Foot & Ankle Specialist current issue

Primum Non Nocere (First, or Above All, Do No Harm)

Berlet, G. C. — Thu, 08 Oct 2009 12:00:09 PDT

Positional Effects of the Knee and Ankle on the Ends of Acute Achilles Tendon Ruptures

Wray, W. H., Regan, C., Patel, S., May, R., Parekh, S. G. — Thu, 08 Oct 2009 12:00:09 PDT

Conservative management of acute Achilles tendon ruptures in a plantarflexed short leg cast or functional brace is a viable alternative to surgery. The ideal plantarflexion angle to allow the free ends of the tendon to oppose one another has not been clearly defined. The purpose of this cadaveric study was to define a plantarflexion angle where the free Achilles tendon ends reliably oppose one another. Ten cadaveric legs amputated at the distal femur were obtained. A laceration of the Achilles tendon was made 4 cm above the calcaneal insertion. A joint-spanning external fixator was placed across the knee. With differing degrees of knee flexion (0, 45, and 90 degrees), the diastasis between the free ends of the Achilles tendon was measured as the ankle was moved from 20 degrees of dorsiflexion to 30 degrees of plantarflexion (—20, —10, neutral, 10, 20, and 30 degrees). Regardless of knee flexion angle, the ankle plantarflexion angle where the free ends of the Achilles tendon opposed one another was 28.0 (95% confidence interval: 25.0-33.6) degrees. The ideal ankle angle in which to immobilize patients appears tightly clustered around 28 degrees of plantarflexion.

Recovery of Calf Muscle Strength Following Acute Achilles Tendon Rupture Treatment: A Comparison Between Minimally Invasive Surgery and Conservative Treatment

Thu, 08 Oct 2009 12:00:09 PDT

The aim of this study was to measure the effect of treatment of acute Achilles tendon ruptures on calf muscle strength recovery. Eighty-three patients with acute Achilles tendon rupture were randomly allocated to either minimally invasive surgery with functional after-treatment or conservative treatment by functional bracing. Calf muscle strength using isokinetic testing was evaluated at 3 months and after 6 or more months posttreatment. To exclusively investigate the effect of treatment on outcome, the authors excluded patients with major complications from the analysis. In 31 of 39 patients in the surgical treatment group and 25 of 34 patients in the conservative treatment group, isokinetic strength tests were performed. In the analysis of differences in mean peak torque, no statistically significant differences were found between surgery and conservative treatment, except for plantar flexion strength at 90 degrees per second at the second measurement, favoring conservative treatment. After 8 to 10 months follow- up, loss of plantar flexion strength was still present in the injured leg in both treatment groups. In conclusion, isokinetic muscle strength testing did not detect a statistically significant difference between minimally invasive surgical treatment with functional after-treatment and conservative treatment by functional bracing of acute Achilles tendon ruptures.

Results of Lapidus Arthrodesis and Locked Plating With Early Weight Bearing

Sorensen, M. D., Hyer, C. F., Berlet, G. C. — Thu, 08 Oct 2009 12:00:09 PDT

In the endeavor toward Lapidus fusion, the authors have studied a new application of locked plating for the first tarsometatarsal joint. The goal was to assess the time to fusion, time to ambulation, rate of delayed union/nonunion, rate of revision, and need for hardware removal following the use of locked-plate technology in the fusion of the first tarsometatarsal joint. The findings denoted an average of 6.95 weeks to radiographic fusion, an average of 2 weeks to ambulation, a 9.52% rate of asymptomatic mal-union, a 0% rate of delayed union or nonunion, and a 0% rate of revision. The rate of need for hardware removal was 4.76%.

Special Segment: Soft Tissue Matrices--David G. Armstrong, DPM, PhD

Thu, 08 Oct 2009 12:00:09 PDT

Special Segment: Soft Tissue Matrices--One Form of Acellular Human Dermis for Use in Tendon and Ligament Repairs in the Foot and Ankle

Blum, B. E., Burgess, A. V. — Thu, 08 Oct 2009 12:00:09 PDT

Trauma to tendons and ligaments represents a significant part of orthopaedic and podiatric injuries. To improve the outcome of repair, complex or chronic injuries may require reinforcement of the primary repair with a graft. Biologic grafts currently available provide different handling, strength, and biological responses. One of the currently available grafts, an acellular human dermal membrane with specific properties, has been successfully used in the augmentation of tendon and ligament repairs for more than 6 years.

Special Segment: Soft Tissue Matrices--Soft-Tissue Augmentation of the Foot and Ankle Using an Acellular Regenerative Tissue Scaffold

Brigido, S. A. — Thu, 08 Oct 2009 12:00:09 PDT

Surgical treatment of damaged soft-tissue structures in the young and physically active patient requires keen understanding of biomechanical forces that are placed on the repair during rehabilitation. Over the years, several materials have been evaluated to mechanically augment suture repair. Autograft tissues such as the gastrocnemius fascia, flexor hallicus longus, peroneus brevis, fascia lata, and plantaris have been implemented successfully. Concerns over donor site morbidity have limited the use of these autologous tissues. Allografts such as fascia lata and tendon have been used successfully but are plagued with practical issues such as inflammatory reaction and suture retention weakness. Acellular regenerative tissue scaffolds have gained in popularity in recent years because of the limited host inflammatory response, ease of use, and high tensile strength.

Imaging of the Foot

Baker, J. R., Landsman, A., Liddell, R. M., Sella, E. J. — Thu, 08 Oct 2009 12:00:09 PDT

Lisfranc Tightrope

Baravarian, B., Geffen, D. — Thu, 08 Oct 2009 12:00:09 PDT

Surgical Reconstruction of the Diabetic Foot and Ankle * Thomas Zgonis * Lippincott Williams & Wilkins * 2009 * ISBN: 0781784581

Thu, 08 Oct 2009 12:00:09 PDT

2009-2010 Conferences

Thu, 08 Oct 2009 12:00:09 PDT