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Related Articles

Continuous Femoral Nerve Block Using 0.125% Bupivacaine Does Not Prevent Early Ambulation After Total Knee Arthroplasty.

Clin Orthop Relat Res. 2013 Jul 16;

Authors: Beebe MJ, Allen R, Anderson MB, Swenson JD, Peters CL

Abstract
BACKGROUND: Continuous femoral nerve block has been shown to decrease opioid use, improve postoperative pain scores, and decrease length of stay. However, several studies have raised the concern that continuous femoral nerve block may delay patient ambulation and increase the risk of falls during the postoperative period.
QUESTIONS/PURPOSES: This study sought to determine whether continuous femoral nerve block with a single-shot sciatic block prevented early ambulation after total knee arthroplasty (TKA) and whether the technique was associated with adverse effects.

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Clinical features and outcomes of foot keloids treated using complete surgical excision and full thickness skin grafting followed by corticosteroid injections.

J Foot Ankle Res. 2013 Jul 15;6(1):26

Authors: Park TH, Park JH, Chang CH

Abstract
BACKGROUND: Keloids are often resistant to treatment and have high recurrence rates. To the best of the authors' knowledge, however, there have been very few case reports related to foot keloids. The purpose of this retrospective case-series was to summarize the baseline characteristics of a cohort of patients, introduce our treatment regimen for the successful treatment of foot keloids.
METHODS: Patients were treated with surgical excision followed by full thickness skin grafting combined with postoperative steroid injections combined with silicone gel sheeting over a period of eight years from December 2004 to November 2012 at our institution. Subjective outcome was evaluated using Patient Scar Assessment Scales. The final objective outcome was judged by two independent physicians at the time of 12 months after treatment as recurrence or non-recurrence.

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A comparison of the Doppler ultrasound interpretation by student and registered podiatrists.

J Foot Ankle Res. 2013;6(1):25

Authors: Young M, Birch I, Potter CA, Saunders R, Otter S, Hussain S, Pellett J, Reynolds N, Jenkin S, Wright W

Abstract
BACKGROUND: Hand held Doppler ultrasound machines are routinely used by podiatrists to assess the arterial perfusion of the lower limb. They are practical, painless and effective as a screening tool, and the available general evidence would suggest that interpretation by practitioners is reliable. This study compared the abilities of student and Health and Care Professions Council (HCPC) registered podiatrists to identify correctly Doppler ultrasound outputs.
METHOD: A prospective single blind comparative study design was utilised. Fifteen Doppler recordings of the blood flow in the posterior tibial artery, five each of monophasic, biphasic and triphasic blood flow, were used to compare the interpretation abilities of 30 undergraduate podiatry students and 30 HCPC registered podiatrists. Chi-squared analysis of the results was undertaken.
RESULTS: Chi-squared analysis found that there was no statistically significant difference between the overall abilities of student podiatrists

Tendoscopic-Assisted Repair of Complete Rupture of the Peroneus Longus Associated With Displaced Fracture of the Os Peroneum--Case Report.

Foot Ankle Int. 2013 Jul 11;

Authors: Ho KK, Chan KB, Lui TH, Chow YY

PMID: 23847274 [PubMed - as supplied by publisher]

Read more... http://www.ncbi.nlm.nih.gov/pubmed/23847274?dopt=Abstract

An Analysis of the Use of the Kellgren and Lawrence Grading System to Evaluate Peritalar Arthritis Following Total Ankle Arthroplasty.

Foot Ankle Int. 2013 Jul 8;

Authors: Mayich DJ, Pinsker E, Mayich MS, Mak W, Daniels TR

Abstract
BACKGROUND: The Kellgren and Lawrence grading system (KLGS) has been used throughout the literature for the radiographic staging of osteoarthritis (OA) of the peritalar joints. Despite its widespread use, the KLGS has never been validated for use in this clinical circumstance. The purpose of this study was to determine the inter- and intrarater reliability of the KLGS in the assessment of radiographic progression of OA in the peritalar joints following total ankle replacement (TAR).
METHODS: One hundred twenty pre- and minimum 5-year postoperative weight-bearing lateral radiographs following 60 consecutive cases of TAR were utilized. Each individual film was considered separately for the purposes of this study. Of those films, 93 and 98 were found to have adequate visualization of the subtalar (STJ) and talonavicular (TNJ) joints, respectively. Three qualified reviewers graded the films according to the KLGS on 2 separate occasions, with 1 month separating the 2 readings. The results were analyzed for intra- and interobserver reliability. The degree of agreement was analyzed using the weighted kappa (κw) statistic, Fleiss's kappa (Fleiss's κ), and percentage agreement RESULTS: Interrater agreements were moderate (κw = 0.37 ± 0.06; Fleiss's κ = 0.21 ± 0.03) for the STJ to fair (κw = 0.43 ± 0.06; Fleiss's κ = 0.25 ± 0.03) for the TNJ. Intrarater agreements for the STJ were moderate (mean κw = 0.43 ± 0.07) and

Multimodal Analgesia Therapy Reduces Length of Hospitalization in Patients Undergoing Fusions of the Ankle and Hindfoot.

Foot Ankle Int. 2013 Jul 8;

Authors: Michelson JD, Addante RA, Charlson MD

Abstract
BACKGROUND: Multimodal postoperative analgesia employs multiple medications given perioperatively to block the generation and perception of pain at different points in the nociceptive pathway. This retrospective study examines its effect on the length of stay for patients undergoing hindfoot and ankle fusions.
METHODS: All patients operated upon by the senior authors between 2007 and 2011, inclusive, underwent ankle fusion, subtalar fusion, pantalar arthrodesis, triple arthrodesis, or combined ankle/subtalar fusions. The perioperative pain management was either the "traditional" method (patient-controlled-analgesia-delivered parenteral narcotics beginning immediately postoperatively) or the multimodal pain protocol (pre- and postoperative oral administration of opioids, celecoxib, pregabalin, acetaminophen, and prednisone). The choice of pain protocol was up to the surgeons, without any exclusion criteria. Physical therapy protocols were not changed during the study. The study included 220 patients; 175 received the multimodal protocol and 45 received traditional management. Multimodal protocol patients were younger (53.9 vs 59.7 years; P < .003), but there were no other differences between the groups with respect to gender, obesity, body mass index, tobacco use, alcohol use, or comorbidities. Complex cases (revision surgeries, Charcot joint surgeries, multiple concurrent procedures, etc) were equally represented in both groups.

Related Articles

The effect of rollover footwear on the rollover function of walking.

J Foot Ankle Res. 2013;6(1):24

Authors: Forghany S, Nester CJ, Richards B

Abstract
BACKGROUND: Rollover footwear is assumed to provide an enhanced surface over which the body can roll more easily. The aim of this study was to investigate the effects of rollover footwear on the rollover function of walking.
METHODS: Twenty subjects walked in three conditions: (i) a MBT shoe (Masai Barefoot Technology) characterized by a stiff sole rounded in the anterior-posterior direction; (ii) alternative rollover shoe (a prototype of Scholl STARLIT) characterized by a stiff sole rounded in the anterior-posterior direction; (iii) a flat control shoe. Data on the lower limb kinematics and ground reaction force were collected. The rollover function of walking was characterized using the radii of lower limb rollover shapes and duration of terminal double limb support. These data were compared between the three shoe conditions and the relationship between the radii of the curved shoe sole and the radii of the rollover shapes investigated.
RESULTS: The radii of the whole and middle part of foot-shoe, ankle-foot and knee-ankle-foot rollover shapes were significantly smaller

Realignment Surgery for Severe Talar Tilt Secondary to Paralytic Cavovarus.

Foot Ankle Int. 2013 Jul 11;

Authors: Lee WC, Ahn JY, Cho JH, Park CH

Abstract
BACKGROUND: Realignment surgeries for mild to moderate ankle osteoarthritis with minimal talar tilt have been reported to be effective. However, there has been no report on joint-sparing surgery of ankle osteoarthritis in patients with paralytic disorders who have severe talar tilt. We therefore investigated whether ankle osteoarthritis with severe talar tilt caused by paralytic disorders can be improved after operative treatment.
METHODS: This study included 12 ankles (11 patients) with varus ankle osteoarthritis from paralytic disorders with cavovarus deformity of the foot. Mean follow-up period was 3.0 years (range, 2-4.5 years). Causes of paralysis were residual polio in 7 ankles (6 patients), cerebral palsy in 2 ankles, and idiopathic in 3 ankles. Preoperative and postoperative clinical assessments were performed using the American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score and a visual analogue scale (VAS). The Ankle Osteoarthritis Scale (AOS) was used for postoperative assessment. Pre- and postoperative radiographic parameters were compared.

Radiographic Correction of Stage III Posterior Tibial Tendon Dysfunction With a Modified Triple Arthrodesis.

Foot Ankle Int. 2013 Jul 5;

Authors: Mehta SK, Kellum RB, Robertson GH, Moore AR, Wingerter SA, Tarquinio TA

Abstract
BACKGROUND: The literature supports fusion as the surgical treatment of choice for stage III posterior tibial tendon dysfunction (PTTD). The present study reports the radiographic correction following a modified triple arthrodesis (fusions of the subtalar, talonavicular, and first tarsometatarsal joints) in patients with stage III PTTD.
METHODS: An institutional review board-approved retrospective study was performed to assess the radiographic outcome of a modified triple arthrodesis in 21 patients (22 feet). Pre- and postoperative weight-bearing radiographs were reviewed in a blinded fashion by clinicians of varying levels of training. The talo-first metatarsal, talocalcaneal, and talonavicular coverage angles were measured on anteroposterior views. On lateral views, the talo-first metatarsal (Meary's), talocalcaneal, calcaneal pitch, and talar declination angles and the medial cuneiform to floor distance were measured. Statistical analysis was performed to compare pre- and postoperative measurements, assess the degree of correction, and determine interobserver reliability of the radiographic measurements.