Background. Research on
Introduction. Charcot neuroarthropathy is a limb threatening condition and the optimal surgical strategy for limb salvage in gross foot deformity remains unclear. We present our experience of using fine wire frames to correct severe
Surgery to the
Purpose. Operative treatment of Lisfranc joint injuries typically includes reduction and stabilization of the medial and middle columns of the
Aims. Although infrequent, a fracture of the cuboid can lead to significant
disruption of the integrity of the
This paper presents the first report of a prospective study to assess the outcome of using coregistration localisation and selective arthrodesis in chronic
Background. Corrective fusion of a deformed / unstable Charcot neuroarthropathy (CN)of the
Aims. Fractures of the navicular can occur in isolation but, owing
to the intimate anatomical and biomechanical relationships, are
often associated with other injuries to the neighbouring bones and
joints in the foot. As a result, they can lead to long-term morbidity
and poor function. Our aim in this study was to identify patterns
of injury in a new classification system of traumatic fractures
of the navicular, with consideration being given to the commonly associated
injuries to the
Introduction: Determination of the origin of chronic foot pain in osteoarthritis (OA) is challenging since clinical examination of the foot faces a complex anatomy with several joints, osseous, and non-osseous structures contributing to the symptoms. Non-invasive imaging methods (Rx, CT, MRI) show a poor correlation with pain degree. Studies using functional imaging based on the detection of activated osteoblasts with 99mTc-Dicarboxypropandiphosphate (DPD) to indicate painful facet joints show promising results, but so far no evaluation for chronic OA pain conditions in foot joints has been conducted and the diagnostic potential was limited due to poor spatial resolution of the scintigraphic assessment. Single Photon Emission Computed Tomography – Computed Tomography (SPECT-CT) combines metabolic information with an exact anatomical localization. We hypothesised that diagnostic infiltration with a local anaesthetic of a painful hindfoot or
Introduction. Surgical approaches to the dorsum of the foot are common for management of
Introduction: Historically, off-loading forefoot neuropathic ulcers with a total contact cast has been an effective treatment method. However, large neuropathic ulcers located on the plantar aspect of the heel or
Purpose: Osteoarthritis (OA) is a common disease with increasing prevalence and rising socioeconomic burden. Of all symptoms accompanying OA, pain is the most disabling and frequent and the major reason why patients affected seek medical help. The determination of the origin of chronic foot OA pain is challenging since clinical examination of the foot faces a complex anatomy with several joints, osseous, and non-osseous structures contributing to the symptoms. For OA non-invasive imaging methods like plain radiograph, CT or MRI underestimate the degree of degenerative changes and show a poor correlation with pain degree. Studies using functional imaging based on the detection of activated osteoblasts with 99mTc-Dicarboxypropandiphosphate (DPD) to indicate painful facet joints in the lower spine show promising results, but so far no evaluation for chronic OA pain conditions in foot joints has been conducted and the diagnostic potential was limited due to poor spatial resolution of the scintigraphic assessment. Single Photon Emission Computed Tomography – Computed Tomography (SPECT-CT) is a new hybrid technique combining metabolic information with an exact anatomical localization. We hypothesised that diagnostic infiltration with a local anaesthetic of a painful hindfoot or
Introduction Fracture dislocation of the midtarsus with subsequent collapse of the longitudinal arch, dislocation of the forefoot and development of the rocker-bottom deformity is a significant complication of the neuropathic foot. Bony deformity and lack of protective sensation may lead to plantar ulceration, infection and amputation. Surgical reconstruction entails reduction of the dislocation and restoration of the alignment of the foot. Fixation of the arthrodesis may be challenging due to bony dissolution, fragmentation and osteoporosis which accompany the Charcot process. The purpose of the the current study is to describe the technique and review the clincial results of midtarsal arthrodesis with intamedullary axial screw fixation used to treat Charcot
Charcot neuro-osteoarthropathy (CN) of the midfoot
presents a major reconstructive challenge for the foot and ankle
surgeon. The Synthes 6 mm
Introduction: Hypermobility is a common finding, however, it lacks diagnostic parameters and is poorly understood, especially in the foot. Aim: To quantify medial column/first ray mobility in patients with
Introduction. We describe a novel single incision approach and its safety in the largest reported series of Lisfranc injuries to date. Via separate subcutaneous windows it is possible to access the medial three rays of the foot for bridge plating, without the concern of narrow skin bridges between multiple incisions. Methods. A retrospective review identified all 150 patients who underwent a Lisfranc ORIF via the modified dorsal approach at the Royal Melbourne Hospital between January 2011 and June 2016. All patients were operated by a single surgeon. Removal of metalwork (ROM) was routinely undertaken at six months post-operatively via the same incision. Medical recored were reviewed to record patient demographics, mechanism of injury and surgical details. Outpatient notes were reviewed to identify wound-related complications including; delayed wound healing, superficial infection, wound dehiscence, deep infection, complex regional pain syndrome (CRPS), neuroma and impaired sensation. Median follow-up was 1012 days (range 188–2141). Results. Median age was 37 years (19–78). 110 (73%) patients were male. Mechanism of injury was: motor vehicle accident (37%), motor bike accident (19%) and fall (18%). 24 (16%) injuries were open, 5 of which required soft tissue reconstruction at the primary surgery. A total of 34 wound related complications occurred (22%); superficial infection (14), delayed wound healing (7), wound dehiscence (5), CRPS (4), impaired sensation (3), neuroma (1). Re-operation was necessary in the 5 patients who experienced wound dehiscence; 4 requiring split skin grafts and 1 requiring a free flap. Crush injuries were 10 times more likely to have wound complications than those sustained in motor vehicle accidents. Patients undergoing ROM were more likely to have wound complications than those who did not. Conclusion. The modified dorsal approach using subcutaneous windows to access the
Arthritis of the mid-foot is a common presentation to the foot and ankle clinic, resulting from primary (idiopathic), post-traumatic, or inflammatory joint degeneration. Treatment in the initial stages is conservative, with
Introduction. Ankle and
We retrospectively reviewed 31 patients who underwent reconstruction procedure for PTT D (Type II Johnson). The surgery was mostly performed by the senior author. Fifty patients underwent 55 procedures, 31 patients were available for review (34 procedures). Clinical and functional outcome were assessed using AOFAS hindfoot score, and the SF-36 health assessment score. The patients had a calcaneal medialising (chevron) osteotomy to correct heel valgus, with or without a calcaneal lengthening osteotomy, and transfer of the FDL tendon to the navicular. All patients were immobilized in non-weight (to partial) bearing POP for 5 weeks, followed by CAM for 6 weeks. There were 7 males and 24 female, with an average age of 60.5 years. The average follow up was 54 months (range 11.5–111.2). The average hindfoot valgus deformity was 15 degrees preoperatively. Eight patients had and additional procedures including (TA lengthening, Lapidus). Four patients required bone graft for calcaneal column lengthening, and in 5 patients the posterior screw was removed due to continuous discomfort. The average AOFAS hindfoot score was 74 (47–100), the average pain score was 31/40 and the average subscore of the heel alignment was 7.9/10. Nineteen patients (61%) were able to perform single heel raise, and 27 patients (87%) were able to perform bilateral heel raise. 26 patients (83.8%) had no lateral impingement pain post operatively. The SF-36 health assessment showed similar functional outcome with age matched population. Two patients had superficial wound infection required oral antibiotics. Hindfoot and