Pub Date : 2024-02-13DOI: 10.1097/btf.0000000000000417
J. D. Del Vecchio, E. Dealbera, Gabriel Ferraz Ferreira, M. Dalmau-Pastor
Hallux rigidus is a degenerative condition of the first metatarsophalangeal joint resulting in stiffness and pain. Surgical treatments can be divided into joint-sparing and joint-sacrificing procedures. Cheilectomy has been recommended as an isolated procedure for the treatment of low-grade hallux rigidus (I and II, even III in some articles). First metatarsal shortening osteotomies are indicated in low-grade hallux rigidus. The Shortening Percutaneous, Intra-articular, Chevron Osteotomy resembles the Green-Watermann procedures regarding shortening and decompression. Shortening Percutaneous, Intra-articular, Chevron Osteotomy provides excellent clinical and functional results and represents a viable treatment option to decrease pain, improve function, and maintain motion for hallux rigidus grade I and II. Level of Evidence: Diagnostic level IV.
拇指外翻是第一跖趾关节的一种退行性病变，会导致关节僵硬和疼痛。手术治疗可分为保留关节和牺牲关节的手术。腓肠肌切除术已被推荐为治疗低度僵直症（Ⅰ度和Ⅱ度，有些文章甚至推荐Ⅲ度）的单独手术。第一跖骨缩短截骨术适用于低度Hallux僵直症。经皮、关节内、Chevron缩短截骨术在缩短和减压方面与Green-Watermann手术相似。缩短经皮、关节内、雪佛龙截骨术可提供极佳的临床和功能效果，是一种可行的治疗方案，可减轻 I 级和 II 级硬下疳患者的疼痛、改善其功能并保持其活动度。证据等级：诊断级别 IV。
{"title":"Cheilectomy and the Shortening PelCO for the Treatment of Low-grade Hallux Rigidus","authors":"J. D. Del Vecchio, E. Dealbera, Gabriel Ferraz Ferreira, M. Dalmau-Pastor","doi":"10.1097/btf.0000000000000417","DOIUrl":"https://doi.org/10.1097/btf.0000000000000417","url":null,"abstract":"Hallux rigidus is a degenerative condition of the first metatarsophalangeal joint resulting in stiffness and pain. Surgical treatments can be divided into joint-sparing and joint-sacrificing procedures. Cheilectomy has been recommended as an isolated procedure for the treatment of low-grade hallux rigidus (I and II, even III in some articles). First metatarsal shortening osteotomies are indicated in low-grade hallux rigidus. The Shortening Percutaneous, Intra-articular, Chevron Osteotomy resembles the Green-Watermann procedures regarding shortening and decompression. Shortening Percutaneous, Intra-articular, Chevron Osteotomy provides excellent clinical and functional results and represents a viable treatment option to decrease pain, improve function, and maintain motion for hallux rigidus grade I and II.\u0000 Level of Evidence: Diagnostic level IV.","PeriodicalId":507475,"journal":{"name":"Techniques in Foot & Ankle Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139841367","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 : 2024-02-13DOI: 10.1097/btf.0000000000000417
J. D. Del Vecchio, E. Dealbera, Gabriel Ferraz Ferreira, M. Dalmau-Pastor
Hallux rigidus is a degenerative condition of the first metatarsophalangeal joint resulting in stiffness and pain. Surgical treatments can be divided into joint-sparing and joint-sacrificing procedures. Cheilectomy has been recommended as an isolated procedure for the treatment of low-grade hallux rigidus (I and II, even III in some articles). First metatarsal shortening osteotomies are indicated in low-grade hallux rigidus. The Shortening Percutaneous, Intra-articular, Chevron Osteotomy resembles the Green-Watermann procedures regarding shortening and decompression. Shortening Percutaneous, Intra-articular, Chevron Osteotomy provides excellent clinical and functional results and represents a viable treatment option to decrease pain, improve function, and maintain motion for hallux rigidus grade I and II. Level of Evidence: Diagnostic level IV.
拇指外翻是第一跖趾关节的一种退行性病变，会导致关节僵硬和疼痛。手术治疗可分为保留关节和牺牲关节的手术。腓肠肌切除术已被推荐为治疗低度僵直症（Ⅰ度和Ⅱ度，有些文章甚至推荐Ⅲ度）的单独手术。第一跖骨缩短截骨术适用于低度Hallux僵直症。经皮、关节内、Chevron缩短截骨术在缩短和减压方面与Green-Watermann手术相似。缩短经皮、关节内、雪佛龙截骨术可提供极佳的临床和功能效果，是一种可行的治疗方案，可减轻 I 级和 II 级硬下疳患者的疼痛、改善其功能并保持其活动度。证据等级：诊断级别 IV。
{"title":"Cheilectomy and the Shortening PelCO for the Treatment of Low-grade Hallux Rigidus","authors":"J. D. Del Vecchio, E. Dealbera, Gabriel Ferraz Ferreira, M. Dalmau-Pastor","doi":"10.1097/btf.0000000000000417","DOIUrl":"https://doi.org/10.1097/btf.0000000000000417","url":null,"abstract":"Hallux rigidus is a degenerative condition of the first metatarsophalangeal joint resulting in stiffness and pain. Surgical treatments can be divided into joint-sparing and joint-sacrificing procedures. Cheilectomy has been recommended as an isolated procedure for the treatment of low-grade hallux rigidus (I and II, even III in some articles). First metatarsal shortening osteotomies are indicated in low-grade hallux rigidus. The Shortening Percutaneous, Intra-articular, Chevron Osteotomy resembles the Green-Watermann procedures regarding shortening and decompression. Shortening Percutaneous, Intra-articular, Chevron Osteotomy provides excellent clinical and functional results and represents a viable treatment option to decrease pain, improve function, and maintain motion for hallux rigidus grade I and II.\u0000 Level of Evidence: Diagnostic level IV.","PeriodicalId":507475,"journal":{"name":"Techniques in Foot & Ankle Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139781339","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 : 2024-01-15DOI: 10.1097/btf.0000000000000415
Moustafa A. Maher, Ahmed Khedr, Ahmed M Kholeif, Yasser A. Radwan, Ali Reda Mansour, A. Haleem
The role of the peroneal tendons in progressive collapsing flatfoot deformity (PCFD), also traditionally known as posterior tibial tendon dysfunction, is likely overlooked and almost certainly understudied. We explored the impact of peroneus brevis (PB) to peroneus longus (PL) transfer in the adult population with flexible PCFD deformities class A1 (flexible hindfoot valgus), B1 (flexible midfoot abduction), and C1 (flexible forefoot varus) as an augmentative measure combined with various bony procedures with proper assessment functionally, clinically, and radiologically. PB to PL tendon transfer poses a simple procedure dealing with muscle imbalance between the medial and lateral columns of the foot. It deals with the new understanding of the PCFD complex as a three-dimensional deformity. It works mainly on the axial plane to limit midfoot abduction and strongly augments the PL acting on the sagittal plane to address the forefoot varus. Finally, to a lesser extent, it deals with the coronal plane of hindfoot valgus, eliminating the primary evertor of the foot (PB) while simultaneously strengthening the PL, which contributes to the medial longitudinal and transverse arches of the foot, therefore decreasing the possibility of lateral column overload commonly caused by the Evans osteotomy through reducing pressure across the calcaneocuboid joint. This procedure is preferably indicated for flexible PCFD deformities class (A1, B1, and C1), yet is contraindicated in neuromuscular deformities with peroneal nerve palsy. Level of Evidence: Level IV.
{"title":"An Emphasis on the Role of Peroneus Brevis to Peroneus Longus Transfer in Progressive Collapsing Flatfoot Deformity","authors":"Moustafa A. Maher, Ahmed Khedr, Ahmed M Kholeif, Yasser A. Radwan, Ali Reda Mansour, A. Haleem","doi":"10.1097/btf.0000000000000415","DOIUrl":"https://doi.org/10.1097/btf.0000000000000415","url":null,"abstract":"The role of the peroneal tendons in progressive collapsing flatfoot deformity (PCFD), also traditionally known as posterior tibial tendon dysfunction, is likely overlooked and almost certainly understudied. We explored the impact of peroneus brevis (PB) to peroneus longus (PL) transfer in the adult population with flexible PCFD deformities class A1 (flexible hindfoot valgus), B1 (flexible midfoot abduction), and C1 (flexible forefoot varus) as an augmentative measure combined with various bony procedures with proper assessment functionally, clinically, and radiologically. PB to PL tendon transfer poses a simple procedure dealing with muscle imbalance between the medial and lateral columns of the foot. It deals with the new understanding of the PCFD complex as a three-dimensional deformity. It works mainly on the axial plane to limit midfoot abduction and strongly augments the PL acting on the sagittal plane to address the forefoot varus. Finally, to a lesser extent, it deals with the coronal plane of hindfoot valgus, eliminating the primary evertor of the foot (PB) while simultaneously strengthening the PL, which contributes to the medial longitudinal and transverse arches of the foot, therefore decreasing the possibility of lateral column overload commonly caused by the Evans osteotomy through reducing pressure across the calcaneocuboid joint. This procedure is preferably indicated for flexible PCFD deformities class (A1, B1, and C1), yet is contraindicated in neuromuscular deformities with peroneal nerve palsy.\u0000 \u0000 Level of Evidence: Level IV.","PeriodicalId":507475,"journal":{"name":"Techniques in Foot & Ankle Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139621777","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 : 2024-01-15DOI: 10.1097/btf.0000000000000414
Choon Chiet Hong, Simone Santini, V. Valderrabano
Forefoot varus is a component of the adult-acquired flatfoot deformity which had to be dealt with independently because isolated hindfoot procedures are insufficient to address this deformity. The dorsal opening wedge osteotomy of the medial cuneiform also known as the Cotton osteotomy is an effective and reliable procedure in the correction of forefoot varus with consistently reported good outcomes in terms of improved radiographic and functional outcomes with excellent bony union rate. Notably, it is also very versatile in that the degree of sagittal correction can be adjusted freely. The use of anatomic Cotton plates with titanium wedge integration makes the osteotomy even more robust with the prevention of early loss of correction and reduction of shear forces at the osteotomy site. Therefore, we describe our technique and experience using an anatomic Cotton plate with titanium wedge integration in Cotton osteotomy for forefoot varus. Level of Evidence: Level V.
{"title":"Cotton Osteotomy: An Integral Midfoot Procedure for Forefoot Varus Correction","authors":"Choon Chiet Hong, Simone Santini, V. Valderrabano","doi":"10.1097/btf.0000000000000414","DOIUrl":"https://doi.org/10.1097/btf.0000000000000414","url":null,"abstract":"Forefoot varus is a component of the adult-acquired flatfoot deformity which had to be dealt with independently because isolated hindfoot procedures are insufficient to address this deformity. The dorsal opening wedge osteotomy of the medial cuneiform also known as the Cotton osteotomy is an effective and reliable procedure in the correction of forefoot varus with consistently reported good outcomes in terms of improved radiographic and functional outcomes with excellent bony union rate. Notably, it is also very versatile in that the degree of sagittal correction can be adjusted freely. The use of anatomic Cotton plates with titanium wedge integration makes the osteotomy even more robust with the prevention of early loss of correction and reduction of shear forces at the osteotomy site. Therefore, we describe our technique and experience using an anatomic Cotton plate with titanium wedge integration in Cotton osteotomy for forefoot varus.\u0000 \u0000 Level of Evidence: Level V.","PeriodicalId":507475,"journal":{"name":"Techniques in Foot & Ankle Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139529764","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 : 2024-01-09DOI: 10.1097/btf.0000000000000412
Teodor Trojner, Tomaž Cvetko, M. Merc
Scarf calcaneal osteotomy is an extra-articular procedure to correct progressive collapsing foot deformity (PCFD). As an open approach may display wound healing problems, we herein report a novel method of percutaneously performed minimally invasive scarf calcaneal osteotomy. Twenty patients aged 56.75 ± 7.13 with grade 1AB of PCFD were included. A radiologic assessment was performed before the procedure and after 3 months. Clinical evaluation was done before the procedure, after 3 months, and after 12 months. The Manchester-Oxford Foot Questionnaire and Functional Foot Index score improved from 77.63 ± 11.67 preoperatively to 33.29 ± 18.55 at the follow-up (P < 0.001) and from 69.26 ± 16.32 preoperatively to 32.00 ± 20.35 at the follow-up (P < 0.001), respectively. There was a statistically significant improvement in all radiologic measurements, namely, talonavicular coverage angle from 20.03 ± 5.51 to 14.18 ± 6.49 (P < 0.001), the distance between medial cuneiform and fifth metatarsal from 0.53 ± 3.31 to 6.95 ± 4.01 (P < 0.001), anteroposterior talo-first metatarsal angle from 22.13 ± 7.28 to 17.09 ± 6.87 (P < 0.005), Meary angle from 25.12 ± 2.73 to 15.17 ± 7.06 (P < 0.001), calcaneal inclination angle from 12.23 ± 4.01 to 16.82 ± 5.53 (P < 0.001), navicular height from 15.57 ± 4.10 to 20.57 ± 6.87 (P < 0.005), and tibio-calcaneal angle from −3.79 ± 5.15 to 6.71 ± 4.41 (P < 0.001). In experienced hands, minimally invasive scarf calcaneal osteotomy seems to be an effective and reproducible subtalar preserving surgical technique for PCFD cases with mild midfoot abduction severity. Diagnostic Level 4. See Instructions for Authors for a complete description of levels of evidence.
{"title":"Minimally Invasive Scarf Calcaneal Osteotomy is an Alternative Technique for the Correction of Progressive Collapsing Foot Deformity","authors":"Teodor Trojner, Tomaž Cvetko, M. Merc","doi":"10.1097/btf.0000000000000412","DOIUrl":"https://doi.org/10.1097/btf.0000000000000412","url":null,"abstract":"Scarf calcaneal osteotomy is an extra-articular procedure to correct progressive collapsing foot deformity (PCFD). As an open approach may display wound healing problems, we herein report a novel method of percutaneously performed minimally invasive scarf calcaneal osteotomy. Twenty patients aged 56.75 ± 7.13 with grade 1AB of PCFD were included. A radiologic assessment was performed before the procedure and after 3 months. Clinical evaluation was done before the procedure, after 3 months, and after 12 months. The Manchester-Oxford Foot Questionnaire and Functional Foot Index score improved from 77.63 ± 11.67 preoperatively to 33.29 ± 18.55 at the follow-up (P < 0.001) and from 69.26 ± 16.32 preoperatively to 32.00 ± 20.35 at the follow-up (P < 0.001), respectively. There was a statistically significant improvement in all radiologic measurements, namely, talonavicular coverage angle from 20.03 ± 5.51 to 14.18 ± 6.49 (P < 0.001), the distance between medial cuneiform and fifth metatarsal from 0.53 ± 3.31 to 6.95 ± 4.01 (P < 0.001), anteroposterior talo-first metatarsal angle from 22.13 ± 7.28 to 17.09 ± 6.87 (P < 0.005), Meary angle from 25.12 ± 2.73 to 15.17 ± 7.06 (P < 0.001), calcaneal inclination angle from 12.23 ± 4.01 to 16.82 ± 5.53 (P < 0.001), navicular height from 15.57 ± 4.10 to 20.57 ± 6.87 (P < 0.005), and tibio-calcaneal angle from −3.79 ± 5.15 to 6.71 ± 4.41 (P < 0.001). In experienced hands, minimally invasive scarf calcaneal osteotomy seems to be an effective and reproducible subtalar preserving surgical technique for PCFD cases with mild midfoot abduction severity.\u0000 \u0000 \u0000 Diagnostic Level 4. See Instructions for Authors for a complete description of levels of evidence.\u0000","PeriodicalId":507475,"journal":{"name":"Techniques in Foot & Ankle Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139442037","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 : 2023-12-28DOI: 10.1097/btf.0000000000000411
Cameron Elgie, Mark A. Glazebrook, Andrew Walls, Gaurav Arora
Tibialis anterior ruptures present unique surgical challenges due to frequently delayed diagnosis, often necessitating tendon reconstruction. The Pulvertaft weave has been a mainstay for tendon coaptation in graft reconstruction, but the bulky nature of that construct is a disadvantage in areas with limited soft tissue, such as the foot and ankle. Here we introduce the “split-tendon docking” technique as an alternative, aiming to maintain the strength of the tendon coaptation while reducing its profile. Preoperative evaluation is discussed, including clinical and imaging assessments. The technique is described, including the approach, graft preparation, and docking technique. Complications and postoperative care are considered. While the technique requires further use and validation, it presents a promising, lower-profile alternative for foot and ankle tendon coaptation. Diagnostic Level 5. See Instructions for Authors for a complete description of levels of evidence.
{"title":"Split-tendon Docking Technique for Tibialis Anterior Allograft Reconstruction","authors":"Cameron Elgie, Mark A. Glazebrook, Andrew Walls, Gaurav Arora","doi":"10.1097/btf.0000000000000411","DOIUrl":"https://doi.org/10.1097/btf.0000000000000411","url":null,"abstract":"Tibialis anterior ruptures present unique surgical challenges due to frequently delayed diagnosis, often necessitating tendon reconstruction. The Pulvertaft weave has been a mainstay for tendon coaptation in graft reconstruction, but the bulky nature of that construct is a disadvantage in areas with limited soft tissue, such as the foot and ankle. Here we introduce the “split-tendon docking” technique as an alternative, aiming to maintain the strength of the tendon coaptation while reducing its profile. Preoperative evaluation is discussed, including clinical and imaging assessments. The technique is described, including the approach, graft preparation, and docking technique. Complications and postoperative care are considered. While the technique requires further use and validation, it presents a promising, lower-profile alternative for foot and ankle tendon coaptation. Diagnostic Level 5. See Instructions for Authors for a complete description of levels of evidence.","PeriodicalId":507475,"journal":{"name":"Techniques in Foot & Ankle Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139151316","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 : 2023-12-21DOI: 10.1097/btf.0000000000000404
S. Florentino, Zein S. El-Zein, Judith F. Baumhauer
Patients with painful midfoot arthritis unsuccessfully treated with conservative measures have been historically left with the surgical option of midfoot arthrodesis as a definitive treatment. In recent years, excision of the deep peroneal nerve has been offered as a potential alternative. Existing literature on the outcomes of patients undergoing deep peroneal neurectomy for the treatment of midfoot arthritis is limited and piecemeal. In this comprehensive review, technique guide, and retrospective case series, we consolidate the evidence around deep peroneal neurectomy for midfoot arthritis, review operative technique, and determine the outcomes of 4 patients who underwent deep peroneal neurectomy from February 2021 to December 2022 using Patient-Reported Outcome Measurement Information System Physical Function and Pain Interference scores. Four original articles from National Center for Biotechnology Information Medline, published through May 2023, were included. The outcomes of patients treated with deep peroneal neurectomy for midfoot arthritis are discussed. In our case series, the average amount of time between surgery and final postoperative Patient-Reported Outcome Measurement Information System scores was 289 days. The average preoperative physical function score was 36.8. Three patients showed a minimal clinically important difference in physical function; postoperative average was 41.3. Three patients had a minimally clinical important reduction in pain levels (average preoperative pain interference score was 65.8; average postoperative pain interference score was 59.3). One patient underwent a revision neurectomy for inadequate pain relief, and another sought additional treatment for inadequate pain relief. All patients returned to walking in a shoe within 1 month. The outcomes of our case series are similar to those of previously published case series, which demonstrate satisfactory results and acceptable complication rates. For patients with symptomatic midfoot arthritis, deep peroneal neurectomy can be an effective treatment option to reduce pain and improve physical function while requiring minimal postoperative recovery time.
{"title":"Deep Peroneal Neurectomy for Midfoot Arthritis: A Comprehensive Review, Surgical Technique, and Case Series","authors":"S. Florentino, Zein S. El-Zein, Judith F. Baumhauer","doi":"10.1097/btf.0000000000000404","DOIUrl":"https://doi.org/10.1097/btf.0000000000000404","url":null,"abstract":"Patients with painful midfoot arthritis unsuccessfully treated with conservative measures have been historically left with the surgical option of midfoot arthrodesis as a definitive treatment. In recent years, excision of the deep peroneal nerve has been offered as a potential alternative. Existing literature on the outcomes of patients undergoing deep peroneal neurectomy for the treatment of midfoot arthritis is limited and piecemeal. In this comprehensive review, technique guide, and retrospective case series, we consolidate the evidence around deep peroneal neurectomy for midfoot arthritis, review operative technique, and determine the outcomes of 4 patients who underwent deep peroneal neurectomy from February 2021 to December 2022 using Patient-Reported Outcome Measurement Information System Physical Function and Pain Interference scores. Four original articles from National Center for Biotechnology Information Medline, published through May 2023, were included. The outcomes of patients treated with deep peroneal neurectomy for midfoot arthritis are discussed. In our case series, the average amount of time between surgery and final postoperative Patient-Reported Outcome Measurement Information System scores was 289 days. The average preoperative physical function score was 36.8. Three patients showed a minimal clinically important difference in physical function; postoperative average was 41.3. Three patients had a minimally clinical important reduction in pain levels (average preoperative pain interference score was 65.8; average postoperative pain interference score was 59.3). One patient underwent a revision neurectomy for inadequate pain relief, and another sought additional treatment for inadequate pain relief. All patients returned to walking in a shoe within 1 month. The outcomes of our case series are similar to those of previously published case series, which demonstrate satisfactory results and acceptable complication rates. For patients with symptomatic midfoot arthritis, deep peroneal neurectomy can be an effective treatment option to reduce pain and improve physical function while requiring minimal postoperative recovery time.","PeriodicalId":507475,"journal":{"name":"Techniques in Foot & Ankle Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139167565","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 : 2023-12-20DOI: 10.1097/btf.0000000000000410
Frederick M. Washburn, Niaz Ahankoob, Victor Bonavida, William Fang, C. Pyle
Treatment of ankle fractures in patients with severe medical comorbidities poses a significant challenge, as these patients are at high risk for major complications, including infection and amputation. Tibiotalocalcaneal arthrodesis (TTCA) is gaining popularity for the surgical treatment of ankle fractures in these medically complex patients. This is traditionally performed with open joint preparation or no joint preparation, both of which have associated postoperative complications. We present our technique for arthroscopic-assisted TTCA and provide a retrospective case series of 4 patients undergoing this technique and their outcomes. Our study showed that arthroscopically-assisted joint preparation for TTCA for ankle fractures in patients with severe medical comorbidities shows promise considering 100% limb salvage rate, successful fusion, and restoration of ambulatory status. Complications were minimal requiring only one return to the operating room for symptomatic aseptic loosening of an interlocking screw. Because this is done in a minimally invasive approach, it may be the preferred technique more widely used in the future to decrease the rate of infection and increase the rate of fusion, especially in medically complex patients. Level IV, retrospective case series.
{"title":"Arthroscopic-assisted Tibiotalocalcaneal Arthrodesis Using a Hindfoot Nail for Treatment of Ankle Fractures in Medically Complex Patients: A Technique Guide and Retrospective Case Series","authors":"Frederick M. Washburn, Niaz Ahankoob, Victor Bonavida, William Fang, C. Pyle","doi":"10.1097/btf.0000000000000410","DOIUrl":"https://doi.org/10.1097/btf.0000000000000410","url":null,"abstract":"Treatment of ankle fractures in patients with severe medical comorbidities poses a significant challenge, as these patients are at high risk for major complications, including infection and amputation. Tibiotalocalcaneal arthrodesis (TTCA) is gaining popularity for the surgical treatment of ankle fractures in these medically complex patients. This is traditionally performed with open joint preparation or no joint preparation, both of which have associated postoperative complications. We present our technique for arthroscopic-assisted TTCA and provide a retrospective case series of 4 patients undergoing this technique and their outcomes. Our study showed that arthroscopically-assisted joint preparation for TTCA for ankle fractures in patients with severe medical comorbidities shows promise considering 100% limb salvage rate, successful fusion, and restoration of ambulatory status. Complications were minimal requiring only one return to the operating room for symptomatic aseptic loosening of an interlocking screw. Because this is done in a minimally invasive approach, it may be the preferred technique more widely used in the future to decrease the rate of infection and increase the rate of fusion, especially in medically complex patients. Level IV, retrospective case series.","PeriodicalId":507475,"journal":{"name":"Techniques in Foot & Ankle Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139168880","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 : 2023-12-19DOI: 10.1097/btf.0000000000000409
E. Uygur
Calcaneus fractures are usually seen in the same pattern of injury, which is characterized by 4 fracture fragments and causes 4 deformities. This article aims to provide a comprehensive guide for the minimal invasive screw fixation method using minimal invasive sinus tarsi incision for calcaneus fractures. The importance of three-dimensional thinking in understanding fracture patterns is emphasized, with suggestions for utilizing computerized tomography scans. The step-by-step surgical procedure is outlined, including reduction maneuvers, fluoroscopic control, and 4 essential x-ray views for accurate assessment. Therefore, it is aimed to identify the proper screw placements for the typical calcaneus fracture fragments. The article concludes by summarizing the presented surgical steps, emphasizing the simplicity and reproducibility of the techniques, and emphasizing the crucial role of three-dimensional thinking in managing calcaneus fractures. Level of Evidence: Level 4, expert opinion.
{"title":"A Screw Fixation Technique for Calcaneus Fractures: Simplifying Three-dimensional Thinking and Minimal Invasive Surgery","authors":"E. Uygur","doi":"10.1097/btf.0000000000000409","DOIUrl":"https://doi.org/10.1097/btf.0000000000000409","url":null,"abstract":"Calcaneus fractures are usually seen in the same pattern of injury, which is characterized by 4 fracture fragments and causes 4 deformities. This article aims to provide a comprehensive guide for the minimal invasive screw fixation method using minimal invasive sinus tarsi incision for calcaneus fractures. The importance of three-dimensional thinking in understanding fracture patterns is emphasized, with suggestions for utilizing computerized tomography scans. The step-by-step surgical procedure is outlined, including reduction maneuvers, fluoroscopic control, and 4 essential x-ray views for accurate assessment. Therefore, it is aimed to identify the proper screw placements for the typical calcaneus fracture fragments. The article concludes by summarizing the presented surgical steps, emphasizing the simplicity and reproducibility of the techniques, and emphasizing the crucial role of three-dimensional thinking in managing calcaneus fractures. Level of Evidence: Level 4, expert opinion.","PeriodicalId":507475,"journal":{"name":"Techniques in Foot & Ankle Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139171102","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 : 2023-12-12DOI: 10.1097/btf.0000000000000405
Glaucia Bordignon, Derek M. Klavas, P. C. Benevides, Dov L. Rosemberg, Johnny L. Lin, Simon Lee, D. Bohl
The use of minimally invasive techniques in the treatment of primary Achilles rupture has become more popular in the past few decades as they have been associated with a lower wound complication rate. Most of the techniques demand the use of procedure-specific instruments and are designed mainly for midsubstance lesions. This article aims to present a novel technique for Achilles tendon repair that can be used for both insertional and midsubstance ruptures, using a mini-incision and with no special instruments required. Level of Evidence: Diagnostic Level V.
{"title":"Primary Repair of Achilles Tendon Rupture Using a Mini-incision: A Novel Technique","authors":"Glaucia Bordignon, Derek M. Klavas, P. C. Benevides, Dov L. Rosemberg, Johnny L. Lin, Simon Lee, D. Bohl","doi":"10.1097/btf.0000000000000405","DOIUrl":"https://doi.org/10.1097/btf.0000000000000405","url":null,"abstract":"The use of minimally invasive techniques in the treatment of primary Achilles rupture has become more popular in the past few decades as they have been associated with a lower wound complication rate. Most of the techniques demand the use of procedure-specific instruments and are designed mainly for midsubstance lesions. This article aims to present a novel technique for Achilles tendon repair that can be used for both insertional and midsubstance ruptures, using a mini-incision and with no special instruments required. Level of Evidence: Diagnostic Level V.","PeriodicalId":507475,"journal":{"name":"Techniques in Foot & Ankle Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139182202","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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