Aims. The purpose of this study is to examine the adductus impact on the second metatarsal by the nonosteotomy nonarthrodesis syndesmosis procedure for the hallux valgus deformity
Aims. The mainstay of surgical
This study sought to determine the medium-term
patient-reported and radiographic outcomes in patients undergoing
surgery for hallux valgus. A total of 118 patients (162 feet) underwent
surgery for hallux valgus between January 2008 and June 2009. The
Manchester-Oxford Foot Questionnaire (MOXFQ), a validated tool for
the assessment of outcome after surgery for hallux valgus, was used
and patient satisfaction was sought. The medical records and radiographs
were reviewed retrospectively. At a mean of 5.2 years (4.7 to 6.0)
post-operatively, the median combined MOXFQ score was 7.8 (IQR:0
to 32.8). The median domain scores for pain, walking/standing, and social
interaction were 10 (IQR: 0 to 45), 0 (IQR: 0 to 32.1) and 6.3 (IQR:
0 to 25) respectively. A total of 119 procedures (73.9%, in 90 patients)
were reported as satisfactory but only 53 feet (32.7%, in 43 patients)
were completely asymptomatic. The mean (SD)
As it remains unproven that hypermobility of
the first tarsometatarsal joint (TMTJ-1) is a significant factor
in hallux valgus deformity, the necessity for including arthrodesis
of TMTJ-1 as part of a surgical
There is little information about how to manage patients with a recurvatum deformity of the distal tibia and osteoarthritis (OA) of the ankle. The aim of this study was to evaluate the functional and radiological outcome of addressing this deformity using a flexion osteotomy and to assess the progression of OA after this procedure. A total of 39 patients (12 women, 27 men; mean age 47 years (28 to 72)) with a distal tibial recurvatum deformity were treated with a flexion osteotomy, between 2010 and 2015. Nine patients (23%) subsequently required conversion to either a total ankle arthroplasty (seven) or an arthrodesis (two) after a mean of 21 months (9 to 36). A total of 30 patients (77%), with a mean follow-up of 30 months (24 to 76), remained for further evaluation. Functional outcome, sagittal ankle joint OA using a modified Kellgren and Lawrence Score, tibial lateral surface (TLS) angle, and talar offset ratio (TOR) were evaluated on pre- and postoperative weight-bearing radiographs.Aims
Patients and Methods
We describe a retrospective review of the clinical and radiological parameters of 32 feet in 30 patients (10 men and 20 women) who underwent
We report the outcomes of 20 patients (12 men,
8 women, 21 feet) with Charcot neuro-arthropathy who underwent correction
of deformities of the ankle and hindfoot using retrograde intramedullary
nail arthrodesis. The mean age of the patients was 62.6 years (46
to 83); their mean BMI was 32.7 (15 to 47) and their median American
Society of Anaesthetists score was 3 (2 to 4). All presented with
severe deformities and 15 had chronic ulceration. All were treated
with reconstructive surgery and seven underwent simultaneous midfoot
fusion using a bolt, locking plate or a combination of both. At
a mean follow-up of 26 months (8 to 54), limb salvage was achieved
in all patients and 12 patients (80%) with ulceration achieved healing
and all but one patient regained independent mobilisation. There was
failure of fixation with a broken nail requiring revision surgery
in one patient. Migration of distal locking screws occurred only
when standard screws had been used but not with hydroxyapatite-coated
screws. The mean American Academy of Orthopaedic Surgeons Foot and
Ankle (AAOS-FAO) score improved from 50.7 (17 to 88) to 65.2 (22
to 88), (p = 0.015). The mean Short Form (SF)-36 Health Survey Physical
Component Score improved from 25.2 (16.4 to 42.8) to 29.8 (17.7
to 44.2), (p = 0.003) and the mean Euroqol EQ‑5D‑5L score improved
from 0.63 (0.51 to 0.78) to 0.67 (0.57 to 0.84), (p = 0.012). Single-stage
We have reviewed the long-term results of 22 patients (23 fusions) with fractures of the os calcis, who had subtalar arthrodesis with
The purpose of this study was to compare the
results of proximal and distal chevron osteotomy in patients with moderate
hallux valgus. We retrospectively reviewed 34 proximal chevron osteotomies without
lateral release (PCO group) and 33 distal chevron osteotomies (DCO
group) performed sequentially by a single surgeon. There were no
differences between the groups with regard to age, length of follow-up,
demographic or radiological parameters. The clinical results were
assessed using the American Orthopaedic Foot and Ankle Society (AOFAS)
scoring system and the radiological results were compared between
the groups. At a mean follow-up of 14.6 months (14 to 32) there were no significant
differences in the mean AOFAS scores between the DCO and PCO groups
(93.9 (82 to 100) and 91.8 (77 to 100), respectively; p = 0.176).
The mean hallux valgus angle, intermetatarsal angle and sesamoid
position were the same in both groups. The metatarsal declination
angle decreased significantly in the PCO group (p = 0.005) and the
mean shortening of the first metatarsal was significantly greater
in the DCO group (p <
0.001). We conclude that the clinical and radiological outcome after
a DCO is comparable with that after a PCO; longer follow-up would
be needed to assess the risk of avascular necrosis. Cite this article:
Between March 1995 and January 2000 we reviewed retrospectively 84 patients with hammer-toe deformity (99 feet; 179 toes) who had undergone metatarsophalangeal soft-tissue release and proximal interphalangeal arthroplasty. The median follow-up was 28 months. Patients were assessed by the American Orthopaedic Foot and Ankle Society Scores (AOFAS) and reviewed by independent assessors. The median AOFAS score was 83, with 87% of patients having a score of more than 60 points; 83% were satisfied and 17% were dissatisfied with the procedure. Pain at the metatarsophalangeal joint was the commonest cause of dissatisfaction, with 14% having moderate or severe pain. Only 2.5% had instability and 9% had formation of callus. There was no statistical difference for the age and gender of the patients, the number of toes operated on, associated surgery for hallux valgus or length of follow-up. Our study was based on an anatomical model and shows good results with no recurrence of deformity.
We carried out a cross-sectional study in 51 patients (81 feet) with a clawed hallux in association with a cavus foot after a modified Robert Jones tendon transfer. The mean follow-up was 42 months (9 to 88). In all feet, concomitant procedures had been undertaken, such as extension osteotomy of the first metatarsal and transfer of the tendon of the peroneus longus to peroneus brevis, to correct the underlying foot deformity. All patients were evaluated clinically and radiologically. The overall rate of patient satisfaction was 86%. The deformity of the hallux was corrected in 80 feet. Catching of the big toe when walking barefoot, transfer lesions and metatarsalgia, hallux flexus, hallux limitus and asymptomatic nonunion of the interphalangeal joint were the most frequent complications. Hallux limitus was more likely when elevation of the first ray occurred (p = 0.012). Additional transfer of the tendon of peroneus longus to peroneus brevis was a significant risk factor for elevation of the first metatarsal (p <
0.0001). The deforming force of extensor hallucis longus is effectively eliminated by the Jones transfer, but the mechanics of the first metatarsophalangeal joint are altered. The muscle balance and stability of the entire first ray should be taken into consideration in the management of clawed hallux.
The Cartiva synthetic cartilage implant (SCI) entered mainstream use in the management of first metatarsophalangeal joint (MTPJ) arthritis following the positive results of large trials in 2016. Limited information is available on the longer-term outcomes of this implant within the literature, particularly when independent from the originator. This single-centre cohort study investigates the efficacy of the Cartiva SCI at up to five years. First MTPJ arthritis was radiologically graded according to the Hattrup and Johnson (HJ) classification. Preoperative and sequential postoperative patient-reported outcome measures (PROMs) were evaluated using the Manchester-Oxford Foot Questionnaire (MOXFQ), and the activities of daily living (ADL) sub-section of the Foot and Ankle Ability Measure (FAAM).Aims
Methods
The Vantage Total Ankle System is a fourth-generation low-profile fixed-bearing implant that has been available since 2016. We aimed to describe our early experience with this implant. This is a single-centre retrospective review of patients who underwent primary total ankle arthroplasty (TAA) with a Vantage implant between November 2017 and February 2020, with a minimum of two years’ follow-up. Four surgeons contributed patients. The primary outcome was reoperation and revision rate of the Vantage implant at two years. Secondary outcomes included radiological alignment, peri-implant complications, and pre- and postoperative patient-reported outcomes.Aims
Methods
This study aimed to compare the outcomes of two different postoperative management approaches following surgical fixation of ankle fractures: traditional cast immobilization versus the Early Motion and Directed Exercise (EMADE) programme. A total of 157 patients aged 18 years or older who underwent successful open reduction and internal fixation (ORIF) of Weber B (AO44B) ankle fractures were recruited to this randomized controlled trial. At two weeks post-surgical fixation, participants were randomized to either light-weight cast-immobilization or the EMADE programme, consisting of progressive home exercises and weekly advice and education. Both groups were restricted to non-weightbearing until six weeks post-surgery. The primary outcome was assessed using the Olerud-Molander Ankle Score (OMAS) questionnaire at 12 weeks post-surgery, with secondary measures at two, six, 24, and 52 weeks. Exploratory cost-effectiveness analyses were also performed.Aims
Methods
We reviewed 91 patients (103 feet) who underwent
a Ludloff osteotomy combined with additional procedures. According
to the combined procedures performed, patients were divided into
Group I (31 feet; first web space release), Group II (35 feet; Akin
osteotomy and trans-articular release), or Group III (37 feet; Akin
osteotomy, supplementary axial Kirschner (K-) wire fixation, and
trans-articular release). Each group was then further subdivided
into severe and moderate deformities. The mean hallux valgus angle
Aims. We hypothesized that there is no difference in the clinical and radiological outcomes using local bone graft versus iliac graft for subtalar distraction arthrodesis in patients with calcaneal malunion. In addition, using local bone graft negates the donor site morbidity. Patients and Methods. We prospectively studied 28 calcaneal malunion patients (the study group) who were managed by subtalar distraction arthrodesis using local calcaneal bone graft. The study group included 16 male and 12 female patients. The median age was 37.5 years (interquartile range (IQR) 29 to 43). The outcome of the study group was compared with a control group of ten patients previously managed by subtalar distraction arthrodesis using iliac bone graft. The control group included six male and four female patients. The median age was 41.5 years (IQR 36 to 44). Results. The mean American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot score improved significantly in the study and the control groups (p < 0.001). Fusion was achieved in 27 patients in the study group at a median time of 13 weeks (IQR 12 to 14), while all the patients in the control group achieved fusion at a mean time of 13.2 weeks (11 to 15). The mean talocalcaneal height and talar declination angle improved significantly in both the study and the control groups (p < 0.001). There was no significant difference between both groups concerning the preoperative or the postoperative clinical and radiological measurements. Donor site morbidity was reported in four out of ten patients in the control group. Conclusion. Local calcaneal bone graft can successfully be used to achieve subtalar distraction arthrodesis with appropriate
This study reports updates the previously published two-year clinical, functional, and radiological results of a group of patients who underwent transfibular total ankle arthroplasty (TAA), with follow-up extended to a minimum of five years. We prospectively evaluated 89 patients who underwent transfibular TAA for end-stage osteoarthritis. Patients’ clinical and radiological examinations were collected pre- and postoperatively at six months and then annually for up to five years of follow-up. Three patients were lost at the final follow-up with a total of 86 patients at the final follow-up.Aims
Methods
Surgical reconstruction of deformed Charcot feet carries a high risk of nonunion, metalwork failure, and deformity recurrence. The primary aim of this study was to identify the factors contributing to these complications following hindfoot Charcot reconstructions. We retrospectively analyzed patients who underwent hindfoot Charcot reconstruction with an intramedullary nail between January 2007 and December 2019 in our unit. Patient demographic details, comorbidities, weightbearing status, and postoperative complications were noted. Metalwork breakage, nonunion, deformity recurrence, concurrent midfoot reconstruction, and the measurements related to intramedullary nail were also recorded.Aims
Methods
We carried out 123 consecutive total ankle replacements in 111 patients with a mean follow-up of four years (2 to 8). Patients with a hindfoot deformity of up to 10° (group A, 91 ankles) were compared with those with a deformity of 11° to 30° (group B, 32 ankles). There were 18 failures (14.6%), with no significant difference in survival between groups A and B. The clinical outcome as measured by the post-operative American Orthopaedic Foot and Ankle Surgeons score was significantly better in group B (p = 0.036). There was no difference between the groups regarding the post-operative range of movement and complications.
The ideal management of acute syndesmotic injuries in elite athletes is controversial. Among several treatment methods used to stabilize the syndesmosis and facilitate healing of the ligaments, the use of suture tape (InternalBrace) has previously been described. The purpose of this study was to analyze the functional outcome, including American Orthopaedic Foot & Ankle Society (AOFAS) scores, knee-to-wall measurements, and the time to return to play in days, of unstable syndesmotic injuries treated with the use of the InternalBrace in elite athletes. Data on a consecutive group of elite athletes who underwent isolated reconstruction of the anterior inferior tibiofibular ligament using the InternalBrace were collected prospectively. Our patient group consisted of 19 elite male athletes with a mean age of 24.5 years (17 to 52). Isolated injuries were seen in 12 patients while associated injuries were found in seven patients (fibular fracture, medial malleolus fracture, anterior talofibular ligament rupture, and posterior malleolus fracture). All patients had a minimum follow-up period of 17 months (mean 27 months (17 to 35)).Aims
Methods
To assess the characteristic clinical features, management, and outcome of patients who present to orthopaedic surgeons with functional dystonia affecting the foot and ankle. We carried out a retrospective search of our records from 2000 to 2019 of patients seen in our adult tertiary referral foot and ankle unit with a diagnosis of functional dystonia.Aims
Methods
In our unit, we adopt a two-stage surgical reconstruction approach using internal fixation for the management of infected Charcot foot deformity. We evaluate our experience with this functional limb salvage method. We conducted a retrospective analysis of prospectively collected data of all patients with infected Charcot foot deformity who underwent two-stage reconstruction with internal fixation between July 2011 and November 2019, with a minimum of 12 months’ follow-up.Aims
Methods
Talonavicular and subtalar joint fusion through
a medial incision (modified triple arthrodesis) has become an increasingly
popular technique for treating symptomatic flatfoot deformity caused
by posterior tibial tendon dysfunction. The purpose of this study was to look at its clinical and radiological
mid- to long-term outcomes, including the rates of recurrent flatfoot
deformity, nonunion and avascular necrosis of the dome of the talus. A total of 84 patients (96 feet) with a symptomatic rigid flatfoot
deformity caused by posterior tibial tendon dysfunction were treated
using a modified triple arthrodesis. The mean age of the patients
was 66 years (35 to 85) and the mean follow-up was 4.7 years (1 to 8.3).
Both clinical and radiological outcomes were analysed retrospectively. In 86 of the 95 feet (90.5%) for which radiographs were available,
there was no loss of
Moderate to severe hallux valgus is conventionally
treated by proximal metatarsal osteotomy. Several recent studies
have shown that the indications for distal metatarsal osteotomy
with a distal soft-tissue procedure could be extended to include
moderate to severe hallux valgus. The purpose of this prospective randomised controlled trial was
to compare the outcome of proximal and distal Chevron osteotomy
in patients undergoing simultaneous bilateral
Charcot neuro-osteoarthropathy (CN) of the midfoot
presents a major reconstructive challenge for the foot and ankle
surgeon. The Synthes 6 mm Midfoot Fusion Bolt is both designed and
recommended for patients who have a deformity of the medial column
of the foot due to CN. We present the results from the first nine
patients (ten feet) on which we attempted to perform fusion of the
medial column using this bolt. Six feet had concurrent hindfoot fusion
using a retrograde nail. Satisfactory
Aims. The purpose of this study was to analyse the biomechanics of
walking, through the ground reaction forces (GRF) measured, after
first metatarsal osteotomy or metatarsophalangeal joint (MTP) arthrodesis. Patients and Methods. A total of 19 patients underwent a Scarf osteotomy (50.3 years,
standard deviation (. sd. ) 12.3) and 18 underwent an arthrodesis
(56.2 years,. sd. 6.5). Clinical and radiographical data
as well as the American Orthopaedic Foot and Ankle Society (AOFAS)
scores were determined. GRF were measured using an instrumented
treadmill. A two-way model of analysis of variance (ANOVA) was used
to determine the effects of surgery on biomechanical parameters
of walking, particularly propulsion. Results. Epidemiological, radiographical and clinical data were comparable
in the two groups and better restoration of propulsive function
was found after osteotomy as shown by ANOVA (two way: surgery ×
foot) with a surgery effect on vertical forces (p <
0.01) and
a foot effect on anteroposterior impulse (p = 0.01). Conclusion. Patients who underwent Scarf osteotomy had a gait pattern similar
to that of their non-operated foot, whereas those who underwent
arthrodesis of the first (metatarsophalangeal) MTP joint did not
totally recover the propulsive forces of the forefoot. Take home message: The main findings of this study were that
after surgical
Preoperative talar valgus deformity ≥ 15° is considered a contraindication for total ankle arthroplasty (TAA). We compared operative procedures and clinical outcomes of TAA in patients with talar valgus deformity ≥ 15° and < 15°. A matched cohort of patients similar for demographics and components used but differing in preoperative coronal-plane tibiotalar valgus deformity ≥ 15° (valgus, n = 50; 52% male, mean age 65.8 years (SD 10.3), mean body mass index (BMI) 29.4 (SD 5.2)) or < 15° (control, n = 50; 58% male, mean age 65.6 years (SD 9.8), mean BMI 28.7 (SD 4.2)), underwent TAA by one surgeon. Preoperative and postoperative radiographs, Ankle Osteoarthritis Scale (AOS) pain and disability and 36-item Short Form Health Survey (SF-36) version 2 scores were collected prospectively. Ancillary procedures, secondary procedures, and complications were recorded.Aims
Methods
We reviewed the outcome of distal chevron metatarsal osteotomy without tendon transfer in 19 consecutive patients (19 feet) with a hallux varus deformity following surgery for hallux valgus. All patients underwent distal chevron metatarsal osteotomy with medial displacement and a medial closing wedge osteotomy along with a medial capsular release. The mean hallux valgus angle improved from −11.6° pre-operatively to 4.7° postoperatively, the mean first-second intermetatarsal angle improved from −0.3° to 3.3° and the distal metatarsal articular angle from 9.5° to 2.3° and the first metatarsophalangeal joints became congruent post-operatively in all 19 feet. The mean relative length ratio of the metatarsus decreased from 1.01 to 0.99 and the mean American Orthopaedic Foot and Ankle Society score improved from 77 to 95 points. In two patients the hallux varus recurred. One was symptom-free but the other remained symptomatic after a repeat distal chevron osteotomy. There were no other complications. We consider that distal chevron metatarsal osteotomy with a medial wedge osteotomy and medial capsular release is a useful procedure for the
Rocker bottom deformity may occur during the conservative treatment of idiopathic congenital clubfoot. Between 1975 and 1996, we treated 715 patients (1120 clubfeet) conservatively. A total of 23 patients (36 feet; 3.2%) developed a rocker bottom deformity. It is these patients that we have studied. The pathoanatomy of the rocker bottom deformity is characterised by a plantar convexity appearing between three and six months of age with the hindfoot equinus position remaining constant. The convexity initially involves the medial column, radiologically identified by the talo-first metatarsal angle and secondly by the lateral column, revealed radiologically as the calcaneo-fifth metatarsal angle. The apex of the deformity is usually at the midtrasal with a dorsal calcaneocuboid subluxation. Ideal management of clubfoot deformity should avoid this complication, with adequate manipulation and splinting and early Achilles’ percutaneous tenotomy if plantar convexity occurs. Adequate soft-tissue release provides satisfactory
Infected and deformed neuropathic feet and ankles are serious challenges for surgical management. In this study we present our experience in performing ankle arthrodesis in a closed manner, without surgical preparation of the joint surfaces by cartilaginous debridement, but instead using an Ilizarov ring fixator (IRF) for deformity correction and facilitating fusion, in arthritic neuropathic ankles with associated osteomyelitis. We retrospectively reviewed all the patients who underwent closed ankle arthrodesis (CAA) in Ilizarov Scientific Centre from 2013 to 2018 (Group A) and compared them with a similar group of patients (Group B) who underwent open ankle arthrodesis (OAA). We then divided the neuropathic patients into three arthritic subgroups: Charcot joint, Charcot-Maire-Tooth disease, and post-traumatic arthritis. All arthrodeses were performed by using an Ilizarov ring fixator. All patients were followed up clinically and radiologically for a minimum of 12 months to assess union and function.Aims
Methods
We studied 11 patients with checkrein deformities of the hallux who underwent surgical treatment. Six had lengthening of the flexor hallucis longus tendon by Z-plasty in the midfoot, and five underwent release of adhesions and lengthening of the tendon by Z-plasty at the musculotendinous junction at the fracture site. All six patients who underwent Z-plasty at the midfoot showed complete
Tibiotalocalcaneal (TTC) fusion is used to treat a variety of conditions affecting the ankle and subtalar joint, including osteoarthritis (OA), Charcot arthropathy, avascular necrosis (AVN) of the talus, failed total ankle arthroplasty, and severe deformity. The prevalence of postoperative complications remains high due to the complexity of hindfoot disease seen in these patients. The aim of this study was to analyze the relationship between preoperative conditions and postoperative complications in order to predict the outcome following primary TTC fusion. We retrospectively reviewed the medical records of 101 patients who underwent TTC fusion at the same institution between 2011 and 2019. Risk ratios (RRs) associated with age, sex, diabetes, cardiovascular disease, smoking, preoperative ankle deformity, and the use of bone graft during surgery were related to the postoperative complications. We determined from these data which pre- and perioperative factors significantly affected the outcome.Aims
Methods
Arthroplasty for end-stage hallux rigidus (HR) is controversial. Arthrodesis remains the gold standard for surgical treatment, although is not without its complications, with rates of up to 10% for nonunion, 14% for reoperation and 10% for metatarsalgia. The aim of this study was to analyze the outcome of a double-stemmed silastic implant (Wright-Medical, Memphis, Tennessee, USA) for patients with end-stage HR. We conducted a retrospective review of 108 consecutive implants in 76 patients, between January 2005 and December 2016, with a minimum follow-up of two years. The mean age of the patients at the time of surgery was 61.6 years (42 to 84). There were 104 females and four males. Clinical, radiological, patient reported outcome measures (PROMS) data, a visual analogue score (VAS) for pain, and satisfaction scores were collected.Aims
Methods
The purpose of this study was to determine the functional outcome and implant survivorship of mobile-bearing total ankle arthroplasty (TAA) performed by a single surgeon. We reviewed 205 consecutive patients (210 ankles) who had undergone mobile-bearing TAA (205 patients) for osteoarthritis of the ankle between January 2005 and December 2015. Their mean follow-up was 6.4 years (2.0 to 13.4). Functional outcome was assessed using the Ankle Osteoarthritis Scale, American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, 36-Item Short-Form Health Survey (SF-36) score, visual analogue scale, and range of movement. Implant survivorship and complications were also evaluated.Aims
Patients and Methods
Hindfoot arthrodesis with retrograde intramedullary nailing has
been described as a surgical strategy to reconstruct deformities
of the ankle and hindfoot in patients with Charcot arthropathy.
This study presents case series of Charcot arthropathy patients
treated with two different retrograde intramedullary straight compression
nails in order to reconstruct the hindfoot and assess the results
over a mid-term follow-up. We performed a retrospective analysis of 18 consecutive patients
and 19 operated feet with Charcot arthropathy who underwent a hindfoot
arthrodesis using a retrograde intramedullary compression nail.
Patients were ten men and eight women with a mean age of 63.43 years
(38.5 to 79.8). We report the rate of limb salvage, complications requiring
additional surgery, and fusion rate in both groups. The mean duration
of follow-up was 46.36 months (37 to 70).Aims
Patients and Methods
Total ankle arthroplasty (TAA) surgery is complex and attracts a wide variety of complications. The literature lacks consistency in reporting adverse events and complications. The aim of this article is to provide a comprehensive analysis of each of these complications from a literature review, and to compare them with rates from our Unit, to aid clinicians with the process of informed consent. A total of 278 consecutive total ankle arthroplasties (251 patients), performed by four surgeons over a six-year period in Wrightington Hospital (Wigan, United Kingdom) were prospectively reviewed. There were 143 men and 108 women with a mean age of 64 years (41 to 86). The data were recorded on each follow-up visit. Any complications either during initial hospital stay or subsequently reported on follow-ups were recorded, investigated, monitored, and treated as warranted. Literature search included the studies reporting the outcomes and complications of TAA implants.Aims
Patients and Methods
Charcot neuroarthropathy is a rare but serious complication of diabetes, causing progressive destruction of the bones and joints of the foot leading to deformity, altered biomechanics and an increased risk of ulceration. Management is complicated by a lack of consensus on diagnostic criteria and an incomplete understanding of the pathogenesis. In this review, we consider recent insights into the development of Charcot neuroarthropathy. It is likely to be dependent on several interrelated factors which may include a genetic pre-disposition in combination with diabetic neuropathy. This leads to decreased neuropeptides (nitric oxide and calcitonin gene-related peptide), which may affect the normal coupling of bone formation and resorption, and increased levels of Receptor activator of nuclear factor kappa-B ligand, potentiating osteoclastogenesis. Repetitive unrecognized trauma due to neuropathy increases levels of pro-inflammatory cytokines (interleukin-1β, interleukin-6, tumour necrosis factor α) which could also contribute to increased bone resorption, in combination with a pre-inflammatory state, with increased autoimmune reactivity and a profile of monocytes primed to transform into osteoclasts - cluster of differentiation 14 (CD14). Increased blood glucose and loss of circulating Receptor for Advanced Glycation End-Products (AGLEPs), leading to increased non-enzymatic glycation of collagen and accumulation of AGLEPs in the tissues of the foot, may also contribute to the pathological process. An understanding of the relative contributions of each of these mechanisms and a final common pathway for the development of Charcot neuroarthropathy are still lacking.
Various radiological parameters are used to evaluate a flatfoot
deformity and their measurements may differ. The aims of this study
were to answer the following questions: 1) Which of the 11 parameters
have the best inter- and intraobserver reliability in a standardized
radiological setting? 2) Are pre- and postoperative assessments
equally reliable? 3) What are the identifiable sources of variation? Measurements of the 11 parameters were recorded on anteroposterior
and lateral weight-bearing radiographs of 38 feet before and after
surgery for flatfoot, by three observers with different experience
in foot surgery (A, ten years; B, three years; C, third-year orthopaedic
resident). The inter- and intraobserver reliability was calculated.Aims
Patients and Methods
The purpose of this study was to compare the clinical and radiographic
outcomes of total ankle arthroplasty (TAA) in patients with pre-operatively
moderate and severe arthritic varus ankles to those achieved for
patients with neutral ankles. A total of 105 patients (105 ankles), matched for age, gender,
body mass index, and follow-up duration, were divided into three
groups by pre-operative coronal plane tibiotalar angle; neutral
(<
5°), moderate (5° to 15°) and severe (>
15°) varus deformity.
American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot
score, a visual analogue scale (VAS), and Short Form (SF)-36 score
were used to compare the clinical outcomes after a mean follow-up period
of 51 months (24 to 147).Aims
Patients and Methods
The aim of this study was to report a single surgeon series of
consecutive patients with moderate hallux valgus managed with a
percutaneous extra-articular reverse-L chevron (PERC) osteotomy. A total of 38 patients underwent 45 procedures. There were 35
women and three men. The mean age of the patients was 48 years (17
to 69). An additional percutaneous Akin osteotomy was performed
in 37 feet and percutaneous lateral capsular release was performed
in 22 feet. Clinical and radiological assessments included the type
of forefoot, range of movement, the American Orthopedic Foot and
Ankle (AOFAS) score, a subjective rating and radiological parameters. The mean follow-up was 59.1 months (45.9 to 75.2). No patients
were lost to follow-up.Aims
Patients and Methods
The aim of this prospective study was to evaluate the intermediate-term
outcomes after revision anatomical ankle ligament reconstruction
augmented with suture tape for a failed modified Broström procedure. A total of 30 patients with persistent instability of the ankle
after a Broström procedure underwent revision augmented with suture
tape. Of these, 24 patients who were followed up for more than two
years were included in the study. There were 13 men and 11 women.
Their mean age was 31.8 years (23 to 44). The mean follow-up was 38.5
months (24 to 56) The clinical outcome was assessed using the Foot
and Ankle Outcome Score (FAOS) and the Foot and Ankle Ability Measure
(FAAM) score. The stability of the ankle was assessed using stress
radiographs.Aims
Patients and Methods
While many forefoot procedures may be performed
as a day case, there are no specific guidelines as to which procedures
are suitable. This study assessed the early post-operative pain
after forefoot surgery performed a day case, compared with conventional
inpatient management. A total of 317 consecutive operations performed by a single surgeon
were included in the study. Those eligible according to the criteria
of the French Society of Anaesthesia (SFAR) were managed as day
cases (127; 40%), while the remainder were managed as inpatients. The groups were comparable in terms of gender, body mass index
and smoking status, although the mean age of the inpatients was
higher (p <
0.001) and they had higher mean American Society
of Anaesthesiologists scores (p = 0.002). The most severe daily
pain was on the first post-operative day, but the levels of pain
were similar in the two groups; (4.2/10, Apart from the most complicated cases, forefoot surgery can safely
be performed as a day case without an increased risk of pain, or
complications compared with management as an inpatient. Cite this article:
The purpose of this study was to evaluate the
change in sagittal tibiotalar alignment after total ankle arthroplasty (TAA)
for osteoarthritis and to investigate factors affecting the restoration
of alignment. This retrospective study included 119 patients (120 ankles) who
underwent three component TAA using the Hintegra prosthesis. A total
of 63 ankles had anterior displacement of the talus before surgery
(group A), 49 had alignment in the normal range (group B), and eight
had posterior displacement of the talus (group C). Ankles in group
A were further sub-divided into those in whom normal alignment was
restored following TAA (41 ankles) and those with persistent displacement
(22 ankles). Radiographic and clinical results were assessed. Pre-operatively, the alignment in group A was significantly more
varus than that in group B, and the posterior slope of the tibial
plafond was greater (p <
0.01 in both cases). The posterior slope
of the tibial component was strongly associated with restoration
of alignment: ankles in which the alignment was restored had significantly
less posterior slope (p <
0.001). An anteriorly translated talus was restored to a normal position
after TAA in most patients. We suggest that surgeons performing
TAA using the Hintegra prosthesis should aim to insert the tibial
component at close to 90° relative to the axis of the tibia, hence
reducing posterior soft-tissue tension and allowing restoration
of normal tibiotalar alignment following surgery. Cite this article:
Few reports compare the contribution of the talonavicular articulation
to overall range of movement in the sagittal plane after total ankle
arthroplasty (TAA) and tibiotalar arthrodesis. The purpose of this
study was to assess changes in ROM and functional outcomes following
tibiotalar arthrodesis and TAA. Patients who underwent isolated tibiotalar arthrodesis or TAA
with greater than two-year follow-up were enrolled in the study.
Overall arc of movement and talonavicular movement in the sagittal
plane were assessed with weight-bearing lateral maximum dorsiflexion
and plantarflexion radiographs. All patients completed Short Form-12
version 2.0 questionnaires, visual analogue scale for pain (VAS)
scores, and the Foot and Ankle Ability Measure (FAAM).Aims
Patients and Methods
Metatarsus primus varus deformity correction
is one of the main objectives in hallux valgus surgery. A ‘syndesmosis’
procedure may be used to correct hallux valgus. An osteotomy is
not involved. The aim is to realign the first metatarsal using soft
tissues and a cerclage wire around the necks of the first and second
metatarsals. We have retrospectively assessed 27 patients (54 feet) using
the American Orthopaedic Foot and Ankle Society (AOFAS) score, radiographs
and measurements of the plantar pressures after bilateral syndesmosis
procedures. There were 26 women. The mean age of the patients was
46 years (18 to 70) and the mean follow-up was 26.4 months (24 to
33.4). Matched-pair comparisons of the AOFAS scores, the radiological
parameters and the plantar pressure measurements were conducted
pre- and post-operatively, with the mean of the left and right feet.
The mean AOFAS score improved from 62.8 to 94.4 points (p <
0.001).
Significant differences were found on all radiological parameters
(p <
0.001). The mean hallux valgus and first intermetatarsal
angles were reduced from 33.2° (24.3° to 49.8°) to 19.1° (10.1°
to 45.3°) (p <
0.001) and from 15.0° (10.2° to 18.6°) to 7.2°
(4.2° to 11.4°) (p <
0.001) respectively. The mean medial sesamoid
position changed from 6.3(4.5 to 7) to 3.6 (2 to 7) (p <
0.001)
according to the Hardy’s scale (0 to 7). The mean maximum force
and the force–time integral under the hallux region were significantly
increased by 71.1% (p = 0.001), (20.57 (0.08 to 58.3) to 35.20 (6.63
to 67.48)) and 73.4% (p = 0.014), (4.44 (0.00 to 22.74) to 7.70
(1.28 to 19.23)) respectively. The occurrence of the maximum force
under the hallux region was delayed by 11% (p = 0.02), (87.3% stance
(36.3% to 100%) to 96.8% stance (93.0% to 100%)). The force data
reflected the restoration of the function of the hallux. Three patients
suffered a stress fracture of the neck of the second metatarsal.
The short-term results of this surgical procedure for the treatment
of hallux valgus are satisfactory. Cite this article:
Severe hallux valgus deformity is conventionally
treated with proximal metatarsal osteotomy. Distal metatarsal osteotomy
with an associated soft-tissue procedure can also be used in moderate
to severe deformity. We compared the clinical and radiological outcomes
of proximal and distal chevron osteotomy in severe hallux valgus deformity
with a soft-tissue release in both. A total of 110 consecutive female
patients (110 feet) were included in a prospective randomised controlled
study. A total of 56 patients underwent a proximal procedure and
54 a distal operation. The mean follow-up was 39 months (24 to 54)
in the proximal group and 38 months (24 to 52) in the distal group.
At follow-up the hallux valgus angle, intermetatarsal angle, distal
metatarsal articular angle, tibial sesamoid position, American Orthopaedic
Foot and Ankle Society (AOFAS) hallux metatarsophalangeal-interphalangeal
score, patient satisfaction level, and complications were similar
in each group. Both methods showed significant post-operative improvement
and high levels of patient satisfaction. Our results suggest that
the distal chevron osteotomy with an associated distal soft-tissue
procedure provides a satisfactory method for correcting severe hallux
valgus deformity. Cite this article:
Achieving arthrodesis of the ankle can be difficult
in the presence of infection, deformity, poor soft tissues and bone loss.
We present a series of 48 patients with complex ankle pathology,
treated with the Ilizarov technique. Infection was present in 30
patients and 30 had significant deformity before surgery. Outcome
was assessed clinically and with patient-reported outcome measures
(Modified American Orthopaedic Foot and Ankle Society (MAOFAS) scale and
the Short-Form (SF-36)). Arthrodesis was achieved in 40 patients with the Ilizarov technique
alone and in six further patients with additional surgery. Infection
was eradicated in all patients at a mean follow-up of 46.6 months
(13 to 162). Successful arthrodesis was less likely in those with
comorbidities and in tibiocalcaneal fusion compared with tibiotalar
fusion. These patients had poor general health scores compared with the
normal population before surgery. The mean MAOFAS score improved
significantly from 24.3 (0 to 90) pre-operatively to 56.2 (30 to
90) post-operatively, but there was only a modest improvement in
general health; the mean SF-36 improved from 44.8 (19 to 66) to
50.1 (21 to 76). There was a major benefit in terms of pain relief. Arthrodesis using the Ilizarov technique is an effective treatment
for complex ankle pathology, with good clinical outcomes and eradication
of infection. However, even after successful arthrodesis general
health scores remain limited. Cite this article:
A total of seven patients (six men and one woman)
with a defect in the Achilles tendon and overlying soft tissue underwent
reconstruction using either a composite radial forearm flap (n =
3) or an anterolateral thigh flap (n = 4). The Achilles tendons
were reconstructed using chimeric palmaris longus (n = 2) or tensor
fascia lata (n = 2) flaps or transfer of the flexor hallucis longus
tendon (n = 3). Surgical parameters such as the rate of complications
and the time between the initial repair and flap surgery were analysed.
Function was measured objectively by recording the circumference
of the calf, the isometric strength of the plantar flexors and the
range of movement of the ankle. The Achilles tendon Total Rupture
Score (ATRS) questionnaire was used as a patient-reported outcome
measure. Most patients had undergone several previous operations
to the Achilles tendon prior to flap surgery. The mean time to flap
surgery was 14.3 months (2.1 to 40.7). At a mean follow-up of 32.3 months (12.1 to 59.6) the circumference
of the calf on the operated lower limb was reduced by a mean of
1.9 cm ( These otherwise indicate that reconstruction of the Achilles
tendon combined with flap cover results in a successful and functional
reconstruction. Cite this article:
We have evaluated the clinical effectiveness
of a metal resurfacing inlay implant for osteochondral defects of
the medial talar dome after failed previous surgical treatment.
We prospectively studied 20 consecutive patients with a mean age
of 38 years (20 to 60), for a mean of three years (2 to 5) post-surgery.
There was statistically significant reduction of pain in each of
four situations (i.e., rest, walking, stair climbing and running;
p ≤ 0.01). The median American Orthopaedic Foot and Ankle Society
ankle-hindfoot score improved from 62 (interquartile range (IQR)
46 to 72) pre-operatively to 87 (IQR 75 to 95) at final follow-up
(p <
0.001). The Foot and Ankle Outcome Score improved on all
subscales (p ≤ 0.03). The mean Short-Form 36 physical component
scale improved from 36 (23 to 50) pre-operatively to 45 (29 to 55)
at final follow-up (p = 0.001); the mental component scale did not
change significantly. On radiographs, progressive degenerative changes
of the opposing tibial plafond were observed in two patients. One
patient required additional surgery for the osteochondral defect.
This study shows that a metal implant is a promising treatment for
osteochondral defects of the medial talar dome after failed previous
surgery. Cite this article: