Objectives

Overlap between the distal tibia and fibula has always been quoted to be positive. If the value is not positive then an injury to the syndesmosis is thought to exist. Our null hypothesis is that it is a normal variant in the adult population.

We reviewed, retrospectively, 65 patients who had undergone arthroscopic treatment for osteochondral lesions of the talus. The 46 men and 19 women with a mean age at operation of 34.25 years, were followed up for a mean of 3.5 years. The medial aspect was affected in 45 patients and the lateral aspect in 20. All the lateral lesions and 35 (75%) of the medial lesions were traumatic in origin. Medial lesions presented later than lateral lesions (3 v 1.5 years) and had a much greater incidence of cystic change (46% v 8%). At follow-up, 34 patients had achieved a good result, and 17 and 14 fair and poor results, respectively. Of the 14 poor results, 13 involved medial lesions. Cystic lesions had a poor outcome in 53% of patients. Excision and curettage led to better results than excision and drilling of the base. Further arthroscopic surgery for patients with a poor result was disappointing. There was no association between outcome and the patient’s age

We assessed 46 Syme’s amputees attending our prosthetic clinics in terms of the clinical and radiological condition of their stumps, their level of function and problems with the prosthesis. Twenty-five were compared with a matching group of 25 transtibial amputees in regard to activity, function and prosthetic behaviour. Function was similar in the two groups, but Syme’s amputees had a higher incidence of prosthetic failure. Overall, Syme’s amputees were pleased with their prostheses and their function. Childhood amputations were associated with fewer long-term problems in terms of function and stump problems. Syme’s amputation is indicated for congenital foot deformities, fibular hemimelia and severe injury to the foot as long as the heel pad remains viable