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 17, 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 7, 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 7, 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 4, 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 1, 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 1, 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 23, 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 22, 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 22, 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 18, 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 3, 2019 Category: Orthopaedics Authors: Roberto Zambelli, Daniel Baumfeld Source Type: research
Role of Coronal Plane Malalignment in Hallux Valgus Correction
Coronal malalignment is an important deformity parameter in hallux valgus feet. Approximately 90% of patients with hallux valgus have some degree of metatarsal pronation. In operated hallux valgus, persistent metatarsal pronation is an independent deformity relapse factor. Coronal malalignment can be identified through an anteroposterior (AP) weight-bearing foot radiograph and a weight-bearing forefoot scan. The AP foot view can identify 3 levels of rotation: mild, moderate and severe metatarsal pronation. Regarding the treatment options, some techniques are capable of rotational correction, such as the proximal rotational...
Source: Foot and Ankle Clinics - November 29, 2019 Category: Orthopaedics Authors: Pablo Wagner, Emilio Wagner Source Type: research
Evolution of Minimally Invasive Surgery in Hallux Valgus
Minimally invasive (MIS) or percutaneous surgery has evolved rapidly through the development of novel techniques with precise description, correct indications, and the incorporation of modifications of safe and effective techniques described in open surgery. The correct term to describe these procedures should be percutaneous and MIS should be reserved for procedures between percutaneous and open surgery (eg, osteosynthesis). According to results, third-generation techniques are useful, effective, and easier than open procedures. It seems that MIS surgery has an extensive learning curve, and therefore it may be difficult t...
Source: Foot and Ankle Clinics - November 29, 2019 Category: Orthopaedics Authors: Jorge Javier Del Vecchio, Mauricio Esteban Ghioldi Source Type: research
Controversies in the Approach to Complex Hallux Valgus Correction
Hallux valgus continues to remain a challenging condition to treat despite the myriad techniques available. Perhaps in no other disorder are the results as apparent to both the clinician and the patient. Successes and failures are apparent for both to see. Symptomatic hallux valgus can create frequent problems for the patient, including difficulty with shoe wear, walking, cosmetic concerns, and lesser toe pathologic conditions. Every aspect of management continues to be debated from the evaluation to the intraoperative and postoperative treatment. (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - November 29, 2019 Category: Orthopaedics Authors: Sudheer Reddy Tags: Preface Source Type: research
Management of Complications After Hallux Valgus Reconstruction
Complications following hallux valgus (HV) reconstruction will have an expected incidence of between 10% and 55% of cases. The more commonly reported complications include undercorrection/recurrence, overcorrection (hallux varus), transfer metatarsalgia, nonunion, malunion, avascular necrosis, arthritis, hardware removal, nerve injury, and ultimately patient dissatisfaction. The presence of arthritis will be an indication for fusion, whereas osteotomies will be the procedure of choice if the first metatarsophalangeal joint is healthy. Wide experience in primary HV surgery is advised before dealing with complex cases of fai...
Source: Foot and Ankle Clinics - November 28, 2019 Category: Orthopaedics Authors: Manuel Monteagudo, Pilar Mart ínez-de-Albornoz Source Type: research
Cost-Effectiveness of Surgical Techniques in Hallux Valgus
Health care costs are increasing. Funding is not increasing at a commensurate rate. Demonstrable cost-effectiveness is critical when selecting operation and implant type. Clinicians must justify their decision on surgery and implant type, providing patient-reported outcome measures (PROM). Providing such data on cost and PROM forms the basis of future cost-effectiveness analysis (CEA). Such analysis is complex. Future research should analyze cost variables individually. Day case surgery, multimodal analgesia, and simultaneous surgery for bilateral cases show promise in reducing cost. With evidence of increased recurrence, ...
Source: Foot and Ankle Clinics - November 27, 2019 Category: Orthopaedics Authors: Andy Molloy, Gavin Heyes Source Type: research
Hypermobility in Hallux Valgus
The interaction between hypermobility and hallux valgus remains both contemporary and incendiary. The difficulty in setting clinical and radiological parameters to diagnose and the complexity of questions that circumnutate the philosophy among etiology and denouement, fires up the debate regarding these conditions. Outcomes among procedures that address or neglect ray instability are still used as argument for any group of believers or nonbelievers. Through proving the true existence of hypermobility and its relationship with bunions, our colleges and professors have produced an incredible amount of excellent data that hel...
Source: Foot and Ankle Clinics - November 25, 2019 Category: Orthopaedics Authors: Nacime Salom ão Barbachan Mansur, Caio Augusto de Souza Nery Source Type: research
Complications after Metatarsal Osteotomies for Hallux Valgus
Avascular necrosis (AVN), nonunion, malunion, and metatarsophalangeal (MTP) osteoarthritis following hallux valgus osteotomies, as well as pathophysiology, diagnosis, prevention strategies, and treatment are discussed in this article. AVN and nonunion are very infrequent, and they can be effectively prevented taking into consideration local anatomy preservation, biomechanics, and patient comorbidities. Shortening, elevation, plantarflexion, varus/valgus, and rotational of the first metatarsal are the most common types of malunion. They can lead to pain, stiffness, deformity recurrence, and transfer metatarsalgia. MTP osteo...
Source: Foot and Ankle Clinics - November 25, 2019 Category: Orthopaedics Authors: Jorge Filippi, Jorge Briceno Source Type: research
Management of Hallux Valgus in Metatarsus Adductus
Metatarsus adductus is common clinical entity with an estimated prevalence of approximately 30%. Multiple radiographic methods exist to evaluate the extent of the deformity, with the Sgarlato and Engel methods most commonly used. Surgical treatment varies, consisting of proximal versus distal metatarsal osteotomies, TMT arthrodesis, and realignment of the lesser rays. Particularly in severe cases, addressing all deformities is critical to obtaining a good outcome. (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - November 20, 2019 Category: Orthopaedics Authors: Sudheer Reddy Source Type: research
Current Trends in Anesthesia Management in Hallux Valgus
Anesthesia management during hallux valgus surgery trends toward multimodal pain control. Locoregional anesthesia with peripheral nerve blocks and wound instillation increase pain control. Peripheral nerve blocks as first-line analgesia are effective with minimal side effects. Local wound instillation has a variable but positive effect with minimal negative side effects. Nonsteroidal anti-inflammatory drugs in bone-to-bone healing remain controversial; however, they reduce opiate requirements and enhance patient satisfaction. Opiate agonists remain the mainstay for postoperative pain; long-acting formulations minimize pain...
Source: Foot and Ankle Clinics - November 19, 2019 Category: Orthopaedics Authors: Max Seiter, Amiethab Aiyer Source Type: research
Current Trends in Fixation Techniques
Hallux valgus is an extremely common and often disabling deformity. In addition to valgus deformity of the hallux, varying degrees of varus and supination of the first metatarsal and instability in the metatarsophalangeal and metatarsocuneiform joints are frequently present. Because of the complexity and multiplicity of deformities, surgical techniques and fixation methods continue to be developed to obtain better results. Recent studies have focused on correcting pronation of the first metatarsal as a way of correcting and equalizing the metatarsal sesamoid bones in a more horizontal and stable position, possibly minimizi...
Source: Foot and Ankle Clinics - November 19, 2019 Category: Orthopaedics Authors: Jos é Antônio Veiga Sanhudo, Tomás Araújo Prado Pereira Source Type: research
Use of Advanced Weightbearing Imaging in Evaluation of Hallux Valgus
Hallux valgus (HV) represents a progressive 3-dimensional deformity that includes bone malalignment, hypermobility of the first ray, and imbalanced soft-tissue structures of the midfoot and forefoot. Conventional radiographs provide sectorized and limited information of the deformity in different planes. The literature evidence supporting the use of cone beam weightbearing computed tomography in the assessment of HV has been growing. It demonstrates important advances that include the ability to reliably perform traditional measurements such as HV angle and intermetatarsal angle in the 3-dimensional setting. (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - November 18, 2019 Category: Orthopaedics Authors: Cesar de Cesar Netto, Martinus Richter Source Type: research
Scientific Evidence in the Treatment of Metatarsalgia
Metatarsalgia is a common foot disease with a multitude of causes. Proper identification of underlying diseases is mandatory to formulate an adequate treatment. Multiple surgical solutions are available to treat metatarsalgia. Only limited scientific evidence is available in the literature. However, most of the techniques used in the treatment of metatarsalgia seem to be reasonable with acceptable results. (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - October 23, 2019 Category: Orthopaedics Authors: Georg Klammer, Norman Espinosa Source Type: research
Distal Minimally Invasive Metatarsal Osteotomy ( “DMMO” Procedure)
The use of a Shannon burr facilitates an osteotomy of the lesser metatarsals without requiring an open approach to the metatarsal. The end result that is aimed for is the same as for open surgery and therefore care needs to be taken to perform the bone cut in the appropriate manner. A description is provided of the surgical technique for distal minimally invasive osteotomy and its newer modifications —the distal intracapsular minimally invasive osteotomy and the distal oblique metatarsal osteotomy. (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - October 23, 2019 Category: Orthopaedics Authors: Olivier Laffen être, Anthony Perera Source Type: research
Current Concepts of Treatment of Metatarsalgia
Metatarsalgia is a frequent complaint in our day-to-day practice. Unfortunately, sometimes we face the frustrating scenario of dealing with an unpredictable malady. This situation is probably explained by the fact that constitutes a complex entity that is not enough appraised. (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - October 23, 2019 Category: Orthopaedics Authors: Gast ón Slullitel Tags: Preface Source Type: research
Current Concepts of Treatment of Metatarsalgia
FOOT AND ANKLE CLINICS (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - October 23, 2019 Category: Orthopaedics Authors: Gast ón Slullitel Source Type: research
Current Controversies in the Approach to Complex Hallux Valgus Deformity Correction (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - October 23, 2019 Category: Orthopaedics Source Type: research
Freiberg ‘s Infraction
Freiberg ’s infraction is an uncommon condition of the lesser metatarsophalangeal joints. Onset is usually between the 11th and 17th year of age. It is the only osteochondrosis that dominantly affects females with a reported female-to-male ratio of 5.1. The second metatarsal is most frequently involved (68 %) followed by the third metatarsal (27%), and the fourth (3%). Surgical treatment options can be categorized in joint destructive and joint preserving procedures. Studies reveal complete resolution of pain and full return to activities in 70% after joint destructive procedure and more than 90% afte r joint preserv...
Source: Foot and Ankle Clinics - October 7, 2019 Category: Orthopaedics Authors: Hans-J örg Trnka, Javier Serrano Lara Source Type: research