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 midfoot have been resistant to the off-loading with total contact casting. Therefore, it is not uncommon for these ulcers to persist for several years leading to eventual infection and/or amputation.

Objective: To assesses a new and effective off-loading mode of treatment for hindfoot and midfoot ulcers. The device is composed of a fiberglass cast with a metal stirrup and a window around the ulcer.

Research, Design and Methods: A retrospective study of 14 diabetic and non-diabetic patients was performed. All had a single chronic planter hindfoot or midfoot neuropathic ulcer that failed to heal via the conventional methods. A fiberglass total contact cast with a metal stirrup was applied. A window was made over the ulcer so as to continue with daily ulcer care. The cast was changed every other week.

Results: The average duration of ulcer prior to application of the metal stirrup was 26 ± 13.2 months (range 7 to 52 months). The ulcer completely healed in 12 of the 14 patients (86%) treated. The mean time for healing was 10.8 weeks for the midfoot ulcers and 12.3 weeks for the heel ulcers. Complications developed in 4 patients: 3 developed superficial wounds and 1 developed a full thickness wound. In 3 of these 4 patients, local wound care was initiated and the Stirrup cast was continued to complete healing of the primary ulcer.

Conclusion: The fiberglass cast with a metal stirrup is an effective off-loading device for midfoot and hindfoot ulcers. It is not removable and does not depend on patient’s compliance. The window around the ulcer allows for daily wound care, drainage of secretions and the use of VAC treatment. The complication rate is comparable to that of Total Contact Casting.

Purpose: The current study assessed the post-operative long-term outcome of up to 9 years follow-up of tarsal coalition treated with resection, utilizing the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot score. To the best of our knowledge this is the first study utilizing that score in regard to Tarsal coalition resection as a sole treatment.

Materials and Methods: Between 1988 and 1999, 36 patients (36 feet) with painful flatfoot and restricted range of motion attributable to talocalcaneal and calcaneonavicular coalition were treated with resection of the coalition in multiple medical centers in Israel. Thirty-one patients were male and five female. Twentyfive patients had unilateral coalition and eleven patients had bilateral coalition. Coalition types were talocalcaneal(29) and calcaneonavicular(7). The patients were interviewed and examined during a follow-up period of 12 to 108 months, with an average of 51.6 months.

Results: Outcome was based on the ankle hindfoot clinical rating system of the American Orthopaedic Foot and Ankle Society. The clinical results were also evaluated statistically. Favorable outcome was evident in only 50% of cases. Average score was 79.2 in talocalcaneal coalition patients and 85.4 in calcaneonavicular coalition patients (not statistically significant). A multivariate statistical analysis was done and an equation was found, which elucidates the connection between age, gender and diagnosis, and AOFAS score.

Conclusions: On the basis of these results, three parameters were found to affect the operative outcome: age, type of coalition and gender. Age itself stands alone as a predictive tool to the postoperative outcome. The equation that was found to correlate age, type of coalition and gender with the score can act as a predictive tool of the outcome and aid in preoperative patient selection for tarsal coalition resection.