Objective: Achilles tendon (AT) ruptures are common in young athletes. Conservative treatment, open surgery and percutaneous/minimally invasive approaches are advocated by different groups around the world, and data are still conflicting. The objective of this study was to use objective and reliable measurements to compare the isokinetic functional results of patients undergoing open repair with those undergoing a percutaneous approach. Methods: This was a retrospective comparative study of 38 subjects undergoing two different approaches for the treatment of acute AT ruptures: open and percutaneous. For the functional evaluation, all patients were subjected to analysis of the calf muscle circumference of both legs, along with the following isokinetic measurements: total flexion work, peak flexion torque, total extension work and peak extension torque. The Achilles Tendon Rupture Score (ATRS) and American Orthopedic Foot and Ankle Score (AOFAS) evaluation scales were applied at the final 12-month follow-up. Results: No serious complications were observed. The mean time to return to sports was 9 months. The ​ AOFAS and ATRS values did not differ significantly between the two groups. The isokinetic variables and circumference in both groups were similar when the non-operated and operated limbs were compared. The groups also did not differ when comparing open and percutaneous approaches. Conclusion: It can be concluded that the two strategies used in this study achieved similar functional results. Level of Evidence III; Retrospective Comparative Study.

Objective: To clinically and radiographically evaluate a group of patients undergoing lateral ankle ligament reconstruction surgery using knee flexor tendon autograft. Methods: The study included and prospectively evaluated 10 patients undergoing lateral ankle ligament reconstruction using knee flexor autograft. Clinical evaluation was performed using the American Orthopedic Foot and Ankle Score (AOFAS), preoperatively and after 1 year of follow-up. Radiographic evaluation included anteroposterior projections associated with ankle varus stress and profile projections of the ankle anterior drawer, also preoperatively and 1 year postoperatively. Results: A mean preoperative AOFAS of 69.3 (SD ± 11.49) was obtained. One year after surgery, there was an increase in the mean score of 98.2 (SD ± 3.01), showing a statistically significant improvement (p < 0.001). The anterior tibiotalar angle values improved markedly, with statistical significance. Although the anterior tibiotalar subluxation values also showed a marked improvement, it was not possible to calculate statistical significance; the group of 10 patients had to be divided into two, as six patients met the criteria when compared to the contralateral side (group 1) and four patients had an absolute value of anterior subluxation of more than 10 mm (group 2). Conclusion: After clinical and radiographic evaluation comparing preoperative and 1-year postoperative data, we conclude that in the analyzed group, the reconstruction technique used produced good or excellent results and should be considered for the treatment of chronic lateral ankle instability. Level of Evidence III; Retrospective Comparative Study.

Hemophilia is a genetically inherited disease linked to the X chromosome. The main alteration of this pathology affects the coagulation mechanisms. The most affected joints are the knees, elbows and ankles. Clinical manifestations include pain, joint bleeding and limited movement. The diagnosis takes into account the clinical picture and imaging tests. In this article, we present the case of a patient with restricted performance of activities of daily living and loss of quality of life due to hemophilic arthropathy in the right ankle. After total joint arthroplasty of the affected joint, there was improvement in the preoperative parameters of the patient. Level of Evidence V; Expert Opinion.

Objective: To evaluate the profile and diagnostic methods of only female patients with stress fracture in the central metatarsal. Methods: Retrospective, descriptive study of patients who were treated on an outpatient basis and diagnosed with stress fractures in the second, third or fourth metatarsals from January 2012 to June 2016. The epidemiological profile, the risk factors presented for the development of this pathology and the diagnostic imaging methods were analyzed. Results: There were 30 patients, with a total of 32 fractures. Fifteen cases of fractures were found in the second metatarsal, 13 in the third and 4 in the fourth. The right foot had 11 fractures, and the left foot had 21. The average patient age was 44.3 years of age. Ten patients had normal body mass index (BMI), 13 were overweight and 7 had Grade I obesity. Sixteen patients were sedentary, and 14 regularly exercised. The diagnosis with radiography at first consultation was 8 cases and 2 after the second consultation. In the other 20 cases, the radiography was negative, and magnetic resonance imaging was requested for diagnostic confirmation. Conclusions: Development of metatarsal stress fractures was observed in the majority of patients who were at least 40 years of age, an age group in which estrogen production has begun to decrease in women. Magnetic resonance imaging is the ideal test for early diagnosis of the lesion. Level of Evidence III; Retrospective Comparative Study.

Objective: To evaluate the radiographic parameter correction and clinical improvement of moderate and severe hallux valgus deformities treated by percutaneous Chevron osteotomy. Methods: Twenty-six patients (30 feet) underwent surgery. The following were measured preoperatively and postoperatively: hallux metatarsophalangeal (MTP) angle, intermetatarsal angle between the 1st and 2nd metatarsals (IMA), distal metatarsal joint angle (DMJA) and pre- and postoperative AOFAS scores with a minimum of 6 months of follow-up. Results: The mean patient age was 52.3 years. Preoperatively, the mean AOFAS score was 45.6, which rose to 90.3 after the procedure, showing a statistically significant improvement. The preoperative mean MTP, IMA and DMJA angles were 29.7°, 14.2° and 14.2°, respectively, and the postoperative values were 12.8°, 8.2° and 11.1°, respectively. The improvements in MTP and IMA angles were also statistically significant. There were no losses in angular parameters or worsening of AOFAS scores during follow-up. Conclusion: The percutaneous Chevron surgical technique proved to be safe and effective for the correction of moderate and severe hallux valgus cases and achieved significant improvements in clinical and radiographic parameters and low rates of postoperative complications. Level of Evidence III; Retrospective Comparative Study.

Objective: To perform an evaluation, based on the 36-Item Short Form Health Survey (SF-36) quality of life questionnaire and American Orthopedic Foot and Ankle Score (AOFAS), of the clinical outcome of patients with a diagnosis of hallux valgus and with hallux and lesser toes surgically treated using the Chevron, Akin and Weil techniques. Methods: Eleven patients with a diagnosis of hallux valgus, treated using the aforementioned techniques between January 2005 and December 2009 and with a minimum follow-up of 24 months, were evaluated. All patients completed the SF-36 and AOFAS questionnaires for the hallux and lesser toes. Results: According to the SF-36, nine patients had good general health, six performed all types of physical activities, six had no problems with physical activities, six had no problems as a result of emotional aspects, eight performed their normal social activities, seven had no pain or limitation of activities due to pain, seven felt excited and full of energy, and seven felt at peace, happy and calm. According to the AOFAS, six good and excellent results were obtained for the lesser toes, and eight good and excellent results were obtained for the hallux. The only significant difference observed in the SF-36 score was for Vitality and Mental Health in patients over 60 years of age, and no differences were observed in regard to patient gender. No differences were observed between age groups or genders in regard to the AOFAS. Conclusion: According to the SF-36 and AOFAS, the combined techniques achieved good results and are therefore recommended for the treatment of hallux valgus and foot alignment. Level of Evidence III; Retrospective Comparative Study.

Objective: To evaluate, using a case series, the results of the surgical treatment of subtle cavovarus foot with extension osteotomy of the first metatarsal and release of the plantar fascia. Methods: Eleven patients and 12 feet, including five males and six females with a mean age of 40 years and minimum follow-up of 12 months. All patients had a diagnosis of subtle cavovarus foot with associated pathologies that did not improve with conservative treatment and were subjected to surgical correction. The patients were evaluated through a clinical examination, the American Orthopedic Foot and Ankle Society (AOFAS) scale, the visual analog scale (VAS) of pain in the pre- and postoperative period, and assessment of the degree of satisfaction and clinical correction of the deformity. Results: The mean AOFAS score increased from 44.4 to 80. The mean pain VAS score decreased from 8.7 to 2.0. Seven patients rated the result as excellent, two patients as good and the other two as regular. Two patients had dehiscence of the surgical wound, one presented a neuropathy in the fibular nerve, and another presented transfer metatarsalgia; all were treated clinically with resolution of the clinical picture. There was no recurrence of deformities or associated pathologies. Conclusion: Surgical treatment of subtle cavovarus foot through first metatarsal osteotomy in combination with plantar fascia release showed good clinical results. Level of Evidence III; Retrospective Comparative Study.

Objective: To evaluate the reproducibility, among orthopaedists, of the Lauge-Hansen classification performed at two different times, with an understanding of the trauma mechanism in each type of fracture. Methods: Thirty radiographs of ankle fractures were selected for assessment by five orthopaedists from our service, two of whom were already trained and three of whom were undergoing orthopaedic residency training. Results: The results were tabulated and plotted, and in a second assessment after 1 week, 66% correct answers and 34% errors were found. In the first assessment, the percentage of correct answers was 61.33%. Conclusion: Management of the classification makes the orthopaedists habituated to using it routinely, facilitating the understanding by other professionals in the field and reducing disagreement among observers. Level of Evidence III; Retrospective Comparative Study.

Objectives: To evaluate radiographic findings of medial longitudinal arch decreases of the foot based on examinations performed before and after posterior tibial transfer surgery to treat motor deficits caused by complete lesions of the peroneal nerve. Methods: A descriptive and analytical study was conducted based on information collected from medical records. Patients with at least two years of follow-up after surgery were included, and their radiographs were evaluated before and after the procedure. In the radiographs with the anteroposterior incidence of the foot, the talocalcaneal, talometatarsal and talonavicular congruence angles were evaluated. In the lateral view, the talocalcaneal, Meary’s and calcaneal pitch angles were analyzed. Data were collected regarding patient profiles, trauma mechanisms and follow-up times. Results: One patient had radiographic results suggestive of a decrease in the plantar arch after posterior tibial tendon transfer. Angular variation among the patients, which was within the normal range, was not significant. Conclusions: No significant decreases in the longitudinal arch of the foot were observed in the studied patients. Level of Evidence III; Retrospective Comparative Study.