New Ideas and Techniques in Foot and Ankle Surgery: A Global Perspective (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - February 24, 2016 Category: Orthopaedics Source Type: research
The Ponseti Method in Low and Middle Income Countries
Diffusing a health care innovation like the Ponseti method in low and middle income countries requires more than the application of the traditional continuing medical education approach of providing lectures on the topic. Challenges include limited personnel, competing priorities, inadequate medical supplies, and limited resources. Experience has indicated that the best chances of success in establishing such a program include identifying and advising in-country “champions” to provide the leadership, energy, and direction to build the program. (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - November 19, 2015 Category: Orthopaedics Authors: Jose A. Morcuende, Thomas M. Cook Source Type: research
Tarsal Coalitions – Calcaneonavicular Coalitions
Calcaneonavicular coalitions are an important cause of adolescent foot pain and deformity. The congenital condition is characterized by an aberrant osseous, cartilaginous, or fibrinous union of the calcaneal and navicular bones. Calcaneonavicular coalitions are the most common form of tarsal coalitions identified within epidemiologic studies. A thorough understanding of this clinically significant entity is important for restoring joint motion and preventing long-term disability. (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - November 19, 2015 Category: Orthopaedics Authors: Stephanie J. Swensen, Norman Y. Otsuka Source Type: research
Managing Pediatric Foot and Ankle Deformity
This special issue of Foot and Ankle Clinics of North America brings together a talented and diverse group of pediatric foot surgeons. I hope that you will find their insights to be helpful to your practice. The topics have been chosen to be those that are either rarely discussed in textbooks, or are relevant enough to require an up-to-date review. (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - November 19, 2015 Category: Orthopaedics Authors: Alice Chu Tags: Preface Source Type: research
Managing Pediatric Foot and Ankle Deformity
FOOT AND ANKLE CLINICS (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - November 19, 2015 Category: Orthopaedics Authors: Alice Chu Source Type: research
Joint-preserving Osteotomies for Malunited Foot & Ankle Fractures (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - November 19, 2015 Category: Orthopaedics Source Type: research
Extraarticular Supramalleolar Osteotomy for Managing Varus Ankle Osteoarthritis, Alternatives for Osteotomy
The supramalleolar osteotomy has been reported to be a joint preserving surgery with good clinical outcome for asymmetric ankle osteoarthritis, especially varus ankle osteoarthritis. Conventional supramalleolar osteotomy of the tibia and fibula creates angulation and translation of the ankle joint without changing the width of the ankle mortise. Distal tibial oblique osteotomy improved the preoperative clinical and radiological parameters; however, mean talar tilt angle did not decrease. Assessment of the ankle arthritis in sagittal, axial, and coronal planes may be helpful to achieve a decrease of the talar tilt in ankle ...
Source: Foot and Ankle Clinics - November 13, 2015 Category: Orthopaedics Authors: Woo-Chun Lee Source Type: research
Corrective Osteotomies for Malunited Tongue-Type Calcaneal Fractures
Displaced tongue-type fractures of the calcaneus can lead to severe pain and disability if not treated appropriately. Failure to reduce articular displacement may require subtalar joint arthrodesis with subsequent loss of function. The subtalar joint is crucial for normal foot and ankle function. In selected cases, if the malunited joint is still in good condition, it is preserved by corrective osteotomy. A joint-preserving osteotomy with axial realignment is a treatment option for malunited tongue-type calcaneal fractures encountered early on, before the development of subtalar arthrosis in carefully selected patients. (S...
Source: Foot and Ankle Clinics - November 13, 2015 Category: Orthopaedics Authors: Guang-Rong Yu, Ming-Zhu Zhang, Yun-Feng Yang Source Type: research
Osteotomies of the Talar Neck for Posttraumatic Malalignment
A talar neck malunion is one of the major complications following operative or nonoperative treatment of talar neck fractures. The most common posttraumatic talar malunion results in varus malalignment of the talar neck and can lead to painful overload of the lateral foot and substantial impairment of hindfoot function. Secondary procedures in patients with painful malunited talar neck fracture include salvage procedures and anatomic reconstruction procedures. Anatomic reconstruction of the talar neck is a reliable surgical treatment to regain function, decrease pain, and restore hindfoot alignment and range of motion. (So...
Source: Foot and Ankle Clinics - November 13, 2015 Category: Orthopaedics Authors: Alexej Barg, Thomas Suter, Florian Nickisch, Nicholas J. Wegner, Beat Hintermann Source Type: research
Pediatric Ankle Fractures
Current clinical concepts are reviewed regarding the epidemiology, anatomy, evaluation, and treatment of pediatric ankle fractures. Correct diagnosis and management relies on appropriate examination, imaging, and knowledge of fracture patterns specific to children. Treatment is guided by patient history, physical examination, plain film radiographs and, in some instances, computed tomography. Treatment goals are to restore acceptable limb alignment, physeal anatomy, and joint congruency. For high-risk physeal fractures, patients should be monitored for growth disturbance as needed until skeletal maturity. (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - October 16, 2015 Category: Orthopaedics Authors: Alvin W. Su, A. Noelle Larson Source Type: research
Foot and ankle deformities in cerebral palsy can be effectively treated with surgery. Surgery should be considered in patients with significant deformity and those who have pain or difficulty with orthotic and shoe wear. Equinus contracture of both gastrocnemius and soleus can be treated with open tendoachilles lengthening; ankle valgus with medial epiphysiodesis. Equinovarus is more commonly seen in hemiplegic patients and this deformity can usually be treated with tendon transfers. Triple arthrodesis is an option in children with severe degenerative changes. It is important to address all aspects of the child’s pat...
Source: Foot and Ankle Clinics - October 16, 2015 Category: Orthopaedics Authors: Mara S. Karamitopoulos, Lana Nirenstein Source Type: research
Painful Flexible Flatfoot
Flatfoot is commonly encountered by pediatric orthopedic surgeons and pediatricians. A paucity of literature exists on how to define a flatfoot. The absence of the medial arch with a valgus hindfoot is the hallmark of this pathology. Flatfoot can be flexible or rigid. This review focuses on the diagnosis and treatment of the flexible flatfoot. Most flatfeet are flexible and clinically asymptomatic, and warrant little intervention. If feet are symptomatic, treatment is needed. Most patients who require treatment improve with foot orthotics and exercises. Only feet resistant to conservative modalities are deemed surgical can...
Source: Foot and Ankle Clinics - October 16, 2015 Category: Orthopaedics Authors: Abdel Majid Sheikh Taha, David S. Feldman Source Type: research
Treatment of Idiopathic Clubfoot in the Ponseti Era and Beyond
The initial treatment of idiopathic clubfoot was mostly surgical for the 1980s/1990s. In the latter half of the 1990s, there was a surge of interest in the Ponseti method of casting after the publication of Dr Ponseti’s 30-year results. Many authors have since shown correction rates in the high 90th percentile, rendering posteromedial release surgery almost obsolete. The success of the Ponseti method has been brought internationally and extrapolated to more and more difficult cases, such as idiopathic or syndromic, primary or recurrence. This new trend will create a different subset of complications. (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - October 16, 2015 Category: Orthopaedics Authors: Alice Chu, Wallace B. Lehman Source Type: research
Tendon Transfers Around the Foot
Tendon transfers are invaluable in the treatment of severe children’s foot deformities. They are often preferable to simple releases, lengthening, or fusion in surgical treatment because they provide an active motor function for deformity correction and, when properly selected, the procedures stabilize the foot against progressive deformity. The authors describe 4 commonly used tendon transfer procedures that are useful in children’s foot deformity surgeries. (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - October 14, 2015 Category: Orthopaedics Authors: Ken N. Kuo, Kuan-Wen Wu, Joseph J. Krzak, Peter A. Smith Source Type: research
Cavus foot is usually related to neurologic abnormalities and then requires complete clinical and imaging evaluation. It is important to identify whether the deformity is flexible or rigid, and combine different soft tissue and bony techniques to accomplish the best lasting results. On rigid feet, it is crucial to determine the apex of the deformity to guide the bony procedures indicated for each specific case. Tarsectomies are preferred to arthrodesis in these rigid feet with the aim of achieve a plantigrade foot. (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - October 14, 2015 Category: Orthopaedics Authors: Monica Paschoal Nogueira, Fernando Farcetta, Alexandre Zuccon Source Type: research
Talocalcaneal coalitions present with complaints of flatfeet, foot or ankle pain after minor injury, or recurrent ankle sprains. Physical examination findings include limited subtalar motion and prominence inferior to the medial malleolus. Use of computed topography (CT) scan is recommended for preoperative planning. Confirmation of resection with intraoperative CT. Resection of talocalcaneal coalitions with fat-graft interposition has superior results to primary arthrodesis. Improved outcomes have been reported after resection, with foot scores averaging 90/100 (AOFAS). (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - October 14, 2015 Category: Orthopaedics Authors: Joshua S. Murphy, Scott J. Mubarak Source Type: research
Discussion includes appropriate circumstances for the use of presented procedures and the author’s preferred treatment for each deformity. (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - October 13, 2015 Category: Orthopaedics Authors: Harold Jacob Pieter van Bosse Source Type: research
Treatment of Severe Recurrent Clubfoot
Understanding the pathoanatomy of severe recurrent clubfoot and its implication on treatment options is important for the successful treatment. A comprehensive clinical evaluation of the different components helps in selecting procedures. Individual needs and social and psychological factors influencing treatment and the impact of treatment on the child have to be considered. With increasing dissemination and improved understanding of the Ponseti method, a further decrease in the frequency of severe recurrent clubfoot can be hoped for and expected. (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - September 13, 2015 Category: Orthopaedics Authors: Christof Radler, Gabriel T. Mindler Source Type: research
Evaluation and Surgical Management of the Overcorrected Clubfoot Deformity in the Adult Patient
This article details the diagnostic approach to the overcorrected clubfoot patient and options for management of the various components of the deformity. (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - September 9, 2015 Category: Orthopaedics Authors: Dawid Burger, Amiethab Aiyer, Mark S. Myerson Source Type: research
Open, Arthroscopic, and Percutaneous Cheilectomy for Hallux Rigidus
Cheilectomy consists of excision of the dorsal exostosis and part of the metatarsal head. It is typically performed for patients in the earlier stages of hallux rigidus presenting with dorsal pain and dorsiflexion stiffness in the absence of through-range symptoms, rest pain, and plantar pain and with negative result on grind test. If joint motion–preserving surgery is appropriate, then cheilectomy is generally considered to be the first-line surgical choice. In addition to the standard open technique, minimally invasive surgery in the form of either percutaneous or arthroscopic surgery is available. The indications,...
Source: Foot and Ankle Clinics - August 28, 2015 Category: Orthopaedics Authors: Richard Walter, Anthony Perera Source Type: research
The Use of Osteotomy in the Management of Hallux Rigidus
Metatarsus elevatus and gastrocnemius tightness contribute to the development of functional hallux rigidus. Although several osteotomies have been described for functional hallux rigidus, certain osteotomies are commonly used in practice for the correction of functional hallux rigidus, a long first metatarsal or an elevated metatarsal, or an unstable tarsometatarsal joint. Proximal plantarflexion osteotomy is used only in the presence of an elevated first metatarsal with a limit to dorsiflexion but without the presence of arthritis at the first metatarsophalangeal joint. In the presence of arthritis at the metatarsophalang...
Source: Foot and Ankle Clinics - August 28, 2015 Category: Orthopaedics Authors: Raheel Shariff, Mark S. Myerson Source Type: research
Proximal Phalanx Hemiarthroplasty for the Treatment of Advanced Hallux Rigidus
Multiple treatment options exist for the management of late-stage hallux rigidus. The goals of treatment are pain reduction and restoration of function. Arthrodesis remains the treatment of choice, but recent advances support the use of first metatarsophalangeal hemiarthroplasty as a viable and successful option in properly selected patients in whom preservation of motion and function are desirable. (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - August 28, 2015 Category: Orthopaedics Authors: Connor Delman, Chris Kreulen, Martin Sullivan, Eric Giza Source Type: research
Hallux rigidus is the most common arthritic malady to afflict the foot. A host of nonoperative measures can alleviate pain, and with failure of conservative treatment, joint preserving and joint sacrificing procedures can be used to treat persistent symptoms. Although arthrodesis is an effective pain-relieving operation, loss of motion at the hallux metatarsophalangeal joint may limit the patient's function and can be an unacceptable solution. Various types of interposition arthroplasty can offer a motion-preserving alternative to arthrodesis. (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - August 28, 2015 Category: Orthopaedics Authors: Chad M. Ferguson, J. Kent Ellington Source Type: research
During my first rotation as a PGY-2 resident in the late 1990s, I specifically remember being told by a (now retired) faculty, “The only thing that you can do with hallux rigidus is fuse it, or cut the bump off!” Certainly, first MTP fusion and cheilectomy are still effective procedures for the properly selected patient. Fortunately though, for many halluces in this world, there have been significant advancements in the treatment of foot and ankle maladies over the past twenty years. The complexity of the treatment of hallux rigidus has improved not only with the myriad of surgical interventions, but also with ...
Source: Foot and Ankle Clinics - August 28, 2015 Category: Orthopaedics Authors: Eric Giza Tags: Preface Source Type: research
Moberg Osteotomy for Hallux Rigidus
This article discusses current techniques, developments, complications, outcomes, and management of the Moberg osteotomy. (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - July 8, 2015 Category: Orthopaedics Authors: Tibor Warganich, Thomas Harris Source Type: research
Resurfacing of the Metatarsal Head to Treat Advanced Hallux Rigidus
Advanced stages of hallux rigidus are usually treated with various arthroplasties or arthrodesis. Recent results with resurfacing of the metatarsal head have shown promising results and outcomes similar or superior to those of arthrodesis. In this article, the authors show their preoperative decision making, surgical techniques, postoperative management, results, and a comparative literature review to identify metatarsal head resurfacing as an acceptable technique for the treatment of advanced hallux rigidus in active patients. Key points in this article are adequate soft tissue release, immediate rigid fixation of the com...
Source: Foot and Ankle Clinics - July 8, 2015 Category: Orthopaedics Authors: Alex J. Kline, Carl T. Hasselman Source Type: research
Hallux rigidus is a painful condition of the great toe characterized by restriction of the metatarsophalangeal joint arc of motion and progressive osteophyte formation. Precise cause of hallux rigidus remains under debate. Anatomic variations and historical, clinical, and radiographic findings have been implicated in the development and progression of hallux rigidus. Radiologic findings associated with hallux rigidus include metatarsal head osteochondral defects, altered metatarsal head morphology, and an elevated hallux interphalangeus angle measure. Associated historical findings include a positive family history and his...
Source: Foot and Ankle Clinics - July 4, 2015 Category: Orthopaedics Authors: Douglas E. Lucas, Kenneth J. Hunt Source Type: research
Clinical Presentation and Management of Hallux Rigidus
Hallux rigidus is the most commonly occurring arthritic condition of the foot and is marked by pain, limited motion in the sagittal plane of the first metatarsophalangeal joint and varying degrees of functional impairment. In conjunction with clinical findings, radiographic grading helps guide therapeutic choices. Nonsurgical management with anti-inflammatory medications, corticosteroid injections, or shoewear and activity modifications can be successful in appropriately selected patients. Patients with more severe disease or refractory to conservative management may benefit from surgical intervention. Operative options ra...
Source: Foot and Ankle Clinics - July 2, 2015 Category: Orthopaedics Authors: Kamran S. Hamid, Selene G. Parekh Source Type: research
Metatarsophalangeal Fusion Techniques with First Metatarsal Bone Loss/Defects
First metatarsophalangeal joint disorder is a common cause of chronic forefoot pain that is frequently encountered in the orthopedic clinic. Numerous surgical techniques have been described to improve patient pain and function in this regard, including prosthetic joint replacement, resection arthroplasty, and arthrodesis. When these procedures fail, surgeons can be confronted with significant first metatarsal bone loss/defects. First metatarsophalangeal joint fusion remains the gold standard, and, in the setting of significant bone loss, the use of structural bone graft must be considered in order to restore length to the ...
Source: Foot and Ankle Clinics - June 13, 2015 Category: Orthopaedics Authors: Brian S. Winters, Boleslaw Czachor, Steven M. Raikin Source Type: research
Metatarsophalangeal Joint Fusion
First metatarsophalangeal (MTP) joint fusion aims at elimination of pain resulting from end-stage arthritis and obtaining a stable, plantigrade first toe. Associated deformities are corrected and greater defects are filled with interposition autograft or allograft. Fusion is generally obtained with screws, staples, and/or low-profile plates. Complications include infection, osteonecrosis, implant protrusion or failure, nonunion, and malunion, the latter 2 each occurring in approximately 6% of cases. The medium-term results of first MTP joint fusion indicate mostly good functional results with success rates of approximately...
Source: Foot and Ankle Clinics - June 9, 2015 Category: Orthopaedics Authors: Stefan Rammelt, Ines Panzner, Thomas Mittlmeier Source Type: research
This article describes and reviews the available literature on nonoperative modalities available in the treatment of hallux rigidus, including manipulation and intra-articular injections, shoe modifications and orthotics, physical therapy, and experimental therapies. (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - June 8, 2015 Category: Orthopaedics Authors: Remesh Kunnasegaran, Gowreeson Thevendran Source Type: research
First Metatarsophalangeal Joint Degeneration
Arthroscopic treatment of hallux rigidus is appropriate after failed nonoperative treatment. Debridement with cheilectomy, and fusion are the main indications for arthroscopic treatment of hallux rigidus. If the cartilage damage is extensive and the patient has consented, then a fusion is performed at the same sitting. (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - June 5, 2015 Category: Orthopaedics Authors: Timo Schmid, Alastair Younger Source Type: research
Subtalar Anatomy and Mechanics
Understanding subtalar joint biomechanics and pathomechanics provides a framework for understanding both common pathologic hindfoot and forefoot conditions and surgical planning. It is important to identify mechanical impairment and to define what mechanical effect is needed to change a pathologic condition. It is also important to know what the initial problem is and what the consequences are in terms of soft tissue or bony stress leading to peritalar injury. Whenever possible, one should try to operate to change pathomechanics and facilitate spontaneous repair of stressed structures. (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - May 29, 2015 Category: Orthopaedics Authors: Ernesto Maceira, Manuel Monteagudo Source Type: research