Posttraumatic Foot Research Articles

Clinical characteristics analysis of 22 062 patients of foot and ankle deformity from QIN Sihe Orthopaedic Surgery Database between May 25, 1978 and December 31, 2020

Based on the clinical data of patients with foot and ankle deformities in the QIN Sihe Orthopaedic Surgery Database, to analyze the characteristics and treatment strategies of foot and ankle deformities, and provide a basis for clinical decision-making. A total of 22 062 patients with foot and ankle deformities who received orthopedic surgery between May 25, 1978 and December 31, 2020 were searched in the QIN Sihe Orthopedic Surgery Database. The gender, age at operation, regional distribution, etiology, type of deformity, operation method, postoperative fixation method, and other information were collected. Among the 22 062 patients, there were 13 046 males (59.13%) and 9 016 females (40.87%); the age at operation ranged from 1 to 77 years, with a median of 17 years, and 20 026 cases (90.77%) were aged 5 to 40 years. The patients came from 32 provinces, municipalities, and autonomous regions across the China and 5 countries including India and the United States, et al. The etiology and diseases type covered 154 kinds (of which sequelae of poliomyelitis, cerebral palsy, spina bifida and tethered spinal cord, congenital equinovarus foot, post-traumatic foot and ankle deformity, and Charcot-Marie-Tooth disease accounted for the highest proportion). The types of deformities included varus foot, equinus foot, valgus foot, talipes calcaneus, equinocavus, high arched foot, claw toe, and flail foot. Surgical methods included tendon lengthening, soft tissue release, tendon transposition, osteotomy orthopedics, and ankle arthrodesis. The 36 620 operations were performed, including 11 561 cases of hip, knee, and lower leg operations to correct the foot and ankle deformities. Postoperative fixation methods included Ilizarov external fixator in 2 709 cases (12.28%), combined external fixator in 3 966 cases (17.98%), and plaster or brace fixation in 15 387 cases (69.74%). Male patients with foot and ankle deformities account for a large proportion, and the population distribution is mainly adolescents, with a wide distribution of regions, causes and diseases, and talipes equinovarus and varus foot are the main types of deformities. Foot and ankle deformities are often combined with deformities of other parts of the lower limb, which requires a holistic treatment concept. The application of foot soft tissue and bone surgery combined with Ilizarov external fixator and combined external fixators provides a guarantee for the correction of complex foot and ankle deformities.

Anomalous common peroneal nerve: An encounter during peroneal nerve decompression

In this case report we discuss about a rare anomaly of the common peroneal nerve. This was encountered during decompression of the peroneal nerve following a post traumatic foot drop. Here, we describe the abnormal division of common peroneal nerve and the importance of identifying it to avoid further nerve injury.

Pediatric Microsurgery in the Reconstruction of Complex Posttraumatic Foot and Ankle Defects: A Long-Term Follow-Up with a Comprehensive Review of the Literature.

Lower limb reconstruction is a well-recognized challenge to the trauma or plastic surgeon. Although techniques and outcomes in the adult population are well documented, they are less so in the pediatric population. Here, we present our experience in the management of posttraumatic foot and ankle defects with free tissue transfer in children. We performed a retrospective analysis of 40 pediatric patients between the ages of 3 and 16 from 2008 to 2016 who underwent foot and ankle soft tissue reconstruction. Any patient who underwent reconstruction for any reason other than trauma was excluded. Data were collected on operative time, free tissue transfer type, use of vein grafts, length of hospital stay, and postoperative morbidity. Also, a comprehensive systematic literature review was completed according to the PRISMA protocol for all previous reports of foot and ankle reconstruction in the young age group with free tissue transfer. Of our 40 patients, 23 were males and 12 females, free tissue transfer was used to reconstruct primarily the dorsum (71%), heel (11%), medial (9%), and lateral (3%) aspect of the foot. The anterior tibial artery was the predominant recipient vessel for anastomosis (77%). Mean inpatient stay was 9 days and our complication rate was 20%, primarily of superficial infection treated with antibiotic therapy. The review of the literature articles is completely analyzed in detail. The need for durable coverage of exposed joints, tendons, fractures, or hardware makes the free flap particularly well suited to trauma reconstruction of the foot and ankle. The lack of underlying vascular disease in this patient group allows for low complication rates. Our study evidences the safety and positive long-term outcomes of free tissue transfer for the reconstruction of huge sized-soft tissue defects of the foot and ankle in children.

Surgical treatment of severe posttraumatic foot deformity

The surgical treatment of a 17-year-old patient with posttraumatic complex and rigid foot deformity by the transosseous osteosynthesis method by Ilizarov (original frame) is presented in the article. Previously, the patient incurred a fracture of the left tibia. He was treated by open reduction and internal fixation with a plate in the private clinic. Within four years, an equinovarus adductus foot deformity had developed. During our treatment, the deformity of the foot was eliminated without resection of the bones of this segment. After one year of treatment, the patient was satisfied with the functional condition of the foot, its cosmetic appearance, and the absence of pain in the foot. The American Orthopedic Foot and Ankle Society scale score increased significantly from 30 points preoperatively to 82 postoperatively, whereas the visual analog scale (VAS)-pain scale score decreased from 7 to 1. His ankle motion increased from 10 preoperatively to 29 postoperatively. This case demonstrates the possibilities of the Ilizarov method and our approach in the treatment of severe rigid foot deformities by the Ilizarov technique.

Analysis of the Composition and Functions of the Microbiome in Diabetic Foot Osteomyelitis Based on 16S rRNA and Metagenome Sequencing Technology

Metagenome sequencing has not been used in infected bone specimens. This prospective observational study explored the microbiome and its function in patients with diabetic foot osteomyelitis (DFO) and posttraumatic foot osteomyelitis (PFO) based on 16S rRNA sequencing and metagenome sequencing technologies. Spearman analysis was used to explore the correlation between dominant species and clinical indicators of patients with DFO. High-throughput sequencing showed that all the specimens were polymicrobial. The microbial diversity was significantly higher in the DFO group than in the PFO group. Firmicutes, Prevotellaceae, and Prevotella were the most abundant microbes in the DFO group. The most abundant microbes in the PFO group were Proteobacteria, Halomonadaceae, and Halomonas Prevotella denticola, Prevotella jejuni, and Prevotella fusca had positive correlation with the duration of diabetic foot infection (DFI_d). Proteus vulgaris was positively correlated with the infection index, while Bacteroides fragilis was negatively correlated. The microbial functional genes were more abundant in the DFO group than in the PFO group. Metagenome sequencing is feasible for the analysis of the microbiome in infected bone specimens. Gram-negative bacteria and anaerobes are dominant in DFO.

A Novel Approach to Post-Traumatic Foot and Ankle Pains using Percutaneous Ultrasound Guided Cryoneurolysis: A Case Report

A Novel Approach to Post-Traumatic Foot and Ankle Pains using Percutaneous Ultrasound Guided Cryoneurolysis: A Case Report

Complex post traumatic foot deformities – Outcomes after corrective surgery

IntroductionComplex posttraumatic foot deformity results in painful foot, altered gait and affects cosmesis. We did a retrospective study on 16 patients to analyse the etiology, types of foot deformity and their outcomes after corrective surgery. MethodsThis retrospective study was done on a consecutive series of patients who underwent corrective surgery for complex post-traumatic foot and ankle deformities. There were 16 patients with 18 foot deformities. The duration of deformity, soft tissues, radiographic changes and measurements, type and anatomic localisation of the deformity determined the surgery needed to correct the deformity. ResultsAmong the 18 foot injuries, 16 were open injuries. Among the type of foot deformity, isolated equinus deformity was seen in 12 feet followed by equinovarus and equinocavovarus in three feet each. Seven patients needed modified footwear. None of the patients required walking aid for ambulation at the end of one year follow up. ConclusionTo conclude, soft tissue injuries were the most common cause of posttraumatic foot deformities compared to bony injuries. Equinus deformity was the commonest deformity. Fifteen patients returned to their preinjury work status.

Safety of Single Vein Anastomosis versus Double Venous Anastomosis in ALT Perforator Flap in Foot and Leg Reconstruction

Introduction: Single or double venous anastomosis in free flap in general and ALT, in particular, is still a matter of debate between micro vascular surgeons. In this study, we will present our experience in single vein anastomosis versus double venous anastomosis in ALT perforator flap used in leg and foot reconstruction as regarding flap outcome, complications, operation time and the need for re-exploration. Patient and Methods: We retrospectively evaluate 60 patients with post traumatic foot and leg defects in the period between January 2014 and January 2018 where free ALT flap was done. The patients were divided into two groups, Group 1 where single vein anastomosis was done and Group 2 where double venous anastomosis was done; we utilize the deep venous system for the anastomosis in all cases. Results: Complete flap survival noticed in 56 cases (93.3%), defect size ranged from 70 to 200 cm (mean 126.35 ± 33.78). There was no difference between the 2 groups as regarding Flap survival, hospital stay, flap complications, donner site morbidity and vascular insufficiency. There is statistically significant difference between both groups as regarding Ischemia time, Operation time, and overall re-exploration rate. Conclusions: Our study suggests that the use of a single venous anastomosis in the venous drainage of anterolateral thigh free flaps is as safe and feasible as the two veins anastomoses.

Poster 206: Percutaneous Ultrasound Guided Cryoneurolysis: A Novel Approach to Post-Traumatic Foot and Ankle Pain

PM&RVolume 10, Issue 9S1 p. S69-S69 Poster 206: Percutaneous Ultrasound Guided Cryoneurolysis: A Novel Approach to Post-Traumatic Foot and Ankle Pain David H. Sherwood DO, David H. Sherwood DO Kansas University Medical Center, Kansas City, MO, United StatesSearch for more papers by this authorNeil Segal MD, Neil Segal MDSearch for more papers by this author David H. Sherwood DO, David H. Sherwood DO Kansas University Medical Center, Kansas City, MO, United StatesSearch for more papers by this authorNeil Segal MD, Neil Segal MDSearch for more papers by this author First published: 26 September 2018 https://doi.org/10.1016/j.pmrj.2018.08.218Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume10, Issue9S12018 AAPM&R Annual Assembly AbstractsSeptember 2018Pages S69-S69 RelatedInformation

Imaging diagnostics of the foot : What the orthopaedic surgeon expects from the radiologist

Foot pain is in the case of long-term congenital, acquired or posttraumatic foot deformities arelevant clinical problem. On the basis of the clinical findings and the orthopaedic question, radiographs of the foot while standing in two planes are supplemented by radiographs of the ankle in an anterior-posterior plane. The imaging diagnostics of the foot are based on the conventional X‑ray diagnostic workup and becomes even more precise and differentiated by the possibility of intersecting imaging procedures. The diagnostic significance of imaging methods is discussed in this overview by means of clinical examples. In this context, cross-sectional imaging procedures can serve the clinician in the further decision-making process and clarify the question whether surgical treatment, for example, in the case osteoarthrosis is indicated. Primarily, prior to any imaging procedure the appropriate medical history, inspection, clinical examination and the gait analysis in patients with foot pain are necessary. Interdisciplinary communication between orthopaedic/trauma surgeons and radiologists is necessary in order to provide the right imaging modality for difficult questions, to correctly interpret the resulting imaging findings, and to derive atherapeutic consequence from this. The decision whether conservative therapy or a surgical procedure is recommended will be made depending on the patients' prior therapies and the restriction of quality of life.

Technical tip: Percutaneous bone shaving and ulcer endoscopy to manage abnormal pressure point of the sole

Abnormal plantar pressure can follow post-traumatic foot deformity, Charcot neuroarthropathy and partial foot amputations. Surgery is indicated if the condition does not improve with orthotic treatment. We describe the techniques of percutaneous shaving of the plantar bone prominence and ulcer endoscopy to manage abnormal pressure points under the sole of the foot.

Extended Anterolateral Thigh Flaps for Reconstruction of Extensive Defects of the Foot and Ankle

The anterolateral thigh flap has been used for coverage of defects in the foot and ankle for years. Conventional extended anterolateral thigh flaps do not undergo thinning procedures, which limit their application. Here, a clinical series of 24 patients is reported in which extended anterolateral thigh flaps were used for posttraumatic foot and ankle reconstruction. Of the 24 flaps, 14 were simple extended anterolateral thigh fasciocutaneous flaps and 10 were thinned extended anterolateral thigh flaps. One artery and two veins, including a superficial vein and an accompanying vein, were anastomosed to vascularize each flap. Follow-up of the 24 patients ranged from 10 months to 4 years postoperatively. All 24 flaps survived successfully, except one case that had partial flap necrosis distally due to excessive thinning. The cutaneous flap territory ranged from 250 cm2 to 400 cm2 (mean, 297 cm2). Only one patient received a debulking procedure. No ulceration occurred in any of the flaps due to contact with the shoe. The extended anterolateral thigh flap is a good alternative for extensive soft tissue defects of the foot and ankle. This study also supports the high reliability and excellent vascular supply of moderate thinned extended ALT flaps.

Thalo Navicular Arthrodesis Of Steinhaeuser In Senegal

Thalo Navicular Arthrodesis Of Steinhaeuser In Senegal

Osteoid osteoma of the lateral cuneiform bone: Presentation following trauma

Osteoid osteomas are not uncommon, benign bone tumours which have well-defined clinical, radiological and pathological characteristics. These tumours can potentially affect any bone in the body, but show a predilection for long tubular bones. The clinical presentation can easily be confusing, if the site in question is rare and the presentation atypical. Lesions occurring in the foot often pose particular problems in diagnosis, often leading to delays in treatment. We present the case of 38-year-old male who presented with persistent post-traumatic foot pain. The subsequent diagnosis of osteoid osteoma of the lateral cuneiform bone was delayed for three years by a combination of atypical history and a very unusual location. This case highlights the need for a high index of suspicion and a low threshold for appropriate imaging in cases of persistent unexplained post-traumatic foot pain.

Fusion in posttraumatic foot and ankle reconstruction.

Despite appropriate acute treatment, many foot and ankle injuries result in posttraumatic arthritis. Arthrodesis remains the mainstay of treatment of end-stage arthritis of the foot and ankle. An understanding of the biomechanics of the foot and ankle, particularly which joints are most responsible for optimal function of the foot, can help guide reconstructive efforts. A careful history and physical examination, appropriate radiographs, and, when necessary, differential selective anesthetic blocks help limit fusion to only those joints that are causing pain. Compression fixation, when possible, remains the treatment of choice. When bone defects are present, however, neutralization fixation may be necessary to prevent a secondary deformity that could result from impaction into a bone defect.

Verletzungen des Lisfranc-Gelenks

Tarsometatarsal injuries represent rare lesions of the midfoot. In 90% of the cases fractures or fracture dislocations are associated with ligamentous injury components. Two-thirds of these injuries are due to high energy trauma by direct axial loading of the foot during motor vehicle accidents or following a fall from substantial height. 50% of the patients are polytraumatized. One-third of the Lisfranc lesions are caused by low energy trauma with indirect loading mechanisms of a mainly plantar-flexed foot. Due to the variety of the clinical and radiographic appearances of Lisfranc joint injuries and inadequate standard radiographic examinations the rate in primarily missed lesions amounts up to 20%, in particular, in patients with multiple trauma. Neglected Lisfranc lesions generally lead to painful posttraumatic foot deformities even at a minor degree of dislocation. As such, bearing in mind the specific trauma mechanism a high degree of suspicion is necessary to detect this specific entity of midfoot lesion employing a standardized clinical and radiographic diagnostic algorithm. Correct management of the soft tissues is essential for the functional outcome as a high rate of compartment syndromes may develop. Treatment follows the general principles of joint injuries, i.e. anatomical reduction and stable retention of the Lisfranc joint components, until definite osteo-ligamentous healing has occurred. With some rare exceptions open reduction and temporary arthrodesis of the Lisfranc joint line with small-fragments transfixation screws or K-wires represents the current gold standard of surgical treatment. Adequate anatomic reduction and stable fixation are prerequisites for good functional results. In patients where posttraumatic foot deformities or painful osteoarthritis has developed, realignement arthrodeses of the corresponding Lisfranc joint segments involved are the tools for an improvement of function.

Posttraumatic deformity correction at the foot

Posttraumatic foot deformities requiring correction result from overlooked or inadequately treated injuries and, on the other hand, from protracted courses because of avascular necrosis, non-union or infection after primary surgery. To achieve a maximum benefit, corrective surgery has to be carried out early before arthritic involvement of adjacent joint becomes evident. As salvage procedures, arthrodeses should be restricted to the affected joints. Especially talus malunion and non-union should be corrected with preservation of the joints whenever possible to achieve favourable functional outcomes. In case of calcaneal malunion with consequential lateral translation a reorientating subtalar arthrodesis should be supplemented by corrective osteotomy of the fracture line. Corrections at the level of Chopart's and Lisfranc's (mid-tarsal and tarsometatarsal) joints must restore the exact relationship between the medial and lateral foot columns. Malunions of the metatarsals and toes are corrected in cases of symptomatic malalignment. This paper reviews corrective procedures for posttraumatic deformities at the different foot regions. A therapy-based classification for mal-unions of the talus and calcaneus is proposed.

The Ruiz-Mora procedure: a surgical treatment of the cock-up deformity of the fifth toe

A fixed rotational deformity of the fifth toe combined with subluxation/dislocation of the fifth metatarsophalangeal joint is also known as the cock-up deformity. If the toe cannot be accommodated by wide or extra-depth shoes surgery may be indicated. Surgical treatment requires adequate bony decompression. Complete excision of the proximal phalanx combined with tightened plantar skin closure after elliptical plantar skin excision, the Ruiz-Mora procedure, provides good relief of symptoms. We reviewed 18 patients with 22 procedures, operated on between 1986 and 1996. Two patients with two procedures had post-traumatic foot deformities and because of the different underlying aetiology and pathology of their deformity were excluded from the study. There were 10 women and eight men, and four patients had bilateral operations. The average age at surgery was 38 years. Follow-up examination was possible for 17 cases. These patients were followed for an average of 6.6 years. After surgery there was no recurrence of deformity. Subjectively, all of the examined patients had complete relief of pain. Three recurrences of a simultaneously surgically treated hammer toe deformity of the fourth toe with a corn on the dorsal aspect of this toe were observed. In two cases a floppy fifth toe, and in another two cases some problems with excessive shortening, were noted. The use of a partial syndactylization between the fourth and fifth toe or a skin incision placed near to interdigital space should be considered to avoid the excessive shortening and the development of a floppy fifth toe.

Vascular decompression. The critical element in forefoot crush injury

The authors present an overview of post-traumatic foot compartment syndrome with an emphasis on the importance of relieving vascular compromise immediately. The incisional approach selected should not only effectively decompress the foot, but also allow for repair of concomitant osseous and soft tissue injury as well. Vascular considerations may dictate the course of simultaneous fracture management.

Early and Late Posttraumatic Foot Reconstruction

When complex trauma occurs in the foot, there is (1) loss of structural continuity that renders the bony architecture mechanically useless and (2) changes in the soft tissue that subject the foot to potential contractures and atrophy. The priorities of salvage of such injuries are early and accurate diagnosis, early reduction and stabilization, careful handling of soft tissues, tissue transfer to fill defects, and early motion. By these means it is possible to diminish the effects of edema, atrophy, stiffness, and osteoporosis. When initial treatment fails, salvage procedures must consider the length of disability, the expected functional outcome after salvage, and the lifestyle of the individual. Late salvage is by selective arthrodesis and realignment of mechanical relationships, followed by aggressive functional rehabilitation.