This study assessed if transfer of the extensor hallucis longus is a valid alternative treatment to split transfer of the
A total of 38 relapsed congenital clubfeet (16 stiff, 22 partially correctable) underwent revision of soft-tissue surgery, with or without a bony procedure, and transfer of the tendon of
Subcutaneous rupture of the tendon of
Aims. To systematically review the efficacy of split tendon transfer surgery on gait-related outcomes for children and adolescents with cerebral palsy (CP) and spastic equinovarus foot deformity. Methods. Five databases (CENTRAL, CINAHL, PubMed, Embase, Web of Science) were systematically screened for studies investigating split
Specific brace-fitting complications in idiopathic congenital talipes equinovarus (CTEV) have been rarely described in published series, and usually focus on non-compliance. Our primary aim was to compare the rate of persistent pressure sores in patients fitted with Markell boots and Mitchell boots. Our additional aims were to describe the frequency of other brace fitting complications and identify age trends in these complications. A retrospective analysis of medical files of 247 idiopathic CTEV patients born between 01/01/2010 - 01/01/2021 was performed. Data was collected using a REDCap database. Pressure sores of sufficient severity for clinician to recommend time out of brace occurred in 22.9% of Mitchell boot and 12.6% of Markell boot patients (X. 2. =6.9, p=0.009). The overall rate of bracing complications was 51.4%. 33.2% of parents admitted to bracing non-compliance and 31.2% of patients required re-casting during the bracing period for relapse. For patients with a minimum follow-up of age 6 years, 44.2% required
Aims. There is a lack of high-quality research investigating outcomes of Ponseti-treated idiopathic clubfeet and correlation with relapse. This study assessed clinical and quality of life (QoL) outcomes using a standardized core outcome set (COS), comparing children with and without relapse. Methods. A total of 11 international centres participated in this institutional review board-approved observational study. Data including demographics, information regarding presentation, treatment, and details of subsequent relapse and management were collected between 1 June 2022 and 30 June 2023 from consecutive clinic patients who had a minimum five-year follow-up. The clubfoot COS incorporating 31 parameters was used. A regression model assessed relationships between baseline variables and outcomes (clinical/QoL). Results. Overall, 293 patients (432 feet) with a median age of 89 months (interquartile range 72 to 113) were included. The relapse rate was 37%, with repeated relapse in 14%. Treatment considered a standard part of the Ponseti journey (recasting, repeat tenotomy, and
Ponseti method has become the most common and validated initial non-operative and/or minimally invasive treatment modality of idiopathic clubfoot regardless of the severity of the deformity worldwide. Despite hundreds of publications in the literature favoring Ponseti method, the data about secondary procedures performed in the follow-up period of clubfoot and their incidence remains sparse and given as small details in the articles. The objective of this study was to analyse our incidence of secondary procedures performed in the midterm followup period of idiopathic clubfoot patients treated with Ponseti method and review of the relevant literature. For this purpose 86 feet of 60 patients with idiopathic clubfoot who were treated with original Ponseti method were enrolled in this retrospective case control study. Unilateral ankle foot orthosis (AFO) was used rather than standart bar-connected foot abduction orthosis varying from 12 months to 25 months in the follow-up period and 74 of 86 (86%) feet required percutaneous achilles tenotomy. The average age of initial cast treatment was 12.64 days (range 1 to 102 days). The mean follow-up time was 71 months (range 19 to 153 months). Thirty seven feet of 24 patients recieved secondary procedures (43%) consisting of; supramalleolary derotational osteotomy (SMDO) (1 patient/2 feet), complete subtalar release (3 patients/5 feet), medial opening lateral closing osteotomy (double osteotomy) (2 patients/3 feet), double osteotomy with transfer of
Purpose of study and background. Psychological factors are considered to play a role in development and maintenance of chronic low back pain (CLBP). Stress or anxiety can change pain sensitivity; however, this has predominantly been studied in healthy individuals with limited work in individuals with musculoskeletal pain. The objective of this study was to quantify the effect of acute exposure to a psychosocial stressor on mechanical pain sensitivity in individuals with and without CLBP. Summary of methods and results. Six individuals with CLBP and 10 individuals without CLBP performed a 10-minute computer task under conditions of low and high psychosocial stress. Psychosocial stress was manipulated using mental maths and memory tasks combined with social evaluative threat. The effect of the stressor was evaluated using blood pressure, heart rate and the state anxiety component of the Spielberger State-Trait Anxiety Index. Mechanical pressure pain threshold (PPT) was recorded on the
Introduction: Activated platelets release various growth factors, some ot which are recognize to improve nerve regeneration. The present study evaluated the effect of platelet-rich-plasma (PRP) in end to end neurorraphy. Material and method: A total of 38 Spragle-Dawley rats were used. The PRP was obteined from each rat and applicated to the same rat. The left hind limb were used as experimental, with the right as control. The animals were treated in two grups. In both groups the sciatic nerve was dissected from the sciatic notch to the bifurcation. The nerve was transected an repaired with epineural suture (ethilon 9–0). Group A (n=12): suture without PRP. Group B (n=15) suture with PRP. The rats were anestherized and electromyographic studie was performed after the following, 120,5 days for group A and 125,86 for group B. Prior to sacrifice muscular and nerve tissue harvesting was performed. The amplitude was expressed as the amplitude at the experimental sde divided by the amplitude at the contralateral, untreated side, multiplied by 100%. Recording was done in gastrocnemius and
We report the effect of introducing a dedicated
Ponseti service on the five-year treatment outcomes of children
with idiopathic clubfoot. Between 2002 and 2004, 100 feet (66 children; 50 boys and 16
girls) were treated in a general paediatric orthopaedic clinic.
Of these, 96 feet (96%) responded to initial casting, 85 requiring
a tenotomy of the tendo-Achillis. Recurrent deformity occurred in
38 feet and was successfully treated in 22 by repeat casting and/or
tenotomy and/or transfer of the tendon of
Purpose. This study aimed to objectively define gait derangements and changes before and after Tibialis Anterior Tendon Transfer surgery in a group of patients treated using the Ponseti method. Methods. 21 feet in 13 patients with Ponseti treated clubfoot who showed supination in swing on clinical examination, underwent gait analysis before, and approximately 12 months after, Tibialis Anterior Tendon transfer. 3–4 weekly casts were applied prior to the surgery, which was performed by transfer of the complete TA tendon to the lateral cuneiform. A parental satisfaction questionnaire was also completed. Results. In all but one patient, increased supination in swing phase was confirmed on pre-operative gait analysis, with EMG evidence of poor Tibialis Anterior modulation through-out the gait cycle. Post-operatively all patients showed improved positioning at initial contact, with heel strike and an absence of supination, and a decrease in swing phase supination. In all patients, knees were overly flexed at initial contact, some continuing through stance phase; there was no change seen postoperatively. All parents reported marked improvements in gait and activity level post-operatively. Conclusion. Gait analysis can be useful to confirm the need for
1. In young rabbits the muscle belly of the
We reviewed 19 patients (30 feet) with congenital vertical talus treated surgically between 1987 and 1999, 22 of them by the same surgeon. The etiological diagnosis was idiopathic in seven patients. Six patients had associated congenital abnormalities (four arthrogryposis, two digitotalar dysmorphism) and six had associated neurological abnormalities (three microcephalic, three spinal dysraphism). Only two patients had surgery after the age of 18 months. The mean age at surgery was 14.7 months (6 to 51). In 15 feet a two-stage procedure was performed. Lengthening of the extensor tendons, notably
Introduction: Hemiplegic cerebral palsy (CP) children are often treated with ankle-foot orthoses (AFO′s) in order to resist abnormal motion patterns and to restore normal function. It has been shown that AFOs are successful in improving pre-positioning of the foot for initial heel strike in CP patients. The myoelectric signal (EMG) during gait provides valuable information with respect to timing of muscular activity. The aim of this study was to evaluate changes in timing of muscle activation in children with hemipelegic CP during gait with and without wearing AFOs. Patients/Materials and Methods: Eight Children (5 boys, 3 girls; mean age 9.5±1.4 years) with mild to moderate hemiplegic CP and no prior surgeries or fixed contractures were studied. The children were tested barefoot and wearing a hinged AFO and shoes. Only children with an initial toe-strike barefoot and a physiological heel-strike with the AFO were included. All children performed a 3-dimensional gait analysis. At least six trials with clear forceplate data have to be collected for each of the two testing condition. Frontal and sagittal video recording took place. A sSurface EMG of vastus medialis/lateralis, rectus femoris, biceps fem-oris, semimembranosus/semitendinosus, gastrocnemius lateralis (only barefoot), and
In this study we evaluated the results of midtarsal
release and open reduction for the treatment of children with convex
congenital foot (CCF) (vertical talus) and compared them with the
published results of peritalar release. Between 1977 and 2009, a
total of 22 children (31 feet) underwent this procedure. In 15 children
(48%) the CCF was isolated and in the remainder it was not (seven
with arthrogryposis, two with spinal dysraphism, one with a polymalformative
syndrome and six with an undefined neurological disorder). Pre-operatively, the mean tibiotalar angle was 150.2° (106° to
175°) and the mean calcaneal pitch angle was -19.3° (-72° to 4°).
The procedure included talonavicular and calcaneocuboid joint capsulotomies,
lengthening of tendons of
Aim. 10 years after the introduction of the Ponseti casting regimen as standard treatment for idiopathic clubfoot at Alder Hey Children's Hospital, we reviewed the mid-term outcomes of the initial 2-year cohort (treated from 2002–2004). Method. 100 feet were treated in 66 patients. 61 of the 100 feet have been prospectively reviewed on an annual/ bi-annual basis since successful correction, with outcomes of the remaining feet obtained by retrospective analysis. Results. 96 feet responded to initial casting; of these, 31 had a recurrence within the first 2 years (16 of which were successfully treated by repeat casting and/or tenotomy and/or transfer of the tendon of
We reviewed our experience of
Aim. To compare outcomes for children treated for idiopathic clubfeet with the Ponseti regimen before (2002–2004) and after (2005–2006) implementation of a dedicated Ponseti service. Method. A retrospective analysis of outcomes for all patients with idiopathic clubfeet treated in the 2 years before and after implementation of a dedicated Ponseti service was undertaken. Results were statistically analysed using Fisher's exact t-test. Results. In the original cohort treated between 2002–2004, with an ad-hoc service where children were treated in general paediatric orthopaedic clinics by a number of different consultants, 100 feet in 66 children were treated. 96 feet (96%) responded to initial casting. 85 feet (85%) required tendo-achilles tenotomy. 31 feet had a recurrence within the first 2 years (16 of which were successfully treated by repeat casting and/or tenotomy and/or transfer of the tendon of
Introduction. Shoes with a rocker sole are commonly prescribed following forefoot surgery to redistribute pressure towards the heel. By shifting the body weight backwards, does the rocker shoe adversely effect balance and so disturb normal muscle activity? This study investigated the effects of the Darco post-operative shoe, and the impact of a contralateral shoe raise, on forefoot pressure, posture and balance. Materials and Methods. Fourteen healthy volunteers were investigated (age 36 ±10.8 yrs 11 females) either wearing (1) left Darco shoe and right standard shoe with/without a 5cm temporary shoe raise (Algeos Ltd) (2) two standard shoes. Postural sway was measured while standing with eyes open/closed and on/off a foam block. Dynamic balance was measured while stepping forwards/backwards and walking. Measurements of foot pressure (TECSKAN Inc USA), 3D body motion (Codamotion, UK) and surface electromyography of lower limb muscles were taken. Results were analysed using a repeated measures ANOVA. Results. The rocker shoe was associated with a 84% (±14) decrease in mean peak medial forefoot pressure a posterior shift of 0.9 cm (±1) in the centre of pressure (COP) and a 223% (±127) increase in
We report our initial experience of using the Ponseti method for the treatment of congenital idiopathic club foot. Between November 2002 and November 2004 we treated 100 feet in 66 children by this method. The standard protocol described by Ponseti was used except that, when necessary, percutaneous tenotomy of tendo Achillis were performed under general anaesthesia in the operating theatre and not under local anaesthesia in the out-patient department. The Pirani score was used for assessment and the mean follow-up time was 18 months (6 to 30). The results were also assessed in terms of the number of casts applied, the need for tenotomy of tendo Achillis and recurrence of the deformity. Tenotomy was required in 85 of the 100 feet. There was a failure to respond to the initial regimen in four feet which then required extensive soft-tissue release. Of the 96 feet which responded to initial casting, 31 (32%) had a recurrence, 16 of which were successfully treated by repeat casting and/or tenotomy and/or transfer of the tendon of
We assessed three children who had limb salvage surgery for sarcomata of the proximal fibula. Their ages ranged from 6 to 13 years. MRI showed involvement of the anterior, lateral and deep posterior compartments. Incisional biopsy showed two osteoblastic osteosarcomata and one Ewing’s sarcoma. Preoperative angiogram confirmed that the tibialis posterior artery was the main blood supply to the foot. The surgical technique was as described by Malawer (1984): via an anterolateral incision, the anterior, lateral and deep posterior compartments were excised en bloc with the proximal fibula. The peroneal artery was sacrificed in all three patients, and the common peroneal nerve and
Purpose: The use of allografts for anterior cruciate ligament (ACL) reconstruction has gained increased popularity. The major benefits of allograft for ACL replacement include decreased morbidity, easier patient rehabilitation and include ease of surgical procedure, decreased harvest site morbidity and easier patient rehabilitation. Further, allografts have improved appeal because of better sterilization techniques, improve graft availability and decreased hospital costs.|The objective of this study was to perform mechanical testing on various types of allograft. Specimens for allograft reconstruction of the anterior cruciate ligament included
We evaluated 28 patients, 52 feet with flaccid paraparesis (27 MMC, 1 neonatal paraplegia) in which a posterior transference of the
1. Telemetering electromyography has been used to investigate the pattern of activity of certain muscles of the lower limb and back while the subjects walked up and down stairs. 2. During walking up and down stairs each limb has a supporting and swinging phase in each complete step. 3. Walking up stairs revealed the following facts. Firstly, raising the body on to the stair above is brought about by the contraction of the soleus, quadriceps femoris, hamstrings and gluteus maximus; the gluteus medius at the same time prevents the body falling on to the unsupported side. Secondly, the
Introduction. It has been postulated that a mild clubfoot does better than a severe clubfoot no matter what treatment course is taken. There have been previous efforts to classify clubfoot. For units worldwide that use the Ponseti Method of clubfoot management, the Pirani scoring system is widely used. This scoring system has previously been shown to predict the number of plasters required to gain correction. Our study aimed to investigate whether the Pirani score gave an indication of longer-term outcome using
Introduction. The rate of total hip arthroplasty (THA) surgery continues to dramatically rise in the United States, with over 300,000 procedures performed in 2010. Although a relatively safe procedure, THA is not without complications. These complications include acetabular fracture, heterotopic ossification, implant failure, and nerve palsy to name a few. The rates of neurologic injury for a primary THA are reported as 0.7–3.5%. These rates increase to 7.6% for revision THA. The direct anterior total hip arthroplasty (DATHA) is gaining popularity amongst orthopedic surgeons. Many of these surgeons elect to use the Hana® table during this procedure for optimal positioning capability. Although intraoperative mobility and positioning of the hip joint during DATHA improves operative access, select positions of the limb put certain neurologic structures at risk. The most commonly reported neurologic injuries in this regard are to the sciatic and femoral nerves. To our knowledge, the use of neuromonitoring during DATHA, especially those using the Hana® table, has not been described in the literature. Methods. The patient was a 60-year-old male with long standing osteoarthritis of the right hip and prior left THA. Somatosensory evoked potential (SSEP) leads were placed bilaterally into the hand (ulnar nerve) as well as the popliteal fossae (posterior tibial nerve). Unilateral electromyography leads were placed into the vastus medialis obliquus, biceps femoris, gastrocnemius,
Background. Administration of Botulinum toxin type A (BTX-A) in patients with spastic cerebral palsy aims to improve mobility by increasing joint range of motion and decreasing passive resistance. However, our recent animal experiments indicated that BTX-A can decrease muscle”s length range of force exertion (Lrange), and increase its passive forces and extracellular matrix (ECM) collagen content. Moreover, BTX-A injected into the
To evaluate the outcome of combined
1. The clinical and radiological features of thirty-two feet with congenital vertical talus are described and subdivided into groups determined by the presence or absence of associated abnormalities. 2. The differential diagnosis of congenital vertical talus from flat foot, talipes calcaneus and uncorrected club foot is discussed. 3. No benefit came from either non-operative treatment or tenotomy of the
We describe three patients who developed gross calcaneus deformity following surgery for talipes equinovarus. One also had an associated valgus deformity and another had supination of the forefoot; all had intractable problems with footwear. Operation for transfer of the
1 . Twenty-two cases of transplantation of the
There are numerous causes of cavovarus feet, the most common of which are the hereditary motor and sensory peripheral neuropathies. Regardless of the underlying aetiology, cavovarus feet are caused by muscle imbalance. Often the imbalance is between a relatively strong tibialis posterior acting against a weaker peroneus brevis, and a relatively weak
We present the results of the management of 17 relapsed club feet in 12 children using the Ilizarov method with gradual distraction and realignment of the joint. Review at a mean of three years after surgery showed maintenance of correction with excellent or good results in 13 feet. Five mobile feet which had been treated by a split transfer of the
To assess outcomes following a radical approach to cases of compartment syndrome in which a significant degree of muscle necrosis is found, 4 paediatric and adolescent patients with a delayed diagnosis of compartment syndrome in which muscle necrosis in single or multiple compartments were treated by radical debridement of necrotic tissue and reconstruction of the anterior compartment through transfer of peroneus brevis to extensor digitorum and hallucis longus tendons. Where suitable, a free vascularised and innervated gracilis muscle transfer to the
1. The results of seventy-six transfers of the
Giant cell tumor of the tendon sheath (nodular synovitis) is a benign soft tissue tumor, usually affecting older women, that most often occurs in the interphalangeal joints of the fingers, wrist or knee. Malign giant cell tumor of the tendon sheath is rare. We present a case of a 56-year-old woman presented with a slow-growing, painless mass on the anteromedial aspect of the ankle 5 year duration. Apparent rapid enlargement of the mass was observed and went under surgery. The resected tumor, measuring 50x21x28 mm.cm, was encapsulated and located on the
The saphenous nerve is classically described as innervating skin of the medial foot extending to the first MTP joint and thus is at risk in surgery to the medial ankle and forefoot. However, it has previously been demonstrated by the senior author that the dorsomedial branch of the superficial peroneal nerve consistently supplies the dorsomedial forefoot, leading to debate as to whether the saphenous nerve should routinely be included in ankle blocks for forefoot surgery. We undertook a cadaveric study to assess the presence and variability of the saphenous nerve. 29 feet were dissected from a level 10 cm above the medial malleolus, and distally to the termination of the saphenous nerve. In 24 specimens (83%), a saphenous nerve was present at the ankle joint. In 5 specimens the nerve terminated at the level of the ankle joint, and in 19 specimens the nerve extended to supply the skin distal to the ankle. At the ankle, the mean distance of the nerve from the
The purpose of this study was to describe the clinical course of patients with Down's syndrome (DS) and congentital talipes equinovarus (CTEV) treated with the Ponseti regimen. The members of the United Kingdom Ponseti Users Group were contacted to provide details of patients with DS and CTEV, whom they had treated using the Ponseti regimen. Nine patients (13 feet: 7 right, 6 left) were identified, and the case notes were reviewed. Six patients were male, 3 female. In all but one case, the DS was diagnosed postnatally. Co-morbidites included atrioventricular septal defect, hearing deficiencies and plagiocephaly. The initial mean Pirani score was 4.5 (range 3.0 to 6.0). Casting was commenced at a mean of 25 days (range 12–84 days). The mean number of casts required was 7 (range 3 to 12), taking a mean of 6.5 weeks (range 3–12) to achieve correction. 6 of the 13 feet (46%) required a tendoachilles tenotomy, and 2 of 13 (15%) required re-casting. No patients have required a
Introduction. Changes in the central nervous system (CNS) pathways controlling trunk and leg muscles in patients with low back pain and radiculopathy have been observed and this study investigated whether surgery impacts upon these changes. Methods. Parameters of corticospinal control were examined on 3 occasions in 22 patients prior to, at 6 and 26 weeks following lumbar decompression surgery and in 14 control subjects at the same intervals. Electromyographic activity was recorded from
We describe a medial midline portal between the tendons of extensor hallucis longus and
Ischaemic preconditioning is a process by which exposure of a tissue to a short period of non-damaging ischaemic stress leads to resistance to the deleterious effects of a subsequent prolonged ischaemic stress. It has been extensively described in the heart, but few studies have examined the possibility that it can occur in skeletal muscle. We have used a rat model of ischaemia of one limb to examine this possibility. Exposure of the hind limb to a period of ischaemia of five minutes and reperfusion for five minutes significantly protected the
1. Nineteen patients with spina bifida, myelomeningocele or lipoma of the cauda equina have been reviewed. Convex pes valgus was found in twenty-five feet. All patients had a neuromuscular imbalance between the evertors and invertors of the foot. 2. Results of release procedures only and of those which combine release procedures with tendon transfers are compared; they show that there is no consistently satisfactory operation for correction of the deformity when it exists with neuromuscular imbalance. 3. An operation in which release procedures are combined with the transfer of the peroneus brevis to the tibialis posterior and of the
The saphenous nerve is classically described as innervating skin of the medial foot to the first MTP joint and thus is at risk in surgery to the medial ankle and foot. However, it has previously been demonstrated that the dorsomedial branch of the superficial peroneal nerve consistently supplies the dorsomedial forefoot, and therefore previous descriptions of the saphenous nerve maybe erroneous. We undertook a cadaveric study to assess the presence and variability of this nerve. 21 cadaveric feet were dissected from a level 5 cm above the medial malleolus, and distally to the termination of the saphenous nerve. In 16 specimens (76%), a saphenous nerve was present, of which 14 were anterior to the saphenous vein. Two of 16 nerves terminated above the medial malleolus. Therefore, only 14 of 21 specimens (66%) had a saphenous nerve present at the level of the medial malleolus. In seven of these 14 specimens (50%), the nerve terminally branched before the level of the tip of the malleolus. The mean distance reached in the foot was 46mm. Only two nerves reached the forefoot, at 97mm and 110 mm from the ankle joint respectively. At the ankle, the mean distance of the nerve from the
Introduction: Changes in the central nervous system (CNS) pathways controlling trunk and leg muscles in patients with low back pain and sciatica have been demonstrated. The aim of this study is to investigate whether these changes are altered by surgery. Methods: Corticospinal excitability was examined on 2 occasions in 15 patients prior to and 6 weeks following lumbar decompression surgery and 7 control subjects – at the same time intervals. This was achieved by recording electromyographic (EMG) activity from
Aim. The treatment of relapsed clubfeet presents a significant challenge. The Ilizarov method of gradual correction has been shown to provide satisfactory outcome. Since 2001 we have employed a newer differential soft tissue distraction using an Ilizarov frame in relapsed feet based on the Ponseti principles. The aim of our study was to analyse the outcome of this treatment. Material and Methods. All feet treated with soft tissue distraction only were studied. The feet were assessed using international clubfoot study group evaluation, pedobarography, and gait analysis, X-rays and ASK (activity scale for kids) questionnaire. Results. Out of 35 feet, 16 children with 27 feet attended for follow-up. The indications for surgery were failed multiple surgeries in 19 feet and failed Ponseti in 8 feet. The average age at operation was 5 years and the median follow-up was 5 years. The average duration of the frame was 5 months. Using international club foot scoring evaluation 25 feet scored ‘good’ and 2 scored ‘fair’. The pedobarography and gait analysis showed improvement when compared to the pre-operative assessment. The ASK functional questionnaire showed all 16 children were able to be independent most of the time. Grade 1 infection was noted in all cases. There were no physeal disruptions, growth arrest or joint subluxations. Five feet needed
Talar neck fractures are associated with high complication rates with significant associated morbidity. Adequate exposure and stable internal fixation remains challenging. We investigated the anterior extensile approach for exposure of these fractures and their fixation by screws introduced through the talo-navicular articulation. We also compared the quality and quantity of exposure of the talar neck obtained by this approach, with the classically described medial/lateral approaches. An anterior approach to the talus between the
Immobilisation causes denervation-like changes in the motor endplates, decreases the content of IGF-I, and increases the number of IGF-I receptors in the spinal cord. In the rat we investigated whether similar changes occur after a fracture of the midshaft of the femur which had been treated by intramedullary fixation with adequate or undersized pins. A more pronounced reduction in muscle wet weight was seen after fixation by undersized pins as well as decreased ash density of the ipsilateral tibia which did not completely return to normal within the 12-week experimental period. The nicotinic cholinergic receptors in the motor endplates of
We made a prospective study of 208 patients with tibial fractures treated by reamed intramedullary nailing. Of these, 11 (5.3%) developed dysfunction of the peroneal nerve with no evidence of a compartment syndrome. The patients with this complication were significantly younger (mean age 25.6 years) and most had closed fractures of the forced-varus type with relatively minor soft-tissue damage. The fibula was intact in three, fractured in the distal or middle third in seven, with only one fracture in the proximal third. Eight of the 11 patients showed a ‘dropped hallux’ syndrome, with weakness of extensor hallucis longus and numbness in the first web space, but no clinical involvement of extensor digitorum longus or
Introduction: Within the period from 1992. to 1996. (War in Bosnia) we performed 528 amputations. At the Chopart level in 45 (8.5%) patients and at the Syme level by 7 (1.3%) patients. Etiology: In more than 90 % patients the injury was caused by mine. Method: Open method, primary suture or primary delayed suture. We had 6 reamput actions and 15 corrections. Result: The Chopart stump inclines to deformation (we can often use only a part of calcaneus and talus). Achille’s tendon pulls the heel in increased supination and this is disturbing when leaning onto it and when placing the prosthesis. We achieved good results with the Baumgartner procedure: lengthening of Achille’s tendon, transfer of tendon m.
Early results of Ponseti treatment in 14 children (17 feet) aged between 2 and 10 years at the start of treatment are assessed. Method and Results 14 children aged between 2 and 10 years (mean 5.4) presented with relapsed or under- corrected club feet. All had previous treatment with strapping and bebax or pedro boots. 8 had subsequently undergone posterior release of the Achilles tendon, ankle and subtalar joint through a longitudinal posterior incision. All patients presented with absent heel strike, walking on the lateral border of the foot. 14 feet had a varus heel and 15 had an internal foot progression angle. Mean Pirani score was 2.14. Photographs and videos were taken. Ponseti casting was implemented. 15 feet required an Achilles tenotomy, and 15 feet had a
