Pub Date : 2020-12-21DOI: 10.30795/jfootankle.2020.v14.1203
L. Lara, Lúcio Torres Filho, G. Cervone, R. Viana, Glaucia Bordignon, J. Grajales, L. Lancia
Objective: To analyze outcomes of hallux valgus surgical correction using the Reverdin-Isham technique by means of clinical and radiographic studies. Methods: We retrospectively assessed 43 feet (38 patients) with moderate to severe hallux valgus treated from June 2009 to July 2014. Mean age at surgery was 59 years; mean postoperative follow-up time was 79 months. Patients were assessed at pre- and postoperative periods both functionally, by the American Orthopaedic Foot and Ankle Society (AOFAS) score, and radiographically, by the hallux valgus angle (HVA), intermetatarsal angle (IMA), distal metatarsal articular angle (DMAA), and shortening of 1st metatarsal bone. Results: AOFAS scores had a mean increase of 55 points. Mean HVA decreased 14.5°, whereas IMA and DMAA exhibited a mean decrease of 3.8° and 9.7°, respectively. Mean shortening of the first metatarsal bone was 3mm. Conclusion: The presented surgical technique showed to be effective to correct mild to moderate hallux valgus, resulting in appropriate angle correction angular and significant increase in AOFAS scores. Level of Evidence IV; Therapeutic Studies; Case Series.
{"title":"Percutaneous surgical treatment of hallux valgus","authors":"L. Lara, Lúcio Torres Filho, G. Cervone, R. Viana, Glaucia Bordignon, J. Grajales, L. Lancia","doi":"10.30795/jfootankle.2020.v14.1203","DOIUrl":"https://doi.org/10.30795/jfootankle.2020.v14.1203","url":null,"abstract":"Objective: To analyze outcomes of hallux valgus surgical correction using the Reverdin-Isham technique by means of clinical and radiographic studies. Methods: We retrospectively assessed 43 feet (38 patients) with moderate to severe hallux valgus treated from June 2009 to July 2014. Mean age at surgery was 59 years; mean postoperative follow-up time was 79 months. Patients were assessed at pre- and postoperative periods both functionally, by the American Orthopaedic Foot and Ankle Society (AOFAS) score, and radiographically, by the hallux valgus angle (HVA), intermetatarsal angle (IMA), distal metatarsal articular angle (DMAA), and shortening of 1st metatarsal bone. Results: AOFAS scores had a mean increase of 55 points. Mean HVA decreased 14.5°, whereas IMA and DMAA exhibited a mean decrease of 3.8° and 9.7°, respectively. Mean shortening of the first metatarsal bone was 3mm. Conclusion: The presented surgical technique showed to be effective to correct mild to moderate hallux valgus, resulting in appropriate angle correction angular and significant increase in AOFAS scores. Level of Evidence IV; Therapeutic Studies; Case Series.","PeriodicalId":21602,"journal":{"name":"Scientific Journal of the Foot & Ankle","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90086632","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-12-21DOI: 10.30795/jfootankle.2020.v14.1208
G. Nunes, J. Magalhães, T. Baumfeld, R. Pinto
Objective: To present the clinical and radiographic results of surgical treatment of patients with moderate to severe hallux valgus (HV) by minimally invasive Chevron - Akin osteotomy (MICA). Methods: The case series comprises 25 patients (30 feet) with diagnoses of moderate to severe HV treated surgically with the MICA technique. All patients answered the American Orthopedic Foot and Ankle Score (AOFAS) and rated pain on visual analogue scale (VAS) at preoperative assessment and at the last follow-up consultation. Radiological assessment included measurement of the valgus angles of the hallux (HVA) and the 1st and 2nd ray intermetatarsal angle (IMA). Complications and satisfaction ratings were also documented. Results: Mean follow-up was 14.6 months. Mean AOFAS increased from 42.8 to 90 and VAS reduced from 8.6 to 1.7. Mean HVA reduced from 31.7o to 8.4o and IMA from 14o to 5o. All these improvements were statistically significant (p<0.001). The most common complication observed was discomfort caused by hardware, affecting five feet (16.6%). Two patients (6.6%) had transitory neurapraxia and one patient (3.3%) developed reflex sympathetic dystrophy. There were no cases of infection, relapse, pseudarthrosis, or malunion of osteotomies. Subjective satisfaction ratings classified 93.3% of results as good or excellent. Conclusion: Minimally invasive Chevron-Akin osteotomy is a safe and reproducible technique that achieves good clinical and radiographic results for treatment of moderate to severe hallux valgus. Level of Evidence IV; Therapeutic Studies; Case Series.
{"title":"Minimally invasive Chevron-Akin osteotomy","authors":"G. Nunes, J. Magalhães, T. Baumfeld, R. Pinto","doi":"10.30795/jfootankle.2020.v14.1208","DOIUrl":"https://doi.org/10.30795/jfootankle.2020.v14.1208","url":null,"abstract":"Objective: To present the clinical and radiographic results of surgical treatment of patients with moderate to severe hallux valgus (HV) by minimally invasive Chevron - Akin osteotomy (MICA). Methods: The case series comprises 25 patients (30 feet) with diagnoses of moderate to severe HV treated surgically with the MICA technique. All patients answered the American Orthopedic Foot and Ankle Score (AOFAS) and rated pain on visual analogue scale (VAS) at preoperative assessment and at the last follow-up consultation. Radiological assessment included measurement of the valgus angles of the hallux (HVA) and the 1st and 2nd ray intermetatarsal angle (IMA). Complications and satisfaction ratings were also documented. Results: Mean follow-up was 14.6 months. Mean AOFAS increased from 42.8 to 90 and VAS reduced from 8.6 to 1.7. Mean HVA reduced from 31.7o to 8.4o and IMA from 14o to 5o. All these improvements were statistically significant (p<0.001). The most common complication observed was discomfort caused by hardware, affecting five feet (16.6%). Two patients (6.6%) had transitory neurapraxia and one patient (3.3%) developed reflex sympathetic dystrophy. There were no cases of infection, relapse, pseudarthrosis, or malunion of osteotomies. Subjective satisfaction ratings classified 93.3% of results as good or excellent. Conclusion: Minimally invasive Chevron-Akin osteotomy is a safe and reproducible technique that achieves good clinical and radiographic results for treatment of moderate to severe hallux valgus. Level of Evidence IV; Therapeutic Studies; Case Series.","PeriodicalId":21602,"journal":{"name":"Scientific Journal of the Foot & Ankle","volume":"11 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86059193","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-12-21DOI: 10.30795/jfootankle.2020.v14.1204
G. Souza, R. Pires, Egídio Santana Junior, L. Ferreira, R. Yoon, Frank A. Liporace
Complex lower extremity trauma with large soft tissue defects requires early wound coverage to reduce the risk of complications. In particular circumstances, however, local or free flaps may be contraindicated due to local or systemic issues. This study presents a helpful and effective salvage procedure for soft tissue reconstruction that uses autologous fat grafting combined with negative pressure wound therapy. Level of Evidence V; Therapeutic Studies; Expert Opinion.
{"title":"Free adipose tissue (FAT) graft pooling for severe dead space management","authors":"G. Souza, R. Pires, Egídio Santana Junior, L. Ferreira, R. Yoon, Frank A. Liporace","doi":"10.30795/jfootankle.2020.v14.1204","DOIUrl":"https://doi.org/10.30795/jfootankle.2020.v14.1204","url":null,"abstract":"Complex lower extremity trauma with large soft tissue defects requires early wound coverage to reduce the risk of complications. In particular circumstances, however, local or free flaps may be contraindicated due to local or systemic issues. This study presents a helpful and effective salvage procedure for soft tissue reconstruction that uses autologous fat grafting combined with negative pressure wound therapy. Level of Evidence V; Therapeutic Studies; Expert Opinion.","PeriodicalId":21602,"journal":{"name":"Scientific Journal of the Foot & Ankle","volume":"51 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81409930","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-12-21DOI: 10.30795/jfootankle.2020.v14.1216
M. Myerson
I remember so clearly when I first became a member of the American Orthopedic Foot and Ankle Society in the early 1980s. I knew everyone. It was a small organization that facilitated friendships, collegiality as well as academic and professional interaction. Now as then, these incredible friendships that we have all established over the decades define our professional life. For those of you who have been involved in the education of residents and fellows you will understand how relevant this is to your own personal growth. I have always felt strongly that you cannot be an educator unless you’re prepared to listen to your students. In the earlier years of training fellows, it was not much of an age differential, and while there was always a matter of the difference in knowledge and experience, I did not yet have the “seniority”. However, over the decades I’ve learned that some of our closest relationships emanate from these mentoring experiences. Here is a quote from Dr George Quill, a fellow in 1989: “In hindsight, I was doubly fortunate to be only the second surgeon in the world to matriculate with Mark Myerson because, in doing so, I gained a generous mentor and a dear friend for life!” Remember this: as an educator you inevitably give of yourself, but you will also receive something in return. When we share compassion with others, we are all tremendously enriched. Teaching of residents and fellows is a responsibility that we all share. During the formative training particularly of fellows, I want them “to lose their GPS”. Residents learn by repetition, but this encourages sterility without analysis. And by following the acquisition of knowledge blindly without questioning and analyzing the process does not help one grow. This is what I mean about losing your GPS, since sooner or later our fellows need to break away from the mentality of being guided by their mentor’s thinking and develop strategies of their own. I have never been afraid to push the envelope of experiences, and I have always embraced intellectual, personal, academic, and professional challenges. Many of you may have heard me saying that life begins at the edge of your comfort zone. In my practice of medicine, I’ve never felt any room for complacency. To accept everything as given, whether we read it in a prominent journal, or hear it from a colleague is meaningless until we can prove it for ourselves. This I learned from my mentor, Dr. Melvin Jahss who insisted in the early 1980’s that very few things were actually new ideas. He maintained that if one read the literature in depth, particularly in other languages, it was all there. I was reminded this many years later when I “rediscovered” what we knowas today as the Ludloff osteotomy. I was sure that I had performed a new procedure. However, sure enough, my fellow at the time Dr. Hans Trnka found this technique referred to in the German literature, and although my technique was completely different since Ludloff di
{"title":"A brief perspective of foot and ankle leadership over the decades","authors":"M. Myerson","doi":"10.30795/jfootankle.2020.v14.1216","DOIUrl":"https://doi.org/10.30795/jfootankle.2020.v14.1216","url":null,"abstract":"I remember so clearly when I first became a member of the American Orthopedic Foot and Ankle Society in the early 1980s. I knew everyone. It was a small organization that facilitated friendships, collegiality as well as academic and professional interaction. Now as then, these incredible friendships that we have all established over the decades define our professional life. \u0000 \u0000For those of you who have been involved in the education of residents and fellows you will understand how relevant this is to your own personal growth. I have always felt strongly that you cannot be an educator unless you’re prepared to listen to your students. In the earlier years of training fellows, it was not much of an age differential, and while there was always a matter of the difference in knowledge and experience, I did not yet have the “seniority”. However, over the decades I’ve learned that some of our closest relationships emanate from these mentoring experiences. Here is a quote from Dr George Quill, a fellow in 1989: “In hindsight, I was doubly fortunate to be only the second surgeon in the world to matriculate with Mark Myerson because, in doing so, I gained a generous mentor and a dear friend for life!” Remember this: as an educator you inevitably give of yourself, but you will also receive something in return. When we share compassion with others, we are all tremendously enriched. Teaching of residents and fellows is a responsibility that we all share. During the formative training particularly of fellows, I want them “to lose their GPS”. Residents learn by repetition, but this encourages sterility without analysis. And by following the acquisition of knowledge blindly without questioning and analyzing the process does not help one grow. This is what I mean about losing your GPS, since sooner or later our fellows need to break away from the mentality of being guided by their mentor’s thinking and develop strategies of their own. \u0000 \u0000I have never been afraid to push the envelope of experiences, and I have always embraced intellectual, personal, academic, and professional challenges. Many of you may have heard me saying that life begins at the edge of your comfort zone. In my practice of medicine, I’ve never felt any room for complacency. To accept everything as given, whether we read it in a prominent journal, or hear it from a colleague is meaningless until we can prove it for ourselves. This I learned from my mentor, Dr. Melvin Jahss who insisted in the early 1980’s that very few things were actually new ideas. He maintained that if one read the literature in depth, particularly in other languages, it was all there. I was reminded this many years later when I “rediscovered” what we knowas today as the Ludloff osteotomy. I was sure that I had performed a new procedure. However, sure enough, my fellow at the time Dr. Hans Trnka found this technique referred to in the German literature, and although my technique was completely different since Ludloff di","PeriodicalId":21602,"journal":{"name":"Scientific Journal of the Foot & Ankle","volume":"17 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82757930","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-12-21DOI: 10.30795/jfootankle.2020.v14.1192
M. A. Gomes, G. Monteiro, José Arteiro Neto
Objective: The present study aimed to verify the state of the art of minimally invasive percutaneous surgical treatment for Haglund syndrome. Methods: This systematic review of the literature was based on a bibliographic survey in the PubMed, Medline and Embase databases. The descriptors "Haglund syndrome", "Haglund", "Achilles", "Minimally invasive", "Percutaneous surgery" and "Osteotomy" were used, in addition to the filters "Randomized Controlled Trial", "Randomized Clinical Trial", "Meta-Analysis", "Systematic Reviews", "Reviews", and "Clinical Trial". Results: A total of 37 articles were included. The total number of patients with Haglund syndrome treated in the included studies was 831 and 920. The mean patient age was 46.6 years (range, 28.7 to 61) and 58% were men. A higher success rate and a lower rate of complications were reported in men, and physically active patients had better treatment results. The mean success rate for minimally invasive percutaneous procedures was 83.4% (range 66 to 100%). Overall patient satisfaction was 77.5% (range 60 to 95%) and the complication rate was 6.3% (range 0 to 23%). Conclusion: Despite a lack of studies with the recommended evidence level, minimally invasive and percutaneous surgical treatments seem to be a good option for patients with Haglund syndrome when conservative treatment fails. Level of Evidence III; Therapeutic Studies; Systematic Review of Level III Studies.
{"title":"Percutaneous surgery in the treatment of Haglund syndrome","authors":"M. A. Gomes, G. Monteiro, José Arteiro Neto","doi":"10.30795/jfootankle.2020.v14.1192","DOIUrl":"https://doi.org/10.30795/jfootankle.2020.v14.1192","url":null,"abstract":"Objective: The present study aimed to verify the state of the art of minimally invasive percutaneous surgical treatment for Haglund syndrome. Methods: This systematic review of the literature was based on a bibliographic survey in the PubMed, Medline and Embase databases. The descriptors \"Haglund syndrome\", \"Haglund\", \"Achilles\", \"Minimally invasive\", \"Percutaneous surgery\" and \"Osteotomy\" were used, in addition to the filters \"Randomized Controlled Trial\", \"Randomized Clinical Trial\", \"Meta-Analysis\", \"Systematic Reviews\", \"Reviews\", and \"Clinical Trial\". Results: A total of 37 articles were included. The total number of patients with Haglund syndrome treated in the included studies was 831 and 920. The mean patient age was 46.6 years (range, 28.7 to 61) and 58% were men. A higher success rate and a lower rate of complications were reported in men, and physically active patients had better treatment results. The mean success rate for minimally invasive percutaneous procedures was 83.4% (range 66 to 100%). Overall patient satisfaction was 77.5% (range 60 to 95%) and the complication rate was 6.3% (range 0 to 23%). Conclusion: Despite a lack of studies with the recommended evidence level, minimally invasive and percutaneous surgical treatments seem to be a good option for patients with Haglund syndrome when conservative treatment fails. Level of Evidence III; Therapeutic Studies; Systematic Review of Level III Studies.","PeriodicalId":21602,"journal":{"name":"Scientific Journal of the Foot & Ankle","volume":"98 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83020565","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-12-21DOI: 10.30795/jfootankle.2020.v14.1213
J. Rodrigues, A. Godoy-Santos, M. Prado, J. Alloza, Adham Amaral e Castro, R. Masagão, Durval do Carmo Santos Barros, C. Nery, L. Rosemberg
Syndesmotic instability is a fundamental question that guides treatment; despite the currently available diagnostic imaging tests, its determination is still challenging. Knowledge of the instability degree assists the physician in the decision-making process regarding surgical or nonsurgical treatments. The authors are currently conducting a prospective diagnostic accuracy study by consecutively selecting individuals aged 18 years and older with an orthopaedic clinical examination indicating suspected acute syndesmotic injury. Magnetic resonance imaging is the reference standard used for evaluating the diagnostic accuracy of 3 computed tomography index tests. These tests include the neutral position and 2 ankle stress maneuvers: external rotation and dorsiflexion. Comparative measurements between the injured syndesmosis and the uninjured contralateral side of the same individual evaluate the tibiofibular relationship and investigate syndesmotic instability. This study aims to describe a summarized research protocol for a new technique using computed tomography with stress maneuvers and to show a didactic example of syndesmotic instability diagnosis. Level of Evidence V; Diagnostic Studies; Expert Opinion.
{"title":"Computed tomography with stress maneuvers for diagnosing syndesmotic instability","authors":"J. Rodrigues, A. Godoy-Santos, M. Prado, J. Alloza, Adham Amaral e Castro, R. Masagão, Durval do Carmo Santos Barros, C. Nery, L. Rosemberg","doi":"10.30795/jfootankle.2020.v14.1213","DOIUrl":"https://doi.org/10.30795/jfootankle.2020.v14.1213","url":null,"abstract":"Syndesmotic instability is a fundamental question that guides treatment; despite the currently available diagnostic imaging tests, its determination is still challenging. Knowledge of the instability degree assists the physician in the decision-making process regarding surgical or nonsurgical treatments. The authors are currently conducting a prospective diagnostic accuracy study by consecutively selecting individuals aged 18 years and older with an orthopaedic clinical examination indicating suspected acute syndesmotic injury. Magnetic resonance imaging is the reference standard used for evaluating the diagnostic accuracy of 3 computed tomography index tests. These tests include the neutral position and 2 ankle stress maneuvers: external rotation and dorsiflexion. Comparative measurements between the injured syndesmosis and the uninjured contralateral side of the same individual evaluate the tibiofibular relationship and investigate syndesmotic instability. This study aims to describe a summarized research protocol for a new technique using computed tomography with stress maneuvers and to show a didactic example of syndesmotic instability diagnosis. Level of Evidence V; Diagnostic Studies; Expert Opinion.","PeriodicalId":21602,"journal":{"name":"Scientific Journal of the Foot & Ankle","volume":"11 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91215794","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-12-21DOI: 10.30795/jfootankle.2020.v14.1196
M. García-Limón, J. Ortiz-Garza, A. Espinosa-Uribe, Eduardo R. Carranza-Cantú, J. Meza-Flores, J. Gutierrez-De la O
Objective: Hallux valgus is a progressive triplanar deformity of the forefoot with an important rotational component (RC) in the first metatarsal, which has been associated with recurrence. There is controversy about using weight-bearing vs. non-weight-bearing radiographs in RC measurement. This study aims to assess interobserver reliability for RC of the first metatarsal using a non-weight-bearing sesamoid view, as well as to correlate the hallux valgus angle, intermetatarsal angle, distal metatarsal articular angle (DMAA) and sesamoid position regarding RC. Methods: An observational, cross-sectional and descriptive study was conducted with 81 feet from 48 patients (66.6% female). RC was evaluated regarding the first metatarsal proximal shaft in non-weight-bearing axial metatarsal radiographs and weight-bearing anteroposterior radiographs. Measurements were taken independently by two foot and ankle subspecialists and an orthopedic resident, all of whom were blinded. Results: Statistically significant intraclass correlations (p = 0.02) were obtained for first metatarsal RC assessment among the three observers (95%CI 0.01–0.65; Cronbach’s α =0.41) in non-weight-bearing axial metatarsal views. Significant correlations (Spearman ρ) were also found for hallux valgus angle (p = 0.04) and DMAA (p = 0.01), and non-significant correlations were found for intermetatarsal angle and sesamoid position (p > 0.05). Conclusion: The significant correlations between hallux valgus angle and DMAA for RC suggest that RC is isolated from the first metatarsal bone structure. This practical assessment method may isolate the first metatarsal head RC regarding the proximal metatarsal in the metaphyseal region and could be useful in centers where weight-bearing CT scans are not available. Level of Evidence IV; Therapeutic Studies; Case Series.
{"title":"The interobserver reliability of first metatarsal rotational component of axial sesamoid radiographs in hallux valgus","authors":"M. García-Limón, J. Ortiz-Garza, A. Espinosa-Uribe, Eduardo R. Carranza-Cantú, J. Meza-Flores, J. Gutierrez-De la O","doi":"10.30795/jfootankle.2020.v14.1196","DOIUrl":"https://doi.org/10.30795/jfootankle.2020.v14.1196","url":null,"abstract":"Objective: Hallux valgus is a progressive triplanar deformity of the forefoot with an important rotational component (RC) in the first metatarsal, which has been associated with recurrence. There is controversy about using weight-bearing vs. non-weight-bearing radiographs in RC measurement. This study aims to assess interobserver reliability for RC of the first metatarsal using a non-weight-bearing sesamoid view, as well as to correlate the hallux valgus angle, intermetatarsal angle, distal metatarsal articular angle (DMAA) and sesamoid position regarding RC. Methods: An observational, cross-sectional and descriptive study was conducted with 81 feet from 48 patients (66.6% female). RC was evaluated regarding the first metatarsal proximal shaft in non-weight-bearing axial metatarsal radiographs and weight-bearing anteroposterior radiographs. Measurements were taken independently by two foot and ankle subspecialists and an orthopedic resident, all of whom were blinded. Results: Statistically significant intraclass correlations (p = 0.02) were obtained for first metatarsal RC assessment among the three observers (95%CI 0.01–0.65; Cronbach’s α =0.41) in non-weight-bearing axial metatarsal views. Significant correlations (Spearman ρ) were also found for hallux valgus angle (p = 0.04) and DMAA (p = 0.01), and non-significant correlations were found for intermetatarsal angle and sesamoid position (p > 0.05). Conclusion: The significant correlations between hallux valgus angle and DMAA for RC suggest that RC is isolated from the first metatarsal bone structure. This practical assessment method may isolate the first metatarsal head RC regarding the proximal metatarsal in the metaphyseal region and could be useful in centers where weight-bearing CT scans are not available. Level of Evidence IV; Therapeutic Studies; Case Series.","PeriodicalId":21602,"journal":{"name":"Scientific Journal of the Foot & Ankle","volume":"35 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80153155","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-12-21DOI: 10.30795/jfootankle.2020.v14.1199
Diego Yearson, I. Melendez, Federico Anain, S. Siniscalchi, J. Drago
Objective: This study proposes a new classification of posterolateral malleolar fractures and a treatment algorithm. Methods: We divided the posterolateral malleolus, which we considered as the posterior malleolus, from the posteromedial one, which we considered as being part of the medial malleolus fracture. The experience with 77 patients treated from February 2017 to February 2020 was assessed. All of them were assessed by frontal and profile radiographies and computed tomography (CT). Among the parameters to classify these fractures, we believe the most determining ones are fracture size, followed by presence of fracture displacement. Results: Fractures were divided into those whose posterior fragment was 25% smaller than the tibial joint surface and those that compromised more than 25% of this joint. The first group underwent syndesmotic opening and was subclassified into 1A (stable fractures), which do not require surgical treatment, and 1B (unstable), which require syndesmotic stabilization. The second group, which comprised the larger fractures, was subclassified into 2 A (non-displaced fractures, or with a displacement below 2 mm), which underwent percutaneous osteosynthesis, 2B (displaced fractures), and 2C (comminuted fractures), which underwent open reduction and internal fixation using a posterior approach. Conclusion: The classifications published so far are anatomic or descriptive, but none of them proposes a therapeutic algorithm for each type of fracture. We believe it will be helpful for its interpretation and decision-making on the need to perform a posterior approach, prioritizing the anatomical reduction of the joint fragment and resolution of syndesmotic instability linked to each fracture pattern using the most simple and effective method. Level of Evidence IV; Therapeutic Studies; Case Series.
{"title":"Posterior malleolar fractures. New classification and treatment algorithm","authors":"Diego Yearson, I. Melendez, Federico Anain, S. Siniscalchi, J. Drago","doi":"10.30795/jfootankle.2020.v14.1199","DOIUrl":"https://doi.org/10.30795/jfootankle.2020.v14.1199","url":null,"abstract":"Objective: This study proposes a new classification of posterolateral malleolar fractures and a treatment algorithm. Methods: We divided the posterolateral malleolus, which we considered as the posterior malleolus, from the posteromedial one, which we considered as being part of the medial malleolus fracture. The experience with 77 patients treated from February 2017 to February 2020 was assessed. All of them were assessed by frontal and profile radiographies and computed tomography (CT). Among the parameters to classify these fractures, we believe the most determining ones are fracture size, followed by presence of fracture displacement. Results: Fractures were divided into those whose posterior fragment was 25% smaller than the tibial joint surface and those that compromised more than 25% of this joint. The first group underwent syndesmotic opening and was subclassified into 1A (stable fractures), which do not require surgical treatment, and 1B (unstable), which require syndesmotic stabilization. The second group, which comprised the larger fractures, was subclassified into 2 A (non-displaced fractures, or with a displacement below 2 mm), which underwent percutaneous osteosynthesis, 2B (displaced fractures), and 2C (comminuted fractures), which underwent open reduction and internal fixation using a posterior approach. Conclusion: The classifications published so far are anatomic or descriptive, but none of them proposes a therapeutic algorithm for each type of fracture. We believe it will be helpful for its interpretation and decision-making on the need to perform a posterior approach, prioritizing the anatomical reduction of the joint fragment and resolution of syndesmotic instability linked to each fracture pattern using the most simple and effective method. Level of Evidence IV; Therapeutic Studies; Case Series.","PeriodicalId":21602,"journal":{"name":"Scientific Journal of the Foot & Ankle","volume":"64 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86214974","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-12-21DOI: 10.30795/jfootankle.2020.v14.1214
E. Pires, C. Lôbo, C. de César Netto, A. Godoy-Santos
Measurement of hindfoot malalignment and flexibility is essential for treatment decision-making in cavovarus foot deformity. Weight-bearing computed tomography (WBCT) shows greater diagnostic accuracy and allows the study of osteoarticular alignment in the physiological upright position. The most commonly used method for measurements on WBCT scans is the foot and ankle offset (FAO), which is based on the structural tripod of the foot: the calcaneus and the first and fifth metatarsal heads. During the Coleman block test, the first metatarsal head is not resting on the ground and, therefore, does not represent the physiological support of the tripod. We describe a new measurement, the forefoot/hindfoot offset (FHO), for assessing hindfoot alignment on WBCT scans. Level of Evidence V; Diagnostic Studies; Expert Opinion.
{"title":"Hindfoot alignment using weight-bearing computed tomography","authors":"E. Pires, C. Lôbo, C. de César Netto, A. Godoy-Santos","doi":"10.30795/jfootankle.2020.v14.1214","DOIUrl":"https://doi.org/10.30795/jfootankle.2020.v14.1214","url":null,"abstract":"Measurement of hindfoot malalignment and flexibility is essential for treatment decision-making in cavovarus foot deformity. Weight-bearing computed tomography (WBCT) shows greater diagnostic accuracy and allows the study of osteoarticular alignment in the physiological upright position. The most commonly used method for measurements on WBCT scans is the foot and ankle offset (FAO), which is based on the structural tripod of the foot: the calcaneus and the first and fifth metatarsal heads. During the Coleman block test, the first metatarsal head is not resting on the ground and, therefore, does not represent the physiological support of the tripod. We describe a new measurement, the forefoot/hindfoot offset (FHO), for assessing hindfoot alignment on WBCT scans. Level of Evidence V; Diagnostic Studies; Expert Opinion.","PeriodicalId":21602,"journal":{"name":"Scientific Journal of the Foot & Ankle","volume":"33 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82659396","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-12-21DOI: 10.30795/jfootankle.2020.v14.1202
M. Ferreyra, M. Nuñez-Samper, R. Viladot, J. Ruiz, A. Isidro, L. Ibáñez
Objective: This work performs a critical review of the different causes described to explain the etiopathogenesis of hallux valgus. Methods: The authors divide the causal factors into two groups: extrinsic and intrinsic factors. In the first group, footwear and mechanical overload caused by different causes such as ballet, trauma, long walks, obesity, etc., should be considered. In the second group we include a series of factors: constitutional ones, such as heredity, sex and age; anatomical aspects, among which we must highlight the morphology and obliquity of the metatarsocuneiform joint; hypermobility of the first ray; metatarsus primus varus; muscle function; and atavism. Results: Hallux valgus probably has a multifactorial etiology whose triggering factor is unknown at the moment. Conclusion: If we know the etiopathogenesis of a deformity, in this case hallux valgus, we can perform a treatment as early and effective as possible. Level of Evidence V; Therapeutic Studies; Expert Opinion.
{"title":"What do we know about hallux valgus pathogenesis?","authors":"M. Ferreyra, M. Nuñez-Samper, R. Viladot, J. Ruiz, A. Isidro, L. Ibáñez","doi":"10.30795/jfootankle.2020.v14.1202","DOIUrl":"https://doi.org/10.30795/jfootankle.2020.v14.1202","url":null,"abstract":"Objective: This work performs a critical review of the different causes described to explain the etiopathogenesis of hallux valgus. Methods: The authors divide the causal factors into two groups: extrinsic and intrinsic factors. In the first group, footwear and mechanical overload caused by different causes such as ballet, trauma, long walks, obesity, etc., should be considered. In the second group we include a series of factors: constitutional ones, such as heredity, sex and age; anatomical aspects, among which we must highlight the morphology and obliquity of the metatarsocuneiform joint; hypermobility of the first ray; metatarsus primus varus; muscle function; and atavism. Results: Hallux valgus probably has a multifactorial etiology whose triggering factor is unknown at the moment. Conclusion: If we know the etiopathogenesis of a deformity, in this case hallux valgus, we can perform a treatment as early and effective as possible. Level of Evidence V; Therapeutic Studies; Expert Opinion.","PeriodicalId":21602,"journal":{"name":"Scientific Journal of the Foot & Ankle","volume":"103 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83066971","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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