Forthcoming Issues
Current Concepts of Treatment of Metatarsalgia (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - July 30, 2019 Category: Orthopaedics Source Type: research

Functional Rehabilitation for Nonsurgical Treatment of Acute Achilles Tendon Rupture
This article describes a high-quality accelerated functional rehabilitation program that begins with early diagnosis and appropriate patient selection to allow initiation of the nonoperative protocol. Complications with nonoperative treatment of Achilles ruptures are significantly lower than with operative treatment; however, re-rupture and elongation of the tendon resulting in decreased strength are problematic and more common if patients are non-compliant. These can be minimized with good patient education, close supervision, and good communication between physical therapist and physician. (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - June 22, 2019 Category: Orthopaedics Authors: Mark Glazebrook, Daniela Rubinger Source Type: research

Open Reconstructive Strategies for Chronic Achilles Tendon Ruptures
Chronic Achilles tendon ruptures typically are treated with surgical intervention except in low-demand patients or patients who are unable to tolerate surgery. Although several treatment strategies are described, most literature is case reports and case series. There is no widely accepted algorithm or gold standard for surgical treatment of chronic Achilles tendon ruptures. Treatment strategy depends on the size of the tendon gap after excision of nonviable tissue and scar tissue. Smaller gaps can be treated with direct end-to-end repair. Medium-sized gaps can be treated with tendon-lengthening procedures. Tendon transfers...
Source: Foot and Ankle Clinics - June 18, 2019 Category: Orthopaedics Authors: Christopher Chen, Kenneth J. Hunt Source Type: research

Surgical Strategies for the Treatment of Insertional Achilles Tendinopathy
Insertional Achilles tendinopathy is one of the most common Achilles tendon disorders and often results in substantial heel pain and functional disability. There is consensus that treatment of insertional Achilles tendinopathy should start with nonoperative modalities. Surgery should be reserved for patients who fail exhaustive conservative treatment for a period of 3 months to 6  months and include débridement of insertional calcifications. Intratendinous degenerative tissue should be débrided and any Haglund deformity resected. Different surgical techniques have been described for reattachment of the d...
Source: Foot and Ankle Clinics - June 18, 2019 Category: Orthopaedics Authors: Alexej Barg, Todd Ludwig Source Type: research

Minimally Invasive Treatments of Acute Achilles Tendon Ruptures
Achilles tendon rupture is a common injury to the lower extremity that requires appropriate treatment to minimize functional deficit. Available treatments of Achilles tendon ruptures include nonoperative, open surgical repair, percutaneous repair, and minimally invasive repair. Open surgical repair obtains favorable functional outcomes with significant potential for deep soft tissue complications, calling into question the value of open repair. Percutaneous repair is an alternative option with comparable functional results and minimal soft tissue complications; however, sural nerve injury is a complication. Minimally invas...
Source: Foot and Ankle Clinics - June 18, 2019 Category: Orthopaedics Authors: Milap S. Patel, Anish R. Kadakia Source Type: research

Updates in the Management of Acute and Chronic Lesions of the Achilles Tendon
We are in a phase of evolution in that humans are demanding more service from the Achilles tendon than ever. With increases of diabetes and obesity, the widespread use of antibiotics, and poor lifestyles, children and adults are challenged by the popularity of sports and occasional high-impact activities. Insults to the Achilles tendon can manifest in various ways, ranging from an acute tendinitis to a complete rupture, to chronic conditions at various locations along the tendon or paratendinous tissue or bone. (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - June 18, 2019 Category: Orthopaedics Authors: Phinit Phisitkul Tags: Preface Source Type: research

Endoscopic Management of Chronic Achilles Tendon Rupture
This article reviews the available literature for endoscopic flexor hallucis longus reconstruction. (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - June 12, 2019 Category: Orthopaedics Authors: Turab Arshad Syed, Anthony Perera Source Type: research

Management of Complications of Achilles Tendon Surgery
This article proposes an algorithm for wound breakdown, infection, and rerupture after Achilles tendon surgery. This algorithm should be used as a guide. (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - May 29, 2019 Category: Orthopaedics Authors: Jordan Liles, Samuel B. Adams Source Type: research

Nonsurgical Treatment Options for Insertional Achilles Tendinopathy
Most nonoperative treatments for insertional Achilles tendinopathy (IAT) have insufficient evidence to support treatment recommendations. Exercise has the highest level of evidence supporting the ability of this treatment option to reduce IAT pain. The effects of exercise may be enhanced by a wide variety of other treatments, including soft tissue treatment, nutritional supplements, iontophoresis, education, stretching, and heel lifts. When exercise is unsuccessful, extracorporeal shock wave therapy seems to be the next best nonoperative treatment option to reduce IAT pain. After other nonoperative treatment options have b...
Source: Foot and Ankle Clinics - May 21, 2019 Category: Orthopaedics Authors: Connor P. Dilger, Ruth L. Chimenti Source Type: research

Minimally Invasive and Endoscopic Approach for the Treatment of Noninsertional Achilles Tendinopathy
Minimally invasive treatment can offer an earlier recovery with less pain and scarring compared with traditional open surgeries. The goals of minimally invasive surgery are to debride degenerative tendon, stimulate healing, and, when appropriate, repair damaged tendon. Sclerotherapy and prolotherapy have been shown to reduce neovascularization and pain. Percutaneous stripping and endoscopic debridement are better options for diffuse tendinopathy. Plantaris release can be useful in diffuse disease in patients with primarily medial-sided Achilles pain. Overall, minimally invasive surgery provides similar benefits as open pro...
Source: Foot and Ankle Clinics - May 21, 2019 Category: Orthopaedics Authors: Craig C. Akoh, Phinit Phisitkul Source Type: research

Biologics in the Treatment of Achilles Tendon Pathologies
Regenerative medicine is gaining more and more space for the treatment of Achilles pathologic conditions. Biologics could play a role in the management of midportion Achilles tendinopathy as a step between conservative and surgical treatment or as an augmentation. Higher-level studies are needed before determining a level of treatment recommendation for biologic strategies for insertional Achilles tendinopathy. Combining imaging with patient ’s functional requests could be the way to reach a protocol for the use of biologics for the treatment of midportion Achilles tendinopathy and, for this perspective, the authors ...
Source: Foot and Ankle Clinics - May 21, 2019 Category: Orthopaedics Authors: Cristian Indino, Riccardo D ’Ambrosi, Federico Giuseppe Usuelli Source Type: research

Maximizing Return to Sports After Achilles Tendon Rupture in Athletes
Achilles tendon ruptures are devastating injuries to athletes, with return-to-sports rates around 70% and some risk for diminished performance post-injury. Surgical management in athletes is often favored for a number of reasons, although evidence guiding the optimal treatment is limited. Functional rehabilitation has been supported as a key component of operative and nonoperative treatment plans. Return-to-play protocols in the literature are sparse and varied due to often ambiguous definitions of what it means to return to sport and a lack of explicit criteria. Optimal sport-specific return-to-play milestones should be d...
Source: Foot and Ankle Clinics - May 18, 2019 Category: Orthopaedics Authors: Jon-Michael E. Caldwell, J. Turner Vosseller Source Type: research

Minimally Invasive and Endoscopic Treatment of Haglund Syndrome
Haglund syndrome is a triad of posterosuperior calcaneal prominence (Haglund deformity), retrocalcaneal bursitis, and insertional Achilles tendinopathy. The sources of pain include the posterior calcaneal wall cartilage, retrocalcaneal and subcutaneous adventitial bursa, and the Achilles tendon. Resection of the posterosuperior calcaneal tubercle, bursectomy, excision of the Achilles tendon pathology, reattachment of the Achilles tendon, gastrocnemius aponeurotic recession, and flexor hallucis longus transfer have been proposed as surgical treatment options. All of them can be performed endoscopically or under minimally in...
Source: Foot and Ankle Clinics - May 18, 2019 Category: Orthopaedics Authors: Tun Hing Lui, Cho Yau Lo, Yuk Chuen Siu Source Type: research

The Cavus Foot
FOOT AND ANKLE CLINICS (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - April 27, 2019 Category: Orthopaedics Authors: Alexej Barg Source Type: research

Copyright
ELSEVIER (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - April 27, 2019 Category: Orthopaedics Source Type: research

Editorial Advisory Board
J. Kent Ellington, MD, MS (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - April 27, 2019 Category: Orthopaedics Source Type: research

Contributors
MARK S. MYERSON, MD (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - April 27, 2019 Category: Orthopaedics Source Type: research

Contents
Alexej Barg (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - April 27, 2019 Category: Orthopaedics Source Type: research

Forthcoming Issues
Updates in the Management of Acute and Chronic Lesions of the Achilles Tendon (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - April 27, 2019 Category: Orthopaedics Source Type: research

Failure of Surgical Treatment in Patients with Cavovarus Deformity
Recurrent deformity after surgical treatment of the cavus foot occurs because a procedure is not performed at the apex of the deformity. In many instances there are multiple apices and, in addition to hindfoot osteotomy or arthrodesis, the midfoot must be corrected. There is not much of a role for the Coleman block test to determine flexibility of the foot, and this has led to many failures where the foot was believed flexible and an osteotomy was insufficient treatment. Skeletal correction, even if perfect, does not last unless the foot is balanced with appropriate tendon transfers. (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - April 6, 2019 Category: Orthopaedics Authors: Shuyuan Li, Mark S. Myerson Source Type: research

Arthrodesis of a Varus Ankle
Patients with varus ankle deformity and concomitant osteoarthritis experience severe disabling pain that affects their daily activity of living. Most cases rarely respond to nonoperative treatment. One surgical option is corrective ankle arthrodesis. Unfortunately, this corrective surgery is challenging and might not be possible as a purely isolated procedure. Corrective ankle arthrodesis for varus ankle is performed with different surgical approaches and techniques, using different methods of fixations. The goal of surgery is to create a pain-free, stable, and plantigrade ankle, hindfoot, and foot. Both the foot and ankle...
Source: Foot and Ankle Clinics - April 6, 2019 Category: Orthopaedics Authors: Faisal AlSayel, Victor Valderrabano Source Type: research

Two-Stage Varus Correction
Coronal plane deformity following total ankle arthroplasty has been associated with poor clinical outcomes and early prosthesis failure. Neutral mechanical alignment and prosthetic joint stability must be achieved through meticulous surgical planning and precise technical execution. Cavovarus foot deformity and varus malalignment of the lower extremity is reviewed, with particular emphasis as it relates to total ankle arthroplasty. Correction of varus malalignment may be performed at the time of total ankle arthroplasty or as a 2-stage procedure. Surgeon experience, revision total ankle arthroplasty, and subtalar arthrodes...
Source: Foot and Ankle Clinics - April 6, 2019 Category: Orthopaedics Authors: Brian Steginsky, Steven L. Haddad Source Type: research

Hindfoot Injuries
Posttraumatic hindfoot varus may result from nonoperative treatment or inadequate reduction and fixation of talar and calcaneal fractures. Adequate visualization of the talar neck via bilateral approaches is essential in avoiding malreduction. In cases of medial comminution of the talar neck, lag screws must be avoided and the use of single or double plates should be considered. A Schanz screw introduced into the calcaneal tuberosity is instrumental in realigning shortening, varus, or valgus deformity of the heel. Special attention should be paid to addressing impaction of the medial facet of both the talus and calcaneus t...
Source: Foot and Ankle Clinics - April 5, 2019 Category: Orthopaedics Authors: Stefan Rammelt, Akaradech Pitakveerakul Source Type: research

Cavus Foot
This article provides a framework for guiding management of these deformities, followed by a detailed surgical approach to correcting moderate cavus deformities, which emphasizes the use of a midfoot osteotomy-arthrodesis. (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - April 5, 2019 Category: Orthopaedics Authors: Mark S. Myerson, C. Lucas Myerson Source Type: research

Updates in Pediatric Cavovarus Deformity
This article focuses on current treatment options depending on the localization of the anatomic pathology. Outcomes of nonoperative and operative treatments are presented. (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - April 5, 2019 Category: Orthopaedics Authors: Kai Ziebarth, Fabian Krause Source Type: research

Inframalleolar Varus Deformity
The cavo varus foot is a complex pathology due to skeletal deformity and neuro-muscular unbalance. The key concept for a successful treatment is to consider the whole foot and ankle complex from a bone and soft tissue perspective. Undercorrection is the main issue in cavo varus foot management, which may be attributed to intrinsic correction defects of the described calcaneal osteotomies or to a lack of understanding about the pathology and the subsequent algorithm of treatment. The authors disclose their daily algorithm of treatment, considering the foot and ankle complex and the role of calcaneal osteotomies in ankle inf...
Source: Foot and Ankle Clinics - April 5, 2019 Category: Orthopaedics Authors: Federico Giuseppe Usuelli, Luigi Manzi Source Type: research

Neurologic Disorders and Cavovarus Deformity
A cavovarus deformity results from muscle imbalances in the foot. There are several etiologies of a cavovarus foot including congenital, neurologic, post-traumatic, and idiopathic. Charcot-Marie-Tooth disease is a common genetic cause of cavovarus foot. History, physical examination, and imaging help determine appropriate treatment. The deformity can be flexible or rigid and can present in children or adults, thus treatment should be individualized to the patient. Non-operative management includes shoe wear modification, physical therapy, and bracing. Operative management consists of soft tissue releases, tendon transfers,...
Source: Foot and Ankle Clinics - April 3, 2019 Category: Orthopaedics Authors: Julie A. Neumann, Florian Nickisch Source Type: research

Anatomy and Biomechanics of Cavovarus Deformity
A high longitudinal plantar arch, varus position of the heel, forefoot equinus, and pronation of the first ray are characteristic of a cavovarus deformity. Forefoot-driven and hindfoot-driven deformities are distinguished based on pathomechanics. In first ray strong plantarflexion, the forefoot touches the ground first. This leads to compensatory varus heel, lock of the midfoot, reduction of the flexible phase, and decrease in shock absorption. In hindfoot-driven cavovarus deformity, the subtalar joint may compensate for varus deformities above the ankle joint. Overload of the lateral soft tissue structures and degenerativ...
Source: Foot and Ankle Clinics - April 2, 2019 Category: Orthopaedics Authors: Nicola Kr ähenbühl, Maxwell W. Weinberg Source Type: research

Clinical Examination and Radiographic Assessment of the Cavus Foot
The purpose of the clinical examination is to detect subtle cavus or cavovarus deformity, assess the severity and type of deformity, differentiate between idiopathic versus secondary etiologies of cavus foot deformity, and evaluate for other associated abnormalities. The clinical examination should begin with a gait analysis. The neurologic examination reveals peripheral neuropathy or central nervous system etiology for the foot deformity. On plain radiographs, forefoot-driven deformity can be assessed using the Meary angle, and hindfoot-driven deformity can be measured by the calcaneal pitch. Computed tomography and MRI s...
Source: Foot and Ankle Clinics - April 2, 2019 Category: Orthopaedics Authors: Craig C. Akoh, Phinit Phisitkul Source Type: research

Joint-Preserving Procedures in Patients with Varus Deformity
The most common cause for end-stage ankle osteoarthritis is posttraumatic, sometimes resulting from concomitant supramalleolar deformity. Aims of the supramalleolar osteotomy include restoring the lower-leg axis to improve intraarticular load distribution and retarding degeneration of the tibiotalar joint. Preoperative planning is based on conventional weight-bearing radiographs. Often advanced imaging, including computed tomography and/or MRI, is needed for a better understanding of the underlying problem. Postoperative complications are not uncommon, including progression of tibiotalar osteoarthritis in up to 25% within ...
Source: Foot and Ankle Clinics - April 2, 2019 Category: Orthopaedics Authors: Alexej Barg, Charles L. Saltzman Source Type: research

The Cavus Foot
Surgical management of the cavovarus deformity remains one of the biggest challenges in foot and ankle surgery. The already complex anatomy and biomechanics of the foot and ankle are further obfuscated when a cavovarus deformity develops and worsens over time. Several treatment algorithms, which are more or less complicated tables and diagrams, have been published over the last few decades. However, such “cookbook” solutions should be interpreted carefully; “standard” procedures often need to be modified due to the complexity and uniqueness of each case. (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - April 2, 2019 Category: Orthopaedics Authors: Alexej Barg Tags: Preface Source Type: research

Total Replacement of Varus Ankle
In the past few decades, total ankle replacement (TAR) has become an increasingly recommended and accepted treatment in patients with end-stage ankle osteoarthritis. However, controversy still exists about the appropriate indications for TAR, specifically in ankles with coronal plane deformities. Although not explicitly proved, the long-term success of TAR seems to largely depend on the extent to which the surgeon is able to balance the ankle joint complex. (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - March 29, 2019 Category: Orthopaedics Authors: Beat Hintermann, Roxa Ruiz Source Type: research

Epidemiology, Etiology, and Anatomy of Osteonecrosis of the Foot and Ankle
Osteonecrosis arises throughout the foot and ankle in various forms and due to numerous causes, with a thousand US cases per year estimated for the ankle alone. Although research continues to elucidate specific mechanisms at work, the pathophysiology remains poorly understood. Nevertheless, the various osteonecrosis pathways converge on osteocyte death, and bony lesions follow a pattern of progression. Understanding the specific anatomy and biomechanics associated with common forms of foot and ankle osteonecrosis should help guide diagnosis and interventions, particularly at earlier stages of disease where etiology-specifi...
Source: Foot and Ankle Clinics - January 26, 2019 Category: Orthopaedics Authors: Daniel K. Moon Source Type: research

Avascular Necrosis of the Sesamoids
Avascular necrosis (AVN) of the sesamoid is pathology of the medial or lateral hallucal sesamoid resulting in pain under the first metatarsophalangeal joint often presenting in young female athletes. There is overlap of stress fracture, nonunion, and AVN that makes defining the diagnosis difficult but the treatment and outcomes are similar. The most reliable operative treatment used for AVN of the sesamoid is an accumulation of anatomic and mechanical factors with repetitive microtrauma. Nonoperative modalities are designed to offload the sesamoid. The only operative treatment used for AVN of the sesamoid is excision of th...
Source: Foot and Ankle Clinics - January 25, 2019 Category: Orthopaedics Authors: Kimberly Bartosiak, Jeremy J. McCormick Source Type: research

Management of M üller-Weiss Disease
M üller-Weiss disease (MWD) is a dysplasia of the tarsal navicular. The shifting of the talar head laterally over the calcaneus drives the subtalar joint into varus. Failure to identify patients with paradoxic flatfoot varus may lead to the incorrect diagnosis and management. Conservative treatment w ith the use of rigid insoles with medial arch support and a lateral heel wedge is effective in most patients. Dwyer calcaneal osteotomy combined with lateral displacement seems to be a satisfactory treatment for patients who had failed to respond to conservative measures and a good alternative to th e different types of p...
Source: Foot and Ankle Clinics - January 25, 2019 Category: Orthopaedics Authors: Manuel Monteagudo, Ernesto Maceira Source Type: research

Epidemiology, Cause, and Anatomy of Osteonecrosis of the Foot and Ankle
Osteonecrosis arises throughout the foot and ankle in various forms and due to numerous causes, with a thousand US cases per year estimated for the ankle alone. Although research continues to elucidate specific mechanisms at work, the pathophysiology remains poorly understood. Nevertheless, the various osteonecrosis pathways converge on osteocyte death, and bony lesions follow a pattern of progression. Understanding the specific anatomy and biomechanics associated with common forms of foot and ankle osteonecrosis should help guide diagnosis and interventions, particularly at earlier stages of disease where etiology-specifi...
Source: Foot and Ankle Clinics - January 25, 2019 Category: Orthopaedics Authors: Daniel K. Moon Source Type: research

Tibiotalocalcaneal Arthrodesis for Severe Talar Avascular Necrosis
Severe talar avascular necrosis has many etiologies and can cause bone loss/hindfoot deformity. Tibiotalar calcaneal arthrodesis is a salvage procedure after severe talar avascular necrosis. Large bone voids can present significant challenges. Modest successes have been reported with structural block allograft tibiotalocalcaneal arthrodesis using either plate and screws, intramedullary nail fixation, or a combination. The advent of 3-dimensional printed titanium trusses has given surgeons another option for filling voids and providing structural support to prevent collapse. Although these options expand the armamentarium, ...
Source: Foot and Ankle Clinics - January 25, 2019 Category: Orthopaedics Authors: James R. Lachman, Samuel B. Adams Source Type: research

Freiberg Disease and Avascular Necrosis of the Metatarsal Heads
Freiberg disease is characterized as osteochondrosis of the second metatarsal head. It is the fourth most common form of primary osteochondrosis with a significant predilection to the adolescent athletic female population, although it has been seen over a wide age range. If treated early, osteochondroses such as Freiberg disease are essentially self-limiting, often resolving with nonoperative management. When surgery is warranted, it is imperative the patient ’s age, activity level, and degree of articular deformity be taken into account. (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - January 25, 2019 Category: Orthopaedics Authors: Andrew Wax, Robert Leland Source Type: research

Ankle Arthrodesis for Talar Avascular Necrosis and Arthrodesis Nonunion
This article reviews the surgical treatment of talar avascular necrosis. Specifically, arthrodesis for this complex entity and potential treatment of nonunions are discussed. The hallmarks of treatment are evolving and can range from nonoperative measures to amputations. Nonoperative treatment and the results of current arthrodesis techniques for late-stage avascular necrosis are reviewed. Surgical correction requires an understanding of the condition ’s natural history, utilization of structural and nonstructural bone grafting techniques, and stable fixation. Although the methods described follow standard orthopedic...
Source: Foot and Ankle Clinics - January 25, 2019 Category: Orthopaedics Authors: Jonathon D. Backus, Daniel L. Ocel Source Type: research

Core Decompression and Bone Grafting for Osteonecrosis of the Talus: A Critical Analysis of the Current Evidence
Several operative treatments have been explored to treat patients with progressive or symptomatic osteonecrosis of the talus, aiming to alleviate pain and restore mobility. Because most affected patients are typically younger and more active individuals, joint preservation techniques have received increasing attention. Core decompression, either through an open or percutaneous drilling approach has been used. Similarly, nonvascularized and vascularized bone grafts have been used in clinical practice with varying results. Owing to the relative paucity of studies, in this review we aimed to investigate the use of (1) core de...
Source: Foot and Ankle Clinics - January 25, 2019 Category: Orthopaedics Authors: Assem A. Sultan, Michael A. Mont Source Type: research

Avascular Necrosis of the Foot and Ankle
FOOT AND ANKLE CLINICS (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - January 25, 2019 Category: Orthopaedics Authors: Kenneth J. Hunt Source Type: research

Copyright
ELSEVIER (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - January 25, 2019 Category: Orthopaedics Source Type: research

Editorial Advisory Board
J. Kent Ellington, MD, MS (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - January 25, 2019 Category: Orthopaedics Source Type: research

Contributors
MARK S. MYERSON, MD (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - January 25, 2019 Category: Orthopaedics Source Type: research

Contents
Kenneth J. Hunt (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - January 25, 2019 Category: Orthopaedics Source Type: research

Forthcoming Issues
The Cavus Foot (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - January 25, 2019 Category: Orthopaedics Source Type: research

Management of Avascular Necrosis in the Foot and Ankle
Avascular necrosis (AVN) involving the bones of the foot and ankle represents a uniquely challenging group of conditions for the foot and ankle surgeon. These rare ailments can strike from a multitude of etiologic pathways and present with a broad range of symptoms and severities. While neither as common nor as easily recognizable as posttraumatic arthritis and lower leg deformity, AVN of bone can lead to considerable disability and compromised function. This makes both recognition and treatment of AVN a challenge for the foot and ankle specialist and underscores the importance of accurately identifying, classifying, and m...
Source: Foot and Ankle Clinics - December 20, 2018 Category: Orthopaedics Authors: Kenneth J. Hunt Tags: Preface Source Type: research

K öhler Disease
K öhler disease is a childhood condition of pain and swelling of the medial midfoot with associated osteochondrosis or avascular necrosis of the tarsal navicular. The age at presentation is between 2 and 10 years, with boys more likely to be affected than girls. Radiographs show increased sclerosis a nd sometimes flattening and fragmentation of the navicular. Long-term outcomes for Köhler disease are favorable regardless of the type of treatment, although a short period of immobilization with a short leg walking cast may reduce the duration of symptoms. (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - December 10, 2018 Category: Orthopaedics Authors: Jeremy Y. Chan, Jeffrey L. Young Source Type: research

Vascularized Pedicle Graft for Talar Osteonecrosis
Vascularized bone grafting for talar avascular osteonecrosis is indicated for patients with modified Ficat and Arlet stage I to III disease with minimal subchondral collapse. Outcomes may be more durable than core decompression alone, especially in patients with more advanced disease. Our preferred method, described in this article, involves core decompression followed by use of a vascularized cuboid pedicle graft placed in the defect. Outcomes reported in a small case series have been encouraging, with more than 80% of patients requiring no further surgery. (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - December 5, 2018 Category: Orthopaedics Authors: Elizabeth A. Cody, James A. Nunley Source Type: research

Imaging Features of Avascular Necrosis of the Foot and Ankle
Avascular necrosis of the foot and ankle is a rare but important cause of pain and functional abnormality. This process may occur in any bone in the foot and ankle; however, it presents most often in characteristic locations. Understanding of key radiographic findings is important in management of these lesions. MRI is the most sensitive and specific method for detection and characterization of this abnormality. (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - November 26, 2018 Category: Orthopaedics Authors: Spencer Couturier, Garry Gold Source Type: research