Foot & Ankle Specialist current issue

Editor's Letter

Baravarian, B. — 2008-07-24

Retrograde Drilling of Osteochondral Lesions of the Talus

Hyer, C. F., Berlet, G. C., Philbin, T. M., Lee, T. H. — 2008-07-24

This study evaluates the use of retrograde drilling in medial osteochondral lesions of the talus (OLTs) with intact articular surfaces. During a 2-year period, 8 consecutive patients underwent surgical treatment for symptomatic posterior medial OLT. All patients underwent arthroscopy of the ankle followed by retrograde drilling of the talar lesion. A novel cannulated system was used to target the lesion, remove the necrotic segment, and then backfill using Grafton gel. The average age of the patients was 36 years old (range, 12-49 years). Follow-up ranged from 8 to 44 months (mean 24 months). One patient was lost to follow-up. Of the remaining 7, outcomes were assessed with a modified American Orthopaedic Foot and Ankle Society (AOFAS) ankle/ hindfoot scale and the SF-12 general health survey. Four patients had repeat magnetic resonance imaging scans at 1-year follow-up. The preoperative AOFAS scores from the modified hindfoot scale ranged from 0 to 41 (mean 22). Postoperative scores ranged from 52 to 68 (mean 56), with a mean improvement of 34 points. The SF-12 has 2 components: the physical component score (PCS) and the mental component score (MCS). Mean preoperative and latest follow-up SF-12 PCS scores were 35.8 and 44.0, respectively. Mean preoperative and latest follow-up SF-12 MCS scores were 40.7 and 52.8, respectively. In this limited series, this technique appears to give comparable short-term results to previously described techniques. Use of a cannulated system simplifies the surgical procedure. Overall, this procedure offers decreased operative time and maximizes safety and accuracy with retrograde talar drilling.

Salvage of the First Ray With External Fixation in the High-Risk Patient

Schweinberger, M. H., Roukis, T. S. — 2008-07-24

In diabetic patients, hallux and first-ray amputations significantly increase the risk of recurrent ulceration and more proximal amputation over time. This small, retrospective study demonstrates that salvage of the first ray can be reliably accomplished, even in high-risk patients, when basic principles of infection management are followed in conjunction with the appropriate use of external fixation. These techniques may help to improve the quality of life and reduce the overall medical resources required for the treatment of recurrent ulceration and amputation in this patient population.

Treatment of Painful Accessory Navicular: A Modification to Simple Excision

Micheli, L. J., Nielson, J. H., Ascani, C., Matanky, B. K., Gerbino, P. G. — 2008-07-24

An accessory tarsal navicular ossicle may produce pain and tenderness despite conservative treatment modalities. This condition causes pain along the medial arch and limitations of activities. This described modification of the Kidner procedure and simple excision technique keeps the tendon insertion intact while restoring some of the normal biomechanical relationships. In addition, this modification has the theoretical advantage of enhancing dynamic support of the longitudinal arch, and by maintaining the continuity of the posterior tibial tendon, a shorter period of immobilization is required. All patients at the most recent follow-up showed improvement, with 11 of 13 patients having excellent results with long-term follow-up.

The Effectiveness of Physician-Directed External Fixation Pin Site Care in Preventing Pin Site Infection in a High-Risk Patient Population

Schweinberger, M. H., Roukis, T. S. — 2008-07-24

Pin tract infection is one of the most frequently reported complications associated with the use of external fixation. Application of compression dressings to prevent motion at the pin-skin interface as well as periodic antiseptic cleansing of the pin sites has been advocated; however, no consensus has been reached on the most effective method of pin site care. This retrospective study was conducted to evaluate the effectiveness of a weekly, physician-directed pin site care protocol on reducing the rate of pin tract infections in a high-risk patient population.

Percutaneous Distal Soft Tissue Release-Akin Procedure, Clinical and Podobarometric Assessment With the BioFoot In-Shoe System: A Preliminary Report

2008-07-24

Hallux valgus (HV) is a common, complex, and progressive deformity of the first ray, leading to biomechanical changes. The purpose of this study is to describe the midterm outcomes of the percutaneous distal soft tissue release–Akin procedure for mild hallux valgus on plantar pressures distribution, clinical outcome, and radiographic parameters. Twenty-six patients (30 feet) who had undergone this procedure were evaluated prospectively. The BioFoot in-shoe system was used for an objective functional evaluation of dynamic plantar pressures in the heel, midfoot, first through fifth metatarsal heads, hallux, and lesser toes. The clinical outcome measurements included preoperative and postoperative American Orthopaedic Foot and Ankle Society (AOFAS) score. The radiological parameters measured were hallux abductus angle (HAA) and first intermetatarsal angle in weight-bearing radiographs. The average follow-up was 12.1 months. There were improvements in the AOFAS rating scale score from 68.7 to 88.1, in HAA from 25.4° to 11.4°, and in the first intermetatarsal angle from 12.0° to 9.2°. The pedobarographic analysis showed a statistically significant decrease (P < .001) in the maximum peak pressure (from 1037 to 498 kPa) and mean pressure (from 487 to 159 kPa) under the hallux. The percutaneous distal soft tissue release–Akin procedure improved the patients' clinical status and reduced the plantar pressures beneath the hallux. This improvement could be attributable to the removal of the medial eminence, which avoids pain around the first metatarsophalangeal joint, and to the Akin procedure, which provides a more physiological postoperative position of the hallux.

The Use of Low-Energy Radial Shockwave in the Treatment of Entrapment Neuropathy of the Medial Calcaneal Nerve: A Pilot Study

Barrett, S. L., Reese, M. M., Tassone, J., Buitrago, M. — 2008-07-24

Medial calcaneal nerve entrapment is a well-recognized cause of heel pain. In addition, the development of an amputation neuroma of the medial calcaneal nerve from prior heel surgery via an open incision on the medial aspect of the heel is a serious common postoperative complication and can be extremely difficult to treat. This preliminary pilot study demonstrates that the use of low-energy extracorporeal shockwave is safe and efficacious in the treatment of this disorder without the morbidity associated with denervation surgery, which would be one of the most common methods to treat this complicated situation. Four patients, 2 with bilateral affectation, for a total of 6 medial calcaneal nerves, had a series of treatments with low-energy radial shockwave with the Swiss DolorClast machine. All 4 patients had improvement in their pain scores, to the point that none elected surgical treatment, and there were no complications.

Charcot Neuroarthropathy

Giza, E., Hyer, C. F., Sella, E. J., Zgonis, T. — 2008-07-24

Rigid Equinovarus Deformity Corrected With a Multiplanar External Fixator

Philbin, T. — 2008-07-24

Operative Techniques for Osteochondral Lesions of the Talus

Giza, E. — 2008-07-24

Advanced Reconstruction: Foot and Ankle: JA Nunley, GB Pfeffer, RW Sanders, E Trepman * American Academy of Orthopaedic Surgeons * 2004 * ISBN: 0-89203-314-2

2008-07-24

2008 Conferences

2008-07-24