Foot and Ankle Surgery RSS feed: Current Issue. Foot and Ankle Surgery is essential reading for everyone interested in the foot and ankle and its disorders. The approach is broad and includes all aspects of the subject from basic science to clinical management. Problems of both children and adults are included, as is trauma and chronic disease. Foot and Ankle Surgery is the official journal of European Foot and Ankle Society . Austrian Foot Society, Belgian Society of Medicine and Surgery of the Foot, British Orthopaedic Foot & Ankle Society, Czech Society for Foot and Ankle Surgery, Danish Foot and Ankle Society, Dutch Orthopaedic Foot and Ankle Association, Finnish Foot and Ankle Society, French Society of Medicine and Surgery of the Foot, German Orthopaedic Foot and Ankle Society, Hellenic Foot and Ankle Society, Irish Orthopaedic Foot & Ankle Society, Italian Foot & Ankle Society, Lithuanian Foot and Ankle Society, Polish Foot and Ankle Society, Portugese Society of Medicine and Surgery of the Foot, Spanish Society of Medicine and Surgery of the Foot and Ankle, Swedish Foot and Ankle Society, Swiss Foot and Ankle Society and the Turkish Foot and Ankle Surgery. The aims of this journal are to promote the art and science of ankle and foot surgery, to publish peer-reviewed research articles, to provide regular reviews by acknowledged experts on common problems, and to provide a forum for discussion with letters to the Editors. Reviews of books are also published. Papers are invited for possible publication in Foot and Ankle Surgery on the understanding that the material has not been published elsewhere or accepted for publication in another journal and does not infringe prior copyright. The papers published in Foot and Ankle Surgery are indexed/abstracted in: the Allied and Complementary Medicine Database, EMBASE, EMCARE, Pascal, Scopus, MEDLINE and Mosby's Nursing Index. http://www.footanklesurgery-journal.com/?rss=yesElsevier Inc.en © 2011 European Foot and Ankle Society. Published by Elsevier Inc. All rights reserved. Foot and Ankle Surgery1268-7731182June 2012 © 2011 European Foot and Ankle Society. Published by Elsevier Inc. All rights reserved. healthpermissions@elsevier.comhttp://www.footanklesurgery-journal.com/article/PIIS1268773111000476/abstract?rss=yesAbstract: Footwear is the oldest known fashion accessory in use. Footwear is often implicated in orthopaedic problems affecting lower limbs and back. Hence footwear modifications have a major role in management of these pathologies as well. This review explores footwear and its role in causation and management of orthopaedic problems. Based on our observations we recommend that children with flexible flatfeet should be encouraged to walk barefoot to help in developing their arches. Women with risk factors for secondary arthritis of knee or back pain may be advised to avoid heels. Commercial shoes which decrease hind foot loading may be used in symptomatic management of hindfoot and mid foot problems. Similarly shoes which decrease forefoot loading may be useful in managing forefoot pathology. Flip-flops should be avoided by diabetics as they do not protect from injuries.Footwear and orthopaedicsH.V. Kurup, C.I.M. Clark, R.K. Dega10.1016/j.fas.2011.03.012Foot and Ankle Surgery 18, 2 (2012)2011-04-18Foot and Ankle Surgery2011-04-18182S1268-7731(12)X0003-1Reviews7983http://www.footanklesurgery-journal.com/article/PIIS126877311100066X/abstract?rss=yesAbstract: Background: Although open reduction and internal fixation via the extended lateral approach is currently considered gold-standard, severely comminuted calcaneal fractures might not be amendable for reconstruction. The primary aim of the current review study was to assess the functional outcome of the primary arthrodesis in the management of comminuted displaced intra-articular calcaneal fractures.Methods: The literature was searched for studies published between January 1st 1990 and December 1st 2010, to identify studies in which a primary arthrodesis was utilized for the treatment of displaced intra-articular calcaneal fractures between. The methodological quality of the included studies was assessed using the Coleman Methodology Score.Results: Seven case series and one abstract were identified, reporting on 120 patients with 128 severely comminuted calcaneal fractures. Average follow-up time was 28 months and union rate 97%. Functional outcome was assessed using the modified AOFAS score in seven studies; with a weighted average of 77.4 (range 72.4–88). One study reported a 75% good to excellent outcome on the Paley score. Three studies reported on return to work, ranging from 75 to 100%. Overall reported wound complications occurred in 19.4%. The average Coleman Methodology Score was 56 (range 38–68) points.Conclusions: The primary arthrodesis for the treatment of Sanders type-IV comminuted displaced intra-articular calcaneal fractures provides overall good results considering the severe nature of the injury. Therefore, in the process of choosing the best treatment modality for a severely comminuted calcaneal fracture, the primary arthrodesis should receive full consideration.The primary arthrodesis for severely comminuted intra-articular fractures of the calcaneus: A systematic reviewT. Schepers10.1016/j.fas.2011.04.004Foot and Ankle Surgery 18, 2 (2012)2011-05-25Foot and Ankle Surgery2011-05-25182S1268-7731(12)X0003-1Reviews8488http://www.footanklesurgery-journal.com/article/PIIS1268773111000750/abstract?rss=yesAbstract: A glomus tumor is a rare and benign vascular tumor. It can originate in multiple locations on the body, although it has most frequently been found in subungeal areas of the hand. This two cases report describes a glomus tumor of the hallux, including a recurrence and a review of the related literature. We believe this case study might be of interest due to the unusual location of this tumor.Glomus tumor of the hallux. Review of the literature and report of two casesC. Polo, D. Borda, D. Poggio, J. Asunción, L. Peidro10.1016/j.fas.2011.05.005Foot and Ankle Surgery 18, 2 (2012)2011-06-22Foot and Ankle Surgery2011-06-22182S1268-7731(12)X0003-1Reviews8993http://www.footanklesurgery-journal.com/article/PIIS1268773111001020/abstract?rss=yesAbstract: The management of rheumatoid patients is a complex process due to the chronic, systemic, multi-joint and extra-articular nature of the disease. In comparison, osteoarthritis and post-traumatic arthritis usually involve a single joint and are hence not comparable to rheumatoid pathology. This review sets out to specifically look at studies on rheumatoid patients with interventions for foot or ankle disease. MEDLINE, EMBASE, the Cochrane databases, Current Controlled Trials and the WHO International Clinical Trials Registry Platform are all searched for relevant studies.The rheumatoid foot and ankle: Current evidenceDavid T. Loveday, Gillian E. Jackson, Nick P.J. Geary10.1016/j.fas.2011.06.001Foot and Ankle Surgery 18, 2 (2012)2011-08-01Foot and Ankle Surgery2011-08-01182S1268-7731(12)X0003-1Reviews94102http://www.footanklesurgery-journal.com/article/PIIS1268773111000452/abstract?rss=yesAbstract: Background: Open reduction with internal fixation for unstable ankle fractures is relatively predictable with excellent outcomes. However, the management of ankle fractures in the elderly remains less predictable secondary to the various co-morbidities associated with advanced age.Methods: A retrospective chart review of 216 patients over the age of 60 that sustained an ankle fracture, was performed to determine the incidence of complications after ORIF of ankle fractures in an elderly population in the perioperative course. Secondly, the incidence of complications in patients that had locking plate fixation compared to those that had non-locking plate fixation was determined. Lastly, the effect of early weight bearing on the incidence of complications was analyzed.Results: There was not a statistically significant difference in the complication rates between the group with co-morbidities (19.01%) and those without (11.96%). The postoperative complication with the highest incidence was wound dehiscence (9.7%), and only diabetes significantly predicted wound dehiscence. The fixation construct and weight-bearing protocol failed to significantly predict any of the indexed complications.Conclusions: Overall, the results suggest that surgical treatment of unstable ankle fractures in the elderly is fairly predictable with an acceptable complication rate. The complication rates are higher with increased age and diabetes, but they failed to reach statistical significance. Conventional plating appears to provide adequate stability without increased risk of hardware failure. In addition patients that were allowed to walk within the first 2 weeks postoperatively did not experience a higher rate of hardware failure.Complications after open reduction and internal fixation of ankle fractures in the elderlyMichael J. Lynde, Travis Sautter, Graham A. Hamilton, John M. Schuberth10.1016/j.fas.2011.03.010Foot and Ankle Surgery 18, 2 (2012)2011-05-02Foot and Ankle Surgery2011-05-02182S1268-7731(12)X0003-1Original Articles103107http://www.footanklesurgery-journal.com/article/PIIS1268773111000464/abstract?rss=yesAbstract: Background: Non-operative treatment for plantar fasciitis varies widely and includes the use of night ankle-foot orthoses (AFOs). This study compares the effectiveness of a posterior AFO, which dorsiflexes the foot, with an anterior AFO, which maintains the foot in a plantigrade position.Method: Each participant was given a questionnaire to fill in to evaluate how satisfied the participants were with the orthosis with regards to comfort, ease of use and appearance, and whether the pain in the foot was reduced and at what stage was the pain decreased.Results: Two-thirds of all participants confirmed that morning pain and stiffness was less after wearing the AFO; both types were relatively easy to don and doff, but the posterior orthosis was more uncomfortable and disrupted sleep. On average, the anterior AFO reduced heel pain more significantly than the posterior orthosis.Conclusion: Plantar fasciitis night AFOs are poorly tolerated orthoses but their use can be justified in that the pain levels are reduced. The anterior AFOs are more comfortable and more effective than posterior AFOs.A comparison of two night ankle-foot orthoses used in the treatment of inferior heel pain: A preliminary investigationJ. Attard, D. Singh10.1016/j.fas.2011.03.011Foot and Ankle Surgery 18, 2 (2012)2011-04-18Foot and Ankle Surgery2011-04-18182S1268-7731(12)X0003-1Original Articles108110http://www.footanklesurgery-journal.com/article/PIIS1268773111000592/abstract?rss=yesAbstract: Background: Arthroscopic ankle arthrodesis (AAA) is a recognised salvage procedure for end-stage arthritis. Its reported disadvantages include a high rate of re-operation for symptomatic prominence of metalwork. We propose that the use of a headless screw would reduce this re-operation rate.Methods: We reviewed 32 AAAs, using the Acutrak™6/7mm headless screw fixation system, to determine peri-operative parameters and complication rates.Results: At an average of 22 months follow-up, 28 (88%) had united radiologically. There were 2 stable fibrous non-unions not requiring further intervention. Of the other 2, one was successfully revised using an open technique, and the other patient died of unrelated causes.There were no other complications in this series, with no cases of metalwork removal for prominence or pain.Conclusions: Using a headless screw fixation for arthroscopic ankle arthrodesis prevents symptomatic metalwork prominence and the requirement for removal.Headless compression screw fixation prevents symptomatic metalwork in arthroscopic ankle arthrodesisAdekoyejo A. Odutola, Barnaby D. Sheridan, Andrew J. Kelly10.1016/j.fas.2011.03.013Foot and Ankle Surgery 18, 2 (2012)2011-05-10Foot and Ankle Surgery2011-05-10182S1268-7731(12)X0003-1Original Articles111113http://www.footanklesurgery-journal.com/article/PIIS1268773111000622/abstract?rss=yesAbstract: Background: The treatment of osteochondral lesions, especially those with a cystic component or those that have failed the standard arthroscopic procedures can be challenging. Synthetic grafts have several potential advantages over other second line treatments including the fact that only one operation is required and no other joint is violated.Method: We report the results of the first series of synthetic grafts used in the treatment of osteochondral lesions of the ankle with a minimum of one year follow up.Results: There was significant improvement in the American Orthopaedic Foot & Ankle Society (AOFAS) Hindfoot and Ankle Osteoarthritis Scale (AOS) scores and all patients were satisfied with the results of surgery. Magnetic Resonance Imaging (MRI) scans at one year have demonstrated resolution of the bony cysts and surrounding bone marrow oedema but, worryingly, continued to show high signal on the T2 weighted images within the plugs themselves. Qualitative T2 mapping has suggested a fibrous rather than hyaline appearance of the cartilage portions of the plugs.Conclusions: The clinical results have been encouraging but more patients and longer follow up are required before firm conclusions can be drawn.Synthetic osteochondral grafting of ankle osteochondral lesionsChristopher J. Pearce, Louise E. Gartner, Adam Mitchell, James D. Calder10.1016/j.fas.2011.04.001Foot and Ankle Surgery 18, 2 (2012)2011-05-18Foot and Ankle Surgery2011-05-18182S1268-7731(12)X0003-1Original Articles114118http://www.footanklesurgery-journal.com/article/PIIS1268773111000695/abstract?rss=yesAbstract: Background: The aim of this epidemiologic study was to evaluate the incidence of the Achilles tendinopathy in non athletes and the coincidence with varus alignment of the hindfoot.Methods: Six hundred ninety-seven patients (1394 feet) have been analysed. The tibiocalcaneal axis was goniometrically measured. The presence of a non insertional and insertional Achilles tendinopathy was clinically determined.Results: Achilles tendinopathy was found in 5.6% of the patients (4% insertional, 3.6% non insertional, 1.9% both forms). The average tibiocalcaneal angle was calculated with −0.76° for the tendinopathy group and −0.96° for the insertional tendinopathy whereas the control group showed an average angle of 1.77°. For the total group the average tibiocalcaneal axis was calculated with 1.62°. Out of 1394 feet 38.3% showed a varus axis of the hindfoot and 61.7% a valgus alignment.Conclusions: The coincidence of varus alignment and Achilles tendinopathy could be validated.Epidemiologic investigation of 1394 feet: Coincidence of hindfoot malalignment and Achilles tendon disordersUte Waldecker, Gerd Hofmann, Saskia Drewitz10.1016/j.fas.2011.04.007Foot and Ankle Surgery 18, 2 (2012)2011-06-06Foot and Ankle Surgery2011-06-06182S1268-7731(12)X0003-1Original Articles119123http://www.footanklesurgery-journal.com/article/PIIS1268773111000701/abstract?rss=yesAbstract: Background: The mainstay of treatment for non-insertional Achilles tendinopathy is non-operative, however a proportion of patients will fail conservative measures. We describe the results of Achilles tendinoscopy with plantaris tendon release in patients who have failed first line conservative treatment for at least 6 months.Methods: A consecutive series of 11 patients with a minimum of 2 years follow up.Results: The mean AOFAS scores significantly improved from 68 pre-op to 92 post op (p=0.0002) as did the AOS scores for both pain (28% pre-op to 8% post op (p=0.0004)) and disability (38% pre-op to 10% post op (p=0.0005). The mean SF-36 scores also improved but were not statistically significant (pre-op 76, post op 87 (p=0.059). There were no complications. 8 of the 11 patients were satisfied, the other 3 somewhat satisfied.Conclusions: The results of Achilles tendinoscopy and division of the plantaris tendon are encouraging but further studies are required to compare it to other treatments. It is minimally invasive and low risk so should not affect the ability to perform a formal open procedure if unsuccessful.Achilles tendinoscopy and plantaris tendon release and division in the treatment of non-insertional Achilles tendinopathyChristopher J. Pearce, James Carmichael, James D. Calder10.1016/j.fas.2011.04.008Foot and Ankle Surgery 18, 2 (2012)2011-05-27Foot and Ankle Surgery2011-05-27182S1268-7731(12)X0003-1Original Articles124127http://www.footanklesurgery-journal.com/article/PIIS1268773111000762/abstract?rss=yesAbstract: Introduction: The Accessory Postero-Lateral (AccPL) portal has recently been described to improve the visualisation for the endoscopic debridement of Haglund's tubercle. The safety of using this portal has been considered previously for posterior ankle arthroscopy. We performed a study to determine the proximity of the AccPL portal to the sural nerve.Methods: We compared the distances between AccPL and PL portals to the sural nerve in 17 cadaveric specimens.Results: The AccPL portal was significantly closer (mean 12.0mm, range 6–19mm, SD=3.64) to the sural nerve than the PL portal (mean 14.1mm, range 11–18mm, SD=2.34) (t(16)=−2.34, p=0.03). In two cases the sural nerve was in contact with the clip but on close inspection, the nerve had not been damaged in any of the specimens.Conclusions: We conclude that the AccPL portal is a safe method to allow visualisation during endoscopic debridement of the Achilles tendon insertion. We also recommend that the portal is used for visualisation rather than instrumentation.The safety profile of a retrospective Accessory Postero-Lateral hind foot portal: The risk of sural nerve damage during visualisation of the Achilles tendon insertionM.R. Carmont, R. Stroud, H. Bjorndalen, J. Crowther, W.J. Ribbans, D. Griffin10.1016/j.fas.2011.05.006Foot and Ankle Surgery 18, 2 (2012)2011-06-27Foot and Ankle Surgery2011-06-27182S1268-7731(12)X0003-1Original Articles128131http://www.footanklesurgery-journal.com/article/PIIS1268773111000774/abstract?rss=yesAbstract: Background: We describe the surgical technique, results and functional outcomes of molded arthrodesis of hallux metatarsophalangeal (MTP) joint using crossed-screw fixation.Methods: 23 Toes in 21 consecutive patients operated between September 2007 and January 2010 were included for the retrospective study. Average age was 60.0 years (range 31–84 years) with male female ratio being 3:4. Differential pitch cannulated crossed screw technique was used in all cases. At the latest follow-up, the radiological findings, the hallux-forefoot AOFAS scores and patient satisfaction questionnaires were used to assess outcomes.Results: Overall fusion rate was 91% with a mean hallux valgus angle of 13.6° (range 8–22°) and a mean dorsi-flexion angle of 25° (range 18–30°). Complication rate was 13% that included two superficial wound infections and one failed fusion that underwent a successful fusion after revision surgery. At a mean follow-up of 17 months (range 6–34 months), the mean AOFAS score was 79 (out of a maximum of 90). 92% of the patients were satisfied with the final outcome and 83% mentioned that they would have the procedure again.Conclusions: Crossed-screw technique of arthrodesis of the first MTP joint is successful for relief of pain, allowing a high level of function and good patient satisfaction.Molded arthrodesis of the hallux metatarsophalangeal joint using the crossed-screw technique: Surgical technique, results and functional outcomesR. Mohammed, A. Gadgil10.1016/j.fas.2011.05.007Foot and Ankle Surgery 18, 2 (2012)2011-06-13Foot and Ankle Surgery2011-06-13182S1268-7731(12)X0003-1Original Articles132135http://www.footanklesurgery-journal.com/article/PIIS1268773111001056/abstract?rss=yesAbstract: Background: We hypothesized that a total replacement of the first metatarsophalangeal joint (MTP-1) would alter the walking pattern with medialisation of the ground reaction force (GRF) of the foot and subsequently cause an increase in bone mineral density (BMD) in the medial metatarsal bones and a decline of BMD in the lateral metatarsal bones.Methods: Twelve patients receiving total joint replacements (Roto-Glide®) of MTP-1 were enrolled in a prospective cohort. BMD and pedobarography of the heel bone and the metatarsal heads were performed preoperatively and at least 12 months postoperatively.Results: BMD in the lateral metatarsals and GRF under the lateral column of the operated feet decreased significantly on the operated feet.Conclusions: Total joint replacement of MTP-1 tends to reduce GRF under the lateral column of the foot causing a corresponding decline in BMD and pedobarographic measures. Our findings support the further use of the Roto-Glide® prosthesis for osteoarthritis of the first metatarsophalangeal joint.Prospective analysis of a first MTP total joint replacement. Evaluation by bone mineral densitometry, pedobarography, and visual analogue score for painEva Wetke, Bo Zerahn, Hakon Kofoed10.1016/j.fas.2011.07.002Foot and Ankle Surgery 18, 2 (2012)2011-08-12Foot and Ankle Surgery2011-08-12182S1268-7731(12)X0003-1Original Articles136140http://www.footanklesurgery-journal.com/article/PIIS1268773111001068/abstract?rss=yesAbstract: Introduction: The aim was to see if as surgeons we were providing safe, efficient and effective, regional blocks for patients undergoing day case, forefoot surgery. We also assessed the costs of, providing this service.Methods: 63 consecutive patients were recruited prospectively for local anaesthetic block. Blocks were, performed by the orthopaedic team. Efficacy of block was assessed intra-operatively with a visual, analogue score (VAS) of 0–10. Satisfaction with the anaesthetic procedure was also assessed.Results: Average time to perform the block was 6min. Mean VAS for knife to skin was 0.44 (95%, confidence 0.07–0.81) and for ankle tourniquet was 1.39 (95% confidence 0.85–1.39). Patients were, highly satisfied with the blocks. No complications were reported.Conclusions: These blocks are quick and easy to perform by orthopaedic surgeons. They are well, tolerated and effective. They result in considerable cost savings to the Hospital.Surgeon administered regional blocks for day case forefoot surgeryJulian Foote, Richard Freeman, Samer Morgan, Andrew Jarvis10.1016/j.fas.2011.07.003Foot and Ankle Surgery 18, 2 (2012)2011-08-12Foot and Ankle Surgery2011-08-12182S1268-7731(12)X0003-1Original Articles141143http://www.footanklesurgery-journal.com/article/PIIS1268773109001362/abstract?rss=yesAbstract: Total Ankle Arthroplasty (TAA) is increasing in popularity following the development of the, next generation of implants and improved surgical technique giving better long-term results. Significant mal-alignment of the ankle pre-operatively has always provided a challenge to the surgeon, to regain anatomical alignment to reduce subsequent wear. We present a series of two cases of TAA, who developed post-operative valgus deformity requiring salvage procedure in the form of a fibula, lengthening osteotomy.Fibula lengthening osteotomy to correct valgus mal-alignment following total ankle arthroplastyBenjamin Thomas Brooke, Nick John Harris, Samer Morgan10.1016/j.fas.2009.11.002Foot and Ankle Surgery 18, 2 (2012)2009-12-18Foot and Ankle Surgery2009-12-18182S1268-7731(12)X0003-1Case Report144147