Feet In Group Research Articles

Locked versus Nonlocked Plate Fixation for Hallux MTP Arthrodesis

Dorsal plate fixation is used commonly for arthrodesis of the hallux first metatarsophalangeal (MTP) joint. Custom dorsal plates incorporating locking technology have been developed recently for applications in the foot to provide relative ease of application and theoretically superior mechanical properties. The purpose of this study is to compare the radiographic and clinical outcomes of patients undergoing hallux MTP joint arthrodesis using a locked plate, or a nonlocked plate. We compared consecutive patients who underwent hallux MTP arthrodesis for a variety of diagnoses with either a precontoured locked titanium dorsal plate (Group 1) or a precontoured, nonlocked stainless steel plate (Group 2). All patients were evaluated with radiographs, visual analog pain scale, American Orthopaedic Foot and Ankle Society (AOFAS) hallux score, and a detailed patient satisfaction survey. There were 73 feet in Group 1 and 107 feet in Group 2. There was a trend toward a higher nonunion rate in Group 1 compared to Group 2. When considering only patients without rheumatoid arthritis (RA), the union rate was significantly higher in Group 2 compared to Group 1. Hardware failure and the overall complication rate was equivalent between the two Groups. As locked plate technology continues to gain popularity for procedures in the foot, it is important that clinical outcomes are reported. Locked titanium plates were associated with higher nonunion rates. Improved plate design, patient selection, and an understanding of plate biomechanics in this unique loading environment may optimize future outcomes for hallux MTP arthrodesis.

Treatment of severe clubfoot with manipulation using synthetic cast material and a foam-casting platform: a preliminary report

Conservative clubfoot treatment requires weekly cast changes. We questioned whether a method using synthetic fiberglass instead of the traditional plaster material and with the infant lying comfortably on a special foam-casting platform could be satisfactorily used. A retrospective cohort review on idiopathic clubfoot treated with this particular method was carried out. The severity of clubfoot at presentation was assessed with the classification of Dimeglio et al. The outcome of treatment was assessed with the same scoring system at the latest follow-up. The need of secondary open surgical releases was noted. The parent's acceptability of this method was evaluated with a self-designed questionnaire. The existence of a learning curve was explored by comparing the outcomes of 22 feet during two time periods: those treated before 31 December 2003 (group 1) and those treated after 1 January 2004 (group 2). The mean Dimeglio Scores improved from 17.5 to 4.1 for group 1 and from 15.0 to 3.2 for group 2. Nine of 10 feet in group 2 had tenotomy of the tendo Achilles and none needed open surgical release whereas 10 out of 12 feet in group 1 required open releases. A learning curve did exist for this method. No major complication was noted with the technique. Parent acceptability was high for this method, which was effective in the management of severe idiopathic clubfoot.

Is It Hazardous or Mandatory to Release the Talocalcaneal Interosseous Ligament in Clubfoot Surgery?

Extreme overcorrection and avascular necrosis are recognized complications in clubfoot surgery and are thought to be the result of division of the talocalcaneal interosseous ligament (TCIL). This is a preliminary report of a prospective study of the cases of 46 patients with 66 idiopathic clubfeet treated by means of soft tissue release using a posteromedial approach at a mean age of 9 months. The deformity was very severe in 51 feet and severe in 15. The feet were divided into 2 equal groups (33 feet each). In group A feet, the TCIL was released, whereas in group B, the ligament was left intact. At a mean follow-up period of 28 months, the result was satisfactory (excellent and good) in 96.9% of feet in group A and in 87.9% of feet in group B. When the mean overall clinical and radiological score was investigated, group A graded excellent whereas group B graded good. In feet with satisfactory outcome, group A showed statistically significant improvement of the anteroposterior and lateral talocalcaneal angles, talocalcaneal index, and lateral calcaneus-first metatarsal angles when compared with group B. This was reflected clinically on better hind foot correction with the release of the TCIL, with no evidence of significant overcorrection. Magnetic resonance imaging of the ankle and foot confirmed no evidence of talar avascular necrosis or extreme overcorrection in 40 feet (60.1%), 20 in each group. We conclude that it is advisable to release the TCIL in severe and very severe clubfeet.

Weight-Bearing Intensity Produces Charcot Deformity in Injured Neuropathic Feet in Diabetes

The purpose of the study was to investigate the relationship between the intensity of unrestrained weight bearing after a non-fracture injury (e.g. sprain), and the development of osteoarthropathic deformities of the foot (Charcot foot) in patients with diabetic neuropathy. 34 diabetic patients (14 Type 1, 20 Type 2) with foot bone injuries were studied in retrospect. At onset of injury symptoms (e.g. foot swelling), 32 of 34 feet displayed unremarkable X-ray, but pathologic MR imaging (e.g. bone marrow edema along the Lisfranc and/or the Chopart joint). Cumulative load forces after the onset of symptoms until treatment by total contact cast (TCC) were estimated using the product of body weight and number of weeks of ambulation (kg x week) as a surrogate. Feet were classified in 3 groups according to the degree of foot deformities found at the start of treatment with TCC: Feet without deformities (group A, n=16), feet with minor deformities (partially reduced plantar arch (group B, n=6) and feet with major deformities (collapsed plantar arch, group C, n=12) Feet in group A had been exposed to 262 (95% CI 135-390) kg x week, compared to 974 (95% CI 342-1606) in group B, and to 2348 (95% CI 1265-3430) kg x week in group C (p<0.05 between groups), indicative of a dose-response relationship between weight-bearing and progressive foot deformities. Destruction along the Lisfranc joint was observed in 2/16 feet in group A, versus 18/18 feet in group B and C combined (p<0.001). In group A, the undeformed feet were healed without major deformities (except for 2 non-compliant patients), whereas in group B and C feet remained as deformed as they were at TCC application. Unrestrained weight-bearing of injured foot bones and joints of more than 400 kg x week (equivalent to 8 weeks of normal walking by a person of 50 kg body weight) prompts Charcot deformities, with disintegration of the Lisfranc joint. Early off-loading by TCC treatment allows healing without deformities.

Ultrasound assessment of early clubfoot treatment: a comparison of the Ponseti method and a modified Copenhagen method

The purpose of this study was to sonographically compare the early anatomical outcome of a group of clubfeet treated with the Ponseti method (group A, nine clubfeet) with a group treated with an adjustable plexidur splint, the Copenhagen method (group B, 19 feet). The clinical severity was assessed using the Diméglio-Bensahel classification. The need for complementary surgery was clinically assessed at the age of about 2 months. Ultrasound investigation was made in the neonatal period, after 2-3 months of non-surgical treatment and 1-2 months post-surgically. After 2 months of non-surgical treatment the correction obtained at the talo-navicular joint, expressed as the distance between the medial malleolus and the navicular (MM-N distance), was significantly greater in group A. After surgery, tenotomy of the Achilles tendon for all group A feet, and posterior or posteriomedial release for 13 feet in group B, the correction at the talo-navicular and calcaneo-cuboid joints was similar for the two groups. Anatomical correction of the displacement in these joints can be achieved without extensive interventional procedures. Ultrasound may be a valuable tool to assess the effects of different treatment protocols quantitatively.

The influence of beliefs about health and illness on foot care in diabetic subjects with severe foot lesions: a comparison of foreign- and Swedish-born individuals

Objective: To explore beliefs about health and illness among foreign-born and Swedish diabetic men with severe diabetic foot lesions that might affect self-care and care-seeking behaviour. Design: Explorative study with consecutive sampling. Focus group interviews with 11 Swedish-born men and individual interviews with 15 foreign-born men, aged 38–74 years (mainly Europeans) with present or previous diabetic foot lesions. Results: Foreign-born men often attributed the ulcer to work-related accidents outside their control, perceived the occurrence of an ulcer as a trifle, stated lack of information about foot care and management of diabetes, showed passive self-care behaviour and visited health professionals when they had new foot problems. Swedes discussed more foot problems, expressed great fears and anxiety when having an ulcer, had a higher degree of knowledge about foot care, showed active self-care behaviour and tried to prevent foot ulcers. In both groups foot lesions caused deterioration of perceived health and quality of life due to decreased level and ability to be active. Conclusion: Beliefs about health and illness differed between foreign- and Swedish-born men and affected self-care and care-seeking behaviour. Their beliefs need to be considered in prevention and management of the diabetic foot. Many patients, especially foreign-born, have an underutilised potential for self-care measures.

Macrodactyly of the foot.

The purpose of this study was to focus on the problems associated with macrodactyly of the foot and to formulate guidelines for optimum treatment. Seventeen feet (fifteen patients) with macrodactyly formed the basis of this retrospective review. The feet were classified into one of two groups, depending on whether the macrodactyly involved only the lesser toes (group A) or involved the great toe with or without involvement of the lesser toes (group B). Toe amputation or ray resection was usually done to reduce the length and width of the foot in group A, whereas the length of the first ray was reduced by epiphysiodesis or amputation of the phalanx in four of the five feet in group B. In both groups, soft-tissue debulking was an integral part of the treatment. The severity of the macrodactyly and the effect of treatment were documented radiographically by measurement of the so-called metatarsal spread angle. At the latest follow-up evaluation, each foot was graded with regard to pain and shoe wear. Toe amputation was performed in six of the twelve feet in group A and toe shortening was performed in two, but only three of those procedures had a good result. Ray resection was performed in five feet (as an initial or secondary procedure) in Group A, and all had a good result. The mean reduction of the metatarsal spread angle was 10.0 degrees following resection of a single ray in Group A. In Group B, four of the five feet were rated as having only a fair result because shortening alone did not effectively reduce the size of the great toe. The macrodactyly of the great toe was not treated in the fifth foot, which also had a fair result. Toe amputation, which is cosmetically unappealing, is not effective for treating macrodactyly of the lesser toes and does not address the enlargement of the forefoot. Ray resection results in the best cosmetic and functional outcomes in feet with involvement of the lesser toes. When the great toe is involved, the result is often only fair, and repeated soft-tissue debulking may be necessary.