The Journal of Bone & Joint Surgery

The Journal of Bone & Joint Surgery, Volume 94, Issue 10

Specialty Update | May 16, 2012

What’s New in Foot and Ankle Surgery

Randall C. Marx, MD¹; Mark S. Mizel, MD²

¹ The San Antonio Orthopedic Group, 2829 Babcock Road, Suite #700, San Antonio, TX 78229
² Box 32577 Palm Beach Gardens, FL 33420. E-mail address: MSMMDLTJG@aol.com

View Disclosures and Other Information

Disclosure statement for author(s): PDF

Specialty Update has been developed in collaboration with the Board of Specialty Societies (BOS) of the American Academy of Orthopaedic Surgeons.

J Bone Joint Surg Am, 2012 May 16;94(10):952-957. doi: 10.2106/JBJS.L.00141

5 Recommendations (Recommend) | 3 Comments | Saved by 3 Users Save Case

Article

Comments (0)

text A A A

Extract

This update summarizes recent research pertaining to the subspecialty of orthopaedic foot and ankle surgery that was published or presented between August 2010 and July 2011. The sources of these studies include The Journal of Bone and Joint Surgery (American and British Volumes), Foot and Ankle International, and the proceedings of Specialty Day at the annual meeting of the American Academy of Orthopaedic Surgeons (AAOS), held on February 19, 2011, in San Diego, California, and the summer meeting of the American Orthopaedic Foot & Ankle Society (AOFAS), held on July 14 through 16, 2010, in Keystone, Colorado.

Figures in this Article

Introduction

Ankle Fractures and Syndesmosis

The distal tibiofibular syndesmosis continues to generate controversy and is an area of ongoing research. No consensus exists on how to accurately assess syndesmotic reduction intraoperatively or on what is the ideal method of fixation when treating this injury. Marmor et al. performed a controlled cadaver-based experiment to evaluate the accuracy of fluoroscopy in the measurement of standard syndesmotic indices¹. Using intraoperative fluoroscopy, the investigators were unable to detect up to 30° of fibular external rotation malreduction with use of standard tibiofibular overlap and tibiofibular clear space parameters. Fluoroscopy was significantly more sensitive for the detection of fibular internal rotation malreduction. Stuart and Panchbhavi retrospectively evaluated syndesmosis screw fixation in a study of 137 ankle fractures associated with distal tibiofibular syndesmotic disruption². The study demonstrated a significantly higher rate of syndesmotic screw breakage in association with 3.5-mm-diameter screws as compared with 4.0 and 4.5-mm-diameter screws. Failure of the syndesmotic hardware was not associated with an increased loss of syndesmotic reduction. DeGroot et al. evaluated the outcome of suture button syndesmosis stabilization in twenty-four patients after a mean duration of follow up of twenty months³. The average AOFAS score was 94 points, and the syndesmotic reduction was maintained in all cases. However, six patients (25%) required removal of the suture button, most commonly because of device prominence and local skin irritation. Four patients demonstrated osteolysis and subsidence of the metallic button, and three patients manifested asymptomatic radiographic ossification of the syndesmotic ligaments.

Chronic ankle syndesmotic disruption is a challenging clinical problem, and there have been few published reports on treatment options. Olson et al. successfully salvaged cases of painful chronic ankle syndesmosis instability with distal tibiofibular arthrodesis⁴. The mean AOFAS score improved from 37 before the arthrodesis to 87 after the arthrodesis, with significant corrections of all radiographic indices, including the medial clear space, talar tilt, and the talocrural angle. In addition, no radiographic signs of progression of ankle arthritis were noted and no patient required conversion to tibiotalar arthrodesis or arthroplasty.

In a study of commonly used postoperative immobilization devices, Orr et al. demonstrated a significantly increased total brake response time when a controlled-ankle-motion boot, a short leg cast, and a left-foot driving adapter were compared with regular shoewear⁵. These results should be used to counsel the patient regarding driving practices in the postoperative period when using an immobilization device.

Calcaneal Fractures and Hindfoot Trauma

Percutaneous and less invasive techniques to fix calcaneal fractures continue to gain acceptance as methods to reduce the wound complication rates associated with more extensile approaches. Tomesen et al.⁶ reported successful radiographic and clinical results in association with the use of a modified version of the percutaneous method described by Forgon and Zadravecz. However, the authors noted a 13% infection rate, with another 46% of the patients requiring a second procedure to remove the implants. Two patients required a subtalar arthrodesis, and another had development of complex regional pain syndrome type I. Two studies analyzed the biomechanical performance of locking plates compared with non-locking plates in an osteoporotic calcaneal fracture model^7,8. No significant mechanical difference was revealed between the two types of plating systems. These biomechanical studies are particularly topical as advanced patient age has been proposed as a relative contraindication to surgical fixation of calcaneal fractures. A retrospective study by Gaskill et al. demonstrated significantly better outcomes following the operative treatment of intra-articular calcaneal fractures in patients over fifty years of age as compared with those in patients younger than fifty years of age⁹.

Osteonecrosis can be a devastating complication of talar neck fractures because of the tenuous blood supply of the talar dome. To more accurately describe the talar blood supply, Miller et al. quantified the talar vascular contributions with gadolinium-enhanced magnetic resonance imaging (MRI) and subsequently dissected latex-injected cadaver specimens¹⁰. The talus derived 16.9% of its blood supply from the peroneal artery, 36.2% from the anterior tibial artery, and 47% from the posterior tibial artery. The study demonstrated a substantial vascular contribution entering the posterior part of the talus, perhaps explaining why not all talar neck fractures result in osteonecrosis.

In a retrospective review of osteonecrosis of the talus, Devries et al. reported successful tibiotalocalcaneal arthrodesis in twelve of fourteen patients who were managed with a retrograde intramedullary nail¹¹. Autograft from the fibula and orthobiologic augmentation were routinely used to promote fusion, and bulk femoral head allograft was utilized to restore hindfoot height in patients with total talar body involvement.

Ankle Sprains and Instability

In a cross-sectional epidemiological study in the United States, Waterman et al. found that the incidence of ankle sprains presenting to emergency departments was 2.15 per 1000 person-years¹². Higher rates of ankle sprains were associated with athletic activity, an age of ten to nineteen years, and male sex (among patients between fifteen and twenty-four years old) and female sex (among patients over thirty years old) as compared with age-matched counterparts. Pihlajamäki et al. compared the outcomes of surgical repair with those of functional treatment for grade-III acute ruptures of the lateral ligament complex of the ankle¹³. At the time of long-term follow-up, the return to preinjury activity levels were comparable between both groups. However, a higher prevalence of reinjury occurred in the functional treatment group whereas a higher rate of osteoarthritis on MRI was found in the surgical treatment group. Prisk et al. performed a biomechanical study to evaluate contact mechanics as well as ankle and hindfoot motion following the Broström ligament repair, the Broström repair with the Gould modification, and anatomic graft reconstruction¹⁴. Compared with the intact lateral ankle ligament controls, neither of the repairs nor the graft reconstruction completely restored native contact mechanics of the ankle joint or hindfoot motion patterns.

Anterolateral soft-tissue impingement is a common contributor to chronic ankle pain following inversion ankle injuries. Ferkel et al. evaluated the usefulness of MRI for detecting soft-tissue impingement by correlating MRI results with intraoperative arthroscopic findings¹⁵. The MRI demonstrated a diagnostic accuracy of 78.9%, with a sensitivity of 83.3% and a specificity of 78.6%. The authors described displacement of normal subcutaneous fat adjacent to the fibula by effusion or soft tissue on lateral and axial MRI sequences as being the findings that were most reliable for diagnosis. Young et al. reported on the complication rates associated with ankle arthroscopy involving contemporary noninvasive distraction techniques and small-joint arthroscopic instruments¹⁶. The observed complication rate was 6.8%, with a higher risk of nerve-related symptoms in patients receiving Workers’ Compensation. The complication rate in that study was lower than rates previously reported in the literature.

Total Ankle Arthroplasty

The role of and indications for total ankle replacement continue to be explored and redefined. Barg et al. reported successful treatment of gouty ankle arthritis with use of the three-component HINTEGRA total ankle system (Newdeal, Lyon, France/Integra, Plainsboro, New Jersey)¹⁷. This prospective observational study demonstrated low complication rates, significant pain relief, high patient satisfaction, and good functional results at intermediate-term follow-up. A cadaver-based biomechanical study by Merian et al. investigated the elongation of hindfoot and midfoot ligaments with ankle and subtalar joint inversion, eversion, dorsiflexion, and plantar flexion¹⁸. The authors identified the superficial and deep posterior tibiotalar ligaments as possible targets for surgical release to improve range of motion in total ankle arthroplasty and noted that release of the tibiocalcaneal ligament may aid in correction of varus talar tilt. Reddy et al. reported successful results and correction of coronal plane deformity of up to 25° following total ankle replacement with use of the Scandinavian Total Ankle Replacement system (STAR Ankle; Small Bone Innovations, Morrisville, Pennsylvania)¹⁹. Adjunctive soft-tissue procedures such as deltoid ligament release and lateral ligament reconstruction were paramount to balancing the ankle prosthesis. Mann et al. reported the long-term results associated with the STAR Ankle prosthesis (Small Bone Innovations), the only mobile-bearing total ankle arthroplasty implant approved by the Food and Drug Administration for use in the United States²⁰. After an average duration of follow-up of 9.1 years, 91% of the prostheses remained implanted, 92% of patients were satisfied with the outcome, and the average AOFAS ankle-hindfoot score improved an average of 39 points.

Total ankle arthroplasty prostheses have produced encouraging results; however, postoperative complications unique to total ankle replacement remain a concern. Raikin et al. reviewed the results of total ankle replacement with use of the Agility Total Ankle System (DePuy Orthopaedics, Warsaw, Indiana) to determine risk factors for healing complications associated with the standard anterior surgical incision²¹. Inflammatory arthritis was the only significant risk factor for major wound complications, with an odds ratio demonstrating a 14.03 times increased risk of complications requiring reoperation compared with noninflammatory causes of arthritis. Lee et al. reported a 25% prevalence of heterotopic ossification in a study of eighty patients who had been managed with primary total ankle arthroplasty²². The heterotopic ossification occurred primarily in the posterior aspect of the ankle and was associated with reduced ankle motion and worse clinical outcomes at two years postoperatively. Krause et al. reported comparable outcomes of total ankle replacement and ankle arthrodesis with regard to pain relief and function at two years postoperatively²³. However, the rate of complications was significantly higher in the total ankle replacement group (54%) as compared with the arthrodesis group (26%). A failed total ankle replacement requiring removal of components can require large structural bone allograft to fill a typically large bone void. Berkowitz et al. reported successful conversion of failed total ankle replacements to ankle or ankle-hindfoot fusion with use of structural bone graft (most commonly bulk femoral head allograft) and internal fixation²⁴.

Achilles Tendon

Chiodo et al. described evidence-based guidelines on the treatment of acute Achilles tendon ruptures²⁵. The work group reached a consensus opinion about the value of a detailed history and physical examination in the diagnosis of acute Achilles tendon rupture as well as the comorbidities that represent relative contraindications to surgical repair, including diabetes, neuropathy, immunocompromised states, an age of more than sixty-five years, tobacco use, sedentary lifestyle, obesity (body mass index >30), and peripheral vascular disease or local/systemic dermatologic disorders. In the randomized prospective study by Willits et al., surgical repair with early weight-bearing and an accelerated rehabilitation protocol was compared with nonsurgical treatment involving the use of a removable pneumatic walking boot with a 2-cm heel lift and an accelerated rehabilitation protocol²⁶. The operative treatment group had a re-rupture rate of 2.8% and a complication rate of 13%, whereas the nonoperative treatment group had a re-rupture rate of 4.2% and a complication rate of 8%. All measured outcomes in both treatment groups were acceptable and clinically similar. Using a rat Achilles tendon rupture model, Okamoto et al. demonstrated higher ultimate load to failure, stronger staining of type-III collagen at seven days, and stronger staining of type-I collagen at twenty-eight days following transplantation of whole bone marrow cells compared with transplantation of mesenchymal stem cells as well as compared with normal Achilles tendons²⁷. This may represent an area of future research to augment Achilles tendon healing in humans.

Non-insertional Achilles tendinopathy is typically treated successfully with conservative measures but infrequently requires surgical intervention. Duthon et al. reported good to excellent results two years postoperatively following gastrocnemius lengthening²⁸. No complications were noted, and improvements of Achilles tendon substance signal intensity and size were discovered on postoperative MRI.

Plantar Fascia and Peroneal Tendons

In a randomized parallel treatment and observer-blinded Level-I study, Rompe et al. compared a plantar fascia-specific stretching program with repetitive low-energy radial shock-wave therapy for the treatment of acute plantar fasciopathy²⁹. The stretching program demonstrated superiority for at least four months after baseline, although both groups demonstrated considerable improvement by fifteen months.

Athavale et al. described the anatomy of the superior peroneal tunnel in detail on the basis of fifty-eight cadaver dissections and analysis of the contour of sixty dry fibulae³⁰. The authors reported a spacious tunnel with a concave retromalleolar groove that may not contribute to tendinopathy of the peroneal tendons. Additional anatomic structures noted within the tunnel included peroneus brevis muscle fibers, a muscle variant named the peroneus quartus, split peroneus brevis tendons, double peroneus longus tendons, and an accessory peroneal nerve.

Adult Acquired Flatfoot Deformity

Lateral column lengthening may be a useful surgical adjunctive procedure to aid in the correction of the forefoot abduction component of adult acquired flatfoot deformity. Grier and Walling demonstrated a higher union rate and a lower complication rate following lateral column lengthening procedures involving tricortical allograft combined with platelet-rich plasma as compared with procedures involving tricortical autograft³¹. Advanced long-standing flatfoot deformity can produce incompetence of the deltoid ligament with subsequent valgus tibiotalar tilt. Jeng et al. described a minimally invasive allograft deltoid ligament reconstruction for patients with advanced flatfoot deformity and passively correctable tibiotalar valgus deformity³². Five of eight patients who underwent this procedure had a successful outcome with reduction of valgus tibiotalar angulation at thirty-six months postoperatively. Deltoid ligament reconstruction requires further investigation to determine appropriate indications and expected results but may allow for correction of ankle valgus deformity while sparing tibiotalar joint motion.

Hallux Rigidus

The standard accepted treatment for advanced hallux rigidus remains arthrodesis. However, a subset of patients regard fusion of the first metatarsophalangeal joint as a less desirable solution and inquire about motion-sparing procedures. Two retrospective studies demonstrated acceptable results in association with a modified capsular interpositional motion-sparing arthroplasty for the treatment of advanced hallux rigidus^33,34. Mackey et al. compared the modified Keller arthroplasty with first metatarsophalangeal joint arthrodesis after an average of sixty-three months of follow-up³³. AOFAS scores in the modified Keller capsular arthroplasty group were significantly better, and a mean of 54° of passive and 30° of active first metatarsophalangeal joint range of motion was preserved. The arthrodesis group had significantly higher plantar pressure under the great toe but not under the second metatarsal head. At a minimum of fifteen months after the use of a modification of the Hamilton interpositional arthroplasty, Sanhudo et al. reported a mean postoperative AOFAS score of 93.6 and a 75% patient satisfaction rate³⁴.

Lesser Toe Deformities

Brachymetatarsia is a relatively common foot deformity causing abnormally short metatarsal bones. This congenital malformation most frequently affects the fourth metatarsal; the second most frequent location is the first metatarsal, followed by the fifth metatarsal. Lee et al. reported successful lengthening with use of a unilateral external fixator to perform distraction osteogenesis for the treatment of first and/or fourth brachymetatarsia³⁵. The mean lengthening was 17.2 mm in the group with first brachymetatarsia and 16.3 mm in the group with fourth brachymetatarsia. All patients were satisfied with the final corrected length of the metatarsal, and all achieved bone union; however, minor complications were frequent, and no improvement in foot function was found.

Hindfoot Deformity

Radiographic measurements are commonly used to quantify varus and valgus hindfoot deformities. Lee et al. evaluated numerous commonly used radiographic indices to determine the reliability and validity of those measurements³⁶. The naviculocuboid overlap, the anteroposterior talus-first metatarsal angle, and the talonavicular coverage angle were determined to be both reliable and valid methods for discriminating hindfoot valgus and varus deformities.

A lateralizing calcaneal osteotomy may be utilized to correct hindfoot deformity and to realign the weight-bearing axis. Krause et al. used cadavers to simulate a pes cavovarus model with a fixed hindfoot varus to study the effect of the z-shaped calcaneal osteotomy on the ground contact point of the hindfoot and the redistribution of the ankle joint contact stress³⁷. The results showed that the lateralizing z-shaped calcaneal osteotomies that were tested significantly shifted the center of force in the ankle in a lateral direction and reduced peak ankle pressures in a fixed cavovarus model.

Upcoming Educational Events

There are several upcoming courses and events relevant to foot and ankle surgery that will be sponsored or cosponsored by the AAOS and AOFAS.

Foot and Ankle Fellowship Match Day, April 3, 2012
Advanced Foot and Ankle Course, May 3 through 5, 2012, Chicago, Illinois
AOFAS Annual Summer Meeting, July 20 through 23, 2012, San Diego, California
The Complete Foot Course, September 27 through 29, 2012, Fairfax, Virginia

Evidence-Based Orthopaedics

The editorial staff of The Journal reviewed a large number of recently published research studies related to the musculoskeletal system that received a Level of Evidence grade of I or II. Over 100 medical journals were reviewed to identify these articles, which all have high-quality study design. In addition to articles published previously in this journal or cited already in this Update, four additional Level-I and II studies were identified that were relevant to foot and ankle surgery. A list of those titles is appended to this review after the standard bibliography. We have provided a brief commentary about each of the articles to help to guide your further reading, in an evidence-based fashion, in this subspecialty area.

Marmor M; Hansen E; Han HK; Buckley J; Matityahu A. Limitations of standard fluoroscopy in detecting rotational malreduction of the syndesmosis in an ankle fracture model. Foot Ankle Int. 2011;32:616-22.

Stuart K; Panchbhavi VK. The fate of syndesmotic screws. Foot Ankle Int. 2011;32:S519-25.

DeGroot H; Al-Omari AA; El Ghazaly SA. Outcomes of suture button repair of the distal tibiofibular syndesmosis. Foot Ankle Int. 2011;32:250-56.

Olson KM; Dairyko GH Jr; Toolan BC. Salvage of chronic instability of the syndesmosis with distal tibiofibular arthrodesis: functional and radiographic results. J Bone Joint Surg Am. 2011;93:66-72.

Orr J; Dowd T; Rush JK; Hsu J; Ficke J; Kirk K. The effect of immobilization devices and left-foot adapter on brake-response time. J Bone Joint Surg Am. 2010;92:2871-7.

Tomesen T; Biert J; Frölke JP. Treatment of displaced intra-articular calcaneal fractures with closed reduction and percutaneous screw fixation. J Bone Joint Surg Am. 2011;93:920-8.

Illert T; Rammelt S; Drewes T; Grass R; Zwipp H. Stability of locking and non-locking plates in an osteoporotic calcaneal fracture model. Foot Ankle Int. 2011;32:307-13.

Blake MH; Owen JR; Sanford TS; Wayne JS; Adelaar RS. Biomechanical evaluation of a locking and nonlocking reconstruction plate in an osteoporotic calcaneal fracture model. Foot Ankle Int. 2011;32:432-6.

Gaskill T; Schweitzer K; Nunley J. Comparison of surgical outcomes of intra-articular calcaneal fractures by age. J Bone Joint Surg Am. 2010;92:2884-9.

Miller AN; Prasarn ML; Dyke JP; Helfet DL; Lorich DG. Quantitative assessment of the vascularity of the talus with gadolinium-enhanced magnetic resonance imaging. J Bone Joint Surg Am. 2011;93:1116-21.

Devries JG; Philbin TM; Hyer CF. Retrograde intramedullary nail arthrodesis for avascular necrosis of the talus. Foot Ankle Int. 2010;31:965-72.

Waterman BR; Owens BD; Davey S; Zacchilli MA; Belmont PJ Jr. The epidemiology of ankle sprains in the United States. J Bone Joint Surg Am. 2010;92:2279-84.

Pihlajamäki H; Hietaniemi K; Paavola M; Visuri T; Mattila VM. Surgical versus functional treatment for acute ruptures of the lateral ligament complex of the ankle in young men: a randomized controlled trial. J Bone Joint Surg Am. 2010;92:2367-74.

Prisk VR; Imhauser CW; O’Loughlin PF; Kennedy JG. Lateral ligament repair and reconstruction restore neither contact mechanics of the ankle joint nor motion patterns of the hindfoot. J Bone Joint Surg Am. 2010;92:2375-86.

Ferkel RD; Tyorkin M; Applegate GR; Heinen GT. MRI evaluation of anterolateral soft tissue impingement of the ankle. Foot Ankle Int. 2010;31:655-61.

Young BH; Flanigan RM; DiGiovanni BF. Complications of ankle arthroscopy utilizing a contemporary noninvasive distraction technique. J Bone Joint Surg Am. 2011;93:963-8.

Barg A; Knupp M; Kapron AL; Hintermann B. Total ankle replacement in patients with gouty arthritis. J Bone Joint Surg Am. 2011;93:357-66.

Merian M; Glisson RR; Nunley JA. J. Ligament balancing for total ankle arthroplasty: an in vitro evaluation of the elongation of the hind- and midfoot ligaments. Foot Ankle Int. 2011;32:S457-72.

Reddy SC; Mann JA; Mann RA; Mangold DR. Correction of moderate to severe coronal plane deformity with the STAR ankle prosthesis. Foot Ankle Int. 2011;32:659-64. Erratum in: Foot Ankle Int. 2011;32:vi.

Mann JA; Mann RA; Horton E. STAR ankle: long-term results. Foot Ankle Int. 2011;32:473-84.

Raikin SM; Kane J; Ciminiello ME. Risk factors for incision-healing complications following total ankle arthroplasty. J Bone Joint Surg Am. 2010;92:2150-5.

Lee KB; Cho YJ; Park JK; Song EK; Yoon TR; Seon JK. Heterotopic ossification after primary total ankle arthroplasty. J Bone Joint Surg Am. 2011;93:751-8.

Krause FG; Windolf M; Bora B; Penner MJ; Wing KJ; Younger AS. Impact of complications in total ankle replacement and ankle arthrodesis analyzed with a validated outcome measurement. J Bone Joint Surg Am. 2011;93:830-9.

Berkowitz MJ; Clare MP; Walling AK; Sanders R. Salvage of failed total ankle arthroplasty with fusion using structural allograft and internal fixation. Foot Ankle Int. 2011;32:S493-502.

Chiodo CP; Glazebrook M; Bluman EM; Cohen BE; Femino JE; Giza E; Watters WC 3rd; Goldberg MJ; Keith M; Haralson RH 3rd; Turkelson CM; Wies JL; Hitchcock K; Raymond L; Anderson S; Boyer K; Sluka P; American Academy of Orthopaedic Surgeons. American Academy of Orthopaedic Surgeons clinical practice guideline on treatment of Achilles tendon rupture. J Bone Joint Surg Am. 2010;92:2466-8.

Willits K; Amendola A; Bryant D; Mohtadi NG; Giffin JR; Fowler P; Kean CO; Kirkley A. Operative versus nonoperative treatment of acute Achilles tendon ruptures: a multicenter randomized trial using accelerated functional rehabilitation. J Bone Joint Surg Am. 2010;92:2767-75.

Okamoto N; Kushida T; Oe K; Umeda M; Ikehara S; Iida H. Treating Achilles tendon rupture in rats with bone-marrow-cell transplantation therapy. J Bone Joint Surg Am. 2010;92:2776-84.

Duthon VB; Lübbeke A; Duc SR; Stern R; Assal M. Noninsertional Achilles tendinopathy treated with gastrocnemius lengthening. Foot Ankle Int. 2011;32:375-9.

Rompe JD; Cacchio A; Weil L Jr; Furia JP; Haist J; Reiners V; Schmitz C; Maffulli N. Plantar fascia-specific stretching versus radial shock-wave therapy as initial treatment of plantar fasciopathy. J Bone Joint Surg Am. 2010;92:2514-22.

Athavale SA; Swathi Vangara SV. Anatomy of the superior peroneal tunnel. J Bone Joint Surg Am. 2011;93:564-71.

Grier KM; Walling AK. The use of tricortical autograft versus allograft in lateral column lengthening for adult acquired flatfoot deformity: an analysis of union rates and complications. Foot Ankle Int. 2010;31:760-9.

Jeng CL; Bluman EM; Myerson MS. Minimally invasive deltoid ligament reconstruction for stage IV flatfoot deformity. Foot Ankle Int. 2011;32:21-30.

Mackey RB; Thomson AB; Kwon O; Mueller MJ; Johnson JE. The modified oblique keller capsular interpositional arthroplasty for hallux rigidus. J Bone Joint Surg Am. 2010;92:1938-46.

Sanhudo JA; Gomes JE; Rodrigo MK. Surgical treatment of advanced hallux rigidus by interpositional arthroplasty. Foot Ankle Int. 2011;32:400-6.

Lee KB; Park HW; Chung JY; Moon ES; Jung ST; Seon JK. Comparison of the outcomes of distraction osteogenesis for first and fourth brachymetatarsia. J Bone Joint Surg Am. 2010;92:2709-18.

Lee KM; Chung CY; Park MS; Lee SH; Cho JH; Choi IH. Reliability and validity of radiographic measurements in hindfoot varus and valgus. J Bone Joint Surg Am. 2010;92:2319-27.

Krause FG; Sutter D; Waehnert D; Windolf M; Schwieger K; Weber M. Ankle joint pressure changes in a pes cavovarus model after lateralizing calcaneal osteotomies. Foot Ankle Int. 2010;31:741-6.

Knapik JJ; Trone DW; Swedler DI; Villasenor A; Bullock SH; Schmied E; Bockelman T; Han P; Jones BH. Injury reduction effectiveness of assigning running shoes based on plantar shape in Marine Corps basic training. Am J Sports Med. 2010;38:1759-67.This randomized controlled trial evaluated the injury reduction effectiveness of running shoes designed to compensate for differences in running mechanics by accommodating the plantar shape of the foot. Commercial shoes marketed as cushioned shoes, motion controlled shoes, or stability shoes were assigned on the basis of whether recruits were judged to have high, normal, or low arches. Injury rates were determined following a twelve-week Marine Corps training regimen. Male and female recruits who were assigned shoes on the basis of their plantar foot shape had similar injury risk compared with those with standard stability shoes, regardless of foot type.

Nilsson-Helander K; Silbernagel KG; Thomeé R; Faxén E; Olsson N; Eriksson BI; Karlsson J. Acute Achilles tendon rupture: a randomized, controlled study comparing surgical and nonsurgical treatments using validated outcome measures. Am J Sports Med. 2010;38:2186-93.This randomized, controlled trial compared the results of operative repair of Achilles tendon ruptures with those of nonoperative treatment, with both groups receiving early mobilization. The early mobilization began after two weeks of treatment with a plantar flexion cast and allowed progressive weight-bearing and motion while protecting the leg in a range-of-motion brace. No significant difference was noted between the treatment groups; however, the re-rupture rate was 12% in the nonoperative treatment group, compared with 4% in the operative treatment group. At twelve months postoperatively, there was no significant difference in functional outcomes between the two treatment groups, except that the heel-rise work test favored the operative treatment group.

Khan RJ; Carey Smith RL. Surgical interventions for treating acute Achilles tendon ruptures. Cochrane Database Syst Rev. 2010;9:CD003674.The authors reviewed all randomized and quasi-randomized trials comparing operative and nonoperative treatment of acute Achilles tendon ruptures to evaluate the relative effects of either treatment. Twelve trials involving 844 patients were ultimately included. The pooled data showed that open surgical repair of acute Achilles tendon ruptures significantly reduced the risk of re-rupture compared with nonoperative treatment but significantly elevated the risk of other complications, including wound infection.

Rath S; Schreuders TA; Stam HJ; Hovius SE; Selles RW. Early active motion versus immobilization after tendon transfer for foot drop deformity: a randomized clinical trial. Clin Orthop Relat Res. 2010;468:2477-84.This randomized clinical trial evaluated the effect of early mobilization compared with cast immobilization on tendon insertion pullout following posterior tibial tendon transfer for the treatment of foot drop deformity. The foot drop was the result of longstanding common peroneal nerve palsy due to Hansen disease. The posterior tibial tendon was split into two slips, which were transferred anterior to the ankle via the circumtibial route; one slip was inserted into the extensor hallucis longus, whereas the other slip was inserted into the extensor digitorum longus with use of a Pulvertaft weave. Rehabilitation time was reduced by fifteen days in the early active postoperative motion group, with no cases of pullout identified in association with either the early active motion or the cast management protocol.

Disclosure: None of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of any aspect of this work. None of the authors, or their institution(s), have had any financial relationship, in the thirty-six months prior to submission of this work, with any entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. Also, no author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

Topics

operative procedure on foot ; operative procedure on ankle

First Page Preview

View Large

Username

Password

Access for Patients

Forgot Password?

Have a subscription to the print edition?

Not a Subscriber?

Buy this Article

Get online access for 30 days for $35

New to JBJS?

Subscribe to the online edition for 30 days for $75

Register for a FREE limited account to get full access to all CME activities, to comment on public articles, or to sign up for alerts.

Have a subscription to the print edition?

Current subscribers to The Journal of Bone & Joint Surgery in either the print or quarterly DVD formats receive free online access to JBJS.org.

Activate your online account now

Forgot your password?

Enter your username and email address. We'll send you a reminder to the email address on record.

Username:*

Email Address:*

Forgot your username or need assistance? Please contact customer service at subs@jbjs.org. If your access is provided
by your institution, please contact you librarian or administrator for username and password information. Institutional
administrators, to reset your institution's master username or password, please contact subs@jbjs.org

References

Accreditation Statement

These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.

CME Activities Associated with This Article

Submit a Comment

Please read the other comments before you post yours. Contributors must reveal any conflict of interest.
Comments are moderated and will appear on the site at the discretion of JBJS editorial staff.

* = Required Field

Comment Author(s) * (if multiple authors, separate names by comma)

Example: John Doe

Affiliation & Institution*

Comment Title*

Comment*

Cancel

Print
PDF
Email

Recipient(s) will receive an email with a link (good for 5 days) to 'What’s New in Foot and Ankle Surgery'.
Your Name:*
Example: John Doe

Email Address:* CC Me:
Enter your valid email address. Example: jdoe@example.com

Recipient's Email Address:*

Separate multiple email address with semi-colons (up to 5).

Subject:* 's The Journal of Bone & Joint Surgery: 'What’s New in Foot and Ankle Surgery'
Subject for your email.

Message:

(Optional, message will truncate at 1000 characters)

Processing your request... Please Wait...

Copyright © in the material you requested is held by The Journal of Bone & Joint Surgery, Inc. (unless otherwise noted). This email ability is provided as a courtesy, and by using it you agree that that you are requesting the material solely for personal, non-commercial use, and that it is subject to Journal of Bone & Joint Surgery, Inc.'s Terms of Use. The information provided in order to email this topic will not be used to send unsolicited email, nor will it be furnished to third parties. Please refer to The Journal of Bone & Joint Surgery Inc.'s Privacy Policy for further information.

Copyright © The Journal of Bone & Joint Surgery Inc. All rights reserved.
Share
Get Citation

Randall C. Marx, Mark S. Mizel; What’s New in Foot and Ankle Surgery. The Journal of Bone & Joint Surgery. 2012 May;94(10):952-957.

Download citation file:

RIS (Zotero)

EndNote

BibTex

Medlars

ProCite

RefWorks

Reference Manager

Copyright © The Journal of Bone and Joint Surgery, Inc.
Rights & Permissions
Article Alerts

Processing your request... Please Wait.
Submit a Comment