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Del Vecchio JJ, Chemes LN, Dealbera ED. Letter Regarding: First-Ray Radiographic Changes After Flexible Adult Acquired Flatfoot Deformity Correction. Foot Ankle Int 2022; 43:457-458. [PMID: 35236165 DOI: 10.1177/10711007221077054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Wang CS, Chiang CC, Tzeng YH, Yang TC, Lin CC. Response to "Letter Regarding: First-Ray Radiographic Changes After Flexible Adult Acquired Flatfoot Deformity Correction". Foot Ankle Int 2022; 43:459-460. [PMID: 35139687 DOI: 10.1177/10711007221077050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Chakraborty U, Hati A, Chandra A. Classical hand and foot deformities in rheumatoid arthritis. QJM 2022; 115:107-108. [PMID: 34904665 DOI: 10.1093/qjmed/hcab316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- U Chakraborty
- Department of Neurology, Bangur Institute of Neurosciences, IPGMER and SSKM, 52/1a, Sambhunath Pandit Street, Gokhel Road, Kolkata 700020, India
| | - A Hati
- Department of Internal Medicine, RG Kar Medical College and Hospital, 1, Khudiram Bose Sarani, Kolkata 700004, India
| | - A Chandra
- Department of Internal Medicine, RG Kar Medical College and Hospital, 1, Khudiram Bose Sarani, Kolkata 700004, India
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Ebskov LB, Johanesen JK, Jantzen C. [Surgical treatment options of foot deformities caused by neuromuscular disorders]. Ugeskr Laeger 2021; 183:V03210293. [PMID: 34981735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Many neuromuscular diseases can lead to paresis and/or spasticity of the peripheral muscles. Due to an unbalance between agonists and antagonists deformities of the foot and ankle may develop. These deformities can often be handled by nonoperative measures but in some patients the effect is insufficient. In these cases, surgical treatment with tendon transfers, osteotomies or arthrodesis can lead to satisfying results. The purpose of this review is to create an overview of the treatment concepts and options for these diseases.
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Abdul BS, Makinyan L, Wessam A, Airapetov G, Aude F, Shindiev K. SUBJECTIVE AND CLINICAL OUTCOMES OF SURGERY FOR CORRECTION OF RHEUMATOID FOREFOOT DEFORMITIES. Georgian Med News 2021:7-12. [PMID: 34749314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Hoffmann-Clayton procedures appears to be promising surgical treatment in severe rheumatoid forefoot deformities. It has been reported that 80% to 90% of foot deformities in adults are due to rheumatoid arthritis. Despite of various surgical approaches, early functional and cosmetic results have been the greatest concern among patients. Thus, optimal surgical approach in correction of severe rheumatoid forefoot deformities is of vital importance for better subjective and clinical results. Clinical study was conducted on 56 painful chronic rheumatoid foot who were treated by arthrodesis of 1st metatarsophalangeal (MTP) and lesser metatarsal head resections. They were divided into 2 groups based on surgical approach in lesser metatarsal head resections. 1st group had 25 feet with dorsal approach (Clayton) and 2nd group - 31 feet with plantar approach (Hoffmann). Subjective and clinical outcomes were evaluated in both groups. The mean post-operative AOFAS scores were 67.82 (range: 32 - 82) and mean post-operative Foot Function Index (FFI) was 0.51 (range: 0.23 to 0.63) in both groups. Eighty seven percent (48/56 feet) reported early pain relief, improved cosmetic appearance, and improved footwear comfort in Hoffmann group. The mean hallux valgus angles improved from 37 to 15 degrees and the 1st intermetatarsal angle from 17 to 8 degrees in both groups. Four feet had non-union of the 1st MTP joint arthrodesis and three among them were re-operated. Hoffmann and Clayton procedures are optimal methods for excision arthroplasty of lesser metatarsal heads. However, Hoffmann (plantar approach) serves to be more convenient resulting in early recovery, adequate functional stability, rehabilitation and better cosmetic results.
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Affiliation(s)
- Basith Sh Abdul
- 1Peoples' Friendship University of Russia, Moscow, Department of Traumatology and Orthopedics; Russia
| | - L Makinyan
- 1Peoples' Friendship University of Russia, Moscow, Department of Traumatology and Orthopedics; Russia
| | - A Wessam
- 1Peoples' Friendship University of Russia, Moscow, Department of Traumatology and Orthopedics; Russia
| | - G Airapetov
- 2Stavropol State Medical University, Department of Traumatology and Orthopedics; Russia
| | - F Aude
- 3City Clinical Hospital № 31, Moscow, Russia
| | - K Shindiev
- 1Peoples' Friendship University of Russia, Moscow, Department of Traumatology and Orthopedics; Russia
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Day J, de Cesar Netto C, Nishikawa DRC, Garfinkel J, Roney A, J O'Malley M, T Deland J, J Ellis S. Three-Dimensional Biometric Weightbearing CT Evaluation of the Operative Treatment of Adult-Acquired Flatfoot Deformity. Foot Ankle Int 2020; 41:930-936. [PMID: 32506953 DOI: 10.1177/1071100720925423] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Assessment of operative correction of adult-acquired flatfoot deformity (AAFD) has been traditionally performed by clinical evaluation and conventional radiographic imaging. Previously, a 3-dimensional biometric weightbearing computed tomography (WBCT) tool, the foot ankle offset (FAO), has been developed and validated in assessing hindfoot alignment. The purpose of this study was to investigate the role of FAO in evaluating operative deformity correction in AAFD. METHODS In this prospective comparative study, 19 adult patients (20 feet) with stage II (flexible) flatfoot deformity underwent preoperative and postoperative standing WBCT examination at mean 19 months (range, 6-24) after surgery. Three-dimensional coordinates of the foot tripod and center of the ankle joint were acquired by 2 independent and blinded observers. These coordinates were used to calculate the FAO using dedicated software, and subsequently compared pre- and postoperatively. The FAO is a previously validated biometric measurement that represents centering of the foot tripod as well as hindfoot alignment, with a normal mean FAO of 2.3% ± 2.9%. In addition, Patient Reported Outcomes Measurement Information System (PROMIS) clinical outcomes scores were compared pre- and postoperatively with a mean follow-up of 22.6 months (range, 14-37). RESULTS There was significant correction of flatfoot deformity from a mean preoperative FAO of 9.8% to a mean postoperative value of 1.3% (P < .001). Additionally, there was statistically significant improvement in all PROMIS domains (P < .05), except depression, at an average follow-up of 22.6 months. Spring ligament reconstruction was the only procedure associated with a significant correction in FAO (P = .0064). CONCLUSION The FAO was a reliable and sensitive tool that was used to evaluate preoperative deformity as well as postoperative correction, with patients demonstrating both significant improvement in FAO as well as patient-reported outcomes. These findings demonstrate the role for biometric 3-dimensional WBCT imaging in assessing operative correction after flatfoot reconstruction, as well as the potential role for operative planning to address preoperative deformity. LEVEL OF EVIDENCE Level II, prospective comparative study.
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Affiliation(s)
| | - Cesar de Cesar Netto
- Department of Orthopedic Foot and Ankle Surgery, University of Iowa School of Medicine, Iowa City, IA, USA
| | - Danilo R C Nishikawa
- Department of Orthopaedics, Hospital do Servidor Publico Municipal de Sao Paulo (HSPM), Foot and Ankle Surgery, Sao Paolo, SP, Brazil
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Kunas GC, Probasco W, Haleem AM, Burket JC, Williamson ERC, Ellis SJ. Evaluation of peritalar subluxation in adult acquired flatfoot deformity using computed tomography and weightbearing multiplanar imaging. Foot Ankle Surg 2018; 24:495-500. [PMID: 29409191 DOI: 10.1016/j.fas.2017.05.010] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Revised: 05/27/2017] [Accepted: 05/29/2017] [Indexed: 02/04/2023]
Abstract
BACKGROUND The aim of this study was to assess the inferior talus-superior talus (inf-tal-sup-tal) angle (previously proven reliable in multiplanar-weight bearing imaging (MP-WB)) on both computed tomography (CT) and MP-WB scans. We sought to compare the angle between the two modalities in both AAFD and control groups, as well as to compare the groups to each other. METHODS Inf-tal-sup-tal angles were compared between a stage II AAFD group (n=38) with routine MP-WB and CT scans and a control group (n=20) with preoperative CT scans for lisfranc injuries and normal hindfoot alignment after healing. RESULTS The CT inf-tal-sup-tal angle was significantly greater in AAFD compared to control (AAFD, 12±6; control, 5±4; p<0.001), but was even greater with MP-WB. There was no significant correlation between inf-tal-sup-tal angles on MP-WB and CT (Pearson's=0.29, p=0.08). CONCLUSIONS MP-WB imaging proved to be correlated more strongly with AAFD than CT by revealing greater hindfoot valgus. This confirmed that CT scans are useful in predicting AAFD, but cannot be used as a surrogate for MP-WB scans.
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Affiliation(s)
- Grace C Kunas
- Department of Foot and Ankle Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021 USA
| | - William Probasco
- Department of Foot and Ankle Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021 USA
| | - Amgad M Haleem
- Department of Orthopedic Surgery, Oklahoma University Health Sciences Center, 920 Stanton L Young Blvd., Williams Pavilion 1380, Oklahoma City, OK, 73104 USA
| | - Jayme C Burket
- Department of Epidemiology and Biostatistics, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021 USA
| | - Emilie R C Williamson
- Department of Foot and Ankle Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021 USA
| | - Scott J Ellis
- Department of Foot and Ankle Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021 USA.
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Abstract
UNLABELLED Lateral column lengthening (LCL) is a common procedure for reconstruction of stage II flexible adult-acquired flatfoot deformity (AAFD). The recent development of porous titanium wedges for this procedure provides an alternative to allograft and autograft. The purpose of this study was to report radiographic and clinical outcomes achieved with porous titanium wedges in LCL. A retrospective analysis of 34 feet in 30 patients with AAFD that received porous titanium wedges for LCL from January 2011 to October 2014. Deformity correction was assessed using both radiographic and clinical parameters. Radiographic correction was assessed using the lateral talo-first metatarsal angle, the talonavicular uncoverage percentage, and the first metatarsocuneiform height. The hindfoot valgus angle was measured. Patients were followed from a minimum of 6 months up to 4 years (mean 16.1 months). Postoperative radiographs demonstrated significant correction in all 3 radiographic criteria and the hindfoot valgus angle. We had no cases of nonunion, no wedge migration, and no wedges have been removed to date. The most common complication was calcaneocuboid joint pain (14.7%). Porous titanium wedges in LCL can achieve good radiographic and clinical correction of AAFD with a low rate of nonunion and other complications. LEVELS OF EVIDENCE Level IV: Case series.
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Affiliation(s)
- Spencer H Moore
- University of Virginia Medical Center, Charlottesville, Virginia
| | | | - M Tyrrell Burrus
- University of Virginia Medical Center, Charlottesville, Virginia
| | - Truitt Cooper
- University of Virginia Medical Center, Charlottesville, Virginia
| | - Joseph S Park
- University of Virginia Medical Center, Charlottesville, Virginia
| | - Venkat Perumal
- University of Virginia Medical Center, Charlottesville, Virginia
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Abstract
BACKGROUND The historic treatment of Charcot foot arthropathy has been immobilization during the active phase of the disease process, followed by accommodative bracing of the acquired deformity. Evidence derived from modern patient-reported outcomes investigations has convinced many surgeons to attempt operative correction of the acquired deformity with a goal of improving quality of life. METHODS Over a 12-year period, 214 patients (9 bilateral) underwent reconstruction of the acquired deformity associated with midtarsal Charcot foot arthropathy. Over time, 3 patterns of deformity were observed based on weight-bearing pattern, relationship of the forefoot to the hindfoot, and integrity of the talocalcaneal joint. A valgus deformity pattern was present in 138, varus in 48, and dislocation of the talocalcaneal joint in 37. A consistent operative strategy was employed. Surgery included percutaneous tendon-Achilles lengthening, resection of infection when present, attempted correction of the structural deformity by wedge resection at the apex of the deformity, and immobilization with a 3-level static circular external fixator. Additional deformity pattern-specific procedures were added over time. Clinical outcomes were based on the historic metrics of limb salvage and resolution of infection and the functional metric of the ability to walk with commercially available therapeutic footwear. RESULTS Seven patients died within a year of surgery, and 15 underwent partial- or whole-foot amputation. Overall, 173 of 223 feet (77.6%) achieved a favorable clinical outcome. Patients with a valgus deformity pattern were most likely to achieve a favorable clinical outcome (120 of 138, 87.0%). Patients with a dislocation pattern were less likely to achieve a favorable clinical outcome (26 of 37, 70.3%), and those with a varus deformity pattern were least likely to achieve a favorable clinical outcome (27 of 48, 56.3%). CONCLUSIONS Operative correction of the acquired deformity of Charcot foot arthropathy was performed with a goal of improving quality of life. Stratification of patients by deformity pattern allowed alterations of the basic surgery to afford improved outcomes. In addition to achieving historic goals of resolution of infection and limb salvage, almost 80% of the patients were able to achieve the functional goal of independent ambulation with commercially available therapeutic footwear. The clinical outcomes achieved in this retrospective case series appear to support the modern paradigm of operative correction of deformity in this complex patient population. This realistic appreciation of outcome expectations should both be helpful in counseling patients on the risk-benefit ratio associated with surgery and provide a benchmark to measure newer strategies of treatment. LEVEL OF EVIDENCE Level IV, retrospective case series.
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Abstract
Total ankle replacement (TAR) has evolved over the past decade as a treatment for end-stage ankle arthritis with improved survivorship. Despite the improving outcomes, ankle deformity represents a challenge to the foot and ankle surgeon with increased risk of implant failure. The use of preoperative computer-assisted guidance has led to better understanding the 3-dimensional ankle anatomy and associated deformities and allows for reproducible, anatomic placement of the TAR components.
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Affiliation(s)
- Feras J Waly
- Department of Orthopaedic Surgery, St Paul's Hospital, 1081 Burrard Street, Vancouver, British Columbia V6Z 1Y6, Canada; Department of Orthopedic Surgery, University of Tabuk, Tabuk 71491, Saudi Arabia.
| | - Nicholas E Yeo
- Department of Orthopaedic Surgery, St Paul's Hospital, 1081 Burrard Street, Vancouver, British Columbia V6Z 1Y6, Canada; Department of Orthopaedic Surgery, Singapore General Hospital, Outram Road, Singapore 169608, Singapore
| | - Murray J Penner
- Department of Orthopedic Surgery, University of British Columbia, 3114 - 910 West 10th Avenue, Vancouver, British Columbia V5Z 1M9, Canada
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Ong CY, Vasanwala FF, Mirpuri TM. Auto-Amputations. Ann Acad Med Singap 2017; 46:480-482. [PMID: 29355287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Chong Yau Ong
- Department of Family Medicine, Sengkang Hospital, Singapore
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Abstract
In 1975, Evans published an article describing the surgical management of the "calcaneo-valgus deformity," pointing out that the deformity was due to relative shortening of the lateral column of the foot. Correction involved "equalizing" both columns by performing an osteotomy in the neck of the calcaneus 1.5 cm from the calcaneocuboid joint, where a trapezoidal wedge of tricortical bone was placed. Although it was considered a success, there were complications, including sural nerve injury, surgical wound dehiscence, undercorrection, and graft subsidence. The osteotomy grew in popularity. Indications extended to other forms of flatfoot with a low incidence of complications.
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Affiliation(s)
- Marcelo E Jara
- Orthopaedic Department, Clínica Dávila, Santiago, Chile.
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Ayerza MA, Piuzzi NS, Aponte-Tinao LA, Farfalli GL, Muscolo DL. Structural allograft reconstruction of the foot and ankle after tumor resections. Musculoskelet Surg 2016; 100:149-156. [PMID: 27324025 DOI: 10.1007/s12306-016-0413-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Accepted: 05/31/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND Structural allografts have been used to correct deformities or to fill bone defects secondary to tumor excisions, trauma, osteochondral lesions, or intercalary arthrodesis. However, the quality of published evidence supporting the use of allograft transplantation in foot and ankle surgery has been reported as fair. The purpose of this study was to report the overall survival of structural allograft in the foot and ankle after tumor resection, and the survival according to the type of allograft and the complication rates in the medium to long term. MATERIALS AND METHODS From January 1989 to June 2011, 44 structural allograft reconstructions of the foot and ankle were performed in 42 patients (28 men and 14 women) due to musculoskeletal tumor resections. Mean age at presentation was 27 years. Mean follow-up was 53 months. Demographic data, diagnosis, site of the neoplasm, operations performed, operative complications, outcomes after surgery, date of last follow-up evaluation, and local recurrences were reviewed for all patients. Regarding the type of 44 allograft reconstructions, 16 were hemicylindrical allografts (HA), 12 intercalary allografts (IA), 10 osteoarticular allografts (OA), and 6 were total calcaneal allograft (CA). RESULTS The overall allograft survival rate, as calculated with the Kaplan-Meier method, at 5 and 10 years was 79 % (95 % CI 64-93 %). When allocated by type of allograft reconstruction the specific allograft survival at 5 and 10 years was: 83 % for CA, 80 % for HA, 77 % for OA, and 75 % for IA. The complications rate for this series was 36 % including: articular failure, local recurrence, infection, fracture and nonunion. CONCLUSION This study showed that structural allograft reconstruction in the foot and ankle after tumor resection may be durable with a 79 % survival rate at 5 and 10 years. The two types of allografts that showed better survival rate were hemicylindrical allografts (80 %) and calcaneus allografts (83 %). The highest complication rates occurred after calcaneus allografts and osteoarticular allografts. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- M A Ayerza
- Institute of Orthopedics "Carlos E. Ottolenghi", Italian Hospital of Buenos Aires, Potosi 4247, CIP: 1199, Buenos Aires, Argentina.
| | - N S Piuzzi
- Institute of Orthopedics "Carlos E. Ottolenghi", Italian Hospital of Buenos Aires, Potosi 4247, CIP: 1199, Buenos Aires, Argentina
| | - L A Aponte-Tinao
- Institute of Orthopedics "Carlos E. Ottolenghi", Italian Hospital of Buenos Aires, Potosi 4247, CIP: 1199, Buenos Aires, Argentina
| | - G L Farfalli
- Institute of Orthopedics "Carlos E. Ottolenghi", Italian Hospital of Buenos Aires, Potosi 4247, CIP: 1199, Buenos Aires, Argentina
| | - D L Muscolo
- Institute of Orthopedics "Carlos E. Ottolenghi", Italian Hospital of Buenos Aires, Potosi 4247, CIP: 1199, Buenos Aires, Argentina
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Morales-Lozano R, Martínez-Barrio J, González-Fernández ML, López-Longo FJ, Ovalles-Bonilla JG, Valor L, Janta I, Nieto JC, Hernández-Flórez D, González CM, Monteagudo I, Garrido J, Carreño L, Naredo E. The feet in systemic lupus erythematosus; are we underestimating their involvement and functional impact? Clin Exp Rheumatol 2016; 34:609-617. [PMID: 27385118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2015] [Accepted: 01/07/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES To evaluate biomechanical and ultrasound (US) abnormalities in SLE patients as compared with controls and to assess the relationship between these abnormalities and SLE activity. METHODS Fifty-four consecutive female patients with SLE with and without foot pain and 60 female controls (30 with foot pain and 30 without foot pain) were recruited. SLE activity was assessed by the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI). SLE patients and controls blindly underwent a comprehensive podiatric, biomechanical and US evaluation of the feet. US assessment included detection of B-mode synovitis, tenosynovitis, enthesopathy, bone changes and synovial, tenosynovial and entheseal power Doppler (PD) signal. RESULTS Thirty-one (57.4%) SLE patients had bilateral foot pain and 5 (9.3%) had unilateral foot pain. Metatarsalgia was the most common location for pain but without significant difference between groups (p=0.284). Toe joint deformities were significantly more common in SLE feet as compared with control feet (p<0.0005). SLE feet showed significantly more biomechanical abnormalities than control feet (p<0.05). B-mode synovitis in the tibiotalar joint was strongly associated with having SLE (p<0.0005) and the presence of synovial PD signal in the MTP joints was found only in painful feet of SLE patients. SLEDAI was significantly higher in patients with foot pain than in those with painless feet (p=0.008). However, SLEDAI did not discriminate between patients with and without biomechanical or US abnormalities. CONCLUSIONS SLE patients showed more biomechanical and US abnormalities in the feet than controls, which were not captured by standardised assessment of the disease activity.
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Affiliation(s)
- Rosario Morales-Lozano
- University Podiatry Clinic, Faculty of E.F.Podiatry Universidad Complutense de Madrid, Spain
| | - Julia Martínez-Barrio
- Department of Rheumatology, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
| | | | | | | | - Lara Valor
- Department of Rheumatology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Iustina Janta
- Department of Rheumatology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Juan Carlos Nieto
- Department of Rheumatology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Diana Hernández-Flórez
- Department of Rheumatology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Carlos M González
- Department of Rheumatology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Indalecio Monteagudo
- Department of Rheumatology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Jesús Garrido
- Department of Social Psychology and Methodology, Universidad Autónoma de Madrid, Spain
| | - Luis Carreño
- Department of Rheumatology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Esperanza Naredo
- Department of Rheumatology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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Mohammad W, Malhotra SK, Garg PK. Clinico-radiological Correlation of Bone Changes in Leprosy Patients Presenting with Disabilities/Deformities. Indian J Lepr 2016; 88:83-95. [PMID: 29757540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Leprosy is a medical - social disease, it is associated with stigma in the society due to the resulting deformities in some persons. Although stigma has decreased after the widespread use of MDT, some disabilities do occur which are mostly due to late initiation of treatment and inappropriate care. Besides the nerve and skin involvement bone changes have been reported to be common in leprosy. These bony changes need to be understood in the present MDT era specially in the context of clinical spectrum and duration of disease/ deformities. Fifty clinically diagnosed and histologically classified leprosy patients with deformities/ disabilities of either hands/feet/face who attended the OPD of Department of Dermatology, Venereology and Leprosy, Government Medical College, Amritsar were examined and evaluated in the study. Radiological examination of hands, feet and skull was done in each case and the bone changes in hands and feet; and skull and paranasal sinus changes were correlated with clinical parameters. Bone changes were observed in 90% of cases radiologically. Specific bone changes in hands and feet, non-specific bone changes in hands, feet, skull and paranasal sinuses were seen in 66%, 82% and 32% of cases respectively. Common specific bone changes in hands and feet observed were primary periostitis (14%), honey combing (46%), bone cyst (36%), thinning and irregularity of cortex (28%) and area of bone destruction (20%); Among the non-specific bone changes observed were contracted fingers/claw hands/claw toes (64%) and absorption of terminal phalanges (40%). The maxillary sinus, and paranasal sinus changes were the most common radiological findings observed in skull. The study of the radiological changes may help the clinicians to understand the gravity of the situation and undertake steps for timely prevention of permanent loss of function and the occurrence of deformities and disabilities.
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Qin L, Pan Y, Zhang M, Xu M, Lao H, O'Laughlin MC, Tong S, Zhao Y, Hung VWY, Cheng JCY, Guo X. Lifelong bound feet in China: a quantitative ultrasound and lifestyle questionnaire study in postmenopausal women. BMJ Open 2015; 5:e006521. [PMID: 25783423 PMCID: PMC4368908 DOI: 10.1136/bmjopen-2014-006521] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE The phenomenon of foot binding, also known as 'lotus feet', has an enduring and influential history in China. To achieve a man-made smaller foot size, lifelong foot binding may have had adverse effects on the skeleton. We investigated bone properties in postmenopausal women with bound feet, which may provide new information for developing countermeasures for prevention of fragility fractures. DESIGN Population-based cohort study. PARTICIPANTS This study involved 254 postmenopausal women aged 65-80, including 172 with bound feet and 82 age- and gender-matched control subjects, living in a remote region of China. OUTCOMES Anthropometric, SF-36 Lifestyle Questionnaire and heel quantitative ultrasound (QUS) data were collected for the whole study population. A small subset of two cases was also invited for assessment of bone mineral density and microarchitecture at the distal tibia using high-resolution peripheral quantitative CT (HR-pQCT) and gait and balance tests. RESULTS Women with bound feet had significantly lower QUS values than age-matched women with normal feet; this was supported by HR-pQCT data. However, SF-36 Questionnaire results did not reveal any statistically significant differences in any categorical responses, including physical functioning, general health vitality and physical component summary score, and number of previous fractures. No impairment of body balance was found in the small subset. CONCLUSIONS The man-made changes caused by foot binding led to reduced physical activity, making the subjects prone to osteoporosis. Women with bound feet and osteoporosis did not have a higher incidence of fragility fractures than controls. This might be explained by compensation in physical activity to improve body balance, implying the importance of improving or maintaining body balance in overall prevention strategies against fragility fractures.
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Affiliation(s)
- Ling Qin
- Department of Orthopaedics and Traumatology, Bone Quality and Health Centre, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Yi Pan
- Department of Endocrinology, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan Province, China
| | - Ming Zhang
- Department of Mechanical Engineering, The Hong Kong Polytechnic University, Hong Kong, Hong Kong
| | - Mian Xu
- Department of Endocrinology, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan Province, China
| | - Hanchang Lao
- Department of Orthopaedics, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan Province, China
| | - Michael C O'Laughlin
- Department of Orthopaedics and Traumatology, Bone Quality and Health Centre, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Shan Tong
- Department of Mechanical Engineering, The Hong Kong Polytechnic University, Hong Kong, Hong Kong
| | - Yanling Zhao
- Training Department of International Osteoporosis Diagnosis and Treatment, Health Promotion Foundation of China, Beijing, China
| | - VWY Hung
- Department of Orthopaedics and Traumatology, Bone Quality and Health Centre, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - JCY Cheng
- Department of Orthopaedics and Traumatology, Bone Quality and Health Centre, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Xia Guo
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, Hong Kong
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Baier C, Springorum HR, Maderbacher G, Pickl C, Grifka J, Götz J. [Arthrodesis for patients with rheumatic arthritis of the ankle and hindfoot. A reasonable option?]. Z Rheumatol 2014; 73:796-805. [PMID: 25373549 DOI: 10.1007/s00393-014-1405-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Ankle and hindfoot deformities as well as degenerative changes are often found in patients with rheumatological diseases. They often suffer from severe pain and complain of increasing immobility. Corrective procedures with ankle or hindfoot arthrodesis are promising options. OBJECTIVES This article presents epidemiological data and describes the clinical aspects, diagnostics and treatment options for patients with ankle and hindfoot osteoarthritis. MATERIALS AND METHODS The retrospective results of 56 patients after ankle or hindfoot arthrodesis are presented. RESULTS After an average follow-up of 52 months the majority of results were good or excellent with relief of pain and reconstruction of the function of the foot. CONCLUSION Ankle or hindfoot arthrodesis represents a promising option for patients with severe osteoarthritis and can safeguard patients from increasing immobility.
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Affiliation(s)
- C Baier
- Orthopädische Klinik, Universität Regensburg im Asklepios Klinikum Bad Abbach, Kaiser-Karl V.-Allee 3, 93077, Bad Abbach, Deutschland,
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19
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Liabakh AP, Mikhnevych OE, Dolhopolov OV. [Transtibial amputation of the lower extremity in patients with ischemic foot contracture]. Klin Khir 2014:39-41. [PMID: 25252412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The results of operative treatment of 8 patients was analyzed, in whom the lower extremity amputation on the upper third of the shin was performed for severe stage of the ischemic foot contacture. Operative interventions is expedient to perform in a specialized stationary, were exists possibility of further prosthesis. It is necessary to perform the extremity amputation in a residual period of the foot ischemic contracture, when operations for restoration of the sole sensitivity are nonperspective as well as in presence of severe trophic disorders on the sole and the shin, but without purulent--necrotic signs. Confirmed data of clinic--instrumental investigations for chronic course of the ischemic process constitutes an absolute indication for operation.
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20
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Aleksandrov IM, Alekberov DA, D'iachkov KA. [X-ray-morphological peculiarities of the long bones and reconstraction of their structure after elimination of knee joint deformation in children with hematogenous osteomyelitis consequences]. Vestn Khir Im I I Grek 2014; 173:61-65. [PMID: 25055537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Roentgeno-morphological peculiarities of the bones forming the knee joint were studied in 47 patients with knee deformation caused by hematogenous osteomyelitis before and after treatment by the method of transosseous osteosynthesis. The stages of reconstruction of distraction regenerate were observed by radiography and computed tomography methods.
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Trieb K, Hofstaetter SG, Panotopoulos J, Wanivenhaus A. The Weil osteotomy for correction of the severe rheumatoid forefoot. Int Orthop 2013; 37:1795-8. [PMID: 23863996 PMCID: PMC3764294 DOI: 10.1007/s00264-013-2011-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2013] [Accepted: 06/24/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE In rheumatoid arthritis the metatarsophalangeal (MTP) joints are predominantly affected with resultant metatarsalgia and dislocation. Therapy options include many different surgical procedures with results that are not always satisfying. We present the oblique Weil metatarsal osteotomy as a treatment option for the rheumatic forefoot. METHODS A total of 216 osteotomies in 63 consecutive patients (72 feet) with a mean age at the time of surgery of 59.3 years and long-standing rheumatoid arthritis were observed prospectively for an average of 57.4 months (minimum 36 months). All patients received a Weil osteotomy of the lesser metatarsals with at least one additional procedure of the forefoot. Patients were evaluated prospectively for clinical outcome by the American Orthopaedic Foot and Ankle Society (AOFAS) lesser MTP-interphalangeal scale and subjective satisfaction. In the radiological evaluation weight-bearing X-rays were analysed for alignment, shortening and union. RESULTS American Orthopaedic Foot and Ankle Society score increased significantly from 21.9 ± 6.7 to 63.3 ± 9.8 (p < 0.05). The increase was significant for all subgroups regarding pain, function and alignment. All joints were dorsally dislocated preoperatively; a subluxation was present in 13.6 % at follow-up. There was a significant decrease of callositas in 82 %, a decrease in need for orthopaedic shoes in 61 %, a decrease of MTP joint stiffness in 96 % and a relief of severe pain in 97 % of all patients. No metatarsal head dislocation or necrosis, pseudoarthrosis or screw perforation was observed. Of 63 patients, 55 (88 %) subjectively reported excellent or good results. CONCLUSIONS We conclude that the Weil procedure for lesser metatarsals is a satisfactory method for correcting the rheumatic forefoot and can be recommended as an approach for the future.
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Affiliation(s)
- Klemens Trieb
- Department of Orthopaedics, Klinikum Wels-Grieskirchen, Grieskirchnerstr. 42, 4600, Wels, Austria.
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22
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Abstract
Correction of the fifth digit deformity and Tailor's Bunion can be rewarding as well as challenging for a foot and ankle surgeon. Immense care should be taken when performing these reconstructive surgical procedure, especially to avoid and minimize complication rates and mainly to prevent neurovascular damage. Appropriate surgical procedure selection for the fifth digit deformity and Tailor's Bunion is necessary in order to obtain a long term predictable outcome.
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Affiliation(s)
- Lawrence DiDomenico
- Ankle and Foot Care Centers/Kent State University College of Podiatric Medicine, 6000 Rockside Woods Boulevard Indepedence, OH 44131, USA.
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Parra-Téllez P, López-Gavito E, Vázquez-Escamilla J. [Metatarsophalangeal arthrodesis of the hallux and arthroplastic resection of the second to fifth metatarsal heads in the rheumatic foot]. Acta Ortop Mex 2013; 27:78-86. [PMID: 24701757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
UNLABELLED The objective of this study is to assess the clinical and radiologic results of patients with rheumatic forefoot who underwent metatarsophalangeal arthrodesis of the first ray and arthroplastic resection of the second to fifth metatarsal heads at the National Rehabilitation Institute. MATERIAL AND METHODS This is a prospective comparative study of the clinical and radiological status before and after the surgical procedure; it is a descriptive, observational single-group study. From April 2006 to December 2011, 31 surgical procedures were performed in 29 female and two male patients. The SPSS 17.0 software was used for the statistical analysis. Efficacy and quality of life indicators were compared using mean comparison tests (Student t test), the indicator of patient safety by means of frequency analysis, and the comparative analysis of the occurrence of complications throughout time. RESULTS The mean preoperative visual analog scale score was 6.2 +/- 1.3, with an average of 1.6 +/- 2.5, with statistical significance, with p < 0.0001 and t = 7.97. Radiographic measurements of the hallux valgus angle showed a remarkable improvement. CONCLUSIONS The surgical procedure described is reliable and efficacious, as patients had an important improvement in quality of life, with pain relief and adaptation to their activities of daily living after surgery.
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Abstract
INTRODUCTION In adult acquired flatfoot deformity, it is unclear whether the lateral column length shortens with progression of the deformity, whether it is short to begin with, or whether it is short at all. To our knowledge, no previous study has examined the lateral column length of patients with adult acquired flatfoot deformity compared to a control population. The purpose of our study was to compare the lateral column length in patients with and without adult acquired flatfoot deformity to see if there was a significant difference. METHODS The study was a retrospective radiographic review of 2 foot and ankle fellowship-trained orthopaedic surgeons' patients with adult flatfoot deformity. Our study population consisted of 75 patients, 85 feet (28 male, 57 female) with adult flatfoot deformity with a mean age of 64 (range, 23-93). Our control population consisted of 57 patients and 70 feet (23 male, 47 female) without flatfoot deformity with a mean age of 61 (range, 40-86 years). Weightbearing anteroposterior (AP) and lateral foot radiographs were analyzed for each patient, and the following measurements were made: medial and lateral column lengths, talonavicular uncoverage angle, talus-first metatarsal angle, calcaneal pitch angle, and medial and lateral column heights. An unpaired t test was used to analyze the measurements between the groups. Ten patients' radiographs were remeasured, and correlation coefficients were obtained to assess the reliability of the measuring techniques. RESULTS For the flatfoot group, the mean medial and lateral column lengths on the AP radiograph were 108.6 mm and 95.8 mm, respectively; the mean talo-navicular uncoverage angle was 26.2 degrees; and the mean talus-first metatarsal angle was 20.0 degrees. In the control group, the mean medial and lateral column lengths on the AP radiograph were 108.8 mm and 96.5 mm, respectively; the mean talo-navicular uncoverage angle was 8.2 degrees; and the mean talus-first metatarsal angle was 7.7 degrees. On the lateral radiograph in the flatfoot group, the mean medial and lateral column lengths were 167.2 mm and 166.6 mm, respectively; the mean medial and lateral column heights were 16.0 mm and 14.7 mm, respectively; the mean calcaneal pitch angle was 15.6 degrees; and the talus-first metatarsal angle was 10.3 degrees and for the control group, the mean medial and lateral column lengths were 165.3 mm and 163.5 mm, respectively; the mean medial and lateral column heights were 22.8 mm and 13.1 mm, respectively; the mean calcaneal pitch angle was 22.4 degrees; and the talus-first metatarsal angle was -3.6 degrees. None of the differences in measurements for medial and lateral column lengths between the flatfoot and control groups achieved statistical significance. However, statistically significant differences between the 2 groups were observed in the measurements for medial and lateral column heights, talo-navicular uncoverage angle, calcaneal pitch angle, and talus-first metatarsal angle. CONCLUSION There is no difference in lateral column lengths between patients with and without adult flatfoot deformity. The perceived shortened lateral column is likely due to forefoot abduction and hindfoot valgus deformities that are associated with adult flatfoot deformity. LEVEL OF EVIDENCE Level III, comparative series.
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Affiliation(s)
- Steve Kang
- University of Southern California-Keck School of Medicine, Los Angeles, CA, USA
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25
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Lorkowski J, Mrzygłód M, Kotela I, Kiełbasiewicz-Lorkowska E, Teul I. [Footwear according to the "business dress code", and the health condition of women's feet--computer-assisted holistic evaluation]. Ann Acad Med Stetin 2013; 59:118-128. [PMID: 25026763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND According to the verdict of the Supreme Court in 2005, an employer may dismiss an employee if their conduct (including dress) exposes the employer to losses or threatens his interests. The aim of the study was a holistic assessment of the pleiotropic effects of high-heeled pointed shoes on the health condition of women's feet, wearing them at work, in accordance with the existing rules of the "business dress code". MATERIALS AND METHODS A holistic multidisciplinary analysis was performed. It takes into account: 1) women employees of banks and other large corporations (82 persons); 2) 2D FEM computer model developed by the authors of foot deformed by pointed high-heeled shoes; 3) web site found after entering the code "business dress code". RESULTS Over 60% of women in the office wore high-heeled shoes. The following has been found among people walking to work in high heels: 1) reduction in the quality of life in about 70% of cases, through periodic occurrence of pain and reduction of functional capacity of the feet; 2) increase in the pressure on the plantar side of the forefoot at least twice; 3) the continued effects the forces deforming the forefoot. CONCLUSIONS 1. An evolutionary change of "dress code" shoes is necessary in order to lead to a reduction in non-physiological overload of feet and the consequence of their disability. 2. These changes are particularly urgent in patients with so-called "sensitive foot".
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Abstract
Deltoid ligament complex insufficiency is a fundamental pathologic component of stage IV AAFD. Failure of the deltoid ligament allows the talus to tilt into valgus within the ankle mortise. If left untreated, ankle joint biomechanics are altered and may lead to debilitating tibiotalar arthritis. All surgical treatments that address the valgus talar tilt seen with stage IV AAFD require accompanying procedures to properly realign the hindfoot. Stage IV AAFD can be subdivided into two groups. Patients with a flexible ankle deformity without advanced tibiotalar arthritis (stage IV-A) can be considered for a joint-sparing procedure. A variety of procedures have been described, but longterm follow-up studies have yet to determine which of these techniques is optimal. Patients with a rigid valgus ankle deformity or a flexible deformity accompanied by advanced tibiotalar arthritis (stage IV-B) should be considered for a joint-sacrificing procedure. To date, the most reliable results for stage IV-B AAFD have been reported with either tibiotalocalcaneal or pan-talar arthrodesis.
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Affiliation(s)
- Jeremy T Smith
- Department of Orthopaedic Surgery, Brigham Foot and Ankle Center at the Faulkner, Brigham and Women's Hospital, 1153 Centre Street, Suite 56, Boston, MA 02130, USA
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27
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Al-Aubaidi Z. [Valgus deformity after distal fibular fracture]. Ugeskr Laeger 2011; 173:2656-2657. [PMID: 22027170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Ankle fracture with involvement of the growth plate is the second most common paediatric fracture after the distal radius. The most common fracture type according to Salter Harris (SH) is type II of the distal tibia combined with green stick of the fibula. Isolated fracture of the distal fibular growth plate is not common and as a rule it does not give any growth arrest. We describe a case of isolated fibular fracture SH type II in a ten year-old girl which ended with symptomatic valgus deformity of the ankle. The patient was operated with good results.
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Affiliation(s)
- Zaid Al-Aubaidi
- Ortopædkirurgisk Afdeling, Odense Universitetshospital, 5000 Odense C, Denmark.
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Iaquinto JM, Wayne JS. Effects of surgical correction for the treatment of adult acquired flatfoot deformity: a computational investigation. J Orthop Res 2011; 29:1047-54. [PMID: 21319218 PMCID: PMC3107949 DOI: 10.1002/jor.21379] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2010] [Accepted: 01/13/2011] [Indexed: 02/04/2023]
Abstract
Computational models of the foot/ankle complex were developed to predict the biomechanical consequences of surgical procedures that correct for stage II adult acquired flatfoot deformity. Cadaveric leg and foot bony anatomy was captured by CT imaging in neutral flexion and imported to the modeling software. Ligaments were approximated as tension only springs attached at insertion sites. Muscle contraction of the gastrocnemius/soleus complex was simulated through force vectors and desired external loads applied to the model. Ligament stiffnesses were modified to reflect stage II flatfoot damage, followed by integration of corrective osteotomies-medializing calcaneal osteotomy (MCO) and Evans and calcaneocuboid distraction arthrodesis (CCDA)--to treat flatfoot. Joint angles, tissue strains, calcaneocuboid contact force, and plantar loads were analyzed. The flatfoot simulation demonstrated clinical signs of disease evidenced by degradation of joint alignment. Repair states corrected these joint misalignments with MCO having greatest impact in the hindfoot, and Evans/CCDA having greatest effect in the mid- and forefoot. The lateral procedures unevenly strained plantar structures, while offloading the medial forefoot, and increased loading on the lateral forefoot, which was amplified by combining with MCO. The Evans procedure raised calcaneocuboid joint contact force to twice intact levels. Computational results are in agreement with clinical and experimental findings. The model demonstrated potential precursors to such complications as lateral tightness and arthritic development and may thus be useful as a predictor of surgical outcomes.
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Affiliation(s)
- Joseph M Iaquinto
- Orthopaedic Research Laboratory, Departments of Biomedical Engineering and Orthopaedic Surgery, Virginia Commonwealth University, Richmond, Virginia, USA
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Goud A, Khurana B, Chiodo C, Weissman BN. Women's musculoskeletal foot conditions exacerbated by shoe wear: an imaging perspective. Am J Orthop (Belle Mead NJ) 2011; 40:183-191. [PMID: 21731927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The predominance of several musculoskeletal foot conditions in women are largely the result of biomechanical alterations caused by ill-fitting shoes. In particular, the altered biomechanics (associated with high-heeled shoes and shoes with a narrowed toe box) has been linked to the genesis of hallux valgus, hammer toe deformity, Haglund syndrome, metatarsal stress fracture, Freiberg infraction, and Morton neuroma. In reviewing the imaging findings of several of these conditions, we emphasize the role of radiographs, special radiographic views, and the utility of more costly studies, such as magnetic resonance imaging.
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Affiliation(s)
- Ajay Goud
- Boston VA Healthcare System, Boston, Massachusetts 02130, USA.
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Abstract
Digital deformities continue to be a common ailment among many patients who present to foot and ankle specialists. When conservative treatment fails to eliminate patient complaints, surgical correction remains a viable treatment option. Proximal interphalangeal joint arthrodesis remains the standard procedure among most foot and ankle surgeons. With continued advances in fixation technology and techniques, surgeons continue to have better options for the achievement of excellent digital surgery outcomes. This article reviews current trends in fixation of digital deformities while highlighting pertinent aspects of the physical examination, radiographic examination, and surgical technique.
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Affiliation(s)
- James Good
- Podiatric Medicine and Surgical Residency PM&S-36, Truman Medical Center, Lakewood, 7900 Lee's Summit Road, Kansas City, MO 64139, USA.
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31
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Kołodziej Ł, Bohatyrewicz A, Budzyński T, Zietek P. [Subtalar arthrodesis through single medial approach in the treatment of acquired, fixed flatfoot deformity--preliminary report]. Chir Narzadow Ruchu Ortop Pol 2009; 74:220-223. [PMID: 19999616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Authors presented the results of subtalar and in some cases talonavicular arthrodesis through single medial approach in the treatment of fixed planovalgus foot deformity. The procedure was performed in 15 feet with fixed hindfoot valgus deformity. In all cases, after achieving correct position, internal fixation of the subtalar and talonavicular joints was done with single, canulated, compressive screw 6.5 and 4.5 mm (Unima, Eos) respectively. Solid fusion was achieved within 8 to 12 weeks after surgery. Arthrodesis of the subtalar and talonavicular joints through a medial approach is usefull procedure in achieving correction and fusion of these joints while avoiding soft tissues healing problems often encountered with traditional lateral approaches.
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Affiliation(s)
- Łukasz Kołodziej
- Katedra i Klinika Ortopedii i Traumatologii, Pomorska Akademia Medyczna w Szczecinie.
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Vieira R, Felicíssimo P. Surgical treatment of three cases of plantar foot ulceration in leprosy. LEPROSY REV 2008; 79:325-330. [PMID: 19009983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Neurophatic foot ulceration (NFU) is a common problem in leprosy patients. Three cases of NFU, who did not respond to conservative measures, were treated with orthopaedic surgery. The purpose of the treatment was, by using different approaches, the reduction of bone hyper pressure areas, allowing the ulcer to heal.
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Affiliation(s)
- Raquel Vieira
- Curry Cabral Hospital, Rua da Beneficência, 8, 1069-166 Lisbon, Portugal.
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33
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Lemaire O, Paul C, Zabraniecki L. Distal Madelung-Launois-Bensaude disease: an unusual differential diagnosis of acromelic arthritis. Clin Exp Rheumatol 2008; 26:351-353. [PMID: 18565262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Madelung-Launois-Bensaude (MLB) disease is uncommon and probably under-diagnosed. It is defined as a symmetrical proximal accumulation of fat. Its physiopathology is obscure, but favouring factors, like alcohol or corticosteroids, are well known. We describe, for the first time, an unusual case of distal form of the disease, involving hands and feet simultaneously. Moreover, this phenotype was associated with a proximal form of MLB, and new localizations in the elbows and knees have been identified. We review the literature concerning distal forms of MLB, and compare the features. This disease is an interesting new differential diagnosis of acromelic arthritis.
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Affiliation(s)
- O Lemaire
- Department of Dermatology of Purpan Hospitalo-Universitary Center, Toulouse, France.
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Lorkowski J, Trybus M, Hładki W, Brongel L. [Underfoot pressure distribution of a patient with unilateral ankylosis of talonavicular joint during rheumatoid arthritis--case report]. Przegl Lek 2008; 65:54-56. [PMID: 18669112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
The aim of our study was to estimate underfoot pressure distribution of a patient with unilateral ankylosis of talonavicular joint during rheumatoid arthritis. The pedobarographic examination during bipedal standing revealed localisation of maximal pressure at the H region on the side opposite of ankylosis and increased underfoot pressure on the T region and decreased on GT, MT1-MT3 and H foot regions on the pathology side. After the end of orthopaedic treatment underfoot, pressure distribution changes persist in spite of pain regression.
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Affiliation(s)
- Jacek Lorkowski
- Klinika Medycyny Ratunkowej i Obrazeń Wielonarzadowych II Katedry Chirurgii, Collegium Medicum UJ w Krakowie.
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35
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Bekler H, Beyzadeoğlu T, Gökçe A. [Tibialis posterior tendon transfer for drop foot deformity]. Acta Orthop Traumatol Turc 2007; 41:387-392. [PMID: 18180574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
OBJECTIVES We evaluated tibialis posterior tendon (TPT) transfers in patients with drop foot deformity. METHODS Eight patients with drop foot deformity (2 females, 6 males; mean age 40 years; range 15 to 75 years) underwent TPT transfer to the dorsum of the foot. The deformity was on the left in three patients and on the right in five patients. Etiology was traumatic peroneal nerve injuries in six patients, and upper-level nerve injuries after hip and lumbar surgery in two patients. For clinical evaluation, the patients were questioned about the results of treatment, and the Stanmore evaluation scale was applied, which is recommended by Yeap et al. for TPT transfers. The mean follow-up period was 39 months (range 8 to 78 months). RESULTS According to the Stanmore scale, the results were excellent in three patients, good in two patients, fair in two patients, and poor in one patient. Subjectively, four patients defined their condition as excellent, three as good, and one as poor. One poor result was associated with polytrauma sequelae including a femoral fracture, posterior acetabular fracture-dislocation, and L3 compression fracture, accompanied by at least a two-level injury to the sciatic nerve. Of two patients with a fair result, one patient developed deep infection at the dorsum of the foot due to inadequate postoperative care and required removal of the suture anchor with partial bone debridement. The other patient had severe paraparesis associated with congenital spondylolisthesis, which aggravated following spinal fusion surgery. CONCLUSION We conclude that TPT transfer is a successful technique for the treatment of drop foot even in ambulatory patients with paraparesis. Addition of tibialis anterior tendon transfer may be useful in these patients.
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Affiliation(s)
- Halil Bekler
- Department of Orthopedics and Traumatology (Ortopedi ve Travmatoloji Anabilim Dali), Medicine Faculty of Yeditepe University, Istanbul, Turkey.
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Yalcin S, Kocaoglu B, Berker N, Erol B. Conservative treatment of Charcot artroparthy in a series of spina bifida patients: the experience of one center and review of the literature. J Pediatr Orthop B 2007; 16:373-9. [PMID: 17762679 DOI: 10.1097/01.bpb.0000218029.81395.95] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
The present study was performed to evaluate the use of patellar tendon-bearing ankle foot orthesis for the treatment of Charcot arthropathy in a series of patients with spina bifida. A cohort of 350 spina bifida patients, ages ranging between 12 months and 22 years were evaluated in our clinic between June 1993 and March 2004. Charcot arthropathy was seen in five of these children. Treatment was initiated with nonsteroidal anti-inflammatory drugs, oral bisphosphonates and immobilization. No change was observed in the patients' symptoms after a month of treatment. At this time, a patellar tendon-bearing ankle foot orthesis was prescribed and used for a period of 6 to 24 months. All patients improved within 2 months. At the end of 2 years of follow-up, three patients are still using the brace without any complaints. One patient still has symptoms, although she is wearing her brace, but she has had significant improvement compared with the initiation of therapy. Non-weight-bearing, immobilization and surgery are the known treatment choices in Charcot arthropathy. Little experience exists about this entity and its treatment. Our experience reveals that the patellar tendon-bearing ankle foot orthesis leads to significant improvement in children with Charcot arthropathy without surgery and immobilization.
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Affiliation(s)
- Selim Yalcin
- Department of Orthopedic Surgery, Marmara University School of Medicine, Istanbul, Turkey
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38
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Abstract
Erosive osteoarthritis is considered an unusual disease, mostly developing among women. The typical locations are the interphalangeal joints of the hands. However, on a few occasions it has also been found in hips, shoulders and feet. We describe two patients (one woman and one man) who have this disease in their feet.
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Affiliation(s)
- Antonio Juan Mas
- Department of Rheumatology, Hospital Son Llàtzer, Palma de Mallorca, Spain.
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39
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Abstract
INTRODUCTION Resection of the metatarsal heads is an established procedure for the therapy of rheumatic forefoot deformations. However, a recurrence of lateral deviation of the lesser toes and painful plantar keratosis remain a challenging problem for the treatment of these patients. The aim of this study was to evaluate our results in cases of rheumatoid forefoot deformities. We performed a resection of the metatarsal heads 2-5 in combination with an arthrodesis of the first toe and resection of keratosis by the plantar approach. MATERIAL AND METHODS Fifteen patients (20 feet) were followed-up clinically and radiologically using the American Orthopedic Foot and Ankle Society (AOFAS), Miehlke-, and Larsen scores. RESULTS Average follow-up time was 3.5 years (range: 1.5-7.5 years). An average AOFAS score of 81/90 was found for the hallux and 90/100 for the lesser toes. A total of 18 feet were rated as pain free, while two feet showed some residual pain. Every case showed an harmonic cascade of the resection. All patients stated that the operation had improved their quality of life and that they would consent to undergoing it again. CONCLUSION Our results after arthrodesis of MP-1 and resection of the metatarsal heads 2-5 using the plantar approach were good compared to the data published in the literature.
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Affiliation(s)
- S Heitkemper
- Orthopädische Universitätsklinik Essen, Hufelandstrasse 55, 45147, Essen.
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40
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Affiliation(s)
- Peter M Stevens
- Primary Children's Medical Center, Salt Lake City, UT 84113, USA.
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41
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Mosca VS. Letter to the JPO editors re: article by Andreacchio et al entitled "lateral column lengthening as treatment for planovalgus foot deformity in ambulatory children with spastic cerebral palsy" (J Pediatr Orthop 2000;20:501-505). J Pediatr Orthop 2006; 26:412. [PMID: 16670559 DOI: 10.1097/01.bpo.0000217720.18352.89] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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42
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Abstract
BACKGROUND This prospective study compared radiographs and CT scans for the quantitative evaluation of healing of hindfoot arthrodeses. METHODS Patients undergoing subtalar or triple arthrodesis were prospectively evaluated. Serial radiographs and CT scans were obtained after surgery. The percent of fusion of the joints was sequentially measured on all radiographs and CT scans. At 6 and 12 months after surgery, the patients completed American Orthopaedic Foot and Ankle Society (AOFAS) and Short Form-12 (SF-12) instruments and a visual analog scale (VAS). RESULTS The mean observed fusion of the posterior facet of the subtalar joint ranged from 41% at 6 weeks to 61% at 12 weeks and to 86% at 6 months on the radiographs; the mean fusion of the posterior facet on the CT scans ranged from 23% to 48% to 64% at the same time intervals. The agreement between the two methods was poor. The clinical results based on the AOFAS, VAS and SF-12 scores were compared to the percent of joints fused on the CT scans. Clinical results appeared to be independent of radiographic results. CONCLUSIONS We believe the progress of the fusion cannot be determined accurately from standard radiographs. CT scanning appears to be significantly more reliable. The concept of what constitutes an adequate fusion deserves more extensive study.
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Affiliation(s)
- Michael J Coughlin
- Idaho Foot and Ankle Fellowship Program, 901 N. Curtis Road, Suite 503, Boise, ID 83706, USA.
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43
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Abstract
BACKGROUND In this retrospective study, both the patients' and surgeons' satisfaction with resection of the first through fifth metatarsal heads for long-standing rheumatoid forefoot deformity was evaluated. METHODS Thirty-four patients (56 feet) had first through fifth metatarsal head resection. After a mean time of 5.3 years, 39 feet (69.6%) (26 patients) were examined clinically and radiographically. RESULTS The complication rate was 14% (8 of 56). There were four superficial and four deep wound infections. Plantar pressure pain under the resected metatarsal heads occurred in six feet. Most patients rated their cosmetic and functional results as good. Eighteen percent of patients (6 of 34) were satisfied and 78% (26 of 34) were satisfied with reservations. Thirty-three percent of patients (11 of 34) were pain free and 53% (18 of 34) had mild pain. The surgeons assessment of the patients' anatomical correction (cosmesis) was good in 90% (50 of 56) and poor in 10% (6 of 56). CONCLUSIONS Our results, which are comparable to those of other studies, confirm the success of metatarsal head resection for the treatment of inflammatory forefoot destruction in rheumatoid arthritis to correct deformity, reduce pain, improve ambulation, and offer the patient a greater variety of shoewear.
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Affiliation(s)
- Patrik Reize
- Orthopädische Universitäts und Poliklinik Tübingen, Hoppe-Seyler Str 3, D-72076 Tübingen, Germany.
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44
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Abstract
Surgical correction of unilateral torsional deformity of the tibia is indicated in fewer than 1% of cases. Treatment is limited to those who have a progressive deformity, who are symptomatic and on whom conservative treatment has failed. We present the results of an osteotomy performed at the supramalleolar level leaving the fibula intact and held with staples. In 7 years, 13 children with a mean age of 13.4 years (range 10-16 years) underwent osteotomy. Six osteotomies were performed for internal tibial torsion (mean 25 degrees) and seven for external tibial torsion (mean 25 degrees). Seven participants were female and six male and all cases were idiopathic. One participant required antibiotics for a wound infection and five had the staples removed. All deformities were well corrected and symptoms improved. Numerous methods have been described to correct this deformity but all have been associated with major complications. We describe a supramalleolar osteotomy, leaving the fibula intact, that achieves good correction with minimal complications.
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Abstract
In rare instances, tarsal coalition leads to cavovarus foot deformity, although the pathologic mechanism leading to this deformity is not clear. This article reports a case of a 14-year-old boy presenting a severe cavovarus deformity of the right foot with talocalcaneal and calcaneonavicular coalitions, and a mild cavus deformity of the left foot with a single talocalcaneal coalition. Computed tomography and postoperative histologic analysis demonstrated a synostosis between talus and calcaneus and a fibrous calcaneonavicular coalition with partial ossification. Instrumented gait analysis revealed a limited range of ankle plantar flexion and increased external rotation of the ankle. Associated skeletal malformations including incomplete hemimelia of the forearm and scoliosis raised the possibility of a teratologic condition, but neurologic examination, spinal magnetic resonance imaging, and nerve conduction velocities were normal. The progressive ossification of combined coalitions during growth of the foot may have been one factor leading to this complex foot deformity. The fine-wire electromyogram showed normal tibialis anterior and posterior muscle activity. Small soft tissue tears in the sinus tarsi may have led to a mild reflexive increase of the muscle tone and tendon shortening, which pulled the forefoot into adduction and the heel into varus, and raised the medial arch. Mechanical alterations of the ankle appear secondary to the heel varus and to the progressive deformity of the talus. Three-dimensional computed tomography reconstruction and gait analysis appeared to be helpful additional parameters to understanding the pathomechanics of this complex foot deformity and for preoperative planning of triple arthrodesis.
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MESH Headings
- Adolescent
- Arthrodesis
- Biomechanical Phenomena
- Ectromelia/complications
- Electromyography
- Foot Deformities, Acquired/complications
- Foot Deformities, Acquired/diagnostic imaging
- Foot Deformities, Acquired/physiopathology
- Foot Deformities, Acquired/surgery
- Forearm/abnormalities
- Gait/physiology
- Humans
- Imaging, Three-Dimensional
- Male
- Ossification, Heterotopic/complications
- Ossification, Heterotopic/diagnostic imaging
- Ossification, Heterotopic/physiopathology
- Ossification, Heterotopic/surgery
- Osteotomy
- Preoperative Care
- Scoliosis/complications
- Synostosis/complications
- Synostosis/diagnostic imaging
- Synostosis/physiopathology
- Synostosis/surgery
- Tarsal Bones/abnormalities
- Tarsal Bones/surgery
- Tomography, X-Ray Computed
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Affiliation(s)
- Yann Philippe Charles
- Service d'Orthopédie Pédiatrique, Centre Hospitalier Universitaire, Hôpital Lapeyronie, 371 Avenue du Doyen G. Giraud, 34295 Montpellier Cedex 5, France.
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46
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Abstract
Posttraumatic arthritis of the joint components of the hind foot is typically linked with hind foot deformity and involvement of the neighbouring joint. The principal goals of any hind foot reconstruction are to achieve a quasi-anatomical reconstruction of the geometry and a stable and plantigrade foot position as a prerequisite for acceptable gait function, and an overall satisfactory result for the patient. Profound knowledge of the functions of the ankle-hind foot complex is the basis for the development of a valid therapeutic strategy. Any surgical reconstruction has to consider previous interventions, local soft tissue conditions, neurovascular status, and the components of deformity and degree of arthritic destruction at the corresponding joint levels. In general, an arthrodesis of any hind foot joint, as a key element in hind foot reconstruction, will be successful if correction of the underlying deformity is also adequately addressed.
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Affiliation(s)
- T Mittlmeier
- Abteilung für Unfall- und Wiederherstellungschirurgie, Chirurgische Klinik und Poliklinik der Universität Rostock.
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van der Krans A, Louwerens JWK, Anderson P. Adult acquired flexible flatfoot, treated by calcaneocuboid distraction arthrodesis, posterior tibial tendon augmentation, and percutaneous Achilles tendon lengthening: a prospective outcome study of 20 patients. Acta Orthop 2006; 77:156-63. [PMID: 16534717 DOI: 10.1080/17453670610045858] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Several methods for the treatment of acquired flexible flatfoot have been described. PATIENTS AND METHODS We followed the outcome of calcaneocuboid distraction arthrodesis with lengthening of the lateral column prospectively in 20 patients (20 feet). The mean age of the patients was 55 (30-66) years and 16 were women. The lateral column lengthening was combined with percutaneous lengthening of the Achilles tendon and augmentation of the posterior tibial tendon in all patients. Fixed forefoot supination, hallux valgus, and/or symptomatic arthrosis, were corrected with arthrodesis of the first cuneiform-metatarsal joint (n = 8) and arthrodesis of the naviculocuneiform joint (n = 2). The Foot Function Index (FFI) and American Orthopedic Foot and Ankle Society (AOFAS) Clinical Rating Index hindfoot score (CRI) were completed preoperatively and at follow-up. Follow-up time was 25 (13-39) months. All patients were physically examined at follow-up at the outpatient clinic, and the overall satisfaction rate was registered. Standardized weight-bearing radiographs were taken preoperatively and at follow-up. The lateral and dorsoplantar talometatarsal angle was measured, together with the ground-navicular distance. RESULTS At follow-up, 17/20 feet had complete relief of pain or only minor symptoms. The overall patient satisfaction rate was excellent or good in 15 patients and 17 patients reported an increase in daily and/or recreational activities. 3 patients complained of pain at the distraction site and/or cuboid-MT5 joint, without signs of arthrosis. All but 1 patient would have chosen to undergo the same procedure given the same circumstances. The improvement in both the FFI and CRI was statistically significant. On radiographic examination, the lateral and dorsoplantar talometatarsal angle and the ground-navicular distance improved significantly. Nonunion developed in 2 patients and united after bone grafting. 3 patients had either paresthesia or anesthesia in the distribution area of the sural nerve. INTERPRETATION We found good short-term results after calcaneocuboid distraction arthrodesis, percutaneous tendon Achilles lengthening, and medial soft tissue augmentation for the treatment of degenerative/acquired flexible flatfoot. Pain or discomfort along the lateral aspect of the foot is the most common and worrying postoperative complaint.
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Affiliation(s)
- Arie van der Krans
- Department of Orthopaedics, University Medical Center, Utrecht, The Netherlands
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48
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Affiliation(s)
- M Beck
- Abteilung für Unfall- und Wiederherstellungschirurgie, Chirurgische Klinik und Poliklinik der Universität Rostock.
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Doğan A, Albayrak M, Akman YE, Zorer G. [The results of calcaneal lengthening osteotomy for the treatment of flexible pes planovalgus and evaluation of alignment of the foot]. Acta Orthop Traumatol Turc 2006; 40:356-66. [PMID: 17220643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
OBJECTIVES We evaluated the results of calcaneal lengthening using the modified Evans osteotomy technique in patients with flexible pes planovalgus and the effectiveness of this technique in restoring the alignment of the foot. METHODS Calcaneal lengthening osteotomy was performed using the modified Evans technique in 22 feet of 11 patients (6 males, 5 females; mean age at the end of follow-up, 10 years 10 months; range 5 years 6 months to 14 years 8 months) with flexible pes planovalgus deformity. Etiologies were cerebral palsy (n=5), sequela of myelomeningocele (n=1), and sensorimotor polyneuropathy (n=1); four patients were evaluated as idiopathic. All the patients received long-term conservative therapy preoperatively, and, except for one patient, none had undergone surgery for the deformity. All patients but one were operated on bilaterally at a single session. Clinical assessment was based on 10 parameters, and radiographic assessment was based on seven parameters on standard anteroposterior and lateral radiographs. The mean follow-up was 18 months (range 13 to 75 months). RESULTS Radiographically, union was achieved in all the patients after a mean of seven weeks (range 6 to 8 weeks). Clinical results were perfect in 17 feet (77.3%), good in three feet (13.6%), fair in one foot (4.6%), and poor in one foot. Radiographically, five feet (22.7%), 13 feet (59.1%), and four feet (18.2%) were assessed as perfect, good, and fair, respectively. An average of 7.3 mm (range 4 to 9 mm) of calcaneal lengthening was obtained (p<0.05). Malpositioning of the graft or overcorrection did not occur. Before surgery, five patients could walk on the heel with (n=3) or without (n=2) support; postoperatively, all the patients but one could perform this without support. CONCLUSION Calcaneal lengthening osteotomy for symptomatic pes planovalgus provides pain relief and significant clinical and radiographic correction in the hind foot and forefoot.
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Affiliation(s)
- Ahmet Doğan
- Istanbul Eğitim ve Araştirma Hastanesi 1. Ortopedi ve Travmatoloji Kliniği.
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50
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Bal A, Aydog E, Aydog ST, Cakci A. Foot deformities in rheumatoid arthritis and relevance of foot function index. Clin Rheumatol 2005; 25:671-5. [PMID: 16344914 DOI: 10.1007/s10067-005-0115-z] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2005] [Revised: 10/04/2005] [Accepted: 10/10/2005] [Indexed: 12/26/2022]
Abstract
The aim of this study were to assess what type of foot deformities are found in rheumatoid arthritis (RA) patients, to detect frequency of deformities, and to evaluate deformities affecting Foot Function Index (FFI) and patient functional capacity. Anteroposterior and lateral weight-bearing radiographs of 156 feet of 78 patients who had RA for > or =2 years and of 76 feet of 38 healthy controls were studied. We measured hallux valgus angle, intermetatarsal angle between first and second (M1/2) and intermetatarsal angle between first and fifth (M1/5) on anteroposterior radiographs, and calcaneal pitch on the lateral radiographs. We examined the feet of all RA patients and healthy controls for hallux rigidus, cock-up deformity, clawing toe, and mallet finger, and measured calcaneal valgus angle. FFI, comprised of pain, disability, and activity limitation subscales, was administered to all RA patients. Their Steinbrocker Functional Class (SFC) and Health Assessment Questionnaire (HAQ) scores were determined. We determined frequency of deformities as 96.2% in RA patients and 97.4% in controls by radiological and physical examination (p>0.05). The frequency of each deformity was markedly increased in RA patients, with the exception of calcaneal valgus deformity. There was significant correlation between SFC and HAQ with FFI and subscales (respectively, r=0.46, p=0.001; r=0.67, p=0.001). For FFI and subscales, HAQ was the most important predictor factor, followed by gender and hallux rigidus. Foot deformities are seen very frequently in RA. These deformities may affect patient functional foot, especially hallux rigidus and calcaneal valgus.
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Affiliation(s)
- Ajda Bal
- Physical Medicine and Rehabilitation Clinic, Health Ministry Dişkapi Educational and Research Hospital, Ankara, Turkey
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