AlloStem/Cellular Bone Allograft and autologous bone graft are accepted methods for managing hindfoot degenerative arthritis. The purpose was to evaluate outcomes of AlloStem and autograft in subtalar arthrodesis and compare overall fusion rates. This study was conducted in IRB compliance. Patients between 18–80 years who qualified for a subtalar fusion were randomized 1:1 to AlloStem or autologous graft. The AOFAS hindfoot ankle scale, FFI-R and SF-12 were collected pre-operatively, 6 weeks, 3 & 6 months, 1 and 2 year. Weight-bearing 3-view ankle X-rays were done at the same intervals. A CT scan was obtained at 6 months.Introduction
Methods
In most cases the etiology of Hallux rigidus is unknown. The purpose of this presentation is to discuss the classification of hallux rigidus, as well as the treatment options for every stage. Treatment suggestions should be individualised depending not only on the grade of the hallux rigidus, but also the patient's expectations. These include expectations regarding footwear, recreational activities and the potential of further surgeries depending upon the initial choice of treatment. Emphasis will be placed on joint preserving options, including adding a Moberg osteotomy to proximal halangs to increase perceived dorsiflexion of the great toe.
Hindfoot fusions are not new and can be a very valuable tool to address a variety of hindfoot problems. It is, however, not a procedure without significant issues. With the combination of a subtalar and talo-navicular fusion most of the ability to compensate for uneven terrain is lost, as is the ability to compensate for minor misalignments in the foot itself. It is therefore extremely important to be diligent in planning and execution of a triple arthrodesis. Deformities should be corrected, but not over-corrected. It is seldom that in situ fusions of deformities are indicated. Stable internal fixation is recommended to avoid loss of correction in the healing period. Indications, surgical approach and rationale for treatment will be discussed.
There are many reasons for muscle imbalance around the foot and ankle but the most common is some form of neuromuscular disease. The etiology is obviously very important in the decision making of treatment options. One should be aware of the progression pattern of the disease or condition. The simplest imbalances to treat are those secondary to a static condition. The initial goal is to determine what force couples are available, what can be used, is it an in phase, or out of phase muscle you want to transfer. Next is to determine if there are any contractures that will have to be addressed and equally important whether there are fixed skeletal deformities present. No tendon transfer will be able to overcome a fixed bony deformity, and those should be corrected prior to transferring muscles.
