The foot and ankle outcome score (FAOS) has been
evaluated for many conditions of the foot and ankle. We evaluated
its construct validity in 136 patients with osteoarthritis of the
ankle, its content validity in 37 patients and its responsiveness
in 39. Data were collected prospectively from the registry of patients
at our institution. All FAOS subscales were rated relevant by patients. The Pain,
Activities of Daily Living, and Quality of Life subscales showed
good correlation with the Physical Component score of the Short-Form-12v2.
All subscales except Symptoms were responsive to change after surgery. We concluded that the FAOS is a weak
The Manchester-Oxford Foot Questionnaire (MOxFQ) is an anatomically specific patient-reported outcome measure (PROM) currently used to assess a wide variety of foot and ankle pathology. It consists of 16 items across three subscales measuring distinct but related traits: walking/standing ability, pain, and social interaction. It is the most used foot and ankle PROM in the UK. Initial MOxFQ validation involved analysis of 100 individuals undergoing hallux valgus surgery. This project aimed to establish whether an individual’s response to the MOxFQ varies with anatomical region of disease (measurement invariance), and to explore structural validity of the factor structure (subscale items) of the MOxFQ. This was a single-centre, prospective cohort study involving 6,637 patients (mean age 52 years (SD 17.79)) presenting with a wide range of foot and ankle pathologies between January 2013 and December 2021. To assess whether the MOxFQ responses vary by anatomical region of foot and ankle disease, we performed multigroup confirmatory factor analysis. To assess the structural validity of the subscale items, exploratory and confirmatory factor analyses were performed.Aims
Methods
Osteochondral lesions of the talus (OLT) are a common cause of disability and chronic ankle pain. Many operative treatment strategies have been introduced; however, they have their own disadvantages. Recently lesion repair using autologous cartilage chip has emerged therefore we investigated the efficacy of particulated autologous cartilage transplantation (PACT) in OLT. We retrospectively analyzed 32 consecutive symptomatic patients with OLT who underwent PACT with minimum one-year follow-up. Standard preoperative radiography and MRI were performed for all patients. Follow-up second-look arthroscopy or MRI was performed with patient consent approximately one-year postoperatively. Magnetic resonance Observation of Cartilage Repair Tissue (MOCART) score and International Cartilage Repair Society (ICRS) grades were used to evaluate the quality of the regenerated cartilage. Clinical outcomes were assessed using the pain visual analogue scale (VAS), Foot Function Index (FFI), and Foot Ankle Outcome Scale (FAOS).Aims
Methods
Despite the increasing numbers of ankle arthroplasties, there are limited studies on their survival and comparisons between different implants. The primary aim of this study was to determine the failure rates of primary ankle arthroplasties commonly used in the UK. A data linkage study combined National Joint Registry (NJR) data and NHS Digital data. The primary outcome of failure was defined as the removal or exchange of any components of the implanted device. Life tables and Kaplan-Meier survival charts were used to illustrate survivorship. Cox proportional hazards regression models were fitted to compare failure rates between 1 April 2010 and 31 December 2018.Aims
Methods
The optimal management of posterior malleolar ankle fractures, a prevalent type of ankle trauma, is essential for improved prognosis. However, there remains a debate over the most effective surgical approach, particularly between screw and plate fixation methods. This study aims to investigate the differences in outcomes associated with these fixation techniques. We conducted a comprehensive review of clinical trials comparing anteroposterior (A-P) screws, posteroanterior (P-A) screws, and plate fixation. Two investigators validated the data sourced from multiple databases (MEDLINE, EMBASE, and Web of Science). Following PRISMA guidelines, we carried out a network meta-analysis (NMA) using visual analogue scale and American Orthopaedic Foot and Ankle Score (AOFAS) as primary outcomes. Secondary outcomes included range of motion limitations, radiological outcomes, and complication rates.Aims
Methods
To identify a core outcome set of postoperative radiographic measurements to assess technical skill in ankle fracture open reduction internal fixation (ORIF), and to validate these against Van der Vleuten’s criteria for effective assessment. An e-Delphi exercise was undertaken at a major trauma centre (n = 39) to identify relevant parameters. Feasibility was tested by two authors. Reliability and validity was tested using postoperative radiographs of ankle fracture operations performed by trainees enrolled in an educational trial (IRCTN 20431944). To determine construct validity, trainees were divided into novice (performed < ten cases at baseline) and intermediate groups (performed ≥ ten cases at baseline). To assess concurrent validity, the procedure-based assessment (PBA) was considered the gold standard. The inter-rater and intrarater reliability was tested using a randomly selected subset of 25 cases.Aims
Methods
To compare the cost-utility of removable brace compared with cast in the management of adult patients with ankle fracture. A within-trial economic evaluation conducted from the UK NHS and personnel social services (PSS) perspective. Health resources and quality-of-life data were collected as part of the Ankle Injury Rehabilitation (AIR) multicentre, randomized controlled trial over a 12-month period using trial case report forms and patient-completed questionnaires. Cost-utility analysis was estimated in terms of the incremental cost per quality adjusted life year (QALY) gained. Estimate uncertainty was explored by bootstrapping, visualized on the incremental cost-effectiveness ratio plane. Net monetary benefit and probability of cost-effectiveness were evaluated at a range of willingness-to-pay thresholds and visualized graphically.Aims
Methods
Although absorbable sutures for the repair of acute Achilles tendon rupture (ATR) have been attracting attention, the rationale for their use remains insufficient. This study prospectively compared the outcomes of absorbable and nonabsorbable sutures for the repair of acute ATR. A total of 40 patients were randomly assigned to either braided absorbable polyglactin suture or braided nonabsorbable polyethylene terephthalate suture groups. ATR was then repaired using the Krackow suture method. At three and six months after surgery, the isokinetic muscle strength of ankle plantar flexion was measured using a computer-based Cybex dynamometer. At six and 12 months after surgery, patient-reported outcomes were measured using the Achilles tendon Total Rupture Score (ATRS), visual analogue scale for pain (VAS pain), and EuroQoL five-dimension health questionnaire (EQ-5D).Aims
Methods
Treatment for delayed wound healing resulting from peripheral vascular diseases and diabetic foot ulcers remains a challenge. A novel surgical technique named ‘tibial cortex transverse transport’ (TTT) has been developed for treating peripheral ischaemia, with encouraging clinical effects. However, its underlying mechanisms remain unclear. In the present study, we explored the potential biological mechanisms of TTT surgery using various techniques in a rat TTT animal model. A novel rat model of TTT was established with a designed external fixator, and effects on wound healing were investigated. Laser speckle perfusion imaging, vessel perfusion, histology, and immunohistochemistry were used to evaluate the wound healing processes.Aims
Methods
We developed the Oxford ankle foot questionnaire to assess the disability associated with foot and ankle problems in children aged from five to 16 years. A survey of 158 children and their parents was carried out to determine the content, scaling, reliability and validity of the
This is a multicentre, non-inventor, prospective observational study of 503 INFINITY fixed bearing total ankle arthroplasties (TAAs). We report our early experience, complications, and radiological and functional outcomes. Patients were recruited from 11 specialist centres between June 2016 and November 2019. Demographic, radiological, and functional outcome data (Ankle Osteoarthritis Scale, Manchester Oxford Questionnaire, and EuroQol five-dimension five-level score) were collected preoperatively, at six months, one year, and two years. The Canadian Orthopaedic Foot and Ankle Society (COFAS) grading system was used to stratify deformity. Early and late complications and reoperations were recorded as adverse events. Radiographs were assessed for lucencies, cysts, and/or subsidence.Aims
Methods
Functional rehabilitation has become an increasingly popular treatment for Achilles tendon rupture (ATR), providing comparably low re-rupture rates to surgery, while avoiding risks of surgical complications. Limited evidence exists on whether gap size should affect patient selection for this treatment option. The aim of this study was to assess if size of gap between ruptured tendon ends affects patient-reported outcome following ATR treated with functional rehabilitation. Analysis of prospectively collected data on all 131 patients diagnosed with ATR at Royal Berkshire Hospital, UK, from August 2016 to January 2019 and managed non-operatively was performed. Diagnosis was confirmed on all patients by dynamic ultrasound scanning and gap size measured with ankle in full plantarflexion. Functional rehabilitation using an established protocol was the preferred treatment. All non-operatively treated patients with completed Achilles Tendon Rupture Scores (ATRS) at a minimum of 12 months following injury were included.Aims
Methods
To evaluate the donor site morbidity and tendon morphology after harvesting whole length, full-thickness peroneus longus tendon (PLT) proximal to the lateral malleolus for ligament reconstructions or tendon transfer. A total of 21 eligible patients (mean age 34.0 years (standard deviation (SD) 11.2); mean follow-up period 31.8 months (SD 7.7), and 12 healthy controls (mean age, 26.8 years (SD 5.9) were included. For patients, clinical evaluation of the donor ankle was performed preoperatively and postoperatively. Square hop test, ankle strength assessment, and MRI of distal calf were assessed bilaterally in the final follow-up. The morphological symmetry of peroneal tendons bilaterally was evaluated by MRI in healthy controls.Aims
Methods
Postoperative rehabilitation regimens following ankle arthrodesis vary considerably. A systematic review was conducted to determine the evidence for weightbearing recommendations following ankle arthrodesis, and to compare outcomes between different regimens. MEDLINE, Web of Science, Embase, and Scopus databases were searched for studies reporting outcomes following ankle arthrodesis, in which standardized postoperative rehabilitation regimens were employed. Eligible studies were grouped according to duration of postoperative nonweightbearing: zero to one weeks (group A), two to three weeks (group B), four to five weeks (group C), or six weeks or more (group D). Outcome data were pooled and compared between groups. Outcomes analyzed included union rates, time to union, clinical scores, and complication rates.Aims
Patients and 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
We hypothesized that there is no difference in the clinical and radiological outcomes using local bone graft 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).Aims
Patients and Methods
The incidence of acute Achilles tendon rupture appears to be increasing. The aim of this study was to summarize various therapies for acute Achilles tendon rupture and discuss their relative merits. A PubMed search about the management of acute Achilles tendon rupture was performed. The search was open for original manuscripts and review papers limited to publication from January 2006 to July 2017. A total of 489 papers were identified initially and finally 323 articles were suitable for this review.Objectives
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
Gastrocnemius tightness predisposes to musculoskeletal pathology
and may require surgical treatment. However, it is not clear what
proportion of patients with foot and ankle pathology have clinically
significant gastrocnemius tightness. The aim of this study was to
compare the prevalence and degree of gastrocnemius tightness in
a control group of patients with a group of patients with foot and
ankle pathology. This prospective, case-matched, observational study compared
gastrocnemius tightness, as assessed by the lunge test, in a control
group and a group with foot and ankle pathology. Gastrocnemius tightness
was calculated as the difference in dorsiflexion of the ankle with
the knee extended and flexed.Aims
Patients and Methods
The aim of this study was to compare the biomechanical stability and clinical outcome of external fixator combined with limited internal fixation (EFLIF) and open reduction and internal fixation (ORIF) in treating Sanders type 2 calcaneal fractures. Two types of fixation systems were selected for finite element analysis and a dual cohort study. Two fixation systems were simulated to fix the fracture in a finite element model. The relative displacement and stress distribution were analysed and compared. A total of 71 consecutive patients with closed Sanders type 2 calcaneal fractures were enrolled and divided into two groups according to the treatment to which they chose: the EFLIF group and the ORIF group. The radiological and clinical outcomes were evaluated and compared.Objectives
Methods
The aim of this study was to present a series of patients with
aseptic failure of a total ankle arthroplasty (TAA) who were treated
with fusion of the hindfoot using a nail. A total of 23 TAAs, in 22 patients, were revised for aseptic
loosening and balloon osteolysis to a hindfoot fusion by a single
surgeon (NH) between January 2012 and August 2014. The procedure
was carried out without bone graft using the Phoenix, Biomet Hindfoot
Arthrodesis Nail. Preoperative investigations included full blood
count, CRP and ESR, and radiological investigations including plain
radiographs and CT scans. Postoperative plain radiographs were assessed
for fusion. When there was any doubt, CT scans were performed.Aims
Patients and Methods
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. A total of 19 patients underwent a Scarf osteotomy (50.3 years,
standard deviation (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
We hypothesised that a minimally invasive peroneus
brevis tendon transfer would be effective for the management of
a chronic rupture of the Achilles tendon. In 17 patients (three
women, 14 men) who underwent minimally invasive transfer and tenodesis
of the peroneus brevis to the calcaneum, at a mean follow-up of
4.6 years (2 to 7) the modified Achilles tendon total rupture score
(ATRS) was recorded and the maximum circumference of the calf of
the operated and contralateral limbs was measured. The strength
of isometric plantar flexion of the gastrocsoleus complex and of
eversion of the ankle were measured bilaterally. Functional outcomes
were classified according to the four-point Boyden scale. At the latest review, the mean maximum circumference of the calf
of the operated limb was not significantly different from the pre-operative
mean value, (41.4 cm, 32 to 50 This procedure may be safely performed, is minimally invasive,
and allows most patients to return to pre-injury sport and daily
activities. 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:
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) correction of hallux
valgus, intermetatarsal, and distal metatarsal articular angles was
18.5° (8.8°), 5.7° (3.3°), and 16.6° (8.8°), respectively. Multivariable
regression analysis identified that an American Association of Anesthesiologists
grade of >
1 (Incident Rate Ratio (IRR) = 1.67, p-value = 0.011)
and recurrent deformity (IRR = 1.77, p-value = 0.003) were associated
with significantly worse MOXFQ scores. No correlation was found
between the severity of deformity, the type, or degree of surgical
correction and the outcome. When using a validated outcome score
for the assessment of outcome after surgery for hallux valgus, the
long-term results are worse than expected when compared with the
short- and mid-term outcomes, with 25.9% of patients dissatisfied
at a mean follow-up of 5.2 years. Cite this article:
The Manchester–Oxford Foot Questionnaire (MOXFQ) is a validated
16-item, patient-reported outcome measure for evaluating outcomes
of foot or ankle surgery. The original development of the instrument
identified three domains. This present study examined whether the
three domains could legitimately be summed to provide a single summary
index score. The MOXFQ and Short-Form (SF)-36 were administered to 671 patients
before surgery of the foot or ankle. Data from the three domains
of the MOXFQ (pain, walking/standing and social interaction) were
subjected to higher order factor analysis. Reliability and validity
of the summary index score was assessed.Objectives
Methods
The responsiveness of the Manchester–Oxford Foot
Questionnaire (MOXFQ) was compared with foot/ankle-specific and
generic outcome measures used to assess all surgery of the foot
and ankle. We recruited 671 consecutive adult patients awaiting
foot or ankle surgery, of whom 427 (63.6%) were female, with a mean
age of 52.8 years (18 to 89). They independently completed the MOXFQ,
Short-Form 36 (SF-36) and EuroQol (EQ-5D) questionnaires pre-operatively
and at a mean of nine months (3.8 to 14.4) post-operatively. Foot/ankle
surgeons assessed American Orthopaedic Foot and Ankle Society (AOFAS)
scores corresponding to four foot/ankle regions. A transition item measured
perceived changes in foot/ankle problems post-surgery. Of 628 eligible
patients proceeding to surgery, 491 (78%) completed questionnaires
and 262 (42%) received clinical assessments both pre- and post-operatively. The
regions receiving surgery were: multiple/whole foot in eight (1.3%),
ankle/hindfoot in 292 (46.5%), mid-foot in 21 (3.3%), hallux in
196 (31.2%), and lesser toes in 111 (17.7%). Foot/ankle-specific
MOXFQ, AOFAS and EQ-5D domains produced larger effect sizes (>
0.8)
than any SF-36 domains, suggesting superior responsiveness. In analyses
that anchored change in scores and effect sizes to patients’ responses
to a transition item about their foot/ankle problems, the MOXFQ
performed well. The SF-36 and EQ-5D performed poorly. Similar analyses,
conducted within foot-region based sub-groups of patients, found
that the responsiveness of the MOXFQ was good compared with the
AOFAS. This evidence supports the MOXFQ’s suitability for assessing
all foot and ankle surgery.
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:
The outcome in 83 patients with congenital clubfoot was evaluated at a mean age of 64 years using three validated questionnaires assessing both quality of life (short-form (SF)-36 and EQ-5D) and foot and ankle function (American Academy of Orthopaedic Surgeons (AAOS) Foot and Ankle questionnaire). In SF-36, male patients scored significantly better than male norms in seven of the eight domains, whereas female patients scored significantly worse than female norms in two of the eight. Male patients scored better than male norms in both the EQ-5D index (p = 0.027) and visual analogue scale (VAS) (p = 0.013), whereas female patients scored worse than female norms in the VAS (p <
0.001). Both male and female patients had a significantly worse outcome on the AAOS Core Scale than did norms. There was a significant correlation for both genders between the SF-36 Physical Component Summary Score and the AAOS Core Scale. The influence on activities of daily life was limited to foot and ankle problems in all patients, and in females there was an adverse effect in physical aspects of quality of life.
In a retrospective study we compared 32 HINTEGRA
total ankle replacements (TARs) and 35 Mobility TARs performed between
July 2005 and May 2010, with a minimum follow-up of two years. The
mean follow-up for the HINTEGRA group was 53 months (24 to 76) and
for the Mobility group was 34 months (24 to 45). All procedures
were performed by a single surgeon. There was no significant difference between the two groups with
regard to the mean AOFAS score, visual analogue score for pain or
range of movement of the ankle at the latest follow-up. Most radiological
measurements did not differ significantly between the two groups.
However, the most common grade of heterotopic ossification (HO)
was grade 3 in the HINTEGRA group (10 of 13 TARs, 76.9%) and grade
2 in the Mobility group (four of seven TARs, 57.1%) (p = 0.025).
Although HO was more frequent in the HINTEGRA group (40.6%) than
in the Mobility group (20.0%), this was not statistically significant
(p = 0.065).The difference in peri-operative complications between
the two groups was not significant, but intra-operative medial malleolar
fractures occurred in four (11.4%) in the Mobility group; four (12.5%)
in the HINTEGRA group and one TAR (2.9%) in the Mobility group failed
(p = 0.185). Cite this article:
A total of 80 patients with an acute rupture of tendo Achillis were randomised to operative repair using an open technique (39 patients) or non-operative treatment in a cast (41 patients). Patients were followed up for one year. Outcome measures included clinical complications, range of movement of the ankle, the Short Musculoskeletal Function Assessment (SMFA), and muscle function dynamometry evaluating dorsiflexion and plantar flexion of the ankle. The primary outcome measure was muscle dynamometry. Re-rupture occurred in two of 37 patients (5%) in the operative group and four of 39 (10%) in the non-operative group, which was not statistically significant (p = 0.68). There was a slightly greater range of plantar flexion and dorsiflexion of the ankle in the operative group at three months which was not statistically significant, but at four and six months the range of dorsiflexion was better in the non-operative group, although this did not reach statistically significance either. After 12 weeks the peak torque difference of plantar flexion compared with the normal side was less in the operative than the non-operative group (47% We were unable to show a convincing functional benefit from surgery for patients with an acute rupture of the tendo Achillis compared with conservative treatment in plaster.
Open reduction and internal fixation of high-energy pilon fractures are often associated with serious complications. Various methods have been used to treat these injuries, with variable results. A total of 17 consecutive patients with pilon fractures of AO/OTA type 43-B3 (n = 1), type C2 (n = 12) and type C3 (n = 4) were treated by indirect reduction by capsuloligamentotaxis and stabilisation using an ankle-spanning Ilizarov fixator. The calcaneal ring was removed at a mean of 3.7 weeks (3 to 6). A total of 16 patients were available for follow-up at a mean of 29 months (23 to 43). The mean time to healing was 15.8 weeks (13 to 23). Nine patients had pin-track infections but none had deep infection or osteomyelitis. Four patients (25%) had malunion. Fair, good or excellent ankle scores were found in 14 patients. External fixation with a ring fixator achieves stable reduction of the fractured fragments without additional trauma to soft tissues. With minimum complications and good healing results, the Ilizarov apparatus is particularly useful for high-energy pilon fractures.
We studied a cohort of 26 diabetic patients with chronic ulceration under the first metatarsal head treated by a modified Jones extensor hallucis longus and a flexor hallucis longus transfer. If the first metatarsal was still plantar flexed following these two transfers, a peroneus longus to the peroneus brevis tendon transfer was also performed. Finally, if ankle dorsiflexion was <
5° with the knee extended, a Strayer-type gastrocnemius recession was performed. The mean duration of chronic ulceration despite a minimum of six months’ conservative care was 16.2 months (6 to 31). A total of 23 of the 26 patients were available for follow-up at a mean of 39.6 months (12 to 61) after surgery. All except one achieved complete ulcer healing at a mean of 4.4 weeks (2 to 8) after surgery, and there was no recurrence of ulceration under the first metatarsal. We believe that tendon balancing using modified Jones extensor hallucis longus and flexor hallucis longus transfers, associated in selected cases with a peroneus longus to brevis transfer and/or Strayer procedure, can promote rapid and sustained healing of chronic diabetic ulcers under the first metatarsal head.
