Painful peroneal spastic flatfeet without coalition or other known etiologies in adolescence, remains a difficult condition to treat. We present eight such cases with radiological and surgical evidence of bony abnormalities in the lateral subtalar region just anterior to the posterior facet.

All patients had presented as tertiary referrals with recalcitrant pain and had undergone a trial of orthotics and physiotherapy. Diagnostic workup included a clinical and radiographic evaluation. Clinical examination consisted of gait examination, foot alignment, range of motion, torsional profile of the lower limbs and marking of symptomatic foci. All patients had standing weightbearing anteroposterior and lateral projections of the foot and ankle, CT and/or MRI scans of the foot. Coalitions and other known intra-articular pathologies like subtalar arthritis were ruled out. All patients had bilateral flatfeet but unilateral peroneal spasm.

All patients had an accessory anterolateral talar facet (ATF) which was arising as an anterior and distal extension of the lateral process of the talus. This caused lateral impingement between the facet and the calcaneum, confirmed by bone edema around the sinus tarsi and marked at the apex of the angle of Gissane on MRI scans. All patients had stiff subtalar joints with very limited movement under anaesthesia, indicating peroneal muscle contracture. Patients were treated with a combination of facet excision, fractional peroneal and gastrosoleus lengthening and calcaneal lengthening to correct the flatfoot and prevent lateral impingement.

Racial and ethnic disparities in pain perception diagnosis and management have become apparent in different specialities.^1,2 We aimed to assess the differences in symptom perception, as expressed in the oswestry disability score, between different ethnic groups in a UK population before and after surgery.

Oswestry Disability Scores (ODI) (completed at every outpatient visit), and other information were obtained retrospectively for 1568 patients seen at our spinal unit over the last two years. Statistical analysis using analysis of variance (ANOVA) was used to determine any true difference in ODI scores between Caucasian, Afro-Caribbean and South Asian different groups pre and post surgery.

Overall scores were significantly higher for the South Asian group when compared with the white using analysis of variance (ANOVA) p< 0.001. Afro-Caribbean patients also showed a trend to higher overall scores from the white group p=0.091 (least squares difference post-hoc test).

From a total of 280 patients who had undergone surgery, South Asians had significantly higher pre-operative scores compared to Caucasians (p> 0.001). Afro-Caribbean’s also scored higher than Caucasians pre-operatively although the difference was not significant (p=0.091). Scores for South Asians and Afro-Caribbean’s remained higher than those for Caucasians postoperatively. All groups however, did show a statistically significant reduction in ODI score compared to the pre-operative score.

Despite the differences in symptom perception or expression we have found to exist between ethnic groups, we conclude that in appropriately selected patients, this does not affect their ability to benefit from surgery

Ethics approval: none

Interest statement: none

Aim: Aim of this study is to determine if cubital tunnel view radiograph of the elbow is useful in the investigation and treatment of Ulnar nerve entrapment at the elbow.

Patients and Methods: 28 patients presenting with symptoms suggestive of ulnar nerve entrapment at the elbow were prospectively studied. Detailed history and clinical examination was elicited in each patient and classified according to McGowan’s classification. Diagnosis of ulnar nerve entrapment at the elbow was confirmed by nerve conduction studies. Cubital tunnel view radiographs were taken and evaluated for any evidence of bony encroachment of the ulnar nerve bed in the cubital tunnel. Those patients with normal cubital tunnel view radiograph underwent simple ulnar nerve decompression where as those with significant bony encroachment of ulnar nerve bed underwent anterior transposition of the ulnar nerve. The results of surgery were assessed at follow up using the Wilson and Krout criteria. The difference in results in two groups was statistically analyzed by applying student ‘t’ test.

Results: There were 20 patients (male=14, female 6) in the simple ulnar nerve decompression group with a mean age of 52 yrs (range 32 to 61 yrs) and 8 patients (male=6, female=2) in anterior transposition group with a mean age 59 yrs (range 45 to 69 yrs). Mean follow up was 25months (range 9 months to 32 months). According to McGowan’s classification there were 5 grade I, 9 grade II and 6 grade III patients in simple decompression group where as there were none grade I, 3 grade II and 5 grade III in anterior transposition group. All patients had neurophysiological evidence of ulnar nerve entrapment in pre-operative nerve conduction study. Wilson and Krout grading at final follow up showed 15 good, 4 fair and 1 poor result in simple decompression group and 5 good, 2 fair and 1 poor result anterior transposition group. There was no statistically significant difference between the two groups (p value < 0.001).

Conclusion: Cubical tunnel view radiographs are valuable in the management of ulnar nerve entrapment at the elbow. Patients with normal radiograph can be treated by simple nerve decompression