Walking Cast Research Articles

Lateral plantar fasciopathy: An frequently overlooked cause of atraumatic pain at the fifth metatarsal base

BackgroundLateral cord plantar fasciitis (LCPF) causes atraumatic pain at the fifth metatarsal base. This study assesses the outcomes of a conservative treatment (PRP + casting) on LCPF. MethodsMedical history, clinical diagnosis, and ultrasound imaging were used to determine LPCF. All patients received a leucocyte-poor PRP injection at the proximal part of the fifth metatarsal base, followed by three weeks in a walking cast. Follow-up questionnaires, encompassing NRS, AOFAS, and Foot Functioning Index (FFI), were administered at 6 weeks, 12 weeks, and 2 years post-treatment. ResultsTen patients were enrolled in the study. Ultrasound findings revealed hyposonant and thickened lateral fascia plantaris at the MT 5 insertion point with normal peronei tendons. There was a notable reduction in pain from pre-treatment (NRSrest 55.1 ± 29.6, NRSactivity 79.20 ± 15.5) to 6 weeks post-treatment (NRSrest: 22.4 ± 23.6, p = 0.03; NRSactivity: 38.6 ± 30.3, p = 0.005). FFI indicated an improvement between 12 weeks (25.7 ± 25.7) and 2 years (9.1 ± 8.5) compared to pre-treatment (42.6 ± 16.7). ConclusionUltrasound stands out as the preferred diagnostic method for identifying LCPF. A PRP injection followed by a walking cast proves effective in relieving LCPF symptoms within six weeks with sustained relief up to two years. Level of evidenceLevel IV

Refinement in Post-Operative Care for Orthopaedic Models: Implementing a Sheep Walking Cast (SWC) for Effective Tibial Fracture Management.

In the healthcare system, lower leg fractures remain relevant, incurring costs related to surgical treatment, hospitalization, and rehabilitation. The duration of treatment may vary depending on the individual case and its severity. Casting as a post-surgical fracture treatment is a common method in human and experimental veterinary medicine. Despite the high importance of sheep in preclinical testing materials for osteosynthesis, there is no standardised cast system ensuring proper stabilisation and functionality of hind limbs during the healing of tibia fractures or defects. Existing treatment approaches for tibial osteosynthesis in laboratory animal science include sling hanging, external fixators, or former Achilles tendon incision. These methods restrict animal movement for 4-6 weeks, limit species-typical behaviour, and impact social interactions. Our pilot study introduces a Standardised Walking Cast (SWC) for sheep, enabling immediate physiological movement post surgery. Seven Rhone sheep (female, 63.5 kg ± 6.45 kg) each with a single tibia defect (6 mm mechanical drilled defect) underwent SWC application for 4 weeks after plate osteosynthesis. The animals bore weight on their operated leg from day one, exhibiting slight lameness (grade 1-2 out of 5). Individual step lengths showed good uniformity (average deviation: 0.89 cm). Group housing successfully started on day three after surgery. Weekly X-rays and cast changes ensured proper placement, depicting the healing process. This study demonstrates the feasibility of using an SWC for up to 72 kg of body weight without sling hanging via ceiling mounting or external fixation techniques. Allowing species-typical movement and social behaviour can significantly improve the physiological behaviour of sheep in experiments, contributing to refinement.

A 2-Stage Approach in Managing Diabetic Forefoot Ulcers.

Forefoot plantar ulcers in patients with diabetic neuropathy are considered to be primarily the result of increased shear forces applied over prominent plantar bony prominences. The purpose of this article is to describe a 2-stage treatment pathway utilizing an outpatient percutaneous tendon-Achilles lengthening (TAL) as the first stage procedure and subsequent proximal metatarsal osteotomy (MTO) as a second stage procedure for a persistent or recurrent ulcer. A consecutive 112 patients (146 feet), who presented to our Multidisciplinary Diabetic Foot Team clinics since February 2019 with plantar nonischemic forefoot ulcers were included in this study. Excluding the patients who died or were lost to follow-up, 96 feet were followed for a minimum 12 months (range 12-36 months). After TAL, patients were encouraged to walk in a walking cast for 6 weeks and were followed for a minimum 12 months. Patients with persistent or recurrent ulcers were investigated with magnetic resonance imaging scan, and based on intramedullary osteomyelitis and septic destruction of distal metatarsal, we describe a second-stage MTO with the 3 most common clinical presentations. Of 96 feet, none had infection or wound-related problems following TAL. Complete transection of the tendon was noted in 4 patients (4%) and heel callosity in 1 patient. In 92 feet (96%), the ulcers healed within 10 weeks (±4 weeks) after TAL but, in 12 feet (10%), the ulcer failed to heal or recurred. At a minimum 12 months after the second-stage MTO, none in this subgroup had recurrence of ulcer or a transfer lesion. TAL followed with a walking cast as an outpatient procedure was effective in healing forefoot ulcers in 96% of feet. Comparable to the widely practiced hand surgery Wide Awake Local Anesthesia No Tourniquet (WALANT) procedure, our approach involved active control of the degree of ankle dorsiflexion by the patient, and the procedure was proven to be safe and well tolerated. When the second-stage MTO was required to offload the forefoot, in our small cohort, patients had ulcer-free outcome for a minimum 12 months. Level IV, retrospective case series.

Outcomes of Management of Severe Clubfoot among Children by Ilizarov External Fixator.

Clubfoot remains the most common birth defect involving the musculoskeletal system. There are various surgical and non-surgical treatment options available for the management of clubfoot. Using the minimally invasive Ilizarov external fixator method has been reported to have good success rates and fewer complications. This study aimed at analysing the morphological and functional outcomes of treating severe clubfoot by Ilizarov external fixator among children from July 2017 to March 2020. Thirty-two children who had either failed Ponseti / surgery or neglected with 44 clubfeet of Dieglio type III and type IV were included in the study. A short-leg walking cast was applied for an additional six weeks after removing of Ilizarov frame and additionally followed by an orthosis for another six weeks. Outcomes were measured by the functional rating system by Laaveg and Ponseti and interpretation done at 1 month and 12 months after the ankle-foot arthrosis. About 86.4% of the patients had good or excellent outcome scores. Pre and post-Demeglio scores and functional rating scores were statistically significant (p<0.001) by using Paired t-test. Complications included superficial pin site infections in 13 feet (29.54%), 5 feet (11.36%) had claw toes, 3 feet (6.81%) had linear skin necrosis and 2 feet (4.54%) had calcaneal fractures which were manageable with minor interventions. The study findings highlighted that the Ilizarov external fixator method can correct complex foot deformities of severe clubfoot with minimum morbidity. Further larger and long-term studies are needed to investigate the effects of the stiff hindfoot and possible degenerative changes on the function and symptoms of these patients as adults.

Children’s orthopaedics

The October 2023 Children’s orthopaedics Roundup360 looks at: Outcomes of open reduction in children with developmental hip dislocation: a multicentre experience over a decade; A torn discoid lateral meniscus impacts lower-limb alignment regardless of age; Who benefits from allowing the physis to grow in slipped capital femoral epiphysis?; Consensus guidelines on the management of musculoskeletal infection affecting children in the UK; Diagnosis of developmental dysplasia of the hip by ultrasound imaging using deep learning; Outcomes at a mean of 13 years after proximal humeral fracture during adolescence; Clubfeet treated according to Ponseti at four years; Controlled ankle movement boot provides improved outcomes with lower complications than short leg walking cast.

An update on tarsal coalitions

Tarsal coalitions are anomalous connections between two or more bones in the hindfoot or midfoot secondary to embryonic failure of segmentation and differentiation of the mesenchyme. Calcaneonavicular and talocalcaneal coalitions are the most common. Although it is a congenital deformity, presentation is usually in adolescence which coincides with ossification of the coalition. Patients typically present with diffuse foot pain, calf muscle pain, recurrent ankle ligament sprains and a rigid hindfoot valgus deformity. Initial management is non-operative and may involve activity reduction, a trial of immobilization in a walking boot or cast, physiotherapy, corticosteroid injections and regular analgesia. Close to a third of patients experience symptom relief but the remaining patients with persistent symptoms will require operative intervention. Patients without degenerative joint disease undergo resection of the coalition. It is now established that an associated severe hindfoot valgus foot should be addressed at this stage to prevent inevitable future joint degeneration. The indications for joint fusion remain unclear and the tendency is to postpone this when possible until a later age. In recent years, arthroscopic resection of talocalcaneal coalitions has gained popularity, despite being technically demanding. It gives good visualization of the coalition, better postoperative pain relief and quicker improvement of the hindfoot stiffness.

Randomized Controlled Trial Comparing Early Mobilization vs Six Weeks of Immobilization in a Walking Cast Following Total Ankle Replacement

Rehabilitation for patients after total ankle replacement traditionally involves weeks of immobilization in a plaster cast followed by progressive mobilization. In a small randomized trial, we compared teh outcomes of patients who received a 3-component cementless, unconstrained, mobile-bearing prosthesis and were initially immobilised in a plaster cast for 6 weeks to thoese who received the same prosthesis but were allowed to mobilise early. Gait, clinical, patient-reported, and radiologic outcomes were measured. The study included 20 patients, 10 in the plaster cast group and 10 in the early mobilization group, and the demographics of the groups did not differ significantly. All patients were followed-up for 24 months. There were no significant differences between the 2 groups 2 years after surgery in ankle dorsiflexion, spatiotemporal gait characteristics, American Orthopaedic Foot and Ankle Society ankle-hindfoot scores, Timed Up and Go Test times, WOMAC (pain, stiffness, function) scores, SF-36 (quality-of-life) scores, or patient satisfaction (pain relief, daily-living, recreational activities, and overall) (all p > .05). Bone mineral density decrease of the medial malleolus and increase at middle tibia, calculated with DEXA scans, was significantly better in early mobilization than plaster cast group at one and 2 years postoperatively, but this was also the case preoperatively. The lack of differences in outcomes suggests that early ankle mobilization may be a safe and reliable method to enhance recovery following ankle arthroplasty with a 3-component cementless, unconstrained, mobile-bearing prosthesis. Compared to traditional plaster casting, patients who are engaged in early mobilization after arthroplasty may enjoy similar functional, mobility, quality-of-life, pain relief, activity level, and satisfaction outcomes.

Minimally invasive tibialis anterior tendon transfer in shuttle technique for the treatment of clubfoot recurrence in adolescent patients

Tibialis anterior transfer in shuttle technique using the tunnelator is an atraumatic surgical technique without injuring the extensor retinaculum. The technique allows for postoperative treatment with pain-adapted full weight-bearing for 6weeks in alower leg cast which is simplified compared to the current literature. Passive, correctable clubfoot recurrences in the event of muscular imbalance (overbalanced anterior tibial muscle). Structural movement restrictions of the foot, muscular insufficiency of the anterior tibial muscle, infection or cancerous lesions in the surgical site. Loosen the tibialis anterior muscle at the base of the first metatarsal. Guide the tendon proximally out of the extensor retinaculum, then shuttle the tendon below the retinaculum with the help of the "tunnelator" and transosseous fixation at the lateral cuneiform. Pain-adapted full weight-bearing in alower leg walking cast for 6weeks postoperatively. In the course of aretrospective study, the above-mentioned surgical procedure was carried out in 20patients (total n = 26 surgeries) between 2013 and 2019. After afollow-up of 12months, complete correction of the clubfoot relapse was found in 88.5% of cases. There were no general or specific surgical complications.

Weightbearing Stable Bimalleolar Ankle Fractures-Bony Equivalents to the Ligamentous Weber B/SER4a Fracture Type? A Prospective Case Series.

Background:In a recent study, we documented that partially unstable Weber B/SER4a fracture types reach union with preserved normal ankle congruence after treatment with a functional orthosis and weightbearing allowed. In the present article, we present a case series of weightbearing stable bimalleolar fractures treated nonoperatively that extends our previously published research.Methods:We included 5 patients with primarily nondisplaced bimalleolar ankle fractures that were stable on weightbearing radiographs. Participants were treated with a walking boot or cast with weightbearing allowed. We also provide a qualitative anatomical analysis of fracture morphology on computed tomographic scans.Results:Median medial clear space (MCS) of fractured ankles after union were 2.4 mm (range, 1.5-3.1). Qualitative descriptions of fracture morphology showed that all fractures were oblique starting at the intercollicular groove of the medial malleolus and extended anteriorly and proximally.Conclusion:MCS measurements after fracture union of nonoperatively treated weightbearing stable bimalleolar fractures seemed consistent with normative data of ankle congruence in our previous study. We consistently recorded oblique fracture patterns involving the anterior colliculus, leaving the origin of posterior deep deltoid ligament intact. We present our material as an argument for the existence of a bony (bimalleolar) equivalent to the ligamentous SER4a fracture.Level of Evidence:Level IV, prospective case series.

Proximal Medial Gastrocnemius Release: Surgical Technique.

PMGR is performed with the patient in the prone position. A thigh tourniquet is not utilized. We prefer to use spinal anesthesia, but local anesthesia could be applied along with sedation. A posteromedial incision is made on or just below the posterior knee crease. The crural fascia is divided, and the proximal insertion of the medial gastrocnemius is identified. Performing the "hook maneuver" with a curved dissector is helpful at this step. Only the white fibers are sectioned in order to allow for a lengthening of the muscular fibers that is completed with forceful ankle dorsiflexion. After proper hemostasis has been achieved, the subcutaneous layer and skin are closed, leaving the fascia open. Nonoperative treatment should be the first option, including analgesics, insoles, heel cups, calf-stretching, injections, and extracorporeal shock wave therapy8. Some authors have also suggested that application of a walking cast for 3 to 6 weeks should be attempted9,10. Once all of these treatment options have failed, operative treatment is appropriate. Historically, open plantar fasciotomy was offered to patients with recalcitrant plantar fasciitis, and this treatment continues to be a surgical option. Other procedure, like the Strayer, Vulpius, or Baumann techniques, involve the calf system and are called "gastrocnemius recession." However, these techniques act in the more distal aspect of the calf system compared with PMGR. PMGR offers patients with recalcitrant plantar fasciitis rapid recovery and good results. This procedure obviates the complications associated with plantar fasciotomy, in which the medial aspect of the proximal plantar fascia is divided to relieve the overload. A plantar fasciotomy (either open or endoscopic11) risks lateral column overload12 or a painful flatfoot if >50% of the fascia is divided. A long recovery period following plantar fasciotomy has also been described7. On the other hand, other procedures have been utilized to lengthen the Achilles-calcaneus-plantar system to an even greater extent. Techniques like the Silfverskiöld (i.e., medial and lateral proximal gastrocnemius release) or Strayer (i.e., division of the distal aspect of the gastrocnemius fascia) technique present a higher rate of complications (up to 38%), specifically nerve injuries13,14. We consider these procedures (classified as gastrocnemius recession procedures) more properly indicated for patients with neurological diseases or with an equinus contracture. The medial gastrocnemius is the more powerful of the 2 bellies. Releasing the medial head alone offers a robust decrease in tension and is safer than approaching the lateral head of the gastrocnemius15. At the same time, this technique provides a quick recovery for the patient. PMGR can also help those patients with other clinical signs related to gastrocnemius tightness, such as calf cramps and pain or repeated muscle injuries. Moreover, it can be effective in patients with second-rocker metatarsalgia or midportion Achilles tendinitis1,16. PMGR has a reported rate of satisfaction of >80%. Most patients undergoing this procedure experience substantial pain relief within the first 2 to 3 months6,17. PMGR is an outpatient procedure with a short operative time and a rapid return to recreational and labor activities. The complication rate is low, and the most common complications are calf hematomas and delayed wound healing. The present article demonstrates a reduction in pain and good functional results. An improvement in the perception of health-related quality of life, especially in the physical and pain domains of the Short Form-36 questionnaire, was also observed. The prone position allows for direct access to the proximal medial head of the gastrocnemius. Preferably, perform PMGR without a tourniquet in order to assure proper hemostasis. Keep the ankle joint free at the end of operating table because ankle dorsiflexion is a helpful maneuver at some stages in this procedure. Digital (index finger) dissection should be performed among the medial head of the gastrocnemius, the hamstrings, and the posterior aspect of the proximal tibia. The hook maneuver, performed with use of a blunt dissector, is helpful to identify all of the white fibers. Only white fibers should be divided. The surgeon must also make sure to cut the more anterior part of the aponeurosis that is hidden by red fibers. After cutting the white fibers, forceful ankle dorsiflexion is required to obtain full lengthening of the muscle. Proper hemostasis should be achieved to prevent formation of a calf hematoma. Advise the patient to do calf-stretches as soon as pain permits in order to prevent a contracting muscle scar. PMGR = proximal medial gastrocnemius releaseESWT = extracorporeal shock wave therapySD = standard deviation.

Acute Fifth Metatarsal Tuberosity Fractures: A Systematic Review of Nonoperative Treatment.

Acute metatarsal fractures are a common lower extremity injury. Although surgery may be recommended in specific cases, most are treated nonoperatively. Treatment protocols vary significantly among practitioners, with no consensus on the most efficacious approach. This systematic review aims to identify the effect of treatment protocols on union rate and functional outcome after an acute fifth metatarsal tuberosity fracture. Multiple databases, including CINAHL, EMBASE, MEDLINE, and the Cochrane CEntral Register of Controlled Trials (CENTRAL) were searched from database inception to March 4, 2018 to identify clinical studies addressing nonoperative management of metatarsal fractures reporting nonunion, pain, and/or length of recovery. Two reviewers independently completed title, abstract, and full-text screening. Data abstraction was completed in duplicate. Outcome measures and complications were descriptively analyzed. A total of 1941 studies were eligible for screening. Seven studies (four randomized controlled trials and three prospective cohort studies) satisfied inclusion criteria. This resulted in a total of 388 patient with acute fifth metatarsal tuberosity fractures in 12 different treatment arms, with the most common treatment including plaster casting (7). The mean age was 42 years (27 to 56 years), and the overall nonunion rate was low (1.1%). Four unique functional scores were reported across all studies, and all showed good to excellent short-term results. The overall qualities of studies were moderate, with particular limitations in randomization and concealment allocation. Most acute fifth metatarsal tuberosity fractures heal well, with good-to-excellent functional outcomes with nonoperative treatment, regardless of technique. We recommend a conservative rehabilitation framework, including 2 to 3 weeks of immobilization in a walking cast, followed by gradual increase in activity and strengthening until clinical union is achieved.

Outcomes of Short Versus Long Leg Casts for Childhood Accidental Spiral Tibial CAST Fractures.

The objective of the current study was to analyze the outcomes of short versus long leg casts in the treatment of childhood accidental spiral tibial (CAST) fractures. A retrospective review was performed of medical records at a single tertiary children's hospital from 2009 to 2014 of children with distal, spiral tibial fractures (CAST fractures). The following points were documented for each patient: sex, laterality of fracture, age at presentation, type of cast, length of time in cast, use of a controlled ankle motion boot after cast removal, suspicion for abuse, and complications including skin irritation, skin breakdown, infection, compartment syndrome, fracture displacement, and gait disturbances. A total of 21 patients with an age range of 12 to 62 months were found to have CAST fractures as confirmed by x-ray. Fourteen were treated with short leg casts, whereas 7 were treated with long leg casts. Both groups healed with equal outcomes, and there was no documented suspicion for abuse in any case. A short leg walking cast seems to be an effective and safe method of treatment for CAST fractures and could be considered as potentially preferable to long leg casts because of the added benefits of increased mobility and function. Follow-up to this preliminary study is warranted to better elucidate any differences in benefit between these treatment options, and clinical judgment should be used when considering immobilization options.

A Description of a Modified Bohler Iron Walking Cast in the Management of Plantar Ulcers

A Description of a Modified Bohler Iron Walking Cast in the Management of Plantar Ulcers

Functional outcome after the nonsurgical treatment for adolescent spasmodic valgus foot.

Adolescent spasmodic valgus foot is usually associated with resistant pain and deformity. It shows controversy regarding its incidence, etiology, and treatment. Our study aimed to evaluate the functional outcome after the nonsurgical treatment for such condition. This study included 50 planovalgus feet secondary to peroneal or peroneo-extensor spasm in 33 adolescents with a mean age of 14 ± 2.8 years. The procedure included foot manipulation under general anesthesia, sinus tarsi injection with corticosteroids, and a walking cast in the neutral position. Patients were evaluated functionally (using the American Orthopedic Foot and Ankle Society (AOFAS)) and radiologically before the procedure, after cast removal, and 3, 9, and 18 months later with special attention given for recurrence during the follow-up period with a mean duration of 22.5 ± 3.5 months. Once general anesthesia had been conducted, the deformity was corrected without any manipulation, and full passive inversion could be easily obtained in 26 feet, the deformity was corrected only after manipulation, and full passive inversion had been obtained in 14 feet, while 10 feet remained stiff even after manipulation. The mean AOFAS score was significantly improved ( p < 0.001) from 40.9 ± 3.5 at presentation to 73.56 ± 5.2 at the last follow-up in which 12 feet was painless and freely mobile and 24 feet had partial relapse, while 14 feet had complete relapse. The nonsurgical treatment for adolescent spasmodic valgus foot could be a simple and effective treatment. Apart from limited complete recurrence, the overall functional outcome was satisfactory. Level of evidence: type IV case series.

Naša iskustva u liječenju preloma dijafize potkoljenice spoljnom fiksacijom

Introduction. Lower leg fractures are most frequent of all fractures of long bones because a lower leg is very exposed part of a leg, especially it is anteromedial side of tibia, located immediately under skin. Aim of this paper is to analyse results of teatment of open and closed diaphysial tibial fractures using method of external fixation. Patients and methods. We analyzed the results of treatment of open and closed diaphysial tibial fractures using method of external fixation at Department of Ortopedics od Doboj hospital in period from 2005 until 2009. All patients with open fractures been treated first with surgical treatment of the wound up to 8 hours and with installation of external fixator. Patients with closed fractures which did not have satisfactory reposition have been installed external fixator which was worn from 4 to 8 weeks and then taken off, they have been applied a closed lower leg walking cast which was worn pending fracture healing verified by a clinical and xray examination. Patients in wich there was no healing process have undergone a subseqent surgical treatment which in all cases was positive. After surgical treatment all patients were sent for physical therapy. Results. Out of 124 patients with diaphysial tibial fractures, 56 (45,2%) were with open fractures and 68 of them (54,8%) were with closed fractures. After a primary treatment, there were 49 (87,5%) open fractures and 39 (57,4%) closed fractures with complications. Conclusion. Treatment of closed and open diaphysial tibial fractures by means of external fixation in open fractures as standard and selected closed fractures have shown good results with a small number of complications which were removed by a second surgical teatment. This method of treatment fractures is recommendable method in a primary as well as in final treatment of these fractures due to a positive treatment outcome.

Components of the joint-sparing, combined bony and soft tissue correction of the cavovarus foot

Combined bony and soft tissue correction of amild foot and flexible rearfoot deformity in cavovarus foot. Drop foot during swing phase and muscular imbalance in the stance phase in cavovarus foot, flexible cavovarus foot, accompanying symptoms such as recurrent calluses and ulcerations, compliance. Pes cavovarus of spastic genesis, mild deformities, fixed bony deformity, lack of compliance, florid inflammation in the foot area, severe peripheral artery disease (PAD), diabetes mellitus. Description of the gradual escalation of joint-sparing bony and soft tissue procedures. Postoperative lower leg cast. In cases of combined bony and soft tissue correction, first 6weeks of nonweight-bearing with lower leg cast, then 6weeks of lower leg walking cast. With adequate bony consolidation, cast removal after atotal of 12weeks. In cases of pure soft-tissue foot correction, 6weeks of lowerleg walking cast. It was shown that only 22.5% of the affected feet (40 preoperative patients with cavovarus foot deformity) had asevere hindfoot equinus due to shortened calf muscles. In astudy with 14patients, it was shown that the tibialis posterior tendon transfer corrects the drop foot component and the excessive medial arch of the feet is significantly reduced by combined soft tissue and bony procedures.

Functional assessment of transplantar nailing for ankle fracture in the elderly: 48 weeks' prospective follow-up of 14 patients.

Retrograde transplantar intramedullary nailing (TIMN) is a recently described option for ankle fracture in elderly patients with multiple comorbidity contraindicating classical internal fixation. The main objective of the present study was to assess mobility after TIMN for ankle fracture in the elderly. The secondary objective was to assess complications. Retrograde TIMN provides reliable fixation of ankle fracture in the elderly, enabling early resumption of walking. Fourteen patients, with a mean age of 79.6years (range: 65-99years), with fracture of the ankle or tibial pilon treated by retrograde TIMN, were prospectively included over a 1-year period (2014-2016). Full weight-bearing with walking cast boot was authorized as of day 1. Mobility was assessed on Parker score in consultation at 6, 12, 24 and 48 weeks. Ten patients were followed up. Mean Parker score was 3.6 (range: 1-5) preoperatively, and 2.4 (range: 1-5) and 2.7 (range: 1-5) at 24 and 48 weeks, respectively: i.e., not significantly different from preoperative values (p=0.057 and p=0.054, respectively). There were no decubitus-related complications. Two patients (20%) showed other complications, including 1 deep infection requiring material ablation. Consolidation was systematic, without hindfoot malunion. Retrograde TIMN appeared to be a useful option for ankle fracture in elderly patients for whom classical internal fixation was contraindicated. It allowed immediate resumption of weight-bearing and early rehabilitation, with no increased morbidity or mortality. IV.

Follow up of MRI bone marrow edema in the treated diabetic Charcot foot - a review of patient charts.

ABSTRACT Background: Ill-defined areas of water-like signal on bone magnetic resonance imaging (MRI), characterized as bone marrow edema or edema-equivalent signal-changes (EESC), is a hallmark of active-stage pedal neuro-osteoarthropathy (Charcot foot) in painless diabetic neuropathy, and is accompanied by local soft-tissue edema and hyperthermia. The longitudinal effects on EESC of treating the foot in a walking cast were elucidated by reviewing consecutive cases of a diabetic foot clinic. Study design: Retrospective observational study, chart review Material and methods: Cases with active-stage Charcot foot were considered, in whom written reports on baseline and follow-up MRI studies were available for assessment. Only cases without concomitant infection or skin ulcer were chosen, in whom both was documented, onset of symptomatic foot swelling and patient compliance with cast treatment. Results: From 1994 to 2017, 45 consecutive cases in 37 patients were retrieved, with 95 MRI follow-up studies (1–6 per case, average interval between studies 13 weeks). Decreasing EESC was documented in 66/95 (69%) follow-up studies. However, 29/95 (31%) studies revealed temporarily increasing, migrating or stagnating EESC. Conclusion: EESC on MRI disappear in response to prolonged offloading and immobilizing treatment; however, physiologic as well as pathologic fluctuations of posttraumatic EESC have to be considered when interpreting the MR images. Conventional MRI is useful for surveillance of active-stage Charcot foot recovery.

Aseptic loosening of total ankle replacement : One-stage revision ankle arthroplasty

To revise one or both loosened prosthesis components, to achieve postoperative pain relief, and preserve ankle range of motion. Aseptic loosening of the tibial and/or talar ankle prosthesis components without substantial bone defect of the tibial or talar bone stock. General surgical or anesthesiological risks, infections, critical soft tissue conditions, nonmanageable hindfoot instability, neurovascular impairment of the lower extremity, neuroarthropathy (e. g. Charcot arthropathy), substantial nonreconstructable osseous defects with or without cysts on the tibial and/or talar side, non-compliance, patients with primary total ankle replacement (TAR) using intramedullary fixation (stem fixation), patients with severely reduced bone quality, insulin-dependent diabetes mellitus, smoking, unrealistic patient expectations, patients with high activity in sports. Exposure of the ankle joint using the previous incision (anterior or lateral transfibular approach). Mobilization and removal of loosened prosthesis component. Careful debridement of bone stock at bone-prosthesis interface. Determination of prosthesis component size. Implantation of definitive prosthesis components. Wound closure in layers. Asoft wound dressing is used. Thromboprophylaxis is recommended. Patient mobilization starts at postoperative day1 with 15 kg partial weight bearing using astabilizing walking boot or cast for 6weeks. Following clinical and radiographic follow-up at 6weeks, full weight bearing is initiated gradually. Between January 2007 and December 2012 aone-stage revision TAR was performed in 14patients with amean age of 52.7± 12.0years (29.8-70.5years). The indication for revision surgery was aseptic loosening of one or both prosthesis components. The mean time between the initial TAR and revision surgery was 5.9± 2.9years (2.0-11.5years). In 2patients atibiotalocalcaneal arthrodesis was performed due to painful aseptic loosening of revision TAR. In all patients asignificant pain relief was observed.

A Comparative Study on Healing Of Diabetic Foot Ulcers Using Total Contact Cast Vs Ambulatory Walking Cast Vs Modified MCR Sandals

A Comparative Study on Healing Of Diabetic Foot Ulcers Using Total Contact Cast Vs Ambulatory Walking Cast Vs Modified MCR Sandals