American Orthopaedic Foot And Ankle Society Ankle-Hindfoot Research Articles

Kirschner Wire Internal Fixation of the Medial Tibiotalar Joint for Indirect Repair of Deltoid Ligament Injury: A Retrospective Comparative Study.

Ankle joint fractures are often accompanied by medial deltoid ligament rupture. There is controversy over whether or how to treat deltoid ligament rupture. This study was aimed to explore the feasibility of repairing the medial deltoid ligament using Kirschner wire internal fixation of the medial tibiotalar joint combined with external fixation. Forty-six patients with ankle fractures involving deltoid ligament rupture, treated between October 2012 and February 2021, were retrospectively evaluated. Twenty-five patients were treated with a Kirschner wire to fix the tibiotalar joint and indirectly repair the deltoid ligament as the repaired group. Twenty-one patients underwent reduction and fixation of internal and external malleolus fractures, and the deltoid ligament was not repaired in the unrepaired group. The American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, visual analog scale (VAS), Medical Outcomes Short Form 36-item questionnaire score (SF-36), and Medial clear space perpendicular (preoperative, postoperative, final follow-up) were used for functional evaluations and reduction assessments. Mann-Whitney test were used to compare the differences between the groups. The follow-up time was 13-112 months with a mean of 59.32 months for the repaired group and 11-94 months with a mean of 53.43 months for the unrepaired group. There was no significant difference in the operative time or intraoperative blood loss between the two groups (p > 0.05). At the last follow-up, the AOFAS ankle-hindfoot and SF-36 scores of the repaired group were significantly higher than those of the non-repaired group (p < 0.05). Moreover, the VAS pain score was significantly lower and the Medial clear space perpendicular was significantly narrower in the repaired group than that in the unrepaired group. Tibiotalar joint fixation using Kirschner wires is a simple and effective technique that can indirectly reduce and repair the deltoid ligament and stabilize the ankle.

Modified posterior fibular groove deepening procedure with repair of the superior peroneal retinaculum for peroneal tendon subluxation.

To evaluate the clinical results of modified peroneal sulcus deepening combined with superior peroneal retinaculum repair in peroneal tendon subluxation treatment. From 2016 to 2020, 18 patients with peroneal tendon subluxation were diagnosed and treated; all patients underwent modified peroneal sulcus deepening combined with superior peroneal retinaculum repair. The visual analogue scale (VAS) score, American Orthopaedic Foot and Ankle Society ankle-hindfoot (AOFAS-AH) score, and subjective patient satisfaction were evaluated before surgery and during follow-up. The operative time was 66.44 ± 5.22min. All patients' surgical incisions showed grade A healing, and there were no complications. All patients were followed up for 24-48months; no patients were lost to follow-up. At the last follow-up, the VAS and AOFAS-AH scores were significantly improved compared with those pre-operatively (P < 0.05). There was no significant difference in the activity of the 18 patients between pre- and post-operatively, and all patients recovered their normal gait before injury. Modified fibular groove deepening combined with superior peroneal retinaculum repair for treating peroneal tendon subluxation may be a simple operation with minimal trauma, rapid recovery, and good clinical efficacy.

Early clinical efficacy analysis of personalized three-dimensional printing talus prosthesis in the treatment of collapse talus necrosis

Object To examine the preliminary clinical efficacy of custom-made three-dimensional(3D) printed talus prosthesis in the treatment of collapse talus necrosis. Methods: The clinical data of 8 patients who received 3D printed custom-made talus prostheses replacement for severe collapsed necrosis of the talus at the Orthopaedic Sports Medical Center, the First Affiliated Hospital to Army Medical University were analyzed retrospectively.All patients were male,with an average age of 38.0 years (range:22 to 65 years).There were 5 cases of left talus collapse and 3 cases of right talus collapse,with the course of disease of 29.7 weeks (range:6 to 96 weeks).The CT data of contralateral healthy talus were used for mirror image design references for the prosthesis,and the electron-beam 3D printing technology was used to prepare the prosthesis.Titanium alloy (Ti6Al4V) was taken as the material for the preparation of the talus body prosthesis,and Co-Cr-Mo material was used as the material for the preparation of the tibialis talus lateral joint surface prosthesis,and the subtalar joint surface of the prosthesis was made from a microporous casting technique.The prosthesis was analyzed preoperatively by digital three-dimensional finite element analysis and solid comparison techniques to measure anatomic match of the prosthesis.A longitudinal incision on medial ankle was made.The necrotic talus was completely removed and the prosthesis was then implanted.The patient was reexamined in the outpatient department 3, 6, and 12 months after surgery.Primary outcome measures were the American Orthopaedic Foot and Ankle Society(AOFAS) ankle-hind foot score,visual analogue scale(VAS) and ankle range of motion.Changes in imaging data and plantar pressure were also assessed.Repeated measures analysis of variance and paired-t test were used to compare the data. Results: The talus prosthesis measure preoperatively was completely consistent with that contralateral healthy talus and there was no operation-related complication. All the wounds healed primarily. The patients were followed up effectively for 23.17 months (range:12 to 48 months).The preoperative dorsiflexion of patients was (7.6±5.7)°,it increased to(14.2±6.6)° at 12 month after surgery (t=-2.67,P=0.03).The plantar flexion increased from (22.0±9.9)°preoperatively to (29.2±8.7)° at 12 month after surgery (t=-8.95,P<0.01).Preoperative AOFAS ankle-hind foot score was 26.3±6.6,and it increased to 70.1±2.2,76.0±3.4 and 79.3±4.2 at 3 month,6 month and 12 month after surgery(F=56.81,P<0.01);Pre-operative VAS was[M(QR)]3.0(0.8),and it increased to 2.5(1.0),1.5(1.0),1.0(1.0)at 3 month,6 month and 12 month after surgery(F=20.00,P<0.01).At the last follow-up,imaging reexamination showed that the prosthesis of all patients were in stable position with no sign of subsidence.No secondary ankle fusion or revision was required.The talus height increased from (27.6±6.0)mm preoperatively to (34.6±3.5)mm (t=-2.94,P<0.01).The plantar pressure showed that the maximum pressure on the healthy ankle was(629.9±26.1)N,and that on the affected side was(521.4±14.4)N.The pressure on the healthy ankle was(350.6±29.6)N,and that on the necrotic side was (212.3±9.7)N.The load on the contralateral forefoot was(38.1±2.8)% and that on the necrotic side was(11.5±2.0)%.The load on the contralateral hindfoot was (24.6±2.5)% and that on the necrotic side was (21.1±1.8)%. Conclusions: The custom-made 3D printed talus prosthesis could restore the talus anatomy,recover the ankle joint function,relieve the pain of patients and improve the life quality of patients.The effect on plantar pressure is mainly achieved by adjusting the center of gravity of plantar pressure backwards and the increase of weight bearing of the healthy foot.

Ankle arthrodesis for end-stage haemophilic ankle arthropathy using a Ilizarov method.

Only a few studies in the literature have reported on the outcome of ankle arthrodesis in haemophilia patients, and the optimal surgery technique for end-stage haemophilic ankle arthropathy remains controversial. The purpose of this study was to evaluate the results of ankle arthrodesis using the Ilizarov method in treating end-stage haemophilic ankle arthropathy. Fourteen haemophilia patients with end-stage ankle arthropathy who underwent ankle arthrodesis using the Ilizarov method from December 2013 to May 2018 were enrolled in this study. The hospital day, fusion rate, complications, and functional outcomes were recorded and analyzed. Functional outcomes were evaluated according to the pre-operative and final follow-up of the American Orthopedic Foot and Ankle Society (AOFAS) ankle-hind foot score, visual analog scale (VAS), and Medical Outcomes Short Form 12-item questionnaire score (SF-12) . All patients achieved bony fusion as confirmed by post-operative radiographs. The average time to fusion was 12.9weeks (range, 10-17weeks). Superficial pin track infection was observed in two patients, and subtalar arthritis was found in one patient. The mean AOFAS ankle-hind foot score, VAS score, physical component summary (PCS), and mental component summary (MCS) at final follow-up were significantly improved compared with the pre-operative data. All patients were satisfied with the surgery. Ankle arthrodesis using the Ilizarov method is a minimally invasive, effective, and safe surgical method and can be a viable option for hemophilia patients with end-stage ankle arthropathy.

Micro-fracture therapy combined with intra-articular injection of platelet-rich plasma for small sized osteochondral lesion of the talus

To investigate the effectiveness of micro-fracture therapy combined with intra-articular injection of platelet-rich plasma (PRP) in the treatment of small sized osteochondral lesion of the talus (OLT). Between September 2014 and October 2017, 43 patients with small sized OLT met the inclusive criteria were admitted and randomly divided into micro-fracture group (21 cases) and combined group (22 cases). Patients in the micro-fracture group were treated with micro-fracture therapy, and patients in the combined group were treated with micro-fracture therapy combined with intra-articular injection of PRP. There was no significant difference in gender, age, disease duration, side of OLT, injured position, lesion area, Mintz classification, and preoperative American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hind foot score and visual analogue scale (VAS) score between the two groups ( P>0.05). After treatment, MRI, VAS score, and AOFAS ankle-hind foot score were used to evaluate the recovery of OLT and the ankle function. All incisions healed by first intention, and no complications such as venous thrombosis and ankle joint infection occurred. All patients were followed up 12-18 months after operation, with an average of 15.6 months. The VAS scores and the AOFAS ankle-hind foot scores were significantly improved at 6 and 12 months after operation in the two groups ( P<0.05), and the scores at 12 months were significantly improved when compared with postoperative scores at 6 months ( P<0.05). Compared with the micro-fracture group, the VAS score and the AOFAS ankle-hind foot score were significantly improved in the combined group at 6 and 12 months after operation ( P<0.05). MRI showed that OLT was well filled in both groups at 12 months after operation. Compared with micro- fracture therapy, micro-fracture therapy combined with intra-articular injection of PRP can effectively reduce pain, improve ankle function, and has a good effectiveness in the treatment of small sized OLT.

Effectiveness of a modified posterior approach for arthroscopic resection on painful talocalcaneal coalition in adults

To investigate the effectiveness of arthroscopic talocalcaneal coalition resection in painful adults via a modified posterior approach. Between January 2015 and December 2017, 9 patients with painful talocalcaneal coalition accepted arthroscopic resection via the posterior malleolus high lateral observation approach combined with the lower medial operation approach. Of them, 6 were male and 3 were female, aged from 19 to 30 years (mean, 24 years). Among them, 2 cases had no definite local trauma and 7 cases had a history of sprain of foot and ankle. The disease duration ranged from 6 to 30 months, with a median of 12 months. Rozansky classification of talocalcaneal coalition for the 9 patients: 5 cases (5 feet) were type Ⅰ, 2 cases (2 feet) type Ⅱ, and 2 cases (2 feet) type Ⅲ. The patients had no sequelae of limb dysfunction and no limb joint surgery in the past. All the patients received anteroposterior and lateral X-ray films and CT scans of the ankle joint during follow-up. The visual analogue scale (VAS) score and American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hind foot score were used to evaluate the effectiveness. The operation time was 60-90 minutes (mean, 76 minutes). All patients were followed up 12-24 months (mean, 18 months). All the incisions healed by first intention, without infection, skin necrosis, lower extremity deep vein thrombosis, vascular nerve and tendon injury, bone bridge recurrence, and other complications. The ankle function recovered well and the pain was relieved obviously after operation, and the patients returned to work at 3-5 months after operation, with an average of 3.9 months. At last follow-up, the VAS score was 0.7±0.5, which was significantly improved ( t=20.239, P=0.000) when compared with preoperative score (4.2±0.5); the AOFAS ankle-hind foot score was 94±4, which was significantly improved ( t=-27.424, P=0.000) when compared with preoperative score (62±2). According to AOFAS ankle-hindfoot scoring system, the results were excellent in 7 cases and good in 2 cases at last follow-up. It is more intuitive, more space, and more flexibility for operation via the modified posterior malleolus high lateral observation approach combined with the lower medial operation approach in talocalcaneal coalition. It is feasible to remove talocalcaneal coalition programmatically according to the specific anatomic signs during the operation.

Platelet rich plasma injection versus extracorporeal shock-wave therapy in treatment of plantar fasciitis

Objective The aim of this study was to determine the efficacy of local platelet-rich plasma (PRP) injection compared with extracorporeal shock-wave therapy (ESWT) for treatment of plantar fasciitis. Background Plantar fasciitis is an important cause of heel pain. ESWT and PRP have emerged as new management options, alternative for surgery. Patients and methods This comparative study included 60 patients, comprising 48 female and 12 male patients with plantar fasciitis diagnosed clinically and by ultrasound. The patients were divided into two groups: 30 patients received single local PRP injection and 30 patients received three sessions of ESWT weekly. All patients were assessed using pain visual analog scale (VAS) score, American Orthopedic Foot and Ankle Society (AOFAS) ankle-hind foot scale, and plantar fascia thickness by ultrasound before treatment and at 1 and 3 months after treatment. Results VAS, AOFAS ankle-hind foot score, and plantar fascia thickness improved significantly in both groups. The AOFAS ankle-hind foot scale shows more improvement in the ESWT group at 1 month after treatment (P = 0.009). Significant improvement in plantar fascia thickness was seen clearly in PRP group at 1 and 3 months after treatment (P Conclusion Local PRP injection and ESWT improve pain and function in patients with plantar fasciitis. ESWT showed early improvement if plantar fasciitis is associated with calcaneal spur.

Arthroereisis for Symptomatic Flexible Flatfoot Deformity in Young Children: Radiological Assessment and Short-Term Follow-Up

The purpose of this study is to recognize those young patients with symptomatic flexible flatfoot deformity who need treatment and to provide radiological evidence that arthroereisis is capable of relocating the talus properly over the calcaneus. We included 28 feet in 14 children who underwent subtalar arthroereisis in association with percutaneous triple-hemisection Achilles tendon lengthening. Selected for arthroereisis were children with symptomatic flexible flatfoot deformity who complained of foot and leg pain, had decreased endurance in sports activities and long walks, who did not respond to conservative treatment modalities for at least 6 months, and in whom at radiological assessment on stance position with the medial arch support orthosis the talonavicular joint lateral subluxation still remained, with Meary's angle in anteroposterior (A/P) and lateral view remaining increased. The mean age at surgery was 10.71 ± 1.58 (range 8 to 14) years. The minimum follow-up duration was 19 months, with mean follow-up duration of 35.14 ± 9.82 (range 19 to 60) months. For estimation of the efficacy of the surgical procedure, the American Orthopaedic Foot and Ankle Society (AFOAS) rating scale was used preoperatively and postoperatively in all patients. The mean preoperative AFOAS ankle-hind foot rating score was 65.14 ± 7.16 (range 58 to 75) points. The mean postoperative AFOAS score was 88.851 ± 5.61 (range 83 to 97) points and the 2-tailed p value <.0001. After arthroereisis surgical treatment, all AOFAS scores and all foot angles improved significantly, except the calcaneal inclination angle which improved slightly.

Minimally invasive single locking plate combined with multiple planar screw internal fixation for pilon fracture

Objective To investigate the clinical effect of minimally invasive single locking plate combined with multiplanar screw internal fixation on pilon fracture of distal tibia. Methods A retrospective case control study was conducted to analyze the clinical data of 51 patients with pilon fracture involving distal tibial articular surface admitted to 81th Group Military Hospital of the Army from January 2013 to August 2017. Among the patients, 20 patients including 15 males and five females, aged (37.5±9.9)years were treated with closed traction reduction or open joint reduction through minimally invasive incision and single main locking plate combined with multiplanar screw placement (study group). There were 13 patients with type II and seven patients with type III according to Ru edi-Allgwer classification of fracture. In addition, 31 patients were treated with open reduction and multi-plate internal fixation (control group), including 25 males and six females, aged (43.4±11.3) years. There were 20 patients with type II and 11 with type III according to Ru edi-Allgwer classification. The operation time, fracture healing time, postoperative complications were compared between the two groups. Burwell-Charnley imaging evaluation criteria were used to assess the quality of fracture reduction. At the last follow-up, ankle function was assessed by the American Orthopedic Foot and Ankle Society (AOFAS) ankle-hind foot functional score. Results All 51 patients were followed up for 6-24 months, with an average of 16 months. The operation time was (82.5±19.2)minutes in the study group and (127.7±40.8)minutes in the control group (P 0.05). Local skin necrosis (not above the plate) occurred in two patients in the study group and in three patients in the control group, with the wounds being healed within 3 months after dressing change and vacuum sealing drainage (VSD). In the control group, one patient had severe infection and recovered after treatment of steel plate removal, debridement and irrigation, and external fixator fixation. Three patients in the control group had skin necrosis resulting in plate exposure, who received transferred skin flaps to cover the wound. The incidence of postoperative complications were 10% (2/20) and 23% in the study group and the control group, respectively (7/31)(P>0.05), with the incidence of severe complications for 0 and 13% (4/31)(P 0.05). At the last follow-up, AOFAS ankle-hind foot function scores were excellent in 12 patients, good in five patients, fair in two patients and poor in one patient in the study group with excellence rate of 85%, while the scores were excellent in 20 patients, good in six patients, fair in three patients and poor in two patients in the control group, with excellence rate of 84% (P>0.05). Conclusion For pilon fracture of distal tibia, both minimally invasive single locking plate combined with multi-plate screw internal fixation and open reduction combined with multi-plate internal fixation have good reduction effect and satisfactory recovery of ankle function, but the former can significantly shorten the operation time and reduce the incidence of serious complications after operation. Key words: Tibial fractures; Fracture fixation, internal; Pilon fractures

Analysis of clinical effect of mini-invasive knotless bridge-suture technique for acute achilles tendon rupture

Objective To investigate clinical effect of minimally invasive knotless bridge-suture technique for acute achilles tendon rupture. Methods The clinial data of 23 patients with acute achilles tendon rupture treated in Department of Orthopaedics, Shanghai Jiao Tong University Affiliated Sixth People′s Hospital from August 2017 to February 2018 were analyzed retrospectively. There were 21 males and 2 females, aged (37.1±5.6) years, with an age range of 29-51 years. Minimally invasive knotless bridge-suture technique was performed in all cases until the soft tissue condition of the patients improved. Patients were followed up by outpatient review at 3 weeks, 6 weeks, 3rd, and 6th months postoperatively, followed by every 3 months, followed up 12 to 18 months, and the deadline was April 2019. Ratio of perimeter of the affected lower extremity to that of the uninjuried, number of repetitions for one leg calf rise in one minute, American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hind foot score, the achilles tendon total rupture score(ATRS) and time to return to work were investigated at last follow-up, as well as complications during the follow-up period. Results Twenty-three cases were followed up. At last follow-up, ratio of perimeter of the affected lower extremity to that of the uninjuried was (92.7±1.8)%, number of repetitions for one leg calf rise in one minute was (25±2) times, AOFAS ankle-hind foot score was (91.5±2.2) scores, ATRS was (92.6±2.4) scores, time to return to work ranged from 6 to 9 weeks. All patients underwent first-stage healing. No skin necrosis, superficial infection and sural nerve injury occurred. No achilles tendon re-rupture was seen during the follow-up period. Conclusion Minimally invasive knotless bridge-suture technique for acute achilles tendon rupture is applied easily and less invasive, enabling patients to return to work earlier and proved to be a secure and effective treatment. Key words: Achilles tendon; Suture technique; Rehabilitation; Knot

Outcome of Achilles tendon plication and transfer of peroneus longus to Achilles tendon for correction of dynamic calcaneo-valgus deformity of the foot in post-polio residual paralysis

Objective: Tendon transfers are indicated when dynamic muscle imbalance results in a deformity that interferes with ambulation or function of the extremities. Foot and ankle are the most dependent parts of the body and are subjected to greater strain than other parts. Calcaneo-valgus deformity is one of the common deformities seen in Post-Polio Residual Paralysis. A host of operative procedures have been described in the management of this deformity. We report the results of the study conducted in our institute where Achilles tendon plication and transfer of Peroneus Longus tendon to Achilles tendon has been done for dynamic calcaneo-valgus deformity of the foot in patients of post-polio residual paralysis. Methods: This is a prospective study of 37 patients with Calcaneovalgus deformity having Post-Polio Residual Paralysis presenting to Balaji Institute of Surgery, Research and Rehabilitation for the Disabled Hospital from December 2009 to December 2012. Informed consent was taken from the parents of all the patients. Ethical committee approval was also taken. Patients with age more than 7 years, ability to walk without support and Peroneal tendon having minimum motor power of grade 4 or 5 as per MRC classification are included in our study. Patients with fixed deformity at ankle joint or subtalar joint are excluded from the study. Pre-operative evaluation included detailed motor examination of the involved lower limbs as per MRC (Medical research council) classification, evaluation of deformity in the hip and knee and range of motion at ankle. AOFAS (American Orthopaedic Foot and Ankle Society) clinical rating system was used to assess the patient pre-operatively and post-operatively. The aggregate score of the AOFAS ankle-hind foot clinical rating scale pre and post operatively were analyzed with use of chi-square analysis. The level of significance of < 0.05 was considered to be significant. The surgical procedure was done under spinal anesthesia with the patient in lateral position under pneumatic tourniquet. A longitudinal incision is made starting from the tip of lateral malleolus midway between the posterior border of lateral malleolus & Achilles tendon to about 8-10cm proximally. Skin flaps are mobilized without dissecting the subcutaneous fat. The two peroneal tendons are identified as they pass down the leg and around the back of the lateral malleolus. The peroneus longus tendon is divided as distally as possible and mobilized. Similarly the Achilles tendon is identified. Plication of the Achilles tendon is done in its middle third with nylon sutures and the peroneus longus tendon is transferred through it using Fish-Mouth (Pulvertaft) tendon suturing technique and is secured over itself proximally under tension providing the tenodesis effect. While this is done the ankle is kept in plantar flexion. The deep fascia is closed over the tendon. Pneumatic tourniquet was released, and the incision was closed in layers after hemostasis was achieved. Below knee cast is applied with the foot in plantar flexion. Movements of the toes are encouraged after recovery from anesthesia. Active toe movements were encouraged in the cast. After six weeks sutures are removed and ankle foot orthoses are provided for another six weeks. During this period supervised active exercises for strengthening the Tendoachilles (static cycling exercise) are started. Patient is reassessed after six weeks and the orthoses is discarded at this stage. Conclusion: Our experience concludes that Achilles tendon plication and transfer of peroneus longus tendon to Achilles tendon is an excellent procedure which improves the dynamic calcaneo-valgus deformity of foot in patients with post-polio residual paralysis. The advantage of the procedure being easy to do with very low complication rate and improves the quality of life in patients with post-polio residual paralysis. 37 patients with the dynamic calcaneo-valgus deformity of foot in patients with post-polio residual paralysis were analyzed with average follow up period of 12.5 months. Dynamic calcaneo-valgus deformity of the foot was corrected in 89.18% of patients. The study fared with 89 percent patients satisfied with the results. The patients showed improvement in their activity limitation, maximum walking distance, gait and stability.

Double calcaneal osteotomy for severe adolescent flexible flatfoot reconstruction

BackgroundThe timing and strategy of treatment for flatfoot still remain controversial. It is a difficult problem when facing severe adolescent flexible flatfoot because a single procedure cannot realign flatfoot deformity effectively.MethodsWe reviewed 13 adolescent flexible flatfoot patients who underwent double calcaneal osteotomy during May 2012 to June 2015. The mean age of patients was 15.2 ± 1.8 (range, 10–18) years. The American Orthopaedic Foot and Ankle Society Ankle-Hindfoot (AOFAS-AH) scores and SF-36 score were adopted to evaluate the preoperative and postoperative functions of the foot. Changes of hindfoot valgus angles, talonavicular uncoverage angles on AP view and talo-first metatarsal angles, and talar pitch angles and calcaneal pitch angles on the lateral film before and after surgery were measured.ResultsAll 13 patients (15 ft) were followed. The mean duration of follow-up was 34.5 ± 15.7 (range, 21–60) months. The hindfoot valgus angle improved from 16.5 ± 4.1 to 2.9 ± 1.6. On the foot AP view, the mean preoperative and postoperative talonavicular coverage angles were 24.9 ± 8.5 and 6.5 ± 3.6. On the lateral view of the foot, the average preoperative and postoperative talo-first metatarsal angles were 18.1 ± 5.5 and 4.9 ± 4.4. The mean preoperative and postoperative talar pitch angles were 36.4 ± 4.7 and 24.0 ± 5.6. The AOFAS-AH score improved from 68.9 ± 12.3 preoperatively to 94.6 ± 3.9 postoperatively.ConclusionWith additional procedures, double calcaneal osteotomy was an effective method for severe adolescent flexible flatfoot.

Arthroscopic debridement combined with microfracture for chronic enthesiopathy of achilles tendon

Objective To evaluate the efficacy of arthroscopic debridement combined with microfracture on management of chronic enthesiopathy of Achilles tendon. Methods Fifteen cases of chronic enthesiopathy of Achilles tendon were enrolled in this study from January 2013 to January 2016. There were 11 males and 4 females, with an average age of 55.5±8.9 years. Five were in left side, and 10 in right side. All the patients failed to recover after conservative treatments for 18 months to 10 years. Pathological tissue was eliminated by blade. Then microfracture was made. Arthroscopic awls (1.5 or 2 mm in diameter) were used for making multiple holes at the footprint of achilles tendon. These holes were made far enough (3-4 mm) apart so they do not break into each other. Fat droplets and bleeding from the marrow cavity were seen when the appropriate depth (approximately 5 to 10 mm) has been reached. The patients were evaluated preoperatively and postoperatively using American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot scores and visual analogue scale (VAS) scores. Results Average operation time and length of stay were 30.6±15.4 min and 6.2±2.8 d, respectively. Postoperative incisions were I stage healing for all patients. There were no perioperative and postoperative complications related to the procedure, such as rupture of achilles tendon, blood vessel and nerve injury. No infection and recurrence was found in all cases. All patients were followed up for an average time of 13.5 months. No rupture of achilles tendon or relapsing symptom was found. Average VAS scores before surgery, 6 month after surgery and at the lattest follow-up were 7.3±1.6, 2.4±1.3, and 2.3±1.3, respectively. Average AOFAS Ankle-Hindfoot scores were 38.5±7.8, 92.9±6.9, and 91.6±7.1, respectively. Average postoperative VAS scores and AOFAS Ankle-Hindfoot scores were significantly improved compared with those before surgery. There was no statistically significant difference among all check point after operation in VAS scores and AOFAS Ankle-Hindfoot scores. At the latest follow-up, all patients were satisfied with the degree of painful relief. According to AOFAS Ankle-Hindfoot scores, overall excellent and good rate was 93.3% (excellent in 10 cases, good in 4 cases, and fair in 1 case). Conclusion Clinical results of arthroscopic debridement combined with microfracture for treatment of chronic enthesiopathy of Achilles tendon are good. This technique is easy and safe to perform. Key words: Arthroscopy; Arthroplasty, subchondral; Achilles tendon; Heel pain

Curative analysis of individual surgery for chronic Achilles tendon rupture

To investigate the effectiveness of individual surgery for chronic Achilles tendon rupture. A retrospective analysis was made on the clinical data of 25 patients (26 Achilles tendons) with chronic Achilles tendon rupture between September 2009 and March 2016, including 22 males and 3 females with a mean age of 38 years (range,18-59 years). The median disease duration was 12 weeks (range, 4 weeks to 12 years). The repairing method depended on the defect size, injury site, and tissue condition of the involved Achilles tendon: 9 Achilles tendons were repaired by end-to-end anastomosis, 8 by a gastrocnemius turndown flap, and 9 by auto free tendon (4 ipsilateral hamstring tendon and 5 ipsilateral 2/3 peroneus longus tendon). The American Orthopedic Foot and Ankle Society (AOFAS) ankle-hind foot score, heel lifting of the affected leg, active ankle range of motion (plantar flexion and dorsiflexion), maximum calf circumference, and complications were applied to assess the effectiveness. Hypersensitivity occurred in 1 incision, and stage I healing was obtained in the other incisions. No complication of re-rupture, infection, nerve injury, or deep venous thrombosis occurred. All the patients were followed up 8-85 months (mean, 34 months). The AOFAS ankle-hind foot score was significantly improved to 95.81±5.34 at last follow-up from preoperative 50.54±5.52 ( t=-34.844, P=0.000); the excellent and good rate was 100% (excellent in 21 cases and good in 4 cases). The active dorsiflexion of the operated side [(13.9±2.4)°] was significantly lower than that of normal side [(16.7±2.0)°] ( t=-9.099, P=0.000), but the active plantar flexion showed no significant difference between affected side [(39.8± 3.2)°] and normal side [(40.6±2.6°)] ( t=-1.917, P=0.068). The maximum calf circumference of the operated side [(379.4±18.8) mm] was significantly lower than that of normal side [(387.1±16.6) cm] ( t=-5.053, P=0.000). The other patients could finish heel lifting of the affected leg without limitation except for 1 patient. All patients returned to normal work and activity, and 12 patients returned to normal sports. Individual surgery depending on the defect, injury site, and tissue condition of the involved Achilles tendon can repair all kinds of chronic Achilles tendon rupture with a low rate of complications.

Kinetic and Functional Impact of Foot Orthoses in Rheumatoid Arthritis Feet: A Randomized Clinical Trial

Objective: To verify the effectiveness of custom-molded FO (Foot Orthoses) on kinetic parameters, pain, and disability in RA patients. Methods: Patients with RA were randomized into FO and no orthoses groups. Kinetic parameters were assessed using a foot pressure system, foot pain was evaluated using the pain subscale of the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale, and disability was evaluated by the total score of the AOFAS anklehindfoot scale and by the Health Assessment Questionnaire for RA. Results: Analyses were performed on data collected at baseline and after 2 months of intervention. Thirty-three women (mean age, 53.0 ± 10.97 years; mean disease duration, 12.2 ± 7.54 years) were evaluated. No differences in the kinetic parameters, and small, but non-significant, improvements in the pain and disability measures were observed in the FO group. Conclusions: FO without other conservative treatments did not have a significant effect on the pain and disability in RA patients. Additional, larger trials are needed to investigate the effects of these devices combined with physical therapy in similar patients. Trial registration: http://www.ensaiosclinicos.gov.br/rg/RBR-24ydf6/, RBR-24ydf6.