Visual Analogue Scale Foot And Ankle Research Articles

Open Reduction Internal Fixation vs Primary Arthrodesis for Displaced Lisfranc Injuries: A Multicenter Randomized Controlled Trial.

There is no consensus whether the primary surgical method should be open reduction and internal fixation (ORIF) or primary arthrodesis (PA) for Lisfranc injuries. The aim of our randomized controlled trial was to compare ORIF and PA for displaced Lisfranc injuries. This study was a national multicenter randomized controlled trial. Altogether 43 displaced Lisfranc injuries were enrolled in this trial. The primary outcome measure was Visual Analogue Scale Foot and Ankle (VAS-FA) at a 24-months follow-up. The secondary outcome measures were VAS-FA pain, function, and other complaints subscales and the American Orthopaedic Foot & Ankle Society (AOFAS) Midfoot Scale. All outcomes were measured at 6, 12, and 24 months. We were unable to reach the planned sample size of 60 patients; thus, the study remains underpowered. The mean VAS-FA Overall score in the ORIF group was 86.5 (95% CI 77.9, 95.1) and 80.1 (95% CI 72.0, 88.1) in the PA group at the 24-month follow-up. We did not find eligible evidence of a difference in VAS-FA Overall scores (mean between-group difference 6.5 [95% CI -5.3, 18.2], Cohen d = 0.100). We did not find evidence of a difference in VAS-FA between ORIF and PA in patients with displaced Lisfranc injuries, and thus both are viable options for the initial surgical method. The trial is underpowered; however, the data may be included in a meta-analysis of similarly designed randomized controlled trials. ClinicalTrials.gov identifier: NCT02953067 24 October 2016. Level I, randomized controlled trial.

Patient-Reported Outcomes after Long-Term Follow-Up of Lisfranc Injuries Treated with Open Reduction Internal Fixation

Category:Midfoot/Forefoot; TraumaIntroduction/Purpose:Lisfranc injuries are thought to contribute to debilitating outcomes in polytrauma patients. Due to the relative rarity of Lisfranc injuries, consistent long-term follow-up is a challenge and clinical outcomes are difficult to assess in this patient population. As a result, there exists a need for further investigation into patient-related clinical outcomes after Lisfranc injury. The purpose of this study was to collect long-term clinical outcome data following Lisfranc injuries using PROMIS Physical Function (PROMIS-PF) and Visual Analogue Scale-Foot and Ankle (VAS-FA).Methods:A chart review was performed to identify all patients who had surgical treatment of an acute Lisfranc injury at our institution from 2005 to 2014. Of forty-five patients identified, we were able to recruit nineteen for a follow-up clinic visit consisting of a physical exam, administration of questionnaires addressing pain and medication usage, radiographs, and completion of outcome surveys including PROMIS-Physical Function and Visual Analogue Scale-Foot and Ankle.Results:There were 14 female and 5 male patients enrolled in the study with a mean time of 6.25 years from the time of injury. Within this cohort, the mean PROMIS-PF score was 52.4+-8.2 and the mean VAS-Foot and Ankle Score was 76.6+-22.3. The risk factors of age, gender, BMI, smoking status, depression, and time from injury showed no statistically significant association with PROMIS-PF or VAS-FA scores using p<0.05 (Table 1).Conclusion:We report satisfactory long-term patient-reported outcomes using PROMIS-PF and VAS-FA independent of several risk factors. However, the small sample size and observational nature of our study contributed to the lack of significance in the data and limit our ability to further infer which patients would be expected to do worse postoperatively.

Comparison of Self-adhesive Taping and Short-Leg Casting to Treat Tuberosity Fractures of the Proximal Fifth Metatarsal: A Prospective Study.

The aim of this study is to compare clinical and radiologic outcomes of self-adhesive taping (SAT) or a short- leg cast (SLC) groups with base of fifth metatarsi. Functional outcome was assessed by the Visual-Analogue-Scale Foot and Ankle (VAS-FA) at the Emergency and at 2, 4, 6, and 12 weeks. Labour loss, bone union and The American Orthopedic Foot and Ankle Score (AOFAS) at 12 weeks were also assessed. There was no difference between the SAT group and SLC group in VAS-FA scores at time of injury, 6 and 12 weeks. The SAT group had a significantly higher mean VAS-FA score at the second and fourth weeks of follow-up compared with the SLC group (P = .001 and P = .039, respectively). No correlation was observed between the fracture gap and functional scores for both groups. There was no difference in AOFAS between two groups at 12 weeks. Twenty one patients were unable to work for a mean of 38.2 days during the treatment. 10 patients with the SAT missed 37.5 days and eleven patients with the SLC g missed 40.2 (p: 0.41). The bone union was also achieved for all patients within 12 weeks. Treatment with SAT in these fractures had satisfactory functional results compared with traditional SLC. Although there were no significant differences in labor loss and use of assistive devices, The VAS-FA score was significantly higher in SAT group than the SLC group at the second and fourth weeks of treatment.

Foot fractures and complex trauma of the foot: a case series.

Foot fractures are common injuries. This retrospective study evaluates their frequency, incidence, treatment and outcomes with emphasis on complex trauma of the foot (CTF), an injury that affects soft tissue as well as bone. From 2005 to 2015, 506 patients with foot fractures were treated at our institution; of these, 27 had CTF. The Zwipp score was applied to diagnose CTF, the Gustilo-Anderson classification to grade open fractures and the Tscherne classification to grade closed fractures. Twelve months after the trauma, 20 CTF patients underwent the final X-ray assessment and clinical evaluation with the Visual Analogue Scale Foot and Ankle (VASFA), the Foot Function Index (FFI) and the 12-Item Short Form Survey (SF-12). Data were analyzed with the Spearman rank correlation test. The forefoot was the most frequently involved compartment both in patients with foot fracture and in those with CTF. At 12-month follow-up, the CTF patients showed a VASFA score of 51.5, an FFI of 47.5 and SF-12 scores of 37.9 (physical component summary) and 45.2 (mental component summary). The VASFA score and the FFI showed a significant correlation (rs = 0.84; p = 0.001). CTF is the cause of considerable residual disability and deeply affects quality of life.

Minimal important change for the visual analogue scale foot and ankle (VAS-FA)

BackgroundVisual analogue scale foot and ankle (VAS-FA) is a patient-reported outcome measure for foot and ankle disorders. The VAS-FA is validated into several languages and well adopted into use. Nonetheless, minimal important change (MIC) for the VAS-FA has not been estimated thus far. MethodsThe VAS-FA score was obtained from 106 patients undergoing surgery for various foot and ankle complaints. MIC was estimated using an anchor-based predictive method. ResultsThe adjusted MIC was 6.8 for total VAS-FA score, and 9.3 for the Pain, 5.8 for the Function, and 5.7 for the Other complaints subscales. The VAS-FA score was found to separate improvement and deterioration in patients’ foot and ankle condition. ConclusionsMIC was successfully defined for the VAS-FA in the current study. The VAS-FA can be used to evaluate foot and ankle patients’ clinical foot and ankle status and its change. Further research on estimating disease-specific MICs is recommended.

Validity of five foot and ankle specific electronic patient-reported outcome (ePRO) instruments in patients undergoing elective orthopedic foot or ankle surgery

BackgroundPatient-reported outcomes (PROs) are widely accepted measures for evaluating outcomes of surgical interventions. As patient-reported information is stored in electronic health records, it is essential that there are valid electronic PRO (ePRO) instruments available for clinicians and researchers. The aim of this study was to evaluate the validity of electronic versions of five widely used foot and ankle specific PRO instruments. MethodsAltogether 111 consecutive elective foot/ankle surgery patients were invited face-to-face to participate in this study. Patients completed electronic versions of the Foot and Ankle Ability Measure (FAAM), the Foot and Ankle Outcome Score (FAOS), the modified Lower Extremity Function Scale (LEFS), the Manchester–Oxford Foot Questionnaire (MOXFQ), and the Visual Analogue Scale Foot and Ankle (VAS-FA) on the day of elective foot and/or ankle surgery. Construct validity, coverage, and targeting of the scales were assessed. ResultsBased on general and predefined thresholds, construct validity, coverage, and targeting of the ePRO versions of the FAAM, the FAOS, the MOXFQ, and the VAS-FA were acceptable. Major issues arose with score distribution and convergent validity of the modified LEFS instrument. ConclusionsThe ePRO versions of the FAAM, the FAOS, the MOXFQ, and the VAS-FA provide valid scores for foot and ankle patients. However, our findings do not support the use of the modified LEFS as an electronic outcome measure for patients with orthopedic foot and/or ankle pathologies.

Validity and internal consistency of the American Orthopaedic Foot and Ankle Society Midfoot Scale in patients with Lisfranc injury

BackgroundThe American Orthopaedic Foot and Ankle Society (AOFAS) Midfoot Scale is an extensively used outcome measure instrument for evaluating outcomes after foot and ankle surgery or trauma. MethodsIn total, 117 patients with Lisfranc injury completed the AOFAS Midfoot Scale and the Visual Analogue Scale Foot and Ankle (VAS-FA) instruments. Internal consistency (correlation between different items), floor and ceiling values, convergent validity, item threshold distribution, and the coverage (item difficulty) of the AOFAS Midfoot scale were tested. ResultsAOFAS Midfoot Scale had high convergent validity and acceptable internal consistency (Cronbach’s alpha >0.70). The ceiling effect was confirmed. The person-item distribution indicated that the scale had a lack of coverage and targeting in our sample. ConclusionsOur data suggests that the AOFAS Midfoot Scale has acceptable validity and internal consistency. However, due to the lack of coverage and targeting, it should not be the primary outcome measure to be used to evaluate the outcomes after Lisfranc injury in the future studies.

Fractures to the anterior process of the calcaneus – Clinical results following functional treatment

BackgroundFractures to the anterior process of the calcaneus (APC) have long been considered rare injuries. Although recent studies have reported a higher incidence, these injuries have yet received little attention in clinical research. Only few case reports/series, all suffering multiple methodical shortcomings, exist. The aim of this study was to objectively evaluate the outcome after fractures to the APC treated by full weight bearing and to investigate the influence of fracture characteristics. MethodsRetrospective register study with prospective follow-up. Adults with acute unilateral fractures to the APC and concomitant injuries limited to the Chopart joint line, treated by full weight-bearing, with a follow-up of ≥ 12 months were included. Fracture characteristics (Degan classification, displacement, intra-articular involvement, comminution) were assessed in CT scans. Return to work (RTW) / sports (RTS), Visual Analogue Scale Foot and Ankle (VAS-FA), Karlsson Score and the 12-Item Short-Form Health Survey (SF-12) were assessed. The influence of age, sex, fracture type/characteristics, and concomitant injuries on the outcome parameters was analyzed. Results27 patients (38 years, IQR 29-58), 74% female with a median follow up of 24 months (IQR 16-41) were included. 56% of the fractures were non-displaced and 82% comminuted. 48% were type I, 33% type II and 19% type III according to Degan. 78% of the patients suffered concomitant injuries of the Chopart joint line. Median RTW was 14 days (IQR 10-42), and RTS 90 days (IQR 30-180). The clinical outcome resulted in a median overall VAS-FA of 95 (IQR 89-98), Karlsson Score of 90 (IQR 82-100) and SF-12 PCS of 56 (IQR 53-58) / SF-12 MCS 55 (48-58). ConclusionFunctional treatment of fractures to the anterior process of the calcaneus yielded good to excellent results and a fast return to work in the vast majority of patients. Yet, a prolonged return to sports was noted. No significant differences regarding the outcome were observed when comparing the different fracture types or any other fracture characteristic assessed.

Assessment of the structural validity of three foot and ankle specific patient-reported outcome measures

BackgroundThe structural validity of the Lower extremity functional scale (LEFS), the Visual analogue scale foot and ankle (VAS-FA), and the Western Ontario and McMaster Universities osteoarthritis index (WOMAC) has not been compared earlier in patients after foot and ankle surgery. MethodsAltogether 165 previously operated patients completed the foot and ankle specific instruments, the 15D health-related quality of life (HRQoL) instrument, and general health (VAS). ResultsThe LEFS, the VAS-FA and the WOMAC had slight differences in their measurement properties. The VAS-FA had the best targeting and coverage. All three foot and ankle measures accounted for mobility and usual activities when compared to the different aspects of generic HRQoL. ConclusionsThe LEFS, the VAS-FA and the WOMAC have relatively similar psychometric properties among foot and ankle patients, yet the VAS-FA provides the best targeting and coverage.

Nonoperative, open reduction and internal fixation or primary arthrodesis in the treatment of Lisfranc injuries: a prospective, randomized, multicenter trial \u2013 study protocol

BackgroundLisfranc injuries are known to be rare and often overlooked injuries that can cause long-term disability and pain when missed or treated incorrectly. The wide variety of Lisfranc injuries ranges from subtle ligament distensions to open fracture dislocations. The treatment of Lisfranc joint injuries is still controversial and very little is known about what types of injury can be treated nonoperatively. The current literature provides only two randomized studies on dislocated Lisfranc injuries. These studies have shown that primary arthrodesis (PA) leads to a similar or better outcome and results in fewer secondary operations when compared with open reduction and internal fixation (ORIF) in ligamentous injuries. There have been no previous randomized studies of the nonoperative versus operative treatment of Lisfranc injuries. Therefore, the purpose of this study is to compare the operative and nonoperative treatment of non-dislocated Lisfranc injuries and to compare the ORIF and PA treatment of dislocated Lisfranc injuries.MethodsThis study is a prospective, randomized, national multi-center trial. The trial comprises two strata: Stratum I compares cast-immobilization versus open reduction and internal fixation (ORIF) treatment of non-dislocated Lisfranc joint injuries. Stratum II compares PA versus ORIF in the treatment of dislocated injuries of the Lisfranc joint. The main hypothesis of stratum I is that the nonoperative treatment of non-dislocated Lisfranc injuries achieves a similar outcome compared with operative treatment (ORIF). The hypothesis of stratum II is that PA of dislocated Lisfranc injuries yields a similar functional outcome compared with ORIF, but that PA results in fewer secondary operations than ORIF. The main outcome measure is the American Orthopaedic Foot and Ankle Society (AOFAS) Midfoot score and the secondary outcome measures are Visual-Analogue-Scale Foot and Ankle (VAS-FA), Visual-Analogue-Scale (VAS), rate of secondary operations and other treatment-related complications. The results will be analyzed after the 2-year follow-up period.DiscussionThis publication presents a prospective, randomized, national multi-center trial study protocol. It provides details of patient flow, randomization, aftercare and methods of analysis of the material and ways to present and publish the results.Trial registrationClinicalTrials.gov identifier: NCT02953067 24.10.2016.

Patient Satisfaction versus Patient Reported Outcomes

Category: Other Introduction/Purpose: Several researches focused on patient reported outcomes (PROs), however, little is known about the actual correlation between the patient satisfaction and PROs. The present study is to determine the correlation between patient satisfaction and PROs. Methods: A total of 35 patients with foot and ankle disability participated in this study to complete the data in terms of the patient satisfaction score and PROs. All of them were treated by a single foot and ankle surgeon. The Thai patient satisfaction score or Foot and Ankle Satisfaction Score [FASS] (0 [worst] -100 [best]) consisted of 4 items regarding patient’s perspectives as 1) symptoms, 2) function, 3) other complaints, and 4) recommendation of his/her treatment for other patients. PROs measures consisted of validated Thai visual analogue scale foot and ankle (VASFA) (0 [worst] -100 [best]) and Thai Short Form-36 (SF-36) (0 [worst] -100 [best]). Results: Mean total FASS was 92.0 ± 11.8, 87.7 ± 17.0, 98.6 ± 6.0, 98.6 ± 8.5 and for the items: symptoms, function, other complaints, and recommendation of his/her treatment for other patients, respectively. Mean total FASS was 94.2 ± 6.8. Mean VASFA was 67.7 ± 18.3. Mean SF-36 was 82.7 ± 10.7.There were no significant correlations between mean total FASS and PROs (VASFA [p-value &lt; 0.05], SF-36 [p-value &lt;0.05]). There were no significant correlations between mean FASS in all items and PROs (VASFA, SF-36) with all p-values &lt; 0.05. The significant correlation was found between VASFA and SF-36 (Pearson correlation coefficient = 0.734; p-value&lt;0.01). Conclusion: One of the successful treatment results is the improvement of patient satisfaction. Even if several researches focused on the assessment of PROs to achieve the successful outcome, this kind of measures was no significant correlation with patient satisfaction. PROs were not able to reflect the patient satisfaction following treatments. Patient satisfaction may be related to other parameters, in addition to the PROs, such as the patient expectation, the post-treatment level of physician-patient relationship, the patient’s confidence in his/her physician capability, etc. Further study is needed to clarify these factors.

The relationships between patient-reported outcome, quality of life, and gait characteristics using a wearable foot inertial-sensor assessment in patients with foot and ankle conditions

Category: Gait analysis Introduction/Purpose: The purpose of this study was to report the relationships between validated patient-reported outcome, health-related quality of life, and gait characteristics using a wearable foot inertial-sensor assessment in patients with foot-ankle conditions. In addition, the inter-metrics correlations were analyzed to determine the relationships between each spatiotemporal or gait parameter. Methods: Fifty-three patients with foot-ankle conditions (38 female/15 male, aged 21–75 years) were collected for this study. Clinical assessments, including evaluations with validated patient-reported outcomes using the visual analogue scale foot and ankle (VAS-FA) score, health-related quality of life using the validated Short Form-36 (SF-36)9, and gait characteristics assessment using a wearable foot inertial-sensor device, were performed and recorded in each patient. Results: Negative correlation between physical component summary (PCS) and maximal cadence only showed a significant value at Pearson’s correlation coefficient (r) = –0.308, P = 0.025. Positive correlations (r) were found between mean walking speed and mean cadence (r = 0.776, P &lt; 0.001) and between maximal walking speed and mean step length (r = 0.498, P &lt; 0.001). Negative correlations (r) were found between mean cadence and mean step length (r = –0.491, P &lt; 0.001) and between maximal cadence and mean step length (r = –0.355, P = 0.009). Conclusion: Regarding relationships among several spatiotemporal parameters and patient-reported outcome measures, cadence is the only parameter that was significantly negatively related with PCS in health-related quality of life. Based on inter-metrics relationships, increased cadence might be used to maintain walking speed as a compensatory mechanism in patients with foot- ankle conditions.

Effects of age and gender on gait characteristics using a wearable foot inertial-sensor device assessment

Category: Gait studies Introduction/Purpose: This study is to determine the effects of age and gender on the gait characteristics using a wearable foot inertial-sensor assessment in the patients with foot and ankle conditions. Methods: There were 53 patients with foot and ankle-related conditions (38 females and 15 males, mean age: 51.4 (±14.0) years) who were collected for this study. For all patients, the clinical assessments, including the evaluations with validated patient- reported outcome using visual analogue scale foot and ankle (VAS-FA) score and health-related quality of life using validated Short Form-36 (SF-36), diagnoses, and gait characteristics assessment using a wearable foot device with the Micro electro mechanical systems (MEMS) inertial-sensor technology during patients’ walking trial for a distance of 10-meter at their self-selected speed. This device captures the gait parameters as distance walked, step counts or length, cadence, and walking speed. Foot Pod output can be wireless synced to a compatible smartphone or tablet. Pearson’s correlation coefficient r or Analysis of variance (ANOVA) tests were used to express the correlation between age and gait parameters or to compare the parameters between male and female groups. Results: There were insignificantly negative Pearson’s correlation coefficients r between age and walking speed or between age and cadence (P&gt;0.05). Male patients had significantly higher maximum walking speed (P=0.015) and step length than female patients (P=0.011). Conclusion: In contrary to the previous study, the present study demonstrated that higher age had no effect on the reduction of walking speed. However, the effects of gender on gait characteristics were proved as higher maximum walking speed and step length in men.

Reliability and validity of the Finnish version of the Visual Analogue Scale Foot and Ankle (VAS-FA)

BackgroundThere have previously been no validated foot and ankle-specific patient-reported outcome measures in Finnish. MethodsThe Visual Analogue Scale Foot and Ankle (VAS-FA) was translated and adapted into Finnish. Thereafter, 165 patients who had undergone foot and ankle surgery completed a questionnaire set on two separate occasions. Analyses included testing of floor-ceiling effect, internal consistency, reproducibility, and validity. ResultsMinor linguistic differences emerged during the translation. Some structural adjustments were made. The mean (SD) total VAS-FA score was 74 (23). In the three subscales, maximum scores were noted in 2–5% of the responses, and internal consistency ranged from 0.81 to 0.94. Reproducibility was excellent (ICC, 0.97). The total VAS-FA score correlated significantly with the Lower Extremity Functional Scale (r=0.84) and the 15D Mobility dimension (r=0.79). The VAS-FA loaded on two factors (pain/movement and problems/limitations). ConclusionsThe Finnish version of the VAS-FA has high reliability and strong validity.

The influence of foot and ankle injury patterns and treatment delays on outcomes in a tertiary hospital; a one-year prospective observation

BackgroundAnkle and foot fractures are amongst the most common injuries, and patterns may vary from primary care set up to tertiary hospitals. Severe foot injuries are projected to have significantly worse outcomes and surgical delays are thought to alter prognosis. MethodsAll patients with foot and ankle trauma were prospectively evaluated at a Tertiary trauma centre over one year. The incidence, fracture patterns, risk factors, and outcomes were evaluated, and cases were divided into simple foot injuries (FASS≤3) and severe foot injuries (FASS>3). Injury mechanisms, associated injuries, and delays in treatment were evaluated, and outcomes were analyzed using Visual–Analogue Scale Foot and Ankle (VASFA), Maryland Foot Score (MFS) and Foot and ankle disability index (FADI). Results294 Foot and Ankle injuries (51 females, 243 males) were encountered in 2919 trauma cases (incidence of 10%). 80 patients (27.2%) had simple foot injuries and 214 (72.8%) had severe foot injuries. 29 patients (9.9%) were below 18years; most (65.3%) patients were between 18 and 45 years age. Road traffic accident was most commonest mode of injury, with ankle fractures (30.6%) the most common. Metatarsal fractures (27.9%) and calcaneal fractures (21.4%) were 2nd and 3rd most common injuries in the foot. Surgical delay averaged 1 day in both severe and simple injuries. Injury led to 32 (10.9%) below knee amputations. Outcome evaluation in 127 (91 severe, 36 simple injuries) patients showed mean Maryland foot score of 89.30 in simple injury group and 84.87 in severe injury group. Mean VASFA score was 82.87 (simple) and 81.87 in severe injury, and mean FADI score was 93.13 (simple) and 91.05 (severe injury). More detailed analysis revealed that more good scores (64.4%) were documented in severe injuries group, and more excellent scores (52.8%) in simple injuries group. ConclusionFoot injuries constitute 10% of all orthopaedic trauma at tertiary hospitals; Majority of them are severe foot injuries, with 68.7% being open injuries. Surgical delay was similar in simple and severe foot and ankle injuries. Outcomes of severe injuries were similar to simple foot and ankle injuries, reflecting on the quality of care that could be administered to them when they present to tertiary hospitals.

Indications of Total Ankle Replacement for Ankle Arthritis: The Evaluation of Quality of Life and Radiographic Findings

Objectives: Little is known about the quality of life and clear cut radiographic grades of ankle arthritis in patients with indication for the total ankle replacement (TAR) comparing with patients without indication for TAR. This study was to compare the quality of life and radiographic grades of ankle arthritis in patients who had ankle arthritis with and without indication for TAR. Methods: From January 2010 to November 2013, the evaluation was conducted on 23 patients aged 18 or older who had ankle arthritis from several causes. The 23 patients were divided into two groups according to their indications of TAR: TAR group (n=7 patients) and non-TAR group (n=16 patients). The medical records of each patient were reviewed to collect for the pre-treatment visual analogue scale (VAS-pain score), visual analogue scale foot and ankle (VAS-FA) score, health-related quality of life score via short-form 36 (SF-36), baseline data including age, gender, side of ankle arthritis, cause of arthritis, radiographic findings, and treatment methods. Results: There were no significant differences in the mean VAS-pain, VAS-FA, and SF-36 scores between the TAR and non-TAR groups (p>0.05). Poorer radiographic grades as Takakura grades 3-4 or the author's grades 3-4 were significantly higher in TAR group (p<0.001). SF-36 scores were significantly lower in patients with poorer radiographic grades in both Takakura (p=0.023) or Angthong (p=0.042) classifications. Conclusion: Although quality of life in patients with indication for TAR was not significantly poorer than patients without indication for TAR, radiographic grades in patients with indication for TAR were significantly poorer than patients without indication for TAR. Radiographic grades of ankle arthritis as Takakura grades 3-4 or the author's grades 3-4 are the clear cut criteria in combination with other accepted criteria to be indications for TAR.

Dual-portal Endoscopic Gastrocnemius Recession for the Treatment of Severe Posttraumatic Equinus Deformity: A Case Series and a Review of Technical Modifications

Several authors have recently reported the benefits of endoscopic gastrocnemius recession (EGR) for the treatment of nontraumatic equinus contracture. However, little is known about its potential for correcting severe posttraumatic equinus contracture. This study aimed to evaluate the effectiveness of dual-portal EGR in patients with severe, intractable equinus following severe trauma to the leg and foot. The recent technique of EGR with supplemental modified procedures was reviewed to improve its capability for correcting deformities and to provide information to avoid complications. The subjects were 4 patients with intractable, progressive, severe posttraumatic soft-tissue equinus contractures after at least 3 months of unsuccessful conservative treatment. The exclusion criteria were spastic contracture, including osseous equinus. One patient with gastrocnemius equinus underwent EGR alone as a straightforward correction. Three patients with gastrocnemius-soleus equinus underwent EGR to correct the gastrocnemius component followed by a modified percutaneous tendo-Achilles lengthening (TAL) procedure to correct any residual deformities. All data of the preoperative period and each successive postoperative period (1, 3, and 6-12 months) were prospectively collected and included the degree of ankle dorsiflexion, American Orthopaedic Foot and Ankle Society (AOFAS) clinical rating scale score, the Visual Analogue Scale-Foot and Ankle (VAS-FA) score, and any related complications. Intraoperatively, the degree of ankle-dorsiflexion was recorded immediately following each procedure. The mean increase in intraoperative dorsiflexion was 35° ± 9.1° (range: 25°-45°) in all 4 patients and 21.7° ± 10.4° (range, 10°-30°) in the 3 patients undergoing EGR and modified TAL, respectively. There were significant differences in the improvements (p<0.05) in the preoperative period and each successive postoperative period in the increased values of ankle dorsiflexion, AOFAS scores, and VAS-FA scores. There were no significant iatrogenic complications. Intractable, severe posttraumatic equinus is not commonly encountered by orthopaedic surgeons. Despite the rarity of this condition, which is responsible for the limited number of patients in this series, our results indicates that dual-portal EGR, with or without modified TAL, is a promising treatment, with satisfactory effectiveness and lower risks of complications, for correcting this problematic deformity.

Arthroscopic debridement for soft tissue ankle impingement

To assess the response to treatment in patients with soft tissue impingement of the ankle managed with arthroscopic debridement. Forty-one ankle arthroscopies were performed for soft tissue impingement between April 2007 and April 2009. There were 26 men and 15 women and the mean age was 30.1 years. Arthroscopy was performed on an average of 21 months after injury. The Visual-Analogue-Scale Foot and Ankle (VASFA) score and Meislin's criteria were used to assess the response to treatment. The mean pre-operative VASFA score was 44.5. This increased to 78.3 postoperatively (p < 0.0001). According to Meislin's criteria, there were 34 good or excellent results, five fair and two poor results. Pre-operative magnetic resonance imaging was useful in detecting tears of the anterior talofibular ligament and excluding osteochondral defects; however, synovitis and soft tissue impingement was under-reported. Arthroscopy is an effective method for the diagnoses and treatment of soft tissue impingement of the ankle joint. This condition is under-reported on MRI.