The following is a brief overview of research related to foot and ankle
surgery that was published or presented between July 2004 and June 2005. The
sources of these studies included The Journal of Bone and Joint Surgery
(American Volume), Foot and Ankle International, and the proceedings of
the Winter and Summer meetings of the American Orthopaedic Foot and Ankle
Society (AOFAS) (held on February 26, 2005, in Washington, DC, and on July 15
through 17, 2005, in Boston, Massachusetts).
Hoiness P, Stromsoe K. Tricortical versus quadricortical syndesmosis
fixation in ankle fractures: a prospective, randomized study comparing two
methods of syndesmosis fixation. J Orthop Trauma. 2004;18:331-7.
Sixty-four patients with AO type-C fractures and widening of >2 mm at
the syndesmosis were managed with two 3.5-mm tricortical syndesmosis screws
(thirty-four patients) or one quadricortical syndesmosis screw (thirty
patients). Both groups were allowed 2 to 5 kg of weight-bearing for eight
weeks. Patients in the quadricortical-screw group continued with minimal
weight-bearing until the screw was removed at eight to twelve weeks. Patients
in the tricortical-screw group were allowed full weight-bearing after eight
weeks. The overall function score was higher in the tricortical-screw group at
three months. However, the difference was not significant at one year. The
difference in dorsiflexion between the injured ankle and the contralateral
side was not significant in either group at three months or one year. It does
not appear to make a significant difference whether one uses tricortical or
quadricortical syndesmotic fixation.
Takao M, Uchio Y, Naito K, Fukazawa I, Kakimaru T, Ochi M. Diagnosis
and treatment of combined intra-articular disorders in acute distal fibular
fractures. J Trauma. 2004;57:1303-7.
The authors performed a prospective, randomized study on seventy-two
patients with Weber type-B distal fibular fractures to evaluate intraarticular
abnormalities associated with distal fibular fractures. The patients were
randomly managed with arthroscopy-assisted open reduction and internal
fixation (AORIF) or with open reduction and internal fixation (ORIF) only.
There were forty-one patients in the AORIF group and thirty-one patients in
the ORIF group. Thirty patients were found to have osteochondral lesions of
the talar dome, and thirty-three were found to have syndesmosis disruption.
The osteochondral lesions were treated with removal of the fragment and
osseous drilling. The syndesmotic injuries were identified by means of a
stress test of the distal tibiofibular articulation after fixation of the
fibular fracture. If instability of the syndesmosis was present, syndesmosis
fixation was performed with use of a 4.5-mm cannulated titanium screw. In both
groups, all of the fibular fractures were fixed with use of the posterior
antiglide plating technique. The postoperative protocol was the same in both
groups. In the AORIF group, ankle arthroscopy was performed one year after the
initial procedure with removal of the plate and/or syndesmotic screw. The mean
AOFAS hindfoot-ankle score was 91.0 in the AORIF group and 87.6 in the ORIF
group. This difference was significant (p = 0.0106). Better clinical results
were obtained when the proper diagnosis and treatment of concomitant
intra-articular abnormalities were achieved during the surgical treatment of
the distal fibular fracture.
Mazieres B, Rouanet S, Velicy J, Scarsi C, Reiner V. Topical
ketoprofen patch (100 mg) for the treatment of ankle sprain: a randomized,
double-blind placebo-controlled study. Am J Sports Med.
A randomized, double-blind, placebo-controlled study was performed to
evaluate the efficacy and tolerability of the daily application of a 100-mg
patch of ketoprofen for the treatment of pain after an acute grade-I or II
ankle sprain that had occurred less than two days previously. One hundred and
sixty-three patients were included in the study. Eighty-one patients received
ketoprofen treatment, and eighty-two patients received a placebo. After one
week of treatment, the decrease in spontaneous pain was significantly greater
(p = 0.0007) in the ketoprofen group than in the placebo group. Tolerance was
good in both groups. This study showed that a seven-day course of treatment
with a ketoprofen patch can reduce pain after these injuries; however,
treatment of ankle ligament injuries with only analgesics, without protecting
the ligaments from additional damage, should be undertaken only with informed
Verhagen RA, Maas M, Dijkgraaf MG, Tol JL, Krips R, van Dijk CN.
Prospective study on diagnostic strategies in osteochondral lesions of the
talus. Is MRI superior to helical CT? J Bone Joint Surg Br.
One hundred and four ankles with chronic ankle pain were evaluated on the
basis of the history, a physical examination, standard anteroposterior and
lateral weight-bearing radiographs of both ankles, anteroposterior mortise
views of both ankles with a 4-cm heel-rise, helical computerized tomography,
magnetic resonance imaging, and diagnostic arthroscopy to determine the best
method for detecting an osteochondral lesion of the talus. Thirty-five
osteochondral lesions were identified in twenty-nine ankles, with twenty-seven
lesions being located in the talus. The authors found that helical
computerized tomography, magnetic resonance imaging, and diagnostic
arthroscopy were significantly better than the other methods. There was no
significant difference between helical computerized tomography and magnetic
resonance imaging. Furthermore, diagnostic arthroscopy was not better than
helical computerized tomography or magnetic resonance imaging for diagnosing
osteochondral lesions. Helical computerized tomography was more accurate than
magnetic resonance imaging when an osteochondral lesion was present. On the
other hand, magnetic resonance imaging was more accurate when there was a
negative test result. This study showed that ankles with chronic pain should
be examined with advanced radiographic methods, with computerized tomography
and magnetic resonance imaging each having its own advantage.
Thomson CE, Gibson JN, Martin D. Interventions for the treatment of
Morton's neuroma. Cochrane Database Syst Rev. 2004;3:CD003118.
The authors reviewed three randomized or quasi-randomized trials involving
121 patients in order to determine the effectiveness of interventions in
adults with Morton's neuroma. There was no evidence to support the use of
supination or pronation insoles. There was a very limited indication that
transposition of the transected plantar interdigital nerve yielded better
long-term results than standard resection and that dorsal incisions resulted
in less symptomatic postoperative scars than plantar incisions did. The
authors concluded that there was insufficient evidence for them to assess the
effectiveness of surgical and nonsurgical treatment options for Morton's
neuroma. This procedure is very surgeon-dependent, and it is difficult to
combine different studies.
Khan RJ, Fick D, Brammar TJ, Crawford J, Parker MJ. Interventions
for treating acute Achilles tendon ruptures. Cochrane Database Syst
Rev. 2004; 3:CD003674.
Fourteen randomized or quasi-randomized trials involving 891 patients were
reviewed. On the basis of four trials involving 356 patients, the authors
concluded that open operative treatment of acute Achilles tendon ruptures
significantly decreased the risk of rerupture when compared with nonoperative
treatment. However, open repair was associated with significantly higher
(relative risk, 10.60; 95% confidence interval, 4.82 to 23.28) rates of wound
infection, adhesions, and disturbed skin sensibility. On the basis of two
studies involving ninety-four patients, the authors reported that percutaneous
repair was associated with a shorter surgical time and a lower risk of
infection compared with open repair. On the basis of five studies involving
273 patients, the authors reported that patients who had been managed with a
functional brace postoperatively had a shorter inpatient stay, less time off
work, and a quicker return to sporting activities compared with those who had
been managed with a cast. The authors were unable to make definitive
conclusions regarding different operative and nonoperative techniques or
different forms of postoperative cast immobilization.
Maciejewski ML, Reiber GE, Smith DG, Wallace C, Hayes S, Boyko EJ.
Effectiveness of diabetic therapeutic footwear in preventing reulceration.
Diabetes Care. 2004;27:1774-82.
The authors reviewed nine published articles on the effectiveness of
therapeutic footwear in preventing foot ulceration in patients with diabetes
and foot risk factors. Risk ratios between therapeutic footwear and
reulceration in all of the studies were <1.0, suggesting that therapeutic
footwear provides some protective benefit. However, in the most rigorous
study, no significant difference was identified between control patients
wearing their own footwear and study patients wearing therapeutic footwear. In
observational studies, a major protective benefit from therapeutic footwear
was found in patients with severe foot deformity or previous toe or ray
amputations. The authors concluded that there was not enough consistent
evidence to support therapeutic footwear and inserts for all patients with
diabetes. The need for therapeutic footwear and inserts should be assessed by
the provider and the patient on the basis of the individual's foot risk