Foot and Ankle

Latest journal articles about foot and ankle from Foot and Ankle International, Journal of Foot and Ankle Research, Journal of Foot and Ankle Surgery, Foot and Ankle Surgery, Foot, The Bone & Joint Journal, Journal of Bone and Joint Surgery, Clinical Orthopaedics and Related Research, Acta Orthopaedica, Orthopedic Clinics of North, America, Journal of Orthopaedic Surgery and Research, Orthopedics

Related Articles Short-Term Functional Outcomes of First Metatarsophalangeal Total Joint Replacement for Hallux Rigidus. Foot Ankle Int. 2013 Jul 22; Authors: Erkocak OF, Senaran H, Altan E, Aydin BK, Acar MA Abstract BACKGROUND: Although metatarsophalangeal (MTP) arthrodesis has been advocated by many authors, implant arthroplasty appears to be successful option in advanced hallux rigidus (HR). The aim of our study was to evaluate the early results of the ToeFit-Plus prosthesis for the treatment of HR. METHODS: Between December 2007 and January 2011, a total of 26 toes of 24 patients with MTP arthritis of the great toe were treated with ToeFit-Plus implant. The average follow-up time was 29.9 (range: 25 to 62) months. All patients were evaluated clinically and radiographically. Postoperative satisfaction and function were scored according to the American Orthopaedic Foot and Ankle Society (AOFAS) score. Pain was assessed with the use of a visual analogue scale. RESULTS: Mean preoperative AOFAS score improved from 42.7 (range: 36 to 59) to 88.5 (range: 59 to 98) at the final follow-up (P < .01). Preoperative average visual analogue scale pain scores improved from 7.4 preoperatively to 1.9 at the final follow-up (P < .01). The average MTP joint range of motion improved from 25.9 degrees preoperatively to 53.8 degrees at the final follow-up. No radiologic loosening was found, but radiolucency was observed in 2 patients with this implant. No revision was required for any of the patients during the follow-up period.

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Related Articles Bone Propeller Flap-A Staged Procedure. J Foot Ankle Surg. 2013 Jul 19; Authors: Tremp M, Largo RD, Borens O, Schaefer DJ, Kalbermatten DF Abstract The ideal reconstruction technique for complex defects of the lower limb consists of replacing tissue with similar tissue in an attempt to achieve a good functional result. A 23-year-old white male sustained a crush injury with a grade IIIB open ankle dislocation. After open reduction and fixation, the patient developed severe osteomyelitis at the tibiotalar joint requiring a staged and radical debridement with a substantial combined soft tissue and bony defect over the distal tibia, fibula, and talus area. The reconstructive approach consisted of a modified model of the propeller flap, implementing the spare part concept in a 2-stage procedure using a prefabricated and vascularized "double-barrel" fibular graft. At 17 months postoperatively, a plain radiograph showed bony union with complete and stable coverage of the soft tissue defect. The patient was fully weightbearing. In conclusion, there is evidence to suggest that the established concept of a soft tissue propeller flap can be implemented on bone. PMID: 23876983 [PubMed - as supplied by publisher]Read more... http://www.ncbi.nlm.nih.gov/pubmed/23876983?dopt=Abstract

Related Articles Pinning across the Metatarsophalangeal Joint for Hammertoe Correction: Where Are We Aiming and What Is the Damage to the Metatarsal Articular Surface? J Foot Ankle Surg. 2013 Jul 18; Authors: Galli MM, Brigido SA, Protzman NM Abstract Kirschner wire (K-wire) fixation across the metatarsophalangeal joint (MTPJ) is commonly used in hammertoe repair surgery. The purpose of the present study was twofold: (1) to determine where the K-wire penetrates the metatarsal articular surface to achieve a rectus digit; and (2) to quantify the percentage of cartilage disruption to better understand the consequences of K-wire transfixation of the MTPJ. Arthrodesis was conducted on the second, third, and fourth proximal interphalangeal joints of 10 below-the-knee cadaver specimens, using a 1.6-mm K-wire. Digital alignment was confirmed with simulated weightbearing intraoperatively and radiographically. The K-wire was removed, and the MTPJ was dissected until the metatarsal head was fully exposed. The penetration point was plotted on a quadrant system with deviation noted from the epicenter. Center was defined as the point equidistant from the medial-to-lateral and superior-to-inferior edges on the distal surface of the metatarsal head, excluding the plantar condyles. Statistically significantly deviations were found in the K-wire placement from the center (35.9% ± 17.5%, p < .001), medial-to-lateral width (22.2% ± 19.2%, p < .001), and dorsal-to-plantar

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Related Articles Metastatic Calcaneal Lesion Associated with Uterine Carcinosarcoma. J Foot Ankle Surg. 2013 Jul 18; Authors: Rice BM, Todd NW, Jensen R, Rush SM, Rogers W Abstract Metastatic lesions of uterine carcinosarcoma most commonly occur in the abdomen and lungs and less frequently in highly vascularized bone. We report a rare case of an 86-year-old female with uterine carcinosarcoma with metastasis to the left calcaneus. The patient had a history of uterine carcinosarcoma with hysterectomy and bilateral salpingo-oophorectomy, along with bilateral pelvic and aortic lymphadenectomy, with no adjuvant therapy. The initial pedal complaint was that of left foot pain. The initial radiographic findings were negative; however, magnetic resonance imaging scans revealed a substantial area of marrow edema in the calcaneus. An excisional biopsy was performed, and histopathologic analysis revealed adenocarcinoma with features consistent with the patient's previous uterine tumor specimen. The patient was given one treatment of chemotherapy and was discharged to a hospice, where she died of her disease 2 weeks later. PMID: 23871174 [PubMed - as supplied by publisher]Read more... http://www.ncbi.nlm.nih.gov/pubmed/23871174?dopt=Abstract

Related Articles Electronic Health Records, Privacy, and Surveillance. J Foot Ankle Surg. 2013 Jul 18; Authors: Malay DS PMID: 23871173 [PubMed - as supplied by publisher]Read more... http://www.ncbi.nlm.nih.gov/pubmed/23871173?dopt=Abstract

Related Articles A Useful Surgical Technique for Retrieval of a Broken Guide Pin in the Midfoot. J Foot Ankle Surg. 2013 Jul 18; Authors: Roy SP, Lim CT, Tan KJ Abstract Perioperative instrument breakage is not an infrequent occurrence, even for experienced surgeons. The most commonly reported instrument breaks in orthopedic procedures are drill bits, followed by Kirschner wires and cannulated guide pins. The reasons for failure include improper technique and repetitive use. The retrieval of broken hardware can be technically challenging, particularly if the fragment has become embedded in bone. Retrieval methods have been described for cannulated guide pin fragments in the hip; however, no specific techniques have been described for the retrieval of guide pin fragments embedded in the bones of the foot. In the present report, we describe a technique we have found useful for retrieval of a guide pin fragment that had broken off during a Lisfranc fracture repair 6 weeks earlier. The technique was used in a delayed situation; however, we believe it would be even easier to use during an intraoperative breakage. PMID: 23871172 [PubMed - as supplied by publisher]Read more... http://www.ncbi.nlm.nih.gov/pubmed/23871172?dopt=Abstract

Related Articles Ultrasound Imaging for Diagnosis of Plantar Plate Ruptures of the Lesser Metatarsophalangeal Joints: A Retrospective Case Series. J Foot Ankle Surg. 2013 Jul 16; Authors: Carlson RM, Dux K, Stuck RM Abstract Tears of the plantar plate can be a source of significant forefoot pain, leading to alterations of foot function and gait. The objective of the present retrospective study was to further determine the value of ultrasound imaging in diagnosing plantar plate tears after clinical evaluation through a comparison of the ultrasound and intraoperative examination findings. Eight patients were identified who had undergone surgical intervention for a painful lesser metatarsophalangeal joint after ultrasound examination to diagnose a plantar plate pathologic entity. The intraoperative examination findings were used to calculate the sensitivity, specificity, and positive and negative predictive values of ultrasound in the diagnosis of plantar plate tears. The sensitivity and specificity of the ultrasound examination was 1 and 0.6, respectively. The positive and negative predictive value was 0.6 and 1, respectively. An ultrasound examination in the diagnosis of lesser metatarsophalangeal joint plantar plate tears displayed comparable sensitivity in identifying the pathologic features when compared with magnetic resonance imaging, with considerably less financial cost for the examination.

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Related Articles Reply to Letter to the Editor: New Tendon Transfer for Correction of Drop-foot in Common Peroneal Nerve Palsy. Clin Orthop Relat Res. 2013 Jul 18; Authors: Vigasio A, Marcoccio IM PMID: 23864489 [PubMed - as supplied by publisher]Read more... http://www.ncbi.nlm.nih.gov/pubmed/23864489?dopt=Abstract

Related Articles Quantitative assessment of the yield of osteoblastic connective tissue progenitors in bone marrow aspirate from the iliac crest, tibia, and calcaneus. J Bone Joint Surg Am. 2013 Jul 17;95(14):1312-6 Authors: Hyer CF, Berlet GC, Bussewitz BW, Hankins T, Ziegler HL, Philbin TM Abstract BACKGROUND: It is well known that bone marrow aspirate from the iliac crest contains osteoblastic connective tissue progenitor cells. Alternative harvest sites in foot and ankle surgery include the distal aspect of the tibia and the calcaneus. To our knowledge, no previous studies have characterized the quality of bone marrow aspirate obtained from these alternative sites and compared the results with those of aspirate from the iliac crest. The goal of this study was to determine which anatomic location yields the highest number of osteoblastic progenitor cells. METHODS: Forty patients were prospectively enrolled in the study, and separate bone marrow aspirate samples were harvested from the ipsilateral anterior iliac crest, distal tibial metaphysis, and calcaneal body. The aspirate was centrifuged to obtain a concentrate of nucleated cells, which were plated and grown in cell culture. Colonies that stained positive for alkaline phosphatase were counted to estimate the number of osteoblastic progenitor cells in the initial sample. The anatomic locations were compared. Clinical parameters (including sex, age, tobacco use, body mass index, and diabetes) were assessed as

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Related Articles Proximal Oblique Sliding Closing Wedge Osteotomy for Hallux Valgus. Foot Ankle Int. 2013 Jul 17; Authors: Wagner E, Ortiz C, Gould JS, Naranje S, Wagner P, Mococain P, Keller A, Valderrama JJ, Espinosa M Abstract BACKGROUND: The proximal oblique sliding closing wedge osteotomy (POSCOW) technique was developed to address moderate to severe hallux valgus deformity. We present a retrospective multicenter study to analyze the midterm radiological and clinical outcomes of patients treated with this type of proximal osteotomy fixed with plates. MATERIALS AND METHODS: One hundred and forty-four patients (187 feet) were operated on between May 2005 and June 2010 in 2 separate centers. Inclusion criteria were symptomatic moderate to severe incongruent hallux valgus deformity, no significant restriction in the first metatarsophalangeal joint movement, none to minimal degenerative changes in the first metatarsophalangeal or the tarsometatarsal joints, and no hypermobility. The median age was 60 years. The preoperative hallux valgus angle (HV) was 35.6 degrees, intermetatarsal angle (IM) was 15.3 degrees, AOFAS score was 53 points. The median follow-up was 35 months (range, 12-73). A POSCOW osteotomy was performed in all patients and fixed with plates. We recorded the satisfaction rate, postoperative clinical and radiological results, and complications.

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