Pub Date : 2024-04-26DOI: 10.1016/j.fas.2024.04.011
Background
This study evaluates the efficacy of the calcaneo-stop (C-Stop) procedure's effectiveness in treating symptomatic flexible flatfoot (FFF) in children.
Methods
A systematic review and meta-analysis were conducted using PubMed, Embase, and Cochrane databases to identify studies until 2023 on the outcomes of the C-Stop procedure in children with FFF. The risk of bias was assessed using MINORS criteria.
Results
Of 85 studies screened, 20 involving 2394 feet from 1415 patients (mean age 11.2 ± 1.3 years) were included. Post-procedure, significant improvements were noted in pain reduction (93.5%), heel alignment (95.21%), and radiological measures, including reductions in Kite (7.32º), Meary (11.65º), Costa-Bartani angles (17.11º), talar declination (12.63º) and increase in Calcaneal Pitch Angle (5.92º). AOFAS scores increased by 22.32 points on average, with 94.83% reporting high satisfaction. Complication rate was low (7.8%).
Conclusions
The C-Stop procedure is effective for treating FFF in children, offering significant clinical, radiological, and functional improvements with high patient satisfaction and a low complication rate.
{"title":"Outcomes of the “Calcaneo-stop” procedure for treating symptomatic flexible flatfoot in children: A systematic review and meta-analysis of 2394 feet","authors":"","doi":"10.1016/j.fas.2024.04.011","DOIUrl":"10.1016/j.fas.2024.04.011","url":null,"abstract":"<div><h3>Background</h3><p>This study evaluates the efficacy of the calcaneo-stop (C-Stop) procedure's effectiveness in treating symptomatic flexible flatfoot (FFF) in children.</p></div><div><h3>Methods</h3><p>A systematic review and meta-analysis were conducted using PubMed, Embase, and Cochrane databases to identify studies until 2023 on the outcomes of the C-Stop procedure in children with FFF. The risk of bias was assessed using MINORS criteria.</p></div><div><h3>Results</h3><p>Of 85 studies screened, 20 involving 2394 feet from 1415 patients (mean age 11.2 ± 1.3 years) were included. Post-procedure, significant improvements were noted in pain reduction (93.5%), heel alignment (95.21%), and radiological measures, including reductions in Kite (7.32º), Meary (11.65º), Costa-Bartani angles (17.11º), talar declination (12.63º) and increase in Calcaneal Pitch Angle (5.92º). AOFAS scores increased by 22.32 points on average, with 94.83% reporting high satisfaction. Complication rate was low (7.8%).</p></div><div><h3>Conclusions</h3><p>The C-Stop procedure is effective for treating FFF in children, offering significant clinical, radiological, and functional improvements with high patient satisfaction and a low complication rate.</p></div><div><h3>Level of evidence</h3><p>Level IV, Systematic review of Level-IV studies</p></div>","PeriodicalId":48743,"journal":{"name":"Foot and Ankle Surgery","volume":"30 7","pages":"Pages 535-545"},"PeriodicalIF":1.9,"publicationDate":"2024-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140877696","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-24DOI: 10.1016/j.fas.2024.04.010
Background
The effect of preoperative first metatarsal pronation on postoperative prognosis of hallux valgus (HV) surgery is under investigation. Utilizing semi-weight-bearing computed tomography, the preoperative pronation angle was assessed to quantify its impact on postoperative prognosis.
Methods
In a retrospective analysis of 31 feet, those with re-increased hallux valgus angle postoperatively were classified as the non-maintained group, and the remainder as the maintained group. Preoperative pronation angles were compared to establish a threshold. Subsequently, feet were re-classified into high or low-pronation categories. The relative risk of non-maintenance in high-pronation category was calculated.
Results
The non-maintained group exhibited a significantly higher preoperative pronation angle (p = 0.021), with a 28.4º threshold. The high-pronation category had a relative risk of 2.34 for non-maintenance.
Conclusions
Increased preoperative first metatarsal pronation angle is associated with correction loss after HV surgery. Utilizing sWBCT to measure the pronation angle provides valuable insights into postoperative prognosis.
{"title":"Preoperative increased pronation angle of the first metatarsus associated with correction loss after hallux valgus surgery: A semi-weight-bearing computed tomography study","authors":"","doi":"10.1016/j.fas.2024.04.010","DOIUrl":"10.1016/j.fas.2024.04.010","url":null,"abstract":"<div><h3>Background</h3><p>The effect of preoperative first metatarsal pronation<span> on postoperative prognosis of hallux valgus<span> (HV) surgery is under investigation. Utilizing semi-weight-bearing computed tomography, the preoperative pronation angle was assessed to quantify its impact on postoperative prognosis.</span></span></p></div><div><h3>Methods</h3><p>In a retrospective analysis of 31 feet, those with re-increased hallux valgus angle postoperatively were classified as the non-maintained group, and the remainder as the maintained group. Preoperative pronation angles were compared to establish a threshold. Subsequently, feet were re-classified into high or low-pronation categories. The relative risk of non-maintenance in high-pronation category was calculated.</p></div><div><h3>Results</h3><p>The non-maintained group exhibited a significantly higher preoperative pronation angle (p = 0.021), with a 28.4º threshold. The high-pronation category had a relative risk of 2.34 for non-maintenance.</p></div><div><h3>Conclusions</h3><p>Increased preoperative first metatarsal pronation angle is associated with correction loss after HV surgery. Utilizing sWBCT to measure the pronation angle provides valuable insights into postoperative prognosis.</p></div><div><h3>Level of evidence</h3><p>III</p></div>","PeriodicalId":48743,"journal":{"name":"Foot and Ankle Surgery","volume":"30 7","pages":"Pages 562-567"},"PeriodicalIF":1.9,"publicationDate":"2024-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140795132","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-18DOI: 10.1016/j.fas.2024.04.007
Background
The purpose of this study was to assess the long-term clinical efficacy of first-generation autologous chondrocyte implantation (ACI) technique for osteochondral lesions of the ankle joint.
Methods
Eleven patients with symptomatic OLTs underwent ACI from December 1997 to October 2002. A total of 9 patients (5 men, 4 women, age 25.2 ± 6.3) were evaluated at baseline and at 1, 3, 10 years, and at final follow-up of minimum 20 years with AOFAS ankle-hindfoot score, NRS for pain, and with the Tegner score.
Results
The AOFAS score improved significantly from the baseline value of 40.4 ± 19.8 to 82.7 ± 12.9 at the final follow-up (p < 0.0005). The NRS for pain improved significantly from 7.8 ± 0.7 at baseline to 4.8 ± 2.1 at the final follow-up (p < 0.0005). Moreover, the Tegner score underwent a modification from the pre-operative median value of 1 (range: 1–3) and from a pre-injury value of 5 (range: 3–7) to 3 (range: 2–4) at the final follow-up (p < 0.0005).
Conclusions
ACI has proven to be an effective treatment option for patients suffering from OLTs, leading to a long-lasting clinical improvement even beyond 20 years of follow-up.
{"title":"Autologous chondrocyte implantation for the treatment of osteochondral lesions of the talus: What happens after 20 years?","authors":"","doi":"10.1016/j.fas.2024.04.007","DOIUrl":"10.1016/j.fas.2024.04.007","url":null,"abstract":"<div><h3>Background</h3><p>The purpose of this study was to assess the long-term clinical efficacy of first-generation autologous chondrocyte implantation (ACI) technique for osteochondral lesions of the ankle joint.</p></div><div><h3>Methods</h3><p>Eleven patients with symptomatic OLTs underwent ACI from December 1997 to October 2002. A total of 9 patients (5 men, 4 women, age 25.2 ± 6.3) were evaluated at baseline and at 1, 3, 10 years, and at final follow-up of minimum 20 years with AOFAS<span><span> ankle-hindfoot score, NRS for pain, and with the </span>Tegner score.</span></p></div><div><h3>Results</h3><p>The AOFAS score improved significantly from the baseline value of 40.4 ± 19.8 to 82.7 ± 12.9 at the final follow-up (p < 0.0005). The NRS for pain improved significantly from 7.8 ± 0.7 at baseline to 4.8 ± 2.1 at the final follow-up (p < 0.0005). Moreover, the Tegner score underwent a modification from the pre-operative median value of 1 (range: 1–3) and from a pre-injury value of 5 (range: 3–7) to 3 (range: 2–4) at the final follow-up (p < 0.0005).</p></div><div><h3>Conclusions</h3><p>ACI has proven to be an effective treatment option for patients suffering from OLTs, leading to a long-lasting clinical improvement even beyond 20 years of follow-up.</p></div><div><h3>Level of evidence</h3><p>Level IV</p></div>","PeriodicalId":48743,"journal":{"name":"Foot and Ankle Surgery","volume":"30 7","pages":"Pages 546-551"},"PeriodicalIF":1.9,"publicationDate":"2024-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140803447","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-16DOI: 10.1016/j.fas.2024.04.009
Introduction
This study aimed to compare the degree of posterior malleolar exposure, the tension of the flap containing the posteromedial neurovascular bundle (NVB), and the distance between the surgical incision and the NVB using three different posteromedial ankle approaches.
Methods
Three approaches were compared: medial posteromedial (MePM) modified posteromedial (MoPM) and posteromedial (PM). We measured the minimal tension of the flap containing the NVB that allowed proper exposure. In the second stage, an axial cut was performed, and we measured the degree of posterior malleolar exposure and the distance between the incision and the NVB
Results
There were significant differences between the three approaches examined regarding the degree of posterior malleolar exposure and distance from the incision to the NBV,favoring the PM approach (71,00% ± 1.83 and 25.50 mm ± 4.20). The PM approach provided a significantly lower tension to the flap containing the posteromedial NVB (6.18 N ± 1.28) compared to the other two approaches
Conclusion
The PM approach achieved the highest degree of posterior malleolar exposure, the lowest tension to the posteromedial NVB, and the greatest distance between the incision and the NBV. Thus, we believe it should be considered the approach of choicefor large fractures of the posteromedial aspect of the PM.
{"title":"Safety and exposure area in three different posteromedial surgical approaches for the treatment of ankle fractures. A cadaveric study","authors":"","doi":"10.1016/j.fas.2024.04.009","DOIUrl":"10.1016/j.fas.2024.04.009","url":null,"abstract":"<div><h3>Introduction</h3><p>This study aimed to compare the degree of posterior malleolar exposure, the tension of the flap containing the posteromedial neurovascular bundle (NVB), and the distance between the surgical incision and the NVB using three different posteromedial ankle approaches.</p></div><div><h3>Methods</h3><p>Three approaches were compared: medial posteromedial (MePM) modified posteromedial (MoPM) and posteromedial (PM). We measured the minimal tension of the flap containing the NVB that allowed proper exposure. In the second stage, an axial cut was performed, and we measured the degree of posterior malleolar exposure and the distance between the incision and the NVB</p></div><div><h3>Results</h3><p>There were significant differences between the three approaches examined regarding the degree of posterior malleolar exposure and distance from the incision to the NBV,favoring the PM approach (71,00% ± 1.83 and 25.50 mm ± 4.20). The PM approach provided a significantly lower tension to the flap containing the posteromedial NVB (6.18 N ± 1.28) compared to the other two approaches</p></div><div><h3>Conclusion</h3><p>The PM approach achieved the highest degree of posterior malleolar exposure, the lowest tension to the posteromedial NVB, and the greatest distance between the incision and the NBV. Thus, we believe it should be considered the approach of choicefor large fractures of the posteromedial aspect of the PM.</p></div>","PeriodicalId":48743,"journal":{"name":"Foot and Ankle Surgery","volume":"30 7","pages":"Pages 557-561"},"PeriodicalIF":1.9,"publicationDate":"2024-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140762304","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-16DOI: 10.1016/j.fas.2024.04.008
Background
As total ankle arthroplasty (TAA) increases in popularity nationwide for the management of end-stage arthritis, it is essential to understand ways to mitigate the risk of infection. Diabetes increases the risk of infection due to compromised immunity and impaired wound-healing mechanisms. However, there is limited research on how diabetic management, inclusive of medications and glucose control, may impact infection risks post-TAA. This study aims to demonstrate the impact of diabetic management on the occurrence of periprosthetic joint infection (PJI) following TAA.
Methods
This was a retrospective study of patients who underwent a TAA at a single academic institution from March 2002 to May 2022. Patients with diabetes who developed an intraarticular infection following TAA were propensity score matched (1:3) to diabetic patients who did not. Data collection included demographics, implant types, diabetic medications, and preoperative hemoglobin A1c. PJI was diagnosed based on Musculoskeletal Infection Society (MSIS) criteria. Statistical analyses assessed differences in medication use, glucose control, and infection rates between groups.
Results
Of the 1863 patients who underwent TAA, 177 patients had a diagnosis of diabetes. The infection rate in patients with diabetes (2.8%) was higher than the total cohort rate (0.8%). Five patients with diabetes developed a PJI at an average of 2.2 months postoperatively. This cohort (n = 5) was compared to propensity score-matched controls (n = 15). There was no significant difference in diabetic medication use. Patients who developed PJI had higher rates of uncontrolled diabetes (60.0% vs. 6.7%) and average A1c levels (7.02% vs. 6.29%) compared to controls.
Conclusion
Our findings suggest that the elevated risk of PJI observed in individuals with diabetes subsequent to TAA may be attributed not solely to the presence of diabetes, but to inadequate glycemic control. Effectively managing blood glucose levels is imperative for achieving favorable outcomes following TAA.
{"title":"Diabetic management and infection risk in total ankle arthroplasty","authors":"","doi":"10.1016/j.fas.2024.04.008","DOIUrl":"10.1016/j.fas.2024.04.008","url":null,"abstract":"<div><h3>Background</h3><p>As total ankle arthroplasty<span> (TAA) increases in popularity nationwide for the management of end-stage arthritis, it is essential to understand ways to mitigate the risk of infection. Diabetes increases the risk of infection due to compromised immunity and impaired wound-healing mechanisms. However, there is limited research on how diabetic management, inclusive of medications and glucose control, may impact infection risks post-TAA. This study aims to demonstrate the impact of diabetic management on the occurrence of periprosthetic joint infection (PJI) following TAA.</span></p></div><div><h3>Methods</h3><p>This was a retrospective study of patients who underwent a TAA at a single academic institution from March 2002 to May 2022. Patients with diabetes who developed an intraarticular infection following TAA were propensity score matched (1:3) to diabetic patients who did not. Data collection included demographics, implant types, diabetic medications, and preoperative hemoglobin A1c<span>. PJI was diagnosed based on Musculoskeletal Infection Society (MSIS) criteria. Statistical analyses assessed differences in medication use, glucose control, and infection rates between groups.</span></p></div><div><h3>Results</h3><p>Of the 1863 patients who underwent TAA, 177 patients had a diagnosis of diabetes. The infection rate in patients with diabetes (2.8%) was higher than the total cohort rate (0.8%). Five patients with diabetes developed a PJI at an average of 2.2 months postoperatively. This cohort (n = 5) was compared to propensity score-matched controls (n = 15). There was no significant difference in diabetic medication use. Patients who developed PJI had higher rates of uncontrolled diabetes (60.0% vs. 6.7%) and average A1c levels (7.02% vs. 6.29%) compared to controls.</p></div><div><h3>Conclusion</h3><p>Our findings suggest that the elevated risk of PJI observed in individuals with diabetes subsequent to TAA may be attributed not solely to the presence of diabetes, but to inadequate glycemic control<span>. Effectively managing blood glucose levels is imperative for achieving favorable outcomes following TAA.</span></p></div><div><h3>Level of evidence</h3><p>III</p></div>","PeriodicalId":48743,"journal":{"name":"Foot and Ankle Surgery","volume":"30 7","pages":"Pages 552-556"},"PeriodicalIF":1.9,"publicationDate":"2024-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140629946","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-20DOI: 10.1016/j.fas.2024.03.009
Martinus Richter , Per-Henrik Agren , Jean-Luc Besse , Maria Coester , Hakon Kofoed , Nicola Maffulli , Martijn Steultjens , Mick Nielsen , Jens Kurt Johansen
Background
The Score Committee of the European Foot and Ankle Society (EFAS) developed, validated, and published the EFAS Score in 13 languages. Currently, the Danish version completed data acquisition and underwent further validation.
Methods
The data were collected pre-operatively and post-operatively at a minimum follow-up of 3 months and mean follow-up of 6 months. Item reduction, scale exploration, confirmatory analyses and responsiveness were executed using classical test theory and item response theory.
Results
The internal consistency was confirmed in the Danish version (Cronbach’s Alpha 0.88). The Standard Error of Measurement (SEM) was 0.31 and is similar to other language versions. Between baseline and follow-up, 77.2% of patients showed an improvement on their EFAS score, with adequate responsiveness (effect size 1.05).
Conclusions
The Danish EFAS Score version was successfully validated in patients with a wide variety of foot and ankle pathologies. All score versions are freely available at www.efas.net.
{"title":"EFAS Score – Validation of Danish Version by the Score Committee of the European Foot and Ankle Society (EFAS)","authors":"Martinus Richter , Per-Henrik Agren , Jean-Luc Besse , Maria Coester , Hakon Kofoed , Nicola Maffulli , Martijn Steultjens , Mick Nielsen , Jens Kurt Johansen","doi":"10.1016/j.fas.2024.03.009","DOIUrl":"10.1016/j.fas.2024.03.009","url":null,"abstract":"<div><h3>Background</h3><p>The Score Committee of the European Foot and Ankle Society (EFAS) developed, validated, and published the EFAS Score in 13 languages. Currently, the Danish version completed data acquisition and underwent further validation.</p></div><div><h3>Methods</h3><p>The data were collected pre-operatively and post-operatively at a minimum follow-up of 3 months and mean follow-up of 6 months. Item reduction, scale exploration, confirmatory analyses and responsiveness were executed using classical test theory and item response theory.</p></div><div><h3>Results</h3><p>The internal consistency was confirmed in the Danish version (Cronbach’s Alpha 0.88). The Standard Error of Measurement (SEM) was 0.31 and is similar to other language versions. Between baseline and follow-up, 77.2% of patients showed an improvement on their EFAS score, with adequate responsiveness (effect size 1.05).</p></div><div><h3>Conclusions</h3><p>The Danish EFAS Score version was successfully validated in patients with a wide variety of foot and ankle pathologies. All score versions are freely available at www.efas.net.</p></div>","PeriodicalId":48743,"journal":{"name":"Foot and Ankle Surgery","volume":"30 4","pages":"Pages 294-298"},"PeriodicalIF":2.5,"publicationDate":"2024-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140269645","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-17DOI: 10.1016/j.fas.2024.03.005
Yun Jae Kim, Ho-Seong Lee, Young-Rak Choi
{"title":"WITHDRAWN: Pronation-Independent Decision-Making for Akin Osteotomy in the Hallux Valgus: Using Proximal–Distal Phalangeal Articular Angle","authors":"Yun Jae Kim, Ho-Seong Lee, Young-Rak Choi","doi":"10.1016/j.fas.2024.03.005","DOIUrl":"https://doi.org/10.1016/j.fas.2024.03.005","url":null,"abstract":"","PeriodicalId":48743,"journal":{"name":"Foot and Ankle Surgery","volume":"28 1","pages":""},"PeriodicalIF":2.5,"publicationDate":"2024-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140205586","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-26eCollection Date: 2024-01-01DOI: 10.29399/npa.28583
Miray Atacan Yaşgüçlükal, Emel Ur Özçelik, Ayşe Deniz Elmali, Özlem Çokar, Veysi Demirbilek
Introduction: We aimed to investigate the long-term prognosis of childhood absence epilepsy (CAE), and identify factors associated with treatment outcomes.
Methods: Patients with a definitive diagnosis of CAE according to the International League Against Epilepsy 2021 criteria and with a minimum of 3-year follow-up duration were included. The children were divided according to the time of seizure control. Early seizure remission was defined as seizure freedom within 6 months after the treatment onset.
Results: Twenty-four patients with a mean age of 13.7 (9.4-22.0) were included in this study. At the final follow-up, all patients were seizure-free except for one case. Seizure freedom was achieved after initial treatment in a mean of 0.78 years. The treatment was ceased in 19 children (79.2%) after a mean of 3.2 years. Patients having absence seizures without motor components had a higher rate of early seizure remission (p=0.026). In 81.3% of the patients; all of whose repetitive post-treatment EEGs were devoid of any generalized spike-wave discharges and absence seizures; remission was established within 6 months or less (p=0.026).
Conclusions: CAE has a favorable prognosis with seizure control obtained in the majority of the cases and more than half of them were obtained within 6 months following the initiation of treatment. Moreover, having an absence seizure without motor components and repetitively normal post-treatment EEGs appear to be associated with a higher rate of early seizure remission.
{"title":"Long-term Prognosis of Childhood Absence Epilepsy.","authors":"Miray Atacan Yaşgüçlükal, Emel Ur Özçelik, Ayşe Deniz Elmali, Özlem Çokar, Veysi Demirbilek","doi":"10.29399/npa.28583","DOIUrl":"10.29399/npa.28583","url":null,"abstract":"<p><strong>Introduction: </strong>We aimed to investigate the long-term prognosis of childhood absence epilepsy (CAE), and identify factors associated with treatment outcomes.</p><p><strong>Methods: </strong>Patients with a definitive diagnosis of CAE according to the International League Against Epilepsy 2021 criteria and with a minimum of 3-year follow-up duration were included. The children were divided according to the time of seizure control. Early seizure remission was defined as seizure freedom within 6 months after the treatment onset.</p><p><strong>Results: </strong>Twenty-four patients with a mean age of 13.7 (9.4-22.0) were included in this study. At the final follow-up, all patients were seizure-free except for one case. Seizure freedom was achieved after initial treatment in a mean of 0.78 years. The treatment was ceased in 19 children (79.2%) after a mean of 3.2 years. Patients having absence seizures without motor components had a higher rate of early seizure remission (p=0.026). In 81.3% of the patients; all of whose repetitive post-treatment EEGs were devoid of any generalized spike-wave discharges and absence seizures; remission was established within 6 months or less (p=0.026).</p><p><strong>Conclusions: </strong>CAE has a favorable prognosis with seizure control obtained in the majority of the cases and more than half of them were obtained within 6 months following the initiation of treatment. Moreover, having an absence seizure without motor components and repetitively normal post-treatment EEGs appear to be associated with a higher rate of early seizure remission.</p>","PeriodicalId":48743,"journal":{"name":"Foot and Ankle Surgery","volume":"23 1","pages":"85-89"},"PeriodicalIF":1.1,"publicationDate":"2024-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10943932/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74361962","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ankle muscle strength should be assessed after a lateral ankle sprain (LAS) because a strength deficit can lead to chronic ankle instability (CAI). No field method is available to obtain quantitative ankle dynamic strength values. This study aimed to assess the reliability of the one-repetition maximal (1-RM) method and to compare ankle muscle strength between healthy volunteers and those with CAI using 1-RM strength assessment approach.
Methods
We recruited 31 healthy volunteers and 32 with CAI. Dorsiflexor, evertor, and invertor 1-RM were performed twice at a one-week interval. The intraclass correlation coefficient (ICC) and minimal detectable change (MDC) were calculated. Strength values were compared between healthy volunteers and CAI.
Results
The 1-RM method is reliable for assessing ankle dorsiflexor, evertor, and invertor strength, with an ICC ranging from 0.76 to 0.88, and MDC ranging from 19 to 31%. Volunteers with CAI obtained evertor (3.0 vs. 3.5 N/kg), invertor (2.9 vs. 3.7 N/kg), and dorsiflexor (5.9 vs. 6.5 N/kg) strength values that were lower than healthy volunteers (p < 0.05).
Conclusion
The 1-RM test can be used in practice to assess evertor, invertor, and dorsiflexor strength during the rehabilitation of LAS. This field method could help practitioners to detect a strength deficit and individualize a strengthening programme if necessary.
背景外踝扭伤（LAS）后应评估踝关节肌肉力量，因为力量不足会导致慢性踝关节不稳定（CAI）。目前还没有一种现场方法可以获得定量的踝关节动态力量值。本研究旨在评估单次最大重复（1-RM）方法的可靠性，并使用 1-RM 力量评估方法比较健康志愿者和 CAI 患者的踝关节肌肉力量。在间隔一周的时间内进行两次背屈、外翻和内翻 1-RM 训练。计算了类内相关系数（ICC）和最小可检测变化（MDC）。结果1-RM法在评估踝关节背屈、外翻和内翻力量方面是可靠的，其ICC范围为0.76-0.88，MDC范围为19-31%。患有 CAI 的志愿者获得的倒立（3.0 对 3.5 N/kg）、倒转（2.9 对 3.7 N/kg）和背屈（5.9 对 6.5 N/kg）力量值均低于健康志愿者（p < 0.05）。这种现场方法可帮助从业人员发现力量不足，并在必要时制定个性化的强化计划。
{"title":"Ankle strength assessed by one repetition maximum: A new approach to detect weaknesses in chronic ankle lateral instability","authors":"Aude Aguilaniu , Cédric Schwartz , Guillaume Abran , Laura Baudoux , Prof Jean-Louis Croisier","doi":"10.1016/j.fas.2024.02.005","DOIUrl":"10.1016/j.fas.2024.02.005","url":null,"abstract":"<div><h3>Background</h3><p>Ankle muscle strength should be assessed after a lateral ankle sprain (LAS) because a strength deficit can lead to chronic ankle instability (CAI). No field method is available to obtain quantitative ankle dynamic strength values. This study aimed to assess the reliability of the one-repetition maximal (1-RM) method and to compare ankle muscle strength between healthy volunteers and those with CAI using 1-RM strength assessment approach.</p></div><div><h3>Methods</h3><p>We recruited 31 healthy volunteers and 32 with CAI. Dorsiflexor, evertor, and invertor 1-RM were performed twice at a one-week interval. The intraclass correlation coefficient (ICC) and minimal detectable change (MDC) were calculated. Strength values were compared between healthy volunteers and CAI.</p></div><div><h3>Results</h3><p>The 1-RM method is reliable for assessing ankle dorsiflexor, evertor, and invertor strength, with an ICC ranging from 0.76 to 0.88, and MDC ranging from 19 to 31%. Volunteers with CAI obtained evertor (3.0 vs. 3.5 N/kg), invertor (2.9 vs. 3.7 N/kg), and dorsiflexor (5.9 vs. 6.5 N/kg) strength values that were lower than healthy volunteers (p < 0.05).</p></div><div><h3>Conclusion</h3><p>The 1-RM test can be used in practice to assess evertor, invertor, and dorsiflexor strength during the rehabilitation of LAS. This field method could help practitioners to detect a strength deficit and individualize a strengthening programme if necessary.</p></div>","PeriodicalId":48743,"journal":{"name":"Foot and Ankle Surgery","volume":"30 4","pages":"Pages 349-353"},"PeriodicalIF":2.5,"publicationDate":"2024-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139922994","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-15DOI: 10.1016/j.fas.2024.02.004
Agustin Herber , Oscar Covarrubias , Mohammad Daher , Wei Shao Tung , Arianna L. Gianakos
Introduction
Plantar fasciitis (PF) is the most common cause of heel pain in adults. There are numerous non-operative treatments available including platelet rich plasma (PRP) injections. PPR has demonstrated effectiveness for a range of musculoskeletal conditions including plantar fasciitis.
Purpose/Objective
To compare the effectiveness of PRP to other conservative treatment options for the management of PF.
Methods
A systematic search of PubMed and Google Scholar was performed for randomized control trials (RCT) comparing PRP to other treatment modalities. Studies met inclusion criteria if mean and standard deviations for visual analog scale (VAS) pain scores, plantar fascia thickness (PFT), Foot Function Index (FFI), or American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Score were reported. Mean differences (MD) were used to compare VAS pain, PFT, FFI, and AOFAS between PRP and other treatments.
Results
Twenty-one RCTs which altogether included 1356 patients were included in the meta-analysis. PRP demonstrated significantly greater improvements in VAS pain scores compared to extracorporeal shock wave therapy (ESWT) (SMD: 0.86; CI: [0.30, 1.41]; p = 0.002), corticosteroid injections (CSI) (SMD: 1.08; CI: [0.05, 2.11]; p = 0.04), and placebo (SMD: 3.42; CI: [2.53, 4.31]; p < 0.00001). In terms of FFI, no significant differences existed among PRP, ESWT, CSI, dextrose prolotherapy (DPT), and meridian trigger points (MTP) in enhancing foot functionality. However, PRP demonstrated a marked advantage over phonophoresis, showing a substantial improvement in FFI scores (SMD: 3.07, 95% CI: 2.34–3.81). PRP did not demonstrate superiority over ESWT, CSI, or MTP for improving PFT, but it was notably more effective than phonophoresis (SMD: 3.18, 95% CI: 2.43–3.94). PRP demonstrated significantly greater improvements in AOFAS scores over CSI (SMD: 3.31, CI: [1.35, 5.27], p = 0.0009) and placebo (SMD: 3.75; CI: [2.81, 4.70]; p < 0.00001).
Conclusion
PRP is more effective than CSI, ESWT, and placebo in reducing VAS and more effective than CSI and placebo in improving AOFAS. PRP did not demonstrate a consistent advantage across all outcome measures, such as PFT and FFI. These findings underscore the complexity of PF treatment and call for a more standardized approach to PRP preparation and outcome measurement.
{"title":"Platelet rich plasma therapy versus other modalities for treatment of plantar fasciitis: A systematic review and meta-analysis","authors":"Agustin Herber , Oscar Covarrubias , Mohammad Daher , Wei Shao Tung , Arianna L. Gianakos","doi":"10.1016/j.fas.2024.02.004","DOIUrl":"10.1016/j.fas.2024.02.004","url":null,"abstract":"<div><h3>Introduction</h3><p>Plantar fasciitis (PF) is the most common cause of heel pain in adults. There are numerous non-operative treatments available including platelet rich plasma (PRP) injections. PPR has demonstrated effectiveness for a range of musculoskeletal conditions including plantar fasciitis.</p></div><div><h3>Purpose/Objective</h3><p>To compare the effectiveness of PRP to other conservative treatment options for the management of PF.</p></div><div><h3>Methods</h3><p>A systematic search of PubMed and Google Scholar was performed for randomized control trials (RCT) comparing PRP to other treatment modalities. Studies met inclusion criteria if mean and standard deviations for visual analog scale (VAS) pain scores, plantar fascia thickness (PFT), Foot Function Index (FFI), or American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Score were reported. Mean differences (MD) were used to compare VAS pain, PFT, FFI, and AOFAS between PRP and other treatments.</p></div><div><h3>Results</h3><p>Twenty-one RCTs which altogether included 1356 patients were included in the meta-analysis. PRP demonstrated significantly greater improvements in VAS pain scores compared to extracorporeal shock wave therapy (ESWT) (SMD: 0.86; CI: [0.30, 1.41]; p = 0.002), corticosteroid injections (CSI) (SMD: 1.08; CI: [0.05, 2.11]; p = 0.04), and placebo (SMD: 3.42; CI: [2.53, 4.31]; p < 0.00001). In terms of FFI, no significant differences existed among PRP, ESWT, CSI, dextrose prolotherapy (DPT), and meridian trigger points (MTP) in enhancing foot functionality. However, PRP demonstrated a marked advantage over phonophoresis, showing a substantial improvement in FFI scores (SMD: 3.07, 95% CI: 2.34–3.81). PRP did not demonstrate superiority over ESWT, CSI, or MTP for improving PFT, but it was notably more effective than phonophoresis (SMD: 3.18, 95% CI: 2.43–3.94). PRP demonstrated significantly greater improvements in AOFAS scores over CSI (SMD: 3.31, CI: [1.35, 5.27], p = 0.0009) and placebo (SMD: 3.75; CI: [2.81, 4.70]; p < 0.00001).</p></div><div><h3>Conclusion</h3><p>PRP is more effective than CSI, ESWT, and placebo in reducing VAS and more effective than CSI and placebo in improving AOFAS. PRP did not demonstrate a consistent advantage across all outcome measures, such as PFT and FFI. These findings underscore the complexity of PF treatment and call for a more standardized approach to PRP preparation and outcome measurement.</p></div><div><h3>Level of Evidence</h3><p>Level I Meta-Analysis</p></div>","PeriodicalId":48743,"journal":{"name":"Foot and Ankle Surgery","volume":"30 4","pages":"Pages 285-293"},"PeriodicalIF":2.5,"publicationDate":"2024-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139890278","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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