Ankle Disability Research Articles

Evaluation of the peroneus longus tendon as an autologous graft in knee surgery

Our hypothesis is that the peroneus longus (PL) is a great option for ligament reconstruction in the knee, and therefore the objective of the study is to determine if the use of this graft is safe and does not cause secondary damage to the harvested area. A prospective study was conducted between April 2019 and September 2022. Patients who underwent any type of knee ligament reconstruction using the PL or just the anterior half (AHPL) as grafts were followed up. These patients were evaluated according to the Tegner–Lysholm score and the International Knee Documentation Committee (IKDC) guidelines for functional evaluation of the knee and the American Orthopedic Foot and Ankle Score (AOFAS) and the Foot and Ankle Disability Index (FADI) for the functional evaluation of the ankle. Most patients had an increase in the IKDC score, Tegner–Lysholm score, AOFAS and FADI regardless of the graft used in the surgical procedure, with mean values at the 24-month follow-up of, respectively, 99.02± 0.02, 98.69± 0.08, 99.92± 0.07, and 99.92± 0.07 for those with PL grafts and 99.31± 0.54, 98.88± 0.95, 100± 0.00, and 100± 0.00 for those with AHPL grafts. The differences in the scores between the two graft groups during each of the follow-up periods were significant (P = 0.001). The use of the peroneus longus tendon as a graft in knee surgeries was shown to be adequate for achieving good knee functional results.

Comparing Innervated and Non-Innervated Glabrous Skin Flaps for Volar Digital Defects: Insights from Patient-Reported Outcomes.

Volar soft tissue defects in digits necessitate reconstructions that restore appearance sensation and minimize complications. This study compares innervated toe pulp (TP) and non-innervated medialis pedis (MP) flaps for reconstructing such defects, focusing on objective and subjective outcomes. Between 1998 and 2017, 101 free glabrous skin flap reconstructions were performed at our institution for volar digital soft tissue injuries, comprising 75 TP and 26 MP flaps. Follow-up assessments included the Michigan Hand Outcomes Questionnaire, Disabilities of the Arm, Shoulder and Hand Questionnaire, Foot and Ankle Disability Index, and sensory testing (static and moving two-point discrimination, Semmes-Weinstein monofilament test). Data analysis utilized the Mann-Whitney U test and Pearson correlation coefficients. The study cohort included 29 participants (15 TP, 14 MP) with an average follow-up of 106 months. Functional and sensory outcomes revealed no significant differences between TP and MP flaps. Both flap types achieved satisfactory function and sensibility, with no statistically significant distinctions in patient-reported outcomes. Subjective complaints were similarly distributed across both groups, with a few reports of cold intolerance and discomfort at the donor site in the TP group. TP and MP flaps provide adequate coverage and sensory outcomes for volar digital defects without significant differences between innervated and non-innervated flap transfers. The flap choice should be tailored to individual patient needs and defect characteristics, emphasizing the importance of patient-centered decision-making in reconstructive surgery. Further research is required to explore the long-term outcomes of these reconstruction methods, especially for larger defects.

Talocalcaneonavicular Realignment: The Foundation for Comprehensive Reconstruction of Severe, Resistant Neurologic Cavovarus, and Equinocavovarus Foot Deformities in Children and Adolescents.

The progression of neurologic cavovarus (NCV) and equinocavovarus (NECV) foot deformities during growth can eventually lead to non-reducible severe talonavicular (TN) and subtalar (ST) joint rotational malalignments. This study aimed to describe a technique to correct severe, resistant inversion deformity of the ST joint complex as the foundational procedure in comprehensive reconstruction of multi-segmental NCV and NECV deformities in pediatric patients and to analyze mid-term radiologic, functional, and satisfaction outcomes. This prospective study included children with severe NCV and NECV foot deformities who underwent TCNR between 2019 and 2022, with a minimum follow-up of 2 years. Talocalcaneal angle, talus-1 metatarsal angles, and TN coverage angle were measured in preoperative and postoperative weight-bearing foot radiographs. The foot and ankle disability index, foot function index, and Maryland foot score evaluated functionality. Qualitative questions assessed perceived improvement, satisfaction, and expectations of patients/caregivers. Descriptive, comparative pre-post, subgroup, correlation, and satisfaction analysis were performed. Twenty-six patients (36 feet: 16 unilateral and 10 bilateral) were included; 50% were female, median age was 12.1 years (IQR, 3.21) and median follow-up was 32.9 months (IQR, 18.7). Fifty-four percent had cerebral palsy, and 23% had charcot-marie-tooth disease; 84.6% were ambulatory. Significant improvements were found in radiologic parameters and functional outcomes (P<0.01), with no relevant differences between unilateral or bilateral procedures, pathology, functional level, or ambulatory capacity (P>0.05). Correlations between radiologic parameters or functional scales with age were generally low. Most reported significant functional improvements, outcomes exceeding expectations, and high satisfaction; they would recommend the surgery and undergo the procedure again. There were 3 minor complications: hypersensitivity, partial recurrence, and undercorrection. The TCNR technique enables realignment of severe, resistant inversion deformity of the ST joint complex in NCV and NECV foot deformities. When combined with procedures to correct the other foot deformities and muscle imbalances, functional outcomes are enhanced, high patient/caregiver satisfaction is achieved, and low complication rates are possible. This approach represents an important modification and extension of an already described technique, the deep plantar-medial release. Level III, therapeutic prospective cohort study.

Peroneus Longus vs Hamstring Tendon Autografts in ACL Reconstruction: A Comparative Study of 106 Patients' Outcomes.

BACKGROUND Anterior cruciate ligament (ACL) reconstruction commonly uses a hamstring tendon autograft, but the peroneus longus tendon can also be used. This study aimed to compare outcomes of anterior cruciate ligament reconstruction in 106 patients using peroneus longus tendon and hamstring tendon autografts. MATERIAL AND METHODS ACL repair was performed on 54 patients using a hamstring tendon autograft and 52 patients with a peroneus longus tendon autograft. Knee function was assessed using the International Knee Documentation Committee (IKDC) and Lysholm scores, while the ankle was evaluated using the American Orthopedic Foot and Ankle Score (AOFAS) and the Foot &amp; Ankle Disability Index (FADI) scores. Donor-site morbidity and graft characteristics were compared. RESULTS There was no difference between the 2 groups in terms of knee IKDC and Lysholm scores (p=0.49, p=0.68, respectively). The diameter of the peroneus longus tendon graft (8.56±0.93) was significantly larger than the hamstring tendon (7.44±0.6) (p<0.001). The peroneus graft harvesting time was significantly shorter (p<0.001). Thigh hypotrophy and donor-site morbidity were significantly higher in the hamstring group (p<0.001 and p=0.006). The donor ankle AOFAS score was 93.46±3.8, and the FADI score was 93.48±4.6. No morbidity associated with the peroneus longus graft was observed. CONCLUSIONS Patients who underwent ACL reconstruction using the peroneus longus tendon experienced faster knee rehabilitation and less donor-site morbidity, such as thigh hypotrophy and knee pain. The peroneus longus tendon, with its larger diameter, fewer graft-related complications, and similar knee scores compared to the hamstring group, is considered a suitable alternative graft source.

Effects of Manual Therapy on Fascial Distortion Model in Adolescent Ankle Sprain: A Pilot Study

ObjectivesThe present study aimed to assess the feasibility of investigating the effects of manual therapy on ankle functional muscle strength, static balance, and disability in adolescent patients with an ankle sprain. MethodsThe study was a nonrandomized prepost clinical feasibility trial. From September 2021 to February 2022, 31 patients with ankle sprain received manual therapy. Functional muscle strength of plantar flexor muscles and static balance were evaluated using the standing heel-rise and unipedal stance tests on the injured and healthy legs before and after the first and second sessions. Foot and Ankle Disability Index (FADI) assessed the disability at baseline, after the first and second sessions, in the third and sixth weeks. ResultsWithin-group analysis of the unipedal stance test with open and closed eyes and the standing heel-rise test showed that injured legs significantly improved after the first and second sessions, compared to uninjured legs (P < .05). Furthermore, there were significant differences among all repeated FADI measures (P < .05). ConclusionsThis study demonstrated that a study was feasible to measure ankle functional muscle strength, static balance, and disability in adolescent patients with an ankle sprain.

Arthrodesis using Iliac Crest autograft in revision surgery of the first metatarsophalangeal joint total arthroplasty for the treatment of Hallux Rigidus: a retrospective study

PurposeThe treatments for hallux rigidus (HR) encompass a wide spectrum, including conservative methods and surgical approaches such as arthroplasty and arthrodesis. This study aims to evaluate the outcomes of revision with arthrodesis following the failure of the first metatarsophalangeal joint total arthroplasty (MTPJ1TA).Materials and methodsPatients who had surgery at two advanced orthopedic centers between January 1, 2020, and January 1, 2024, were reviewed. Those with at least 6 months of postoperative follow-up were assessed for demographics (gender, age, side), reoperation rates, complications, Visual Analogue Scale (VAS) scores, Foot and Ankle Disability Index (FADI) scores, and American Orthopaedic Foot and Ankle Society Hallux Metatarsophalangeal and Interphalangeal Scale (AOFAS-HMI) scores. Radiological evaluations included hallux valgus angle (HVA), intermetatarsal angle (IMA), dorsiflexion angle (DFA), and first ray length (FRL) in anteroposterior and lateral views.ResultsOf 27 patients, 4 were male (15%) and 23 female (85%), with an average age of 56.18 ± 7.49 years (range 41–72). Arthrodesis was performed in 26 patients, with one requiring reoperation due to implant failure. Average VAS scores were 7.14 preoperatively and 3.55 postoperatively (p < 0.05). Average FADI scores were 50.51 preoperatively and 71.51 postoperatively (p < 0.05). Average AOFAS-HMI scores were 51.22 preoperatively and 70.59 postoperatively (p < 0.05). Average HVA was 19.7° preoperatively and 6.29° postoperatively (p < 0.05). Average IMA was 10.66° preoperatively and 11.37° postoperatively (p = 0.406). Average DFA was 34.14° preoperatively and 22.33° postoperatively (p < 0.05). Average anteroposterior FRL was 10.17 cm preoperatively and 10.77 cm postoperatively (p < 0.05). Average lateral FRL was 10.12 cm preoperatively and 10.42 cm postoperatively (p < 0.05). None of the patients in the study exhibited postoperative donor site complications or transfer metatarsalgia, while a 100% rate of bone union was observed.ConclusionWe think that revision of MTPJ1TA with arthrodesis is a safe treatment option. Additionally, the use of an iliac crest autograft can be a viable option to restore bone stock and create a biological environment conducive to fusion. This study evaluates revision surgery with arthrodesis in the largest patient group with failed MTPJ1TA, highlighting its significance in the field. However, further studies are needed to determine the ideal surgical procedure.

Treating Plantar Fasciitis: Platelet-Rich Plasma or Corticosteroids? A Single-Center Clinical Trial

Background: Plantar fasciitis (PF) is one of the leading causes of heel discomfort worldwide. There is no definitive treatment available for PF; however, two primary therapies are under investigation: Local injection of either corticosteroids or platelet-rich plasma (PRP). There are disagreements regarding the precise and effective dosage of these therapeutic approaches and their superiority over each other. Objectives: This study was conducted to compare the effects of corticosteroids and PRP in the treatment of PF. Methods: In this single-center clinical trial, 30 patients were divided into two groups (PRP vs. corticosteroids), with 15 patients in each group. In addition to receiving medication treatment, participants were given daily exercise regimens. The PRP group had a mean age of 44.07 ± 8.21 years, while the corticosteroid group had a mean age of 44 ± 9.85 years. The efficacy of these interventions was assessed primarily using the Numeric Pain Rating Scale (NPRS), the Roles and Maudsley score (RM), and the Foot and Ankle Disability Index (FADI). Results: Over a 3-month period, the NPRS decreased in the corticosteroid group from 7.07 ± 0.95 to 3.69 ± 1.43, and in the PRP group from 7.76 ± 0.92 to 3 ± 1.68 (P &lt; 0.001). The FADI improved in the corticosteroid group from 54.84 ± 8.33 to 75.76 ± 11.96, and in the PRP group from 49.3 ± 10.11 to 78.15 ± 16.76 (P &lt; 0.001). Plantar fascia thickness decreased in the corticosteroid group from 5.03 ± 0.62 to 4.51 ± 0.59, and in the PRP group from 5.43 ± 0.91 to 4.38 ± 1.04 (P &lt; 0.001). The results indicated that both groups demonstrated significant improvement in the first three months. Although the PRP group showed greater improvement than the corticosteroid group after three months, the differences between the two groups were not statistically significant. Conclusions: Our results showed that the effects of corticosteroid injections subside after one month, whereas PRP has more stable effects over time.

Incidence of post-traumatic osteoarthritis in 44B ankle fractures: Analysis of risk factors

ObjectiveThe purpose of this study was to analyse the clinical and radiographic data of a consecutive series of patients treated surgically for AO/OTA 44B ankle fracture at Ferrara University Hospital, Italy, with a view to identifying risk factors contributing to worse clinical and radiographic outcomes with a minium follow up of 6 years. Materials and methodsFor each patient the following data were recorded: gender, age, Body Mass Index (BMI), follow up (months), previous ankle sprains, type of work, Kellgren-Lawrence (K&L) score, AO/OTA classification for ankle fracture, Foot and Ankle Disability Index (FADI score), ankle dislocation, syndesmotic transfixation, quality of reduction. ResultsFADI score in patients with AO/OTA 44B1 fracture was 95.5±7.5, in 44B2 it was 90.0±8.4 and in 44B3 it was 84.0±13.0 (p25 it was 88.6±11.4 (p=0.047 95%I.C. 0.01-8.10). In case of fracture-dislocation there was a statistically significant difference in the FADI (94.4±6.0 vs 85.8±11.98)(P=0.002 95% I.C. 0.01-8.9). In the former group, there was a statistically significant difference in the ​the K&L (1.97±0.65 vs 2.63±0.85) (P=0.006 95% I.C 0.01-1.00).Finally, the quality of the reduction was a statistically significant parameter in both the FADI and K&L (P=0.012 95% I.C. 0.90-10.60 and P=0.012 95%I.C. 0.01-1.00 respectively). ConclusionThe most influential risk factors for worse outcome in AO/OTA 44B ankle fractures were found to be BMI, injury severity, fracture-dislocation and reduction quality.

Comparative effects of myofascial release with and without eccentric resistance on pain, range of motion, and functional disability in patients with Achilles tendinopathy

BackgroundThe ankle is one of the most commonly injured areas in people with active and sedentary lives. Achilles tendinopathy (AT) is characterized by pain and stiffness that limits daily living work. Myofascial release and eccentric training are believed to improve soft tissue circulation, strength, pain, ROM, and function. ObjectiveTo compare the effects of myofascial release with and without eccentric resistance on pain, range of motion, and functional disability in patients with AT. MethodologyThis randomized clinical trial was conducted with a sample of 72 participants selected via a convenient sampling technique. Participants were divided into two groups, Group A was given myofascial release therapy, and Group B was given myofascial release with eccentric resistance. Numeric Pain Rating Scale (NPRS), Goniometer, and Foot ankle disability index (FADI) were outcome measure tools for pain, range of motion, and functional disability. The assessment was done at baseline, 2nd and 4th week. Mann-Whitney U Test and Friedman's ANOVA were applied to find between-group and within-group differences. P-value was set at ≤0.05. ResultsThere was a significant difference in pain (p = 0.03), plantarflexion ROM (p = 0.008), and functional disability (p = 0.02) between the two groups. However, no significant difference was observed in dorsiflexion (p = 0.06). Within-group differences were also significant (p < 0.05). ConclusionIt is concluded that myofascial release with eccentric resistance was more effective than myofascial release without eccentric resistance in improving pain, range of motion, and functional disability in Achilles tendinopathy.

Talocalcaneal Coalition Resection with Local Fat Grafting and Flatfoot Reconstruction.

Talocalcaneal (TC) coalitions typically present in the pediatric population with medial hindfoot and/or ankle pain and absent subtalar range of motion. Coalition resection with fat interposition is well described for isolated tarsal coalitions1,2; however, patients with concomitant rigid flatfoot may benefit from additional reconstructive procedures. To address this, we employ the surgical technique of TC resection with local fat grafting and flatfoot reconstruction. This procedure is described in 3 steps: (1) gastrocnemius recession and fat harvesting, (2) TC coalition resection with local fat interposition, and (3) peroneus brevis Z-lengthening and calcaneal lateral column lengthening osteotomy with allograft. A 3 to 4-cm posteromedial longitudinal incision is made at the distal extent of the medial head of the gastrocnemius muscle. The gastrocnemius tendon is identified, dissected free of surrounding tissue, and transected. Superficial fat is then harvested from this incision before wound closure. A 7-cm incision is made from the posterior aspect of the medial malleolus to the talonavicular joint. The neurovascular bundle and flexor tendons are dissected carefully from the surrounding tissue as a group and protected while the coalition is completely resected, and bone wax and the local fat are utilized at the resection site to prevent regrowth of the coalition. An approximately 7-cm incision is then made laterally and obliquely following the Langer lines and centered over the lateral calcaneus. The peroneal tendons are released from their sheaths, and the peroneus brevis is Z-lengthened. A calcaneal osteotomy is performed about 1.5 cm proximal to the calcaneocuboid joint and angled to avoid the anterior and middle subtalar facet joints. Two Kirschner wires are inserted retrograde across the calcaneocuboid joint, and the calcaneal osteotomy is opened. A trapezoid-shaped allograft bone wedge is impacted, and the Kirschner wires are advanced across into the calcaneus. The lengthened peroneus brevis tendon is repaired, and the wound is closed in a layered fashion. First-line treatment is nonoperative with orthotics and immobilization. Surgical options include coalition resection with or without calcaneal lengthening osteotomy, arthrodesis, or arthroereisis. Following coalition resection, various grafts can be utilized, including fat autografts, bone wax, or split flexor hallucis longus tendon3-6. This procedure addresses TC coalition with concomitant rigid flatfoot. Resection alone may increase subtalar motion but does not correct a flatfoot deformity. Historically, surgeons performed arthrodesis or arthroereisis, but these are rarely performed in young patients. In patients with coalitions involving >50% of the posterior facet or preexisting degenerative changes, arthrodesis may be indicated7. Patients can expect improvement in pain and function8-11. Previous investigators reported improved patient satisfaction, improved range of motion, clinical and radiographic hindfoot correction, and an improved American Orthopaedic Foot & Ankle Society hindfoot score at the time of final follow-up8,9. Carefully free the neurovascular bundle from the surrounding soft tissue so that it can be carefully retracted away from the area of coalition resection.Utilize the interval between the posterior tibialis and flexor digitorum longus tendons to approach the coalition.Expose the medial wall of the coalition and perform a careful resection that avoids inadvertently diverging into the body of the talus or calcaneus.Place a smooth lamina spreader into the resected area and gently open the subtalar joint to confirm complete coalition resection.Place 2 retrograde wires across the calcaneocuboid joint before performing the osteotomy. Without this step, up to 50% of cases experience calcaneocuboid subluxation and/or rotation after the lateral column lengthening12.To determine the size of the allograft, place a lamina spreader into the osteotomy site to measure the width.If present, rigid supination of the forefoot must be corrected with a medial cuneiform plantar-based closing osteotomy. AOFAS = American Orthopaedic Foot & Ankle SocietyFADI = Foot and Ankle Disability IndexMRI = magnetic resonance imagingCT = computed tomographyOR = operating roomK-wire = Kirschner wire.

Peroneus Tendon Autograft in a Revision Anterior Cruciate Ligament Reconstruction

Introduction: The tendon graft option in revision surgery for anterior cruciate ligament re-tear still represents a debatable subject, regarding which is the best. As a primary option, the peroneus longus tendon (PLT) auto graft used in the reconstruction of the anterior cruciate ligament has been reported with success in many studies, but there are few reports about the uses of PLT in revision surgeries. This study aimed to assess the functional result of PLT autograft in revision ACL surgeries. Methods: A retrospective study was done on 16 young male patients, who underwent revision surgeries for ACL re-tear, using double or triple folded full thickness peroneus longus tendon autograft graft, functional results of the knee and ankle using Lysholm score and American orthopaedic foot and ankle disability inde, evaluated after two years of surgeries. Results: After two years of surgery, the Lysholm score was good – an ecellent result in 11 patients (73.33%), fair-good in 3 patients (20%) and poor in one patient only (6.66%). American foot and ankle score was 100 in 14 patients and 95 only in one patient. Conclusion: It has been concluded that PLT auto graft, represents a good graft option in revision ACL surgeries with no or little donor site morbidity.

Clinical outcomes of subtalar arthroereisis for the treatment of stage 1 flexible progressive collapsing foot deformity

BackgroundThe use of subtalar arthroereisis as an adjunct to the surgical treatment of stage 1 flexible progressive collapsing foot deformity (PCFD) is controversial. The aim was to investigate the clinical outcomes and report the implant removal rate of subtalar arthroereisis as an adjunct for stage 1 PCFD.MethodsA retrospective study of 212 consecutive feet undergoing operative management of stage 1 PCFD with adjunctive subtalar arthroereisis between October 2010 and April 2018. The primary outcome was the Foot and Ankle Outcome Score (FAOS). Secondary outcomes included Foot and Ankle Disability Index (FADI), Euroqol-5D-5L Index and implant removal rate.ResultsPost-operative clinical FAOS outcomes were collected for 153 feet (72.2%). At mean 2.5-year follow-up, the mean ± standard deviation FAOS for each domain was as follows; Pain: 81.5 ± 18.5, Symptoms: 79.5 ± 12.9, Activities of Daily Living: 82.5 ± 15.4 and Quality of Life: 64.2 ± 23.7. EQ-5D-5L Index was 0.884 ± 0.152. Pre-operative scores were available for 20 of these feet demonstrating a statistically significant improvement in all FAOS, FADI and EQ-5D-5L domains (p < 0.05). The implant removal rate for persistent sinus tarsi pain was 48.1% (n = 102).ConclusionUse of a subtalar arthroereisis implant as an adjunct to conventional procedures in stage 1 flexible PCFD can result in significant improvement in pain and function. Patients should be counselled as to the relatively frequent rate of subsequent implant removal.Level of evidenceIV.

Prediction of Recurrent Lateral Ankle Sprain and Ankle Pain Using Applied Care Strategies and Patient-Reported Outcomes.

Lateral ankle sprain (LAS) patients often have deficient patient-reported outcomes (PROs) at return-to-activity (RTA), potentially increasing risk for recurrent LAS and ankle pain. Additionally, applied care strategies are known to correct impairments, but their ability to mitigate risk for long-term consequences remains unknown. To determine if applied care strategies and PRO scores at RTA and 6-months post-RTA predict recurrent LAS and ankle pain 12 months after an acute LAS. Prospective cohort study. Online survey. We enrolled 63 individuals within one week of sustaining an acute LAS. Participants completed online surveys about their health history and recent LAS. At RTA and 6 months post-RTA, participants completed online surveys regarding demographics, applied care strategies, and patient reported outcomes (PROs): Foot and Ankle Disability Index, Identification of Functional Ankle Instability, Godin Leisure-Time Exercise Questionnaire, Short Form-8. At 12 months post-RTA, we asked participants if they sustained recurrent LAS. Chi-squares determined if recurrent LAS and ankle pain at 12-months were related to applied care strategies or ankle pain at RTA. Independent t-tests compared demographics and PROs at RTA and 6-months between participants with and without a recurrent LAS or ankle pain at 12-months. Logistic regression and area under the receiver operating characteristic (AUROC) analyses determined if demographics, applied care strategies, ankle pain at RTA, and PRO scores at RTA and 6-months predicted recurrent LAS and ankle pain at 12-months. Participants with a recurrent LAS had a lower walking boot use (P=0.05) and were taller than those without (P=0.03). Increased height and lack of walking boot use were predictive of recurrent LAS (P<0.01, R2=0.33, AUROC=0.81[0.68, 0.95]). LAS patients who are taller and do not use a walking boot might have greater risk for a recurrent LAS withing 12 months of RTA.

Factors predicting the outcome of arthroscopic debridement and microfracture technique in treatment of osteochondral lesions of talus

Aims and Scope: Osteochondral lesions of the talus (OLT) are common injuries that occur following ankle sprains and fractures. Surgical management, either through open or arthroscopic technique, is required to eliminate the pain and restore the ankle’s function. This study aims to evaluate the prognostic significance of demographic variables and lesion’s characteristics. Method and Techniques: In this study, 40 ankle (40 patients), who underwent arthroscopic debridement and microfracture technique to treat osteochondral lesion of the talus, were evaluated retrospectively after two years. The functional outcome of the ankle joint was assessed by using foot – ankle disability score, (FADS), pain analysing scale score (PASS), American orthopaedic foot and ankle society (AOFAS) score, and Ogilvie-Harris scaling system. Then the association between patients’ age and gender, and the lesions’ characteristics, including size, grade, and location, were evaluated. Results: Outcome results varied according to the scoring system, but all patients achieved satisfied outcome and pain relieve. Younger patients with smaller lesions achieved a better clinical result. All measures including PASS, AOFAS, Ogilvie-Harris, FADS appeared to be significantly better in smaller lesions. (P-value &lt;0.05) PASS and Ogilvie-Harris scales showed better results in younger patients. Ogilvie-Harris test result was notably superior in the lateral lesions. Conclusion: The patient’s age and size of the lesion are two prognostic factors of arthroscopic debridement and microfracture of OLTs. We believe arthroscopic management can be associated with a better outcome in lesions smaller than 1.5 cm in diameter and patients younger than 40-years-old. Level of Clinical Evidence: Level 2 – prognostic study

Functional and clinical outcome of arthroscopic primary single bundle anterior cruciate ligament reconstruction using peroneus longus autograft

Background: Peroneus longus tendon (PLT) autograft has emerged as one of the primary graft options for arthroscopic anterior cruciate ligament reconstruction (ACLR). We aimed to study whether PLT autograft could be used as primary graft for arthroscopic single bundle ACLR, without compromising stability of donor ankle. Materials and Methods: A prospective observational study of 120 patients, who underwent single bundle arthroscopic ACLR with ipsilateral PLT autograft was done. Functional outcome of patients were evaluated with international knee documentation (IKDC) and Lysholm knee scores after one year. The donor ankle morbidity was assessed using American orthopedic foot and ankle score (AOFAS) and foot and ankle disability index (FADI) scores. Results: The mean IKDC pre-op subjective score was 55.3 ± 10.7 and after one year follow-up was 91.4 ± 5.86. The mean difference of IKDC score between pre-op and post-op evaluation was 33.1 ± 11.4, with a p-value of &lt;0.001. The pre-operative mean Lysholm score was 67.6 ± 10.8 and on follow-up after 1 year was 93.6 ± 6.3. The mean difference of Lysholm score was 25.1± 10.4, and p-value &lt;0.001. The mean AOFAS score was 98.14 ± 3.16 and the mean FADI score was 98.37 ± 2.71 on one year follow-up. Conclusion: The significant improvements in IKDC and Lysholm knee scores after using PLT autograft, makes it one of the graft choices for ACLR. The apprehension of donor ankle instability is mitigated by excellent AOFAS and FADI scores reported in the study. PLT is an ideal graft choice for arthroscopic primary single bundle ACLR. Keywords: anterior cruciate ligament; peroneus longus tendon; autograft; arthroscopy; ACL reconstruction

Penatalaksanaan Fisioterapi pada Kasus Post Fraktur Calcaneus di RSUD Salatiga: Case Report

Introduction: A fracture is a discontinuity in bone (or cartilage) resulting from mechanical forces that exceed the bone's ability to support it. Objective: to determine physiotherapy management in cases of post left calcaneus fracture. Method: ultrasound therapy, stretching exercise, strengthening exercise. Results: evaluation of Manual Muscle Testing, Numeric Rating Scale, Foot and Ankle Disability (FADI) measurements during 4 meetings.

Effect of Adding Neurofeedback to Neuromuscular Training on Brain Waves in Athletes With Chronic Ankle Instability: A Randomized Clinical Trial

Background and Aims This study evaluated the effects of neuromuscular training compared with neurofeedback and neuromuscular training on brain waves, foot and ankle ability, and pain intensity of table tennis players with chronic ankle instability. Methods This clinical trial study was conducted on 29 table tennis players with chronic ankle instability, which were randomly divided into combined neurofeedback+neuromuscular (Mean±SD age: 21.73±2.60 years, hieght: 173.42±5.57 cm, wieght: 77.10±10.42 kg) and neuromuscular groups (Mean±SD age: 22.14±2.53 years, Mean±SD height: 169.26±6.77 cm, Mean±SD weight:77.95±15.70 kg). ProComp Infiniti System and BioGraph Infiniti version 5 software were used to measure brain waves and perform neurofeedback protocol. The foot and ankle disability questionnaire and the visual analog scale were employed to assess foot and ankle ability and pain intensity, respectively. The rehabilitation protocol was performed for eight weeks. The paired t test and 1-way analysis of covariance were used for the data analyses. Results The paired t test results revealed a significant decrease in the amplitude of theta, alpha, and sensorimotor rhythm (SMR) waves in both groups (P&lt;0.05) and an increase in the amplitude of the beta wave only in the combined group (P&lt;0.05). In addition, ankle ability was significantly increased during daily activities and exercise in both groups (P&lt;0.05). On the other hand, the results of a 1-way analysis of covariance indicated a significant difference between the two groups regarding theta and beta amplitudes and degree of ankle disability during exercise, and the improvement was greater in the combined group (P&lt;0.05). Conclusion According to the results, combined exercises (neuromuscular and neurofeedback) can be used as rehabilitation in table tennis players with chronic ankle instability to correct brain waves, improve leg and ankle ability, and reduce pain.

Long-term outcomes of first metatarsophalangeal hemiarthroplasty for hallux rigidus

Hallux rigidus (HR) is arthritis of the first metatarsophalangeal joint.First metatarsophalangeal joint hemiarthroplasty surgery is one of the treatment options for end stage hallux rigidus.The aim of this study is to evaluate the long-term outcomes of hemiarthroplasty of the first MTPJ with a metallic implant in patients with end-stage HR. Patients who underwent hemiarthroplasty surgery with the diagnosis of HR were included in the study. Self-Administered Foot Evaluation Questionnaire (SAFE-Q) and Foot and Ankle Disability Index (FADI) scores were used in pre-operative and post-operative final follow-ups to evaluate the clinical status of the patients. Post-operative 1st metatarsophalangeal joint range of motion was measured and recorded separately for each patient. The intra-hospital and follow-up complications and revision surgeries of the patients were recorded. Thirty-five patients with a mean follow-up of 8.1 years were included in the study. There was a statistically significant positive change in both FADI and SAFE-Q scores compared to the pre-operative process(p = 0.0001). The average dorsiflexion angle at the final follow-up was 22.0 ± 8.2. Thus, it was determined that the 5-year and 8-year survival rates of patients in this study were 97.1% and 87.8%, respectively. In conclusion, the long-term results show that the use of hemiarthroplasty in the treatment of end-stage HR leads to high patient satisfaction, increased range of motion and a high survival rate.

Ankle and Foot Health Status in Primary School Teachers (Cross-Sectional Study)

Background: Prolonged standing and the demands of teaching significantly impact the foot health of primary school teachers. Previous studies have highlighted the prevalence of foot problems in this demographic, but there is a lack of comprehensive research specifically targeting the relationship between occupational demands and foot health among teachers. Objective: This study aims to assess the foot and ankle health of primary school teachers, examining the impact of prolonged standing and other occupational factors on their foot health and overall quality of life. Methods: A cross-sectional study was conducted over a six-month period, involving 400 primary school teachers aged 23-40 years, selected through non-probability purposive sampling. Participants with a history of foot trauma or surgery were excluded. The Foot and Ankle Disability Index (FADI) was utilized for data collection, assessing functional disability related to the foot and ankle. Data analysis employed descriptive and inferential statistics, including Pearson Correlation tests, using SPSS software version 25. Results: The study found that 60% of teachers reported foot discomfort, with 30% experiencing moderate to severe pain. Difficulty in stair navigation was evident, with 25.9% experiencing difficulty in going up stairs and 26.8% in going down stairs. A strong correlation was observed between the total FADIS score and general level of pain (Pearson Correlation .713). Severe foot pain corresponded with lower FADI scores, indicating a negative impact on daily functioning and quality of life. Conclusion: The study concludes that primary school teachers face significant foot health challenges, likely due to the occupational demands of prolonged standing and inadequate footwear. The findings suggest the need for ergonomic workplace adjustments and awareness programs to mitigate these issues. Interventions focusing on appropriate footwear and regular breaks could enhance foot health and overall well-being.

Increased medial talar tilt may incite ankle pain and predispose ankle osteoarthritis after correction of severity of knee varus deformity among patients undergoing bilateral total knee arthroplasty: a prospective observation

PurposePatients with varus knee osteoarthritis usually compensate at the ankle and typically walk with hindfoot valgus alignment. As the neutral weight-bearing axis of the lower limbs is restored with Total Knee Arthroplasty (TKA), ankle and hindfoot biomechanics also acutely change. This study aims to investigate whether any ankle clinical-radiographical changes occur as a result of bilateral mechanical TKA in patients with bilateral Osteoarthritis knee at a minimum follow-up of 6 months.MethodsThe prospective observational study included 61 patients (122 knees) undergoing simultaneous bilateral TKA (mechanical alignment). Tibio-talar angle(TTA), tibial Anterior Surface angle (TAS), lateral distal tibial angle (LDTA), talar-tilt angle (TT), anatomical talocrural angle (aTC), ground surface and distal tibial plafond angle (GP), ground surface and an upper surface of talus angle (GT)and tibial plateau and tibial plafond angle (PP) were measured on long-film radiographs to look for changes in the ankle, whereas functional assessment was done using American Foot and Ankle Society (AOFAS), Foot and Ankle Disability Index (FADI), and Forgotten Joint (FJS-12) scores. Patients were sub-grouped based on the Hip-Knee-Ankle (HKA) axis, and the effect of the severity of knee varus on the ankles after TKA was also analyzed. The minimum follow-up was 6 months.ResultsA significant decrease in the tibial plateau-tibial plafond (PP), ground-tibial plafond (GP), and ground-talar dome (GT) angles was noted after TKA (p-value < 0.05). Postoperative functional parameters were comparable to the preoperative status except for FADI, which significantly improved (p-value-0.03). Sub-group analysis based on the severity of knee varus (HKA) revealed GT to be most significantly reduced (p-value-0.036), while the talar tilt (TT) increased (p-value-0.044). Functional outcomes of the ankles clinically improved with the correction of severe knee varus after TKA. At a mean follow-up of 13.2 months post-TKA, 7 out of 61 (11.4%) patients complained of post-TKA ipsilateral ankle pain.ConclusionMechanically aligned bilateral TKA in severe varus deformity of the knee significantly decreases the GT angle but increases the varus tilt of the talus with lateral talar incongruency and under-coverage. Although the acute correction of severe knee varus deformity aligns the tibia more neutrally, resulting in an overall clinically evident improvement in ankle functional outcome, the increased varus talar tilt remains a deep concern.Level of EvidenceProspective, observational, comparative study Level II.