Treatment Of Foot Research Articles

Evaluation of Online AI-Generated Foot and Ankle Surgery Information

As a natural progression from educational pamphlets to the worldwide web, and now artificial intelligence (AI), OpenAI chatbots provide a simple way of obtaining pathology-specific patient information, however, little is known concerning the readability and quality of foot and ankle surgery information. This investigation compares such information using the commercially available OpenAI ChatGPT Chatbot and FootCareMD®. A list of common foot and ankle pathologies from FootCareMD® were queried and compared with similar results using ChatGPT. From both resources, the Flesch Reading Ease Score (FRES) and Flesch-Kincaid Grade Level (FKGL) scores were calculated for each condition. Qualitative analysis of each query was performed using the JAMA Benchmark Criteria Score and the DISCERN Score.The overall ChatGPT and FootCareMD® FRES scores were 31.12 ± 7.86 and 55.18 ± 7.27, respectively (p < .0001). The overall ChatGPT and FootCareMD® FKGL scores were 13.79 ± 1.22 and 9.60 ± 1.24 respectively (p < .0001), except for the pilon fracture FKGL scores (p = .09). The average JAMA Benchmark for all information obtained through ChatGPT and FootCareMD® were 0 ± 0 and 1.95 ± 0.15 (p < .001), respectively. The DISCERN Score for all information obtained through ChatGPT and FootCareMD® were 52.53 ± 5.39 and 66.93 ± 4.57 (p < .001), respectively. AI-assisted queries concerning common foot and ankle pathologies are written at a higher grade level and with less reliability and accuracy compared to similar information available on FootCareMD®. With the ease of use and increase in AI technology, consideration should be given to the nature and quality of information being shared with respect to the diagnosis and treatment of foot and ankle conditions.

AOFAS Diabetic Foot Survey Results

Introduction: Foot and ankle pathology in patients with diabetes mellitus is prevalent in the United States and may be associated with significant morbidity. Patient outcomes can be improved by optimal medical management; deformity management and correction to limit the development of infection and ulceration; and timely, appropriate treatment of infection and ulceration when it occurs. Orthopaedic foot and ankle surgeons are well-qualified to treat these patients, either individually or as members of a healthcare professional team. However, there are some healthcare professionals and members of the public who are under the impression that orthopaedic foot and ankle surgeon are either unwilling or uninterested in treating this patient population. The authors hypothesized that this impression was a misconception and this study was designed to address this question. Methods: An online survey was sent to 1376 AOFAS members practicing in the United States. There were six questions, two of which were demographic and one that asked for additional comments. The survey was completed by 297 (22%) members from 45 states and the District of Columbia. Results: Nonoperative treatment of foot and ankle disorders in patients with diabetes mellitus was performed by 98.7% of responders including 98.7% for fractures; 97.6% for common disorders (e.g., bunions, hammer toes, flatfeet, plantar fasciitis, osteoarthritis, tendon disorders); 89.9% for Charcot arthropathy; 77.1% for infections; and 69.0% for ulcers. Operative treatment of foot and ankle disorders in patients with diabetes mellitus was performed by 98.7% of responders including 97.0% for fracture fixation; 96.3% for gastrocnemius recession and/ or Achilles tendon lengthening; 94.6% for arthrodesis for osteoarthritis; 94.3% for hammer toe surgery; 92.6% for bunion surgery; 89.6% for Charcot exostectomy; 83.8% for Charcot reconstruction; 83.5% for amputations within foot; 81.1% for below knee amputations; 74.8% for operative debridement of infections/ ulcers; and 57.9% for total ankle replacement. When asked which healthcare professionals treat diabetic patients in their community, 96.6% listed podiatrists; 91.3% listed orthopaedic foot and ankle surgeons; 69.0% listed other MD/ DO surgeons (e.g. general, plastics, vascular); 64.0% listed nurses (e.g., APRN, wound care specialist); 37.4% listed other orthopaedic surgeons; 31.7% listed non- surgeon MD/ DO physicians; 32.3% listed physician assistants; and 2% listed other. Conclusion: The vast majority of orthopaedic foot and ankle surgeons practicing in the United States who responded to the survey provide operative and nonoperative treatment to patients with diabetes mellitus and foot and ankle disorders. Given the extensive medical education and training of orthopaedic foot and ankle surgeons, their knowledge and surgical skill, and the benefits patients with diabetes receive from appropriate and timely foot and ankle care, efforts should be made to educate the public and other healthcare professionals of the availability of most orthopaedic foot and ankle surgeons to provide this care.

Aneurismal bone cyst of the medial cuneiform bone: a case report of a new surgical approach and literature review

Introduction An aneurysmal bone cyst (ABC) is a rare, non-neoplastic, destructive, hemorrhagic, and expansile lesion accounting for 1 % of all bone tumors. ABC of the foot is very rare. Patients with foot ABC usually complain of pain and swelling of the affected area. Radiographs and MRI may be helpful in the diagnosis of ABC. No single surgical procedure has gained wide acceptance in the treatment of foot ABC.Purpose To show new effective surgical approach in the treatment of patient with ABC of the medial cuneiform bone.Material and methods We present the case of a 47-year-old woman with a 10-months history of pain and swelling in her right foot. Postoperative histopathological evaluation of resected tissues confirmed the diagnosis of ABC. An en bloc resection (total extraction of the remnant of the medial cuneiform bone) was performed and the defect was replaced with a fibular bone graft from the right leg. Allograft (Bio-Ost®) was placed along the autograft. Tibialis anterior tendon was attached to the fibular bone graft. We performed fixation of the foot and ankle using the Ilizarov original apparatus for prevention of bone graft instability and opportunity for early weight-bearing on the operated foot.Results The postoperative period was uncomplicated with complete healing of the bone defect without recurrence after 12 months of observation. AOFAS score increased significantly from 34 points preoperatively to 92 at 1-year follow-up.Discussion The optimal treatment of this lesion is still under discussion. Different treatment modalities have been described in the literature: wide resection, curettage with or without adjuvants, arterial embolization, intralesional sclerotherapy. Biological reconstruction using bone graft seems to be the best option, but fractures and nonunion are common complications of bone grafting.Conclusion The combination of Ilizarov external fixation and bone grafting provided favorable conditions for the healing of foot bone defect due to ABC without complications, allowed mobility and early weight-bearing of the patient. Recurrence was not detected radiologically. Harvesting of the fibular bone graft did not affect the position of the foot and its movements. Our surgical approach should be considered as a treatment option in similar cases.

UK Foot and Ankle Thrombo-Embolism Audit (UK-FATE): A Multicentre Prospective Study of Venous Thromboembolism in Foot and Ankle Surgery

Category: Other Introduction/Purpose: There is wide variation in the threshold and provision of thromboprophylaxis in the treatment of foot and ankle conditions. One of the difficulties in affecting change in practice in this area is the low incidence of postoperative, symptomatic VTE. Therefore, a large number of patients need to be included in any series for meaningful conclusions to be drawn. Primary objective To observe the UK-wide variation in post-operative thromboprophylaxis, and to analyse the 90-day incidence of symptomatic venous thrombo-embolism related to: -Elective foot and ankle surgery -Trauma foot and ankle surgery -Treatment of Achilles tendon ruptures (operative and non-operative) Methods: This was a multi-centre prospective audit spanning a collection duration of 9 months. Primary outcomes included symptomatic VTE up to 90 days following foot &amp; ankle surgery and Achilles tendon rupture and VTE related mortality up to 90 days following treatment. Secondary outcomes included methods of thromboprophylaxis used, and possible confounding variables and influencing factors for VTE. Results: A total of 10,983 patients were included from 56 sites in the UK. This was split into 51.72% trauma (n=5571), 3.78% diabetic surgery (n=415) and 45.18% elective surgery (n=4962). There was 95 VTE events across the whole cohort (0.86%). Diabetic foot disease surgery had the highest rate of VTE (Below knee amputation 5.3% and acute foot debridement 2.6%). The trauma diagnosis with the highest rate of VTE was Achilles tendon rupture (3.7%). All elective foot procedures had a VTE rate &lt; 1% except elective tendon procedure (1.1%). Factors with statistically significant association with VTE included trauma surgery where prophylaxis stopped greater than 1day pre surgery (p=.027), non-compliance with prophylaxis (p=.001), post-surgical infection (p=.005), and the comorbidities asthma (p=.014), cancer (p=.014), dementia (p=.001), diabetes (p=.005), stroke (p &lt; 0.001) and recent long-distance travel (p=.048). Conclusion: This is a large-scale multicentre study which recorded multiple possible confounding variables. There were 12 different chemical prophylaxis used across the study, with the highest rate of VTE in patients administered Apixaban (4.9%). The most common chemical prophylaxis used in the study was Enoxaparin (27.19%) followed by Dalteparin (20.38%). There was no evidence of a decrease in VTE if mechanical prophylaxis was used. The study identified specific diagnosis with increased risk of VTE and comorbidities.

Fractures and dislocations of the foot and ankle in people with diabetes: a literature review.

Diabetes (DM) increases fracture risk, and bone quality depends on type diabetes type, duration, and other comorbidities. Diabetes is associated with a 32% increased relative risk (RR) of total fractures and 24% increased RR of ankle fractures compared with patients without DM. Type 2 DM is associated with a 37% increased RR of foot fractures compared with patients without DM. The incidence of ankle fractures in the general population is 169/100,000 per year, while foot fractures occur less frequently, with an incidence of 142/100,000 per year. Biomechanical properties of bone are negatively impacted by stiff collagen, contributing to the increased risk of fragility fractures in patients with DM. Systemic elevation of proinflammatory cytokines, such as tumor necrosis factor-alpha (TNFα), interleukin-1β (IL-1β), and interleukin 6 (IL-6), impact bone healing in patients with DM. Fractures in patients with DM, can be associated with poorly regulated levels of RANKL (receptor activator of nuclear transcription factor kappa-b ligand) leading to prolonged osteoclastogenesis, and net bone resorption. One of the most salient factors in treating fractures and dislocations of the foot and ankle is to recognize the difference between patients with uncomplicated and complicated DM. Complicated diabetes is defined as 'end organ damage', and for the purposes of this review, includes patients with neuropathy, peripheral artery disease (PAD) and/or chronic renal disease. Uncomplicated diabetes is not associated with 'end organ damage'. Foot and ankle fractures in patients with complicated DM pose challenges, and surgery is associated with increased risks of impaired wound healing, delayed fracture healing, malunion, infection, surgical site infection, and revision surgery. While patients with uncomplicated DM can be treated like patients without DM, patients with complicated DM require close follow-up and robust fixation methods should be considered to withstand the anticipated prolonged healing period. The aims of this review are as follows: (1) to review pertinent aspects of DM bone physiology and fracture healing, (2) to review the recent literature on treatment of foot and ankle fractures in patients with complicated DM, and (3) to provide treatment protocols based on the recent published evidence.

Application of Amniotic Membrane Allograft in the Treatment of Foot and Ankle Pathologies: A Review of the Basic Science and Clinical Evidence

Application of Amniotic Membrane Allograft in the Treatment of Foot and Ankle Pathologies: A Review of the Basic Science and Clinical Evidence

Epidemiological Analysis of Foot and Ankle Injuries in Athletes: Experience of a Single Specialized Center

Category: Sports; Ankle Introduction/Purpose: The number of professional and amateur athletes has increased, consequently leading to an increase in the incidence of sports injuries. Understanding the epidemiological profile of foot and ankle's injuries in athletes is relevant for the prevention and treatment its occurrence. As far as we know, there is a lack of studies that report the epidemiological profile of athletes with foot and ankle disorders considering different sports. The aim of this study is to describe the epidemiology of foot and ankle injuries in athletes treated at an outpatient clinic specializing in injuries resulting from sports practice. The primary hypothesis is that ankle instability is the most frequent injury in athletes in the foot and ankle specialty outpatient clinic. Methods: Observational, retrospective, descriptive and comparative level IV of evidence study. The sample consisted of patients treated at an outpatient clinic specializing in foot and ankle injuries in sport, between January 1, 2015 and December 31, 2020. Three certified orthopedic physicians reviewed the charts and documented patient demographics, sport, diagnosis and lesion laterality. Age was analyzed according to age groups. The inclusion criteria were patients practicing amateurs or sports professionals of all age groups. We only count the first visits and the main modality and diagnosis of the patient. Exclusion criteria were insufficient data documented in chart, injuries that did not occur secondary to sports practice, and patients with conditions unrelated to the ankle and foot. Statistical analyzes were performed using software: SPSS V20, Minitab 16 and Excel Office 2010. We performed a multivariate logistic regression analysis to verify the association of gender, age and laterality with the main injuries documented. Results: A total of 763 patients (387 men and 376 women) met the inclusion criteria. The mean age was 35 years (SD= +-14.1; min=8.9; max=77). The most prevalent age group was young adults with 51.7% and the least prevalent was children with 1.4%. The most prevalent diseases were chronic lateral ankle instability (n=134, 17.6%), acute lateral ankle sprain (n=120, 15.7%) and plantar fasciitis (n=69, 9%). The multivariable analysis by logistic regression identified as a risk factor for lateral ankle instability the age group of young adults and females. In acute lateral ankle sprain, age was identified as a risk factor with statistical significance. In overuse injuries, only the female gender was evidenced as a risk factor. In non-insertional Achilles tendinopathy, bilaterality was associated as a risk factor with disease while in insertional Achilles tendinopathy, only the male gender was identified as a risk factor, as well as in Achilles tendon rupture. Conclusion: The literature specifically describing foot and ankle injuries during sport is limited, despite being highly prevalent injuries. Our work correlated several factors such as age, gender and laterality with specific sports through multivariate analysis, adding epidemiological data to the literature that help in the prevention and treatment of foot and ankle injuries in sports.

Application of perforator propeller flap of lower limb in the treatment of foot and ankle defect in children

To investigate the effectiveness of perforator propeller flap of lower limb in the treatment of foot and ankle defect in children. The clinical data of 28 children with foot and ankle defect treated with perforator propeller flap of lower limb between January 2018 and January 2021 were retrospectively analyzed. There were 18 boys and 10 girls with an average age of 7.3 years (range, 6-14 years). There were 8 cases of traffic accident injury and 20 cases of chronic infection wound. The disease duration was 2-4 months, with an average of 2.8 months. After thorough debridement, the residual wound size ranged from 5 cm×4 cm to 9 cm×5 cm. Repairing was performed after 7-28 days of the infection in control. According to the location, size, and shape of the wound, the perforating vessels were located by ultrasonic Doppler, and the perforator propeller flap (area ranged from 6 cm×5 cm to 11 cm×6 cm) was designed and harvested to repair the wound. Flap transfer combined with free split-thickness skin graft covered the wound in 2 cases. The donor site was sutured directly (22 cases) or repaired with skin graft (6 cases). Twenty-six flaps survived, of which 20 cases were in primary healing, and 6 cases had epidermal necrosis at the end of small paddle, which healed after dressing change. Necrosis occurred in 2 cases due to venous crisis which healed after anterolateral femoral flap free transplantation. Primary wound healing was achieved in donor site. All 28 children were followed up 6-24 months (mean, 10.5 months). The texture, shape, and motor function of the lower limb was satisfactory. At last follow-up, the American Orthopaedic Foot and Ankle Association (AOFAS) score was 89.8±8.0, which was significantly different from the preoperative score (79.6±10.4) ( t=-11.205, P<0.001); 20 cases were excellent, 6 cases were good, and 2 cases were poor, and the excellent and good rate was 92.8%. The perforator propeller flap of lower limb in children has its own characteristics. It is a reliable method to repair the foot and ankle defect in children.

A Scoping Review Regarding the Treatment of Foot and Ankle Ganglia

Category:OtherIntroduction/Purpose:Ganglion cysts are a well documented phenomena occurring in a variety of joints. They are described as a tumour like lesion filled with mucopolysaccharides. The majority occur in the hand and wrist (88%) with a small yet significant minority occurring in the foot and ankle (11%). Currently, there is a lack of high-quality literature regarding the management of ganglia in the foot and ankle region. Therefore this scoping review aims to systematically map and summarise current evidence regarding the management of ganglia of the foot and ankle, whilst identifying areas for further research.Methods:This scoping review follows the methodology outlined by Arksey and O'Malley, Levac, the Joanna Briggs Institute and PRISMA framework.. A detailed search strategy was used to identify relevant articles using free text terms such as 'foot' 'ankle' 'ganglion' 'ganglia' 'ganglionic cyst'. This was carried out in four electronic databases; PubMed, EMBASE, CINAHL and Ovid MEDLINE. A stage two-stage independent screening process based and title and/or abstract then full-text was carried our by two reviewers. The a-priori selection criteria included all primary research (observational studies and randomised control trials) whilst excluding (case reports, letters to editors, editorials, commentaries and review articles). Studies that did not separate the treatment of foot and ankle tumours from ganglia were excluded. The MINORS criteria were used to assess methodological quality of included studies.Results:In total, 2286 unique articles were initially identified, from which 11 met the criteria for inclusion. A variety of conservative and surgical treatment strategies were reported. The use of surgical excision was reported in all 11 studies, ten of which via an open surgical approach, with only one study using an endoscopic approach. The use of conservative treatments, involving aspiration and/or steroid injection, were reported in only 5 studies. As for the recurrence rate, 7 studies reported a rate of 5.7% - 65.7%, with an overall pooled recurrence rate of 30.6%. Pooled recurrence rates showed that surgical excisions were associated with a lower recurrence rate than conservative treatments. Complications other than occurrence were described in 6 studies. Only 3 studies performed an analysis of outcomes based on the location or site of origin of ganglia.Conclusion:The current literature regarding the treatment of foot and ankle ganglia is of a low-quality, as the articles included in this scoping review are level III or IV cohort or case series design. The literature alludes to the idea that a surgical approach provides greater efficacy than a conservative approach. There is also limited evidence to suggest that factors such as the origin or location of ganglia may affect treatment outcomes. Alternative approaches utilised in the treatment of wrist ganglia are yet to be investigated. Further research is required before more definitive conclusions into any such associations may be drawn.

Marked Mobility Improvement: Men and Women Respond Similarly to Operative Treatment of Foot &amp; Ankle Pathologies

Category:Ankle; HindfootIntroduction/Purpose:Differences between men and women in the perception, incidence, and outcomes of various orthopaedic injuries are well-documented. Recent studies have noted that women display increased ankle ligamentous laxity and double the rate of ankle sprains in relation to their male peers. Current studies indicate that, in general, women and men respond similarly to surgical correction of such pathologies. However, a gender difference in mobility has not been investigated. Given the mobility implications associated with chronic foot and ankle conditions, a need exists to better characterize baseline and postoperative functionality in men and women. The objective of this study was to assess changes in LifeSpace Mobility Assessment (LSA) scores of male and female patients following surgical correction of non-traumatic ankle, hindfoot, and midfoot conditions.Methods:A prospective study of elective ankle, hindfoot, and midfoot procedures conducted by a single surgeon between September 1, 2015 and August 31, 2019 was undertaken following IRB approval. LSA scores on 184 patients - 137 women and 53 men - were collected at preoperative, 3-month, 6-month, and 12-month clinic visits. The electronic medical record was queried for patient demographic and surgical data. Demographics, surgical factors, and patient-reported LSA scores were compared utilizing an independent sample t-test for continuous, normally distributed data. All categorical data was analyzed with a chi- squared or Fischer's exact tests. Alpha and beta were set at 0.05 and 0.8, respectively.Results:The average age of female participants was 51.2 (SD 16.4) years and 48.2 (SD 17.1) years for male participants (p=0.273). There were no significant differences in frequencies of comorbidities (p>0.05). Men and women in this cohort underwent elective foot and ankle surgery for a similar diseases processes, most commonly soft tissue pathology, followed by osteoarthritis (p=0.440). Women had significantly lower LSA scores at preoperative (63.7 [SD 38.1] vs. 84.8 [SD 35.9], p=0.002), 3 month postoperative (52.5 [SD 33.8] vs. 69.9 [SD 34.5], p=0.006), and 1 year postoperative (81.2 [SD 37.2] vs. 105.5 [SD 18.2], p=0.019) timepoints relative to their male peers. No differences in mobility at 6 months postop were observed (p=0.714). Overall, women and men had similar absolute increases in postoperative mobility at 1-year after surgery (17.5 vs. 20.7, p>0.05) as well as similar percentage of increased mobility (27% vs. 24%, p>0.05).Conclusion:The present study provides further evidence of the gender differences in chronic foot and ankle pathologies. Both sexes improved similarly pre to postoperatively, however, women did not reach the same level of absolute mobility as their male counterparts. Prior studies have shown that women characterize a greater degree of limitation with foot and ankle conditions as 'normal' relative to men, making it plausible that they delay treatment until they become more severely symptomatic than men. This persistent deficit highlights the importance of early recognition of mobility impairment in order to preserve function among the sexes in foot and ankle care.

The SUPERankle procedure in the treatment of foot and ankle deformities in fibular hemimelia

Objective: To review indications for limb amputation or reconstruction using the SUPERankle procedure in patients diagnosed with Paley type 3 or 4 fibular hemimelia; To evaluate the correction of deformities needed to achieve a stable plantigrade foot, review variations of the original technique and their applicability, and describe challenges encountered in their execution. Methods: Qualitative, retrospective, descriptive study of 4 patients who underwent the SUPERankle procedure between 2019 and 2020 for treatment of foot and ankle deformities in fibular hemimelia. Pre- and postoperative clinical and radiographic evaluations were performed to identify objective evidence of the correction of foot and ankle deformities. The operative techniques employed are described. Results: The included patients met anatomical and psychosocial criteria for reconstruction, as established in the literature. Clinical correction of foot and ankle deformities was achieved, but on radiographic evaluation, there was no statistical difference; this was likely due to the small number of patients, given the rarity of fibular hemimelia. Conclusion: The procedure is reproducible, but requires a knowledgeable, well-trained surgical team. Correction of foot and ankle deformities can be achieved. The choice between amputation or reconstruction should be the result of an informed decision by Family members, supported by a multidisciplinary team. Level of Evidence IV; Qualitative Study; Case Series.

Diagnosis and treatment of congenital vertical talus in children under 3 years old (review)

Congenital vertical ram is a rare pathology, the incidence of it is 1 case per 10 thousand newborns. This anomaly is usually manifested by a severe planovalgus deformity of the foot. Moreover, it is often (in 50% of cases) associated with chromosomal syndromes (arthrogryposis, neurofibromatosis, myelodysplasia, etc.), with spinal, neuromuscular anomalies of development. As a result, it is necessary to focus the attention of pediatric orthopedists and radiologists on the parameters of the diagnosis in order to reduce false diagnoses and unreasonable surgical interventions in children, show options for surgical techniques for the treatment of feet with an inborn vertical position of the talus in children under 3 years. The presented review of domestic and foreign literature demonstrates the main advantages and disadvantages of existing approaches in the treatment of children under 3 years of age with congenital vertical ram. Demonstrate the main advantages and disadvantages of existing approaches in the treatment of this pathology. Analysis of the literature showed that the causes of the formation of the congenital vertical talus are not fully explored. In Russia, up to the present moment, its diagnosis is still difficult. Congenital vertical talus is one of the rare problems in world orthopedic practice in comparison with congenital clubfoot, but doctors who are constantly treating children with deformities of the feet have such patients regularly.

Functional assessment of foot and ankle tendinopathies treated with tendoscopy

Objective: To assess postoperative clinical functional outcomes, based on the American Orthopaedic Foot &amp; Ankle Society (AOFAS) score, of tendoscopies performed in the treatment of foot and ankle pathologies. Methods: Our comparative assessment used AOFAS scores obtained preoperatively and at early and late postoperative stages - 1 month and 6 to 12 months after surgery - of 14 patients with foot and ankle tendinopathies. These included peroneal tendon dislocation, peroneal tendonitis, and tearing of the peroneus longus or brevis, all treated with tendoscopy for peroneal reconstruction and tenorrhaphy. The AOFAS score was obtained by functional assessment during outpatient physical examination. We presented a descriptive analysis of cases, comparing scores over time through the Friedman test followed by Dunn’s test. The relationship between score variations and sex was assessed using the Mann-Whitney test; their comparison with age used Spearman’s linear correlation coefficient. Significance levels were 5%.Results: The AOFAS score showed important improvements such as preoperative scores of 56 and 67 followed by postoperative scores of 100 both in the early and late stages, supporting the efficacy and persistence of this treatment strategy. The p-value obtained after statistical analysis was &lt;0.0001. Conclusion: We concluded that the treatment of foot and ankle comorbidities with tendoscopy, in addition to being less invasive, shows consistency and efficacy as demonstrated by the AOFAS score and functional assessment via postoperative physical examinations. AOFAS scores were increased and maintained at high levels in the postoperative period, demonstrating the efficacy of this procedure and the duration of treatment results. Level of Evidence IV; Case Series; Therapeutic Studies - Investigation of Treatment Results.

ANKLE ARTHROSCOPY IN POST TRAUMATIC ANKLE PAIN

Background: The clinical use of ankle arthroscopy for diagnosis and treatment of foot and ankle disorders has increased over the last few decades, it may seem novel to those unfamiliar to this technique. The recent advances in the equipment as well as sound knowledge of the anatomy of the portals required for safe scope insertion have made a possible number of diagnostic and therapeutic procedures. Aim: to give a good, efficient and radical minimal invasive solution to the chronic post traumatic ankle pain, Also we can perform an arthroscopic assisted ankle arthrodesis. Methods: This study was conducted on 25 patients with post traumatic ankle pain. They were being collected from the orthopedic department of Benha University and orthopedic department of Railway hospital. Results: Majority of cases were males by 72%, Mean ± SD of age was 37.52 ± 11.87 and majority of cases had right side lesion by 72%. There was highly statistically significant difference between preoperative and postoperative regarding diagnosis score with better score postoperative. 80% of cases had no complications, 4% had Subchonfrs sclerosis, 4% had RSD well early, and 4% had Fair mild pain + mild swelling. Conclusion: Arthroscopic management of post-traumatic ankle pain was indicated if the history and clinical examination are suggestive, arthroscopy proved to be effective for confirming the diagnosis and for treatment.

Managing the Neglected and the Residual Clubfeet with the New Operative Procedure (Hussain’s Procedure) – An Experience of Six-Month Fellowship

Background: Pakistan Society for Rehabilitation of the Disabled Orthopedic Hospital is renowned for the correction of orthopedic deformities including foot and ankle deformities. Dr. Afzal Hussain, a consultant orthopedic surgeon in the hospital, pioneers in treatment of foot and ankle deformities and he has developed a new operative procedure for congenital clubfoot. Working with the surgeon for 6 months during the fellowship, management of the neglected and the residual congenital clubfeet with the new operative procedure and their follow-ups were assisted by the first author.&#x0D; Materials and Methods: Operative procedure of the neglected and the residual congenital clubfeet, which were performed with the new operative procedure by Dr. Hussain, were assisted by the first author and a minimum of 5 years follow up was done by the senior author (Afzal Hussain). Cumming’s modification of Laavag and Ponseti score was applied for the calculation of the results at the follow-ups.&#x0D; Results: During the follow-ups of 11 cases of neglected congenital clubfeet and 9 cases of residual clubfeet (operated earlier with posteromedial release) which had been operated by the new operative procedure, Cumming’s modification of Laavag and Ponseti scores of the operated clubfeet were calculated and the results were found to be excellent.&#x0D; Conclusion: Early results of the new operative procedure by Dr. Afzal Hussain for congenital clubfoot in the neglected and the residual congenital clubfeet were found to be excellent.

Foot and Ankle Injections in Athletes.

Injections are commonly used by health care practitioners to treat foot and ankle injuries in athletes despite ongoing questions regarding efficacy and safety. An extensive literature review was performed through MEDLINE, Google Scholar, and EBSCOhost from database inception to 2021. Keywords searched were injections, athletes, sports, foot and ankle, corticosteroids, platelet-rich plasma, and placental tissue. Search results included articles written in the English language and encompassed reviews, case series, empirical studies, and basic science articles. Clinical review. Level 4. Corticosteroids, platelet-rich plasma/autologous blood, anesthetic, and placental tissue injections are commonly used in the treatment of foot and ankle injuries. Primary indications for injections in athletes include plantar fasciitis, Achilles tendinosis, isolated syndesmotic injury, and ankle impingement with varying clinical results. Despite promising results from limited case series and comparative studies, the data for safety and efficacy of injections for foot and ankle injuries in athletes remain inconclusive.

Treatment of Foot and Ankle Infection with Antibiotic Cement Spacer

Treatment of Foot and Ankle Infection with Antibiotic Cement Spacer

Application of 3D biological nano scaffold materials in the health treatment of foot and ankle sports

Bone tissue is an important part of the human body and plays an indispensable physiological function. Damage to bone tissue will have a serious impact on the health of patients. Three types of MGPC scaffolds were prepared using 3D printing technology. The macroscopic, microstructure, and histology of the three scaffolds were observed under an electron microscope. The cells grew normally and spread well. Rat L-929 fibroblasts were cultured in three scaffold extracts, and the cells were cultured with DMEM as a control. Cell proliferation was detected by cell counting. Scanning electron microscopy of the cell-scaffold complex revealed that a large number of chondrocytes adhered and grew on the surface of the MGPC scaffold. With the increase of culture time, the number of cells in each group showed an increasing trend. MGPC has no cytotoxicity, excellent physical and chemical properties, and is expected to become a biological scaffold material.

Extensor Tendon Transfers for Treatment of Foot Drop in Charcot-Marie-Tooth Disease: A Biomechanical Evaluation

Category:Midfoot/Forefoot; Ankle; Lesser Toes; OtherIntroduction/Purpose:Transfer of the Extensor hallucis longus (EHL) and extensor digitorum longus (EDL) tendons is an underutilized procedure for the treatment of drop foot in patients with Charcot-Marie-Tooth disease (CMT). Transfer of these tendons should be considered for augmentation of ankle dorsiflexion in the CMT population, regardless of the presence of clawed toes. The preferred site for tendon transfer, however, remains unknown. We hypothesized that EHL/EDL transfers will improve ankle dorsiflexion compared to the intact state but will produce similar motion at either the metatarsal necks or cuneiforms.Methods:Eight fresh-frozen cadaveric specimens transected at the mid-tibia were mounted into a specialized jig with the ankle held in 20 degrees of plantarflexion. The EHL and EDL tendons were isolated and connected to linear actuators with suture. Diodes secured on the 1st metatarsal, 5th metatarsal and tibia provided optical data for tibiopedal position in 3-dimensions. After preloading, the tendons were tested at 25%, 50%, 75% and 100% of maximal physiologic force for the EHL and EDL muscles, individually and combined.Results:Transfers to metatarsal and cuneiform locations significantly improved ankle dorsiflexion compared to the intact state. No difference was observed between these transfer sites. Following transfer, only 25% of maximal force by combined EHL and EDL was required to achieve a neutral foot position.Conclusion:Transfer of the long toe extensors, into either the metatarsals or cuneiforms, significantly increases dorsiflexion of the ankle. Transfer should be considered for augmentation of dorsiflexion in the CMT population, regardless of the presence of clawed toes. This study supports tendon transfers into the cuneiforms, which involves less time, fewer steps and easier tendon balancing without compromising dorsiflexion power.

Basic Clinical Examination of the Foot and Ankle.

Successful treatment of foot and ankle diseases requires an accurate diagnosis. In addition to differentiated history taking, clinical examination is the most important component in the diagnosis of foot and ankle diseases. The present video explains the common provocation tests and functional tests that are used in the basic clinical examination of the foot and ankle complex. In addition to general inspection and palpation, the focus is on different diagnostic tests and clinical signs that improve diagnostic accuracy. The present basic clinical examination methods allow a structured approach to clinical issues and can be a good basis, if supplemented by further specific and individual tests.