Pub Date : 2019-11-11DOI: 10.30795/scijfootankle.2019.v13.1087
M. P. Filho, V. Nogueira, M. Dinato, Marcio De Farias Freitas
Introduction: Arthrodesis is considered the gold standard treatment for the final stages of hallux rigidus, promoting long-term symptom improvement. Arthrodesis is traditionally performed as open surgery. However, in recent years, the prevalence of minimally invasive surgery has increased due to its decreased aggression to soft tissue, shorter surgical time and association with a more comfortable postoperative period with reduced pain intensity. The objective of the study is to describe the percutaneous metatarsophalangeal arthrodesis technique with a single medial portal and to evaluate postoperative outcomes regarding union time, the presence of residual pain and the degree of satisfaction in a series of 22 patients. Methods: This is a series of 22 patients (23 feet) who underwent surgery between January 2017 and July 2018. The union time was assessed, and the patients reported their pre- and postoperative pain levels using the pain visual analog scale (VAS) and their degree of satisfaction. Surgical wound dehiscence, superficial and deep infection and need for orthopedic hardware removal were considered complications. Results: All patients underwent clinical evaluation. In 3 patients, union could not be assessed due to the lack of postoperative radiographs. Twenty patients were women, and 2 were men. Their mean age was 67.8 years. The mean time between the date of surgery and the evaluation was 51 weeks. The follow-up time ranged from 6 to 24 months, with a mean union time of 9 weeks. The union rate was 80%. Five cases showed no radiographic union, although the patients had stable and asymptomatic arthrodesis that required no revision. There were no cases of postoperative infection. In 3 patients, orthopedic hardware was removed. The mean preoperative pain intensity was 8.73, and the mean postoperative pain intensity was 1.26 (p<0.001). All patients were satisfied with the surgery. Conclusion: Percutaneous arthrodesis of the metatarsophalangeal joint of the hallux potentially provides outcomes similar to those of the conventional method reported in the literature and tends to produce a more comfortable postoperative period and better cosmetic results because it uses smaller incisions.
{"title":"TL 18200 - Percutaneous metatarsophalangeal arthrodesis for the treatment of hallux rigidus","authors":"M. P. Filho, V. Nogueira, M. Dinato, Marcio De Farias Freitas","doi":"10.30795/scijfootankle.2019.v13.1087","DOIUrl":"https://doi.org/10.30795/scijfootankle.2019.v13.1087","url":null,"abstract":"Introduction: Arthrodesis is considered the gold standard treatment for the final stages of hallux rigidus, promoting long-term symptom improvement. Arthrodesis is traditionally performed as open surgery. However, in recent years, the prevalence of minimally invasive surgery has increased due to its decreased aggression to soft tissue, shorter surgical time and association with a more comfortable postoperative period with reduced pain intensity. The objective of the study is to describe the percutaneous metatarsophalangeal arthrodesis technique with a single medial portal and to evaluate postoperative outcomes regarding union time, the presence of residual pain and the degree of satisfaction in a series of 22 patients. Methods: This is a series of 22 patients (23 feet) who underwent surgery between January 2017 and July 2018. The union time was assessed, and the patients reported their pre- and postoperative pain levels using the pain visual analog scale (VAS) and their degree of satisfaction. Surgical wound dehiscence, superficial and deep infection and need for orthopedic hardware removal were considered complications. Results: All patients underwent clinical evaluation. In 3 patients, union could not be assessed due to the lack of postoperative radiographs. Twenty patients were women, and 2 were men. Their mean age was 67.8 years. The mean time between the date of surgery and the evaluation was 51 weeks. The follow-up time ranged from 6 to 24 months, with a mean union time of 9 weeks. The union rate was 80%. Five cases showed no radiographic union, although the patients had stable and asymptomatic arthrodesis that required no revision. There were no cases of postoperative infection. In 3 patients, orthopedic hardware was removed. The mean preoperative pain intensity was 8.73, and the mean postoperative pain intensity was 1.26 (p<0.001). All patients were satisfied with the surgery. Conclusion: Percutaneous arthrodesis of the metatarsophalangeal joint of the hallux potentially provides outcomes similar to those of the conventional method reported in the literature and tends to produce a more comfortable postoperative period and better cosmetic results because it uses smaller incisions.","PeriodicalId":21602,"journal":{"name":"Scientific Journal of the Foot & Ankle","volume":"7 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80074997","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 : 2019-11-11DOI: 10.30795/scijfootankle.2019.v13.1019
K. Stéfani, Leonardo V. Moraes, J. Mcmurtrie, Haley McKissack, Jianguang Peng, Ashish B. Shah
Introduction: Proximal fifth metatarsal fracture fixation is usually treated conservatively, but when chosen for surgical treatment, percutaneous fixation with screws is the most used. This study aims to evaluate the presence of injury of the structures at risk and to measure the distance of these structures to the entry point. Methods: Eleven fresh-frozen below-the-knee specimens underwent standard operative fixation for a Jones fracture via the “High and inside” percutaneous technique. A guide wire was placed through the medullary canal and confirmed on fluoroscopy. The cannulated drill with a drill sleeve was then placed over the wire and advanced to the diaphysis. The guide wire was left, and the skin and subcutaneous tissues were carefully removed from the lateral midfoot to fully expose the structures at risk. The guidewire was then removed, and then the solid screw was placed. Neurovascular and tendinous structures were assessed for any injury. The distance of the wire in the base of the fifth metatarsal and these structures was measured and documented, including the branches of the sural nerve, cuboid, fourth metatarsal, peroneus longus, and peroneus brevis tendons. Results: The structure with the shortest average distance from the pin was the peroneus brevis, measuring 0.91 mm (±1.22 mm S.D.), followed by the cuboid articular surface, sural nerve, peroneus longus, and base of the fourth metatarsal, respectively. The pin had damaged the peroneus brevis in 5 of 11 cadavers. The average distance from the tendon insertion point was 7.2 mm. The furthest measured distance was 10 mm, while the closest was 3 mm. The screw head contacted the articular surface of the cuboid in 3 of 11 cadavers. There were no instances of pin contact with or damage to the peroneus longus, sural nerve, or fourth metatarsal head. Conclusion: We conclude that percutaneous fixation of fractures of the base of the fifth metatarsus presents a risk of partial lesion of the peroneus brevis tendon and lateral aspect of the cuboid. Therefore, specific care with these structures should be taken during the procedure.
{"title":"PO 18145 - Anatomical structures at risk in proximal fifth metatarsal fracture fixation","authors":"K. Stéfani, Leonardo V. Moraes, J. Mcmurtrie, Haley McKissack, Jianguang Peng, Ashish B. Shah","doi":"10.30795/scijfootankle.2019.v13.1019","DOIUrl":"https://doi.org/10.30795/scijfootankle.2019.v13.1019","url":null,"abstract":"Introduction: Proximal fifth metatarsal fracture fixation is usually treated conservatively, but when chosen for surgical treatment, percutaneous fixation with screws is the most used. This study aims to evaluate the presence of injury of the structures at risk and to measure the distance of these structures to the entry point. Methods: Eleven fresh-frozen below-the-knee specimens underwent standard operative fixation for a Jones fracture via the “High and inside” percutaneous technique. A guide wire was placed through the medullary canal and confirmed on fluoroscopy. The cannulated drill with a drill sleeve was then placed over the wire and advanced to the diaphysis. The guide wire was left, and the skin and subcutaneous tissues were carefully removed from the lateral midfoot to fully expose the structures at risk. The guidewire was then removed, and then the solid screw was placed. Neurovascular and tendinous structures were assessed for any injury. The distance of the wire in the base of the fifth metatarsal and these structures was measured and documented, including the branches of the sural nerve, cuboid, fourth metatarsal, peroneus longus, and peroneus brevis tendons. Results: The structure with the shortest average distance from the pin was the peroneus brevis, measuring 0.91 mm (±1.22 mm S.D.), followed by the cuboid articular surface, sural nerve, peroneus longus, and base of the fourth metatarsal, respectively. The pin had damaged the peroneus brevis in 5 of 11 cadavers. The average distance from the tendon insertion point was 7.2 mm. The furthest measured distance was 10 mm, while the closest was 3 mm. The screw head contacted the articular surface of the cuboid in 3 of 11 cadavers. There were no instances of pin contact with or damage to the peroneus longus, sural nerve, or fourth metatarsal head. Conclusion: We conclude that percutaneous fixation of fractures of the base of the fifth metatarsus presents a risk of partial lesion of the peroneus brevis tendon and lateral aspect of the cuboid. Therefore, specific care with these structures should be taken during the procedure.","PeriodicalId":21602,"journal":{"name":"Scientific Journal of the Foot & Ankle","volume":"64 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80234749","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 : 2019-11-11DOI: 10.30795/scijfootankle.2019.v13.1075
Henrique Mansur, G. Carvalho, Isnar Castro Júnior
Introduction: Plantar fasciitis is an inflammatory process of multifactorial etiology that affects the origin of the plantar fascia and surrounding structures. A difference in length between lower limbs is relatively common within the population and can sometimes cause changes in biomechanics and symptoms. The objective of this study is to evaluate the relationship between lower limb dysmetria and plantar fasciitis. Methods: A cross-sectional study was performed to measure the length of the lower limbs by scanometry in patients diagnosed with plantar fasciitis. Other risk factors, such as body mass index, foot shape and the presence of plantar calcaneal spur, were also assessed in foot radiographs. Results: Of the 54 patients included in the study, 44.4% were men, and the mean age was 50.38 (23-73 years); 81.5% had pain in one foot, and 53.7% had feet that were considered plantigrade. We observed dysmetria in 88.9% of the sample, with a mean of 0.749 cm (SD ±0.63). In addition, 46.3% feet with pain showed calcaneal spurs on the radiographs. Conclusion: Approximately 90% of patients showed lower-limb dysmetria and, in most cases, the side with the shorter limb was affected by plantar fasciitis
足底筋膜炎是一种多因素的炎症过程，影响足底筋膜和周围结构的起源。下肢长度差异在人群中相对常见，有时会引起生物力学和症状的变化。本研究的目的是评估下肢运动障碍与足底筋膜炎之间的关系。方法:对诊断为足底筋膜炎的患者进行横断面扫描测量下肢长度的研究。其他危险因素，如身体质量指数、足型和足底跟骨刺的存在，也在足部x线片中进行了评估。结果:纳入研究的54例患者中，男性占44.4%，平均年龄50.38岁(23-73岁);81.5%的人有一只脚疼痛，53.7%的人有脚癣。我们观察到88.9%的样本存在异常，平均为0.749 cm (SD±0.63)。此外，46.3%的疼痛足在x线片上显示跟骨刺。结论:约90%的患者表现为下肢运动障碍，大多数情况下，下肢较短的一侧受足底筋膜炎影响
{"title":"TL 18165 - Relationship between lower limb dysmetria and plantar fasciitis","authors":"Henrique Mansur, G. Carvalho, Isnar Castro Júnior","doi":"10.30795/scijfootankle.2019.v13.1075","DOIUrl":"https://doi.org/10.30795/scijfootankle.2019.v13.1075","url":null,"abstract":"Introduction: Plantar fasciitis is an inflammatory process of multifactorial etiology that affects the origin of the plantar fascia and surrounding structures. A difference in length between lower limbs is relatively common within the population and can sometimes cause changes in biomechanics and symptoms. The objective of this study is to evaluate the relationship between lower limb dysmetria and plantar fasciitis. Methods: A cross-sectional study was performed to measure the length of the lower limbs by scanometry in patients diagnosed with plantar fasciitis. Other risk factors, such as body mass index, foot shape and the presence of plantar calcaneal spur, were also assessed in foot radiographs. Results: Of the 54 patients included in the study, 44.4% were men, and the mean age was 50.38 (23-73 years); 81.5% had pain in one foot, and 53.7% had feet that were considered plantigrade. We observed dysmetria in 88.9% of the sample, with a mean of 0.749 cm (SD ±0.63). In addition, 46.3% feet with pain showed calcaneal spurs on the radiographs. Conclusion: Approximately 90% of patients showed lower-limb dysmetria and, in most cases, the side with the shorter limb was affected by plantar fasciitis","PeriodicalId":21602,"journal":{"name":"Scientific Journal of the Foot & Ankle","volume":"5 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79132152","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 : 2019-11-11DOI: 10.30795/scijfootankle.2019.v13.1023
Henrique Mansur, Gil Galvão Bernardes Silveira, Isnar Castro Júnior
Introduction: The bone graft is an important component of foot and ankle arthrodesis and is used in conditions in which the biological system is known to be unfavorable and scraping the joint will cause a considerable structural defect. The objective was to evaluate the union rate of subtalar arthrodesis in smokers and nonsmokers and to determine the effect of the use of different types of bone autografts. Methods: Retrospective study with radiological evaluation of patients diagnosed with subtalar arthrosis who underwent primary arthrodesis from January 2008 to December 2014. All patients with a minimum follow-up period of 12 months were included and were divided into smokers and nonsmokers treated with or without autologous bone grafting. Results: In total, 235 patients with a mean age of 47 years were evaluated; whom 90 (40%) were smokers, and 141 (60%) were nonsmokers. In 221 (94%) cases, the indication for arthrodesis was sequelae of calcaneal fractures. A bone graft was used in 27.7% patients. The overall union rate was 85.4%, and 14.6% of the patients developed pseudarthrosis. A significant difference was found in the nonunion rate of smokers versus nonsmokers (p=0.015), especially in those who did not receive a bone graft (p=0.014). However, no significant difference was found between smokers who received a bone graft and those who did not (p=0.072). The union rate was related to the donor site, with pseudarthrosis observed in 33.3% of surgeries involving a calcaneal autograft (p=0.011). Conclusion: Smoking increased the likelihood of pseudarthrosis in subtalar arthrodesis by 2.5 fold, and pseudarthrosis was related to the bone autograft donor site.
{"title":"PO 18164 - Subtalar arthrodesis with bone graft","authors":"Henrique Mansur, Gil Galvão Bernardes Silveira, Isnar Castro Júnior","doi":"10.30795/scijfootankle.2019.v13.1023","DOIUrl":"https://doi.org/10.30795/scijfootankle.2019.v13.1023","url":null,"abstract":"Introduction: The bone graft is an important component of foot and ankle arthrodesis and is used in conditions in which the biological system is known to be unfavorable and scraping the joint will cause a considerable structural defect. The objective was to evaluate the union rate of subtalar arthrodesis in smokers and nonsmokers and to determine the effect of the use of different types of bone autografts. Methods: Retrospective study with radiological evaluation of patients diagnosed with subtalar arthrosis who underwent primary arthrodesis from January 2008 to December 2014. All patients with a minimum follow-up period of 12 months were included and were divided into smokers and nonsmokers treated with or without autologous bone grafting. Results: In total, 235 patients with a mean age of 47 years were evaluated; whom 90 (40%) were smokers, and 141 (60%) were nonsmokers. In 221 (94%) cases, the indication for arthrodesis was sequelae of calcaneal fractures. A bone graft was used in 27.7% patients. The overall union rate was 85.4%, and 14.6% of the patients developed pseudarthrosis. A significant difference was found in the nonunion rate of smokers versus nonsmokers (p=0.015), especially in those who did not receive a bone graft (p=0.014). However, no significant difference was found between smokers who received a bone graft and those who did not (p=0.072). The union rate was related to the donor site, with pseudarthrosis observed in 33.3% of surgeries involving a calcaneal autograft (p=0.011). Conclusion: Smoking increased the likelihood of pseudarthrosis in subtalar arthrodesis by 2.5 fold, and pseudarthrosis was related to the bone autograft donor site.","PeriodicalId":21602,"journal":{"name":"Scientific Journal of the Foot & Ankle","volume":"2 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84972385","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 : 2019-11-11DOI: 10.30795/scijfootankle.2019.v13.1007
G. Saito, A. Sanders, M. O'Malley, J. Deland, S. Ellis, Constantine A. Demetracopoulos
Introduction: Correct positioning of implants in total ankle arthroplasty (TAA) is a key step to ensure the longevity of the prosthesis. Patient-specific instrumentation (PSI) via preoperative computed tomography for TAA was developed and made available through PROPHECY (Wright Medical, Memphis, TN). The purpose of this study was to compare the use of PSI with the standard referencing guide (SRG) in regard to the accuracy of tibial implant positioning, operative time, and fluoroscopy time. Methods: A retrospective analysis of 99 patients who underwent a primary TAA with the INFINITY prosthesis (Wright Medical, Memphis, TN) was performed. Patients were divided in two groups based on the type of instrumentation used during the TAA (75 in the PSI - PROPHECY group vs 24 in the SRG group). Results: Tibial implant positioning was similar between groups. In the coronal plane, the absolute deviation of the tibial implant was 1.7 ± 1.4 degrees for the SRG and 1.6 ± 1.2 degrees for PSI (P = 0.710). In the sagittal plane, the absolute alignment deviation of the tibial implant was 1.8 ± 1.4 degrees for the SRG and 1.9 ± 1.5 degrees for PSI (P = 0.675). Operative time (P = 0.040) and fluoroscopy time (P < 0.001) were significantly decreased in the PSI group. The PSI preoperative plan report correctly predicted the implant size in 73% of cases for the tibial component and in only 51% of cases for the talar component. Conclusions: PSI provided similar tibial component alignment to standard instrumentation while decreasing the operative and fluoroscopy time. However, PSI preoperative plan reports were poor predictors of implant sizing. Therefore, the final decision should always be based on the surgeon’s experience to prevent errors in implant sizing and positioning.
{"title":"TL 18051 - Accuracy of patient-specific instrumentation in total ankle arthroplasty","authors":"G. Saito, A. Sanders, M. O'Malley, J. Deland, S. Ellis, Constantine A. Demetracopoulos","doi":"10.30795/scijfootankle.2019.v13.1007","DOIUrl":"https://doi.org/10.30795/scijfootankle.2019.v13.1007","url":null,"abstract":"Introduction: Correct positioning of implants in total ankle arthroplasty (TAA) is a key step to ensure the longevity of the prosthesis. Patient-specific instrumentation (PSI) via preoperative computed tomography for TAA was developed and made available through PROPHECY (Wright Medical, Memphis, TN). The purpose of this study was to compare the use of PSI with the standard referencing guide (SRG) in regard to the accuracy of tibial implant positioning, operative time, and fluoroscopy time. Methods: A retrospective analysis of 99 patients who underwent a primary TAA with the INFINITY prosthesis (Wright Medical, Memphis, TN) was performed. Patients were divided in two groups based on the type of instrumentation used during the TAA (75 in the PSI - PROPHECY group vs 24 in the SRG group). Results: Tibial implant positioning was similar between groups. In the coronal plane, the absolute deviation of the tibial implant was 1.7 ± 1.4 degrees for the SRG and 1.6 ± 1.2 degrees for PSI (P = 0.710). In the sagittal plane, the absolute alignment deviation of the tibial implant was 1.8 ± 1.4 degrees for the SRG and 1.9 ± 1.5 degrees for PSI (P = 0.675). Operative time (P = 0.040) and fluoroscopy time (P < 0.001) were significantly decreased in the PSI group. The PSI preoperative plan report correctly predicted the implant size in 73% of cases for the tibial component and in only 51% of cases for the talar component. Conclusions: PSI provided similar tibial component alignment to standard instrumentation while decreasing the operative and fluoroscopy time. However, PSI preoperative plan reports were poor predictors of implant sizing. Therefore, the final decision should always be based on the surgeon’s experience to prevent errors in implant sizing and positioning.","PeriodicalId":21602,"journal":{"name":"Scientific Journal of the Foot & Ankle","volume":"86 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85068146","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 : 2019-11-11DOI: 10.30795/scijfootankle.2019.v13.1047
B. R. Miranda, R. Barroco, Letícia Zaccaria Prates de Oliveira, Mahmoud Beerens Abdul Ghani Abdul Ghani, Antonio Candido de Paula Neto, Douglas Hideki Ikeuti
Introduction: Hallux valgus is a 3-dimensional deformity involving an increased intermetatarsal I/II angle and a rotational deformity of the first metatarsal bone. Kim et al. developed a method for measuring the tibial sesamoid position relative to the coronal rotation of the first metatarsal bone in computed tomography scans under simulated weight-bearing conditions. Objective: To describe a method for the topographic assessment of the correction of tibial sesamoid and metatarsal pronation using computed tomography scans under simulated weight-bearing and active toe extension. Method: We performed computed tomography under simulated weight-bearing conditions with and without active toe dorsiflexion, observing the degree of metatarsal pronation and sesamoid subluxation. For measurement purposes, we used the classifications of Kim et al. and Smith et al. Results: We observed tomographic correction, both angular and rotational, by measuring the intermetatarsal angle and tibial sesamoid position, which were confirmed by the change in the alpha angle suggested by Kim et al. Discussion: Toe extension was described as a peroneus longus tendon activation test by Klemola et al., who used this maneuver to demonstrate clinical rotational correction of hallux valgus. We described the use of a tomographic technique that followed this principle to preoperatively observe the underlying factors that may affect the rotational correction of the deformity. Conclusion: The method has the capacity for correction in various planes involving derotation of the first metatarsal bone and the relationship between such derotation and the change in sesamoid position in relation to the coronal plane of the foot.
{"title":"PO 18235 - New tomographic method for measuring metatarsal rotation in hallux valgus","authors":"B. R. Miranda, R. Barroco, Letícia Zaccaria Prates de Oliveira, Mahmoud Beerens Abdul Ghani Abdul Ghani, Antonio Candido de Paula Neto, Douglas Hideki Ikeuti","doi":"10.30795/scijfootankle.2019.v13.1047","DOIUrl":"https://doi.org/10.30795/scijfootankle.2019.v13.1047","url":null,"abstract":"Introduction: Hallux valgus is a 3-dimensional deformity involving an increased intermetatarsal I/II angle and a rotational deformity of the first metatarsal bone. Kim et al. developed a method for measuring the tibial sesamoid position relative to the coronal rotation of the first metatarsal bone in computed tomography scans under simulated weight-bearing conditions. Objective: To describe a method for the topographic assessment of the correction of tibial sesamoid and metatarsal pronation using computed tomography scans under simulated weight-bearing and active toe extension. Method: We performed computed tomography under simulated weight-bearing conditions with and without active toe dorsiflexion, observing the degree of metatarsal pronation and sesamoid subluxation. For measurement purposes, we used the classifications of Kim et al. and Smith et al. Results: We observed tomographic correction, both angular and rotational, by measuring the intermetatarsal angle and tibial sesamoid position, which were confirmed by the change in the alpha angle suggested by Kim et al. Discussion: Toe extension was described as a peroneus longus tendon activation test by Klemola et al., who used this maneuver to demonstrate clinical rotational correction of hallux valgus. We described the use of a tomographic technique that followed this principle to preoperatively observe the underlying factors that may affect the rotational correction of the deformity. Conclusion: The method has the capacity for correction in various planes involving derotation of the first metatarsal bone and the relationship between such derotation and the change in sesamoid position in relation to the coronal plane of the foot.","PeriodicalId":21602,"journal":{"name":"Scientific Journal of the Foot & Ankle","volume":"97 2 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85586315","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 : 2019-11-11DOI: 10.30795/scijfootankle.2019.v13.988
T. Baumfeld, M. Prado, A. Mendes, C. Nery, D. Baumfeld
Introduction: The Chevron osteotomy is a reliable and popular osteotomy for treating hallux valgus worldwide. Many modifications have been described, but none of them address the rotational deformity of the first metatarsal. The objective of this study is to describe a variation of biplanar Chevron osteotomy that can address first metatarsal rotation when necessary. Methods: The indications for the Rotational Biplanar Chevron Osteotomy (RBCO) are mild to moderate hallux valgus deformity associated with hallux pronation related to internal rotation of the first metatarsal bone. We describe a technique that uses a medial-based wedge parallel to the plantar limb of the osteotomy to free the distal fragment for correct rotation. Results: The more recent concern about hallux valgus surgery represents a very interesting concept that this deformity truly occurs in three different planes, and we may have mistreated the rotation component using current techniques. Many authors have revisited numerous common techniques to adapt them to correct metatarsal pronation. To the best of our knowledge, this is the first paper to describe a modification of the Chevron osteotomy to address rotation of the first metatarsal. Conclusion: We can conclude that rotational biplanar Chevron osteotomy is an useful tool in the treatment of mild hallux valgus associated with metatarsal pronation.
{"title":"PO 18074 - Rotational biplanar Chevron osteotomy","authors":"T. Baumfeld, M. Prado, A. Mendes, C. Nery, D. Baumfeld","doi":"10.30795/scijfootankle.2019.v13.988","DOIUrl":"https://doi.org/10.30795/scijfootankle.2019.v13.988","url":null,"abstract":"Introduction: The Chevron osteotomy is a reliable and popular osteotomy for treating hallux valgus worldwide. Many modifications have been described, but none of them address the rotational deformity of the first metatarsal. The objective of this study is to describe a variation of biplanar Chevron osteotomy that can address first metatarsal rotation when necessary. Methods: The indications for the Rotational Biplanar Chevron Osteotomy (RBCO) are mild to moderate hallux valgus deformity associated with hallux pronation related to internal rotation of the first metatarsal bone. We describe a technique that uses a medial-based wedge parallel to the plantar limb of the osteotomy to free the distal fragment for correct rotation. Results: The more recent concern about hallux valgus surgery represents a very interesting concept that this deformity truly occurs in three different planes, and we may have mistreated the rotation component using current techniques. Many authors have revisited numerous common techniques to adapt them to correct metatarsal pronation. To the best of our knowledge, this is the first paper to describe a modification of the Chevron osteotomy to address rotation of the first metatarsal. Conclusion: We can conclude that rotational biplanar Chevron osteotomy is an useful tool in the treatment of mild hallux valgus associated with metatarsal pronation.","PeriodicalId":21602,"journal":{"name":"Scientific Journal of the Foot & Ankle","volume":"52 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83801199","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 : 2019-11-11DOI: 10.30795/scijfootankle.2019.v13.1050
N. Mansur, L. Fonseca, A. Lemos, V. Pereira, C. Dias, C. Nery
Introduction: Adult acquired flat foot deformity (AAFD) is a condition characterized by tendon and ligament failure that leads to progressive midfoot collapse and to hindfoot valgus. Calcaneal osteotomies are among the oldest and most conventional procedures for the treatment of angular limb deformities; they aim to reestablish the alignment and the line of action vector of the triceps surae muscle. Various disadvantages of classic osteotomies have been established in recent years, such as fixation loss, insufficient correction and reduced tarsal tunnel volume. Malerba Z-type osteotomy aims to resolve possible complications resulting from the usual incisions, to enhance the procedure and to allow multiplane corrections. Objective: To describe the functional and radiographic outcomes of Malerba Z-type osteotomy in patients with AAFD subjected to reconstructive surgery. Methods: Ten patients diagnosed with AAFD, with a mean age of 45 years (35-55), were operated on from January 2017 to January 2018. All patients underwent weight-bearing radiographs and alignment measurements and functional assessment using the pain visual analog scale (VAS) and the American Orthopedic Foot and Ankle Society (AOFAS) scale preoperatively and at the final evaluation at a mean of 12 months (6-18 months) after surgery. Results: The 10 patients showed positive progression after the surgery, reporting no major complications. Only one case of superficial dehiscence and one case of transient sural nerve neuropraxia (in different patients) were observed. On average, the AOFAS score increased by 50 points on average (25.7 to 76.6), and the VAS score decreased by 4 points (8.3 to 3.4). The mean calcaneal pitch increased from 5.5° to 15.2°. Nine patients transitioned from valgus malalignment (hindfoot angle greater than 10°) to the physiological (5 to 10° valgus) range. Conclusion: Ankle-foot realignment is an essential condition for surgical success in AAFD; it promotes a soft-tissue healing environment while maintaining an adequate muscle line of action. Malerba Z-type osteotomy was found to be a safe technique with high potential for deformity correction, leading to functional and radiographic improvement in patients who undergo this surgery.
{"title":"PO 18239 - Malerba Z-type osteotomy for the treatment of adult acquired flatfoot deformity","authors":"N. Mansur, L. Fonseca, A. Lemos, V. Pereira, C. Dias, C. Nery","doi":"10.30795/scijfootankle.2019.v13.1050","DOIUrl":"https://doi.org/10.30795/scijfootankle.2019.v13.1050","url":null,"abstract":"Introduction: Adult acquired flat foot deformity (AAFD) is a condition characterized by tendon and ligament failure that leads to progressive midfoot collapse and to hindfoot valgus. Calcaneal osteotomies are among the oldest and most conventional procedures for the treatment of angular limb deformities; they aim to reestablish the alignment and the line of action vector of the triceps surae muscle. Various disadvantages of classic osteotomies have been established in recent years, such as fixation loss, insufficient correction and reduced tarsal tunnel volume. Malerba Z-type osteotomy aims to resolve possible complications resulting from the usual incisions, to enhance the procedure and to allow multiplane corrections. Objective: To describe the functional and radiographic outcomes of Malerba Z-type osteotomy in patients with AAFD subjected to reconstructive surgery. Methods: Ten patients diagnosed with AAFD, with a mean age of 45 years (35-55), were operated on from January 2017 to January 2018. All patients underwent weight-bearing radiographs and alignment measurements and functional assessment using the pain visual analog scale (VAS) and the American Orthopedic Foot and Ankle Society (AOFAS) scale preoperatively and at the final evaluation at a mean of 12 months (6-18 months) after surgery. Results: The 10 patients showed positive progression after the surgery, reporting no major complications. Only one case of superficial dehiscence and one case of transient sural nerve neuropraxia (in different patients) were observed. On average, the AOFAS score increased by 50 points on average (25.7 to 76.6), and the VAS score decreased by 4 points (8.3 to 3.4). The mean calcaneal pitch increased from 5.5° to 15.2°. Nine patients transitioned from valgus malalignment (hindfoot angle greater than 10°) to the physiological (5 to 10° valgus) range. Conclusion: Ankle-foot realignment is an essential condition for surgical success in AAFD; it promotes a soft-tissue healing environment while maintaining an adequate muscle line of action. Malerba Z-type osteotomy was found to be a safe technique with high potential for deformity correction, leading to functional and radiographic improvement in patients who undergo this surgery.","PeriodicalId":21602,"journal":{"name":"Scientific Journal of the Foot & Ankle","volume":"15 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91022173","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 : 2019-11-11DOI: 10.30795/scijfootankle.2019.v13.1051
W. V. Fonseca, Rogério de Andrade Gomes, Gilberto Coelho Byrro Oliveira, Sidney Max e Silva, Matheus Maciel Vilela, B. J. Pádua
Objective: To describe the technique and results of arthroscopic arthrodesis through lateral portals in clinical cases of medial subtalar coalition. The posterior arthroscopic technique is considered the most difficult method for coalition resection. Methods: Five patients were operated on from April 2015 to July 2018, a study period of approximately 2 years and 3 months. The patients’ age ranged from 37 years and 6 months to 58 years and 1 month, with a mean age of 44 years and 5 months. All patients were operated on through 2 lateral portals using an eyepiece and knee and shoulder arthroscopic surgery instruments, and fixation was performed using 6.5- and 7.0-mm screws. The use of osteotomes was combined with curettes for coalition osteotomy and fusion release. An accessory lateral posterior portal was also used in one patient. Results: The patients were evaluated at 1, 2, 4 and 6 weeks and subsequently at 3 months, when computed tomography was performed to confirm the fusion. The final evaluations were performed at 6 months and 1 year. At the initial evaluation, the mean American Orthopedic Foot and Ankle Society Score (AOFAS) score was 56.7 points preoperatively; it increased to 87.4 after the blocked inversion/eversion was addressed through arthrodesis. Conclusion: This coalition osteotomy and curettage technique involving the release of the blocked subtalar motion to achieve fusion of the posterior, anterior and medial portions of the subtalar joint was found to be feasible through arthroscopic lateral portals. We recommend this procedure as long as no valgus deformity or significant abduction is present.
{"title":"PO 18244 - Arthroscopic subtalar arthrodesis in tarsal coalition","authors":"W. V. Fonseca, Rogério de Andrade Gomes, Gilberto Coelho Byrro Oliveira, Sidney Max e Silva, Matheus Maciel Vilela, B. J. Pádua","doi":"10.30795/scijfootankle.2019.v13.1051","DOIUrl":"https://doi.org/10.30795/scijfootankle.2019.v13.1051","url":null,"abstract":"Objective: To describe the technique and results of arthroscopic arthrodesis through lateral portals in clinical cases of medial subtalar coalition. The posterior arthroscopic technique is considered the most difficult method for coalition resection. Methods: Five patients were operated on from April 2015 to July 2018, a study period of approximately 2 years and 3 months. The patients’ age ranged from 37 years and 6 months to 58 years and 1 month, with a mean age of 44 years and 5 months. All patients were operated on through 2 lateral portals using an eyepiece and knee and shoulder arthroscopic surgery instruments, and fixation was performed using 6.5- and 7.0-mm screws. The use of osteotomes was combined with curettes for coalition osteotomy and fusion release. An accessory lateral posterior portal was also used in one patient. Results: The patients were evaluated at 1, 2, 4 and 6 weeks and subsequently at 3 months, when computed tomography was performed to confirm the fusion. The final evaluations were performed at 6 months and 1 year. At the initial evaluation, the mean American Orthopedic Foot and Ankle Society Score (AOFAS) score was 56.7 points preoperatively; it increased to 87.4 after the blocked inversion/eversion was addressed through arthrodesis. Conclusion: This coalition osteotomy and curettage technique involving the release of the blocked subtalar motion to achieve fusion of the posterior, anterior and medial portions of the subtalar joint was found to be feasible through arthroscopic lateral portals. We recommend this procedure as long as no valgus deformity or significant abduction is present.","PeriodicalId":21602,"journal":{"name":"Scientific Journal of the Foot & Ankle","volume":"9 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90652216","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 : 2019-11-11DOI: 10.30795/scijfootankle.2019.v13.1011
Rafael da Rocha Macedo, Gustavo Henrique Ramalho Mattos, Thiago Kazunori Neves Kanashiro, Alexandre Alcaide, Eduardo Almeida Dias Souza
Introduction: Running as a physical activity has gained considerable prominence in recent years. The diagnosis of footprint type has also been increasing in popularity, and several methods can be used for this purpose. However, we still lack effective mechanisms for accurate assessment. This study assesses the interobserver accuracy of diagnostic methods of footprint type in runners using 3 assessment methods: physical examination, podoscopy and baropodometry, in comparison with radiographic measurement of Meary’s and calcaneal pitch angles. Methods: A cross-sectional study of runners. In total, 40 patients were selected, namely, 29 men and 11 women, whose mean age was 39 years. Physical examination, podoscopy and baropodometry were performed and assessed by 4 raters; the results were compared with the radiographic classification of the footprint type identified by measuring Meary’s angle and the calcaneal pitch angle. Results: The interrater agreement regarding these parameters was assessed using the weighted Cohen's kappa coefficient, which showed significant agreement regarding the physical examination, podoscopy and baropodometry. The kappa coefficient indicated that agreement was marginal when the results of the 3 methods were compared with the classification of radiographic angles. Conclusion: We obtained excellent agreement among observers when the physical examination, podoscopy and baropodometry were used for the diagnosis of the footprint type of runners. However, when the results of the physical examination, podoscopy and baropodometry were compared with radiographic measurements, agreement regarding the diagnosis of footprint type was low.
{"title":"TL 18070 - Interobserver agreement of assessment methods for static footprint analysis in runners","authors":"Rafael da Rocha Macedo, Gustavo Henrique Ramalho Mattos, Thiago Kazunori Neves Kanashiro, Alexandre Alcaide, Eduardo Almeida Dias Souza","doi":"10.30795/scijfootankle.2019.v13.1011","DOIUrl":"https://doi.org/10.30795/scijfootankle.2019.v13.1011","url":null,"abstract":"Introduction: Running as a physical activity has gained considerable prominence in recent years. The diagnosis of footprint type has also been increasing in popularity, and several methods can be used for this purpose. However, we still lack effective mechanisms for accurate assessment. This study assesses the interobserver accuracy of diagnostic methods of footprint type in runners using 3 assessment methods: physical examination, podoscopy and baropodometry, in comparison with radiographic measurement of Meary’s and calcaneal pitch angles. Methods: A cross-sectional study of runners. In total, 40 patients were selected, namely, 29 men and 11 women, whose mean age was 39 years. Physical examination, podoscopy and baropodometry were performed and assessed by 4 raters; the results were compared with the radiographic classification of the footprint type identified by measuring Meary’s angle and the calcaneal pitch angle. Results: The interrater agreement regarding these parameters was assessed using the weighted Cohen's kappa coefficient, which showed significant agreement regarding the physical examination, podoscopy and baropodometry. The kappa coefficient indicated that agreement was marginal when the results of the 3 methods were compared with the classification of radiographic angles. Conclusion: We obtained excellent agreement among observers when the physical examination, podoscopy and baropodometry were used for the diagnosis of the footprint type of runners. However, when the results of the physical examination, podoscopy and baropodometry were compared with radiographic measurements, agreement regarding the diagnosis of footprint type was low.","PeriodicalId":21602,"journal":{"name":"Scientific Journal of the Foot & Ankle","volume":"3 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79260616","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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