Ankle Deformity Research Articles

Osteochondroma of the distal tibia with associated varus deformity of ankle

Osteochondroma or exostosis is a bony developmental anomaly, which arises from exophytic outgrowth on bone surfaces characteristically. The most common site is the distal femur followed by the proximal humerus and proximal tibia. It is made up of a bony protrusion that is covered by a cartilage cap. Osteochondroma is asymptomatic and grows away from the nearby joint. It is very common in kids and young adults. Sometimes patient comes in 2nd decade with complaints of pain and swelling. This paper reports a presentation of osteochondroma present over the right distal tibia.

Distal Tibial Dome Osteotomy With Ilizarov Fixation in Correction of Ankle Deformity Resulting From Malunited Ankle Fusion

Background: Distal tibial osteotomy is used in the treatment of ankle deformities. Many methods of fixation of this osteotomy were described, including plates, pins, and ilizarov. Dome osteotomy is a cylindrical osteotomy with no bone loss, with the axis of bone is rotated around the center of the circle. We conducted a case series of treatment of ankle deformity due to malunited ankle fusion with distal tibial dome osteotomy. Methods: Eight patients with a history of poliomyelitis with ankle deformity due to a malunited ankle fusion underwent distal tibial dome osteotomy with ilizarov fixation for deformity correction. Postoperative follow up was done up to 12 months postoperatively. We intended to follow up the union of the osteotomy, the axis of the limb, the external clinical appearance, and patient satisfaction. Results: Deformity correction was achieved in all patients regarding the clinical alignment, with no apparent clinical residual deformity in coronal, sagittal plane, or rotational deformity, the limb was cosmetically straight with a plantigrade foot satisfactory to the patients with improving quality of gait. The osteotomy fully united in all patients in a period of 8 to 11 weeks with an average of 9.3 weeks, after which frame was removed. No patient had nonunion or delayed union of the osteotomy. Three patients had pin tract infection during the period of the fixator which was treated by local dressings and antibiotics. Conclusion: Distal tibial focal dome osteotomy fixed by ilizarov is an effective treatment option in malunited ankle fusion deformities.

Anterior or Posterior Tibial Tendon Transfer to the Peroneus Tertius for Equinovarus Deformity.

Equinovarus deformity correction was performed by soft tissue release and bone deformity correction, and tendon transfer to maintain deformity correction. Because of the high complication rate of tendon fixation methods, partial or total anterior tibial tendon or posterior tibial tendon transfer to the peroneus tertius tendon was reported. The purpose of this study was (i) to review the results of this tendon transfer technique after release and correction of talipes equinovarus, and (ii) to analyze the complication of this technique. Between February 2017 and May 2022, 176 patients (210 feet) with equinus and/or varus foot and ankle deformities underwent anterior or posterior tibial tendon transfer to the peroneus tertius in our institute. Preoperative and postoperative foot and ankle range of motion (passive and active) were checked. The postoperative radiographic assessment included antero-posterior (AP), lateral, and hindfoot alignment radiographs. Preoperative and postoperative lateral tibio-talar, talo-calcaneal, talo-first metatarsal, tibial-sole angles, hindfoot alignment, and anterior subluxation of the talus were checked. The American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale, and visual analog scale (VAS) were used to assess pain. Paired Student's t-test was used to compare the clinical scores and radiographic angles before the operation and at the last follow-up. The mean age of the patients was 23.27 ± 13.44 years (range, 3-69 years). The mean follow-up time was 25.56 ± 16.37 months (range, 12-68 months). There were significant differences between the preoperative and postoperative measurements of the lateral tibio-talar angle, lateral talo-calcaneal angle, lateral talo-first metatarsal angle, lateral tibial-sole angle, and hindfoot alignment (p < 0.001). There was significant difference between the preoperative and postoperative AOFAS and VAS scores (p < 0.001). The early complications included infection in one patient, skin necrosis in two patients, and plantar numbness in three patients. The late complications included pin infection in three patients, tibio-talar joint compression in four patients, forefoot pain in two patients, toe flexion in two patients, and plantar numbness in one patient. There were three cases of complications (1.43%) related to the transferred tendons. Tibialis anterior or posterior tendon transfer to the peroneus tertius is a safe and effective method for equinovarus deformity correction. It yielded excellent outcomes that produced high patient satisfaction and few complications.

Prediction of prognosis in supramalleolar osteotomy with or without additional fibula osteotomy by approaching a biomechanical study: a finite element analysis.

Supramalleolar osteotomy (SMO) is a representative procedure to restore a malalignment in the varus ankle deformity by shifting the concentrated pressure on the medial ankle joint to the lateral area. Additionally, fibula osteotomy (FO) is selectively selected and performed according to the surgeon's preference. However, it is controversial whether FO is effective in shifting the abnormal pressure from the medial to the lateral area on the ankle joint. Some cadaveric studies have been performed to prove this. However, it is difficult to consistently reconstruct amount of the varus ankle deformities angle in cadavers and to guarantee reliable contact pressure between the ankle joint. Thus, the aim of this study was predicted and quantitatively compared a peak pressure between single SMO and SMO with FO procedure by using a finite element analysis as a powerful biomechanical tool to those limitations of cadaveric study. This study reconstructed total 4 3D foot and ankle models including a normal and pre-op model and 2 post-op models. The pre-op model was modified by assigning 10° varus tilting corresponding to stage 3b in the classification of varus ankle osteoarthritis based on the validated normal model. Also, the post-op models were reconstructed by applying single SMO and SMO with FO, respectively. All of the models were assumed as one-leg standing position and to mimic smooth ankle joint motion. Peak contact pressure change was predicted at the medial ankle joint by using computational simulation. As a result, 2 post-op models showed a remarkably peak pressure reduction by up to 5.5 times on the medial tibiotalar joint. However, a comparison between single SMO and SMO with FO model showed no appreciable differences. In conclusion, this study predicted that single SMO may be as effective as SMO with FO in reducing peak contact pressure on the medial tibiotalar joint in varus ankle osteoarthritis.

Tibial hemimelia: a surgical approach for bone reconstruction and lengthening

Tibial hemimelia is a rare condition with a reported incidence of approximately one in one million live births. Although tibial hemimeliacan vary its presentation, it often presents a shortened lower limb associated with deformities in the knee and ankle. The objective ofthis study is to present a case of tibial hemimelia and the surgical technique performed to correct the deformity and bone lengtheningusing a circular external fixator in several stages. A 15-year-old male patient was evaluated, presenting Jones type 3 tibial hemimelia(visible distal part, but no proximal) in the right lower limb associated with congenital clubfoot and ankle deformity. Studying andplanning the patient’s case was essential to classify and define the best treatment. These treatments can be flawed and often reachamputation. In the case described, several surgical approaches were performed with the objective of reconstructions and deformitycorrection, followed by limb lengthening, presenting excellent results. Level of evidence IV; Therapeutic studies; Case Report.

Use of computer-assisted hexapod external fixators for complex foot and ankle reconstructions – An analysis of functional outcomes and complications

IntroductionFoot and ankle pathology can often require complex surgical reconstruction. Until recently, circular external fixators such as the Ilizarov frame have proven to be useful, yet they fall short when progressive, precise corrections are required. Computer-assisted hexapod external fixators seek to address many of the shortfalls of traditional circular fixators. However, evidence for their use is scarce. The objective of this work was to evaluate the functional and quality of life outcomes and post-operative complications of patients treated with computer-assisted hexapod external fixation. MethodsA retrospective, observational study was conducted. All cases were treated with either a TrueLok hex (TL-HEX) or a Taylor Spatial Frame (TSF) fixator. Primary outcomes were post-operative improvement in 12-Item Short Form Survey (SF12) and American Orthopaedic Foot and Ankle Score (AOFAS) scores, and complications following Paley’s classification. ResultsA total of 59 patients with complex foot and ankle conditions using 64 external fixation frames were included. The median sum of both SF12 score domains improved from a preoperative score of 63.6 to 91.3 at last follow-up (p < 0.001). Median AOFAS improved from a preoperative score of 35 to 75.5 at last follow up (p < 0.001). Functional improvement was not affected by the choice of external fixator. Complications occurred in 49 cases (77 %). The most common post-operative complications included pin tract complications in 37 (58 %) cases, joint rigidity in 24 (38 %) and axial deviation in 9 (14 %). ConclusionsComputer-assisted hexapod external fixation is an effective technique to correct complex foot and ankle deformities and leads to a marked improvement in post-operative functional and quality-of-life outcomes with a high minor complication rate.

The Effect of Planovalgus on Balance and Motor Function in Children With Cerebral Palsy

Objective Lower limb deformity in children with cerebral palsy (CP) is a common musculoskeletal problem and planovalgus is the most prevalent, characterized by talus median subluxation, calcaneal valgus, and supinated forefoot. According to studies, one issue in orthopedics and pathology is the accurate diagnosis and proper treatment of planovalgus deformity in children with bilateral spastic cerebral palsy, which has attracted researchers’ attention. Accordingly, the present study investigates the effect of planovalgus deformity on the motor performance and balance of these children. Materials &amp; Methods This cross-sectional study employed a descriptive-analytical design. The convenient sampling method was used among children with bilateral spastic cerebral palsy, diagnosed with unilateral planovalgus, who were referred to the clinics of the University of Social Welfare and Rehabilitation Sciences (Nezam Mafi) and occupational therapy clinics from September 2022 to February 2023 in Tehran City, Iran. Meanwhile, all participants were willing to cooperate in this research. A total of 27 participants were evaluated by an occupational therapist based on the specified criteria and gross motor function classification system (GMFCS), which included the assessments of balance, muscle strength, range of motion, and pain. Data analysis was done using the SPSS software, version 16. Results The results revealed a statistically significant difference between the mean range of motion of ankle dorsiflexion and knee extension between the two limbs (P&lt;0.001). The mean muscle strength of the quadriceps and ankle plantar flexors indicated a statistically significant difference in the affected limb (P&lt;0.001). Additionally, the mean displacement of the center of pressure of the foot also demonstrated a statistically significant difference regarding topographical involvement (P&lt;0.001). Conclusion Planovalgus deformity is one of the most common ankle deformities, which is of great concern for children with cerebral palsy. The results obtained from the assessments of the child’s balance and motor function demonstrated the importance of assessment strategies and early interventions to achieve better rehabilitation outcomes for children with CP and planovalgus deformity.

Safety of TNF-α inhibitors: A real-world study based on the US FDA Adverse Event Reporting System Database.

As a common treatment for rheumatoid arthritis (RA), the adverse reactions of TNF-α inhibitors (TNFis) in practical application have garnered attention. This study aims to investigate the adverse drug events (ADEs) associated with TNFi in RA patients as reported in the FDA Adverse Event Reporting System, to offer insights for clinical use. Cases related to RA and primarily involving TNFi were extracted from the FDA Adverse Event Reporting System database and compared by gender stratification. Screening was conducted based on reporting odds ratio and information component to identify positive ADEs for different TNFis and evaluate common and unique ADEs among various TNFis. There are 4 common ADEs among TNFis, including pulmonary tuberculosis, infection, hypersensitivity, and herpes zoster, as described in the package inserts. However, each TNFi has unique positive ADEs. Adalimumab has 63 unique positive ADEs, including lower respiratory tract inflammation, systemic lupus erythematosus rash, vascular dementia, ovarian neoplasm, adhesion, sarcoma, coccidioidomycosis, etc. Golimumab has 6 unique positive ADEs, including pneumonia cryptococcal, device deployment issue, pneumonia bacterial, polyneuropathy, device malfunction, device issue, etc; certolizumab has 24 unique positive ADEs, including maternal exposure before pregnancy, premature rupture of membranes, exposure via breast milk, staphylococcal sepsis, erysipelas, low birth weight baby, herpes virus infection, premature delivery, etc; etanercept has 180 unique positive ADEs, including joint destruction, chondrolysis, finger deformity, ankle deformity, joint warmth, etc; infliximab has 60 unique positive ADEs, including Hodgkin's disease, metastatic neoplasm, non-Hodgkin's Lymphoma, etc. Although the aforementioned 5 TNFis share common ADEs such as herpes zoster, clinicians must exercise caution when selecting specific medications, especially for RA patients concurrently suffering from malignancies. The analysis indicates that infliximab is associated with 60 unique positive ADEs, including Hodgkin's disease, metastatic neoplasm, and non-Hodgkin's lymphoma; therefore, these patients should use infliximab with greater caution. Similarly, certolizumab should be used with increased caution in pregnant and postpartum women.

Management of Distal Tibial Deformity Secondary to Traumatic Physeal Arrest: Systematic Review and Meta-Analysis

Abstract Background Injuries of the ankle growth plate are the second most common physeal injury of the childhood and comprises 6% of all fractures of the tibia. These injuries are typically observed among children 10 to 12 years of age, usually as Salter-Harris (SH) Type 1 and Type 2 fractures followed by Type 3 and Type 4 fractures. Objective To review modalities of treatment for distal tibia deformity secondary to physeal arrest post traumatic and to perform a systematic review and meta- analysis of the outcome for different methods of treatment. Methodology The included studies published between 2000 and 2021. Regarding the type of included studies, 8 studies (out of 10 studies) were retrospective; while 2 studies were prospective. Results Meta-analysis study was done on 6 studies which described Epiphysiodesis technique for distal tibial deformities secondary to post-traumatic physeal arrest; with overall number of patients (N = 215). We calculated efficacy for each technique through (Bone union ―success rate‖) and (Excellent functional outcome). We calculated safety for each technique through (Revision rate) and (Complication’s rate). Data Sources Medline databases (PubMed, Medscape, ScienceDirect. EMF-Portal) and all materials available in the Internet till 2022. Conclusion Ilizarov technique for corrections of post-traumatic physeal arrest ankle deformities showed better efficacy and safety profiles, compared to Epiphysiodesis. Which also, showed relatively good efficacy and safety especially in children with post-traumatic physeal arrest ankle deformities.

Defining the Patient Acceptable Symptom State (PASS) for PROMIS After Total Ankle Replacement.

Although patient-reported outcomes (PROs), such as the Patient-Reported Outcomes Measurement Information System (PROMIS), are a key element of evaluating success after total ankle replacement (TAR), many do not explicitly state a key factor of postoperative success: is the patient satisfied with their outcome after TAR? The patient acceptable symptom state (PASS) represents the symptom threshold beyond which patients consider themselves well. This study aimed to establish the PROMIS thresholds for the PASS in a primary cohort of TAR patients. This single-institution study included 127 primary TAR patients with preoperative and 2-year postoperative PROMIS scores. At 2 years postoperatively, patients answered 2 PASS anchor questions (Satisfaction, Delighted-Terrible scale) with Likert-scale responses. PASS thresholds with 95% confidence intervals (CIs) were calculated from PROMIS scores using an anchor-based method. Using a bootstrapping technique with 1,000 iterations, the Youden index was calculated to determine the best specificity and sensitivity coordinates to maximize their combination. Finally, preoperative variables associated with the likelihood of achieving the PASS were assessed. There was a strong association between PASS thresholds and PROMIS domains, especially Pain Interference (PASS threshold of <56.0, area under the receiver operating characteristic curve [AUC] = 0.940), Pain Intensity (<48.4, AUC = 0.936), and Physical Function (>44.7, AUC = 0.883). The likelihood of achieving the PASS was not affected by age, race, gender, American Society of Anesthesiologists (ASA) class, body mass index, or severity of ankle deformity. Patients with worse preoperative Physical Function and Global Mental Health scores were less likely to meet the PASS threshold for Physical Function postoperatively (p = 0.028 and 0.041). The ability to reach the PASS after TAR was most strongly associated with postoperative PROMIS pain scores. However, PASS thresholds were generally poorer than population means. This demonstrates that patients do not need to reach normal pain or physical function levels to have an acceptable symptom state after TAR. Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Stabilizing effect of total ankle arthroplasty by distal translation and lateralization of talus in varus ankle deformity.

In end-stage arthritis indicated for total ankle arthroplasty (TAA), full-thickness cartilage damage, subchondral bone defect/shaving, and fluttering of the talar dome occur, shortening the distance between the tibial and talar insertions of ligaments and leading to laxity of ligaments surrounding the ankle joint. Under such conditions, medial ligaments (including the deltoid ligament) would not be expected to function properly. To stabilize the ankle joint during the stance phase, medial ligament function under tension is important. This study therefore examined whether TAA contributes to lengthening of the medial tibio-talar joint as evaluated radiographically, as a preferable method for achieving tensile effects on medial ligaments. Twenty-four feet with end-stage varus deformity of the ankle joint that underwent TAA were retrospectively investigated, excluding cases with any malleolar osteotomy or fracture. Distance between proximal and distal insertions of medial ligaments, lateralization of the talus, and talar tilt angle under valgus/varus stress condition were evaluated pre- and postoperatively. Distance between proximal and distal insertions of medial ligaments was significantly elongated after TAA. At the same time, the talus showed significant lateralization. Furthermore, talar tilt under valgus/varus stress conditions was also significantly reduced after TAA. TAA affects distal translation and lateralization of the talus in cases of varus ankle deformity. These effects might contribute to re-providing tensile force on lax medial ligaments, improving ligament function.

Indications, Associated Procedures, and Results of Ankle Plafond-Plasty for Varus Ankle Osteoarthritis: A Systematic Review and Meta-Analysis.

Plafond-plasty is a joint-preserving procedure to treat varus ankle osteoarthritis (OA) with asymmetrical joint involvement. The aim of this systematic review and meta-analysis was to evaluate indications, different surgical techniques, associated procedures, and results of plafond-plasty in varus ankle OA and to analyze the level of evidence (LOE) and quality of evidence (QOE) of the included studies. A systematic review of the literature was performed using MEDLINE, Embase, and Cochrane. Five studies evaluating 99 ankles were included. A non-rigid varus ankle deformity and an ankle OA Takakura stage 3b or less were the most recommended pre-operative indications. Meta-analysis showed a significant post-operative improvement in clinical and radiological parameters. Many associated surgical procedures have been reported, the most frequent being medial additional supramalleolar osteotomy and lateral ankle ligament reconstruction. The level of evidence and methodological quality assessment of the included studies showed an overall low quality. Plafond-plasty seems to be a promising surgical option when managing varus ankle OA with asymmetrical joint involvement, extending the indications for joint sparing surgery. Additional associated procedures should be carefully evaluated case-by-case. IV.

Radiographic Analysis of Valgus Ankle Deformity With or Without Medial Longitudinal Arch Collapse.

Establishing a surgical plan for ankle deformities necessitates a comprehensive understanding of the deforming forces involved, and the morphology of the ankle deformity plays an important role as well. Valgus tibiotalar tilt development has mostly been described in patients with a low medial longitudinal arch, as seen in progressive collapsing foot deformity (PCFD). However, some valgus ankles demonstrate no radiographic evidence of a collapsed medial arch. This study aims to investigate whether there are differences in the radiographic morphology of valgus ankle deformities between patients with and without a low medial longitudinal arch to explore if they have different etiologies. We retrospectively reviewed patients who underwent surgical treatment for asymmetric valgus ankle deformity at our institution between 2017 and 2021. Patients with a valgus tibiotalar tilt (TT) greater than 4 degrees and Meary angle greater than 30 degrees (mean: 38.9) were included in the PCFD group (n = 29). The non-PCFD group (n = 24) with TT greater than 4 degrees and Meary angle less than 4 degrees (mean: 0.3) was also established. In the weightbearing ankle anteroposterior view, the TT and medial distal tibial angle were measured. Additionally, to assess the mediolateral position of the talus, the talar center migration (TCM) and lateral talar dome-plafond distance (LTD-P) ratio in the coronal plane were measured. In weightbearing computed tomography (WBCT), the degree of axial plane talocalcaneal subluxation and the prevalence of sinus tarsi bony impingement were assessed. Intergroup comparison was conducted. Both groups demonstrated a similar degree of TT, with a mean of 11.6 degrees in the PCFD group and 13.7 degrees in the non-PCFD group (P = .2330). However, the PCFD group showed a significantly greater TCM and LTD-P ratio compared with those of the non-PCFD group (P < .0001), indicating that PCFD patients have a more medially translated talus in ankle anteroposterior radiographs. WBCT showed that the PCFD group on average had 18 degrees greater axial plane talocalcaneal subluxation (P < .0001) and 52% higher prevalence of sinus tarsi bony impingement (P = .0002) compared with the non-PCFD group. This study suggests that valgus ankles may exhibit different radiographic morphologies depending on the status of the longitudinal arch. Valgus ankles in PCFD patients tend to have a more medially translated talus. This finding may suggest the presence of different deforming forces between the 2 groups and may indicate the need for different treatment strategies to address talar tilt. Level III, case-control.

Management of post-traumatic ankle deformities in children.

The objective of this clinical appraisal was to assess the clinical-radiological results of ankle deformity correction secondary to physeal injury, utilizing the methods based on the age of the child, site & severity of the deformity, remaining growth potential, condition of the soft tissue envelop and integrity of neurovascular status. Fifteen subjects ≤ 16 years of age, with angular deformities of the ankle secondary to physeal injury, were included. Deformities secondary to infection and pathological fractures were excluded. Demographic data, type of injury, treatment method, and follow-up were recorded from the case files. Treatment categories included osteotomies for acute correction (> 10 years) and growth modulation (≤ 10 years). Male to female ratio was 7:8, with an average age of 11.8 ± 2.31 years (range 9-16 years). The right and left ratio was 7:8. Mean duration of follow-up was 1 year and 4 months. Gradual deformity correction was done in 2 cases utilizing the principle of growth modulation, while acute correction by osteotomy was done in 13 cases. The average pre-operative ankle deformity was 20.8 ± 3.11 degrees (Range -25 to 24 degrees). Radiological union was attained at a mean of 11 weeks (8-24). Nine patients achieved neutral ankle alignment. The mean residual varus was 2.3°, and the valgus was 4°. There was a statistically significant improvement of the AOFAS score by 17 points from a mean pre-operative score of 57 (44-84) to 74 (56-100) points at the final follow-up (p-value < 0.001). The average pre-operative shortening was 2.36 ± 0.21 cm, which was completely corrected in 9 individuals. Management of angular deformities around the ankle calls attention to correcting the resultant angular deformity and/or limb length disparity, utilizing acute or gradual correction. A successful outcome depends on early recognition and patient-specific treatment of paediatric ankle fracture patterns. Correlating the results of our study with the available literature, we feel that both acute or gradual correction for angular deformities around the ankle is a feasible solution as long as principles of deformity correction are adhered to. Techniques for salvaging and restoring the viability of injured physeal plate warrant additional research.

Mechatronic 5-DOF Parallel External Fixator With Correction-Assisted Software for Correcting Foot–Ankle Deformities

Mechatronic 5-DOF Parallel External Fixator With Correction-Assisted Software for Correcting Foot–Ankle Deformities

Peroneus longus tendon autograft versus allograft in revision ACLR: A retrospective comparison

PurposeThe use of peroneus longus tendon (PLT) autografts in primary anterior cruciate ligament reconstruction (ACLR) has increased recently, but there is a lack of research on its use in revision ACLR. This study aimed to compare the clinical outcomes and complications between revision ACLR using allografts and PLT autografts. Materials and methodsFifty-nine patients who underwent arthroscopic revision of ACLR with complete clinical follow-ups between 2012 and 2021 were retrospectively reviewed. Allograft was used in 44 of these patients, and PLT autograft was used in 15 of them. Lysholm knee score, Tegner activity score, Lachman, and anterior drawer tests were performed after a mean follow-up of 60months (range: 19–116). The American Orthopaedic Foot and Ankle Society (AOFAS) scale was used to evaluate the donor ankle functions. Clinical outcomes and complications were compared between groups. ResultsBoth groups showed significantly improved functional outcomes compared to their preoperative assessments. However, both groups had similar clinical results at the final follow-up, including Lysholm knee score, Tegner activity scale, knee range of motion, return to sports, time to return to daily activities, and rate of re-rupture. No major complications were seen in any of the patients. The AOFAS score was 99.13±2.64 in the PLT autograft group without loss of ankle muscle strength, deformity, instability, and permanent iatrogenic neurovascular injuries. The cumulative cost of the allograft group was significantly higher than the PLT autograft group. ConclusionsThe PLT autograft might be an alternative autograft option to allografts due to similar clinical outcomes, low donor site morbidity, and reduced cost in ACLR revisions, especially if the primary ACLR was performed using grafts harvested around the knee. Level of evidenceIII; retrospective comparative study.

Further evaluation of a hands‐on‐shoulder plus praise procedure to reduce toe walking

AbstractIdiopathic toe walking (ITW) refers to ambulation with a toe‐to‐toe gait in the absence of a known cause. Although it is exhibited by typically developing children, it is more common among children with autism spectrum disorder (ASD). Persistent ITW can cause several long‐term medical problems, including ankle deformities and balance and posture abnormalities. In the current study, we first conducted a series of no interaction or alone conditions to verify that ITW exhibited by four children with ASD persisted in the absence of social consequences. We then evaluated a hands‐on‐shoulder plus praise procedure in which gentle pressure is applied to participants' shoulders to prompt their heels to contact the ground, along with praise for appropriate steps in order to reduce ITW. Results suggest that the procedure was effective with all participants, and measures of social validity indicate that caregivers approved of the procedure. We discuss the results in terms of the putative mechanisms responsible for the effects of the procedure as well as the conditions under which the procedure might be used.

Achilles tendon rupture prevention in physical activity and sports: predisposition factors

Objective: to summarize all clinically significant factors determining the Achilles tendon predisposition to rupture.Materials and methods: the basis of this scientific-analytical review was the analysis of data from the electronic portals PubMed-NCBI, Google Academy, and “Scientific electronic e-Library.ru”.Results: the presented literature review indicates that injuries and ruptures of the Achilles tendon can be provoked by numerous factors, among which genetic predisposition, individual anatomico-morphological features of the tendon complex structure, initial connective tissue failure, pathological changes in the Achilles tendon structure itself, foot and ankle deformities are of great importance. Men are more susceptible to this injury. Tendon injuries are most common either in 30–40 years, or in the period from 60 to 80 years. Professional athletes and people who lead sedentary lifestyles and do not exercise properly are at risk of Achilles tendon ruptures. Concomitant metabolic disorders and use of some medications also play an important role in the predisposition to this injury. Local corticosteroid injections pose a particular tendon rupture risk. The combination of several established factors significantly increases the likelihood of this emergency.Conclusions: early detection of predisposition to Achilles tendon rupture will allow timely development of effective measures for its prevention in physical training and sports.

Plain Ankle Radiographs Underestimate Valgus Tibiotalar Tilt in Progressive Collapsing Foot Deformity: A Comparative Analysis with WBCT

Category: Ankle Arthritis Introduction/Purpose: Detection and accurate assessment of valgus tibiotalar tilt are important for staging and surgical planning of progressive collapsing foot deformity (PCFD). Plain ankle radiographs (XRs) have been used to evaluate this condition, but recent literature suggests that XRs may underestimate ankle deformities when compared to weightbearing computed tomography (WBCT), which is becoming increasingly utilized in PCFD evaluation. However, the discrepancies between these methods have not been explored. This study aims to: 1) determine the difference in tibiotalar tilt measurements between XRs and WBCTs; 2) compare the prevalence of significant valgus tibiotalar tilt (&gt;4 degrees) between XRs and WBCTs in PCFD patients; and 3) determine the radiographic characteristics of patients who exhibit a discrepancy between XR and WBCT in the presence of significant valgus tibiotalar tilt. Methods: One hundred thirty-eight PCFD patients (Mean age: 55.1 years) having both WBCT and ankle XRs were reviewed. On ankle XRs, tibiotalar tilt (TTXR) and medial distal tibial angle (MDTAXR) were measured. On WBCT, the TTWBCT and MDTAWBCT were assessed at three locations (25% [anterior], 50% [middle], and 75% [posterior] of the sagittal dimension of the distal tibial plafond) in coronal views (Figure 1). The degree of tibiotalar tilt and prevalence of significant valgus tibiotalar tilt were compared between TTXR and the TTWBCT. Bland-Altman plots compared the mean TT and MDTA from XRs to those of the three coronal WBCT images to determine which region in WBCT is most similar to the XRs in each measurement. The radiographic characteristics of patients with and without a discrepancy between XRs and WBCTs for the presence of significant valgus tibiotalar tilt were examined via subgroup analysis. Results: Mean TTXR and TTWBCT were 1.5 (standard deviation [SD] 3) and 4.1(SD 3) degrees, respectively, indicating that XRs underestimate tibiotalar tilt by 63.4%. The prevalence of significant valgus tibiotalar tilt was 10.1% on XRs and 37.7% on WBCTs. Half the patients (4/8) who had bone-on-bone contact with tibiotalar tilt on WBCT didn’t exhibit such findings on XR (Figure 1). Bland-Altman plots showed that TTXR and MDTAXR best correlate with middle TTWBCT and MDTAWBCT (Figure 2). Subgroup analysis revealed that patients who exhibited significant valgus tibiotalar tilt on WBCTs, but not XRs, had smaller anterior TTWBCT and MDTAWBCT than those without such discrepancy (p &lt;.05, Table 1), indicating that patients with a greater varus deformity on the anterior distal tibia are more likely to exhibit the discrepancy. Conclusion: This study demonstrates that ankle XRs underestimate valgus tibiotalar tilt compared to WBCTs in PCFD patients. The ankle XR parameters had the strongest correlation with those of the midpoint of the tibiotalar joint in WBCT and understated anterior side tilt and distal tibial deformity, likely due to beam projection angle and superimposition. Based on the findings of this study, WBCTs may be useful for detecting actual deformities in the ankle joint in PCFD patients; nevertheless, surgeons must be cognizant that they may underestimate the deformity in the anterior ankle when using conventional radiographs to assess ankle deformities in PCFD.

Total Ankle Arthroplasty is Associated with Decreased Risk of Postoperative Total Knee Arthroplasty Compared to Ankle Arthrodesis

Category: Ankle Arthritis Introduction/Purpose: There is a known association between ankle arthritis and ipsilateral knee arthritis. However, it is unknown if the increased range of motion and improved gait mechanics provided by total ankle arthroplasty (TAA) may delay the progression of knee arthritis compared to ankle arthrodesis (AA). We hypothesized that patients treated with TAA would have a lower incidence and longer time to total knee arthroplasty (TKA) compared to AA. Methods: We retrospectively reviewed a matched cohort of 5726 AA and 5726 TAA performed between 1/1/2007 and 12/31/2021 using a commercial claims database. Patients with a history of preoperative ipsilateral or unknown laterality TKA were excluded. Records were reviewed for demographics, comorbidities, diagnosis, documented history of an ankle deformity, and postoperative ipsilateral or unknown laterality TKA. Mahalanobis nearest neighbor matching was performed based on age, gender, year of surgery, geographical region, and diagnosis was used to determine the cohorts from 13,679 AAs and 5726 TAAs. Mean follow-up was 2.2 years. Univariate and multivariate analyses were performed to assess for risk factors. Significance was set at p&lt; 0.05. Results: Patients who underwent TAA were older (p &lt; 0.001), female (p &lt; 0.001), had earlier ankle surgery (p &lt; 0.001), and increased ankle deformity (p &lt; 0.001) than AA, but rates of rheumatoid arthritis (p=0.54) and posttraumatic arthritis (p=0.53) compared to osteoarthritis were similar. Patients who underwent AA were 2.77 times more likely to undergo a postoperative TKA compared to TAA (p &lt; 0.001). However, for those who underwent a TKA, patients with an AA (mean=3.48 years) tended to wait longer before proceeding with TKA than patients who underwent TAA (mean=2.62 years, p&lt; 0.001). Risk factors for undergoing postoperative TKA included having AA (p &lt; 0.001), earlier year of ankle surgery (p &lt; 0.001), older age (p &lt; 0.001), lack of ankle deformity (p &lt; 0.005), lack of obesity (p &lt; 0.047), and posttraumatic arthritis (p &lt; 0.001), while gender (p=0.55) and rheumatoid arthritis (p=0.75) were not. Conclusion: Our results showed that there is a significantly higher incidence of patients undergoing TKA after AA compared to TAA (p &lt; 0.001). Therefore, we recommend that surgeons consider TAA over AA, especially in young, active patients with minimal knee arthritis as a strategy to help delay the progression of knee arthritis. Patients who underwent AA tended to have a longer time interval to TKA (p &lt; 0.001), which may be related to the longer expected recovery from an AA compared to TAA. With improved rehabilitation protocols for TAA, patients may recover faster so that they can proceed with their ipsilateral TKA earlier.