Foot and Ankle Surgery

A meta-analysis of randomised controlled trials comparing conventional to minimally invasive approaches for repair of an Achilles tendon rupture

Samuel E. McMahon, Toby O. Smith, Caroline B. Hing — 2010-12-17

Abstract: Achilles tendon ruptures are a common injury afflicting predominantly the young male occasional sportsman. Previous studies have shown that outcome is better with surgical repair for the young active patient. There is no consensus as to whether there is a difference in outcome between open and percutaneous minimally invasive surgery (MIS). A meta-analysis was undertaken to compare the clinical outcomes of MIS with conventional open surgical repair. Six randomised controlled trials of 277 Achilles tendon repairs were eligible for review. This included 136 minimally invasive repairs and 141 conventional open repairs. On analysis, there was no significant difference between the two surgical approaches in respect to the incidence of re-rupture, tissue adhesion, sural nerve injury, deep infection and deep vein thrombosis (p>0.05). However, MIS had a significantly reduced risk of superficial wound infection, with three times greater patient satisfaction for good to excellent results compared with conventional open surgical approaches.

The influence of shoe sole's varying thickness on lower limb muscle activity

A.K. Ramanathan, E.J. Parish, G.P. Arnold, T.S. Drew, W. Wang, R.J. Abboud — 2010-09-20

Abstract: Background: The lateral ligament injury of the ankle is acknowledged to be the most common ankle injury sustained in sport. Increased peroneus longus muscle contraction in the shod population has already been documented. This study aimed to quantify the effect of shoe sole's varying thickness on peroneus longus muscle activity.Methods: Electromyographic recordings of the peroneus longus muscle activity following unanticipated inversion of the foot from 0° to 20° in a two-footplate tilting platform were collected from 38 healthy participants. The four test conditions were: barefoot, standard shoe, and shoes with 2.5cm and 5cm sole adaptation respectively.Results: Compared to the barefoot condition, there is an increase in the magnitude of muscle contraction on wearing shoes, which further increases with thickening shoe soles. The peroneus longus was responding earlier in the shod conditions when compared to the barefoot, although the results were variable within the three shod conditions.Conclusion: Footwear with increasing shoe sole thickness evokes a correspondingly stronger protective eversion response from the peroneus longus to counter the increasing moment at the ankle-subtalar joint complex following sudden foot inversion. Hence, fashion footwear with thicker sole is likely to increase the risk of lateral ligament injury of the ankle when such protective response is overwhelmed. Similarly, the clinicians need to be cautious regarding the amount of shoe raise that they could provide for patients with limb length discrepancy without any detrimental untoward side effects.

First metatarsophalangeal joint replacement: Long-term results of a double stemmed flexible silicone prosthesis

E.W. ter Keurs, S. Wassink, B.J. Burger, P.C.G. Hubach — 2010-09-09

Abstract: Background: The aim of this retrospective study was to evaluate the long-term results of a Swanson type silicone prosthesis used for the first metatarsophalangeal (FMTP) joint replacement. It compares implants with and without the use of grommets.Methods: Fifty-nine FMTP joints were replaced. The average follow-up period was 9 years. Subjective and clinical findings were scored according to the AOFAS-HMI (American Orthopedic Foot and Ankle Society-Hallux Metatarsophalangeal-Interphalangeal) score. X-ray examination was carried out by evaluation of the presence of reactive bone areas around the implant.Results: Ninety-five percent of patients had relief of pain. Clinical findings showed a reasonable function (range of motion >30°) in 77% of the FMTP joints. A trend for decrease in radiolucency and lytic bone was seen in areas around the implant with the use of grommets.Conclusion: The prosthesis shows good results concerning pain relief and a reasonable to good function (>30° range of motion) of the FMTP joint in most patients. Reactive bone areas around the implant decreased by the use of grommets.

Tibio-talo-calcaneo fusion using a locked intramedullary compressive nail

2010-09-03

Abstract: We present the clinical results and outcomes of 30 consecutive patients (31 ankles) who have undergone tibio-talo-calcaneal arthrodesis using an intramedullary nail to achieve bony union. This was a prospective study and surgery was performed by the senior author in a single hospital. We achieved high levels of satisfaction and outcome via the AOFAS and SF-36 scoring systems. We propose that this method of arthrodesis is reliable and easily reproducible for patients with severe arthritis and bone loss at the ankle and subtalar joints.

Complication rates following operative treatment of calcaneus fractures

Nelson F. SooHoo, Eugene Farng, Lucie Krenek, David S. Zingmond — 2010-09-01

Abstract: Background: The purpose of this study is to report the short-term complication rates and mid-term subtalar fusion rates following operative management of calcaneal fractures.Methods: This is a retrospective study of Californians undergoing operative treatment of a calaneus fracture from 1995 to 2005. The main outcomes reported are readmission for a short-term complication within 90 days of surgery and reoperation for subtalar fusion during the observation period.Results: We identified 4481 patients who underwent open reduction and internal fixation of their fracture as inpatients within 30 days of the index admission. The short-term rate of complications included a 90-day rate of readmission of 1.03% for wound infection, 0.25% for thromboembolic disease, and 0.22% for mortality. The mid-term rate of subtalar fusion was 3.49% at 5 years post-operatively.Conclusions: This study reports the short-term complication rates and mid-term subtalar fusion rates following operative management of calcaneal fractures using population-based data.

Anatomical reconstruction of the lateral ligaments using Gracillis tendon in chronic ankle instability; a new technique

2010-11-09

Abstract: Background: Many surgical technique have been described to assess the outcome of anatomical reconstruction of the lateral ligaments using Gracillis tendon. This technique aims to restore the stability of the ankle by reconstruction of the talofibular ligament (ATFL) and the calcaneofibular ligament (CFL) using the Gracillis tendon.Methods: From January 2004 to February 2008; inclusive, 16 patients; 11 male and 5 female, underwent an anatomic reconstruction of the lateral ankle ligament for chronic ankle instability. Their ages ranged from 18 to 29 giving a mean age of 25 years. Patients were then subjected to radiologic and clinical assessments for a period of at least 33.5 months. For pain scoring the Americans Orthopaedic Foot and Ankle Society (AOFAS) scores were used; whilst subjective symptom was evaluated using the Olerud and Molander ankle scoring system.Results: All patients returned for the final evaluation and subjective excellent or good results were recorded on self-assessment, pain scores, AOFAS and Karissons scores. Additionally Olerud and Molander ankle scoring was also done. During the final follow-up, the mean post-operative AOFAS score was 96 (range 80–100), the Visual analog score was 6 (range 0–4), Karissons score was 94.7 (range 80–100) and last but not least Olerud and Molander score was 87.5 (range 70–100). It was noted that the ankle range of motion was not affected by lateral ankle reconstruction. The talar tilt was reduced from a mean of 12–4° (p<0.0001) and the anterior drawer was reduced from a mean of 11–4mm (p<0.001) by the ankle ligament reconstruction.Conclusion: Anatomical reconstruction of the lateral ligaments of chronic ankle instability using Gracillis tendon graft resulted in successful results, excellent ankle stability, significant reduction in pain and negligible loss of ankle and hind foot motion.

Modified Watson-Jones technique for chronic lateral ankle instability in athletes: Clinical and radiological mid- to long-term follow-up

2010-09-28

Summary: Background: We clinically and radiologically assessed mid- to long-term follow-up of a group of patients treated with a modified Watson-Jones technique for chronic ankle instability.Methods: Fourteen athletes were retrospectively evaluated with physical examination, and Tegner, Good and AOFAS scales; moreover, a 2-view stress, side-to-side X-ray, was performed.Results: All patients were followed-up at a mean of 10.8 years. No one reported further ankle sprains. Mean Good scale value decreased from 3.7 to 1.6, while the Tegner scale decreased from 6.8 to 5.1; the mean AOFAS score was 92.2. Mean sagittal-plane ROM was 62.3° (4.9° S/S difference), while mean coronal-plane ROM was 25.5° (3.8° S/S difference). Mean X-ray talar tilt angle was 4.5° (0.1° S/S difference), while mean anterior drawer test angle was 5.4mm (0.5mm S/S difference).Conclusions: The modified Watson-Jones procedure seems to be a reliable technique in providing satisfactory mid- to long-term clinical and radiological results.

The role of Plantaris Longus in Achilles tendinopathy: A biomechanical study

2010-09-14

Abstract: Background: The Plantaris Longus Tendon (PLT) may be implicated in Achilles (AT) tendinopathy. Different mechanical characteristics may be the cause. This study is designed to measure these.Methods: Six PLT and six AT were harvested from frozen cadavers (aged 65–88). Samples were stretched to failure using a Minimat 2000™ (Rheometric Scientific Inc.). Force and elongation were recorded. Calculated tangent stiffness, failure stress and strain were obtained. Averaged mechanical properties were compared using paired, one-tailed t-tests.Results: Mean stiffness was higher (p<0.001) in the PLT, measuring 5.71N/mm (4.68–6.64), compared with 1.73N/mm (1.40–2.22) in AT. Failure stress was also higher (p<0.01) in PLT: 1.42N/mm2 (0.86–2.23) AT: 0.20N/mm2 (0.16–0.25). Failure strain was less (p<0.05) in PLT: 14.1% (11.5–16.8) than AT: 21.8% (14.9–37.9).Conclusions: The PLT is stiffer, stronger than AT, demonstrating potential for relative movement under load. The stiffer PLT could tether AT and initiate an inflammatory response.

Prospective review of medium term outcomes following interpositional arthroplasty for hammer toe deformity correction

Mordicai Atinga, Laurie Dodd, Julian Foote, Simon Palmer — 2010-10-25

Abstract: Background: Hammer toe is a common lesser toe deformity that is usually found to affect the second toe. A number of procedures have been applied in its surgical management with varying results but there is still no consensus on the best technique.Materials and method: We prospectively reviewed a consecutive series of patients treated with interpositional arthroplasty, early mobilisation and with a minimal follow up of 6 months. We measured outcome using the Manchester Oxford foot and ankle questionnaire and a global impression of change score.Results: There was a high level of satisfaction with the resulting pain relief and the type of footwear worn thereafter. We had no complications in terms of infection or chronic pain. There were no early recurrences within our follow up period.Conclusions: Overall we demonstrate good to excellent results with this surgical tactic allowing pain relief, early mobilisation and a low risk of infection.

Incidence and factors predicting pulmonary embolism and deep venous thrombosis following surgical treatment of ankle fractures

Nelson F. SooHoo, Michael Eagan, Lucie Krenek, David S. Zingmond — 2011-12-01

Abstract: Background: The purpose of this study was to identify the incidence and risk factors associated with pulmonary embolism and deep venous thrombosis following open reduction and internal fixation of ankle fractures.Methods: This was a retrospective study of patients in California undergoing operative treatment of an ankle fracture from 1995 to 2005. The main outcome measure was readmission for pulmonary embolism or deep venous thrombosis within 90 days of surgery.Results: A total of 57,183 patients from the California discharge database were identified. The readmission rate for pulmonary embolism was low at 0.34%. The risk was increased in patients aged 50–75, those with open fractures, and those with higher Charlson comorbidity score. The overall rate of readmission for deep venous thrombosis was also low at 0.05%.Conclusions: The overall rate of thromboembolic disease was low in this large patient sample. Increased age and comorbidity were associated with an increased risk.

The incidence of venous thromboembolism in patients undergoing surgery for acute Achilles tendon ruptures

Nikiforos Pandelis Saragas, Paulo Norberto Faria Ferrao — 2011-01-21

Abstract: Background: This retrospective analysis was prompted by the authors’ observation of the relatively high incidence of venous thromboembolism (VTE) in the surgical repair of acute Achilles tendon ruptures.Method: 88 patients were treated surgically for an acute Achilles tendon rupture. No prophylactic anticoagulation was given to any patients. The incidence of VTE was then reviewed retrospectively.Results: Five patients developed symptomatic deep vein thrombosis (5,7%) and one a near-fatal pulmonary embolus (1.1%). There were no major bleeding or cardiovascular adverse events. One patient developed a thrombus of the lesser saphenous vein (1.1%) and there was one superficial sepsis (1.1%). A temporary peroneal nerve palsy occurred in one patient (1.1%). There were two re-ruptures (2.3%).Conclusion: There is no doubt that thromboprophylaxis must be given to the high risk patient and is also recommended for major orthopaedic surgery. Limited data is available for the use of thromboprophylaxis in foot and ankle surgery. In light of the unacceptably high incidence of venous thromboembolism in this study, the authors suggest that routine venous thromboembolism prophylaxis should be considered for these patients.Level of evidence: Therapeutic study, Level III (retrospective study).

A touch pressure sensory assessment of the surgical treatment of the tarsal tunnel syndrome

William H. Gondring, Byron Shields — 2010-09-28

Abstract: Background: Decompressive tarsal tunnel surgery may improve dysfunctional plantar foot sensation in, patients with tarsal tunnel syndrome and peripheral neuropathy. However, quantitative sensory, assessment is lacking.Method: Quantitative sensory threshold evaluation of 42 feet in 37 consecutive (29 non-diabetic and 8 diabetic) patients was done before and after surgical decompression for tarsal tunnel syndrome. Insensitivity was documented quantitatively (grams force) before and after surgery using a graded series of twenty Semmes–Weinstein monofilaments applied to the anatomic nerve regions of the plantar aspect of the foot.Results: Sensory evaluation at an average of 12 months after surgery showed significant improvement, of mean sensory threshold, compared with preoperative values, for medial calcaneal, medial plantar, and lateral plantar nerves.Conclusion: Quantitative sensory assessment with a graded series of twenty Semmes–Weinstein, monofilaments showed significant sensory improvement in the medial calcaneal, medial plantar, and, lateral plantar nerves after posterior tibial nerve decompression.

The first metatarsophalangeal joint meniscus and its relation to hallux valgus deformity—An anatomical and clinical study

Greta Dereymaeker, Thomas Mulier, Pauline Girisch — 2010-10-08

Abstract: Background: This study describes the anatomy and incidence of the metatarsophalangeal (MTP) joint meniscus, a structure not mentioned before in literature.Methods: An anatomical cadaver study on 102 feet was performed with special attention to the first MTP joint anatomy. These results were compared with the per-operative findings in a clinical prospective study on 100 consecutive hallux valgus surgeries.Results: On cadavers this meniscus is more common in patients with hallux valgus. Clinically, in patients with a mild hallux valgus the meniscus is found in more than half of cases during surgery, while it is seldom found in patients with moderate or severe deformities.Conclusions: The presence of this structure seems to stabilize the MTP joint preventing progression of the hallux valgus deformity and may explain the pain, which is often seen in mild bunions in younger, patients. Once the rotational deformity increases the meniscus tears and slips into the joint. In the more advanced hallux valgus deformity this meniscus plays little function and seems to disappear, leading to arthrosis.

Extended lateral approach for elective hind foot surgery—A safe and versatile incision

David Thyagarajan, Ganesh Walkey, Andrew Kelly, Ian Winson — 2010-11-25

Abstract: Aim: The aim of our study was to review our experience of the extended lateral approach to the hind foot in treatment of non-traumatic foot disorders with particular reference to wound complications.Materials and methods: We retrospectively reviewed 51 consecutive patients who under went extended lateral approach to the hind foot for treatment of various non traumatic foot disorders. We documented the indication for surgery, co-morbidity, quality of wound healing and other wound related problems.Results: The mean age was 47.9. There were three superficial wound infections (5.8%). One had slight sensory loss close to the scar, one developed hypersensitivity over the scar. There was no wound break down or any deep infection. No sural nerve deficit was noted. Six patients had the calcaneal screw removed due to prominent metal work (11.7%).Conclusion: The extended lateral approach to hind foot is safe in the surgical treatment of a wide variety of non-traumatic foot conditions. Despite the larger deep dissection, the arterial anatomy ensures reliable wound healing and a low incidence of wound complications.

Posttraumatic arthrodesis of the subtalar joint – outcome in workers compensation and rates of non-union

Sven Hungerer, Oliver Trapp, Peter Augat, Volker Bühren — 2010-12-09

Abstract: Background: Regardless of the simple surgical technique, the success of the subtalar arthrodesis is limited by the rate of non-unions of the arthrodesis. The functional outcome of workers compensation is known to be poorer compared to patients without pending litigation. The aim of this study was to quantify the rate of non-unions and to determine risk factors leading to failure of the osseous consolidation after arthrodesis of the subtalar joint. The outcome assessed is a general health assessment with the SF-36 questionnaire and more illness specific with the AOFAS hindfoot score. Secondly, the influence of the health insurance status of the patients with or without worker's compensation on the outcome was tested.Methods and results: The inclusive criterion was an arthrodesis of the subtalar joint with and without autologous cancellous bone grafting and screw osteosynthesis. This cohort study included the clinical course of 115 patients with posttraumatic osteoarthritis from 2000 to 2006. The average age of the patients (n=115) was 47±11.0 years, 83% of the treated patients were men. 68% of the patients suffered of secondary osteoarthritis after calcaneal fracture. The time interval from trauma to presenting at the physician due to therapy resistant pain was in the average 5.5±9.9 years. After primary arthrodesis (n=101) of the subtalar joint osseous consolidation was proved in 55% cases, consolidation was questionable in 21% and the rate of no consolidation with revision was remarkable high with 24%. The duration of osseous consolidation was proved by plain projection radiography or computer tomography and clinical reduction of pain. For primary arthrodesis osseous consolidation was reached after 6.4±6.3 month, after secondary arthrodesis osseous consolidation was reached after 9.4±13.1 month. After revision surgery 57% of the arthrodesis healed, 12% the osseous consolidation was questionable, and the failure rate was still 12%.Conclusion: The outcome measures of the patients with SF-36 and the more functional related AOFAS hindfoot score showed poor outcome rates after subtalar fusion in posttraumatic osteoarthritis. The AOFAS hindfoot score was 47±24 points after primary arthrodesis and 46±17 points after secondary arthrodesis of the subtalar joint. The patients regained their former ability to work only in 30% after fusion of the subtalar joint. If revision surgery was necessary 8% of the patients got back to their work prior to the injury.

Toilet seat injury of the Achilles tendon a series of twelve cases

2010-12-15

Abstract: Lacerations of the Achilles tendon are caused by a number of mechanisms. The toilet seat as a cause of Achilles tendon injury is rare. We report on this rare mechanism of laceration of the tendo Achilles. The injury can be avoided with the use of western toilets and the additional devascularisation caused by extending the wound should be avoided while repairing the tendon in such situations.

Correction of complex equino cavo varus foot deformity in skeletally mature patients by Ilizarov external fixation versus staged external–internal fixation

Khaled Emara, El Hussein El Moatasem, Ossama El Shazly — 2011-01-14

Abstract: Background: Complex foot deformity is a multi-planar foot deformity with many etiologic factors. Different corrective procedures using Ilizarov external fixation have been described which include, soft tissue release, V-osteotomy, multiple osteotomies and triple fusion.Methods: In this study we compare the results of two groups of skeletally mature patients with complex foot deformity who were treated by two different protocols. The first group (27 patients, 29 feet) was treated by triple fusion fixed by Ilizarov external fixator until union. The second group (29 patients, 30 feet), was treated by triple fusion with initial fixation by Ilizarov external fixation until correction of the deformity was achieved clinically, and then the Ilizarov fixation was replaced by internal fixation using percutaneous screws. Both groups were compared as regard the surgical outcome and the incidence of complications.Results: There was statistically significant difference between the two groups regarding duration of external fixation and duration of casting with shorter duration in the group 2. Also there was statistically significant difference between both groups regarding pin tract infection with less incidence in group 2.Conclusion: Early removal of Ilizarov external fixation after correction of the deformity and percutaneous internal fixation using 6.5 cannulated screws can shorten the duration of treatment and be more comfortable for the patient with a low risk of recurrence or infection

Arthroscopic ankle arthrodesis: Are results reproducible irrespective of pre-operative deformity?

Z. Dannawi, D.H. Nawabi, A. Patel, J.J.H. Leong, D.J. Moore — 2011-02-22

Abstract: Background: Arthroscopic ankle arthrodesis is gaining in popularity. It has been shown to have a shorter time to union and less morbidity than traditional open procedures. The arthroscopic technique has been mainly used for ankles with minimal deformity. Our aim was to find out whether we could reproduce the good results of arthroscopic ankle arthrodesis in both minimally and markedly deformed ankles.Methods: We reviewed 62 patients who underwent an arthroscopic ankle arthrodesis for end stage arthritis. The average follow up was 63 months (range 21–92 months). Patients were evaluated subjectively and objectively using the Mazur grading system. 4 patients died before final review and 3 were lost to follow-up leaving 55 patients for evaluation.The pre-operative tibiotalar angle in the coronal plane was between 26° valgus and 24° varus. We divided our patients into 2 groups based on the tibiotalar angle. Group A (n=31) had a varus or valgus deformity of less than 15̊ and Group B (n=24) had a deformity equal to or more than 15°.Results: The overall fusion rate was 91%. Fusion occurred in 29 of 31 (94%) ankles in Group A compared to 21 of 24 (88%) in Group B (p=0.64).The overall mean time to union was 10.4 weeks. The time to union in Group A was 8.8 weeks compared to 12.7 weeks for Group B (p=0.001). Using the Mazur ankle grading system, 84% of the cases in Group A had a good to excellent result compared to 79% in Group B (p=0.73). There were 2 superficial infections, 2 cases of deep vein thrombosis and 3 patients required removal of prominent screws.Conclusions: We have shown that arthroscopic ankle arthrodesis yields reliable and reproducible results in a District General Hospital setting with high union rates, short time to union and low complication rates. It can be satisfactorily employed for ankles with significant deformity, although this resulted in a longer time to union. The end results remain uniformly good to excellent.

Interventions for treating proximal fifth metatarsal fractures in adults: A meta-analysis of the current evidence-base

T.O. Smith, A. Clark, C.B. Hing — 2011-02-22

Abstract: Background: This study assessed the clinical and radiological outcomes of different non-surgical interventions, surgical versus non-surgical interventions, and different surgical interventions used in the management of proximal fifth metatarsal fractures.Methods: A systematic review of published and unpublished literature was undertaken.Results: Six studies, assessing 330 patients and 333 fractures of the proximal fifth metatarsal were reviewed. Four studies assessed outcomes following tuberosity fractures, whilst 2 studies recruited patients following proximal diaphyseal or Jones fractures. The findings suggested that bandage is superior to below knee cast immobilisation for patient-reported functional and pain scores, with no difference in fracture union or re-fracture, and a shorter duration to return to work. There was no significant difference in complication rates or functional outcomes for patients managed in a plaster slipper compared to a bandage post-injury. When comparing surgical and non-surgical management, intramedullary screw fixation results in a shorter time to fracture union, reduced complication rates and earlier return to pre-injury activities compared to non-surgical cast immobilisation. However, the evidence-base is limited in it size and presented with a number of methodological limitations.Conclusions: Further well-conducted randomised controlled trials are required to determine the optimal management strategy for the different types of proximal fifth metatarsal fractures.

Lateral sesamoid position in hallux valgus: Correlation with the conventional radiological assessment

Yuvraj Agrawal, Aravind Desai, Jaysheel Mehta — 2011-02-22

Abstract: Background: We aimed to quantify the severity of the hallux valgus based on the lateral sesamoid position and to establish a correlation of our simple assessment method with the conventional radiological assessments.Methods: We reviewed one hundred and twenty two dorso-plantar weight bearing radiographs of feet. The intermetatarsal and hallux valgus angles were measured by the conventional methods; and the position of lateral sesamoid in relation to first metatarsal neck was assessed by our new and simple method.Results: Significant correlation was noted between intermetatarsal angle and lateral sesamoid position (Rho 0.74, p < 0.0001); lateral sesamoid position and hallux valgus angle (Rho 0.56, p < 0.0001). Similar trends were noted in different grades of severity of hallux valgus in all the three methods of assessment.Conclusions: Our method of assessing hallux valgus deformity based on the lateral sesamoid position is simple, less time consuming and has statistically significant correlation with that of the established conventional radiological measurements.

Catapult splint: A foot dorsiflexion assist splint

Vineet Jain, Mayank Agrawal, Anil Dhal — 2011-02-22

Abstract: Background: Loss of dorsiflexion is a common problem in cases where an external fixator or Ilizarov assembly is applied. It results in functional impairment of the foot by affecting the swing phase of gait cycle. We devised a simple dynamic dorsiflexion assist splint for prevention, correction of equinus/cavus deformity and maintenance of normal dorsiflexion of foot.Methods: This prospective study used a rubber splint styled in the shape of a catapult, made of discarded car rubber tubes attached to the frame of fixator in 50 patients.Results: In 17 patients there was varying amount of loss of dorsiflexion at the time of application of splint while in 22 patients it was applied soon after the application of the fixator. In the rest of patients it was applied for cavus deformity. Out of 17 patients 10 had complete recovery of dorsiflexion. 22 patients in whom it was applied at the outset had normal range of movement at ankle. Correction was achieved in all 6 cases of cavus deformity and prevented its occurrence in the rest of 5 cases.Conclusion: Catapult splint is a low cost foot dorsiflexion assist splint.

“The Chisel Test”—A useful operative, technique for determining adequate, compression during arthrodesis

Dishan Singh, Lee Parker, John Angel — 2011-05-09

Abstract: Healing of an arthrodesis occurs optimally when the prepared joint surfaces are held rigidly under compression . We routinely use the “Chisel test” intra-operatively to determine whether we have achieved adequate compression and rigidity after fixation of our foot and ankle fusions. This previously un-reported technique uses tools already on hand when performing an arthrodesis and takes seconds to perform.

Percutaneous core decompression: A successful method of treatment of Stage I avascular necrosis of the talus

John Grice, Les Cannon — 2009-11-13

Abstract: The talus is a bone uncommonly affected by avascular necrosis (AVN) . Factors such as trauma and pre-existing inflammatory arthropathy (particularly with concomitant steroid use) increase the risk of development of AVN.We report a case of resolution of Stage I AVN, diagnosed clinically and on magnetic resonance imaging (MRI), treated successfully by percutaneous core decompression of the talus.An MRI 12 weeks post-operatively showed complete resolution of the appearances of AVN.

Multifocal bone tuberculosis: A case report

F. Dlimi, M. Abouzahir, M. Mahfoud, M.S. Berrada, A. El Bardouni, M. El Yaacoubi — 2011-06-27

Abstract: Multifocal long bones tuberculosis without articular involvement is very rare. Pain and swelling are the common presenting symptoms. Difficulties in diagnosis often lead to delayed treatment, sometimes with devastating consequences for patients. Radiographs may mimic other diseases. Histopathological study is necessary to establish the diagnosis. The antibacillary chemotherapy produces excellent results. We report a case of a 60-year-old woman afflicted with multifocal tibial tuberculosis.

Metatarsal stress fractures secondary to soft-tissue osteochondroma in the foot: Case report and literature review

Karan Malhotra, Timothy Nunn, Muthusamy Chandramohan, Jai Shanker — 2011-06-17

Abstract: Soft-tissue osteochondromas are rare, benign tumours developing in the soft tissues. Diagnosis is challenging however, as the differential includes malignancy. As simple excision is curative, early recognition by clinical and radiological evaluation will help avoid unnecessary surgery. A 43-year-old gentleman presented to us with a painful lump on the plantar aspect of his foot. Initial imaging suggested bony involvement of the lesion, raising concerns of malignancy. Further investigation demonstrated the bony abnormalities to be stress fractures, caused by altered forces due to the lump. The lump was excised and histologically confirmed to be a soft-tissue osteochondroma. Soft-tissue osteochondromas have not previously been reported in association with stress fractures. We present this case, a literature review and a list of differential diagnoses highlighting the importance of considering soft-tissue osteochondroma when evaluating a well-defined, osseous, soft-tissue mass in the extremity, and the difficulties in making this diagnosis.

Open medial ankle dislocation without associated fracture: A case report

F. Dlimi, M. Mahfoud, M.S. Berrada, A. El Bardouni, M. El Yaacoubi — 2011-07-04

Abstract: Tibiotalar dislocation without associated fracture is a rare injury. We report a case of an unusual open medial ankle dislocation without any associated bony injury. After reduction and debridement under general anaesthesia, capsule suture and ligaments repair were performed. An external fixator was applied for ankle immobilization. After 3 years follow-up, functional results were excellent without signs of instability or degenerative arthritis.

Re: “The translating Weil osteotomy in the treatment on an overriding second toe: A report of 25 cases”. [Foot and Ankle surgery 16 (2010) 152–158]

Werner Pauli, Philipp Honigmann — 2011-05-19

Dear Editor, We read the retrospective study “The translating Weil osteotomy in the treatment on an overriding second toe: A report of 25 cases” Bevernage et al. with great interest.

Re: The translating Weil osteotomy in the treatment on an overriding second toe: a report of 25 cases, Foot and Ankle Surgery 16 (2010) 152–158

Bernhard Devos Bevernage, Paul-André Deleu, Thibaut Leemrijse — 2011-05-05

We would like to thank you for the opportunity to address some comments to the “letter to the editor” concerning the article “The translating Weil osteotomy in the treatment of an overriding second toe: a report of 25 cases”, Foot and Ankle Surgery 16 (2010) 152–158.