Symptomatic tarsal coalitions failing conservative treatment are traditionally managed by open resection. Arthroscopic excision of calcaneonavicular bars have previously been described as has a technique for excising talocalcaneal bars using an arthroscope to guide an open resection. We describe an entirely arthroscopic technique for excising talocalcaneal coalitions and present a retrospective two-surgeon case series of the first eight patients (nine feet). Outcome measures include restoration of subtalar movements, return to work and sports, visual analogue pain scales and Sports Athlete Foot and Ankle Scores (SAFAS). Follow-up ranges from 1 year to 5.5 years. Subtalar movements were improved in all feet. Deformity was not always fully corrected but pain and SAFAS scores improved in all patients bar one. They all had a rapid return to good function apart from this same patient who required subsequent fusions. The posterior tibial nerve was damaged in one patient. Minimal destruction of bone and soft tissues allows early mobilization and minimizes pain. We acknowledge the risk of neurological damage from any operative technique. Patient selection and preoperative planning are crucial. This series from two independent surgeons supports the feasibility and effectiveness of this technique

Purpose of study. Serial manipulations and casting for the treatment of congenital clubfoot has long been the practice internationally. There are, however, a great variety of manipulative techniques being practiced with differing results. We aim to determine how the rate of major surgery, ie. a full posteromedial-release (PMR), as initial surgical intervention has changed since introducing the Ponseti method of plastering at our centre in 2002. We also aim to determine whether pre-operative radiographs have any bearing on the type of surgery performed. Methods. Clinical records and radiographs of all patients presenting to our clubfoot clinic in the years 1999–2000 and 2009–2010 respectively were reviewed. Patients were included if they had clinical clubfoot, and excluded if they presented after 3 months of age, had undergone prior treatment or suffered from associated congenital anomalies. We then determined which patients underwent PMR as primary surgical intervention following serial castings. We also measured the radiographic parameters on all available radiographs (tibiocalcaneal, talometatarsal-I, lateral and AP talocalcaneal angles) and performed a statistical analysis to determine their value in predicting the type of surgery required. Results. In the pre-Ponseti group we included 83 feet of which 34 had undergone PMR. In the Ponseti group there were 68 feet, of which none had undergone PMR. This was found to be statistically significant. Of the measured angles, the tibiocalcaneal and lateral talocalcaneal had the highest correlation with clinical severity (.67 and −.45 respectively). Conclusion. Employing the Ponseti method of plastering has significantly decreased the need for major surgery at our centre. This is in keeping with published results internationally. We found the tibiocalcaneal angle to be the most predictive of need for major surgery, and the talometatarsal-I to be the least predictive. The role of pre-operative X-rays, however, remains unclear as surgical decisions are made on clinical grounds. NO DISCLOSURES

Background. The adult acquired flat foot is caused by a complete or partial tear of the tibialis posterior tendon. We present the results of flexor digitorum longus transfer and medializing calcaneal osteotomy for recontruction of the deformity. Material & Methods. Twenty-six patients (31 feet) with an average age of 58 years (36–75) were operated for an acquired flat foot deformity. The patients were seen before surgery, one year after surgery and an average of 85 months after surgery to assess the following parameters: AOFAS Score, VAS Score for pain (0–10). Foot x-rays in full weightbearing position (dorsoplantar and lateral) were done at every visit in order to assess the following parameters: tarsometatarsale angle on the dorsoplantar and lateral x-ray, talocalcaneal angle on the lateral x-ray, calcaneal pitch angle and medial cuneiforme height on the lateral x-ray. Results. The AOFAS hindfoot score improved from 46.4 to 89.5 (max.: 100) points 1 year postoperatively und decreased to 87.8 points at the last follow-up. VAS for pain decreased from 6.6 to 1.1 at the one year follow-up and increased to 1.5 at the last follow-up. All radiologic parameters improved and stayed without significant changes over time. Following complications were seen: one recurrence, two patients with irritation of the sural nerve, one patient with hypesthesia of the big toe. In six patients the screws had to be removed. Apart from that no other revision surgery had to be done. Conclusion. Flexor digitorum longus transfer together with medializing calcaneal osteotomy provides excellent results for the therapy of acquired flat foot deformity. The results did not change significantly over time

Ankle sprains have been shown to be the most common sports related injury. Ankle sprain may be classified into low ankle sprain or high ankle sprain. Low ankle sprain is a result of lateral ligament disruption. It accounts for approximately 25% of all sports related injuries. The ankle lateral ligament complex consists of three important structures, namely the anterior talofibular ligament (ATFL), calcaneofibular ligament (CFL) and posterior talofibular ligament (PTFL). The ATFL is the weakest and most easily injured of these ligaments. It is often described as a thickening of the anterolateral ankle capsule. The ATFL sits in a vertical alignment when the ankle is plantarflexed and thus is the main stabiliser against an inversion stress. T he CFL is extracapsular and spans both the tibiotalar and talocalcaneal joints. The CFL is vertical when the ankle is dorsiflexed. An isolated injury to the CFL is uncommon. Early diagnosis, functional management and rehabilitation are the keys to preventing chronic ankle instability following a lateral ligament injury. Surgery does not play a major role in the management of acute ligament ruptures. Despite this up to 20% of patients will develop chronic instability and pain with activities of daily living and sport especially on uneven terrain. Anatomic reconstruction for this group of patients is associated with 90% good to excellent results. It is important that surgery is followed by functional rehabilitation. One of the aims of surgery in patients with recurrent instability is to prevent the development of ankle arthritis. It should be noted that the results of surgical reconstruction are less predictable in patients with greater than 10 year history of instability. Careful assessment of the patient with chronic instability is required to exclude other associated conditions such as cavovarus deformity or generalised ligamentous laxity as these conditions would need to be addressed in order to obtain a successful outcome. High ankle sprain is the result of injury to the syndesmotic ligaments. The distal tibiofibular joint is comprised of the tibia and fibula, which are connected by anterior inferior tibiofibular ligament, interosseous ligament and the posterior inferior tibiofibular ligament (superficial and deep components). The mechanism of injury is external rotation and hyperdorsiflexion. High index of suspicion is required as syndesmotic injuries can occur in association of low ankle sprains. The clinical tests used in diagnosing syndesmotic injuries (external rotation, squeeze, fibular translation and cotton) do not have a high predictive value. It is important to exclude a high fibular fracture. Plain radiographs are required. If the radiograph is normal then MRI scan is highly accurate in detecting the syndesmotic disruption. Functional rehabilitation is required in patients with stable injuries. Syndesmotic injuries are often associated with a prolonged recovery time. Accurate reduction and operative stabilisation is associated with the best functional outcome in patients with an unstable syndesmotic injury. Stabilisation has traditionally been with screw fixation. Suture button syndesmosis fixation is an alternative. Early short-term reviews show this alternate technique has improved patient outcomes and faster rehabilitation without the need for implant removal