Ankle fusion (AF), a durable intervention for ankle arthritis, has been the management of choice but restricts mobility. Recently, total ankle replacement (TAR) has been offered to patients looking to maintain mobility. The aim was to compare the biomechanics of AF and TAR while walking on inverted and everted slopes which create a greater demand for complex foot mobility than level walking. A ten-camera motion detection setup captured trials as patients walked in both directions over a 5⁰ lateral slope with embedded force plates. Moments (Nm/Kg) across the knee and ankle were exported from Visual 3D in the sagittal and frontal plane, and data were reported as means with 95% confidence intervals. 15 patients were recruited (6 TAR, 9 AF). The median age, follow-up and BMI was 67 years, 4 years and 35.8 kg/m² in AF, and 73 years, 7 years and 28.1 kg/m² in TAR, respectively. During inverted slope walking (4 TAR, 7 AF), abduction moments across (i) the knee: TAR 0.38 (0.37–0.39) vs AF 0.37 (0.27–0.52) and (ii) the ankle: TAR 0.20 (0.13–0.27) vs AF 0.25 (0.18–0.32), and extension moments across (i) the knee: TAR 0.68 (0.38–0.97) vs AF 0.85 (0.69–1.01) and (ii) the ankle: TAR 1.46 (1.30–1.62) vs AF 1.30 (1.08–1.52). During everted walking (5 TAR, 7 AF), abduction moments across (i) the knee: TAR 0.41 (0.30–0.52) vs AF 0.46 (0.27–0.66) and (ii) the ankle: TAR 0.24 (0.11–0.38) vs AF 0.26 (0.18–0.33), and extension moments across (i) the knee: TAR 0.76 (0.54–0.99) vs AF 0.93 (0.72–1.14) and (ii) the ankle: TAR 1.39 (1.19–1.59) vs AF 1.26 (1.04–1.48). There were no differences in abduction moments during inverted or everted slope walking. However, patients with AF had increased extension moments across the knee, particularly on inverted slopes, suggesting that AF creates a greater demand for knee compensation than TAR

Aim. Anatomical reduction and Stable fixation of Lisfranc injuries is considered the gold standard. There is controversy about how it is best achieved. Some surgeons would advocate routine open anatomical reduction, which as a concept was popular in 1980s but the same anatomical reduction and fixation can be achieved percutaneously. We describe our method of close reduction and percutaneous fixation and present our results. Materials and methods. 22 patients with a minimum follow up of 12 months were included. We achieved satisfactory anatomical reduction percutaneously in all patients and internal fixation was performed using cannulated screws for medial and middle columns. Functional outcome was evaluated using Foot and Ankle Disability Index (FADI) and components of this score were analysed individually to assess which domain was most affected. Vertical ground reaction forces were measured using a force plate in a walking platform. Results. The average age at operation was 48 years (17–67). Mean follow up was 20 months (13–60). The average Foot & Ankle Disability Index at final follow up was 79 (66–94). No loss of reduction or metal breakage was noted. Walking on uneven surface, going down stairs, heavy work and pain first thing in the morning were the domains of functional Index that showed poor recovery. None of the patients had pain at rest. Only three patients found it extremely hard to return to recreational activities. None of the patients had problems related to wound. Gait analysis showed a prolonged push-off (p=0.22) and significantly prolonged pre-swing phase (p=0.015) of the affected limb. Conclusions. Percutaneous reduction and fixation technique for Lisfranc injuries provides predicatable good functional outcome and gait pattern similar to open tecchinques with a potentially decreased risk of wound problems

Aims

Flexor hallucis longus (FHL) tendon transfer is a well-recognized technique in the treatment of the neglected tendo Achillis (TA) rupture.

Aims

The surgical management of ankle arthritis with tibiotalar arthrodesis is known to alter gait, as compared with normal ankles. The purpose of this study was to assess post-operative gait function with gait before arthrodesis.

Van Nes rotationplasty may be used for patients with congenital proximal focal femoral deficiency (PFFD). The lower limb is rotated to use the ankle and foot as a functional knee joint within a prosthesis. A small series of cases was investigated to determine the long-term outcome. At a mean of 21.5 years (11 to 45) after their rotationplasty, a total of 12 prosthetic patients completed the Short-Form (SF)-36, Faces Pain Scale-Revised, Harris hip score, Oswestry back pain score and Prosthetic Evaluation Questionnaires, as did 12 age- and gender-matched normal control participants. A physical examination and gait analysis, computerised dynamic posturography (CDP), and timed ‘Up & Go’ testing was also completed. Wilcoxon Signed rank test was used to compare each PFFD patient with a matched control participant with false discovery rate of 5%.

There were no differences between the groups in overall health and well-being on the SF-36. Significant differences were seen in gait parameters in the PFFD group. Using CDP, the PFFD group had reduced symmetry in stance, and reduced end point and maximum excursions.

Patients who had undergone Van Nes rotationplasty had a high level of function and quality of life at long-term follow-up, but presented with significant differences in gait and posture compared with the control group.

Cite this article: Bone Joint J 2013;95-B:192–8.

It has been suggested that extracorporeal shockwave therapy is a safe and effective treatment for pain relief from recalcitrant plantar fasciopathy (PF). However, the changes in gait and associated biomechanical parameters have not been well characterised. We recruited 12 female patients with recalcitrant PF who had a mean age of 59 years (50 to 70) and mean body mass index of 25 kg/m² (22 to 30). The patients reported a mean duration of symptoms of 9.3 months (6 to 15). Shockwave therapy consisting of 1500 impulses (energy flux density 0.26 mJ/mm²) was applied for three sessions, each three weeks apart. A pain visual analogue scale (VAS) rating, plantar pressure assessment and motion analysis were carried out before and nine weeks after first shock wave therapy. It was demonstrated that patients increased their walking velocity and cadence as well indicating a decrease in pain after shockwave therapy. In the symptomatic foot, the peak contact pressure over the forefoot increased and the contact area over the digits decreased. The total foot impulse also decreased as did stance duration. The duration the centre of pressure remained in the hindfoot increased in the symptomatic foot after shockwave therapy. The differences in centre of pressure trajectory at baseline decreased at final follow-up. In conclusion, shockwave therapy not only decreased the pain VAS rating but also improved the gait parameters of the symptomatic foot in PF patients.

Cite this article: Bone Joint J 2013;95-B:1088–93.

Hallux rigidus was first described in 1887. Many aetiological factors have been postulated, but none has been supported by scientific evidence. We have examined the static and dynamic imbalances in the first metatarsophalangeal joint which we postulated could be the cause of this condition. We performed a finite-element analysis study on a male subject and calculated a mathematical model of the joint when subjected to both normal and abnormal physiological loads.

The results gave statistically significant evidence for an increase in tension of the plantar fascia as the cause of abnormal stress on the articular cartilage rather than mismatch of the articular surfaces or subclinical muscle contractures. Our study indicated a clinical potential cause of hallux rigidus and challenged the many aetiological theories. It could influence the choice of surgical procedure for the treatment of early grades of hallux rigidus.