Pub Date : 2024-04-22DOI: 10.1177/10711007241237529
SarahRose Hall, Jonathan R. M. Kaplan, Oliver N. Schipper, Ettore Vulcano, A. Holly Johnson, J. Benjamin Jackson, Amiethab A. Aiyer, Tyler A. Gonzalez
{"title":"Minimally Invasive Approaches to Haglund’s Deformity and Insertional Achilles Tendinopathy: A Contemporary Review","authors":"SarahRose Hall, Jonathan R. M. Kaplan, Oliver N. Schipper, Ettore Vulcano, A. Holly Johnson, J. Benjamin Jackson, Amiethab A. Aiyer, Tyler A. Gonzalez","doi":"10.1177/10711007241237529","DOIUrl":"https://doi.org/10.1177/10711007241237529","url":null,"abstract":"","PeriodicalId":12446,"journal":{"name":"Foot & Ankle International","volume":"30 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2024-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140636728","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background:Ankle osteoarthritis (OA) mainly arises from trauma, particularly lateral ligament injuries. Among lateral ligament injuries, ankles with calcaneofibular ligament (CFL) injuries exhibit increased instability and can be a risk factor ankle OA progression. However, the relationship between CFL injury and OA progression remains unclear. Therefore, this study aims to assess the relationship between CFL injuries and ankle OA by investigating stress changes and osteophyte formation in subtalar joint.Methods:We retrospectively reviewed the magnetic resonance imaging (MRI) and plain radiographic evaluations of 100 ankles of 91 patients presenting with chronic ankle instability (CAI), ankle OA, or other ankle conditions. The association between CFL injuries on the oblique view of MRI and the severity of ankle OA (based on Takakura-Tanaka classification) was statistically evaluated. Additionally, 71 ankles were further subjected to CT evaluation to determine the association between the CFL injuries and the Hounsfield unit (HU) ratios of the subtalar joint and medial gutter, and the correlation between the subtalar HU ratios and osteophyte severity were statistically evaluated.Results:CFL injury was observed in 35.9% (14/39) of patients with stage 0, 42.9% (9/21) with stage 1, 50.0% (10/20) with stage 2, 100% (9/9) with stage 3a, and 90.9% (10/11) with stage 3b. CFL-injured ankles exhibited higher HU ratios in the medial gutter and lower ratios in the medial posterior subtalar joint compared to uninjured ankles. A negative correlation was observed between medial osteophyte severity and the medial subtalar joint HU ratio.Conclusion:Our findings suggest that CFL injuries are common in severe ankle OA impairing the compensatory function of the subtalar joint through abnormal stress distribution and osteophyte formation.Level of Evidence:Level III, retrospective cohort study.
背景：踝关节骨关节炎（OA）主要源于创伤，尤其是外侧韧带损伤。在外侧韧带损伤中，小腿腓骨韧带（CFL）损伤的踝关节表现出更大的不稳定性，可能成为踝关节OA恶化的危险因素。然而，小腿腓骨韧带损伤与 OA 进展之间的关系仍不清楚。方法：我们回顾性地检查了91例慢性踝关节不稳定（CAI）、踝关节OA或其他踝关节疾病患者的100只脚踝的磁共振成像（MRI）和X光平片评估结果。对核磁共振成像斜视图上的 CFL 损伤与踝关节 OA 严重程度（基于高仓-田中分类法）之间的关联进行了统计评估。此外，还对 71 只脚踝进行了 CT 评估，以确定 CFL 损伤与踝关节和内侧沟的 Hounsfield 单位（HU）比率之间的关联，并对踝关节 HU 比率与骨质增生严重程度之间的相关性进行了统计评估。结果：35.9%（14/39）的 0 期患者、42.9%（9/21）的 1 期患者、50.0%（10/20）的 2 期患者、100%（9/9）的 3a 期患者和 90.9%（10/11）的 3b 期患者观察到 CFL 损伤。与未受伤的踝关节相比，CFL 受伤踝关节内侧沟的 HU 比率较高，而内侧后距下关节的 HU 比率较低。结论：我们的研究结果表明，CFL损伤在严重踝关节OA中很常见，它通过异常的应力分布和骨质增生的形成损害了踝关节的代偿功能。
{"title":"The Relationship Between Calcaneofibular Ligament Injury and Ankle Osteoarthritis Progression: A Comprehensive Analysis of Stress Distribution and Osteophyte Formation in the Subtalar Joint","authors":"Satoru Sakurai, Tomoyuki Nakasa, Yasunari Ikuta, Shingo Kawabata, Dan Moriwaki, Saori Ishibashi, Asyumaredha Asril Silan, Nobuo Adachi","doi":"10.1177/10711007241245363","DOIUrl":"https://doi.org/10.1177/10711007241245363","url":null,"abstract":"Background:Ankle osteoarthritis (OA) mainly arises from trauma, particularly lateral ligament injuries. Among lateral ligament injuries, ankles with calcaneofibular ligament (CFL) injuries exhibit increased instability and can be a risk factor ankle OA progression. However, the relationship between CFL injury and OA progression remains unclear. Therefore, this study aims to assess the relationship between CFL injuries and ankle OA by investigating stress changes and osteophyte formation in subtalar joint.Methods:We retrospectively reviewed the magnetic resonance imaging (MRI) and plain radiographic evaluations of 100 ankles of 91 patients presenting with chronic ankle instability (CAI), ankle OA, or other ankle conditions. The association between CFL injuries on the oblique view of MRI and the severity of ankle OA (based on Takakura-Tanaka classification) was statistically evaluated. Additionally, 71 ankles were further subjected to CT evaluation to determine the association between the CFL injuries and the Hounsfield unit (HU) ratios of the subtalar joint and medial gutter, and the correlation between the subtalar HU ratios and osteophyte severity were statistically evaluated.Results:CFL injury was observed in 35.9% (14/39) of patients with stage 0, 42.9% (9/21) with stage 1, 50.0% (10/20) with stage 2, 100% (9/9) with stage 3a, and 90.9% (10/11) with stage 3b. CFL-injured ankles exhibited higher HU ratios in the medial gutter and lower ratios in the medial posterior subtalar joint compared to uninjured ankles. A negative correlation was observed between medial osteophyte severity and the medial subtalar joint HU ratio.Conclusion:Our findings suggest that CFL injuries are common in severe ankle OA impairing the compensatory function of the subtalar joint through abnormal stress distribution and osteophyte formation.Level of Evidence:Level III, retrospective cohort study.","PeriodicalId":12446,"journal":{"name":"Foot & Ankle International","volume":"115 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2024-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140636007","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-18DOI: 10.1177/10711007241238226
Chao Wang, Zhi Wang, Hongmou Zhao, Mingzhu Zhang
Background:The traditional scarf osteotomy (TSO) has limited ability to correct the first metatarsal pronation. A novel modification that we refer to as a “dovetailed notch scarf osteotomy” (DNSO) has been developed to enhance the ability to correct coronal plane pronation. The study aimed to observe and compare TSO to DNSO in the treatment of moderate to severe hallux valgus deformity.Methods:This retrospective study included 78 feet that had a TSO and 105 feet that had a DNSO. Minimum follow-up was 24 months. Weightbearing computed tomography (WBCT) and weightbearing anterior-posterior (AP) radiographs were taken preoperatively and at the last follow-up. We measured the intermetatarsal angle (IMA), hallux valgus angle, distal metatarsal articular surface angle on AP radiographs and first metatarsal coronal pronation angle (α angle), tibial sesamoid coronal grading, and first metatarsal length on WBCT. Clinical assessment was done using visual analog scale (VAS), American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot scale, Foot and Ankle Ability Measure (FAAM), and the 36-Item Short Form Health Survey (SF-36). The occurrence of postoperative complications was also documented.Results:The DNSO group exhibited a significantly higher correction amount of α angle and IMA (14.3 ± 9.9 and 10.3 ± 4.6 degrees) than the TSO group (8.6 ± 5.9 and 5.4 ± 5.9 degrees) during the final follow-up assessment ( P < .05).The DNSO group (10.1 [8.0-12.0] degrees and 4.8 [3.9-5.6] degrees) demonstrated significantly smaller α angle and IMA compared with the TSO group (4.8 [3.9-5.6] degrees and 9.5 [7.5-11.5] degrees) at 24 months postsurgery ( P < .05). The postoperative FAAM activities of daily living and SF-36 physical functioning scores were significantly higher in the DNSO group (97.2 ± 3.3 and 95.7 ± 4.4 points) compared with the TSO group (92.3 ± 3.3 and 87.7 ± 8.7 points) ( P < .05). Additionally, hallux varus occurred in 1 case in the DNSO group, whereas 4 cases were observed in the TSO group.Conclusion:Two osteotomy methods can effectively correct moderate to severe hallux valgus deformity. Compared with the TSO, the DNSO has stronger correction ability. The most crucial aspect lies in its controllability when correcting first metatarsal pronation and addressing IMA.Level of Evidence:Level III, retrospective comparative study.
{"title":"Radiologic and Clinical Outcomes of the Dovetailed Notch Scarf Osteotomy for Correcting the First Metatarsal Pronation in Moderate to Severe Hallux Valgus Deformity: A Comparative Study","authors":"Chao Wang, Zhi Wang, Hongmou Zhao, Mingzhu Zhang","doi":"10.1177/10711007241238226","DOIUrl":"https://doi.org/10.1177/10711007241238226","url":null,"abstract":"Background:The traditional scarf osteotomy (TSO) has limited ability to correct the first metatarsal pronation. A novel modification that we refer to as a “dovetailed notch scarf osteotomy” (DNSO) has been developed to enhance the ability to correct coronal plane pronation. The study aimed to observe and compare TSO to DNSO in the treatment of moderate to severe hallux valgus deformity.Methods:This retrospective study included 78 feet that had a TSO and 105 feet that had a DNSO. Minimum follow-up was 24 months. Weightbearing computed tomography (WBCT) and weightbearing anterior-posterior (AP) radiographs were taken preoperatively and at the last follow-up. We measured the intermetatarsal angle (IMA), hallux valgus angle, distal metatarsal articular surface angle on AP radiographs and first metatarsal coronal pronation angle (α angle), tibial sesamoid coronal grading, and first metatarsal length on WBCT. Clinical assessment was done using visual analog scale (VAS), American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot scale, Foot and Ankle Ability Measure (FAAM), and the 36-Item Short Form Health Survey (SF-36). The occurrence of postoperative complications was also documented.Results:The DNSO group exhibited a significantly higher correction amount of α angle and IMA (14.3 ± 9.9 and 10.3 ± 4.6 degrees) than the TSO group (8.6 ± 5.9 and 5.4 ± 5.9 degrees) during the final follow-up assessment ( P < .05).The DNSO group (10.1 [8.0-12.0] degrees and 4.8 [3.9-5.6] degrees) demonstrated significantly smaller α angle and IMA compared with the TSO group (4.8 [3.9-5.6] degrees and 9.5 [7.5-11.5] degrees) at 24 months postsurgery ( P < .05). The postoperative FAAM activities of daily living and SF-36 physical functioning scores were significantly higher in the DNSO group (97.2 ± 3.3 and 95.7 ± 4.4 points) compared with the TSO group (92.3 ± 3.3 and 87.7 ± 8.7 points) ( P < .05). Additionally, hallux varus occurred in 1 case in the DNSO group, whereas 4 cases were observed in the TSO group.Conclusion:Two osteotomy methods can effectively correct moderate to severe hallux valgus deformity. Compared with the TSO, the DNSO has stronger correction ability. The most crucial aspect lies in its controllability when correcting first metatarsal pronation and addressing IMA.Level of Evidence:Level III, retrospective comparative study.","PeriodicalId":12446,"journal":{"name":"Foot & Ankle International","volume":"2 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2024-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140625415","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-15DOI: 10.1177/10711007241241075
Angela Seidel, Amal Chidda, Virginie Perez, Fabian Krause, Ivan Zderic, Boyko Gueorguiev, Karl-Andre Lalonde, Brad Meulenkamp
Background:Pressure distribution in the ankle joint is known to be dependent on various factors, including hindfoot alignment. We seek to evaluate how hindfoot alignment affects contact pressures in the ankle joint in the setting of supination external rotation (SER) type ankle fractures.Methods:SER fractures were created in 10 human cadaver lower extremity specimens, simulating progressive stages of injury: without fracture (step 0), SER fracture and intact deltoid ligament (step 1), superficial deltoid ligament disruption (step 2), and deep deltoid ligament disruption (step 3). At each step, varus and valgus alignment was simulated by displacing the calcaneal tuberosity 7 mm medial or lateral. Each limb was axially loaded following each osteotomy at a static load of 350 N. The center of force (COF), contact area (CA), and peak contact pressure (PP) under load were measured, and radiographs of the ankle mortise were taken to analyze the medial clear space (MCS) and talar tilt (TT).Results:The COF (5.3 mm, P = .030) and the CA (−188.4 mm2, P = .015) changed in step 3 in the valgus hindfoot alignment compared to baseline parameters, indicating the importance of deep deltoid ligament integrity in maintaining normal ankle joint contact stress in the valgus hindfoot. These changes were not seen in the setting of varus alignment (COF: 2.3 mm, P = .059; CA −121 mm2, P = .133). PP were found to not change significantly in either varus or valgus (varus: −4.9 N, P = .132; valgus: −4 N, P = .464). The MCS demonstrated widening in step 3 compared to step 2 (0.7 mm, P = .020) in both varus and valgus hindfoot. The TT increased significantly in step 3 in the valgus hindfoot (2.8 degrees, P = .020) compared to step 0.Conclusion:SER-IV fractures with valgus hindfoot alignment showed significant changes in pressure distribution and radiographic parameters when compared to SER-IV fractures with varus hindfoot alignment.Clinical Relevance:Based on this cadaver modeling study, patients with SERIV fracture with varus hindfoot alignment and complete deltoid ligament lesion may not need fracture fixation, whereas those with valgus hindfoot alignment likely need fracture fixation.
{"title":"Biomechanical Effects of Hindfoot Alignment in Supination External Rotation Malleolar Fractures: A Human Cadaveric Model","authors":"Angela Seidel, Amal Chidda, Virginie Perez, Fabian Krause, Ivan Zderic, Boyko Gueorguiev, Karl-Andre Lalonde, Brad Meulenkamp","doi":"10.1177/10711007241241075","DOIUrl":"https://doi.org/10.1177/10711007241241075","url":null,"abstract":"Background:Pressure distribution in the ankle joint is known to be dependent on various factors, including hindfoot alignment. We seek to evaluate how hindfoot alignment affects contact pressures in the ankle joint in the setting of supination external rotation (SER) type ankle fractures.Methods:SER fractures were created in 10 human cadaver lower extremity specimens, simulating progressive stages of injury: without fracture (step 0), SER fracture and intact deltoid ligament (step 1), superficial deltoid ligament disruption (step 2), and deep deltoid ligament disruption (step 3). At each step, varus and valgus alignment was simulated by displacing the calcaneal tuberosity 7 mm medial or lateral. Each limb was axially loaded following each osteotomy at a static load of 350 N. The center of force (COF), contact area (CA), and peak contact pressure (PP) under load were measured, and radiographs of the ankle mortise were taken to analyze the medial clear space (MCS) and talar tilt (TT).Results:The COF (5.3 mm, P = .030) and the CA (−188.4 mm<jats:sup>2</jats:sup>, P = .015) changed in step 3 in the valgus hindfoot alignment compared to baseline parameters, indicating the importance of deep deltoid ligament integrity in maintaining normal ankle joint contact stress in the valgus hindfoot. These changes were not seen in the setting of varus alignment (COF: 2.3 mm, P = .059; CA −121 mm<jats:sup>2</jats:sup>, P = .133). PP were found to not change significantly in either varus or valgus (varus: −4.9 N, P = .132; valgus: −4 N, P = .464). The MCS demonstrated widening in step 3 compared to step 2 (0.7 mm, P = .020) in both varus and valgus hindfoot. The TT increased significantly in step 3 in the valgus hindfoot (2.8 degrees, P = .020) compared to step 0.Conclusion:SER-IV fractures with valgus hindfoot alignment showed significant changes in pressure distribution and radiographic parameters when compared to SER-IV fractures with varus hindfoot alignment.Clinical Relevance:Based on this cadaver modeling study, patients with SERIV fracture with varus hindfoot alignment and complete deltoid ligament lesion may not need fracture fixation, whereas those with valgus hindfoot alignment likely need fracture fixation.","PeriodicalId":12446,"journal":{"name":"Foot & Ankle International","volume":"47 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2024-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140572235","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-15DOI: 10.1177/10711007241242779
Karan Malhotra, Shelain Patel, Nicholas Cullen, Matthew Welck
Background:The cavovarus foot is a complex 3-dimensional deformity. Although a multitude of techniques are described for its surgical management, few of these are evidence based or guided by classification systems. Surgical management involves realignment of the hindfoot and soft tissue balancing, followed by forefoot balancing. Our aim was to analyze the pattern of residual forefoot deformities once the hindfoot is corrected, to guide forefoot correction.Methods:We included 20 cavovarus feet from 16 adult patients with Charcot-Marie-Tooth who underwent weightbearing CT (mean age 43.4 years, range: 22-78 years, 14 males). Patients included had flexible deformities, with no previous surgery. Using specialized software (Bonelogic 2.1, Disior) a 3-dimensional, virtual model was created. Using morphologic data captured from normal feet in patients without pathology as a guide, the talonavicular joint of the cavovarus foot was digitally reduced to a “normal” position to simulate the correction that would be achieved during surgical correction. Models of the corrected position were exported and geometrically analyzed using Blender 3.64 to identify anatomical trends.Results:We identified 4 types of cavovarus forefoot morphotypes. Type 0 was defined as a balanced forefoot (2 cases, 10%). Type 1 was defined as a forefoot where the first metatarsal was relatively plantarflexed to the rest of the foot, with no significant residual adduction after talonavicular joint correction (12 cases, 60%). Type 2 was defined as a forefoot where the second and first metatarsals were progressively plantarflexed, with no significant adduction (4 cases, 20%). Type 3 was defined as a forefoot where the metatarsals were adducted after talonavicular derotation (2 cases, 10%).Conclusion:In this relatively small cohort, we identified 4 forefoot morphotypes in cavovarus feet that might help surgeons to recognize and anticipate the residual forefoot deformities after hindfoot correction. Different treatment strategies may be required for different morphotypes to achieve balanced correction.Level of Evidence:Level IV, retrospective case series.
{"title":"Forefoot Morphotypes in Cavovarus Feet: A Novel Assessment of Deformity","authors":"Karan Malhotra, Shelain Patel, Nicholas Cullen, Matthew Welck","doi":"10.1177/10711007241242779","DOIUrl":"https://doi.org/10.1177/10711007241242779","url":null,"abstract":"Background:The cavovarus foot is a complex 3-dimensional deformity. Although a multitude of techniques are described for its surgical management, few of these are evidence based or guided by classification systems. Surgical management involves realignment of the hindfoot and soft tissue balancing, followed by forefoot balancing. Our aim was to analyze the pattern of residual forefoot deformities once the hindfoot is corrected, to guide forefoot correction.Methods:We included 20 cavovarus feet from 16 adult patients with Charcot-Marie-Tooth who underwent weightbearing CT (mean age 43.4 years, range: 22-78 years, 14 males). Patients included had flexible deformities, with no previous surgery. Using specialized software (Bonelogic 2.1, Disior) a 3-dimensional, virtual model was created. Using morphologic data captured from normal feet in patients without pathology as a guide, the talonavicular joint of the cavovarus foot was digitally reduced to a “normal” position to simulate the correction that would be achieved during surgical correction. Models of the corrected position were exported and geometrically analyzed using Blender 3.64 to identify anatomical trends.Results:We identified 4 types of cavovarus forefoot morphotypes. Type 0 was defined as a balanced forefoot (2 cases, 10%). Type 1 was defined as a forefoot where the first metatarsal was relatively plantarflexed to the rest of the foot, with no significant residual adduction after talonavicular joint correction (12 cases, 60%). Type 2 was defined as a forefoot where the second and first metatarsals were progressively plantarflexed, with no significant adduction (4 cases, 20%). Type 3 was defined as a forefoot where the metatarsals were adducted after talonavicular derotation (2 cases, 10%).Conclusion:In this relatively small cohort, we identified 4 forefoot morphotypes in cavovarus feet that might help surgeons to recognize and anticipate the residual forefoot deformities after hindfoot correction. Different treatment strategies may be required for different morphotypes to achieve balanced correction.Level of Evidence:Level IV, retrospective case series.","PeriodicalId":12446,"journal":{"name":"Foot & Ankle International","volume":"35 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2024-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140572337","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-15DOI: 10.1177/10711007241241264
Bernd Friesenbichler, Thomas Rutishauer, Pascal Rippstein, Renate List, Samara Monn, Jens Mainzer, Nicola A. Maffiuletti
Background:Haglund exostosis–related heel pain may be surgically treated with dorsal closing wedge calcaneal osteotomy (DCWCO). Recent reports on this technique show good clinical and self-reported outcomes. However, uncertainty about functional consequences related to ankle muscle strength and gait function due to a shortened Achilles tendon lever arm exists.Methods:Fifteen patients (15 feet) with Haglund exostosis–related heel pain were surgically treated with DCWCO and evaluated before and 1 year after surgery. Isometric plantar flexion and dorsiflexion strength was quantified for both the involved and the uninvolved limb. Gait analysis was performed at a self-selected walking speed using a 3D motion capture system including force plates. Self-reported outcomes (Foot Function Index and Global Treatment Outcome) were also assessed.Results:Before surgery, as well as after surgery, plantar flexion strength of the involved limb was significantly lower compared to the uninvolved limb while dorsiflexion strength did not differ between limbs at both time points. Step length and time, ankle flexion angles, power generation, and propulsive impulses during gait did not differ between limbs both before and after surgery. Propulsive impulse and step length of the involved limb increased from pre- to postsurgery with an effect size of 1.04 and 0.48, respectively, revealing a general improvement in gait dynamics. Total Foot Function Index improved by 48% after surgery, and 80% of patients rated their surgery as “helped” or “helped a lot” (Global Treatment Outcome).Conclusion:In this relatively small cohort, we found that patients treated for Haglund exostosis–related heel pain with DCWCO surgery had minor interlimb differences in gait kinematics and kinetics and generally improved gait dynamics and self-reported function at 1-year follow-up.Level of Evidence:Level II, observational prospective cohort study.
{"title":"Ankle Muscle Strength and Gait Function After Dorsal Closing Wedge Calcaneal Osteotomy for Haglund Exostosis–Related Heel Pain","authors":"Bernd Friesenbichler, Thomas Rutishauer, Pascal Rippstein, Renate List, Samara Monn, Jens Mainzer, Nicola A. Maffiuletti","doi":"10.1177/10711007241241264","DOIUrl":"https://doi.org/10.1177/10711007241241264","url":null,"abstract":"Background:Haglund exostosis–related heel pain may be surgically treated with dorsal closing wedge calcaneal osteotomy (DCWCO). Recent reports on this technique show good clinical and self-reported outcomes. However, uncertainty about functional consequences related to ankle muscle strength and gait function due to a shortened Achilles tendon lever arm exists.Methods:Fifteen patients (15 feet) with Haglund exostosis–related heel pain were surgically treated with DCWCO and evaluated before and 1 year after surgery. Isometric plantar flexion and dorsiflexion strength was quantified for both the involved and the uninvolved limb. Gait analysis was performed at a self-selected walking speed using a 3D motion capture system including force plates. Self-reported outcomes (Foot Function Index and Global Treatment Outcome) were also assessed.Results:Before surgery, as well as after surgery, plantar flexion strength of the involved limb was significantly lower compared to the uninvolved limb while dorsiflexion strength did not differ between limbs at both time points. Step length and time, ankle flexion angles, power generation, and propulsive impulses during gait did not differ between limbs both before and after surgery. Propulsive impulse and step length of the involved limb increased from pre- to postsurgery with an effect size of 1.04 and 0.48, respectively, revealing a general improvement in gait dynamics. Total Foot Function Index improved by 48% after surgery, and 80% of patients rated their surgery as “helped” or “helped a lot” (Global Treatment Outcome).Conclusion:In this relatively small cohort, we found that patients treated for Haglund exostosis–related heel pain with DCWCO surgery had minor interlimb differences in gait kinematics and kinetics and generally improved gait dynamics and self-reported function at 1-year follow-up.Level of Evidence:Level II, observational prospective cohort study.","PeriodicalId":12446,"journal":{"name":"Foot & Ankle International","volume":"134 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2024-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140572426","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-09DOI: 10.1177/10711007241241073
Kacper Ruzik, Bartosz Gonera, Andrzej Borowski, Piotr Karauda, Paloma Aragonés, Łukasz Olewnik
Background:The lateral ankle joint comprises the anterior talofibular ligament (ATFL), calcaneofibular ligament (CFL), and posterior talofibular ligament (PTFL). The purpose of this study was to propose a classification of CFL morphology.Methods:The material comprised 120 paired lower limbs from human cadavers (30 male, 30 female), mean age 62.3 years. The morphology was carefully assessed, and morphometric measurements were performed.Results:A 4-part method for anatomic classification can be suggested based on our study. Type 1 (48.3%), the most common type, was characterized by a bandlike morphology. Type 2 (9.2%) was characterized by a Y-shaped band, and type 3 (21.7%) by a V-shaped band. Type 4 (20.8%) was characterized by the presence of 2 or 3 bands. Type 2 and 4 were divided into further subtypes based on origin footprint.Conclusion:The aim of our study was to describe variations of calcaneofibular ligament. Our proposed 4-part classification may be of value in clinical practice in future recognition of CFL injuries and in its repair or reconstruction.Clinical Relevance:The anatomy of the CFL plays an important role in stability of the ankle. Greater recognition of anatomical variation may help improve reconstructive options for patients with chronic lateral ankle instability.
{"title":"Anatomic Variations of the Calcaneofibular Ligament","authors":"Kacper Ruzik, Bartosz Gonera, Andrzej Borowski, Piotr Karauda, Paloma Aragonés, Łukasz Olewnik","doi":"10.1177/10711007241241073","DOIUrl":"https://doi.org/10.1177/10711007241241073","url":null,"abstract":"Background:The lateral ankle joint comprises the anterior talofibular ligament (ATFL), calcaneofibular ligament (CFL), and posterior talofibular ligament (PTFL). The purpose of this study was to propose a classification of CFL morphology.Methods:The material comprised 120 paired lower limbs from human cadavers (30 male, 30 female), mean age 62.3 years. The morphology was carefully assessed, and morphometric measurements were performed.Results:A 4-part method for anatomic classification can be suggested based on our study. Type 1 (48.3%), the most common type, was characterized by a bandlike morphology. Type 2 (9.2%) was characterized by a Y-shaped band, and type 3 (21.7%) by a V-shaped band. Type 4 (20.8%) was characterized by the presence of 2 or 3 bands. Type 2 and 4 were divided into further subtypes based on origin footprint.Conclusion:The aim of our study was to describe variations of calcaneofibular ligament. Our proposed 4-part classification may be of value in clinical practice in future recognition of CFL injuries and in its repair or reconstruction.Clinical Relevance:The anatomy of the CFL plays an important role in stability of the ankle. Greater recognition of anatomical variation may help improve reconstructive options for patients with chronic lateral ankle instability.","PeriodicalId":12446,"journal":{"name":"Foot & Ankle International","volume":"4 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2024-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140572328","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background:Osteochondral lesions of the talus (OLTs) are among the common sports-related injuries. However, there are few reports on the return to sports after OLT surgery in skeletally immature children. This study was performed to evaluate the return to sports after microfracture for OLTs in skeletally immature children.Methods:This study involved 17 ankles of 16 patients (mean age, 13.2 years; range, 10-16 years) with open tibial epiphyses on magnetic resonance imaging (MRI) who underwent microfracture for OLTs <10 mm in diameter and confirmation of lesion instability under arthroscopy. Nine of 17 ankles had additional lateral ankle ligament stabilization. All patients were participating in some form of sports. The Japanese Society for Surgery of the Foot (JSSF) score, Ankle Activity Score (AAS), return to sports rate, lesion size, grade of subchondral bone marrow edema, and Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) score on MRI were evaluated after microfracture. The mean postoperative follow-up period was 53.5 months.Results:The mean JSSF score significantly improved from 76.1 points preoperatively to 94.9 points at the final follow-up ( P < .01). The mean AAS showed no change from preoperative state to final follow-up. The return to sports rate was 100%. The lesion size significantly decreased from 76.3 to 56.7 mm2 in area ( P = .02) and from 283.2 to 185.6 mm3 in volume ( P = .05). The bone marrow edema grade decreased in 8 of 17 ankles. The total MOCART score showed a significant improvement from 6 months to 1 year postoperatively ( P = .05).Conclusion:All skeletally immature children who underwent microfracture for OLTs in this study were able to return to sports activity and showed improvements in clinical scores and MRI parameters. Microfracture may be considered an effective first-line treatment for OLTs <10 mm in diameter in skeletally immature athletes.Level of Evidence:Level IV, retrospective case-control study.
{"title":"Return to Sports Activity After Microfracture for Osteochondral Lesion of the Talus in Skeletally Immature Children","authors":"Seiya Tomonaga, Ichiro Yoshimura, Tomonobu Hagio, Tetsuro Ishimatsu, Yuki Sugino, Ryo Fukagawa, Yoshimasa Taniguchi, Takuaki Yamamoto","doi":"10.1177/10711007241241067","DOIUrl":"https://doi.org/10.1177/10711007241241067","url":null,"abstract":"Background:Osteochondral lesions of the talus (OLTs) are among the common sports-related injuries. However, there are few reports on the return to sports after OLT surgery in skeletally immature children. This study was performed to evaluate the return to sports after microfracture for OLTs in skeletally immature children.Methods:This study involved 17 ankles of 16 patients (mean age, 13.2 years; range, 10-16 years) with open tibial epiphyses on magnetic resonance imaging (MRI) who underwent microfracture for OLTs <10 mm in diameter and confirmation of lesion instability under arthroscopy. Nine of 17 ankles had additional lateral ankle ligament stabilization. All patients were participating in some form of sports. The Japanese Society for Surgery of the Foot (JSSF) score, Ankle Activity Score (AAS), return to sports rate, lesion size, grade of subchondral bone marrow edema, and Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) score on MRI were evaluated after microfracture. The mean postoperative follow-up period was 53.5 months.Results:The mean JSSF score significantly improved from 76.1 points preoperatively to 94.9 points at the final follow-up ( P < .01). The mean AAS showed no change from preoperative state to final follow-up. The return to sports rate was 100%. The lesion size significantly decreased from 76.3 to 56.7 mm<jats:sup>2</jats:sup> in area ( P = .02) and from 283.2 to 185.6 mm<jats:sup>3</jats:sup> in volume ( P = .05). The bone marrow edema grade decreased in 8 of 17 ankles. The total MOCART score showed a significant improvement from 6 months to 1 year postoperatively ( P = .05).Conclusion:All skeletally immature children who underwent microfracture for OLTs in this study were able to return to sports activity and showed improvements in clinical scores and MRI parameters. Microfracture may be considered an effective first-line treatment for OLTs <10 mm in diameter in skeletally immature athletes.Level of Evidence:Level IV, retrospective case-control study.","PeriodicalId":12446,"journal":{"name":"Foot & Ankle International","volume":"102 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2024-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140572332","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-23DOI: 10.1177/10711007241235271
{"title":"Thank You to Foot & Ankle International Reviewers","authors":"","doi":"10.1177/10711007241235271","DOIUrl":"https://doi.org/10.1177/10711007241235271","url":null,"abstract":"","PeriodicalId":12446,"journal":{"name":"Foot & Ankle International","volume":"306 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2024-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140202436","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：