Pediatric flatfeet are common, usually asymptomatic, and typically improve over time as young children age. It is critical to differentiate flexible from rigid flatfeet and to assess for associated Achilles contracture with a careful history, physical examination, and initial radiographs. Although there are limited data, nonsurgical management of symptomatic flatfeet, both flexible and rigid, should be exhausted before considering surgical intervention. If patients fail conservative treatment, surgical management with joint preserving, deformity corrective techniques are typically used for pediatric flexible flatfeet in co...
Source: Foot and Ankle Clinics - June 2, 2017 Category: Orthopaedics Authors: Samuel E. Ford, Brian P. Scannell Source Type: research
Management of the Malunited Triple Arthrodesis
Malunion remains a common complication after triple arthrodesis, with rates as high as 6% in the reported literature. Careful patient evaluation is critical to determine the location and degree of bony deformity. A stepwise systematic approach to correct hindfoot and midfoot deformity is presented in this article. Few studies have been published to guide foot and ankle surgeons with this difficult clinical scenario but reports have demonstrated high success rates and low rates of complications after revision triple arthrodesis. (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - June 2, 2017 Category: Orthopaedics Authors: Jeffrey D. Seybold Source Type: research
Kinematics and Function of Total Ankle Replacements Versus Normal Ankles
End-stage ankle arthritis produces severe functional disability, quantifiable by gait abnormalities. In all categories of gait parameters, total ankle arthroplasty (TAA) satistically significantly improves function, compared to patients ’ preoperative function. There are increases in step length, cadence and velocity; in sagittal plane motion of the ankle, as well has hip and knee motion, and in ankle power and moment. These functional gait improvements correspond to clinical improvements of pain relief and satisfaction. Although these improvements fail to reach the functional performance of healthy controls, the imp...
Source: Foot and Ankle Clinics - May 12, 2017 Category: Orthopaedics Authors: Justin M. Kane, Scott Coleman, James W. Brodsky Source Type: research
Soft Tissue Reconstruction After Total Ankle Arthroplasty
Wound complications following total ankle replacement are common. A team approach, including plastic surgeons, should be utilized to manage these wound issues. The handling of the wound, from the index procedure, to a variety of flaps, can be utilized to provide a successful outcome following an ankle replacement. (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - May 12, 2017 Category: Orthopaedics Authors: Yash J. Avashia, Ronnie L. Shammas, Suhail K. Mithani, Selene G. Parekh Source Type: research
Ankle Arthrodesis Versus Total Ankle Arthroplasty
Reoperation rates are higher in total ankle arthroplasties (TAAs) compared with ankle arthrodesis. Infection rates for primary TAAs are 1.4% to 2.4%. The survival rate of TAA is approximately 75% to 90% at 10 years. Arc of motion is maintained with TAAs compared with ankle arthrodesis. Ankle arthrodesis increases arc of motion through the talonavicular joint. Several factors are strong reasons to favor ankle fusion rather than TAA. TAA and ankle arthrodesis are effective treatments of end-stage ankle arthritis but the choice must be tailored to individual patients. (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - May 12, 2017 Category: Orthopaedics Authors: Joel Morash, David M. Walton, Mark Glazebrook Source Type: research
Current Update in Total Ankle Arthroplasty
Ankle replacement results may be compromised by malposition of the components. An anterior displacement can be measured on a lateral standing radiograph. The ankle may appear anteriorly translated because the ankle is overstuffed, the heel cord is tight, or the posterior capsule is tight. In ankle instability with degenerative arthritis, the talus may be anteriorly translated, internally rotated, and in varus. In an ankle replacement, this deformity may persist and will require correction. On occasion, the talus is inserted too anterior; revision to a flat cut talar component and posterior translation of the talar componen...
Source: Foot and Ankle Clinics - May 12, 2017 Category: Orthopaedics Authors: Alastair Younger, Andrea Veljkovic Source Type: research
Current Updates in Total Ankle Arthroplasty
FOOT AND ANKLE CLINICS (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - May 12, 2017 Category: Orthopaedics Authors: J. Chris Coetzee Source Type: research
Malalignment Correction of the Lower Limb Before, During, and After Total Ankle Arthroplasty
This article helps clinicians to identify deformity and provides a basic template to consider how to address each challenge. (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - March 31, 2017 Category: Orthopaedics Authors: Taggart T. Gauvain, Michael A. Hames, William C. McGarvey Source Type: research
Management of Talar Component Subsidence
Component subsidence has been found to be the top complication that leads to failure of the total ankle arthroplasty (TAA). The cause of subsidence formation is unclear, and is multifactorial. Talar subsidence is more frequently met than tibial subsidence, and the subsequent big bone loss is demanding to handle. As a revision treatment option, neither a revision TAA nor a salvage ankle and/or hindfoot arthrodesis procedure is easy to perform or can obtain a definite outcome. The Salto XT can be used to treat most of the TAA systems available for use in the United States with acceptable short-term outcomes. (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - March 31, 2017 Category: Orthopaedics Authors: Shu-Yuan Li, Mark Myerson Source Type: research
Total Ankle Replacement in the Presence of Talar Varus or Valgus Deformities
This article recommends a two-staged reconstruction for more severely deformed feet. (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - March 30, 2017 Category: Orthopaedics Authors: Andrew Dodd, Timothy R. Daniels Source Type: research
Is There Anything to Learn from a National Joint Registry?
This article reviews the existing registry-based literature with respect to what is already known. The potential positives and down sides of registry data also are highlighted. (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - March 30, 2017 Category: Orthopaedics Authors: Dawson Muir Source Type: research
Dealing with the Stiff Ankle
In patients with a stiff ankle replacement, appropriate resection of scarred capsular structures, hypertrophic bone debridement, and careful release of tendons should be performed to achieve good outcomes. Appropriately sized and correctly implanted components are required to restore ankle function to as normal as possible. Although not proven, the better a total ankle replacement is balanced, the less likely scar and heterotopic bone formation will occur. In patients with a stiff and painful ankle replacement, a preoperative diagnostic workup is mandatory to understand the underlying pathologic process and plan appropriat...
Source: Foot and Ankle Clinics - March 30, 2017 Category: Orthopaedics Authors: Beat Hintermann, Roxa Ruiz, Alexej Barg Source Type: research
Osteolysis in Total Ankle Replacement
Aseptic loosening of implants remains the most common reason for revision surgery for hip, knee, or ankle prostheses. Although a great scientific effort has been made to explain the underlying mechanisms it remains poorly understood, complex, and multifactorial. Many factors, including age, body weight, activity lesions, implant design, fixation methods, material proprieties, immunologic responses, and biomechanical adaptations to total ankle replacement all contribute to the development of periprosthetic osteolysis. (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - March 28, 2017 Category: Orthopaedics Authors: Norman Espinosa, Georg Klammer, Stephan H. Wirth Source Type: research
Revision of Stemmed Agility Implants
Total ankle arthroplasty has advanced rapidly in the last 20 years. Early agility implants enjoyed improved survivability compared with more archaic total ankle implants. When talar subsidence occurs, the revision options include a stemmed component to improve stability by spanning the subtalar joint. Removal and revision of these stemmed components can be difficult because of ingrowth and bone loss. (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - March 28, 2017 Category: Orthopaedics Authors: Michael M. Brage, Uma E. Ramadorai Source Type: research
How To Diagnose and Treat Infection in Total Ankle Arthroplasty
Periprosthetic infection after total ankle arthroplasty (TAA) is a serious complication, often requiring revision surgery, including revision arthroplasty, conversion to ankle arthrodesis, or even amputation. Risk factors for periprosthetic ankle infection include prior surgery at the site of infection, low functional preoperative score, diabetes, and wound healing problems. The clinical presentation of patients with periprosthetic ankle joint infection can be variable and dependent on infection manifestation: acute versus chronic. The initial evaluation in patients with suspected periprosthetic joint infections should inc...
Source: Foot and Ankle Clinics - March 28, 2017 Category: Orthopaedics Authors: Yousef Alrashidi, Ahmed E. Galhoum, Martin Wiewiorski, Mario Herrera-P érez, Raymond Y. Hsu, Alexej Barg, Victor Valderrabano Source Type: research
Experience with Navigation in Total Ankle Arthroplasty. Is It Worth the Cost?
Optimal placement of correctly sized total ankle replacement (TAR) implants is elemental to prolonging the working life. The negative mechanical effects of implant malalignment are well characterized. There is one FDA-approved navigated TAR system with limited but encouraging outcomes data. Therefore, its value can be estimated only based on benefits other than a proven clinical outcomes improvement over conventional systems. These include unique preoperative planning through 3-dimensional templating and virtual surgery and the patient-specific cut guides, which also reduce overall instrumentation needed for the case. To b...
Source: Foot and Ankle Clinics - March 28, 2017 Category: Orthopaedics Authors: Christopher W. Reb, Gregory C. Berlet Source Type: research
Over the past 15 years, since I was the Guest Editor for the 2002 issue Foot and Ankle Clinics of North America on Total Ankle Replacement (Volume 7, Issue 4), significant and positive steps have been taken in the field. (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - March 28, 2017 Category: Orthopaedics Authors: J. Chris Coetzee Source Type: research
Pearls and Pitfalls for a Surgeon New to Ankle Replacements
The role of the surgeon learning curve in total ankle replacement (TAR) has produced contradictory results. It is important for a new surgeon to know what clinical and radiological parameters are considered reliable and ideal. It is clear that exposure to a high-volume center will increase the reliability of a new surgeon approaching TAR. Implant choice may be influenced by surgeon training, and the debate of mobile versus fix-bearing prosthesis is still open. Anterior versus lateral approach is still an open debate, with any hypothetical advantages given by the direct vision on the center of rotation to be proven. (Source...
Source: Foot and Ankle Clinics - March 12, 2017 Category: Orthopaedics Authors: Federico Giuseppe Usuelli, Camilla Maccario Source Type: research
Open Reduction and Internal Fixation Versus Primary Arthrodesis for Lisfranc Injuries
The objective of this article was to examine the current literature regarding open reduction and internal fixation versus primary arthrodesis of Lisfranc injuries. (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - February 4, 2017 Category: Orthopaedics Authors: Brian M. Weatherford, Donald R. Bohay, John G. Anderson Source Type: research
The Role of Percutaneous Reduction and Fixation of Lisfranc Injuries
To be able to perform percutaneous fixation of Lisfranc injuries, this article emphasizes that an anatomic reduction must be mandatory. When uncertainty remains as to whether closed reduction is anatomic, formal open reduction is recommended because accuracy of reduction is correlated with long-term outcome. Closed injuries with minimal displacement, bony avulsions, and skeletally immature individuals seem the most appropriate indications for percutaneous fixation. Not all injuries are ideal for this method of treatment, and this is an area that needs to be more clearly defined in the future. (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - February 4, 2017 Category: Orthopaedics Authors: Rupesh A. Puna, Matthew P.W. Tomlinson Source Type: research
Syndesmosis Stabilisation: Screws Versus Flexible Fixation
Orthopedic surgery is not short of situations where there is controversy regarding optimum management. Treating ankle syndesmosis injuries is an example where practice varies widely and there are many questions that remain unsatisfactorily answered. When addressing the type of syndesmosis stabilization that is required it is essential to ascertain the extent of instability. Only then can a logical approach to restoring the ankle mortise be achieved. Fixation of fibula shaft fractures and posterior malleolus fractures can restore sufficient stability to render syndesmosis stabilization unnecessary. The indications and techn...
Source: Foot and Ankle Clinics - February 4, 2017 Category: Orthopaedics Authors: Matthew C. Solan, Mark S. Davies, Anthony Sakellariou Source Type: research
Gastrocnemius or Achilles Lengthening at Time of Trauma Fixation
Gastrocnemius equinus is a frequent comorbidity with traumatic injuries of the foot and ankle. Gastrocnemius lengthening at the time of definitive treatment facilitates obtaining and maintaining an anatomic reduction of the injury. The lengthening procedure is accomplished in 5 steps and results in fewer long-term, problematic sequelae. (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - February 4, 2017 Category: Orthopaedics Authors: Stephen K. Benirschke, Patricia Ann Kramer Source Type: research
Complex Foot Injury
Complex foot injuries occur infrequently, but are life-changing events. They often present with other injuries as the result of a high-energy trauma. After initial stabilization, early assessment should be regarding salvagability. All treatment strategies are intensive. The initial treatment includes prevention of progression ischemia/necrosis, prevention of infection, and considering salvage or amputation. Definitive treatment for salvage includes anatomic reconstruction with stable internal fixation and early soft tissue coverage followed by aggressive rehabilitation. Prognosis after complex injuries is hard to predict. ...
Source: Foot and Ankle Clinics - February 4, 2017 Category: Orthopaedics Authors: Tim Schepers, Stefan Rammelt Source Type: research
Current Controversies in Foot and Ankle Trauma
This issue of Foot and Ankle Clinics of North America covers a variety of controversial topics in foot and ankle trauma. At times, clinical decisions are straightforward, black or white, yes or no decisions. It is hoped that this issue provides some discussion of topics that fall into the gray. Controversy is defined as a prolonged public dispute or debate concerning a matter of opinion. Some of the work presented you may agree with —some you may not. It is intended to make you think and stimulate discussion. (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - February 4, 2017 Category: Orthopaedics Authors: Michael P. Swords Tags: Preface Source Type: research
Current Controversies in Foot and Ankle Trauma
FOOT AND ANKLE CLINICS (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - February 4, 2017 Category: Orthopaedics Authors: Michael P. Swords Source Type: research
Chopart joint injuries have a profound effect on global foot function. Surgical treatment aims at joint reconstruction and axial alignment with restoration of the normal relationship of the lateral and medial foot columns. Internal fixation is tailored to the individual fracture pattern and achieved with resorbable pins, Kirschner wires, screws, and/or anatomically shaped minifragment plates. If instability persists, temporary joint transfixation may be achieved with Kirschner wires or bridge plating. Primary fusion sacrifices essential joints and should be reserved for severe initial cartilage damage. Corrective fusion be...
Source: Foot and Ankle Clinics - December 21, 2016 Category: Orthopaedics Authors: Stefan Rammelt, Tim Schepers Source Type: research
Late Treatment of Syndesmotic Injuries
Normal syndesmosis anatomy and alignment are essential to ankle function. Although injuries to the syndesmosis are common with ankle injuries, accurate diagnosis and reduction continue to be a challenge. Late reconstruction for syndesmosis is reviewed. A surgical technique for late reconstruction is outlined in detail. (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - December 21, 2016 Category: Orthopaedics Authors: Michael Swords, Andrew Sands, John R. Shank Source Type: research
Early Fixation of Calcaneus Fractures
The treatment of calcaneus fractures is controversial. Historically, most operatively treated fractures have been approached with a lateral extensile incision requiring delay in operative treatment until swelling has improved. There is a current trend and interest in small incision approaches allowing, and in some cases requiring, earlier operative fixation. Clinical scenarios amenable to consideration for early fixation are reviewed. The sinus tarsi surgical approach and reduction techniques are outlined in detail. (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - December 21, 2016 Category: Orthopaedics Authors: Michael Swords, Phillip Penny Source Type: research
Calcaneal Fracture Management
Calcaneal fracture management has historically been a controversial topic and represents an area of sustained interest over the past several decades. The authors review current methods for calcaneal fracture fixation with an extensile lateral approach and small incision techniques. Early reports of small incision techniques have reported promising outcomes and reduced risks for complications. These techniques may be beneficial to reduce the risk of soft tissue complications and improve the rate of recovery. (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - December 21, 2016 Category: Orthopaedics Authors: Nathan J. Kiewiet, Bruce J. Sangeorzan Source Type: research
Managing Complications of Calcaneus Fractures
Calcaneus fractures remain among the most complicated fractures for orthopedic surgeons to manage because of the complexity of various fracture patterns, the limited surrounding soft tissue envelope, and the prolonged rehabilitation issues impacting function after successful treatment. Despite this, appropriate management of complications associated with calcaneus fractures is critical for the complete care of this injury, whether treated operatively or nonoperatively. The authors present the common complications encountered with fractures of the calcaneus and management thereof. (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - December 18, 2016 Category: Orthopaedics Authors: Michael P. Clare, William S. Crawford Source Type: research
Posterior Malleolar Fractures
Injuries to the posterior malleolus are of prognostic relevance in ankle fracture-dislocations. The three-dimensional outline of the fragments as reflected by computed tomography classification, involvement of the fibular notch, and the presence of intercalary fragments seem to be of greater therapeutic relevance than the size of the fragment and amount of the articular surface involved. Operative treatment aims at reconstruction of the posterior tibial plafond, the fibular notch, and the integrity of the posterior inferior tibiofibular syndesmosis. Direct open reduction and fixation of posterior malleolus fragments via po...
Source: Foot and Ankle Clinics - December 18, 2016 Category: Orthopaedics Authors: Jan Barton íček, Stefan Rammelt, Michal Tuček Source Type: research
Primary Arthrodesis for Tibial Pilon Fractures
Staged primary ankle arthrodesis is a viable option for high-energy pilon fractures that are nonreconstructible, in patients with delay in treatment or multiple medical comorbidities, or in patients with peripheral neuropathy. Small retrospective series demonstrate high union and low wound complication rates, although further studies are needed to determine the long-term results. Ankle arthrodesis offers decreased complication rates while eliminating the potential of posttraumatic ankle arthritis pain. (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - December 18, 2016 Category: Orthopaedics Authors: Bryant Ho, John Ketz Source Type: research
Treatment of Peripheral Talus Fractures
Peripheral talus fractures include injuries to the lateral process, posteromedial talar body, and talar head. These injuries are rare and are often missed. Nonunion with conservative treatment is high and excision can lead to joint instability, rapid arthrosis, and earlier need for arthrodesis. Open reduction internal fixation of most peripheral talus fractures is critical to achieving a good outcome. Open reduction leads to more rapid union and ability to mobilize the ankle and subtalar joints, quicker revascularization of the talus, and lower rates of arthrosis. Surgical treatment can lead to substantial functional impro...
Source: Foot and Ankle Clinics - December 18, 2016 Category: Orthopaedics Authors: John R. Shank, Stephen K. Benirschke, Michael Swords Source Type: research
Role of Recombinant Human Bone Morphogenetic Protein-2 on Hindfoot Arthrodesis
Despite advances in understanding bone healing physiology and surgical techniques, delayed union and nonunion still occur after the treatment of hindfoot arthrodesis. There is increasing appeal of bone morphogenetic proteins (BMPs) owing to the innate osteoinductive abilities of BMPs. Effective treatment with BMPs has been shown in animal studies. Human clinical studies have also shown success. The only study investigating the use of recombinant human BMP (rhBMP)-2 in hindfoot arthrodesis found a significant increase in fusion rate. Treatment cost effective. Complications from their use remain low. rhBMP-2 is a safe and ef...
Source: Foot and Ankle Clinics - November 19, 2016 Category: Orthopaedics Authors: Jeremy Hreha, Ethan S. Krell, Christopher Bibbo Source Type: research
The Efficacy of Platelet-Derived Growth Factor as a Bone-Stimulating Agent
This article highlights findings from basic science, animal, and human clinical research that led to the approval of Augment Bone Graft. We present an adaptation of the surgical techniques described for investigators participating in the pivotal trial. (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - November 19, 2016 Category: Orthopaedics Authors: Ethan S. Krell, Christopher W. DiGiovanni Source Type: research
The Role of Orthobiologics in Fracture Healing and Arthrodesis
Nonunion after tibial shaft fracture and hindfoot arthrodesis remains a major problem. Known risk factors include advanced age, immunosuppression, smoking, and diabetes. Several factors must be considered in the fracture healing process. This review evaluates the efficacy of orthobiologics in improving union rates after fracture or arthrodesis. Use of compounds have shown increased cellular proliferation experimentally. Percutaneous autologous bone marrow has shown increased cellular proliferation. Matrix supplementation has shown significant improvements in bone healing. Several studies have highlighted the importance of ...
Source: Foot and Ankle Clinics - November 19, 2016 Category: Orthopaedics Authors: Sheldon S. Lin, Michael G. Yeranosian Source Type: research
The Science Behind Wear Testing for Great Toe Implants for Hallux Rigidus
Various methods of repairing damaged articular cartilage surfaces have been proposed and a variety of implant materials have been tried in an attempt to decrease pain and improve function after cartilage repair. The hydrogel made of polyvinyl alcohol and saline is a unique material used as an implant in the great toe for advanced stage arthritis. (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - November 19, 2016 Category: Orthopaedics Authors: Judith F. Baumhauer, Michele Marcolongo Source Type: research
Bone Marrow Aspirate Concentrate for Bone Healing in Foot and Ankle Surgery
Autologous bone marrow aspirate concentrate (BMAC) has become a popular orthobiologic to augment bone healing. The potential benefit comes from osteoprogenitor cells and growth factors that can lead to new bone formation in the setting of foot and ankle arthrodesis procedures. BMAC has an excellent safety record and has demonstrated efficacy in animal models of bone healing. Although scant, the literature on the use of BMAC in foot and ankle surgery does demonstrate promise for this orthobiologic adjuvant. (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - November 19, 2016 Category: Orthopaedics Authors: Joshua S. Harford, Travis J. Dekker, Samuel B. Adams Source Type: research
Large BM Intra-Articular Allograft
Posttraumatic tibiotalar arthritis is a challenging problem in young, active patients. Many of these patients do not want to pursue ankle arthrodesis after they fail conservative treatment measures, as they wish to preserve joint motion. Osteochondral shell allograft arthroplasty has been described as a reasonable alternative for treating these patients. The procedure itself is technically demanding; however, with improvements in surgical technique and adequate preoperative patient counseling, it provides improvement in ankle function and has good outcomes for most patients at long-term follow-up. (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - November 19, 2016 Category: Orthopaedics Authors: Joan R. Williams, Michael E. Brage Source Type: research