Thoracoplasty has been described as primarily a cosmetic resection of the rib hump. The purpose of our study was to investigate whether removal of a normal spine stabilizer affected the correction of the spine, particularly in the sagittal plane. Thirty-eight adolescent idiopathic scoliosis patients who underwent thoracoplasty were compared with eighteen controls in terms of maintenance of correction and patient satisfaction using the SRS questionnaire. Thoracoplasty had no effect on curve correction in the coronal plane. It did show a significant effect on sagittal plane correction of the thoracic hypokyphosis without any significant detractors in terms of patient outcome

To investigate whether thoracoplasty affected spinal correction. We also compared patient outcomes thoracoplasty patients and controls, as well as long-term curve maintenance.

Thoracoplasty did increase the correction of thoracic hypokyphosis, without any significant detractors in terms of patient outcome.

Current understanding of the scoliotic curve as a three dimensional helix has led to increased recognition of the importance of sagittal contour and balancing the spine’s reciprocal curves to avoid problems such as flat back syndrome. Correction of the scoliotic curve intraoperatively may require the removal of spine stabilizers such as the disc and annulus, posterior facet and capsule, and thoracic cage stabilizers such as the ribs.

Thirty-eight patients who had either concave para-median or convex Steel mid-rib thoracoplasty were reviewed and compared to eighteen controls. Prospective patient outcomes using the Scoliosis Research Society instrument with an average of > one year follow-up were available for thirty patients. Degree of curve settle and maintenance of correction was measured on follow-up radiographs.

Thoracoplasty had no effect on curve correction in the coronal plane. It did show a significant effect on sagittal plane correction of thoracic hypokyphosis. The paramedian group showed a mean increase of tweleve degrees, the Steel group 8.7 degrees, and, the control group 3.1 degrees. No significant difference between pain, satisfaction, function, and self-image was found. Long-term radiographic follow-up (average three years) showed a mean coronal curve settle of 4.6 degrees (thoracoplasty) versus 3.1 degrees (non-thoracoplasty), and an accompanying improvement in sagittal plane correction of 4.2 and 3.0 degrees, respectively.

Twenty-one symptomatic flat feet from the surgical wait list were compared with twenty-one matched controls. The radiographs were digitized, blinded and the measurements made two occasions by two observers in different order.

On the lateral radiograph the talar to first metatarsal angle reached greatest significance at p< 0.0001, and had an inter and intra observer reliability of 0.83 and 0.75 respectively (r² value). Only three other of the twelve measurements made reached statistical significance. Radiographic assessment of reconstructive procedures should show restoration of the arch of the foot: We recommend using the talar neck to first metatarsal angle on the lateral view as the correct indicator of loss or restoration of an arch.

The purpose of this study was to determine the radiographic measures that differentiate the symptomatic adult flat foot from a normal foot, and determine the reliability of the measurements.

Although many radiographic measures of flat foot are described, only four out of twelve measurements studied were significantly different between symptomatic adult flat foot and normal adults.

Radiographic assessment of reconstructive procedures should show restoration of the arch of the foot: We recommend using the talar neck to first metatarsal angle on the lateral view as the correct indicator of loss or restoration of an arch.

Twenty-one symptomatic flat feet from the surgical wait list were compared with twenty-one matched controls. Diagnoses included rheumatoid arthritis and posterior tibial tendonitis. All previously described measures of loss of arch were measured on standing AP and lateral radiographs of the foot taken using the same radiographic technique at a single facility. The radiographs were digitized, blinded and the measurements made two occasions by two observers in different order.

On the lateral radiograph the talar to first metatarsal angle reached greatest significance at p< 0.0001, and had an inter and intra observer reliability of 0.83 and 0.75 respectively (r² value). The medial cuniform to 5^th metatarsal height also reached signficance, but had poor intraobserver reliability (r² =0.09). On the AP view, only the talar head uncoverage distance reached significance (p< 0..0001) but had poor inter and intraobserver reliability (r²=0.05 and 0.08).

The purpose of this study was to investigate the effects of varying tire pressures on rolling resistance of pneumatic wheelchair tires and compare the rolling resistance of pneumatic versus solid wheelchair tires.

Our study demonstrated that, statistically significant increases in rolling resistance occurred at and below 50% of the recommended tire pressures (RTP) for the pneumatic tires tested. Also, solid tires performed worse than pneumatic tires at 25% (RTP).

Shoulder pain among the spinal cord injured wheelchair users is reported between 60–100%. Despite the shoulder problems, it’s not uncommon to see WC users with low or flat tires. To reduce the need for regular inflating of tires, people have switched to the popular solid tire. Unfortunately, based on our results, the use of the popular solid tires may still contribute to repetitive strain disorders in wheelchair users.

Compared to the recommended tire pressures the pneumatic tires showed statistically significant decreases in rolling distance at 25% and 50% RTP. The rolling distances of the two solid tires performed similarly to 25% RTP of the pneumatic tires.

This prospective study measured the differences in rolling resistance of five types of commonly used wheelchair tires (three pneumatic: two solid: under four different tire pressures (100%, 75%, 50% and 25% RTP) using a standardized roll down test ramp and a wheelchair with a 56 kg load. Four samples of rolling distances (five per tire pressure per sample) were measured for each tire type and analyzed (repeated measure ANOVA).

Introduction and Aims: Pivotal to most clubfoot management protocols is Achilles tendon lengthening or tenotomy to address hindfoot deformity. The effectiveness of Botulinum A toxin (BTX-A) in defunctioning the triceps surae muscle complex as an alternative to tenotomy was investigated.

Method: Newborns, infants and children referred for suspected clubfoot deformity to the authors’ institution from September 1, 2000 to September 17, 2003 were reviewed consecutively for inclusion in this prospective study. Patients underwent manipulation and castings (above knee casts) emulating Ponseti’s principles until hindfoot stall was encountered. In order to defunction the triceps surae muscle complex, BTX-A at 10 IU per kilogram was injected into this muscle complex. Outcome measures included surgical rate, Pirani clubfoot score, ankle dorsiflexion with knee in flexion and extension, and recurrences. Patients were divided according to age: Group I (< 30 days old) and Group II (> 30 days and < 8 month old).

Results: Fifty-one patients with 73 feet met the criteria for inclusion in the study with 29 patients in Group I and 22 in Group II. Mean age of Group I was 16 months (2.5–33 months) and average follow-up was nine months post-BTX-A injection (1 week-27 months post-injection). Mean age of Group II was 23.5 months (3.8–44.6 months) and average follow-up was 15 months post BTX-A injection (1 week–27 months post-injection). Ankle dorsiflexion in knee flexion and extension remained above 20/15 degrees, respectively, and Pirani scores below 0.5 following BTX-A injection for both groups. All but one patient (one foot) who reached the point of hindfoot stall during the protocol of manipulations and castings had successful defunctioning of the triceps surae complex using a single BTX-A injection. This one patient out of 51 (1.9% of patients and 1.3% of feet) did not respond to the protocol. Of the 50 patients who responded to the protocol, nine patients lost some degree of dorsiflexion due to non-compliance with boots and bars, with fitting problems accounting for two cases. All these patients have corrected with either a return to manipulations and casting alone (one patient), or a combination of repeated BTX-A injection and further manipulations and castings (eight patients)

Conclusion: These results are comparable to those reported in the literature using Ponseti’s method or the physical therapy method and were achieved without the need of tenotomy or more frequent manipulations. The use of BTX-A as an adjunctive therapy in the non-invasive approach of manipulation and casting in idiopathic clubfoot is an effective and safe alternative and one that may be preferable to parents.