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Smoking Cessation: The Role of the Foot and Ankle Surgeon

Greenhagen, R. M., Johnson, A. R., Bevilacqua, N. J. — Fri, 13 Nov 2009 10:29:36 PST

Tobacco cigarette smoking causes many negative effects on the body, and it is the leading preventable cause of death in the United States. These negative effects are a concern for the foot and ankle surgeon, as smoking can increase the risk of diabetes and peripheral artery disease and delay healing of surgical incisions and ulcerations of the lower extremities. Tobacco cigarette smoking can also increase the risk of avascular necrosis and delayed union and nonunions of fractures and osteotomies. Smoking cessation is an important component in the overall treatment of conditions affecting the foot and ankle. Smoking cessation can be a difficult goal to achieve, but proper education and support can help patients reach this goal.

Scarf Osteotomy for the Correction of Adolescent Hallux Valgus

John, S., Weil, L., Weil, L. S., Chase, K. — Fri, 06 Nov 2009 12:05:55 PST

Adolescent hallux valgus deformity is a complex surgical condition. Although several techniques have been described to correct this deformity in adults, limitations exist for adolescents because of the presence of open growth plates and high recurrence rates. This retrospective study reports results of 7 patients (14 feet) using the Scarf osteotomy for correction of adolescent hallux valgus deformity. All patients underwent concomitant bilateral hallux valgus surgery. Radiographic evaluation measures included intermetatarsal 1-2 angle, hallux valgus angle, and distal metatarsal articular angle. Data recorded from the lateral radiograph evaluated the first metatarsal declination angle. Postoperative patient satisfaction was assessed using a standard patient satisfaction survey. Postoperative, subjective, and objective measurements were calculated using the American College of Foot and Ankle Surgeons (ACFAS) Scoring Scale for the First Metatarsophalangeal Joint and First Ray and the American Orthopaedic Foot & Ankle Society (AOFAS) Hallux Metatarsophalangeal-Interphalangeal Scoring Scale. Average patient age and follow-up were 14.43 years and 57 months, respectively. There was 100% maternal inheritance of hallux valgus deformity. The average postoperative ACFAS Metatarsophalangeal Joint and First Ray Scale (module 1) score was 94.72, and the average AOFAS Hallux Metatarsophalangeal-Interphalangeal Scale score was 96.43. Complications included 1 patient who underwent revision surgery on 1 foot 18 years after the date of index surgery because of painful recurrence of the deformity. The authors believe the Scarf osteotomy is a safe, effective, and versatile procedure for the correction of juvenile and adolescent hallux valgus deformity.

Apligraf: Bilayered Skin Substitute to Augment Healing of Chronic Wounds in Diabetic Patients

DeCarbo, W. T. — Mon, 02 Nov 2009 14:09:40 PST

Chronic wounds are wounds that fail to heal or fail to progress to healing within an appropriate time frame. Standard wound care consists of debridement of all nonviable tissue, off-loading, and maintaining a moist environment, typically with saline-moistened gauze. Infection control, blood flow, and nutrition also play pivotal roles in wound healing. Bioengineered tissue, Apligraf, has been shown to be both efficacious and safe when used in chronic wounds. Apligraf delivers growth factors and cytokines to the wound environment to help complete closure and decrease healing time.

Bilayered Bioengineered Skin Substitute to Augment Wound Healing

DeCarbo, W. T. — Mon, 02 Nov 2009 14:09:39 PST

Wounds that fail standard wound care for more than 4 weeks are often very difficult to heal. Several factors including senescent cells, an inflammatory wound environment, unavailable growth factors, and the presence of bacteria inhibit chronic wounds from healing. Bioengineered tissue, such as Apligraf (Organogenesis Inc, Canton, Massachusetts), has been shown to be both safe and effective in decreasing healing time and increasing the incidence of complete wound closure. The science and technology behind bioengineered tissue has altered the way chronic wounds are treated.

Fibrolipoma of the Toe

Lui, T. H. — Wed, 28 Oct 2009 09:07:06 PDT

Lipoma is one of the most common benign soft-tissue tumors. It is most common in the regions of the upper back, neck, abdomen, and the proximal part of the extremities. Toe lipoma is rare. The author presents a case of third toe fibrolipoma that was successfully treated by toe amputation.

Opening Wedge Osteotomies for Correction of Hallux Valgus: A Review of Wedge Plate Fixation

Smith, W. B., Hyer, C. F., DeCarbo, W. T., Berlet, G. C., Lee, T. H. — Mon, 26 Oct 2009 08:25:30 PDT

Osteotomy of the proximal metatarsal for the correction of moderate to severe hallux valgus deformity is commonly performed. The purpose of this study is to review the early results of a technique for the correction of hallux valgus, an opening wedge osteotomy of the proximal first metatarsal with opening wedge plate fixation. A review was performed of the results of 47 patients (49 feet) who underwent correction of hallux valgus with proximal metatarsal opening wedge osteotomy. Allosteotomies were secured with platefixation on the medial side. Evaluation consisted of preoperative and postoperative radiographic as well as clinical evaluations. Mean corrections of 7° were achieved for the 1-2 intermetatarsal angles. Fourteen complications occurred, 6 of which involved mild hardware irritation and did not affect outcome. Four nonunions or delayed unions were identified. The authors find the opening wedge osteotomy of the proximal first metatarsal to be a technically straightforward procedure for correcting moderate to severe hallux valgus. The correction obtained is comparable to other described techniques.

Ilizarov External Fixation Technique for Repair of a Calcaneal Avulsion Fracture and Achilles Tendon Rupture

Ramanujam, C. L., Capobianco, C. M., Zgonis, T. — Mon, 26 Oct 2009 08:25:29 PDT

Epidemiology and Outcomes of Achilles Tendon Ruptures in the National Football League

Parekh, S. G., Wray, W. H., Brimmo, O., Sennett, B. J., Wapner, K. L. — Tue, 13 Oct 2009 09:10:47 PDT

The purpose of this study is to document the epidemiology of Achilles tendon ruptures in the National Football League (NFL) and to quantify the impact of these injuries on player performance. A retrospective review of several online NFL player registries identified 31 Achilles tendon ruptures in NFL players between 1997 and 2002. Nineteen percent of injuries occurred during preseason play, while another 18% occurred during the first month of the official season. There was a postinjury reduction of 88%, 83%, and 78% in power ratings for wide receivers, running backs, and tight ends, respectively, over a 3-year period. There was a 95%, 87%, and 64% postinjury reduction in power ratings for linebackers, cornerbacks, and defensive tackles over a 3-year period. On average, players experienced a greater than 50% reduction in their power ratings following such an injury. Thirty-two percent (n = 10) of NFL players who sustained an Achilles tendon rupture did not return to play in the NFL.

Tibiofemoral Angle and Its Relation to Ankle Sprain Occurrence

Pefanis, N., Karagounis, P., Tsiganos, G., Armenis, E., Baltopoulos, P. — Tue, 13 Oct 2009 09:10:46 PDT

The lack of a normal joint orientation generates translational or shear forces across the joint. These forces can put abnormally high strain on the cartilage and the surrounding capsuloligamentous tissues. Ankle joint structure can affect or be affected by bony malformations of the surrounding areas, including the knee and hip. The aim of the current study is to examine the possible relationship between the tibiofemoral (TFA) angle and other factors (anthropometric characteristics, medical history, and age) on the occurrence of ankle sprains because its value provides useful information for the anatomical alignment of the lower extremity. The study sample consisted of 45 high-level athletes, evenly distributed among 3 sports (basketball, soccer, and volleyball). TFA measurements were made on radiographs. The study lasted 2 years. A logistic regression was used to determine the importance of each factor on the probability in question. A significance level of P = .1 was used. The factors contributing more to an ankle sprain were a previous injury of the same type followed by body mass index (BMI) and age. On the contrary, TFA was proven to be statistically nonsignificant. When the BMI variable was substituted with body inertia propensity, a derived variable, the TFA remained statistically nonsignificant. TFA magnitude does not seem to be a determinant factor that could increase the probability of spraining an ankle.

Posterior Impingement in a Pediatric Population: A Review and Case Report

Khan, R. A., Wahab, S., Ullah, E. — Fri, 09 Oct 2009 07:23:59 PDT

Fracture of the os trigonum is exceptionally rare, and it is even rarer in the pediatric age group. Symptomatically and radiographically, it may be confused with what is known as the os trigonum syndrome (constellation of symptoms produced by fracture of the lateral tubercle of the posterior talar process). The authors report a case of a fracture of the os trigonum, as well as its clinical features and management.

Neurilemmoma of the First Branch of the Lateral Plantar Nerve Causing Tarsal Tunnel Syndrome

Kwok, K. B., Lui, T. H., Lo, W. N. — Tue, 06 Oct 2009 11:36:13 PDT

In this article, the authors report a case of tarsal tunnel syndrome caused by neurilemmoma of the first branch of the lateral plantar nerve, with symptom resolved after excision. A 42-year-old man presented with left medial heel pain radiating to the lateral sole for 6 months. On examination, there was positive Tinel sign over the medial heel with pain radiating to the lateral sole. Ultrasonography and magnetic resonance imaging confirmed the presence of a 1-cm neurogenic tumor inside the tarsal tunnel. Intraoperatively, a 1-cm neurilemmoma was found at the first branch of the lateral plantar nerve inside the tarsal tunnel. The lesion was excised completely with preservation of its fascicle. The symptom resolved completely after the operation.

Static Measure of Foot Loading

Tue, 06 Oct 2009 11:36:11 PDT

Static and dynamic loading of the foot are important characteristics for understanding human walking in both health and disease. The goal of this investigation was to determine whether an objective measure of normal midstance loading of the foot could reliably be recorded using readily available disposable qualitative recording devices. Ten randomly selected normal volunteers were trained to step on Harris mat and Pressure Stat recording devices during normal walking. Each of the recordings was divided into 5 weight-bearing regions by 2 separate examiners. After outlining each foot, the recordings were digitized and compared. Interobserver reliability ranged from 0.81 to 0.96 for the Harris mat technique and 0.94 to 0.97 for the Pressure Stat technique. Data from a linear regression plot indicate high precision of calculations of the foot masks between the 2 examiners based on an R² value of 0.966 using the Pressure Stat method. These data plus a linear regression plot suggest that both qualitative recording devices, when digitized using a standardized format, appear to obtain a reliable objective measure of midstance loading during normal gait. The Pressure Stat device may be slightly more reliable. It is planned to use this standardized experimental model to compare objectively patterns of midstance loading in patients with injury or disease that is capable of altering normal walking.

Orthotics and Shoes

Koller, A., Rosenbloom, K. B., Schweinberger, M. H., Smith, S. — Fri, 04 Sep 2009 06:35:14 PDT