Complex Ankle Fractures
Anatomic reduction of the posterior malleolus is mandatory for a good functional outcome. Preoperative planning with a computed tomography scan ’s axial view helps to decide which approach and surgical position we should choose. Based on posterior malleolus fracture anatomy, a guideline is suggested to facilitate decision making on which approach seems to give the best exposure with minimum complications. (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - September 18, 2020 Category: Orthopaedics Authors: Guillermo Martin Arrondo, German Matias Joannas Source Type: research
Sinus Tarsi Approach for Calcaneal Fractures
Displaced intra-articular calcaneal fractures are among the most difficult articular fractures to treat, with a high rate of potential complications. Is important to restore calcaneus posterior facet anatomy as well as calcaneus width, length, and height. The extensile lateral approach provides excellent fracture visualization and allows reduction of the displaced fracture fragments, but high complication rate has been described with this approach, so many studies favor the sinus tarsi approach. Recent evidence favoring sinus tarsi rather than the extensile lateral approach has shifted opinion toward this less invasive app...
Source: Foot and Ankle Clinics - September 18, 2020 Category: Orthopaedics Authors: Gabriel Khazen, Cesar Khazen Rassi Source Type: research
Anterior and Posterior Ankle Impingement Syndromes
We describe the clinical and potential imaging features, as well as the arthroscopic/endoscopic management strategies, for the 4 main impingement syndromes of the ankle: anterolateral, anterior, anteromedial, and posterior impingement. (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - September 9, 2020 Category: Orthopaedics Authors: Caio Nery, Daniel Baumfeld Source Type: research
Advances in Minimally Invasive Surgery
FOOT AND ANKLE CLINICS (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - July 29, 2020 Category: Orthopaedics Authors: Anthony Perera Source Type: research
The first issue of Foot and Ankle Clinics devoted to minimally invasive techniques was published in 2016, and the first American Orthopaedic Foot& Ankle Society presentation on minimally invasive surgery (MIS) surgery was presented back in 2013 when I presented my 2 years of comparative results. We have come a long way since then. In that time percutaneous surgery has been introduced to North America, and there are now a number of highly skilled experts doing tremendous work there. This has gone on to become a popular procedure in the United States and Canada now thanks to GRECMIP, who have been instrumental in spreadi...
Source: Foot and Ankle Clinics - July 29, 2020 Category: Orthopaedics Authors: Anthony Perera Source Type: research
Learning Curve for Minimally Invasive Surgery and How to Minimize It
In this article the authors discuss their experience of performing minimally invasive surgery, with emphasis on technique and how to avoid pitfalls. They also discuss the educational literature for learning new techniques and how to shorten the “learning curve.” (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - July 10, 2020 Category: Orthopaedics Authors: Harvinder Bedi, Ben Hickey Source Type: research
The Windswept Foot: Dealing with Metatarsus Adductus and Toe Valgus
The windswept foot remains a reconstructive challenge. The hallux valgus associated with the medially displaced lesser metatarsal heads is hard to correct. Either the lesser metatarsal heads need to be displaced laterally or the deformity accepted. With the deformity, all the toes tend to be aligned into valgus with the position of the flexor and extensor tendons. Several treatment alternatives exist and may require a combination of open and percutaneous surgery. The authors think that, in severe metatarsus adductus, proximal correction of the first, second, and third metatarsals is required. (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - July 10, 2020 Category: Orthopaedics Authors: Anna-Kathrin Leucht, Alastair Younger, Andrea Veljkovic, Anthony Perera Source Type: research
Minimally Invasive Advances
Minimally invasive procedures to treat lesser toes deformities are among the main surgeries of percutaneous techniques and considered mature techniques due to technical versatility and high correction potential, with low rates of complications. Although they seem technically simple procedures, there are important technical details for each of them to obtain a reliable correction. To achieve success in lesser toes percutaneous treatment, it is imperative to follow minimally invasive basic principles, especially postoperative care with specific bandages for unfixed osteotomies. Practical training is mandatory before starting...
Source: Foot and Ankle Clinics - July 10, 2020 Category: Orthopaedics Authors: Guillaume Cordier, Gustavo Araujo Nunes Source Type: research
Percutaneous Lateral Release in Hallux Valgus
In the last decade, minimally invasive or percutaneous surgery has evolved rapidly through the development of novel techniques. Treatment of hallux valgus deformity is one of the indications for percutaneous surgery, both for bony and soft tissue correction. The release of the structures on the lateral part of the first metatarsophalangeal joint (lateral release) is one of the best indications for percutaneous surgery in the forefoot. In this article, a detailed description of the anatomy of the metatarsophalangeal joint is provided, along with the indications and tips to perform a safe percutaneous lateral release. (Sourc...
Source: Foot and Ankle Clinics - July 9, 2020 Category: Orthopaedics Authors: Jorge Javier Del Vecchio, Miki Dalmau-Pastor Source Type: research
Minimally Invasive Surgery: Osteotomies for Diabetic Foot Disease
Minimally invasive distal metatarsal diaphyseal osteotomy (DMDO) is an effective procedure for the treatment of complicated chronic diabetic foot ulcers under the heads of all lateral metatarsal bones (including the fifth). Resistant toe ulcers and recurrent pressure ulcers can be treated effectively by DMDO. For diabetic patients, the main advantages of this method are minimal surgical scars and tissue damage, immediately postoperative weight bearing, absence of osteosynthesis and consequent potential infection of metal fixation, reduction of the previous high plantar pressures by the restoration of a harmonic balanced fo...
Source: Foot and Ankle Clinics - July 9, 2020 Category: Orthopaedics Authors: Carlo Biz, Pietro Ruggieri Source Type: research
Minimally Invasive Hallux Valgus Surgery —A Systematic Review and Assessment of State of the Art
Minimally invasive techniques in the treatment of hallux valgus deformity have seen growing popularity since the 1990s. The purpose of this article is to assess the existing body of literature as to the safety and efficacy of minimally invasive techniques and identify areas for further development. The appeal of minimizing soft tissue damage, reducing surgical time, and faster recovery is currently offset by the initial learning curve and a lack of high-quality studies regarding minimally invasive techniques. There is currently insufficient evidence to recommend one minimally invasive technique over another and further hig...
Source: Foot and Ankle Clinics - July 8, 2020 Category: Orthopaedics Authors: Luckshmana Jeyaseelan, Francesc Malagelada Source Type: research
Endoscopic Resection of Tarsal Coalitions
Endoscopic resection of tarsal coalitions is technically feasible for both talocalcaneal and calcaneonavicular coalitions. Careful consideration of each individual patient is necessary before proceeding with endoscopic resection. Endoscopic resection of these coalitions may offer benefits in terms of faster recovery and less wound problems, but this has not been proven. Several case reports and case series appear in the literature and are reviewed here along with the different techniques reported. Better-quality evidence is required to assess the clinically relevant benefits and the recurrence rate for endoscopic resection...
Source: Foot and Ankle Clinics - July 4, 2020 Category: Orthopaedics Authors: Andrew King, Stephen Parsons Source Type: research
Fixation Principles in Minimal Incision Hallux Valgus Surgery
Minimal incision surgical principals rely on the soft tissue envelope to maintain stability that is supplemented by a variety of clinically recommended fixation methods. The extended distal first metatarsal osteotomy has renewed interest because of the ability to laterally translate, angulate, and rotate the metatarsal head in proper alignment with the sesamoids to a neutral alignment. The soft tissue envelope of capsule, ligaments, and tendons will re-align once the bone deformity is corrected. The periosteum is maintained to provide a biologic scaffold for new bone formation and must be minimally disrupted during the int...
Source: Foot and Ankle Clinics - July 4, 2020 Category: Orthopaedics Authors: David B. Kay Source Type: research
Bunionette: Is There a Minimally Invasive Solution?
A bunionette deformity is a painful prominence on the lateral aspect of the fifth metatarsal head. Surgical treatment can be considered if conservative treatment has failed to relieve the symptoms. The percutaneous approach consists of 2 steps: a condylectomy and an osteotomy of the fifth metatarsal. The learning curve is small and the final results are similar to the open techniques. The main advantages are the hardware-free technique and the minimally invasive approach. This percutaneous approach avoids complications related to hardware and soft tissue healing. Because of this low complication rate, the percutaneous tech...
Source: Foot and Ankle Clinics - July 3, 2020 Category: Orthopaedics Authors: Frederick Michels, St éphane Guillo Source Type: research
Lapidus, a Percutaneous Approach
Described in the early 1900s by Albrecht and Lapidus, the Lapidus procedure became an important tool in the armamentarium. With the increase of percutaneous techniques, the development of a percutaneous Lapidus seemed obvious. (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - July 3, 2020 Category: Orthopaedics Authors: Joel Vernois, David Redfern, GRECMIP soon MIFAS Source Type: research
Complications of Minimally Invasive Surgery for Hallux Valgus and How to Deal with Them
This article discusses the possible complications in minimally invasive surgery (MIS) for hallux valgus. The rate of complications and the outcomes are at least comparable with open techniques. A percutaneous technique provides the best conditions for undisturbed healing. Some possible complications exist in MIS that do not exist in open surgery, such as lesion of soft tissue structures that are not under direct visible control or skin burns. These complications usually result from technical mistakes in performing the operation. It is therefore crucial to get proper education from cadaver training and visiting experienced ...
Source: Foot and Ankle Clinics - June 18, 2020 Category: Orthopaedics Authors: Georg Hochheuser Source Type: research
Role of Minimally Invasive Surgery in Adult Flatfoot Deformity
Adult acquired flatfoot deformity (AAFD) as a consequence of posterior tibial tendon dysfunction is commonly divided in flexible (stages I and II) and fixed (stages III and IV) deformities. The aim of this article is to summarize the evidence available for minimally invasive surgical techniques that can be used in the treatment of flexible AAFD, including tibialis posterior tendoscopy, subtalar arthroereisis, minimally invasive calcaneal osteotomy, and medial proximal gastrocnemius recession. A treatment algorithm and technical tips have also been provided. (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - June 18, 2020 Category: Orthopaedics Authors: Alessio Bernasconi, Robbie Ray Source Type: research
Correction of the Neglected Clubfoot in the Adolescent and Adult Patient
Clubfoot is a complex 4-dimensional deformity involving the hindfoot, midfoot, and forefoot. The fourth dimension is time. Treatment aims at achieving a pain-free, plantigrade, and mobile foot but, over time, flexible deformities become fixed and more difficult to manage. The Ponseti method of serial manipulation and casting can be used successfully in older children and may reduce the need for extensive open surgery. Alternatively, gradual correction of by an external device enables simultaneous correction of all components of the deformity without shortening the foot. Combining gradual soft tissue distraction with open r...
Source: Foot and Ankle Clinics - May 5, 2020 Category: Orthopaedics Authors: Nicholas Peterson, Christopher Prior Source Type: research
An Approach to Managing Midfoot Charcot Deformities
We present an approach to managing complex deformities in Charcot neuroarthropathy that typically present around the midfoot. This approach follows a stepwise progression from prevention, early detection, nonoperative through to operative management. It centers on multidisciplinary care with input from diabetologists, orthotists, plaster technicians, physiotherapists, orthopedic, vascular, and/or plastic surgeons. We discuss the timing of surgery with regard to Eichenholtz stage of disease and trends toward early surgical intervention. We review traditional and new surgical concepts. We evaluate the role of limited interve...
Source: Foot and Ankle Clinics - May 5, 2020 Category: Orthopaedics Authors: Ashtin Doorgakant, Mark B. Davies Source Type: research
Treatment of Ankle and Hindfoot Charcot Arthropathy
It is now well accepted that diabetic patients with clinically and radiographically nonplantigrade Charcot foot arthropathy are best managed with correction of the acquired deformity. Several investigations have demonstrated a high probability for a favorable clinical outcome when the deformity is in the midfoot. Unstable deformity at the subtalar or ankle joints portends a far worse clinical outcome. The goal of this discussion was to describe the author's approach to this highly challenging clinical problem. (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - May 5, 2020 Category: Orthopaedics Authors: Michael S. Pinzur Source Type: research
Correction of Severe Foot and Ankle Deformities
For the majority of Orthopedic Foot and Ankle surgeons, there is a wide range in the complexity and nature of cases due to the huge variance of conditions we treat. (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - May 5, 2020 Category: Orthopaedics Authors: Andy Molloy Tags: Preface Source Type: research
https://www.foot.theclinics.com/article/S1083-7515(19)30095-6/fulltext; https://www.foot.theclinics.com/article/S1083-7515(19)30135-4/fulltext; https://www.foot.theclinics.com/article/S1083-7515(19)30115-9/fulltext. (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - May 5, 2020 Category: Orthopaedics Source Type: research
Managing the Complex Cavus Foot Deformity
This article describes approaches to and the management of complex cavus foot deformities. Correction of rigid multiplanar deformities can be very challenging, given the presence of skeletal deformities in multiple planes and combined with a varying degree of muscle imbalance. The complexity of these cases always requires a case-by-case approach. Some of the cases presented here occur in patients who have previously undergone surgical management for their deformity, several of which are complicated by additional deformities. With a firm understanding and application of the principles of deformity correction, however, one m...
Source: Foot and Ankle Clinics - April 8, 2020 Category: Orthopaedics Authors: Mark S. Myerson, C. Lucas Myerson Source Type: research
Reconstruction of Severe Ankle and Pilon Fracture Malunions
This article provides a review of current methods of treatment and their outcomes. (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - April 8, 2020 Category: Orthopaedics Authors: Ben Fischer, Lyndon William Mason Source Type: research
Managing Severely Malunited Calcaneal Fractures and Fracture-Dislocations
Severe calcaneal malunions are debilitating conditions owing to substantial hindfoot deformity with subtalar arthritis and soft tissue imbalance. Type III malunions are best treated with a subtalar distraction bone block fusion. Additional osteotomies may be required for severe varus or superior displacement of the calcaneal tuberosity. Type IV malunions result from malunited calcaneal fracture-dislocations and require a 3-dimensional corrective osteotomy. Type V malunions warrant additional ankle debridement and reconstruction of the calcaneal shape to provide support for the talus in the ankle mortise. Accompanying soft ...
Source: Foot and Ankle Clinics - April 5, 2020 Category: Orthopaedics Authors: Stefan Rammelt, Christine Marx Source Type: research
Managing Severe Foot and Ankle Deformities in Global Humanitarian Programs
The severe foot and ankle deformities the authors ’ organization has encountered in humanitarian programs worldwide are more complicated than those surgeons treat in daily practice in developed countries. Severity of deformity, patients’ economic limitations, patients’ expectations and realistic needs in life, availability of surgical instrum entation, the local team’s understanding of foot and ankle surgery and their ability to do consultation for patients postoperatively, and compliance of patients all account for success of the surgery. Regardless of the effort surgeons make, complications and re...
Source: Foot and Ankle Clinics - April 2, 2020 Category: Orthopaedics Authors: Shuyuan Li, Mark S. Myerson Source Type: research
The Use of Virtual Planning and Patient-specific Guides to Correct Complex Deformities of the Foot and Ankle
This article provides an overview regarding the virtual planning and precise execution of corrective osteotomies around the foot and ankle. Based on 3-dimensional data obtained from CT scans, surgeons are able to create a virtual plan of how to correct a complex deformity. This plan is transferred into the production of true patient-specific guides, designed to perform a specific surgical intervention. The authors have extensive experience with this technique and were involved in the development of the method. The current article provides an overview regarding the virtual planning and precise execution of corrective osteot...
Source: Foot and Ankle Clinics - April 2, 2020 Category: Orthopaedics Authors: Stephan H. Wirth, Norman Espinosa Source Type: research
Salvage Arthrodesis for Failed Total Ankle Replacement
Salvage arthrodesis for failed total ankle replacement can be a successful procedure. The decision to perform salvage arthrodesis is based on many factors, but the following are the most important indications: severe loss of bonestock (tibia, talus, or both), inadequate soft tissue coverage, or the inability to eradicate an infection. With few revision implants on the market, salvage arthrodesis is currently the most common treatment for failed replacement and justification for revision ankle replacement is limited when any of these factors are present. (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - March 24, 2020 Category: Orthopaedics Authors: Samuel B. Adams Source Type: research
Correction of Severe Hallux Valgus with Metatarsal Adductus Applying the Concepts of Minimally Invasive Surgery
We describe the application of concepts of minimally invasive techniques to correct this deformity. Proximal metatarsal osteotomy to correct the position of lesser metatarsals, followed by minimally invasive bunion surgery, shows promising results. In a short series, proximal metatarsal osteotomy showed excellent correction of the deformity. At final follow-up, all the deformed feet consolidated in correct positions. (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - March 23, 2020 Category: Orthopaedics Authors: Alon Burg, Ezequiel Palmanovich Source Type: research
Treatment of Stage 4 Flatfoot
Stage 4 flatfoot represents only a small proportion of flatfoot cases and is likely to become even rarer. The evidence base to guide treatment is limited to case series and expert opinion. Therefore, a pragmatic approach to treatment must be taken. Low-demand individuals may manage well with conservative treatment. Surgical management is complex, likely to require staging, and has a significant complication profile. Patients should be fully informed and understanding of this. First principles of surgery should be followed, including restoring hindfoot and ankle joint alignment, appropriate soft tissue balancing, and optimi...
Source: Foot and Ankle Clinics - March 23, 2020 Category: Orthopaedics Authors: Gavin Heyes, Andrew Molloy Source Type: research
Postoperative Considerations in the Management of Hallux Valgus
Postoperative management of hallux valgus varies widely. Setting preoperative expectations is an important aspect of attaining a successful outcome, but this is not routinely reviewed in the literature. This chapter offers suggestions on successfully navigating this area of patient care. Current concepts focus on pain control, immobilization, and return to activities. This chapter also reviews the current literature in these areas and sets out the authors ’ preferred management in the postoperative setting. (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - January 23, 2020 Category: Orthopaedics Authors: William A. Hester, David I. Pedowitz Source Type: research
Current Controversies in the Approach to Complex Hallux Valgus Deformity Correction
FOOT AND ANKLE CLINICS (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - January 23, 2020 Category: Orthopaedics Authors: Sudheer C. Reddy Source Type: research
Evolution of Thinking of the Lapidus Procedure and Fixation
The evolution of Lapidus fixation has been strongly associated with the understanding of the anatomy and function of the first tarsometatarsal joint, the mechanism of hypermobility of the first tarsometatarsal joint, and cause of the hallux valgus deformity in 3 dimensions. Some methods, such as plantar plating, nitinol staples, and intramedullary fixation, have proven to be stronger biomechanically in cadaveric testing. Theoretically, stable fixation will reduce the rate of complications, in particular, that of nonunion and allow for early postoperative weight-bearing. Further clinical studies are needed to examine whethe...
Source: Foot and Ankle Clinics - December 19, 2019 Category: Orthopaedics Authors: Shuyuan Li, Mark S. Myerson Source Type: research
Intraoperative and Postoperative Evaluation of Hallux Valgus Correction
The hallux valgus is one of the most challenging foot and ankle deformities to correct. The current concept is to consider the hallux valgus as a triplane deformity, and the parameters in transverse, sagittal, and frontal planes must be considered. The hallux valgus angle, intermetatarsal angle, tibial sesamoid position, and lateral edge of the first metatarsal head are valuable parameters to evaluate to understand the magnitude of the deformity. Diaphyseal corrections, such as scarf, and proximal interventions, such as crescentic osteotomy and Lapidus arthrodesis, are the most powerful techniques to address triplane defor...
Source: Foot and Ankle Clinics - December 4, 2019 Category: Orthopaedics Authors: Roberto Zambelli, Daniel Baumfeld Source Type: research