Pub Date : 2019-11-11DOI: 10.30795/scijfootankle.2019.v13.1027
Jordanna Maria Pereira, Ricardo Cardenuto Ferreira, Marco Túlio Costa, Noé De Marchi Neto, Daiana Kerry Picanço Gobbo, Milena Peloggia Cursino Fernandes
Introduction: Congenital distal tibiofibular diastasis is an extremely rare entity of unknown etiology that compromises the feet and ankles with different degrees of deformity, although in general, the feet show equinovarus deformity, and the talus is proximally dislocated due to the separation of the distal tibial and fibular epiphyses. There are few reports of this disorder in the literature, and most describe cases that ultimately lead to limb amputation. We present the cases of 2 patients treated from birth to skeletal maturity. Methods: Two female patients with clubfoot at birth were diagnosed with congenital distal tibiofibular diastasis. One of them had the deformity of the right foot, and the other had deformity of both limbs. Both patients underwent early distal tibiofibular arthrodesis and serial stretching of the compromised feet and legs. Results: After 20 years of clinical follow-up and after reaching skeletal maturity, both patients had plantigrade feet without significant shortening of the lower limbs or pain, and both performed activities of daily living without restrictions, wearing conventional shoes. Conclusion: Early distal tibiofibular arthrodesis followed by limb stretching was effective for treating congenital distal tibiofibular diastasis and is a good alternative to amputation, which is indicated in the literature.
{"title":"PO 18191 - Congenital distal tibiofibular diastasis","authors":"Jordanna Maria Pereira, Ricardo Cardenuto Ferreira, Marco Túlio Costa, Noé De Marchi Neto, Daiana Kerry Picanço Gobbo, Milena Peloggia Cursino Fernandes","doi":"10.30795/scijfootankle.2019.v13.1027","DOIUrl":"https://doi.org/10.30795/scijfootankle.2019.v13.1027","url":null,"abstract":"Introduction: Congenital distal tibiofibular diastasis is an extremely rare entity of unknown etiology that compromises the feet and ankles with different degrees of deformity, although in general, the feet show equinovarus deformity, and the talus is proximally dislocated due to the separation of the distal tibial and fibular epiphyses. There are few reports of this disorder in the literature, and most describe cases that ultimately lead to limb amputation. We present the cases of 2 patients treated from birth to skeletal maturity. Methods: Two female patients with clubfoot at birth were diagnosed with congenital distal tibiofibular diastasis. One of them had the deformity of the right foot, and the other had deformity of both limbs. Both patients underwent early distal tibiofibular arthrodesis and serial stretching of the compromised feet and legs. Results: After 20 years of clinical follow-up and after reaching skeletal maturity, both patients had plantigrade feet without significant shortening of the lower limbs or pain, and both performed activities of daily living without restrictions, wearing conventional shoes. Conclusion: Early distal tibiofibular arthrodesis followed by limb stretching was effective for treating congenital distal tibiofibular diastasis and is a good alternative to amputation, which is indicated in the literature.","PeriodicalId":21602,"journal":{"name":"Scientific Journal of the Foot & Ankle","volume":"216 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91387674","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.v13.1048
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: The McBride test was created to assess hallux valgus reduction and is also used to assess capsular and lateral soft-tissue tension indicating the need for lateral capsular release after the bone procedure in the first metatarsal bone. The flowcharts for lateral soft-tissue release remain unclear and lack consensus among surgeons. Objective: To propose a modified version of the test for the complementary preoperative assessment of hallux valgus reduction. Methods: We describe a method in which the examiner supinates the first metatarsal head medially to manually correct the pronation of the first metatarsal and then applies varus force to the hallux to test the lateral capsular tension of the metatarsophalangeal joint. Results: A significant reduction in lateral capsular tension was observed in the metatarsal head lifting and rotating maneuver compared with the conventional McBride test. Discussion: Hallux valgus reduction is greater with manual correction of the deformity than with the classic McBride test, most likely because of the resulting rotational bone repositioning and soft-tissue balancing. These changes seem to decrease the lateral tension that limits the correction of the deformity in the metatarsophalangeal angular plane. Conclusion: We believe that this modified version of the McBride test can be used as a more reliable predictor of the need for lateral metatarsophalangeal release after the metatarsal position is corrected through osteotomy or cuneometatarsal arthrodesis.
{"title":"PO 18236 - Assessment of hallux valgus reduction using a modified version of the McBride test","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.v13.1048","DOIUrl":"https://doi.org/10.30795/scijfootankle.2019.v13.1048","url":null,"abstract":"Introduction: The McBride test was created to assess hallux valgus reduction and is also used to assess capsular and lateral soft-tissue tension indicating the need for lateral capsular release after the bone procedure in the first metatarsal bone. The flowcharts for lateral soft-tissue release remain unclear and lack consensus among surgeons. Objective: To propose a modified version of the test for the complementary preoperative assessment of hallux valgus reduction. Methods: We describe a method in which the examiner supinates the first metatarsal head medially to manually correct the pronation of the first metatarsal and then applies varus force to the hallux to test the lateral capsular tension of the metatarsophalangeal joint. Results: A significant reduction in lateral capsular tension was observed in the metatarsal head lifting and rotating maneuver compared with the conventional McBride test. Discussion: Hallux valgus reduction is greater with manual correction of the deformity than with the classic McBride test, most likely because of the resulting rotational bone repositioning and soft-tissue balancing. These changes seem to decrease the lateral tension that limits the correction of the deformity in the metatarsophalangeal angular plane. Conclusion: We believe that this modified version of the McBride test can be used as a more reliable predictor of the need for lateral metatarsophalangeal release after the metatarsal position is corrected through osteotomy or cuneometatarsal arthrodesis. \u0000 ","PeriodicalId":21602,"journal":{"name":"Scientific Journal of the Foot & Ankle","volume":"219 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87025805","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.v13.1042
Jorge Eduardo de Schoucair Jambeiro, Antero Tavare Cordeiro Neto, Fernando Delmonte Moreira, J. A. Oliveira, Marcela Arimatea Cabral
Introduction: There is no consensus regarding the best surgical treatment for Hallux Valgus (HV). The use of percutaneous procedures for HV has been increasingly explored. The present study aims to evaluate and compare the radiographic results of percutaneous surgeries for HV treatment performed at our institution. Methods: A retrospective study was performed on radiographs and medical records of patients undergoing percutaneous surgery for HV treatment from August 2017 to August 2018. Using pre and postoperative radiographs, the Hallux valgus angle (HVA), intermetatarsal angle (IMA), and bone sesamoid deviation measurement and classification were performed according to the AOFAS criteria for angular measurements. Results: We evaluated the radiographs of 19 patients, representing a total of 25 feet, with a minimum segment time of four months, 84.2% females, and a mean age of 58 years. In 13 feet, there was an association of the Chevron and Akin techniques and in 12 of the Reverdin-Isham and Akin techniques. On average, the preoperative IMA was 13.4º, and in the postoperative period, 7.2º HVA had a mean of 26.3º in the preoperative period and in the postoperative period an average value of 11,2º. We observed improvement of the dislocation of the sesamoids in all cases by postoperative radiography. We did not find any serious complications. Discussion: There was a decrease in the postoperative measurements in all evaluated cases, with a mean of 15º in the HVA and 6,2º in the IMA. Chevron osteotomy associated with AKIN obtained a higher degree of correction of the IMA as predicted. The HVA using both techniques provided good correction without significant differences, which could be explained by the association of the Akin osteotomy in the two evaluated techniques. Conclusion: Percutaneous surgeries with Chevron plus Akin and Riverdin-Isham plus Akin techniques performed at our institution proved to be efficient for HV correction, with a reduction of postoperative HVA and IMA.
{"title":"PO 18217 - Radiographic evaluation of results of percutaneous surgery of Hallux Valgus","authors":"Jorge Eduardo de Schoucair Jambeiro, Antero Tavare Cordeiro Neto, Fernando Delmonte Moreira, J. A. Oliveira, Marcela Arimatea Cabral","doi":"10.30795/scijfootankle.2019.v13.1042","DOIUrl":"https://doi.org/10.30795/scijfootankle.2019.v13.1042","url":null,"abstract":"Introduction: There is no consensus regarding the best surgical treatment for Hallux Valgus (HV). The use of percutaneous procedures for HV has been increasingly explored. The present study aims to evaluate and compare the radiographic results of percutaneous surgeries for HV treatment performed at our institution. Methods: A retrospective study was performed on radiographs and medical records of patients undergoing percutaneous surgery for HV treatment from August 2017 to August 2018. Using pre and postoperative radiographs, the Hallux valgus angle (HVA), intermetatarsal angle (IMA), and bone sesamoid deviation measurement and classification were performed according to the AOFAS criteria for angular measurements. Results: We evaluated the radiographs of 19 patients, representing a total of 25 feet, with a minimum segment time of four months, 84.2% females, and a mean age of 58 years. In 13 feet, there was an association of the Chevron and Akin techniques and in 12 of the Reverdin-Isham and Akin techniques. On average, the preoperative IMA was 13.4º, and in the postoperative period, 7.2º HVA had a mean of 26.3º in the preoperative period and in the postoperative period an average value of 11,2º. We observed improvement of the dislocation of the sesamoids in all cases by postoperative radiography. We did not find any serious complications. Discussion: There was a decrease in the postoperative measurements in all evaluated cases, with a mean of 15º in the HVA and 6,2º in the IMA. Chevron osteotomy associated with AKIN obtained a higher degree of correction of the IMA as predicted. The HVA using both techniques provided good correction without significant differences, which could be explained by the association of the Akin osteotomy in the two evaluated techniques. Conclusion: Percutaneous surgeries with Chevron plus Akin and Riverdin-Isham plus Akin techniques performed at our institution proved to be efficient for HV correction, with a reduction of postoperative HVA and IMA.","PeriodicalId":21602,"journal":{"name":"Scientific Journal of the Foot & Ankle","volume":"21 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86012872","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.v13.1018
Kelly Cristina Stéfani, Vinícius Quadros Borges, Gabriel Ferraz Ferreira, Leonardo V. M. Moraes
Objective: The objective of this study was to prospectively evaluate operated cases of AO type 43C tibial pilon fracture and to assess factors that might influence functional outcomes during the late postoperative period. Methods: Patients were classified according to the OTA/AO Classification using X-ray and computed tomography (CT) scans. Patients with type 43C fractures were included in this study. A total of 98 tibial pilon osteosynthesis surgeries were performed, and 35 cases were selected for this study based on the inclusion criteria. The treatment protocol established was based on the Tscherne Classification. Results: We observed that immediate skin complications might be a prognostic factor for the late removal of osteosynthesis material (mean = 2 years postoperation) because an association was found between skin complications and the removal of osteosynthesis material. We observed a high incidence of late arthritis complications in both groups, which indicates that post-traumatic arthritis associated with 43C pilon fractures is practically certain. Conclusion: No differences were found between the groups when correlating the American Foot and Ankle Score (AOFAS), the degree of arthritis, and skin complications; therefore, complications did not determine the outcomes of tibial pilon fracture. Although the cartilage damage that occurs at the time of injury is a significant mediator of the clinical outcome, more important factors affect the final treatment outcome. In our study, these factors were the treatment protocol based on soft tissue involvement, anatomical reconstruction of the joint, and rigid internal fixation with early range of motion.
目的:本研究的目的是对AO型43C胫骨pilon骨折的手术病例进行前瞻性评估，并评估术后后期可能影响功能结局的因素。方法:采用x线及CT扫描对患者进行OTA/AO分型。43C型骨折患者纳入本研究。共行98例胫骨pilon植骨手术，根据纳入标准选取35例纳入本研究。根据Tscherne分类建立治疗方案。结果:我们观察到即刻皮肤并发症可能是后期骨合成材料移除(平均术后2年)的预后因素，因为皮肤并发症与骨合成材料移除之间存在关联。我们观察到两组患者晚期关节炎并发症的发生率都很高，这表明创伤后关节炎与43C皮隆骨折的相关性实际上是肯定的。结论:美国足踝评分(American Foot and Ankle Score, AOFAS)、关节炎程度及皮肤并发症在两组间无显著差异;因此，并发症并不能决定胫骨pilon骨折的预后。虽然损伤时发生的软骨损伤是临床结果的重要中介，但更重要的因素影响最终的治疗结果。在我们的研究中，这些因素是基于软组织受累、关节解剖重建和早期活动范围的刚性内固定的治疗方案。
{"title":"PO 18143 - AO type 43C tibial pilon fractures","authors":"Kelly Cristina Stéfani, Vinícius Quadros Borges, Gabriel Ferraz Ferreira, Leonardo V. M. Moraes","doi":"10.30795/scijfootankle.2019.v13.1018","DOIUrl":"https://doi.org/10.30795/scijfootankle.2019.v13.1018","url":null,"abstract":"Objective: The objective of this study was to prospectively evaluate operated cases of AO type 43C tibial pilon fracture and to assess factors that might influence functional outcomes during the late postoperative period. Methods: Patients were classified according to the OTA/AO Classification using X-ray and computed tomography (CT) scans. Patients with type 43C fractures were included in this study. A total of 98 tibial pilon osteosynthesis surgeries were performed, and 35 cases were selected for this study based on the inclusion criteria. The treatment protocol established was based on the Tscherne Classification. Results: We observed that immediate skin complications might be a prognostic factor for the late removal of osteosynthesis material (mean = 2 years postoperation) because an association was found between skin complications and the removal of osteosynthesis material. We observed a high incidence of late arthritis complications in both groups, which indicates that post-traumatic arthritis associated with 43C pilon fractures is practically certain. Conclusion: No differences were found between the groups when correlating the American Foot and Ankle Score (AOFAS), the degree of arthritis, and skin complications; therefore, complications did not determine the outcomes of tibial pilon fracture. Although the cartilage damage that occurs at the time of injury is a significant mediator of the clinical outcome, more important factors affect the final treatment outcome. In our study, these factors were the treatment protocol based on soft tissue involvement, anatomical reconstruction of the joint, and rigid internal fixation with early range of motion.","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":"90595792","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.v13.1065
L. Lara, Fábio Lemos Rodrigues, J. Grajales, Lúcio Carlos Azevedo Torres Filho
Objective: The present study was conducted to clinically and radiographically analyze the outcomes of the surgical treatment of mild and moderate hallux valgus using the modified Reverdin-Isham technique. Methods: We retrospectively studied 46 feet of 39 patients with mild and moderate hallux valgus from June 2010 to July 2017. The mean postoperative follow-up was 36 months, and the mean patient age was 53 years. All patients who underwent the modified Reverdin-Isham technique were clinically and radiologically evaluated before and after surgery using the American Orthopedic Foot and Ankle Society (AOFAS) scale, and radiographs were acquired to calculate the hallux valgus angle (HVA), the intermetatarsal angle (IMA) and the distal metatarsal articular angle (DMAA). Results: The AOFAS score increased by a mean of 54 points. Radiologically, the mean HVA decreased by an average of 17.1°, the IMA by 4.2° and the DMAA by 12°. Conclusion: The modified percutaneous Reverdim-Isham technique made it possible to correct mild and moderate hallux valgus deformities with good angular correction and increased stability compared with the classical technique, in addition to providing an increase in the AOFAS score.
{"title":"TL 18130 - Surgical treatment of hallux valgus using the modified Reverdin-Isham technique","authors":"L. Lara, Fábio Lemos Rodrigues, J. Grajales, Lúcio Carlos Azevedo Torres Filho","doi":"10.30795/scijfootankle.2019.v13.1065","DOIUrl":"https://doi.org/10.30795/scijfootankle.2019.v13.1065","url":null,"abstract":"Objective: The present study was conducted to clinically and radiographically analyze the outcomes of the surgical treatment of mild and moderate hallux valgus using the modified Reverdin-Isham technique. Methods: We retrospectively studied 46 feet of 39 patients with mild and moderate hallux valgus from June 2010 to July 2017. The mean postoperative follow-up was 36 months, and the mean patient age was 53 years. All patients who underwent the modified Reverdin-Isham technique were clinically and radiologically evaluated before and after surgery using the American Orthopedic Foot and Ankle Society (AOFAS) scale, and radiographs were acquired to calculate the hallux valgus angle (HVA), the intermetatarsal angle (IMA) and the distal metatarsal articular angle (DMAA). Results: The AOFAS score increased by a mean of 54 points. Radiologically, the mean HVA decreased by an average of 17.1°, the IMA by 4.2° and the DMAA by 12°. Conclusion: The modified percutaneous Reverdim-Isham technique made it possible to correct mild and moderate hallux valgus deformities with good angular correction and increased stability compared with the classical technique, in addition to providing an increase in the AOFAS score.","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":"87043875","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.v13.989
T. Baumfeld, N. S. Mansur, F. Villalón, Paulo Dos Santos, Bruno Shiefer, M. Tamaoki
Introduction: Conservative treatment for insertional Achilles tendinopathy (IAT) has failed to produce encouraging results in recent years. Shockwave therapy (SWT) has become a reliable option for the management of this disease in recent years. The objective of this study is to report the effectiveness of low-energy SWT combined with an eccentric strengthening protocol in 19 consecutive patients. Methods: This is a prospective study of 19 patients diagnosed with IAT. The protocol consisted of SWT combined with eccentric training for 12 weeks. All patients were evaluated on the first day and after 24 weeks using the Victorian Institute of Sport Assessment-Achilles (VISA-A) score, the Pain Visual Analog Scale (VAS) and the American Orthopedic Foot and Ankle Society (AOFAS) questionnaire and algometry. The patients were also evaluated for compliance with the protocol, complications and final outcome. Results: All patients completed the study without complications. In total, 15 (79%) patients fully complied with the Alfredson protocol, and 13 (68%) considered the treatment successful. At the final evaluation, the patients required more pressure on the calcaneus to trigger pain (Algometry 1), reported less pain when applying the algometer with 3 kg of pressure (Algometry 2) and had less global pain (VAS) and higher AOFAS and VISA-A scores. All differences were significant. Conclusion: Eccentric training combined with SWT is an effective treatment for IAT. Further placebo-controlled studies with a longer follow-up are necessary to support this statement.
{"title":"PO 18076 - Shockwave therapy associated with eccentric strengthening for Achilles insertional tendinopathy","authors":"T. Baumfeld, N. S. Mansur, F. Villalón, Paulo Dos Santos, Bruno Shiefer, M. Tamaoki","doi":"10.30795/scijfootankle.2019.v13.989","DOIUrl":"https://doi.org/10.30795/scijfootankle.2019.v13.989","url":null,"abstract":"Introduction: Conservative treatment for insertional Achilles tendinopathy (IAT) has failed to produce encouraging results in recent years. Shockwave therapy (SWT) has become a reliable option for the management of this disease in recent years. The objective of this study is to report the effectiveness of low-energy SWT combined with an eccentric strengthening protocol in 19 consecutive patients. Methods: This is a prospective study of 19 patients diagnosed with IAT. The protocol consisted of SWT combined with eccentric training for 12 weeks. All patients were evaluated on the first day and after 24 weeks using the Victorian Institute of Sport Assessment-Achilles (VISA-A) score, the Pain Visual Analog Scale (VAS) and the American Orthopedic Foot and Ankle Society (AOFAS) questionnaire and algometry. The patients were also evaluated for compliance with the protocol, complications and final outcome. Results: All patients completed the study without complications. In total, 15 (79%) patients fully complied with the Alfredson protocol, and 13 (68%) considered the treatment successful. At the final evaluation, the patients required more pressure on the calcaneus to trigger pain (Algometry 1), reported less pain when applying the algometer with 3 kg of pressure (Algometry 2) and had less global pain (VAS) and higher AOFAS and VISA-A scores. All differences were significant. Conclusion: Eccentric training combined with SWT is an effective treatment for IAT. Further placebo-controlled studies with a longer follow-up are necessary to support this statement.","PeriodicalId":21602,"journal":{"name":"Scientific Journal of the Foot & Ankle","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83159419","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.v13.1003
Sergio Rodrigues Tirico
Objective: To evaluate the outcomes of proximal metatarsal osteotomies for metatarsal head shortening and/or lifting, assessing pain and function, using the American Orthopedic Foot and Ankle Society (AOFAS) scale. Methods: From November 2002 to November 2014, 29 feet (13 right feet and 16 left feet) of 22 patients (25 women and 4 men) aged 21 to 85 years, with a mean age of 52.8 years, underwent surgery, with a mean follow-up time of 73 months (7 to 150 months). The patients were treated with proximal end metatarsal osteotomies fixed with metallic wires, staples or compression plates with and without grading. Treated comorbidities included hallux valgus deformity, splayfoot, hallux rigidus, pes cavus, hammertoe, crossover toe and plantar plate repair. The patients were evaluated using the AOFAS lesser toes. Results: The AOFAS score improved from 34.5 points (±12.5) preoperatively to 88.9 points (±7.9) postoperatively (p<0.0001). One patient developed a late infection in the foot that was controlled with antibiotics; although the correction of the second toe was partially lost, an acceptable transversal arch was maintained. In all cases except for the infection, no metatarsalgia recurrence or change in the deformity of the corresponding toes occurred. Discussion: Surgical treatment aimed to improve the mechanical distribution of weight and to stabilize the transversal arch, thereby reducing metatarsalgia. The forefoot was stabilized by sufficient shortening and/or lifting to treat metatarsalgia, especially in the 2nd and 3rd rays. We also aimed to achieve complete flexibility of the metatarsophalangeal joints with good alignment. The favorable outcome of this method is comparable to that of the study by Aiello, who achieved good outcomes in 84.9% of 45 feet, whereas our study showed good outcomes in 96% of 29 feet. Conclusion: Proximal metatarsal osteotomies with fixation with metal implants for metatarsalgia treatment showed satisfactory outcomes in 96% of operated cases. We believe that this procedure is effective and safe and has a high rate of patient satisfaction.
{"title":"TL - 18033 - Proximal metatarsal osteotomy with fixation for the treatment of metatarsalgia","authors":"Sergio Rodrigues Tirico","doi":"10.30795/scijfootankle.2019.v13.1003","DOIUrl":"https://doi.org/10.30795/scijfootankle.2019.v13.1003","url":null,"abstract":"Objective: To evaluate the outcomes of proximal metatarsal osteotomies for metatarsal head shortening and/or lifting, assessing pain and function, using the American Orthopedic Foot and Ankle Society (AOFAS) scale. Methods: From November 2002 to November 2014, 29 feet (13 right feet and 16 left feet) of 22 patients (25 women and 4 men) aged 21 to 85 years, with a mean age of 52.8 years, underwent surgery, with a mean follow-up time of 73 months (7 to 150 months). The patients were treated with proximal end metatarsal osteotomies fixed with metallic wires, staples or compression plates with and without grading. Treated comorbidities included hallux valgus deformity, splayfoot, hallux rigidus, pes cavus, hammertoe, crossover toe and plantar plate repair. The patients were evaluated using the AOFAS lesser toes. Results: The AOFAS score improved from 34.5 points (±12.5) preoperatively to 88.9 points (±7.9) postoperatively (p<0.0001). One patient developed a late infection in the foot that was controlled with antibiotics; although the correction of the second toe was partially lost, an acceptable transversal arch was maintained. In all cases except for the infection, no metatarsalgia recurrence or change in the deformity of the corresponding toes occurred. Discussion: Surgical treatment aimed to improve the mechanical distribution of weight and to stabilize the transversal arch, thereby reducing metatarsalgia. The forefoot was stabilized by sufficient shortening and/or lifting to treat metatarsalgia, especially in the 2nd and 3rd rays. We also aimed to achieve complete flexibility of the metatarsophalangeal joints with good alignment. The favorable outcome of this method is comparable to that of the study by Aiello, who achieved good outcomes in 84.9% of 45 feet, whereas our study showed good outcomes in 96% of 29 feet. Conclusion: Proximal metatarsal osteotomies with fixation with metal implants for metatarsalgia treatment showed satisfactory outcomes in 96% of operated cases. We believe that this procedure is effective and safe and has a high rate of patient satisfaction.","PeriodicalId":21602,"journal":{"name":"Scientific Journal of the Foot & Ankle","volume":"92 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91260020","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.v13.1033
R. Barroco, Antonio Candido de Paula Neto, Douglas Hideki Ikeuti, Letícia Zaccaria Prates de Oliveira, B. R. Miranda, Mahmoud Beerens Abdul Ghani Abdul Ghani
Introduction: Anterior tibial tendon ruptures are quite rare. All studies found in the literature refer to the adult population, with no reports of this injury in the pediatric population. The literature on the treatment of this injury is scarce. Objective: To report the case of a child subjected to peroneus brevis tendon transfer for the sequela of a severe anterior tibial and extensor hallucis longus tendon injury. Methods: Male patient, 8 years of age, was run over by a car and sustained an exposed tibial fracture and major soft-tissue injury of the foot. Anterior tibial, posterior tibial and extensor hallucis longus tendon rupture were detected. Damage control, soft-tissue cover and conservative treatment of the anterior tibial and extensor hallucis longus tendons were initially performed; however, the conservative treatment failed, and valgus deformity and pronation developed. Subsequently, tenoplasty (posterior tibial tendon), the Strayer procedure (gastrocnemius recession of the Achilles tendon) and elongation of the peroneus longus and brevis tendons were also performed, but the patient experienced deformity recurrence. Subcutaneous peroneus brevis tendon transfer to the navicular was then chosen, with postoperative use of an ankle-foot orthosis (AFO) and physical therapy. Results: The deformity was improved. The patient progressed with satisfactory gait and strength. He currently walks without support using an AFO. Both the patient and his family were satisfied with the functional outcome of the tendon transfer. Conclusion: Reconstruction of anterior tibial and extensor hallucis longus tendon rupture through peroneus brevis tendon transfer is a viable and reliable treatment option. No complications such as adhesions or correction failure were observed, thus corroborating the viability of this method.
{"title":"PO 18205 - Case report","authors":"R. Barroco, Antonio Candido de Paula Neto, Douglas Hideki Ikeuti, Letícia Zaccaria Prates de Oliveira, B. R. Miranda, Mahmoud Beerens Abdul Ghani Abdul Ghani","doi":"10.30795/scijfootankle.2019.v13.1033","DOIUrl":"https://doi.org/10.30795/scijfootankle.2019.v13.1033","url":null,"abstract":"Introduction: Anterior tibial tendon ruptures are quite rare. All studies found in the literature refer to the adult population, with no reports of this injury in the pediatric population. The literature on the treatment of this injury is scarce. Objective: To report the case of a child subjected to peroneus brevis tendon transfer for the sequela of a severe anterior tibial and extensor hallucis longus tendon injury. Methods: Male patient, 8 years of age, was run over by a car and sustained an exposed tibial fracture and major soft-tissue injury of the foot. Anterior tibial, posterior tibial and extensor hallucis longus tendon rupture were detected. Damage control, soft-tissue cover and conservative treatment of the anterior tibial and extensor hallucis longus tendons were initially performed; however, the conservative treatment failed, and valgus deformity and pronation developed. Subsequently, tenoplasty (posterior tibial tendon), the Strayer procedure (gastrocnemius recession of the Achilles tendon) and elongation of the peroneus longus and brevis tendons were also performed, but the patient experienced deformity recurrence. Subcutaneous peroneus brevis tendon transfer to the navicular was then chosen, with postoperative use of an ankle-foot orthosis (AFO) and physical therapy. Results: The deformity was improved. The patient progressed with satisfactory gait and strength. He currently walks without support using an AFO. Both the patient and his family were satisfied with the functional outcome of the tendon transfer. Conclusion: Reconstruction of anterior tibial and extensor hallucis longus tendon rupture through peroneus brevis tendon transfer is a viable and reliable treatment option. No complications such as adhesions or correction failure were observed, thus corroborating the viability of this method.","PeriodicalId":21602,"journal":{"name":"Scientific Journal of the Foot & Ankle","volume":"11 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81975535","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.v13.1020
K. Stéfani, A. Rodrigues, Vinícius Quadros Borges, G. Ferreira, Leonardo V. Moraes
Introduction: Diabetes mellitus (DM) has become a global public health problem. The concept of detection and management of diabetes mellitus in primary care centers is widely practiced in Brazil by the general practitioner. The aim of this study was to evaluate the efficacy of our educational program for diabetics for patients with diabetes mellitus and to determine the predictors of compliance. Methods: A cross-sectional prospective study was performed in a quaternary hospital where patients with diabetes were referred to the outpatient clinic of the diabetic foot group so that they were part of a multidisciplinary group (medical orthopedists specialists in foot and ankle, medical endocrinologists, physiotherapist and nurse) with a specific protocol for guidelines for foot care. Specialist orthopedic doctors of the foot and ankle completed the protocol and performed the specific physical examination. Results: Of the 578 diabetic patients, the mean age was 67 years, 69% were female, 53% used insulin to control the disease and the disease duration was 14 years. Obesity was diagnosed by calculation of the body mass index (BMI), and 85% patients were overweight. Evaluation of protective sensibility showed that 68% were significantly decreased, with sensation from the 4.0 g monofilament. One hundred and twenty seven patients required surgery resulting from clinical complications of the disease: 64 ulcers (Wagner classification 57% ulcers had a degree 1 Wagner classification, 63% affected forefoots), 54 Charcot arthropathies (52% Eichenholz in phase 3, 61% located in the mid-foot), and 9 cases of osteomyelitis. Fifty-three patients had one or more prior amputations at the time of their first appointment, mostly of the toes (66%). Conclusion: The costs related to the disease increased greatly with the appearance of complications, especially if there was a need for hospitalization and surgical treatment. The prevention of injuries with adequate glycemic control and the provision of protective shoes is essential.
{"title":"PO 18146 - The efficacy of a diabetic educational program and predictors of compliance of patients with non-insulin dependent diabetes mellitus (type 2)","authors":"K. Stéfani, A. Rodrigues, Vinícius Quadros Borges, G. Ferreira, Leonardo V. Moraes","doi":"10.30795/scijfootankle.2019.v13.1020","DOIUrl":"https://doi.org/10.30795/scijfootankle.2019.v13.1020","url":null,"abstract":"Introduction: Diabetes mellitus (DM) has become a global public health problem. The concept of detection and management of diabetes mellitus in primary care centers is widely practiced in Brazil by the general practitioner. The aim of this study was to evaluate the efficacy of our educational program for diabetics for patients with diabetes mellitus and to determine the predictors of compliance. Methods: A cross-sectional prospective study was performed in a quaternary hospital where patients with diabetes were referred to the outpatient clinic of the diabetic foot group so that they were part of a multidisciplinary group (medical orthopedists specialists in foot and ankle, medical endocrinologists, physiotherapist and nurse) with a specific protocol for guidelines for foot care. Specialist orthopedic doctors of the foot and ankle completed the protocol and performed the specific physical examination. Results: Of the 578 diabetic patients, the mean age was 67 years, 69% were female, 53% used insulin to control the disease and the disease duration was 14 years. Obesity was diagnosed by calculation of the body mass index (BMI), and 85% patients were overweight. Evaluation of protective sensibility showed that 68% were significantly decreased, with sensation from the 4.0 g monofilament. One hundred and twenty seven patients required surgery resulting from clinical complications of the disease: 64 ulcers (Wagner classification 57% ulcers had a degree 1 Wagner classification, 63% affected forefoots), 54 Charcot arthropathies (52% Eichenholz in phase 3, 61% located in the mid-foot), and 9 cases of osteomyelitis. Fifty-three patients had one or more prior amputations at the time of their first appointment, mostly of the toes (66%). Conclusion: The costs related to the disease increased greatly with the appearance of complications, especially if there was a need for hospitalization and surgical treatment. The prevention of injuries with adequate glycemic control and the provision of protective shoes is essential. \u0000 ","PeriodicalId":21602,"journal":{"name":"Scientific Journal of the Foot & Ankle","volume":"12 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73697410","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.v13.1066
Fernanda Ferreira Gomes, Henrique Mansur, Maria Laura Silva Gomes, D. Ramalho, Isnar Moreira de Castro Júnior
Objective: To assess the efficacy of intra-articular viscosupplementation in patients with symptomatic subtalar osteoarthritis after calcaneal fracture. Methods: Thirty-eight patients with a mean age of 50 years were divided into 3 groups: hyaluronic acid (HA) alone, corticoids alone or hyaluronic acid and corticoids combined. Three consecutive doses of the appropriate medication were administered at one-week intervals. The patients were evaluated for pain and hindfoot function using the American Orthopedic Foot and Ankle Society (AOFAS) scale and the visual analog scale (VAS) at 4 different timepoints (before infiltration and 4, 12 and 24 weeks after infiltration). Results: There was significant improvement in the AOFAS score (from medians of 55 and 73 at baseline to 99 and 100 after 24 weeks; p<0.001) and the VAS score (from medians of 8 and 7 before infiltration to 1 and 2 at 24 weeks after infiltration; p<0.001) scores in the groups with hyaluronic acid alone and in combination with corticoid, respectively. In group 2, the scores improved after only 4 weeks (from 83 to 91.5 and from 7 to 5), returning to near-baseline values at the end of the follow-up (from 83 to 82.5 and from 7 to 7). Conclusion: Infiltration with hyaluronic acid was effective and safe and should be included in the therapeutic arsenal of conservative treatments for symptomatic posttraumatic subtalar osteoarthritis.
{"title":"TL 18131 - Functional evaluation of hyaluronic acid infiltration in the subtalar joint of patients with posttraumatic osteoarthritis","authors":"Fernanda Ferreira Gomes, Henrique Mansur, Maria Laura Silva Gomes, D. Ramalho, Isnar Moreira de Castro Júnior","doi":"10.30795/scijfootankle.2019.v13.1066","DOIUrl":"https://doi.org/10.30795/scijfootankle.2019.v13.1066","url":null,"abstract":"Objective: To assess the efficacy of intra-articular viscosupplementation in patients with symptomatic subtalar osteoarthritis after calcaneal fracture. Methods: Thirty-eight patients with a mean age of 50 years were divided into 3 groups: hyaluronic acid (HA) alone, corticoids alone or hyaluronic acid and corticoids combined. Three consecutive doses of the appropriate medication were administered at one-week intervals. The patients were evaluated for pain and hindfoot function using the American Orthopedic Foot and Ankle Society (AOFAS) scale and the visual analog scale (VAS) at 4 different timepoints (before infiltration and 4, 12 and 24 weeks after infiltration). Results: There was significant improvement in the AOFAS score (from medians of 55 and 73 at baseline to 99 and 100 after 24 weeks; p<0.001) and the VAS score (from medians of 8 and 7 before infiltration to 1 and 2 at 24 weeks after infiltration; p<0.001) scores in the groups with hyaluronic acid alone and in combination with corticoid, respectively. In group 2, the scores improved after only 4 weeks (from 83 to 91.5 and from 7 to 5), returning to near-baseline values at the end of the follow-up (from 83 to 82.5 and from 7 to 7). Conclusion: Infiltration with hyaluronic acid was effective and safe and should be included in the therapeutic arsenal of conservative treatments for symptomatic posttraumatic subtalar osteoarthritis.","PeriodicalId":21602,"journal":{"name":"Scientific Journal of the Foot & Ankle","volume":"32 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91185197","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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