative treatment options are available, evidence of the benefits and harms of these options are lacking. OBJECTIVES To assess the benefits and harms of any conservative treatment for ankle OA in adults in order to provide a synthesis of the evidence as a base for future treatment guidelines. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL 2014, issue 9), MEDLINE (Ovid) (1946 up to 11 September 2014), EMBASE (1947 to September 2014), PsycINFO (1806 to September 2014), CINAHL (1985 to September 2014), PEDro (all years till September 2014), AMED until September 2014, ClinicalTrials.gov, Current Controlled Trials, The Dutch Register. To identify potentially relevant studies we screened reference lists in retrieved review articles and trials. SELECTION CRITERIA We considered randomised or controlled clinical trials investigating any non-surgical intervention for ankle OA for inclusion. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. MAIN RESULTS No other RCT concerning any other conservative treatment besides the use of hyaluronic acid (HA) for ankle OA was identified. Six randomised controlled trials (RCTs) were included.A total of 240 participants diagnosed with ankle OA were included in this review. The primary analysis included three RCTs (109 participants) which compared HA to placebo. One study compared HA to exercise therapy, one compared HA combined with exercise therapy to an intra-articular injection of botulinum toxin and one compared four different dosages of HA.Primary analysis: a pooled analysis of two trials (45 participants) found that the Ankle Osteoarthritis Scale (AOS) total score (measuring pain and physical function) was reduced by 12% (95% CI -24% to -1%) at six months (mean difference (MD) -12.53 (95% CI -23.84 to -1.22) on a scale of 0 to 100; number needed to treat for an additional beneficial outcome (NNTB) = 4 (95% CI 2 to 205); this evidence was graded as low quality, due to limitations in study design (unclear risk of selection bias for two studies and unclear risk for attrition bias for one study) and imprecision of results: a small population size (45 participants). It is not known if a mean difference of 12.53 points on a 100 point scale is clinically relevant. No minimal important clinical difference is known for this score. Pain and function outcomes were not reported separately. Radiographic joint structure changes were not investigated. For the mean quality of life at six months (two trials; 45 participants) no meta-analysis could be performed due to missing data. No serious adverse events (SAEs) were noted and no participants withdrew because of an adverse event. There were a few adverse events (AEs) 5/63 (8%) in the HA group and 2/46 (4%) in the placebo group. The Peto odds ratio (Peto OR) to have an adverse event was 2.34 higher compared to the control group (95% CI 0.45 to 12.11). This evidence is inconclusive because of a wide CI and a small number of events.For comparing HA to exercise therapy (30 participants) the results for pain on a Visual Analogue Scale (VAS 0 to 10) at 12 months are inconclusive (MD 0.70, 95% CI -2.54 to 1.14). The American Orthopedic Foot and Ankle Society score (AOFAS score) was 13.10 points (MD) higher in favour of HA (95% CI 2.97 to 23.23) on a scale of 0 to 100. The evidence was graded as low. No adverse events were found. Radiographic structure changes were not measured; no participants withdrew due to AEs; no SAEs were found.For the comparison of HA injection combined with exercise therapy to an intra-articular injection of botulinum toxin A (BoNT-A) (75 participants), the outcome of the AOS pain score of the affected joint at six months is inconclusive (MD 0.10, 95% CI -0.42 to 0.62). The physical function (the AOS disability score) at six months is inconclusive (MD 0.20, 95% CI -0.34 to 0.74). The same number of AEs were found in both groups; HA 2/37 (5.9%), BoNT-A 2/38 (5.8%) (risk ratio (RR) 1.03, 95% CI 0.15 to 6.91). Radiographic changes were not examined, no SAEs were found and no participants withdrew because of an AE. The evidence was graded as low.The RCT comparing four different dosing schedules for HA (26 participants) showed the best median decrease in pain on walking VAS (on a scale of 0 to 100) for 3 x 1 ml at 27 weeks with a median decrease of 30. Physical function, radiographic changes and quality of life were not measured.Twenty-seven percent of all participants had AEs, most of them in the 2ml group (57% in this group). No participants withdrew due to an AE and no SAEs were noted.Overall the quality of the evidence showed some serious limitations. The evidence was graded low for the primary analysis comparing HA to placebo. This was based on a limitation in design and implementation: sample sizes were small (45 to 92 participants) and and imprecision in results: there was an unclear risk of bias for several items concerning the three studies used in the meta analysis. AUTHORS' CONCLUSIONS Currently, there is insufficient data to create a synthesis of the evidence as a base for future guidelines for ankle OA. Since the aetiology of ankle OA is different, guidelines that are currently used for hip and knee OA may not be applicable for ankle OA. Simple analgesics as recommended for hip and knee OA seem however a reasonable first step to treat ankle OA. It is unclear if there is a benefit or harm for HA as treatment for ankle OA compared to placebo at six months based on a low quality of evidence. Inconclusive results were found comparing HA to other treatments. HA can be conditionally recommended if patients have an inadequate response to simple analgesics. It remains unclear which patients (age, grade of ankle OA) benefit the most from HA injections and which dosage schedule should be used.
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Affiliation(s)
| | - Cheriel J Hofstad
- Sint MaartenskliniekDepartment of Human Movement Science, and Department of Research, Development and EducationPO Box 9011NijmegenNetherlands6500 GM
| | - Gino MMJ Kerkhoffs
- Academic Medical CenterDepartment of Orthopaedic SurgeryMeibergdreef 9AmsterdamNetherlands1105 AZ
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De la Corte-Rodriguez H, Rodriguez-Merchan EC. The current role of orthoses in treating haemophilic arthropathy. Haemophilia 2015; 21:723-30. [DOI: 10.1111/hae.12779] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2015] [Indexed: 11/30/2022]
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Abstract
This review article summarizes the currently available (poor) evidence of conservative treatment of asymmetric ankle osteoarthritis in the literature and adds the authors' experience with the particular technique. The use of dietary supplementation, viscosupplementation, platelet-rich plasma, nonsteroidal anti-inflammotory drugs, corticosteroid injections, physical therapy, shoe modifications and orthoses, and patient's education in asymmetric ankle osteoarthritis is outlined. There definitively is a place for conservative treatment with reasonable success in patients whose ankles do not qualify anymore for joint-preserving surgery and in patients with medical or orthopedic contraindications for realignment surgery, total ankle replacement, and ankle arthrodesis.
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Affiliation(s)
- Timo Schmid
- Department of Orthopaedic Surgery, Inselspital, University of Berne, Freiburgstrasse, Berne 3010, Switzerland
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15
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Rao S, Riskowski JL, Hannan MT. Musculoskeletal conditions of the foot and ankle: assessments and treatment options. Best Pract Res Clin Rheumatol 2013; 26:345-68. [PMID: 22867931 DOI: 10.1016/j.berh.2012.05.009] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Musculoskeletal conditions of the foot and ankle are an important public health challenge due to their increasing incidence combined with their substantial negative impact on patients' quality of life. Non-pharmacological treatments serve as the first line of treatment and are frequently used for patients with musculoskeletal conditions of the foot and ankle. This review provides a summary of the assessments and non-invasive treatment options based upon available evidence. Recent studies show that individuals with foot and ankle pain have multiple co-existing impairments in alignment, motion, load distribution and muscle performance that may be evident in static and/or dynamic tasks. In addition, both clinical and epidemiological studies support the inter-dependence between the foot and proximal joints. For instance, aberrant foot structure has been linked to foot osteoarthritis (OA), as well as OA and pain at the knee and hip. Most recently, advances in motion capture technology and plantar load distribution measurement offer opportunities for precise dynamic assessments of the foot and ankle. In individuals with musculoskeletal conditions of the foot and ankle, the chief objectives of treatment are to afford pain relief, restore mechanics (alignment, motion and/or load distribution) and return the patient to their desired level of activity participation. Given that most patients present with multiple impairments, combinational therapies that target foot-specific as well as global impairments have shown promising results. In particular, in individuals with rheumatoid arthritis and other rheumatic diseases, comprehensive rehabilitation strategies including early detection, foot-based interventions (such as orthoses) and wellness-based approaches for physical activity and self-management have been successful. While significant improvements have been made in the last decade to the assessment and treatment of foot and ankle conditions, few randomised clinical trials specifically have investigated patients with foot or ankle conditions to provide global insights into this area. Consequently, current recommendations vary based upon the scope of studies presented in this review as well as the strength of studies. This review indicates a need for more in-depth investigations into the components of assessment and treatment options for foot and ankle musculoskeletal conditions.
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Affiliation(s)
- Smita Rao
- Department of Physical Therapy, Steinhardt School of Culture, Education and Human Development, New York University, USA
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17
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Tulchin K, Orendurff M, Karol L. A comparison of multi-segment foot kinematics during level overground and treadmill walking. Gait Posture 2010; 31:104-8. [PMID: 19854652 DOI: 10.1016/j.gaitpost.2009.09.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2009] [Revised: 08/21/2009] [Accepted: 09/12/2009] [Indexed: 02/02/2023]
Abstract
Previous work comparing treadmill and overground walking has focused on lower extremity motion and kinetics, with few identified differences. However, a comparison of multi-segment foot kinematics between these conditions has not been previously reported. Sagittal ankle motion using a single rigid body foot model and three-dimensional hindfoot and forefoot kinematics were compared during barefoot, level, overground walking at a self-selected speed and treadmill walking at a similar speed for 20 healthy adults. Slight differences were seen in ankle plantarflexion and hindfoot plantarflexion during first rocker, as well as peak forefoot eversion and abduction, however all changes were less than 3 degrees , and most were within the day-to-day repeatability. These results indicate that foot mechanics as determined using a multi-segment foot model were similar between overground and treadmill walking at similar speeds in healthy adults. Treadmill protocols may provide a controlled method to analyze a patient's ability to adapt to walking at different speeds and surface slopes, which are encountered often during ambulation of daily living.
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Affiliation(s)
- Kirsten Tulchin
- Texas Scottish Rite Hospital for Children, Movement Science Laboratory, 2222 Welborn Street, Dallas, TX 75219, USA.
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18
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Rao S, Baumhauer JF, Tome J, Nawoczenski DA. Comparison of in vivo segmental foot motion during walking and step descent in patients with midfoot arthritis and matched asymptomatic control subjects. J Biomech 2009; 42:1054-60. [DOI: 10.1016/j.jbiomech.2009.02.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2008] [Revised: 02/13/2009] [Accepted: 02/17/2009] [Indexed: 10/20/2022]
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Martin RL, Stewart GW, Conti SF. Posttraumatic ankle arthritis: an update on conservative and surgical management. J Orthop Sports Phys Ther 2007; 37:253-9. [PMID: 17549954 DOI: 10.2519/jospt.2007.2404] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
This manuscript offers current information regarding the examination, conservative treatment, and surgical treatment for individuals with posttraumatic arthritis. Although inflammatory and osteoarthritis can occur, posttraumatic arthritis is the most common form of arthritis to affect the ankle. Posttraumatic ankle arthritis occurs in a generally younger, active population. It is radiographically characterized by an asymmetrical degenerative process and may be associated with a history of trauma, instability, and/or lower extremity malalignment. When choosing between conservative/nonoperative versus surgical intervention, the extent of subchondral bone exposed and the time over which the arthritis has developed are factors that should be considered. The role and effectiveness for conservative treatment, such as medication, patient education, shoe modification, bracing, stretching, mobilization, strengthening, and symptom management, needs to be further determined. Surgical procedures for posttraumatic ankle arthritis can include distraction arthroplasty, arthrodesis, or total ankle arthroplasty. Unlike the relatively new procedure of distraction arthroplasty, the outcomes for arthrodesis have been well defined. Arthrodesis generally has a good outcome, but its limitations have been recognized. These limitations include the extended time required to achieve fusion, potential for nonunion, arthritis developing in adjacent joints, leg length discrepancy, malalignment, chronic edema, symptoms due to the hardware, stress fractures, and continued pain. While first generation total ankle arthroplasty led to poor results, advancements in prosthetic design and surgical technique have revived optimism regarding total ankle arthroplasty as an alternative to arthrodesis. The key for the future of total ankle arthroplasty may not be related to the development of newer ankle components but rather in refining the criteria to determine who would best benefit from joint replacement versus fusion.
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Affiliation(s)
- Robroy L Martin
- Department of Physical Therapy, Duquesne University, Pittsburgh, PA, USA.
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Huang YC, Harbst K, Kotajarvi B, Hansen D, Koff MF, Kitaoka HB, Kaufman KR. Effects of Ankle-Foot Orthoses on Ankle and Foot Kinematics in Patients With Subtalar Osteoarthritis. Arch Phys Med Rehabil 2006; 87:1131-6. [PMID: 16876560 DOI: 10.1016/j.apmr.2006.03.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2005] [Accepted: 03/28/2006] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To determine whether different foot orthoses have a similar effect on foot kinematics in subjects with subtalar osteoarthritis (OA) when walking on various ground conditions. DESIGN Within-subject comparison study. SETTING Biomechanics research laboratory. PARTICIPANTS Ten subjects with unilateral subtalar OA. INTERVENTIONS Custom-made ankle foot orthosis (AFO), rigid hindfoot orthosis (HFO-R), and articulated hindfoot orthosis (HFO-A) were used by subjects walking on level, ascending, and descending ramp, and side slope conditions. MAIN OUTCOME MEASURES The triplanar range of motion of the calcaneus relative to tibia (hindfoot) and metatarsal relative to calcaneus (forefoot) was measured using an 8-camera motion analysis system when subjects with subtalar OA wore different foot orthoses. RESULTS Braces tended to perform similarly in reducing motion of the forefoot and hindfoot for all ground conditions when compared with unbraced but wearing shoes. The AFO significantly restricted frontal plane hindfoot motion during ramp descent (P<.01) and on a side slope when the arthritic subtalar joint was higher than the unaffected side (P=.02). The HFO-A provided significant frontal plane hindfoot motion restriction during ramp descent (P<.01) and on a side slope when the arthritic subtalar joint was lower than the unaffected side (P=.03). The HFO-R significantly restricted frontal plane hindfoot motion in all ground conditions except ramp ascent (P<.05). CONCLUSIONS The HFO-R provides significant subtalar joint motion restriction while walking. The HFO-R may be considered an optimal orthosis for patients with subtalar OA pain arising from subtalar motion.
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Affiliation(s)
- Yu-Chi Huang
- Orthopedic Motion Analysis Laboratory, Division of Orthopedic Research, Mayo Clinic Rochester, MN 55905, USA
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