The present study sought to assess the clinical and radiological results and long-term joint impact of different techniques of lateral ankle ligament reconstruction.

Introduction The aims of this paper was to check the main clinical features of the posterior ankle impingment syndrom and to evaluate the results of the surgical treatment according to a retrospective study. Material and Methods 21 patients (17 males,4 females),(mean age of 33 years)were operated on between 1991 and 1999. 71 % had sporting activities. Plantar flexion were painful in 94 % of cases with various radiological changings of the posterior process of the talus and soft tissues surrounded (XRays, radionucleid imaging, CTscan and MRI). A posterior approach were performed with bone resection and peritalar joints debridment. Results All the patients were clinically and radiologically reviewed using AOFAS score. The mean follow-up was of 5 years(range 3 to 10 years). No septic evolution were reported. The overall functional results were excellent with a mean AOFAS score of 90/100 points with no degenerative changings in the peritalar joints. The patients were satisfied in 90 % of the cases Discussion-Conclusion Surgical managment is a successful and reliable procedure to treat the posterior ankle impingment syndrom, very frequent in sporting population and nowadays well documented by conventional Xrays and uptodate radiological examinations.

Purpose: This prospective study focused on an interhospital collaboration for foot and ankle surgery. Collaboration was organised between the referring surgeon and four regional foot and ankle specialists. We evaluated concordance and discordance between expert opinions.

Material and methods: Patients for whom an opinion was requested were selected by the requesting surgeon based on problems involving diagnosis or therapeutic indications. Opinions were requested by email. Individual protocols were established for the clinical report and x-ray file of each type of condition. The final therapeutic decision was made by the requesting surgeon.

Results: Among the 450 patients seen for foot and ankle disorders, opinions were requested from experts for 30. The conditions involved: the forefoot (46%), the middle foot (16%), the hindfoot (7%) and the ankle (31%). Mean time for the response was eleven days (1–60). Experts responded to all requests (120 responses) but in four cases (3%) could not provide an opinion. The index of diagnostic agreement among the experts was 3.2/4. The index for therapeutic indications showed agreement at 2.6/4. Agreement between the therapy proposed to the patient and that proposed by the experts was 2.6/3.

Discussion: We analysed the advantages for the patient, the responsibility of the requesting and responding surgeon, and the problems related to remuneration of this type of counselling. Compared with other technologies, email was found to be simple, reliable, and low-cost with good quality images. This work showed that there was concordance between the opinions and that electronic expertise counselling is certainly very useful for foot disorders. Requests addressed to several experts increases precision and provides complementary information for difficult cases. It is important that the different participants know each other.

Conclusion: This work is the first step towards the development of a care network for foot and ankle disease enabling graduated patient management.

Aims: Hindfoot deformity in varus position is an aetiology of chronic ankle instability without laxity. In this condition, a Dwyer osteotomy has to be performed.

Methods: Between 1992 and 2000, 15 patients have been operated on, with this technique. The mean varus deformity was of 5û (3û to 10û).13 patients had sporting activities, 8 of them in competition. Instability during sporting activity were present in 60% of cases. Associated lesions were reported in 6 cases. A Dwyer procedure using a 1/3 tube plate þxed with two screws were performed in all cases. Associated procedures were performed at the same time as such as a lateral ligamentoplasty or a þrst metatarsal osteotomy. All patients were reviewed clinically and radiologically using AOFAS score.

Results: The mean follow-up was of 3.5 years (1 to 9 years). The only one complication reported was a skin necrosis, treated by a cutaneous ßap in a patient operated on with Dwyer and ligamentoplasty in the same procedure. No ankle instability was reported. Mild pain was reported in 10 patients and 50% of them only for sporting activities.11 patients returned to sporting activity and 33% of them at the same level. The mean Kita-oka score was of 92 (85 to 100). The patients were satisþed and very satisþed in 80 of cases.

Conclusions: Dwyer lateral closing wedge calcaneal osteotomy is successful for the treatment of chronic ankle instability without laxity and with varus hindfoot deformity. When laxity is associated with varus deformity an operative procedure in two steps is necessary to avoid wound complication. Dwyer osteotomy has to be performed þrst.